Prevention Intervention Trial Research Articles

Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision.

To derive and initially validate a brief bedside clinical decision support tool that identifies emergency department (ED) patients at high risk of substantial, persistent posttraumatic stress symptoms after a motor vehicle collision. Derivation (n=1,282, 19 ED sites) and validation (n=282, 11 separate ED sites) data were obtained from adults prospectively enrolled in the Advancing Understanding of RecOvery afteR traumA study who were discharged from the ED after motor vehicle collision-related trauma. The primary outcome was substantial posttraumatic stress symptoms at 3 months (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 ≥38). Logistic regression derivation models were evaluated for discriminative ability using the area under the curve and the accuracy of predicted risk probabilities (Brier score). Candidate posttraumatic stress predictors assessed in these models (n=265) spanned a range of sociodemographic, baseline health, peritraumatic, and mechanistic domains. The final model selection was based on performance and ease of administration. Significant 3-month posttraumatic stress symptoms were common in the derivation (27%) and validation (26%) cohort. The area under the curve and Brier score of the final 8-question tool were 0.82 and 0.14 in the derivation cohort and 0.76 and 0.17 in the validation cohort. This simple 8-question tool demonstrates promise to risk-stratify individuals with substantial posttraumatic stress symptoms who are discharged to home after a motor vehicle collision. Both external validation of this instrument, and work to further develop more accurate tools, are needed. Such tools might benefit public health by enabling the conduct of preventive intervention trials and assisting the growing number of EDs that provide services to trauma survivors aimed at promoting psychological recovery.

Predictors of Retention of African American Mothers in a Parent-Based HIV Preventive Intervention Trial

Predictors of Retention of African American Mothers in a Parent-Based HIV Preventive Intervention Trial

Longitudinal associations between age 20 problematic substance use and opioid use disorder incidence at age 30 – findings from an urban cohort

This study used data from a longitudinal prevention study in an urban cohort to examine associations between nicotine dependence, alcohol, and cannabis use disorder and disorder criteria at age 20, with opioid use disorder (OUD) incidence or criteria onset by age 30. The study sample included 1408 participants (57.5% female, 72.5% African American) drawn from two cohorts of participants in a mid-Atlantic region of the U.S. as part of a series of randomized controlled trials of elementary school-based universal prevention interventions. Lifetime cannabis use disorder (CUD), alcohol use disorder (AUD; both DSM-IV), and current nicotine dependence (Fagerstrom Test for Nicotine Dependence, FTND) assessed at age 20 were used to predict (1) DSM-IV lifetime OUD at age 30, and (2) OUD criteria between ages 20 and 30 in multivariable logistic regression models. Covariates for all analyses included sociodemographics (sex, race, and free/reduced-priced lunch status), community disadvantage, and intervention status. Nicotine dependence (FTND≥3) at age 20 predicted age 30 DSM-IV lifetime OUD (aOR = 2.37; 95% CI 1.02,5.54). The number of CUD criteria (aOR = 1.30; 95% CI 1.09,1.57) and nicotine dependence severity scores (aOR = 1.22; 95% CI = 1.05,1.41) at age 20 predicted any OUD criteria between the ages of 20 and 30. Findings are consistent with previous research on opioid use behavior in young adulthood and suggest that nicotine dependence and CUD criteria among urban young people predict onset of OUD and OUD criteria in young adulthood.

Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews

BackgroundReliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)].MethodsMedline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of s of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews.FindingsThe overview identified 30 systematic reviews of patient education, footwear and off-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap.InterpretationThe majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice.

Demographic and cultural correlates of traditional eating among Alaska Native adults at risk for cardiovascular disease.

This cross-sectional study assessed how traditional eating relates to cultural and community factors. Alaska Native adults from the Norton Sound region were recruited and surveyed between 2015–2018 for a randomized clinical trial of multiple risk behavior change interventions for cardiovascular disease prevention. Participants (n = 291) were 49% female with a mean age of 47 years (SD = 14). A 34-item food frequency questionnaire assessed consumption of foods traditional and nontraditional to the regional Alaska Native diet. A novel measure, termed the “traditional foods index”, was computed as weekly servings of culturally traditional food consumption divided by total foods reported. Overall, the sample’s traditional foods index averaged 21%±16%, with higher values reported by participants assessed in summer (23%±17%) than winter (19%±15%, p<0.05); by women (22%±16%) than men (19%±16%, p < .05); and by residents of smaller communities (22%±17%) than the comparatively larger community of Nome (17%±14%, p<0.05). The traditional foods index was correlated with age (r = .26, p < .01), as well as the cultural variables of community connectedness (r = .19, p < .01), community standing (r = .15, p < .01), and traditional language comprehension (r = .19, p < .01). In a multivariate regression model, age, community connectedness, and community standing remained significantly associated with traditional diet. These findings may inform the design and evaluation of community-based, culturally-relevant dietary initiatives for heart health.

The Japan-Multimodal Intervention Trial for Prevention of Dementia PRIME Tamba (J-MINT PRIME Tamba): Study protocol of a randomised controlled multi-domain intervention trial

The Japan-Multimodal Intervention Trial for Prevention of Dementia PRIME Tamba (J-MINT PRIME Tamba) is a randomised controlled trial to prevent cognitive decline in community-dwelling cognitively ordinary older people at risk of dementia. Participants are aged 65–85 years living in a rural area in Japan, aware of very mild decline in cognitive function or abilities of activities of daily living, have at least one vascular risk (e.g. hypertension or diabetes), and have a Mini-Mental State Examination score of 24 or higher. Approximately 200 participants are randomly divided into two groups, with the intervention group receiving a multi-modal intervention, including lifestyle-related disease management, physical exercise, cognitive training, and nutritional counselling, over 18 months. The primary outcome is change in the composite score of seven neuropsychological tests, including the Free and Cued Selective Reminding Test, Logical Memory I and II subsets of the Wechsler Memory Scale-Revised, and Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale. In addition, changes in a wide range of other parameters such as physical function, blood test results, sleep, and frailty are also analysed as secondary outcomes. We believe that this study's results will contribute significantly to the development of dementia prevention measures in Japan.Clinical trial registration number: UMIN000041938

Secondary Analysis to Inform the Development of Adaptive Preventive Interventions.

For the past 30years, scholars across the fields of epidemiology, education, psychology, and numerous other fields have worked to develop interventions designed to reduce risk and enhance protection to prevent mental, emotional, and behavioral problems across the lifespan. This article presents a series of next steps that leverage this foundational science to inform the development of adaptive preventive interventions. Adaptive preventive interventions (APIs) tailor the intervention to fit the diverse, sometimes changing, needs of participants with the goal of better prevention outcomes for more individuals. Secondary analyses of data from preventive intervention trials to identify moderators, mediators, and antecedents of attrition and intervention failure can be useful for designing effective APIs. Moderators that identify intervention effect heterogeneity can be used within an API to tailor the intervention to meet the unique needs of important participant subgroups. Mediators and predictors of disengagement and attrition can be helpful tailoring variables in an API to trigger change to the intervention. Preventive intervention trials that incorporate frequent assessment of potential mediators, moderators, and antecedents of attrition during the intervention period are needed. Secondary analyses of data from preventive intervention trials provide an important foundation for next-generation APIs.

Cross-species transcriptome analysis for early detection and specific therapeutic targeting of human lupus nephritis

ObjectivesPatients with lupus nephritis (LN) are in urgent need for early diagnosis and therapeutic interventions targeting aberrant molecular pathways enriched in affected kidneys.MethodsWe used mRNA-sequencing in effector (spleen) and target...

Women's Health Initiative Strong and Healthy (WHISH): A pragmatic physical activity intervention trial for cardiovascular disease prevention

BackgroundNational guidelines promote physical activity to reduce cardiovascular disease (CVD); yet, no RCT has tested the effectiveness of physical activity as the sole intervention for primary CVD prevention in older adults. The Women's Health Initiative (WHI) Strong and Healthy (WHISH) trial, a pragmatic trial embedded in the WHI-Extension Study (ES), is testing whether increasing physical activity and decreasing sedentary behavior will reduce major CV events in older women. MethodsThe randomized consent design was used to assign 49,331 women (aged 68–99 years in 2015) who had consented to ongoing WHI-ES follow-up and for whom CV outcomes were available through WHI-ES procedures (N = 18,985) and/or linkage to the Centers for Medicare and Medicaid Services (N = 30,346) to a physical activity (PA) intervention designed to promote national recommendations (N = 24,657) or “usual activity” comparison (N = 24,674). Women assigned to the intervention provided passive consent to receive the intervention and provide data. A multi-component PA intervention is delivered by seasonal (quarterly) newsletters with targeted inserts (lower, middle, higher) based on self-reported levels of physical functioning (PF) and physical activity; monthly motivational telephone messages; monthly emails; a website; and contact with staff, as requested. Major CV events, myocardial infarction (MI), stroke, or CVD death, collected annually through WHI-ES, comprise the primary outcome. Hip fracture and non-CVD death are primary safety outcomes. Intention-to-treat analyses in all randomized participants will include 8 years of follow-up. ConclusionDetermining whether increased physical activity and decreased sedentary behavior reduce major CV events in older women is of major public health significance.Clinical trials registration:ClinicalTrials.govidentifier:NCT02425345

Positive associations between cannabis and alcohol use polygenic risk scores and phenotypic opioid misuse among African-Americans.

BackgroundThis study examined whether polygenic risk scores (PRS) for lifetime cannabis and alcohol use were associated with misusing opioids, and whether sex differences existed in these relations in an urban, African-American sample.MethodsData were drawn from three cohorts of participants (N = 1,103; 45% male) who were recruited in first grade as part of a series of elementary school-based, universal preventive intervention trials conducted in a Mid-Atlantic region of the U.S. In young adulthood, participants provided a DNA sample and reported on whether they had used heroin or misused prescription opioids in their lifetime. Three substance use PRS were computed based on prior GWAS: lifetime cannabis use from Pasman et al. (2018), heavy drinking indexed via maximum number of drinks from Gelernter et al. (2019), and alcohol consumption from Kranzler et al. (2019).ResultsHigher PRS for lifetime cannabis use, greater heavy drinking, and greater alcohol consumption were associated with heightened risk for misusing opioids among the whole sample. Significant sex by PRS interactions were also observed such that higher PRS for heavy drinking and alcohol consumption were associated with a greater likelihood of opioid misuse among males, but not females.ConclusionOur findings further elucidate the genetic contributions to misusing opioids by showing that the genetics of cannabis and alcohol consumption are associated with lifetime opioid misuse among young adults, though replication of our findings is needed.

Gram-negative central line-associated bloodstream infection incidence peak during the summer: a national seasonality cohort study

Central line-associated bloodstream infections (CLABSI) cause increased morbidity, mortality, and hospital costs that are partially preventable. The phenomenon of seasonality among CLABSI rates has not been fully elucidated, but has implications for accurate surveillance and infection prevention trials. Longitudinal dynamic cohort of hospitals participating in hospital-wide and intensive care unit bloodstream infection surveillance for at least one full year over 2000 to 2014. Mixed-effects negative binomial regression analysis calculated the peak-to-low ratio between months as an adjusted CLABSI incidence rate ratio (IRR) with 95% confidence intervals (CI). Multivariate regression models examined the associations between CLABSI pathogens and ambient temperature and relative humidity. The study population included 104 hospital sites comprising 11,239 CLABSI. Regression analysis identified a hospital-wide increase in total CLABSI during July–August, with a higher gram-negative peak-to-low incidence rate ratio (IRR 2.52 [95% CI 1.92–3.30], p < 0.001) compared to gram-positive bacteria (IRR 1.29 [95% CI 1.11–1.48], p < 0.001). Subgroup analysis replicated this trend for CLABSI diagnosed in the intensive care unit. Only gram-negative CLABSI rates were associated with increased temperature (IRR + 30.3% per 5 °C increase [95% CI 17.3–43.6], p < 0.001) and humidity (IRR + 22.9% per 10% increase [95% CI 7.7–38.3), p < 0.001). The incidence and proportion of gram-negative CLABSI approximately doubled during the summer periods. Ambient temperature and humidity were associated with increases of hospital-acquired gram-negative infections. CLABSI surveillance, preventive intervention trials and epidemiological studies should consider seasonal variation and climatological factors when preparing study designs or interpreting their results.

A scoping review of outcomes commonly reported in obesity prevention interventions aiming to improve obesity-related health behaviors in children to age 5 years.

This scoping review was undertaken as the first stage of development of the Core Outcome Sets for Early Prevention of Obesity in CHildhood (COS-EPOCH). The aim of this review is to identify the outcomes collected and reported in randomized controlled trials of early childhood obesity prevention interventions. A systematic scoping review was undertaken following published guidelines. Trial registries and Medline were searched, and records retrieved were screened by two reviewers. Included trials aimed to prevent childhood obesity in the first 5 years of life and were randomized. Data were extracted using a standardized form. Outcomes were assigned to outcome domains, and similar definitions within each domain were merged, based on key literature and expert consensus. Outcome and domain frequencies were estimated and presented in outcome matrices. Eighteen outcome domains were identified from 161 included studies: "anthropometry," "dietary intake," "physical activity," "sedentary behaviour," "emotional functioning/wellbeing," "feeding," "cognitive/executive functioning," "sleep," "other," "study-related," "parenting practices," "motor skill development," "environmental," "blood and lymphatic system," "perceptions and preferences," "quality of life," and "economic," "oral health." The most frequently reported outcome domain was anthropometry (92% of studies), followed by dietary intake (77%) and physical activity (60%). 221 unique outcomes were identified, indicating a high degree of heterogeneity. Body mass index was the only outcome reported in >50% of studies. The considerable heterogeneity in outcomes supports the need for the development of COS-EPOCH.

Weight loss in a cardiovascular trial population identifies people at future risk of dementia.

IntroductionPopulations at increased risk of dementia need to be identified for well‐powered trials of preventive interventions. Weight loss, which often occurs in pre‐clinical dementia, could identify a population at sufficiently high dementia risk.MethodsIn 12,975 survivors in the Heart Protection Study statin trial of people with, or at high risk of, cardiovascular disease, the association of weight change over 5 years during the trial with post‐trial dementia recorded in electronic hospital admission and death records (n = 784) was assessed, after adjustment for age, sex, treatment allocation, and deprivation measures.ResultsAmong the 60% without substantial weight gain (≤2 kg weight gain), each 1 kg weight loss was associated with a risk ratio for dementia of 1.04 (95% confidence interval, 1.02–1.07). Weight loss ≥4 kg and cognitive function below the mean identified participants aged ≥67 years with a 13% 10‐year dementia risk.DiscussionThe combination of weight loss and high vascular risk identified individuals at high risk of dementia who could be recruited to dementia prevention trials.

Tools for harmonization of data in World‐Wide FINGERS

AbstractBackgroundWorld‐Wide FINGERS (WW‐FINGERS) is a global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention (Kivipelto et al., 2020). With over 30 countries conducting studies within the network, harmonizing interventions and data collection wherever possible is a priority. However, study‐specific adaptations are inevitable to accommodate differences in language, culture, and environment. Thus, a single data collection system is not feasible across WW‐FINGERS and opportunities for synergies between study‐specific systems should be explored.MethodREDCap (Research Electronic Data Capture) is a secure, web‐based software platform which supports validated data capture for research studies (Harris et al., 2009). The underlying blueprint for each REDCap project is a ‘data dictionary’ – a .csv file containing all metadata required to recreate case report forms (CRF) for each point of data collection, including variable names and response options. Data dictionaries can be easily exported, shared, and imported into other REDCap instances. This enables utilization of the same overall structure where possible and preserves response options and variable names while making needed adaptations. Within the WW‐FINGERS network, the study to Protect Brain Health through a Lifestyle Intervention to Reduce Risk (U.S. POINTER) developed a REDCap system based on its protocol and shared its data dictionary with two other WW‐FINGERS studies – AUstralian‐Multidomain Approach to Reduce Dementia Risk by PrOtecting Brain Health with Lifestyle Intervention (AU‐ARROW) and LatAm FINGERS (Latin American initiative for lifestyle Intervention to Prevent Cognitive Decline and reduce risk study).ResultAU‐ARROW and LatAm FINGERS are in the process of incorporating relevant pieces of the U.S. POINTER REDCap project into REDCap systems developed for their studies. While the systems are not identical given the different intervention structures, we aim to standardize 50‐75% of the common variables used across the studies.ConclusionUsing REDCap allows each WW‐FINGERS study to develop its own customized system for data capture, while easily standardizing common variable names, response options, and CRFs; along with exporting de‐identified data. As a result, data sharing and analysis across the WW‐FINGERS network can be streamlined. Furthermore, this process may serve as a roadmap for other global consortia’s similar efforts.

Baseline characteristics in Japan‐multimodal intervention trial for prevention of dementia (J‐MINT) Tamba study

AbstractBackgroundTo prevent Alzheimer’s disease, a multimodal intervention has been tried in world wide. J‐MINT is a trial in Japan and is studied in three different areas. J‐MINT Tamba, one of substudies of J‐MINT, has begun in September, 2020 in a Japanese rural area (UMIN000041938). The aim of this study is to report the characteristics of participants at the baseline, especially focusing on APOE subtypes and their cognitive functions.MethodThis study was cross‐sectional design. The inclusion criteria in this study were as follows; 1) Tamba citizen aged 65‐85 at the time of enrollment, 2) 24 or higher in the Mini‐Mental State Examination, and 3) having at least 1 of the following vascular risks (Treating hypertension or having systolic BP &gt;=140 mm Hg or diastolic BP &gt;= 85 mm Hg and treating diabetes or HbA1c &gt;=6.0%). Cognitive functions were evaluated by following tests; the Trail Making Test (TMT) part A and part B, forward digit span, backward digit span, the Digit Symbol Substitution Test (DSST), the logical memory test from WMS‐R (immediate and delayed recall), and the Free and Cued Selective Reminding Test (FCSRT). The APOE epsilon 4 carrier or noncarrier were identified by serum blood test. Additionally, life‐related factors and number of drug use and type were assessed by self‐reported questionnaire. We performed statistical analyses using multiple regression, with each cognitive function as the dependent variables, the APOE epsilon 4 carrier and the other factors (and interaction) as the independent variable, and age and sex as confounding variables.ResultTotal 203 elderly were registered (mean age: 73.9 ± 4.8 years, females: 71.4%). The number of participants of APOE epsilon 4 carrier were 18.6% and that of participants with polypharmacy were 35.8%. Although the cognitive functions were not related with the APOE epsilon 4 carrier, TMT part A and DSST were observed the interaction between the APOE epsilon 4 carrier and polypharmacy (coefficient: 16.2, p values &lt; 0.01; ‐10.1, 0.03).ConclusionCoexistence of APOE epsilon 4 and polypharmacy showed lower cognitive functions in spite of the community‐dwelling elderly with normal cognition. These elderlies might develop cognitive decline in early phase.

Core outcome set for preventive intervention trials in chronic and episodic migraine (COSMIG): an international, consensus-derived and multistakeholder initiative

ObjectiveTypically, migraine prevention trials focus on reducing migraine days. This narrow focus may not capture all that is important to people with migraine. Inconsistency in outcome selection across trials limits...

Home modifications to prevent home fall injuries in houses with Māori occupants (MHIPI): a randomised controlled trial

As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. Health Research Council of New Zealand.

