Satisfaction and Mental Health Outcomes Associated with a Large Regional Helpline.

We surveyed users of a behavioral health helpline serving New York City and surroundings, to assess their helpline experiences, changes in psychological distress after contacting the helpline, and factors associated with differences in these measures. We surveyed users twice: roughly 2 weeks following their helpline contact, from 4/2019 to 9/2019 (N = 1097 respondents) and again 6 months following contact, from 10/2019 to 3/2020 (N = 732 respondents). Eighty-nine percent of respondents reported that contacting the helpline helped them deal a little or a lot more effectively with their problems. Rates of psychological distress decreased from 41.3% 2 weeks following helpline contact to 29.0% 6 months after (P < 0.05). Improvements in psychological distress were found across a range of demographic characteristics and were greatest for repeat users. Users reported broadly positive experiences with the helpline and improved psychological distress 6 months later. Behavioral health helplines can offer beneficial services to diverse populations, complementing the formal behavioral healthcare system.

Association of military life experiences and health indicators among military spouses.

BACKGROUND: The health and well-being of military spouses directly contribute to a robust military force by enabling the spouse to better support the active duty member's career. In order to understand the overall health and well-being of military spouses, we assessed health indicators among military spouses using the Healthy People 2020 framework and examined associations of these health indicators with military experiences and psychosocial factors. METHODS: Using data from the Millennium Cohort Family Study, a U.S. Department of Defense-sponsored survey of 9872 spouses of service members with 2-5 years of military service, we examined attainment of Healthy People 2020 goals for spouses and service members, including healthy weight, exercise, sleep, and alcohol and tobacco use. Multivariable logistic regression models assessed associations of spouse health indicators with stressful military life experiences and social support, adjusting for demographics and military descriptors. The spousal survey was administered nationwide in 2011. RESULTS: The majority of military spouses met each health goal assessed. However, less than half met the healthy weight and the strength training goals. Reporting greater perceived family support from the military was associated with better behavioral health outcomes, while having no one to turn to for support was associated with poorer outcomes. Using the Healthy People 2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences, that may contribute to physical health behaviors and outcomes among military spouses. With respect to demographic characteristics, the findings are consistent with other literature that women are more likely to refrain from risky substance use and that greater education is associated with better overall health outcomes. CONCLUSIONS: Findings suggest that enhanced social and military support and tailored programming for military spouses may improve health outcomes and contribute to the well-being of military couples. Such programming could also bolster force readiness and retention.

Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science.

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.

HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward.

Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.

Exploring the social and community context of African American adolescents' HIV vulnerability.

There is an increasing call for HIV prevention programs that target social determinants of HIV. The purpose of this study was to examine the experiences and perceptions of 12 African American adolescents to identify important social and community targets for HIV prevention. We used photovoice methodology to engage adolescents in a critical analysis of their experiences to arrive at a deeper understanding of the social determinants of HIV and determine specific action steps to reduce HIV risk. Analyses revealed a variety of social and environmental factors that affect the lives of African American adolescents by creating conditions that put them at greater risk for HIV. Study findings support mobilizing community action through raising awareness and advocating for increased neighborhood resources and institutional support. We conclude with research and practice implications for community-relevant HIV prevention among African American youth.

Partner Effects: Analyzing Service Member and Spouse Drinking Over Time.

INTRODUCTION: Excessive alcohol use is a significant problem in the military. Although there is a growing emphasis on family-centered alcohol prevention approaches, little is known about the interplay between partners' drinking behaviors. This study examines how service members and their spouses influence each other's drinking behavior over time and explores the complex individual, interpersonal, and organizational factors that may contribute to alcohol use. METHODS: A sample of 3,200 couples from the Millennium Cohort Family Study was surveyed at baseline (2011-2013) and follow-up (2014-2016). The research team estimated how much partners' drinking behaviors influenced one another from baseline to follow-up using a longitudinal structural equation modeling approach. Data analyses were conducted in 2021 and 2022. RESULTS: Drinking patterns converged between spouses from baseline to follow-up. Participants' own baseline drinking had a small but significant effect on changes in their partners' drinking from baseline to follow-up. Results from a Monte Carlo simulation showed that the longitudinal model could reliably estimate this partner effect in the presence of several potential sources of bias, including partner selection. The model also identified several common risk and protective factors for drinking shared by both service members and their spouses. CONCLUSIONS: Findings suggest that changing the drinking habits of one spouse could lead to a change in the drinking habits of the other, which supports family-centered alcohol prevention approaches in the military. Dual-military couples especially may benefit from targeted interventions because they face a higher risk of unhealthy alcohol consumption.

