Changes in Mental Health, Emotional Distress, and Substance Use Affecting Women Experiencing Violence and Their Service Providers during COVID-19 in a U.S. Southern State.

Research conducted during the COVID-19 pandemic has revealed many unintended consequences of mandated safety precautions, including increased perpetration of intimate partner violence (IPV), increases in substance use, and worsening mental health conditions. We conducted a repeated, cross-sectional survey of survivors of IPV, a longitudinal survey of service providers working in an IPV shelter, and interviews with both. We conducted surveys at the beginning of the pandemic and nearly half a year later to assess mental health and, for clients, substance use. Results showed that two small samples of survivors living in the shelter in 2020 and 2021 experienced both mental health decline and increased use of substances. Qualitative data from in-depth interviews suggest that COVID-19-related restrictions mirrored survivors' experiences of power and control in violent relationships. Further, IPV service providers-essential workers during COVID-19-experienced stress associated with reports of burnout and mental fatigue. This study suggests that community-based organizations can help mitigate the impacts of COVID-19 on survivors of IPV but should avoid adding additional work for staff as service providers experienced mental and emotional stress.

Adapting an evidence-based HIV prevention intervention for pregnant African-American women in substance abuse treatment.

An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.

Context of Acceptability of Topical Microbicides: Sexual Relationships.

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.

Students' special needs and problems as reasons for the adaptation of substance abuse prevention curricula in the nation's middle schools.

In this study we estimate the proportion of the nation's middle school teachers who have adapted substance abuse curricula in response to their students' special problems or needs. We also explore a variety of characteristics associated with schools, teachers, and the curricula implemented that are associated with adaptations made in response to the most prevalent of these student problems or needs. Study data were collected in 1999 from a representative sample of lead substance abuse prevention teachers in the nation's public and private schools. We found that 79.8% of respondents report adapting their prevention curricula in response to at least one of the dozen student problems and needs specified. The problems cited most frequently, by slightly more than half of all respondents, relate to the needs of students who are sexually active or have discipline problems. Associated most strongly with adaptations for these two reasons were teachers who were recently trained in their curricula, and substance abuse prevention lessons that could readily be integrated into the school's overall curriculum. We discuss the need for curriculum developers to recognize the frequency with which, and reasons for which, teachers are adapting their curricula, and to include appropriate optional content that addresses students' needs.

Who's calling the shots? Decision-makers and the adoption of effective school-based substance use prevention curricula.

This study investigates the relative roles of school district and school-level decision-makers in the implementation of effective substance use prevention curricula. Drawing on a "Site-Based Management" approach to effective decision-making, we hypothesized that schools whose personnel played active decision-making roles would be more likely to implement effective curricula than those in which decision-making was the prerogative of school district personnel. Study data comprised 1369 questionnaires completed by a representative national sample of both district-level prevention coordinators and middle school-based lead prevention teachers. From the perspective of the lead prevention teachers, the school district-level prevention coordinator was more influential than school staff in selecting effective prevention curricula. However, we did find some support for our hypothesis from our district-level informants, who indicated that community groups and advisory committees also play a modest role in the selection of such curricula.

The principles of effectiveness: early awareness and plans for implementation in a national sample of public schools and their districts.

The US Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds to: a) base drug and violence prevention programs on needs assessment data, b) develop measurable program goals and objectives, c) implement programs with research evidence of effectiveness, and d) periodically evaluate programs relative to their goals and objectives. This paper reports the extent of awareness of the Principles of Effectiveness and plans for their implementation among public school districts and schools in the United States in the year following their announcement. Results showed a greater percentage of public school districts than individual schools knew about the principles and planned for implementation, but baseline levels of awareness for both districts and schools were relatively low. Schools were more likely to know about the principles when their associated school district also knew. Results suggest a need for greater communication about the principles to school districts, and in turn, a need for greater communication between district and school-level substance use prevention staff.

A comparison of current practice in school-based substance use prevention programs with meta-analysis findings.

The series of seminal meta-analytic studies of school-based substance use prevention program studies conducted by the late Nancy S. Tobler and colleagues concluded that programs with content focused on social influences' knowledge, drug refusal skills, and generic competency skills and that use participatory or interactive teaching strategies were more effective than programs focused on knowledge and attitudes and favoring traditional didactic instruction. The present study compared current school practice against evidence-based standards for "effective content" and "effective delivery," derived from the Tobler findings. Respondents were the lead staff who taught substance use prevention in the 1998-1999 school year in a national sample of public and private schools that included middle school grades (N = 1,795). Results indicate that most providers (62.25%) taught effective content, but few used effective delivery (17.44%), and fewer still used both effective content and delivery (14.23%). Those who taught an evidence-based program (e.g., Life Skills Training, Project ALERT), however, were more likely to implement both effective content and delivery, as were those teachers who were recently trained in substance use prevention and were comfortable using interactive teaching methods. The findings indicate that the transfer to practice of research knowledge about school-based substance use prevention programming has been limited.

Factors associated with fidelity to substance use prevention curriculum guides in the nation's middle schools.

Teachers' fidelity of implementation of substance use prevention curricula is widely considered desirable and is linked empirically to effectiveness. The authors examine factors pertinent to teachers' fidelity to curricula guides, using data from a nationally representative sample of 1,905 lead substance use prevention teachers in the nation's public and private schools. Findings suggest that about one-fifth of teachers of substance use prevention curricula did not use a curriculum guide at all, whereas only 15% reported they followed one very closely. Positively associated with adherence were teachers' discretion in their coverage of prevention lessons, beliefs concerning the effectiveness of the most recent training they received and the curricula they taught, and level of support they received from their principals for substance use prevention. The authors conclude that some degree of curriculum adaptation is inevitable and suggest how adherence to curricula guides may be improved through teacher training.

The prevalence of effective substance use prevention curricula in U.S. middle schools.

Despite an abundance of evaluative evidence concerning the effectiveness of several school-based substance use prevention curricula, many of the nation's middle schools continue to implement curricula that are either untested or ineffective. This study reports the prevalence of substance use prevention curricula in the nation's public and private schools that contain middle school grades. We also report school- and respondent-related background characteristics differentiating schools using at least 1 effective curriculum from those using ineffective or untested curricula. Respondents comprised the lead staff who taught substance use prevention in a representative sample of 1,905 of the nation's public and private schools that include middle school grades. Data were collected in 1999 by means of a self-administered survey. Altogether, 26.8% of all schools, including 34.6% of public schools and 12.6% of private schools, used at least 1 of the 10 effective curricula specified. Few school or respondent characteristics were related to program implementation. Over two thirds of schools reported using more than 1 curriculum, and almost half reported using 3 or more. Results demonstrate the considerable gap between our understanding of effective curricula and current school practice. Prevention researchers and practitioners should work closely together to find ways to increase the proportion of schools implementing effective curricula.