Purpose: The objective of this study was to conduct a preliminary evaluation of a new young adult... more Purpose: The objective of this study was to conduct a preliminary evaluation of a new young adult-centered metaintervention to improve treatment engagement among those with serious mental illness. Methods: Young adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. Results: The randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such
Background: Young adults have elevated rates of mental health disorders, yet they often do not re... more Background: Young adults have elevated rates of mental health disorders, yet they often do not receive consistent care. The challenge of continuing to engage young adults has been pervasive worldwide. Few engagement interventions have been designed for young adults with serious mental illness. Just Do You is a theoretically guided engagement intervention. It uses innovative modalities (i.e., technology, expressive arts activities, narrative expression, mentoring) to engage participants in conversations about services and how they work, while simultaneously orienting them to treatment. Methods/design: This pilot and feasibility study utilizes a hybrid research design, examining feasibility, acceptability, and preliminary impact, alongside implementation. The study combines qualitative methods, a small pilot randomized trial, and a small cost-benefit analysis. Respondents are clinic staff and young adults who have made initial contact with the Personalized Recovery Oriented Services (PROS) program. Quantitative survey data are collected at baseline, 2 weeks (post-intervention), 1 month, and 3 months. The assessments focus on measuring feasibility, acceptability, engagement, and mental health outcomes. Medical record extraction will be used to triangulate self-report data. We will conduct single degree of freedom contrasts to examine whether Just Do You leads to improved outcomes relative to Treatment-As-Usual using robust regression for each outcome measure. We will examine whether changes in the proposed mediating variables occur across groups using a similar contrast strategy. In addition, we will use structural equation modeling to examine the contribution of mediators to ultimate outcomes. Finally, we will use constant comparison coding techniques for qualitative analyses. Discussion: The aim of this study is to examine the feasibility of a young adult engagement meta-intervention through an intensive preliminary pilot trial, learning through collaboration with stakeholders. Just Do You has the potential to fill a gap in the service system for young adults with serious mental illnesses, improving the seemingly intractable problem of disengagement. The program uses culturally responsive strategies, is recovery-oriented, and builds upon the best evidence to date. Our efforts align with local and national health care reform efforts embedding people with lived experience.
Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms ... more Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.
Objective: To understand the benefits of an intensive 6-months-long training program (with or wit... more Objective: To understand the benefits of an intensive 6-months-long training program (with or without assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without additional assistance of a care manager. In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore impact on PCPs’ initial and subsequent intentions/decisions to adopt 11 specific changes in ADHD practices. Effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined. Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD ev...
ImportanceStudies linking the quality of parent-adolescent relationships with young adult health ... more ImportanceStudies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships.ObjectiveTo evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains.Design, Setting, and ParticipantsThis cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020.ExposuresParental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants.Main Outcomes and MeasuresWave ...
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diag... more Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods U...
Background Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people a... more Background Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. Purpose We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured. Methods We conducted analyses using data from the 2015 U.S...
IMPORTANCE Adolescent well care visits provide opportunities for clinicians to facilitate parenta... more IMPORTANCE Adolescent well care visits provide opportunities for clinicians to facilitate parentadolescent communication (PAC) to reduce pregnancy, sexually transmitted infections, and alcoholrelated harm among adolescents. OBJECTIVE To test the effect of brief parent-targeted interventions delivered in primary care settings on PAC about sexual and alcohol use behaviors. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at a primary care pediatric practice from January 4, 2016, to April 10, 2017. Adolescents who were scheduled for a well care visit were recruited, along with their parent or guardian. Data analyses continued through April 30, 2018. INTERVENTIONS During well care visits, parents in sexual health intervention and alcohol prevention intervention groups received coaching to discuss written intervention materials encouraging PAC about sex or alcohol, respectively, with their adolescent within 2 weeks, followed by a brief clinician endorsement. After 2 weeks, parents received a follow-up telephone call. Control group parents received usual care. MAIN OUTCOMES AND MEASURES Participants were surveyed 4 months after the well care visit. Parent-reported and adolescent-reported quality of PAC was measured using the 20-item Parent-Adolescent Communication Scale, in which a higher score indicates better PAC; and frequency of PAC about sex or alcohol was measured using a 4-point Likert-type scale with 1 indicating not at all or never, and 4 indicating a lot or often. RESULTS Of 196 parent-adolescent dyads assessed for eligibility, 118 (60.2%) were eligible to participate. These 118 dyads were randomized to 1 of 3 groups: (1) sexual health intervention (n = 38 [32.2%]); (2) alcohol prevention intervention (n = 40 [33.9%]); and control (n = 40 [33.9%]); 104 parents (88.1%) and 99 adolescents (83.9%) completed the study. Parents included 112 women (94.9%) and had a mean (SD) age of 45.8 (6.9) years. Adolescents included 60 girls (50.9%); 67 adolescents (56.8%) were aged 14 years, and 51 adolescents (43.2%) were aged 15 years. Participant race/ethnicity reflected that of the practice (63 black adolescents [53.4%]; 46 white adolescents [38.9%]; 111 non-Hispanic adolescents [94.1%]). At baseline, 15 adolescents (12.7%) reported a history of sexual behavior and 16 adolescents (13.6%) reported a history of alcohol use. Intention-totreat analyses found that 4 months after the intervention, adolescents in the sexual health intervention group reported a higher mean frequency score for PAC about sex compared with those (continued) Key Points Question Can parent-targeted interventions delivered within primary care settings affect parent-adolescent communication about sexual health and alcohol use? Findings This randomized clinical trial included 118 parent-adolescent dyads and found that brief parent-targeted interventions in primary care pediatric settings were acceptable, were feasible, and significantly increased adolescentreported frequency of parentadolescent communication about sexual health and alcohol use. Meaning Delivering parent-targeted interventions in primary care settings may be an important strategy for influencing parent-adolescent communication and adolescent behaviors and improving health outcomes.
Background & Aims: Among patients with irritable bowel syndrome (IBS), it would be helpful to ide... more Background & Aims: Among patients with irritable bowel syndrome (IBS), it would be helpful to identify those most likely to respond to specific treatments, yet few factors have been identified that reliably predict positive outcome. We sought to identify pretreatment baseline characteristics that associate with symptom improvement in patients who received empirically validated regimens of cognitive behavior therapy (CBT) or IBS education. Methods: We analyzed data from the IBS Outcome Study, in which 436 patients with IBS (average age, 41 years; 80% female) were randomly assigned to groups that received to 4 or 10 weeks of cognitive behavior therapy or education. Baseline data were collected from all participants on sociodemographic and clinical features and comorbidities. Interaction analyses used a modified linear probability model with Huber-White robust estimators to identify baseline factors that moderated as a function of treatment condition symptom improvement based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Results: Whether the primary outcome of IBS symptom improvement was rated by patients or physician assessors blind to treatment 2 weeks after it ended, higher percentages of patients had symptom improvement after CBT compared with EDU among those with low levels of trait anxiety (71.3% vs 34.9%; P<.05) or anxiety sensitivity (71.7% vs 38.6%; P<.05) and for those with baseline typical levels of trait anxiety (66.0% vs 47.1%; P<.05) or anxiety sensitivity (66.3%
Journal of the Society for Social Work and Research, 2018
We describe randomized explanatory trials (RETs), a framework for evaluating interventions to pre... more We describe randomized explanatory trials (RETs), a framework for evaluating interventions to prevent adolescent problem behaviors. The approach maps intervention components onto hypothesized mediators of program effects and then uses structural equation modeling to evaluate whether the program changed those mediators and if assumptions of mediator relevance are viable. We review and explain key concepts related to theoretical issues of choosing and conceptualizing mediators, mapping structural relations among mediators, considering cascading effects, and incorporating theories of treatment duration and decay. We also explore methodological issues, including the choice of time intervals between assessments, the use of instrumental variables, methods for dealing with measurement error, and sample-size planning. In addition, we discuss analytic issues including use of structural equation modeling rather than ANOVA, ANCOVA and logistic/OLS regression; how to handle large numbers of mediators; incorporating covariates; use of per-protocol vs. intent-to-treat analyses; quantifying and testing mediation; and use of causal inference approaches to mediation. Because RETs can identify program components that are successful in bringing about change and why—providing more useful evaluations than outcome-only designs—we argue that RETs rather than randomized controlled trials should be the gold standard for program evaluation.
BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sust... more BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education. METHODS: A total of 436 Rome III-diagnosed IBS patients (80% F, M age = 41 years) were randomized to: 4 session home-based CBT (minimal contact (MC-CBT)), 10 session clinic-based CBT (standard (S-CBT)), or 4 session IBS education (EDU). Follow-up occurred at 2 weeks and 3, 6, 9, and 12 months following treatment completion. Treatment response was based a priori on
and conducts research on the intersection of economic, ethnic, and gender inequality in Guatemala... more and conducts research on the intersection of economic, ethnic, and gender inequality in Guatemala. Linda Asturias is a cultural anthropologist and Director of Estudio 1360, a research organization in Guatemala City, where she works with nurse/anthropologist Idalma Mejia and anthropologist Luisa Mazariegos on a wide range of social science related projects.
Journal of the Society for Social Work and Research, 2017
The present study aimed to (a) identify what mental health profiles exist among emerging adults w... more The present study aimed to (a) identify what mental health profiles exist among emerging adults with a history of childhood contact with Child Protective Services (CPS), and (b) examine whether the level of young-adult functioning varies across the profiles. Method: Latent profile analysis was conducted with a nationally representative sample of youths (mean age 5 18.99, N 5 1,179) who were tracked for an extended time following CPS investigation. Results: A fiveprofile solution-minimal symptoms, midlevel symptoms, multimorbid, trauma symptoms, and substance problems-provides the best fit for the data. Young-adult functioning levels vary across the profiles with the members of the minimalsymptoms profile functioning better in many domains compared with members of other profiles. Members of the minimal symptoms, the midlevel symptoms, and the multimorbid profiles scored the lowest, the midlevel, and the highest, respectively, across all mental health symptoms. These three profiles were estimated to comprise close to 90% of the study population. Conclusions: The mental health profiles among the study population correspond to symptom severity rather than to specific diagnostic categories. Policy and practice implications are provided.
This article draws insights from several disciplines to propose an integrated perspective on mech... more This article draws insights from several disciplines to propose an integrated perspective on mechanisms underlying narrative persuasion. One approach to narratives emphasizes a deictic shift into the narrative, resulting in an absorbed state of processing and a loss of one's sense of self (e.g., transportation, narrative engagement, identification). Another approach focuses on processes to construct meaning from a narrative; that is, how narratives are actively compared with and applied to one's life. The current work has conceptualized the relationship between these two broad processes as occurring in sequence, and as a pathway of narrative persuasion: A shift and absorption into the narrative leads to a process of reflecting on the narrative, which is antecedent to narrative influence.
Purpose: The objective of this study was to conduct a preliminary evaluation of a new young adult... more Purpose: The objective of this study was to conduct a preliminary evaluation of a new young adult-centered metaintervention to improve treatment engagement among those with serious mental illness. Methods: Young adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. Results: The randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such
Background: Young adults have elevated rates of mental health disorders, yet they often do not re... more Background: Young adults have elevated rates of mental health disorders, yet they often do not receive consistent care. The challenge of continuing to engage young adults has been pervasive worldwide. Few engagement interventions have been designed for young adults with serious mental illness. Just Do You is a theoretically guided engagement intervention. It uses innovative modalities (i.e., technology, expressive arts activities, narrative expression, mentoring) to engage participants in conversations about services and how they work, while simultaneously orienting them to treatment. Methods/design: This pilot and feasibility study utilizes a hybrid research design, examining feasibility, acceptability, and preliminary impact, alongside implementation. The study combines qualitative methods, a small pilot randomized trial, and a small cost-benefit analysis. Respondents are clinic staff and young adults who have made initial contact with the Personalized Recovery Oriented Services (PROS) program. Quantitative survey data are collected at baseline, 2 weeks (post-intervention), 1 month, and 3 months. The assessments focus on measuring feasibility, acceptability, engagement, and mental health outcomes. Medical record extraction will be used to triangulate self-report data. We will conduct single degree of freedom contrasts to examine whether Just Do You leads to improved outcomes relative to Treatment-As-Usual using robust regression for each outcome measure. We will examine whether changes in the proposed mediating variables occur across groups using a similar contrast strategy. In addition, we will use structural equation modeling to examine the contribution of mediators to ultimate outcomes. Finally, we will use constant comparison coding techniques for qualitative analyses. Discussion: The aim of this study is to examine the feasibility of a young adult engagement meta-intervention through an intensive preliminary pilot trial, learning through collaboration with stakeholders. Just Do You has the potential to fill a gap in the service system for young adults with serious mental illnesses, improving the seemingly intractable problem of disengagement. The program uses culturally responsive strategies, is recovery-oriented, and builds upon the best evidence to date. Our efforts align with local and national health care reform efforts embedding people with lived experience.
Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms ... more Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.
Objective: To understand the benefits of an intensive 6-months-long training program (with or wit... more Objective: To understand the benefits of an intensive 6-months-long training program (with or without assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without additional assistance of a care manager. In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore impact on PCPs’ initial and subsequent intentions/decisions to adopt 11 specific changes in ADHD practices. Effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined. Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD ev...
ImportanceStudies linking the quality of parent-adolescent relationships with young adult health ... more ImportanceStudies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships.ObjectiveTo evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains.Design, Setting, and ParticipantsThis cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020.ExposuresParental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants.Main Outcomes and MeasuresWave ...
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diag... more Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods U...
Background Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people a... more Background Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. Purpose We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured. Methods We conducted analyses using data from the 2015 U.S...
IMPORTANCE Adolescent well care visits provide opportunities for clinicians to facilitate parenta... more IMPORTANCE Adolescent well care visits provide opportunities for clinicians to facilitate parentadolescent communication (PAC) to reduce pregnancy, sexually transmitted infections, and alcoholrelated harm among adolescents. OBJECTIVE To test the effect of brief parent-targeted interventions delivered in primary care settings on PAC about sexual and alcohol use behaviors. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at a primary care pediatric practice from January 4, 2016, to April 10, 2017. Adolescents who were scheduled for a well care visit were recruited, along with their parent or guardian. Data analyses continued through April 30, 2018. INTERVENTIONS During well care visits, parents in sexual health intervention and alcohol prevention intervention groups received coaching to discuss written intervention materials encouraging PAC about sex or alcohol, respectively, with their adolescent within 2 weeks, followed by a brief clinician endorsement. After 2 weeks, parents received a follow-up telephone call. Control group parents received usual care. MAIN OUTCOMES AND MEASURES Participants were surveyed 4 months after the well care visit. Parent-reported and adolescent-reported quality of PAC was measured using the 20-item Parent-Adolescent Communication Scale, in which a higher score indicates better PAC; and frequency of PAC about sex or alcohol was measured using a 4-point Likert-type scale with 1 indicating not at all or never, and 4 indicating a lot or often. RESULTS Of 196 parent-adolescent dyads assessed for eligibility, 118 (60.2%) were eligible to participate. These 118 dyads were randomized to 1 of 3 groups: (1) sexual health intervention (n = 38 [32.2%]); (2) alcohol prevention intervention (n = 40 [33.9%]); and control (n = 40 [33.9%]); 104 parents (88.1%) and 99 adolescents (83.9%) completed the study. Parents included 112 women (94.9%) and had a mean (SD) age of 45.8 (6.9) years. Adolescents included 60 girls (50.9%); 67 adolescents (56.8%) were aged 14 years, and 51 adolescents (43.2%) were aged 15 years. Participant race/ethnicity reflected that of the practice (63 black adolescents [53.4%]; 46 white adolescents [38.9%]; 111 non-Hispanic adolescents [94.1%]). At baseline, 15 adolescents (12.7%) reported a history of sexual behavior and 16 adolescents (13.6%) reported a history of alcohol use. Intention-totreat analyses found that 4 months after the intervention, adolescents in the sexual health intervention group reported a higher mean frequency score for PAC about sex compared with those (continued) Key Points Question Can parent-targeted interventions delivered within primary care settings affect parent-adolescent communication about sexual health and alcohol use? Findings This randomized clinical trial included 118 parent-adolescent dyads and found that brief parent-targeted interventions in primary care pediatric settings were acceptable, were feasible, and significantly increased adolescentreported frequency of parentadolescent communication about sexual health and alcohol use. Meaning Delivering parent-targeted interventions in primary care settings may be an important strategy for influencing parent-adolescent communication and adolescent behaviors and improving health outcomes.
Background & Aims: Among patients with irritable bowel syndrome (IBS), it would be helpful to ide... more Background & Aims: Among patients with irritable bowel syndrome (IBS), it would be helpful to identify those most likely to respond to specific treatments, yet few factors have been identified that reliably predict positive outcome. We sought to identify pretreatment baseline characteristics that associate with symptom improvement in patients who received empirically validated regimens of cognitive behavior therapy (CBT) or IBS education. Methods: We analyzed data from the IBS Outcome Study, in which 436 patients with IBS (average age, 41 years; 80% female) were randomly assigned to groups that received to 4 or 10 weeks of cognitive behavior therapy or education. Baseline data were collected from all participants on sociodemographic and clinical features and comorbidities. Interaction analyses used a modified linear probability model with Huber-White robust estimators to identify baseline factors that moderated as a function of treatment condition symptom improvement based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Results: Whether the primary outcome of IBS symptom improvement was rated by patients or physician assessors blind to treatment 2 weeks after it ended, higher percentages of patients had symptom improvement after CBT compared with EDU among those with low levels of trait anxiety (71.3% vs 34.9%; P<.05) or anxiety sensitivity (71.7% vs 38.6%; P<.05) and for those with baseline typical levels of trait anxiety (66.0% vs 47.1%; P<.05) or anxiety sensitivity (66.3%
Journal of the Society for Social Work and Research, 2018
We describe randomized explanatory trials (RETs), a framework for evaluating interventions to pre... more We describe randomized explanatory trials (RETs), a framework for evaluating interventions to prevent adolescent problem behaviors. The approach maps intervention components onto hypothesized mediators of program effects and then uses structural equation modeling to evaluate whether the program changed those mediators and if assumptions of mediator relevance are viable. We review and explain key concepts related to theoretical issues of choosing and conceptualizing mediators, mapping structural relations among mediators, considering cascading effects, and incorporating theories of treatment duration and decay. We also explore methodological issues, including the choice of time intervals between assessments, the use of instrumental variables, methods for dealing with measurement error, and sample-size planning. In addition, we discuss analytic issues including use of structural equation modeling rather than ANOVA, ANCOVA and logistic/OLS regression; how to handle large numbers of mediators; incorporating covariates; use of per-protocol vs. intent-to-treat analyses; quantifying and testing mediation; and use of causal inference approaches to mediation. Because RETs can identify program components that are successful in bringing about change and why—providing more useful evaluations than outcome-only designs—we argue that RETs rather than randomized controlled trials should be the gold standard for program evaluation.
BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sust... more BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education. METHODS: A total of 436 Rome III-diagnosed IBS patients (80% F, M age = 41 years) were randomized to: 4 session home-based CBT (minimal contact (MC-CBT)), 10 session clinic-based CBT (standard (S-CBT)), or 4 session IBS education (EDU). Follow-up occurred at 2 weeks and 3, 6, 9, and 12 months following treatment completion. Treatment response was based a priori on
and conducts research on the intersection of economic, ethnic, and gender inequality in Guatemala... more and conducts research on the intersection of economic, ethnic, and gender inequality in Guatemala. Linda Asturias is a cultural anthropologist and Director of Estudio 1360, a research organization in Guatemala City, where she works with nurse/anthropologist Idalma Mejia and anthropologist Luisa Mazariegos on a wide range of social science related projects.
Journal of the Society for Social Work and Research, 2017
The present study aimed to (a) identify what mental health profiles exist among emerging adults w... more The present study aimed to (a) identify what mental health profiles exist among emerging adults with a history of childhood contact with Child Protective Services (CPS), and (b) examine whether the level of young-adult functioning varies across the profiles. Method: Latent profile analysis was conducted with a nationally representative sample of youths (mean age 5 18.99, N 5 1,179) who were tracked for an extended time following CPS investigation. Results: A fiveprofile solution-minimal symptoms, midlevel symptoms, multimorbid, trauma symptoms, and substance problems-provides the best fit for the data. Young-adult functioning levels vary across the profiles with the members of the minimalsymptoms profile functioning better in many domains compared with members of other profiles. Members of the minimal symptoms, the midlevel symptoms, and the multimorbid profiles scored the lowest, the midlevel, and the highest, respectively, across all mental health symptoms. These three profiles were estimated to comprise close to 90% of the study population. Conclusions: The mental health profiles among the study population correspond to symptom severity rather than to specific diagnostic categories. Policy and practice implications are provided.
This article draws insights from several disciplines to propose an integrated perspective on mech... more This article draws insights from several disciplines to propose an integrated perspective on mechanisms underlying narrative persuasion. One approach to narratives emphasizes a deictic shift into the narrative, resulting in an absorbed state of processing and a loss of one's sense of self (e.g., transportation, narrative engagement, identification). Another approach focuses on processes to construct meaning from a narrative; that is, how narratives are actively compared with and applied to one's life. The current work has conceptualized the relationship between these two broad processes as occurring in sequence, and as a pathway of narrative persuasion: A shift and absorption into the narrative leads to a process of reflecting on the narrative, which is antecedent to narrative influence.
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Papers by James Jaccard