Browsing by Author "Zapolski, Tamika C. B."
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Item Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities(Elsevier, 2021) Aalsma, Matthew C.; Aarons, Gregory A.; Adams, Zachary W.; Alton, Madison D.; Boustani, Malaz; Dir, Allyson L.; Embi, Peter J.; Grannis, Shaun; Hulvershorn, Leslie A.; Huntsinger, Douglas; Lewis, Cara C.; Monahan, Patrick; Saldana, Lisa; Schwartz, Katherine; Simon, Kosali I.; Terry, Nicolas; Wiehe, Sarah E.; Zapolski, Tamika C. B.; Pediatrics, School of MedicineBackground: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. Methods/design: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. Discussion: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.Item Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race, Patient Gender, and Provider Pain-Related Attitudes(Elsevier, 2019) Miller, Megan M.; Williams, Amy E.; Zapolski, Tamika C. B.; Rand, Kevin L.; Hirsh, Adam T.; Psychology, School of SciencePrevious studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers’ pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups.Item Concurrent Substance Use and Related Problems among African American Adolescents: A Daily Diary Study(2020-08) Banks, Devin Elizabeth; Zapolski, Tamika C. B.; Cyders, Melissa; Hensel, Devon; Pietri, EvavaAfrican American adolescents have historically been considered at low risk for substance use relative to the White adolescent majority based on national prevalence estimates. However, during the last decade, African American adolescents’ rates of marijuana use—alone and in combination with other substances—have increased disproportionately relative to those of their White peers. Given the strong relationship between marijuana use and other substance use and the functional consequences associated with concurrent substance use during adolescence, the increase in marijuana use among African American youth may contribute to increased substance-related health disparities across the lifespan. Thus, the current study examined daily associations between marijuana use and other substance use among African American adolescents relative to their White peers. It also examined whether those associations differentially predicted behavioral health consequences among African American adolescents. Participants (N = 35; 42.9% African American) were adolescents age 14-18 who reported past 30-day use of marijuana, alcohol, and/or tobacco products. Respondents completed daily diaries reporting their substance use for 14 consecutive days, followed by self-report measures of internalizing symptoms, externalizing symptoms, and substance use problems. Multilevel regression and structural equation models were used to account for the nesting of days within individuals. Participants completed 458 diaries for a completion rate of 93.5%. African American respondents reported greater daily- and individual-level rates of marijuana use and concurrent substance use than White respondents. However, in multilevel models controlling for demographics, marijuana use was not related to concurrent use of alcohol and/or tobacco use and this relationship did not vary by race. Racial differences in the relationship between concurrent substance use and behavioral health consequences were observed such that the relationship was positive among White youth but not African American youth. Findings suggest that African American youth are at high risk for engagement in problematic patterns of substance use but that daily diary methods may not be most appropriate for illuminating these patterns. Despite these unexpected results, disparities in substance-related consequences among African Americans adults persist. Future research should examine long-term rather than proximal consequences of concurrent substance use among African American adolescents.Item Daily Experiences of Racial Microaggressions and Health Outcomes Among Black Adolescents: A Daily Diary Study(2023-08) Clifton, Richelle Lee; Zapolski, Tamika C. B.; Stewart, Jesse C.; Johnson, India R.; Aalsma, Matthew C.Racial microaggressions are associated with multiple negative health outcomes, including increased distress, anxiety (Blume et al., 2012; Schoulte et al., 2011), and substance use (Su et al., 2019). The negative effects of racial microaggressions have been observed through daily assessments (Burrow & Ong, 2010; Ong et al., 2009; Swim et al., 2003). However, these studies have been conducted almost exclusively among Black adults. Thus, the first aim of the current study is to examine the impact of daily experiences of racial microaggressions on health outcomes among Black adolescents. Further, it is also important to examine factors that might influence the relationship between racial microaggressions and health outcomes. One factor that has received a considerable amount of attention is racial identity, with more recent studies examining the impact of racial identity profiles. Thus, the second aim of the current study was to explore variability in these risk pathways based on racial identity profiles. Participants were Black adolescents (N = 48; 79.2% girls; Mage=17.13). Respondents completed measures of racial identity at baseline and daily diary measures of racial microaggressions, depression, anxiety, aggression, and substance use for 14 days. Participants reported an average of 5.56 experiences of racial microaggressions per day. Neither concurrent or lagged-day associations between racial microaggressions and symptoms of depression or symptoms of anxiety were significant. Concurrent analyses indicated that the between-person effect of racial microaggressions on aggression was significant (estimate=0.345, SE=0.138, t=2.495, p=0.016), and that effect was still evident one day later (estimate=0.107, SE=0.040, t=2.686, p=0.007). The concurrent, within-person effect of racial microaggressions on cannabis use was also significant (OR=1.524, 95%CI[0.103, 0.740], p=0.010). Four racial identity profiles were identified (labeled race- focused, undifferentiated, integrationist, and multiculturalist) and a number of effects were significant within profiles. This study further highlighted that Black youth are experiencing an overwhelming number of racial microaggressions on a daily basis. Additionally, this project represents a crucial step in advancing our understanding of how racial microaggressions operate to influence health outcomes among Black adolescents on the daily level and highlights several areas for needed study and intervention.Item Dieting and Substance Use Among White and Black Adolescent Girls(Elsevier, 2021) Rowe, Alia T.; Khazvand, Shirin; Wu, Wei; Barnes-Najor, Jessica; Zapolski, Tamika C. B.; Psychology, School of ScienceObjective: Previous research has found an increasing co-occurrence of dieting and substance use behavior among adolescent girls. However, to date few studies have examined the temporal ordering of these behaviors. Further, limited research has been conducted to explore whether the pathways are similar among both White and Black girls. Method: For the current study 1580 girls (grade 6-11; 78.2% White; 21.8% Black) provided data on their dieting behavior and substance use. A cross-lagged panel design was used to examine the concurrent and prospective relationship between dieting behavior and substance use across one year, then by race. Results: Among the full sample of girls, there was a significant concurrent relationship. Additionally, dieting behavior predicted substance use one year later, but the inverse relationship was not found. For the stratified analysis, dieting behavior and substance use were not correlated among Black girls at either time point, however concurrent relationships were found for White girls. For the prospective pathways non-significant effects were found for both groups. Discussion: These findings provide support for a temporal relationship between dieting behavior and substance use, such that the former predicts risk for the latter. However, when examined by race, some pathways of the full sample were found for White girls, whereas Black girls did not report an association between study variables. Thus, future studies should consider the impact of race within risk pathways.Item Discrimination and Substance Use: Examining the Moderating Role of Impulsivity Among Racial-Ethnic Minority Adolescents(Taylor & Francis, 2021) Riley, Tennisha N.; Clifton, Richelle L.; Khazvand, Shirin; Zapolski, Tamika C. B.; Psychology, School of ScienceBackground: Research on substance use among racial-ethnic minority populations notes that discrimination experiences predict substance use outcomes. Individual-level factors, such as impulsivity, are also known risk factors for substance use. However, little is known about the direct and interaction effects between discrimination experiences and impulsivity among racial-ethnic minority youth. The current study examines the effects of perceived experiences of discrimination on alcohol and marijuana use among racial-ethnic minority youth, and whether individual differences in impulsivity traits help to further understand potential risk for substance use. Methods: Participants were 112 racial-ethnic minority adolescents (Mage = 15.27; African American, Hispanic, Multiracial, Native American/Alaskan Native, or Other). Adolescents completed self-report measures of perceived experiences of discrimination, alcohol and marijuana use (past year occurrence and problematic use), and five impulsivity traits (i.e., sensation seeking, lack of planning, lack of perseverance, negative urgency, and positive urgency). Results: A significant main effect of perceived discrimination on problem marijuana use was found, as well as a significant main effect of lack of premeditation on current marijuana use. Several marginally significant main effects emerged for alcohol use and problem alcohol use (i.e., positive urgency and sensation seeking, respectively). Conclusion: While no significant moderation effects emerged, marginal findings suggest a potential interactive effect of discrimination and impulsivity traits on problem alcohol and marijuana use among racial-ethnic minority youth. Further research is needed in this area to replicate findings, which is critical to informing effective intervention and prevention efforts for this population of youth.Item Does a Crossover Age Effect Exist for African American and Hispanic Binge Drinkers? Findings from the 2010 to 2013 National Study on Drug Use and Health(Wiley, 2017-06) Zapolski, Tamika C. B.; Baldwin, Patrick; Banks, Devin E.; Stump, Timothy E.; Psychology, School of ScienceBACKGROUND: Among general population studies, lower rates of binge drinking tend to be found among African Americans and Hispanics compared to Whites. However, among older adult populations, minority groups have been shown to be at higher risk for binge drinking, suggesting the presence of a crossover effect from low to high risk as a function of age. To date, limited research has examined the crossover effect among African American and Hispanic populations compared to non-Hispanic Whites across large developmental time frames or explored variation in risk based on income or gender. This study aimed to fill these gaps in the literature. METHODS: Data were compiled from the 2010 to 2013 National Survey on Drug Use and Health surveys, which provide annual, nationally representative data on substance use behaviors among individuals aged 12 and older. Hispanic, non-Hispanic African American, and non-Hispanic White respondents were included (N = 205,198) in the analyses. RESULTS: A crossover effect was found for African American males and females among the lowest income level (i.e., incomes less than $20,000). Specifically, after controlling for education and marital status, compared to Whites, risk for binge drinking was lower for African American males at ages 18 to 24 and for females at ages 18 to 34, but higher for both African American males and females at ages 50 to 64. No crossover effect was found for Hispanic respondents. CONCLUSIONS: Although African Americans are generally at lower risk for binge drinking, risk appears to increase disproportionately with age among those who are impoverished. Explanatory factors, such as social determinants of health prevalent within low-income African American communities (e.g., lower education, violence exposure, housing insecurity) and potential areas for intervention programming are discussed.Item Early development of local data dashboards to depict the substance use care cascade for youth involved in the legal system: qualitative findings from end users(Springer Nature, 2024-05-30) Dir, Allyson L.; O’Reilly, Lauren; Pederson, Casey; Schwartz, Katherine; Brown, Steven A.; Reda, Khairi; Gillenwater, Logan; Gharbi, Sami; Wiehe, Sarah E.; Adams, Zachary W.; Hulvershorn, Leslie A.; Zapolski, Tamika C. B.; Boustani, Malaz; Aalsma, Matthew C.; Psychiatry, School of MedicineIntroduction: Rates of substance use are high among youth involved in the legal system (YILS); however, YILS are less likely to initiate and complete substance use treatment compared to their non legally-involved peers. There are multiple steps involved in connecting youth to needed services, from screening and referral within the juvenile legal system to treatment initiation and completion within the behavioral health system. Understanding potential gaps in the care continuum requires data and decision-making from these two systems. The current study reports on the development of data dashboards that integrate these systems' data to help guide decisions to improve substance use screening and treatment for YILS, focusing on end-user feedback regarding dashboard utility. Methods: Three focus groups were conducted with n = 21 end-users from juvenile legal systems and community mental health centers in front-line positions and in decision-making roles across 8 counties to gather feedback on an early version of the data dashboards; dashboards were then modified based on feedback. Results: Qualitative analysis revealed topics related to (1) important aesthetic features of the dashboard, (2) user features such as filtering options and benchmarking to compare local data with other counties, and (3) the centrality of consistent terminology for data dashboard elements. Results also revealed the use of dashboards to facilitate collaboration between legal and behavioral health systems. Conclusions: Feedback from end-users highlight important design elements and dashboard utility as well as the challenges of working with cross-system and cross-jurisdiction data.Item Examining Depression as a Risk Factor for Cardiovascular Disease in People with HIV: A Systematic Review(Oxford University Press, 2023) Polanka, Brittanny M.; Gupta, Samir K.; So-Armah, Kaku A.; Freiberg, Matthew S.; Zapolski, Tamika C. B.; Hirsh, Adam T.; Stewart, Jesse C.; Medicine, School of MedicineBackground: People with human immunodeficiency virus (HIV) have an increased risk of cardiovascular disease (CVD) not fully accounted for by traditional or HIV-specific risk factors. Successful management of HIV does not eliminate this excess risk. Thus, there is a need to identify novel risk factors for CVD among people with HIV (PWH). Purpose: Our objective was to systematically review the literature on one such candidate CVD risk factor in PWH-depression. Methods: A systematic literature search of PubMed, PsycINFO, EMBASE, Web of Science, and CINAHL was performed to identify published English-language studies examining associations of depression with clinical CVD, subclinical CVD, and biological mechanisms (immune activation, systemic inflammation, altered coagulation) among PWH between the earliest date and June 22, 2021. Results: Thirty-five articles were included. For clinical CVD (k = 8), findings suggests that depression is consistently associated with an increased risk of incident CVD. For subclinical CVD (k = 5), one longitudinal analysis reported a positive association, and four cross-sectional analyses reported null associations. For immune activation (k = 13), systemic inflammation (k = 17), and altered coagulation (k = 5), findings were mixed, and there was considerable heterogeneity in sample characteristics and methodological quality across studies. Conclusions: Depression may be an independent risk factor for CVD among PWH. Additional research is needed to confirm depression's association with clinical CVD and to determine whether depression is consistently and meaningfully associated with subclinical CVD and biological mechanisms of CVD in HIV. We propose a research agenda for this emerging area.Item Examining differential relationships of substance use and risky sexual behavior among African American and white adolescents(2016-11-01) Banks, Devin E.; Zapolski, Tamika C. B.; Cyders, Melissa A.; Rand, Kevin L.Adolescents are at disproportionate risk for health consequences associated with risky sexual behavior (RSB), including sexually transmitted infections and unintended pregnancy. Racial disparities have also been observed with African American adolescents experiencing higher rates of such negative health outcomes than their White peers. Substance use, particularly alcohol and marijuana use, has been shown to predict RSB among adolescents of both racial groups. However, research suggests that alcohol use is more predictive of RSB in White adolescents than African American adolescents, perhaps due to significantly higher rates of alcohol use among White adolescents. Given recent trends indicating higher rates of marijuana use among African American adolescents than their White peers and a strong association between marijuana use and RSB among African American adolescents, marijuana use may better explain the relationship between substance use and risky sexual behavior among African Americans than alcohol use. Thus, the current study examined whether alcohol and marijuana use have differential effects on adolescent RSB by race at the event- and global-level of analysis. To that end, 113 adolescents ages 14-18 (African American = 93, White=20) completed self-report measures of substance use and RSB. Contrary to hypotheses, results revealed no racial differences in the relationship between substance use and RSB. However, post-hoc analyses revealed that marijuana use significantly predicted frequency of sex among African American adolescents above the effects of alcohol. These findings indicate that previously documented racial differences in the relationship between substance use and RSB may not be accounted for by marijuana use, but suggest that future studies continue to examine the unique impact of marijuana use on RSB, particularly among African American adolescents.