Nicotine use among reservation-area American Indian adolescents compared with a national sample.

BACKGROUND: Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS: Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS: Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS: Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.

Intersecting sex and American Indian identity moderates school and individual correlates of binge drinking among reservation-area adolescents.

Reservation-area American Indian (AI) youth demonstrate higher rates of binge drinking (BD) than their non-AI peers. However, individual and school-level differences in BD disparities between reservation-area AI/non-AI female and male adolescents remain unexamined. This study applies an Intersectional framework to examine risk and protective factors of BD among reservation-area youth at the intersection of their sex and AI identities. A nationally representative sample of adolescents (N = 14,769; Mage = 14.6, 49% female; 61% AI) attending 103 reservation-serving schools completed a survey between 2015 and 2019. Multilevel modeling was used to examine differences in risk and protective factors of BD between AI and non-AI male and female adolescents. Our findings indicate that the effects of student and school-level risk and protective factors on adolescents' BD are driven primarily by sex within AI and non-AI groups. Implications for future confirmatory research and tailoring school-based prevention programs are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Comparison of COVID-19 Outcomes Between Reservation-Area American Indian and U.S. National Students.

Introduction: This study presents data from 2 population-based surveys of youth (reservation-area American Indian adolescents and U.S. adolescents) on self, family, and friend morbidity and changes in substance use and negative impacts during COVID-19. Methods: Data were obtained in spring 2021 from surveys of American Indian students living on or near reservations (8th grade, n=398; 10th grade, n=367; 12th grade, n=290) and national students from Monitoring the Future (8th grade, n=11,446; 10th grade, n=11,792; 12th grade, n=9,022). The main outcomes were COVID-19 testing, perceived morbidity/mortality, substance-use changes, and emotional changes during COVID-19. Results: The American Indian sample had a greater proportion of testing (e.g., American Indian 8th grade: 58.1% [95% CI=48.6, 68.8]; Monitoring the Future 8th grade: 43.6% [95% CI=39.8, 47.5]) and friend/family hospitalization (e.g., American Indian 8th grade: 36.2% [95% CI=26.2, 47.5]; Monitoring the Future 8th grade: 11.9% [95% CI=10.6, 13.3]). Across grades, greater proportions of the national sample reported increased anxiety, anger, boredom, loneliness, depression, worry, and trouble concentrating, whereas greater proportions of reservation-area American Indians reported decreased anxiety, loneliness, and depression. Conclusions: Findings indicate that reservation-area American Indian youth experienced unique health consequences 1 year into the COVID-19 pandemic compared with national students, illustrating the need for American Indian-specific COVID-19 public health monitoring and response.

The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions.

OBJECTIVE: The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect. METHODS: Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus. RESULTS: Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target. CONCLUSIONS: Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.

Delivery of written exposure therapy for PTSD in a university counseling center.

Posttraumatic stress disorder (PTSD) occurs at high rates among college students, and there is an urgent need to develop brief and accessible interventions to help these at-risk students achieve academic and career success. This open-trial pilot study tested the feasibility and effectiveness of Written Exposure Therapy (WET; Sloan & Marx, 2019), a brief, five-session exposure-based treatment, when delivered in a real-world Counseling Services Center. Students who met criteria for probable PTSD were assessed at baseline, posttreatment, and 3-month follow-up using self-report assessments of PTSD and depression. Of 28 eligible college students, 22/28 (78.6%) completed at least one treatment session, and of those students, 14/22 (63.6%) completed the full five sessions, 12 of whom completed both the posttreatment assessment and the 3-month follow-up assessment. Data were analyzed using intent-to-treat (N = 22) and per-protocol (n = 12) samples. As hypothesized, in both samples, PTSD symptoms decreased from baseline to posttreatment (η² = .60-.81; very large effects), and these improvements were maintained at the 3-month follow-up. Similar findings were observed with respect to decreases in self-reported depression, but not with respect to decreases in educational impairment or increases in academic self-efficacy. Qualitative data indicated that both students and therapists found the treatment credible and acceptable. These findings offer preliminary support for the utility of WET for PTSD when delivered in a student counseling services center. Suggestions for adapting WET within a student counseling services environment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family ties: examining family functioning and alcohol use among American Indian youth.

