Sarah B. Hunter

Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior

Background. Early sexual initiation is an important social and health issue. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancies and sexually transmitted diseases are more common among those who begin sexual activity earlier. The American Academy of Pediatrics has suggested that portrayals of sex on entertainment television (TV) may contribute to precocious adolescent sex. Approximately two-thirds of TV programs contain sexual content. However, empirical data examining the relationships between exposure to sex on TV and adolescent sexual behaviors are rare and inadequate for addressing the issue of causal effects. Design and Participants. We conducted a national longitudinal survey of 1792 adolescents, 12 to 17 years of age. In baseline and 1-year follow-up interviews, participants reported their TV viewing habits and sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behavior (versus talk about sex but no behavior). Outcome Measures. Initiation of intercourse and advancement in noncoital sexual activity level, during a 1-year period. Results. Multivariate regression analysis indicated that adolescents who viewed more sexual content at baseline were more likely to initiate intercourse and progress to more advanced noncoital sexual activities during the subsequent year, controlling for respondent characteristics that might otherwise explain these relationships. The size of the adjusted intercourse effect was such that youths in the 90th percentile of TV sex viewing had a predicted probability of intercourse initiation that was approximately double that of youths in the 10th percentile, for all ages studied. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior. African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the subsequent year. Conclusions. Watching sex on TV predicts and may hasten adolescent sexual initiation. Reducing the amount of sexual content in entertainment programming, reducing adolescent exposure to this content, or increasing references to and depictions of possible negative consequences of sexual activity could appreciably delay the initiation of coital and noncoital activities. Alternatively, parents may be able to reduce the effects of sexual content by watching TV with their teenaged children and discussing their own beliefs about sex and the behaviors portrayed. Pediatricians should encourage these family discussions.

Prevalence and Characteristics of Clients with Co-Occurring Disorders in Outpatient Substance Abuse Treatment

This article reports on the prevalence of probable mental health disorders among clients entering outpatient substance abuse treatment, their clinical characteristics, and past access to substance abuse and mental health care. Four hundred fifteen individuals (74% of those eligible) entering three publicly funded outpatient substance abuse treatment facilities in Los Angeles County were screened for a probable mental health disorder. Of the 210 with a positive screener (just over 50% of those screened), 195 (93%) were interviewed. Depression and anxiety were the most common disorders, and more than a third had two or more probable disorders. Close to 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. Our results indicate high rates of co‐occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access.

The Getting To Outcomes Demonstration and Evaluation: An Illustration of the Prevention Support System

Communities are increasingly being required by state and federal funders to achieve outcomes and be accountable, yet are often not provided the guidance or the tools needed to successfully meet this challenge. To improve the likelihood of achieving positive outcomes, the Getting To Outcomes (GTO) intervention (manual, training, technical assistance) is designed to provide the necessary guidance and tools, tailored to community needs, in order to build individual capacity and program performance. GTO is an example of a Prevention Support System intervention, which as conceptualized by the Interactive Systems Framework, plays a key role in bridging the gap between prevention science (Prevention Synthesis and Translation System) and prevention practice (Prevention Delivery System). We evaluated the impact of GTO on individual capacity and program performance using survey- and interview-based methods. We tracked the implementation of GTO and gathered user feedback about its utility and acceptability. The evaluation of GTO suggests that it can build individual capacity and program performance and as such demonstrates that the Prevention Support System can successfully fulfill its intended role. Lessons learned from the implementation of GTO relevant to illuminating the framework are discussed.

Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis

Background and Aims To review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care. Methods We conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes. Results CBT/MI proved effective for treating subclinical and clinical AUD and MDD compared with controls, with small overall effect sizes at post-treatment [g = 0.17, confidence interval (CI) = 0.07–0.28, P < 0.001 for decrease of alcohol consumption and g = 0.27, CI: 0.13–0.41, P < 0.001 for decrease of symptoms of depression, respectively]. Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face-to-face interventions (g = 0.73 and g = 0.23, respectively, P = 0.030). Conclusions Combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual.

An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment.

CONTEXT Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment. OBJECTIVE The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care. DESIGN A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years. SETTING Four treatment programs in Los Angeles County. PARTICIPANTS We screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group. INTERVENTION Sixteen 2-hour group sessions of cognitive behavioral therapy for depression. MAIN OUTCOME MEASURES Change in depression symptoms, mental health functioning, and days of alcohol and problem substance use. RESULTS Intervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available. CONCLUSIONS Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01191788.

Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes.

OBJECTIVE Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes. METHOD We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed with the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use; motivation to change; and positive expectancies. RESULTS Sequential analysis indicated that facilitator open-ended questions and reflections of change talk increased group change talk. Group change talk was then followed by more change talk. Multilevel models accounting for rolling group enrollment revealed group change talk was associated with decreased alcohol intentions, alcohol use, and heavy drinking 3 months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies. CONCLUSIONS Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which were then associated with individual changes. Selective reflection of change talk in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change.

A randomized controlled trial of a group motivational interviewing intervention for adolescents with a first time alcohol or drug offense

Group motivational interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting [n=193; 67% male, 45% Hispanic; mean age 16.6 (SD=1.05)] were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, and intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at 3 months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted.

Developing a Group Motivational Interviewing Intervention for First-Time Adolescent Offenders At-Risk for an Alcohol or Drug Use Disorder

This study examined how teens who had committed a first-time alcohol or other drug (AOD) offense responded to a motivational interviewing (MI) group intervention. Participants were 101 first-time AOD adolescent offenders (M = 15.88; 63% male, 54% Hispanic). The authors developed and tested a six-session curriculum called Free Talk and solicited feedback from different teens after each session. Groups were recorded and transcribed. Feedback was categorized using the Motivational Interviewing Treatment Integrity scale (MITI 3.0). Feedback indicated high levels of evocation, collaboration, autonomy/support, and empathy. The current study highlights that utilizing group MI can be an acceptable approach for at-risk youth.

Technical Assistance as a Prevention Capacity-Building Tool: A Demonstration Using the Getting To Outcomes® Framework

Demands on community-based prevention programs for performance accountability and positive outcomes are ever increasing in the face of constrained resources. Relatively little is known about how technical assistance (TA) should be structured to benefit community-based organizations and to lead to better outcomes. In this study, data from multiple sources were used to describe an effective TA model designed to improve the capacity of community-based organizations to plan, implement, and evaluate prevention programming. This article is the first of its kind to provide detailed analyses of the TA delivered to community-based organizations to build substance abuse prevention capacity. The results of this study describe the range of TA services provided and the importance of two-way communication between the TA provider and recipient. TA recipients reported high satisfaction and an improved understanding of targeted TA activities. However, achieving these benefits requires significant program staff time, and not all skills were successfully transferred. Results from this study suggest how TA may be structured to be effective in supporting quality prevention programming in community settings.

Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial

Importance Primary care offers an important and underutilized setting to deliver treatment for opioid and/or alcohol use disorders (OAUD). Collaborative care (CC) is effective but has not been tested for OAUD. Objective To determine whether CC for OAUD improves delivery of evidence-based treatments for OAUD and increases self-reported abstinence compared with usual primary care. Design, Setting, and Participants A randomized clinical trial of 377 primary care patients with OAUD was conducted in 2 clinics in a federally qualified health center. Participants were recruited from June 3, 2014, to January 15, 2016, and followed for 6 months. Interventions Of the 377 participants, 187 were randomized to CC and 190 were randomized to usual care; 77 (20.4%) of the participants were female, of whom 39 (20.9%) were randomized to CC and 38 (20.0%) were randomized to UC. The mean (SD) age of all respondents at baseline was 42 (12.0) years, 41(11.7) years for the CC group, and 43 (12.2) yearsfor the UC group. Collaborative care was a system-level intervention, designed to increase the delivery of either a 6-session brief psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders. Usual care participants were told that the clinic provided OAUD treatment and given a number for appointment scheduling and list of community referrals. Main Outcomes and Measures The primary outcomes were use of any evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol at 6 months. The secondary outcomes included the Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement measures, abstinence from other substances, heavy drinking, health-related quality of life, and consequences from OAUD. Results At 6 months, the proportion of participants who received any OAUD treatment was higher in the CC group compared with usual care (73 [39.0%] vs 32 [16.8%]; logistic model adjusted OR, 3.97; 95% CI, 2.32-6.79; P < .001). A higher proportion of CC participants reported abstinence from opioids or alcohol at 6 months (32.8% vs 22.3%); after linear probability model adjustment for covariates (&bgr; = 0.12; 95% CI, 0.01-0.23; P = .03). In secondary analyses, the proportion meeting the HEDIS initiation and engagement measures was also higher among CC participants (initiation, 31.6% vs 13.7%; adjusted OR, 3.54; 95% CI, 2.02-6.20; P < .001; engagement, 15.5% vs 4.2%; adjusted OR, 5.89; 95% CI, 2.43-14.32; P < .001) as was abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol (26.3% vs 15.6%; effect estimate, &bgr; = 0.13; 95% CI, 0.03-0.23; P = .01). Conclusions and Relevance Among adults with OAUD in primary care, the SUMMIT collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months, than usual care. Trial Registration clinicaltrials.gov Identifier: NCT01810159