Monitoring long-term opioid therapy and chronic noncancer pain in primary care: Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP).

OBJECTIVE: To replicate and extend previous research by examining, among a larger sample, the effectiveness of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at increasing adherence to the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy among chronic noncancer patients seen in primary care-medications, hospitalization, monitoring/safety, assessment, and nonpharmacological pain treatment referrals. DESIGN/METHODS: Using data collected from medical records, a between-subjects comparison (PC-POP enrollees vs nonenrollees) was conducted to determine if there were differences between the groups 12 months post-enrollment in PC-POP (12 months post-index date for nonenrollees). Additionally, a within-subjects comparison of outcomes was also conducted with PC-POP enrollees, ie, 12 months pre-enrollment to 12 months post-enrollment. SUBJECTS: A convenience sample of adult Veterans with chronic noncancer pain receiving opioid therapy consecutively for ≥3 months in primary care. RESULTS: A total of 734 Veterans (423 PC-POP enrollees and 311 nonenrollees) were included in the analyses. Results showed increased concordance with VA/DoD guidelines among those enrolled in PC-POP, characterized by increased documentation of urine drug screens, Stratification Tool for Opioid Risk Mitigation reports, Narcan education/prescriptions, assessment measures for mental health/substance use/physical function, and referrals for nonpharmacological pain treatment. A decrease in morphine equivalent daily dose among patients enrolled in PC-POP across a 2-year timeframe was also found. CONCLUSIONS: PC-POP increases guideline concordant care for providers working in primary care.

Trajectories of motivation and self-efficacy during a smoking quit attempt: An ecological momentary assessment study.

OBJECTIVE: Conceptual models of addiction highlight self-efficacy and motivation as key variables important during a smoking quit attempt; however, recent research has primarily focused on self-efficacy. Given the importance of motivation in these models, a clearer understanding of the effects of motivation during a smoking quit attempt is needed. METHOD: This study utilized ecological momentary assessment (EMA) to investigate the dynamic effects of motivation and self-efficacy early in a quit attempt. Participants were 356 smokers (45% male; 34% African American, 33% non-Hispanic White, 33% Latino). Participants completed EMAs of motivation, self-efficacy, and smoking for 4 days prequit through 1 week postquit, and returned for a follow-up assessment at 4 weeks postquit. Trajectory parameters of motivation and self-efficacy (mean, slope, and volatility) were analyzed in separate and combined regression models to predict smoking outcomes. RESULTS: Prequit results showed that parameters of motivation and self-efficacy were not associated with smoking on quit day. Postquit analyses revealed that participants with lower mean levels of motivation and self-efficacy were more likely to smoke at the end of Week 1. Moreover, individuals with decreasing levels of motivation over the first week of their quit attempt were more likely to be smoking at the end of Week 4. CONCLUSIONS: These findings highlight the need to incorporate dynamic measures of motivation in smoking research. Furthermore, the results underscore the value of utilizing EMA methods and trajectory parameters to gain a more nuanced understanding of the dynamic effects that key mechanisms have on smoking during a quit attempt. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sexism, racism, and nationalism: Factors associated with the 2016 U.S. presidential election results?

After the generally unexpected outcome of the 2016 U.S. presidential election, many explanations were proposed to account for the results. Three narratives that received a considerable amount of media attention were that sexist, racist, and/or nationalist attitudes influenced voting decisions. Some empirical work has supported each of these accounts. However, sexism, racism, and nationalism are interrelated, and most studies about the 2016 election have not examined these three factors in conjunction to determine the unique contribution of each. Thus, we investigated the extent to which each factor (assessed as sexism toward women, Modern Racism, and U.S. nationalism) was uniquely related to evaluations of Hillary Clinton and Donald Trump, voting intentions, and actual voting behavior. Participants completed online questionnaires before (N = 489) and after (N = 192) the 2016 U.S. election. More positive evaluation of Clinton and intentions to vote for Clinton were associated with lower levels of Modern Racism. More positive evaluation of Trump was associated with greater sexism toward women, Modern Racism, and U.S. nationalism. Intent to vote for Trump was associated with greater sexism toward women and Modern Racism. However, only Modern Racism significantly predicted voting behavior. Greater Modern Racism was associated with greater likelihood of voting for Trump and lower likelihood of voting for Clinton. When considered in conjunction, Modern Racism was the most consistent predictor across the different election outcome variables. Sexism toward women and U.S. nationalism were generally not significantly related to evaluations, intentions to vote, or voting behavior when accounting for Modern Racism. Thus, our data indicate that Modern Racism was correlated with vote choice in the 2016 election.

Socioeconomic status, mindfulness, and momentary associations between stress and smoking lapse during a quit attempt.