Purpose: This study aims to examine a second-order latent variable of family functioning built from two established protective factors for American Indian (AI) youth, i.e. family cohesion and parental monitoring. This study then examines if family functioning is related to alcohol use frequency or age of initiation for AI youth. Additionally, this study examines if family functioning served as a moderator for the risk factor of peer alcohol use. Design/methodology/approach: Data came from the 2021 Our Youth, Our Future survey. Participants were 4,373 AI adolescents from Grades 6-12 across the contiguous USA. Structural equation modeling (SEM) was used to test the latent variable of family functioning. Structural paths and interaction terms between peer use and family functioning were added to the SEM to explore direct and moderating effects. Findings: Family cohesion and parental monitoring were best represented by a second-order latent variable of family functioning, which was related to later initiation and lower alcohol use frequency. Practical implications: The findings regarding the initiation of alcohol use may be applicable to prevention programs, with family functioning serving as a protective factor for the initiation of alcohol use. Programs working toward alcohol prevention may be best served by focusing on family-based programs. Originality/value: The latent variable of family functioning is appropriate for use in AI samples. Family functioning, which is an inherent resilience factor in AI communities, was shown to be protective against harmful alcohol use behaviors.

Self-reported Illness Experiences and Psychosocial Outcomes for Reservation-Area American Indian Youth During COVID-19.

Importance: Impacts of COVID-19 on reservation-area American Indian youth are unknown and may be substantial owing to the significant COVID-19 morbidity and mortality experienced by American Indian populations. Objective: To measure self-reported illness experiences and changes in psychosocial factors during the COVID-19 pandemic among reservation-area American Indian youth. Design, Setting, and Participants: This cross-sectional study included a random sample of US schools on or near US Indian reservations during Spring 2021, stratified by region, with students in grades 6 to 12 completing cross-sectional online surveys. All enrolled self-identifying American Indian students in grades 6 to 12 attending the 20 participating schools were eligible to be surveyed; participants represented 60.4% of eligible students in these schools. Data were analyzed from January 5 to July 15, 2022. Exposures: Onset of the COVID-19 pandemic. Main Outcomes and Measures: Outcomes of interest were COVID-19 self-reported illness outcomes for self and family and close friends; perceived changes in family and friend relationships, school engagement, social isolation, and other psychological factors since the COVID-19 pandemic began; and worry over COVID-19-related health outcomes. Results: A total of 2559 American Indian students (1201 [46.9%] male; 1284 [50.2%] female; 70 [2.7%] another gender; mean [SD] 14.7 [8.9] years) were included in the analysis. Approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection (14.3% [95% CI, 11.4%-17.6%]), a higher rate than for all cases nationally at the time of the survey. Regarding prevalence of COVID-19 among family and close friends, 75.4% (95% CI, 68.8%-80.9%) of participants reported having at least 1 family member or friend who had contracted COVID-19, while 27.9% (95% CI, 18.8%-39.3%) of participants reported that at least 1 family member or close friend had died of COVID-19. Regarding psychosocial impacts, COVID-19 was associated with strained friend relationships (eg, 34.0% [95% CI, 28.4%-40.0%] of students reported worry over losing friends), lower school engagement, and less social connectedness (eg, 62.2% [95% CI, 56.7%-67.4%] of students reported feeling less socially connected to people), although more than 60% of students also reported feeling no change or a decrease in negative emotions. Males were less likely to report perceived negative impacts, especially for negative emotions such as sadness (29.2% [95% CI, 23.3%-35.9%] of males vs 46.1% [95% CI, 43.9%-48.3%] of females reported feeling more sad) and anxiety (21.8% [95% CI, 18.2%-25.8%] of males vs 39.2% [95% CI, 34.1%-44.6%] of females reported feeling more anxious). Conclusions and Relevance: This cross-sectional study provides novel insight into the perceived experiences of reservation-area American Indian youth, a population at uniquely elevated risk of poor health status and health care access, during the COVID-19 pandemic. Although mortality and morbidity rates from COVID-19 were high on American Indian reservations, student reports of psychosocial impacts were complex and suggest many students were resilient in the face of the pandemic. These findings could be used to understand and address the challenges facing American Indian youth due to the pandemic and to guide future research that examines the factors and processes associated with the reported outcomes.

Profiles of Ecosystemic Resilience and Risk: American Indian Adolescent Substance Use during the First Year of the COVID-19 Crisis.

The COVID-19 pandemic has caused an unprecedented disruption to the lives of American Indian (AI) adolescents. While reservation-area AI youth already have a higher risk of substance use (SU) compared to their non-AI peers, COVID-19 stressors likely exacerbated this risk. However, COVID-19-specific and general resilience factors may have buffered against increased SU over the course of the pandemic. Using a person-centered, ecosystemic framework of resilience, we used latent profile analysis to identify ecosystemic resilience profiles indicated by general and COVID-19-specific risk and resilience factors, then examined inter-profile changes in alcohol and cannabis use after the onset of the COVID-19 pandemic from the spring of 2020 to the spring of 2021. The sample was 2218 reservation-area AI adolescents (7-12th grade; schools = 20; Mage = 15, SD = 1.7; 52% female). Four profiles emerged: Average Risk and Resilience, High Resilience, Low Resilience, and High Risk. Adolescents with a High-Risk profile demonstrated increases in alcohol and cannabis use, while High Resilience youth demonstrated decreases. These findings support the hypothesized COVID-19-specific ecosystemic resilience profiles and the application of a person-centered ecosystemic framework to identify which AI adolescents are most likely to experience substance use changes during a life-altering crisis like COVID-19.

Associations between impulsivity and self-care adherence in individuals diagnosed with Type 2 or prediabetes.

Diabetes is a chronic disease requiring extensive self-care. Different impulsivity constructs, including choice-based and self-report personality measures are associated with decreasing diabetes self-care adherence. However, both choice-based and self-report impulsivity have never been measured for individuals diagnosed with either Type 2 or prediabetes in the same study. The current study examined the relationship between impulsivity and diabetes self-care in 101 adults diagnosed with either Type 2 or prediabetes. Results indicated that increasing self-reported impulsiveness was significantly correlated with decreasing Type 2 diabetic self-care, whereas the choice-based measure was not associated with any self-care measure. No association between impulsivity and self-care was significant for individuals diagnosed with prediabetes. Path analyses showed that self-reported impulsiveness directly and positively predicted problems controlling blood sugar levels in individuals diagnosed with either prediabetes or Type 2 diabetes. However, self-reported impulsiveness only indirectly and negatively predicted exercise and diet adherence via diabetes management self-efficacy for individuals diagnosed with Type 2 diabetes. These results show what specific impulsivity constructs and diabetes management self-efficacy may be incorporated into interventions for increasing specific self-care behaviors.

School-related Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted.

Dynamics of risk: Recent changes in psychological inflexibility precede subsequent changes in returning US veterans' posttraumatic stress.

OBJECTIVES: As a malleable risk-factor, psychological inflexibility is implicated in the development and maintenance of posttraumatic stress symptoms (PTS). Unfortunately, limited research has addressed whether changes in psychological inflexibility are antecedent to changes in PTS severity over time, or whether such changes are mutually dependent. METHODS: Utilizing bivariate latent difference score modeling, this longitudinal study sequenced intraindividual changes in psychological inflexibility and PTS severity within a sample of 305 returning US veterans. Veterans' self-reported psychological inflexibility and PTS severity were assessed quarterly over 1 year. RESULTS: Results indicated that early reductions in psychological inflexibility potentiated later declines in veterans' PTS severity, accounting for veterans' prior levels of psychological inflexibility and PTS severity. CONCLUSIONS: These findings underscore the unique role of changes in psychological inflexibility as an important mechanism of change in PTS severity and provide empirical support for an antecedent model of the role of psychological inflexibility in PTS recovery.

Be under your own influence: Effectiveness of a Culturally-Adapted drug prevention campaign targeting Reservation-Dwelling American Indian youth.