Longitudinal Patterns of Military Spousal Alcohol Consumption: Findings From the Millennium Cohort Family Study.

OBJECTIVE: Alcohol use in the military is prevalent and has short- and long-term health, safety, and career consequences. Although several studies have examined service members' alcohol consumption, few have focused on alcohol use among military spouses. This study assessed factors at individual, interpersonal, and organizational levels to determine associations with risky alcohol use among military spouses. METHOD: Data from baseline and first follow-up of the Millennium Cohort Family Study were used (N = 5,475; 4,923 female) to model spousal self-reported risky drinking (heavy and/or binge drinking) at follow-up. Predictors included demographic characteristics, spousal adverse childhood experiences and mental health, smoking status, marital status, family satisfaction, social support, military stress, and service member military characteristics. Logistic regression models assessed the adjusted associations between spouse and service member characteristics and spousal risky drinking at follow-up. RESULTS: Among spouses in this sample, 19% were risky drinkers at follow-up. Baseline alcohol use status was associated with risky drinking at follow-up. Most spouses (64.2%) did not change their drinking behavior between baseline and follow-up; those who did change were nearly evenly split between an increasing (17.0%) versus decreasing (18.7%) pattern. Risk factors included male gender, cigarette smoking, elevated symptoms of post-traumatic stress, marital separation, and service member deployment with combat. CONCLUSIONS: Although most military spouses were not engaging in risky drinking, one in five were, with about half of these having moved into the risky drinking category over time. Risky alcohol use among spouses has ramifications for themselves, the service member, and the family unit.

Associations between spouse and service member prescriptions for high-risk and long-term opioids: A dyadic study.

BACKGROUND: Estimates suggest approximately 2.4% of service members, and 15% of service members who have engaged in recent combat, report misusing pain relievers in the past year. This study explores the extent to which military spouses' obtainment of opioids is associated with their service member partners' obtainment of opioid prescriptions, in addition to other factors such as service member health, state prescribing patterns, and sociodemographic characteristics. METHODS: Data were drawn from the Millennium Cohort Family Study, a large, longitudinal survey of married spouses of service members from all service branches, and archival data analyzed from 2018 to 2020. The dependent variables were spouse long-term opioid therapy and spouse opioid prescriptions that pose a high risk of adverse outcomes. RESULTS: Seven percent of spouse and service member dyads met the criteria for high-risk opioid use, generally because they had purchased a prescription for a ≥90 Morphine Milligram Equivalents daily dose (76.7% for spouses, 72.8% for service members). Strong associations were found between spouse and service member opioid therapies (OR = 5.53 for long-term; OR = 2.20 for high-risk). CONCLUSIONS: Findings suggest that reducing the number of long-term and high-risk opioid prescriptions to service members may subsequently reduce the number of similar prescriptions obtained by their spouses. Reducing the number of service members and spouses at risk for adverse events may prove to be effective in stemming the opioid epidemic and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses.

INTRODUCTION: Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support. MATERIALS AND METHODS: Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support. RESULTS: Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military. CONCLUSION: These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.

High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study.

INTRODUCTION: The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses' opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness. MATERIALS AND METHODS: This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military's Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members' spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses' physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center's Institutional Review Board and the Office of Management and Budget approved the study. RESULTS: Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions. CONCLUSIONS: Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Assessing the Impact of Stricter Alcohol Advertising Standards: The Case of Beam Global Spirits.

Reducing youth exposure to alcohol advertising is a global health priority. In most countries around the world, the alcohol industry is given the opportunity to regulate itself with respect to advertising practices. Generally, the alcohol industry self-regulations are lax, allowing youth to be disproportionately exposed to alcohol advertising. However, Beam Global Spirits and Wine (Beam) voluntarily adopted more restrictive advertising standards in the United States in 2007. This study assessed Beam's compliance with their new standard and estimates its effect on youth exposure and advertising costs. We found that Beam's compliance with its more restrictive standards was imperfect, but never-the-less, we estimated that youth exposure to alcohol advertising was reduced compared to other spirits brands. Beam's more restrictive standards did not increase their advertising costs and therefore other alcohol companies should consider adopting similar standards around the world.

First tobacco product tried: associations with smoking status and demographics among college students.

INTRODUCTION: As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students. METHODS: A cross-sectional web survey of 3146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010. RESULTS: Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco. CONCLUSIONS: While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes.

Increasing provision of adolescent vaccines in primary care: a randomized controlled trial.

OBJECTIVES: To assess the effectiveness of in-person and webinar-delivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage. METHODS: We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state's immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines (≥1 dose, females only). RESULTS: At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P >.05). CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine.