Beth S. Russell

Intersecting Epidemics Among Pregnant Women: Alcohol Use, Interpersonal Violence, and HIV Infection in South Africa

A critical factor for understanding negative health outcomes is acknowledging the synergistic quality that clusters of health problems create. An important step in addressing clusters of health problems involves gaining an awareness of the contextual factors that connect them. This paper considers the intersection of 3 mutually reinforcing health problems: alcohol use, interpersonal violence (IPV), and HIV infection among pregnant women residing in South Africa. We explore how SAVA (substance abuse, violence and AIDS) - a syndemics related theory - underscores the dire need to intervene in various areas of psycho-social health and general well-being. Based on World Health Organization data, we highlight the remarkably high rates of alcohol use, IPV, and HIV infection among South African women compared with women residing in other countries around the world. We conclude by highlighting the need for improved recognition of the intersection of these epidemics and for improved surveillance of the prevalence of alcohol use among pregnant women. Finally, based on the literature reviewed, we provide recommendations for future interventions.

Social Influence on Adolescent Polysubstance Use: The Escalation to Opioid Use

Background: Fewer than 9% of 12–17 year olds in need (∼146,000 of 1.7 million) receive inpatient or outpatient substance abuse recovery services or other mental health services (SAMHSA, 2012). The literature on adolescent addiction is sparse, however, as most published addiction recovery efforts involve adult populations—often college students. Objectives: The present study examined social influences on escalating substance use (from tobacco, alcohol, and marijuana use to polysubstance use involving opioids) for students enrolled in recovery high schools. Methods: A sample of 31 adolescents enrolled in substance use recovery high schools were surveyed on their patterns of substance use leading to their abuse of opioids. Results: Youth who begin their substance use as young as age 8 are often pressured by peer culture to do so and come from substance-using families. Their escalation in polysubstance use to a pattern including opioids was also most often attributed to peer influence over several years. Conclusions/Importance: This paper is one of scant few that address patterns of use in high school students. Perhaps most salient from this study are the tertiary prevention implications: similar to their adult counterparts, students enrolled in recovery high school programs are likely from substance-using families and have combined complex constellations of substances including opioids by dint of their relationships with substance-using peers.

Family functioning and adolescent alcohol use: A moderated mediation analysis

The primary goals of this longitudinal study were to examine the relationship between family functioning and adolescent alcohol use and to examine whether depressed mood mediates this relationship. An additional goal was to explore whether these relations were moderated by gender. The sample included 1031 high school students from the Mid-Atlantic United States. Participants completed surveys in school during the spring of 2007, 2008, and 2009. Path analysis results indicated that family functioning predicted alcohol use for girls. Moreover, depressed mood mediated this relationship. None of the direct paths between family functioning and adolescent alcohol use were significant for boys. However, similar to girls, depressed mood negatively predicted alcohol use for boys. Taken together, the findings highlight the need for prevention programs targeting adolescent substance use to consider gender-specific trajectories.

Parenting and Preschool Self-Regulation as Predictors of Social Emotional Competence in 1st Grade

ABSTRACT The current longitudinal study used data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD) to examine a model of development that emphasizes early caregiving environments as predictors of social emotional competence (including classroom competence). This path analysis model included features of parenting, emotion regulation, preschool language skills, and attention to predict child outcomes in 1st grade. Early caregiving environments were directly predictive of peer relationship satisfaction, oppositional behavior, social skills, and classroom competence over and above significant mediated effects through preschool self-regulation (language, inattention, and anger/frustration). These results suggest that the characteristics of supportive and stimulating caregiving shift in valence over time, such that qualities of the infant-child relationship that are significant in predicting early childhood outcomes are not the same as the caregiving qualities that move to the foreground in predicting primary school outcomes. Implications for school-readiness programming are discussed, including interventions in the early caregiving system to encourage sensitive and supportive parent-child interactions to bolster school readiness via the development of social-emotional competence.

Parenting and Adolescent Substance Use: Moderation Effects of Community Engagement

Supportive parenting practices including autonomy granting and non-parental factors including adolescents’ connections to their communities are significantly associated with adolescent substance use outcomes; however, few longitudinal studies have considered both factors concurrently in nationally representative samples. Using longitudinal data from a nationally representative sample of adolescents in grades 7–12 (n = 12,139; 51% male), results indicated that community engagement significantly moderated the association between parental autonomy granting and substance use into emerging adulthood. Results also suggested that community disadvantage was a significant risk factor for adolescents’ substance use. These results further indicated that substance use among emerging adults was also high when accounting for prior levels of community engagement and parental-autonomy, and while controlling for substance use during adolescence.

Distress Tolerance and Emotion Regulation: Promoting Maternal Well-Being Across the Transition to Parenthood

SYNOPSIS Objective. This study examined the association between newborns’ daily crying and five measures of new mothers’ emotional states. Design. One hundred seven new mothers responded via a one-time, anonymous, online survey that assessed their stress, well-being, emotion regulation, frustration, and coping skills. Mothers also reported their infant’s daily cry duration. Results. Average daily crying was related to mothers’ emotional experiences, and relations also existed among the five mental health measures. Regression models indicate the strongest predictors of frustration were infant’s average cry duration, maternal well-being, and infant’s health status at enrollment. Conclusion. Mental health professionals can support families through the normative, but often stressful, experience of their infant’s cries. However, a re-evaluation of the clinical criteria for excessive crying is needed, as the results suggest that mothers whose infants cry considerably less than the widely used Wessel’s 3-hour-per-day criterion for excessive crying experience significant negative mental health.

Differences in Adolescent Emotion Regulation and Impulsivity: A Group Comparison Study of School-Based Recovery Students

ABSTRACT Background: Recovery high schools (RHS) vary in organization and operating philosophy, but are designed to support the unique needs of students struggling with substance use disorders (SUD). Previous research on youth risk taking behaviors suggests emotion regulation is a key predictor of outcomes. Specifically, the ability to respond in adaptive rather than maladaptive ways is often associated with challenges of impulsivity, poor distress tolerance, and adolescent substance use. Objectives: The current study considers data from RHS students in order to answer research questions concerning impulsivity and emotion regulation of youth working to change their risk trajectories in comparison to group of typically developing youth. Methods: Participants (n = 114) in the study were composed of students enrolled in 3 RHS programs and a comparison group of similar aged youth (15–20 years) without an identified SUD. Data collection occurred through an anonymous online survey set of four measures of reactivity and impulsivity, emotion regulation, and parent and peer influence, as well as an online version of the Stroop Inhibitory Control Task. Results: Participants in the three RHS groups reported decreased emotion regulation abilities, increased impulsivity and increased peer influence when compared to the comparison group; differential effects within RHS are presented. Conclusions/Importance: Results are consistent with the extant literature that difficulty regulating emotions is associated with an increased risk for substance abuse and suggests these difficulties persist in early recovery. Results also suggest the need to better understand how different operating philosophies of programs influence student outcomes and the recovery process.

Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations.

In the adult population chronic pain can lead to loss of productivity and earning potential, and decreased quality of life. There are distinct groups with increased vulnerability for the emergence of chronic pain. These groups may be defined by developmental status and/or life circumstances. Within the pediatric, geriatric, and drug abuser populations, chronic pain represents a significant health issue. This article focuses on known anatomic, physiologic, and genetic mechanisms underlying chronic pain in these populations, and highlights the need for a multimodal approach from multiple health care professionals for management of chronic pain in those with the most risk.

Distress Tolerance Intervention for Improving Self-Management of Chronic Conditions: A Systematic Review:

Background: The inability to tolerate distress can negatively influence effective self-management (SM) of chronic conditions by interfering with the ability to focus on illness needs and impairing problem-solving and prioritizing capabilities, as well as engagement in SM activities. Interventions to increase distress tolerance offer a holistic approach to chronic disease SM and may enhance the individual’s ability to apply SM skills and resources to improve quality of life and overall health. The purpose of this systematic review was to deepen understanding of the relationships among distress tolerance and goal-oriented problem-solving as an aspect of chronic disease SM. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were used to develop a search strategy, selection criteria, screening, and identification and extraction procedures. PubMed, CINAHL, PsychInfo, and Scopus were searched from 2006 to December 2017 using the following search terms: distress tolerance, chronic conditions, self-management. Results: Across the 11 studies included in the literature review, there was a high level of heterogeneity in the use of subjective and objective measures to assess distress tolerance, and only one study included instruments to measure goal-oriented problem-solving, the target of distress tolerance interventions that are assumed to influence the selected health outcome. Conclusion: Further research is needed on the efficacy of distress tolerance interventions for improving SM of chronic conditions. Theory-driven interventions that explicate the precise goal-oriented problem-solving and SM behaviors that are expected to change as a result of the distress tolerance intervention will provide insight on the efficacy of the intervention and help close the theory–practice gap.

The Impact of Adolescent Substance Use on Family Functioning: The Mediating Role of Internalizing Symptoms

This longitudinal study sought to investigate associations between adolescent substance use and family functioning and whether internalizing symptoms play a mediating role in this relationship; based on growing evidence from the literature, we also explored gender differences. Participants (N = 1,036) completed surveys in school during 2007, 2008, and 2009. Path analysis results indicated that boys’ alcohol use negatively predicted family functioning while marijuana use results indicate both significant impacts on family functioning. Further results show that boys’ depressive symptoms mediated the relationships between alcohol use and family cohesion and adaptability. For girls, depressive symptoms negatively predicted family functioning (cohesion, adaptability, communication with mother/father), whereas anxiety symptoms positively predicted this same set of family functioning outcomes with the exception of communication with father.