The Multi-Domain Intervention Trial in Older Adults With Diabetes Mellitus for Prevention of Dementia in Japan: Study Protocol for a Multi-Center, Randomized, 18-Month Controlled Trial

Background: The Japan-Multi-domain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes (J-MIND-Diabetes) is an 18-month, multi-centered, open-labeled, randomized controlled trial designed to identify whether multi-domain intervention targeting modifiable risk factors for dementia could prevent the progression of cognitive decline among older adults with type 2 diabetes mellitus (T2DM). This manuscript describes the study protocol for the J-MIND-Diabetes trial.Materials and Methods: Subjects of this trial will comprise a total of 300 T2DM outpatients aged 70–85 years with mild cognitive impairment. Subjects will be centrally randomized into intervention and control groups at a 1:1 allocation ratio using the stratified permuted-block randomization methods. The intervention group will participate in multi-domain intervention programs aimed at: (1) management of metabolic and vascular risk factors; (2) physical exercise and self-monitoring of physical activity; (3) nutritional guidance; and (4) social participation. The control group will receive usual T2DM care and general instructions on dementia prevention. The primary and secondary outcomes will be assessed at baseline, at 6- and 18-month follow-up. The primary outcome is change from baseline at 18 months in a global composite score combining several neuropsychological domains, including global cognitive function, memory, attention, executive function, processing speed and language. Secondary outcomes include: (1) cognitive changes in neuropsychological tests; (2) changes in geriatrics assessments; (3) metabolic control and diabetic complications; (4) changes in blood and urinary markers.Discussion: This trial will be the first trial to demonstrate the effectiveness of multi-domain intervention in preventing cognitive decline in older adults with T2DM at increased risk of dementia in Japan.Trial Registration: UMIN000035911; Registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) 18 February 2019. (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000040908).

Interpersonal abuse and alcohol use among African American young women: the mediating role of emotion dysregulation

African American women experience a high prevalence of alcohol-related consequences, and no studies have explicitly examined the associations among lifetime interpersonal abuse, emotion dysregulation, and alcohol-related outcomes during the critical period of young adulthood within this population. This study used baseline data from a sample of African American young women (N = 560) who use alcohol, aged 18 to 24, enrolled in an HIV prevention intervention trial to examine whether emotion dysregulation mediated the relation between lifetime history of abuse and problematic alcohol use. Further, we sought to examine whether there were potential differential levels of problematic alcohol use based on the number of abuse types experienced. Multiple regression analyses showed that exposure to two or more forms of abuse was associated with problematic alcohol use, β = .24, p < .001, and heavy alcohol consumption, β = .23, p < .001, whereas history of a single form was not. Indirect effects of both single and multiple forms of abuse on problematic alcohol use (95% confidence interval [CI] [.16, 1.02]; [.46, 1.64]) and heavy alcohol consumption (95% CI [.02, .26]; [.05, .45]) via emotion dysregulation severity were found. Abuse and emotion dysregulation were associated with frequency of alcohol use and binge drinking, but not typical amount consumed. Hazardous alcohol consumption was prevalent among this sample of African American young women who use alcohol. This study provides preliminary evidence that emotion dysregulation may be an important mechanism buttressing the association between lifetime history of interpersonal abuse and problematic alcohol use among African American young women who use alcohol.

Acute suicide prevention: A systematic review of the evidence and implications for clinical practice

• Suicide prevention is an international health priority. • Evidence-based interventions are needed for health professionals to deliver quality suicide prevention care. • A systematic review of the literature revealed no randomised control trials supporting acute suicide prevention strategies. • There is an urgent need for clinical trials to evaluate and compare acute suicide prevention interventions. Responding appropriately to people in acute distress, including suicidality, is a critical aspect of suicide prevention. Six clinical interventions are used to respond to acute suicidality—pharmacotherapy, Observations, Contracting for Safety, Crisis Response Planning, Safety Planning, and Care • Collaborate • Connect. This study used a systematic review to identify the efficacy of these acute suicide prevention interventions. OvidSP was used to search EMBASE, Emcare, Medline, Ovid Nursing, and PsycINFO from inception to 1 December 2020. The searches combined the terms for suicid* in the title AND observation OR contract*, OR no-suicide OR no-harm OR safe* OR crisis response, OR CRP, OR coping, OR Care Collaborate Connect in the title, abstract, or keywords. Five randomised control trials that evaluated one or more of the five interventions were identified. Interventions evaluated Contracting for Safety, Crisis Response Planning, Safety Planning, and Care • Collaborate • Connect. However, no studies met inclusion criteria. Efficacy trials of suicide prevention interventions are urgently needed to ensure those seeking support for suicidality receive timely and effective interventions and to meet this international health priority.