Electronic screening and brief intervention to reduce cannabis use and consequences among graduate students presenting to a student health center: A pilot study.

This pilot study sought to test the feasibility of screening and delivering a web-based intervention to reduce marijuana use and consequences among graduate student presenting to a Student Health Center (SHC). Graduate students completed a 9-item electronic health screening instrument during their visit to the SHC. Those who reported monthly or greater marijuana use were eligible for participation in the pilot trial. Forty-nine students completed baseline assessments and were randomly assigned to an electronic screening and brief intervention (eSBI) for marijuana (eCHECKUPTOGO-marijuana; [BI]) or a control condition (CTL) that consisted of minimal general health information. Participants completed measures of marijuana use frequency and negative consequences at baseline, 3- and 6-months. Latent growth modeling was used to provide effect size estimates for the influence of the intervention on 6-month outcomes. Effect size estimates showed a small-to-medium effect of BI on marijuana use frequency at 6-months; there was no evidence of the BI on consequences. Results suggest that BI may hold promise as a method to reduce marijuana use among graduate students who present to primary care settings. Future research should test the efficacy of this approach in a full-scale randomized controlled trial.

Web-based screening and brief intervention for student marijuana use in a university health center: pilot study to examine the implementation of eCHECKUP TO GO in different contexts.

This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control)×2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6 months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.

Depressive symptoms and antiretroviral therapy (ART) initiation among HIV-infected Russian drinkers.

The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/µl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.

Effects of alcohol cues and alcohol intoxication on drug use expectancies among men who have sex with men.

Although alcohol and drug use have been identified as HIV-risk factors for men who have sex with men (MSM), little is known about how they interact. An alcohol administration paradigm was used to examine alcohol's cue and pharmacological effects on perceived drug use benefits and consequences in 117 MSM. Planned contrasts indicated that those in the alcohol cue (i.e., placebo) condition reported lower perceived drug consequences compared to controls. No cue effects were found for drug benefits. There was no pharmacological effect of alcohol as compared to alcohol cue on either outcome. Findings suggest that alcohol cues may influence the perception of consequences related to drug use, which has implications for health interventions targeting substance use and HIV risk.

Psychoticism and paranoid ideation in patients with nonpsychotic major depressive disorder: prevalence, response to treatment, and impact on short- and long-term treatment outcome.

UNLABELLED: Objective/Introduction: We sought to characterize the impact of the 90-item Symptom Checklist (SCL-90) subscales for paranoid ideation (PI) and psychoticism (P) in patients with major depressive disorder (MDD), on acute antidepressant response and on relapse prevention. METHODS: Subjects with Structured Clinical Interview for DSM Disorders-diagnosed nonpsychotic MDD were recruited into a clinical trial of open-label fluoxetine 10-60 mg/day for 12 weeks, followed by double-blind randomization of responders (n=262) to fluoxetine continuation or placebo for 12 months. PI and P were assessed with the patient-rated SCL-90. The association of these symptoms with response to treatment was assessed by logistic regression. RESULTS: We found significant decreases in PI and P during acute treatment phase for fluoxetine responders and nonresponders, although only 10.3% and 7.5% of patients experienced a >50% reduction in PI and P scores, respectively. Neither PI nor P scores significantly predicted time to relapse. P scores predicted a lower response rate to treatment with fluoxetine. DISCUSSION: The results of the present study suggest that there is a significant relationship between the presence of psychoticism in patients with nonpsychotic MDD, and the likelihood of overall depressive symptom improvement following a trial of monotherapy with fluoxetine. CONCLUSION: An increased burden of psychoticism in depressed subjects may confer poorer response to fluoxetine, but not increased risk of relapse among fluoxetine responders.

Relationship between probability of receiving placebo and probability of prematurely discontinuing treatment in double-blind, randomized clinical trials for MDD: a meta-analysis.

An increased likelihood of receiving placebo in randomized clinical trials has been found to predict greater chances of trial success. However, patients who are less likely to receive active therapy (and more likely to receive placebo) may be at increased risk of attrition which, in turn, can limit the statistical power of a study. Therefore, in the present work, we sought to investigate the relationship between the probability of receiving placebo and the likelihood of prematurely discontinuing treatment. Medline/Pubmed publication databases were searched for RCT in MDD. A meta-regression established that the likelihood of receiving placebo did not predict either antidepressant discontinuation rates, placebo-discontinuation rates or the risk ratio of discontinuing antidepressants versus placebo. An increased likelihood of receiving placebo did not inflate discontinuation rates which did not influence the degree of antidepressant-placebo "separation".