BACKGROUND: Models of health disparities highlight stress among low socioeconomic status (SES) smokers as a barrier to cessation. Recent studies suggest that mindfulness may improve cessation outcomes by reducing stress during a quit attempt. The current study examined associations of SES and mindfulness with ecological momentary assessments (EMAs) of stress and smoking lapse during a quit attempt. METHODS: EMAs (N = 32,329) were gathered from 364 smokers engaged in a quit attempt. A multilevel structural equation model estimated within person paths from momentary stress to subsequent smoking lapse. Between person paths estimated paths from a latent variable for SES and mindfulness to stress and smoking lapse, the indirect effect of SES and mindfulness on lapse through stress, and moderation of within person stress-lapse associations by SES and mindfulness. RESULTS: Within person estimates found that momentary increases in stress predicted increased risk of subsequent smoking lapse. Between person estimates found that lower SES was indirectly associated with greater risk for smoking lapse through increased stress; and, higher mindfulness was indirectly associated with lower risk for smoking lapse through reduced stress. Additionally, higher SES participants, who reported lower stress during the quit attempt, showed a stronger relationship between momentary increases in stress and risk for subsequent smoking lapse. CONCLUSIONS: Among low SES smokers engaged in a quit attempt, both SES and mindfulness uniquely influenced smoking lapse through their influence on stress. Findings support reports that mindfulness presents a promising intervention target to reduce stress and improve cessation outcomes among low SES smokers.

Student Integration into STEM Careers and Culture: A Longitudinal Examination of Summer Faculty Mentors and Project Ownership.

It is widely recognized that the United States needs to attract and retain more people in science, technology, engineering, and mathematics (STEM) careers. Intensive undergraduate research experiences (UREs) are one of the few strategies shown to improve longitudinal student interest and persistence in STEM-related career pathways; however, less is known about the underlying process linking activities to positive outcomes. The tripartite integration model of social influences (TIMSI) provides a framework for understanding the social influence processes by which students integrate into STEM careers and culture. The current study used a longitudinal design and latent growth curve modeling to examine and predict the development of scientific research career persistence intentions over the course of an intensive summer URE. The latent growth curve analysis showed that student persistence intentions declined and rebounded over the course of the summer. Furthermore, the positive impact of faculty mentor role modeling on growth trajectories was mediated through internalization of science community values. In addition, project ownership was found to buffer students from the typical trend of declining and rebounding persistence intentions. The TIMSI framework illuminates the contextual features and underlying psychological processes that link UREs to student integration into STEM careers and culture.

A review of sociocultural factors that may underlie differences in African American and European American anxiety.

Preliminary evidence indicates there may be differences in the prevalence and severity of anxiety in African Americans and European Americans. A number of sociocultural risk and protective factors have been suggested to contribute to these group differences, such as salience of physical illnesses, discrimination, stigma toward mental illness, religiosity, and ethnic identity. In this paper, the literature concerning each of these factors is reviewed. Overall, the strongest evidence was found for ethnic identity and stigma toward mental illness as factors underlying group differences in anxiety. Ethnic identity and stigma toward mental illness consistently differed by racial group and were associated with anxiety in African Americans. Ethnic identity may buffer against the negative consequences of anxiety, reducing prevalence rates in African Americans. Stigma toward mental illness may decrease African Americans willingness to report anxiety symptoms, reducing overall prevalence rates but increasing the severity of treated cases. The research regarding discrimination, salience of physical illnesses, and religiosity was less clear. Much more research is required, but the findings of this review suggest that future studies should put particular emphasis on stigma toward mental illness and ethnic identity as important factors in understanding African American anxiety outcomes.

MRI parcellation of the frontal lobe in boys with attention deficit hyperactivity disorder or Tourette syndrome.

Dysfunction of frontal-striatal-thalamic-frontal circuitry has been hypothesized to underlie both attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS). Several research groups have therefore used anatomic magnetic resonance imaging (aMRI) to obtain volumetric measurements of subregions of the frontal lobe in these disorders. Most previous studies have relied on subparcellation methods that utilize callosal landmarks to derive subregions of the frontal lobe. In contrast, we present here an investigation of frontal lobe morphometry in ADHD and TS based on a reliable frontal subparcellation protocol that combines contiguous sulcal/gyral boundaries to derive frontal lobe modules based on prior functional studies. This highly reliable procedure subdivides the frontal lobe into five major modules: prefrontal, premotor, motor (precentral gyrus), anterior cingulate, and deep white matter. The first four modules are also segmented into gray and gyral white matter compartments. The protocol was applied to T1-weighted, SPGR coronal MRI images of 13 school-aged boys with ADHD, 13 boys with TS, and 13 age- and gender-matched controls. In ADHD, we found volumetric reductions in both the gray and white matter of the prefrontal cortex. These findings, in conjunction with previous reports on basal ganglia abnormalities, suggest that prefrontal-striatal pathways may be anomalous in ADHD. In TS, we found volumetric decreases in the left deep frontal white matter. Decreases in deep white matter suggest the presence of abnormalities in long associational and projection fiber bundles in TS. The findings of this study both confirm and extend our knowledge of the neurobiology of ADHD and TS, indicating that the reliable parcellation method presented has the potential of increasing our understanding of the role of the frontal lobe in developmental and psychiatric disorders.