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Item Antecedents of Fatal Overdose in an Adult Cohort Identified through Administrative Record Linkage in Indiana, 2015–2022(Elsevier, 2023) Ray, Bradley; Christian, Kaitlyn; Bailey, Timothy; Alton, Madison; Proctor, Alison; Haggerty, John; Lowder, Evan; Aalsma, Matthew; Pediatrics, School of MedicineBackground: The United States continues to experience unprecedented rates of overdose mortality and need to identify effective policies or practices that can be implemented. This study aims to measure the prevalence, frequency, timing, and rate of touchpoints that occurred prior to a fatal overdose where communities might intervene. Methods: In collaboration with Indiana state government, we conducted record-linkage of statewide administrative datasets to vital records (January 1, 2015, through August 26, 2022) to identify touchpoints (jail booking, prison release, prescription medication dispensation, emergency department visits, and emergency medical services). We examined touchpoints within 12-months prior to a fatal overdose among an adult cohort and explored variation over time and by demographic characteristics. Results: Over the 92-month study period there were 13,882 overdose deaths (89.3% accidental poisonings, X40-X44) in our adult cohort that were record-linked to multiple administrative datasets and revealed nearly two-thirds (64.7%; n=8980) experienced an emergency department visit, the most prevalent touchpoint followed by prescription medication dispensation, emergency medical services responses, jail booking, and prison release. However, with approximately 1 out of every 100 returning citizens dying from drug overdose within 12-months of release, prison release had the highest touchpoint rate followed by emergency medical services responses, jail booking, emergency department visits, and prescription medication dispensation. Conclusion: Record-linking administrative data from routine practice to vital records from overdose mortality is a viable means of identifying where resources should be situated to reduce fatal overdose, with potential to evaluate the effectiveness of overdose prevention efforts.Item Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers(Springer Nature, 2024-06-21) O’Reilly, Lauren M.; Schwartz, Katherine; Brown, Steven A.; Dir, Allyson; Gillenwater, Logan; Adams, Zachary; Zapolski, Tamika; Hulvershorn, Leslie A.; Aalsma, Matthew; Pediatrics, School of MedicineBackground: Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. Methods: Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). Results: Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. Conclusions: These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.Item Attitudes Towards Substance Use: A Potential Mechanism in the Relationship Between Conduct Disorder and Substance Use in Detained Youth(Office of the Vice Chancellor for Research, 2016-04-08) Kolp, Haley; Hershberger, Alexandra; Aalsma, Matthew; Cyders, Melissa A.Background: There is a well-established relationship between conduct disorder and substance use, particularly in detained youth. Attitudes toward substance use predict alcohol and marijuana use; however, little research has investigated attitudes as a mechanism between conduct disorder and substance use specifically in detained youth. Methods: Ninety-three detained youth (Mean age=15; SD=1.346; Female=15.1%) completed a court ordered psychological assessment, which included the Substance Abuse Subtle Screening Inventory for Adolescents (SASSI-A) and the Youth Self Report (YSR) to assess alcohol and drug use, attitudes towards substance use, and conduct disorder symptomology. Results: Two mediation models were run using Andrew Hayes’ PROCESS to test the effect of conduct disorder on alcohol use and drug use (run in separate models) through attitudes towards substance use, controlling for age and gender. Conduct disorder directly related to positive attitudes toward substance use in the alcohol model (b=0.47, t(91)=4.45, p<.001) and drug use model (b=0.30, t(91)=3.33, p=.001). Conduct disorder directly related to alcohol use (b=0.32, t(89)=2.60, p=.02) and drug use (b=0.44, t(89)=3.04, p=0.003). Attitudes toward substance use were associated with higher alcohol use scores, (b=0.42, t(89)=3.99, p<.001) and drug use scores (b=0.27, t(89)=1.92, p=.06). The relationship between conduct disorder and alcohol use was significantly mediated by positive attitudes toward substance use (b=0.20, CI 0.04 to 0.42); however, the relationship between conduct disorder and drug use as mediated by positive attitudes towards substance use was non-significant (b=0.07, CI -0.003 to 0.24). Discussion: The results support that one way in which conduct disorder increases risk for substance use in detained youth is through increasing the likelihood of holding positive attitudes towards substance use. Modifying positive alcohol attitudes might be a prime point of intervention to avoid risks associated with substance use among conduct disordered detained youth.Item Conduct disorder symptoms and illicit drug use in juvenile justice involved youth: The reciprocal relationship between positive illicit drug use attitudes and illicit drug use(Taylor & Francis, 2018-07-03) Kolp, Haley M.; Hershberger, Alexandra R.; Sanders, Jasmyn; Um, Miji; Aalsma, Matthew; Cyders, Melissa A.; Psychology, School of ScienceConduct disorder (CD) symptoms cooccur at high rates with illicit drug use in juvenile justice involved youth, which results in poorer outcomes; however, research has not identified where best to intervene in this relationship, limiting the identification of modifiable risk factors to reduce negative effects of CD symptoms. Two mediation models were examined to investigate the potential for CD symptoms to influence a reciprocal relationship between illicit drug use and positive drug attitudes, controlling for age, gender, and race. Data were examined for 245 juvenile justice involved youth (mean age = 15.46, SD = 1.30, range 12-18, 64.9% Black, 80.4% male) who completed court-ordered psychological assessments. Findings indicate: (1) Positive attitudes toward illicit drug use significantly mediated the relationship between CD symptoms and illicit drug use (β = 0.16, CI 0.09-0.27; test for indirect effect z = 4.17, p < .001) and (2) illicit drug use significantly mediated the relationship between CD symptoms and positive attitudes toward illicit drug use (β = 0.20, CI 0.12-0.32; test for indirect effect z = 4.87, p < .001). Overall, the present study suggests that CD symptoms impart risk for illicit drug use both indirectly, through more positive attitudes toward illicit drug use, and directly, which further strengthens positive attitudes toward illicit drug use.Item Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors(Elsevier, 2017) Oruche, Ukamaka M.; Robb, Sheri L.; Aalsma, Matthew; Pescosolido, Bernice; Brown-Podgorski, Brittany; Burke Draucker, Claire; School of NursingThis article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.Item Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China(SAGE, 2016-09) Davis, Alissa; Best, John; Luo, Juhua; Van Der Pol, Barbara; Dodge, Brian; Meyerson, Beth; Aalsma, Matthew; Wei, Chongyi; Tucker, Joseph D.