Be Under Your Own Influence (BUYOI) is a previously validated school-based intervention designed to delay adolescent substance use (SU) initiation. This study examined the effectiveness of a culturally-adapted version of BUYOI in delaying SU initiation among reservation-dwelling American Indian (AI) youth. Five reservation-based middle schools participated. Three schools were randomly assigned to receive BUYOI-AI (N = 321), and two schools served as controls (N = 176). Beginning in 7th grade, all participating students completed four assessments over the study period. Discrete time hazard models estimated the effects of BUYOI on students' risk of initiating alcohol, alcohol intoxication and marijuana before the end of 8th grade. AI students exposed to BUYOI had a lower risk of initiating alcohol use or intoxication, though sex moderated the effect on intoxication. These findings provide preliminary support for the effectiveness of a culturally-adapted version of BUYOI in delaying AI youth's first-time alcohol use and intoxication.

Opioid Misuse Among American Indian Adolescents.

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF).Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence.Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively.Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels.Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

Ready to collaborate?: medical learner experiences in interprofessional collaborative practice settings.

BACKGROUND: Interprofessional collaborative practice (IPCP) offers great potential to improve healthcare. Increases in IPCP will require educating learners in authentic IPCP settings and will generate opportunities and challenges. METHODS: In January 2015, we implemented an IPCP model called Collaborative Care (CC) for hospitalized adult medical patients. We explored learner perspectives regarding their educational experiences. We deductively coded transcripts from semi-structured interviews with medical learners. Data related to educational experiences were thematically analyzed. RESULTS: Twenty-four of 28 (85.7%) medical learners rotating on CC from January to May 2015 completed interviews. Subsequent inductive analysis of these interviews identified four themes: Loss of Educational Opportunities during Rounds, Feelings of Uncertainty during New Situations, Strategies for Adaptation, and Improved Communication with Patients and the Team. CONCLUSIONS: Increased implementation of IPCP will lead to a greater number of learners being exposed to authentic IPCP settings and will generate opportunities and challenges. Though learners perceived improved communication skills in an IPCP model, they also described loss of profession-specific learning opportunities and feelings of uncertainty. These findings corroborate the need for novel teaching methods aligned with IPCP clinical learning environments and educational assessment strategies that reflect attainment of both profession-specific and interprofessional competencies.

The Role of Future Orientation and Self-determination on American Indian Adolescents' Intentions to Use Alcohol and Marijuana.

Substance use (SU) rates among American Indian (AI) adolescents have been greater than national rates for decades, with little progress made on reducing them. Reasons for this may include lack of evidence on which to base effective interventions, the uniqueness of this population, and the overall lack of attention that this population has received in reducing socioeconomic and health disparities. Moreover, there has been limited focus on understanding how positive individual characteristics may serve as protective factors for AI adolescents. Using data from 379 AI youth living on or near four northern plains reservations, the current study examines the relationship between future orientation (FO) and self-determination (SD) and intentions to use alcohol and marijuana, with negative consequences of SU for future goals and autonomy evaluated as potential mediators. SEM models were estimated for alcohol use and marijuana use intentions, with two separate models for each dependent variable-one assessing the direct and indirect effects of FO via perceived consequences for future goals and the other assessing the effects of SD via perceived consequences for autonomy. All models displayed good fit, but the pattern of significant effects varied by substance, by construct (FO vs. SD), and by gender. Findings suggested that SD, and more proximally, perceived consequences of use for autonomy, may be particularly useful promotive factors to target SU prevention in AI adolescents. Culturally congruent interventions designed to promote SD and autonomous motivations to abstain may be particularly impactful within a young AI adolescent population, as early adolescence represents a critical period of development for personal autonomy and identity.

Factor Structure and Initial Validation of a Brief Measure of Perceived Emotional and Physical Distress Tolerance in Post-9/11 US Veterans.

Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (Mage= 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.

Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services.

BACKGROUND: Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. OBJECTIVE: To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. DESIGN: Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. PARTICIPANTS: Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. MAIN MEASURES: The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. KEY RESULTS: We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). CONCLUSIONS: Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.