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthDifferences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.Item Differential Factors Influencing Hispanic/Latinx Adolescent Engagement in Mind-Body Skills Groups for Depression(2021-08) Salgado, Eduardo F.; Salyers, Michelle; Zapolski, Tamika; Aalsma, MatthewMajor Depressive Disorder is a prevalent and pervasive problem in the United States, and this mental disorder disproportionately affects adolescents of color. In particular, there is little research understanding how Hispanic/Latinx adolescents utilize and engage with mental health services, such as psychotherapy, to reduce their symptoms of depression, including factors that are positively and negatively related to engagement. As such, the aims of this study were to understand whether there were any relationships between presenting characteristics of adolescents seeking therapy for depression and their subsequent engagement with therapeutic services, with a focus on analyses examining trends in Hispanic/Latinx adolescents. To investigate these aims, we utilized data from a pilot study in which adolescents (n=42) received a mind-body intervention for depression called Mind-Body Skills Groups. We examined possible relationships between depression severity, age, Hispanic/Latinx background, and their interactions with engagement, as measured by attendance rates, self-reported motivation, and at-home skills practice. We hypothesized that high depression severity, high age, and being Hispanic/Latinx would all negatively influence engagement; we also hypothesized the depression-engagement and age-engagement relationships would be moderated by Hispanic/Latinx background. Results revealed initial relationships between lower age and being Hispanic/Latinx with higher attendance rates; depression severity was not related to attendance. When these relationships were further analyzed using hierarchical regression, no significant relationships between predictor and outcomes variables, as well as their interactions, were discovered. In an exploratory analysis investigating factors of adolescent depression using subscales, greater interpersonal problems predicted higher attendance rates. Results are interpreted relative to limitations of the small sample size and possible measurement concerns within this study, including a discussion of possible ways to improve related studies on Hispanic/Latinx youth in the future.Item Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth(Springer, 2019-02) Zapolski, Tamika C. B.; Clifton, Richelle L.; Banks, Devin E.; Hershberger, Alexandra; Aalsma, Matthew; Psychology, School of ScienceJuvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.Item Functional connectivity in frontostriatal networks differentiate offspring of parents with substance use disorders from other high-risk youth(Elsevier, 2021) Kwon, Elizabeth; Hummer, Tom; Andrews, Katharine D.; Finn, Peter; Aalsma, Matthew; Bailey, Allen; Hanquier, Jocelyne; Wang, Ting; Hulvershorn, Leslie; Psychiatry, School of MedicineBackground: Family history (FH) of substance use disorders (SUDs) is known to elevate SUD risk in offspring. However, the influence of FH SUDs has been confounded by the effect of externalizing psychopathologies in the addiction risk neuroimaging literature. Thus, the current study aimed to assess the association between parental SUDs and offspring functional connectivity in samples matched for psychopathology and demographics. Methods: Ninety 11-12-year-old participants with externalizing disorders were included in the study (48 FH+, 42 FH-). We conducted independent component analyses (ICA) and seed-based analyses (orbitofrontal cortex; OFC, nucleus accumbens (NAcc), dorsolateral prefrontal cortex) with resting state data. Results: FH+ adolescents showed stronger functional connectivity between the right lateral OFC seed and anterior cingulate cortex compared to FH- adolescents (p < 0.05, corrected). Compared to FH-, FH+ adolescents showed stronger negative functional connectivity between the left lateral OFC seed and right postcentral gyrus and between the left NAcc seed and right middle occipital gyrus (p < 0.05, corrected). Poorer emotion regulation was associated with more negative connectivity between right occipital/left NAcc among FH+ adolescents based on the seed-based analysis. FH- adolescents had stronger negative functional connectivity between ventral attention/salience networks and dorsal attention/visuospatial networks in the ICA. Conclusions: Both analytic methods found group differences in functional connectivity between brain regions associated with executive functioning and regions associated with sensory input (e.g., postcentral gyrus, occipital regions). We speculate that families densely loaded for SUD may confer risk by altered neurocircuitry that is associated with emotion regulation and valuation of external stimuli beyond what would be explained by externalizing psychopathology alone.Item Getting a Grip on My Depression: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms(Sage, 2019-10) McCord Stafford, Allison; Aalsma, Matthew; Bigatti, Silvia; Oruche, Ukamaka M.; Burke Draucker, Claire; Pediatrics, School of MedicineLatina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women (n = 25, M age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled being overburdened and becoming depressed. They responded to this problem through a five-phase psychosocial process that we labeled Getting a Grip on My Depression. Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms.