Browsing by Author "Walters, Scott T."
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Item A Structural Equation Modeling Approach to Meta-analytic Mediation Analysis Using Individual Participant Data: Testing Protective Behavioral Strategies as a Mediator of Brief Motivational Intervention Effects on Alcohol-Related Problems(Springer Nature, 2021-11-12) Huh, David; Li, Xiaoyin; Zhou, Zhengyang; Walters, Scott T.; Baldwin, Scott A.; Tan, Zhengqi; Larimer, Mary E.; Mun, Eun-YoungThis paper introduces a meta-analytic mediation analysis approach for individual participant data (IPD) from multiple studies. Mediation analysis evaluates whether the effectiveness of an intervention on health outcomes occurs because of change in a key behavior targeted by the intervention. However, individual trials are often statistically underpowered to test mediation hypotheses. Existing approaches for evaluating mediation in the meta-analytic context are limited by their reliance on aggregate data; thus, findings may be confounded with study-level differences unrelated to the pathway of interest. To overcome the limitations of existing meta-analytic mediation approaches, we used a one-stage estimation approach using structural equation modeling (SEM) to combine IPD from multiple studies for mediation analysis. This approach (1) accounts for the clustering of participants within studies, (2) accommodates missing data via multiple imputation, and (3) allows valid inferences about the indirect (i.e., mediated) effects via bootstrapped confidence intervals. We used data (N = 3691 from 10 studies) from Project INTEGRATE (Mun et al. Psychology of Addictive Behaviors, 29, 34-48, 2015) to illustrate the SEM approach to meta-analytic mediation analysis by testing whether improvements in the use of protective behavioral strategies mediate the effectiveness of brief motivational interventions for alcohol-related problems among college students. To facilitate the application of the methodology, we provide annotated computer code in R and data for replication. At a substantive level, stand-alone personalized feedback interventions reduced alcohol-related problems via greater use of protective behavioral strategies; however, the net-mediated effect across strategies was small in size, on average.Item ASSESSING REPRODUCTIVE INTERCONCEPTION CARE BEHAVIORS, BARRIERS, AND FACILITATORS AMONG WOMEN RECENTLY PREGNANT AND HOMELESS(2022-08) Galvin, Annalynn M.; Thompson, Erika; Lewis, Melissa; Walters, Scott T.Interconception care, care provided to mothers between pregnancies, reduces short birth interval risks such as prematurity and low birthweight. Women experiencing homelessness have higher rates of unintended pregnancy and may experience stronger benefits from reproductive interconception care through either unintended pregnancy reductions or healthy pregnancy promotion via family planning. It is critical to build on limited research on interconception care within this population to potentially reduce poverty and cyclical, intergenerational homelessness. By utilizing a sequential explanatory mixed-methods design, this proposed study aimed to first determine prevalence ratios of interconception behaviors such as attendance of maternal postpartum visits, birth spacing and family planning counseling, and postpartum contraception outcomes of women experiencing homelessness, then identify the most salient interconception barriers and facilitators related to interconception information (e.g., knowledge), motivation (e.g., personal attitudes), and behavioral skills (e.g., perceived self-efficacy) among postpartum women who experienced homelessness during pregnancy. Using the 2016-2019 Pregnancy Risk Assessment and Monitoring System, the prevalence of interconception care behaviors among women experiencing homelessness and the associations between housing status and interconception care behaviors were estimated. The sample (n=100,706) was primarily non-Hispanic White (59.4%), married (61.9%) women with private insurance (59.4%) and less than a 4-year degree (63.0%). Approximately 2.4% of participants experienced housing instability in the 12 months before their child was born. Perinatal housing instability was significantly associated with lower odds of attending a postpartum maternal visit (aOR=0.45, 95% CI 0.37, 0.56) and (aOR=1.30, 95% CI 1.07, 1.57) when compared to women who did not experience homelessness in the last 12 months from the time of the interview. Findings from aim 1 determined specific interconception care behavior deficits to further explore via one-hour semi-structured interviews with 12 women experiencing homelessness while pregnant who had given birth within the last four years. Eligible women were recruited through local agency partnerships using purposive sampling. Interviews were audio-recorded, coded to consensus, and analyzed for themes. Information-related themes included knowledge and misconceptions about perinatal processes (e.g., pregnancy, labor and delivery, becoming pregnant, preventing pregnancy) as well as information-seeking themes. Motivation-related themes included attitudes about recent interconception care experiences, perinatal social influences, perceived susceptibility to future pregnancy, and attitudes regarding reasons for not engaging in postpartum pregnancy prevention. Behavioral skill-related themes included objective ability to engage in perinatal behaviors during housing instability, as well as perceived self-efficacy related to barriers and facilitators to engaging in reproductive interconception pregnancies as well as ease of pregnancy. Macro-related themes included housing effects on perinatal period, how perinatal experiences affected seeking stable housing, and how the interconnected nature of housing and other macro-level factors influenced reproductive interconception care. These findings establish a baseline understanding of interconception behaviors and the associated barriers and facilitators related to interconception care information, motivation, and behavioral skills among women experiencing homelessness. Findings may potentially strengthen current interconception practices and augment reductions in unintended pregnancy, short birth intervals, or adverse birth outcomes in future pregnancies, thus improving pregnancy outcomes and improving the health of women before, during, and after pregnancy.Item Changes in Healthcare Utilization and Charges Among Supportive Housing Residents Enrolled in a Health Coaching Program(2019-05) Chhetri, Shlesma; Spence-Almaguer, Emily; Walters, Scott T.; Stockbridge, Erica L.; Aryal, SubhashThe effectiveness of self-management programs on healthcare use outcomes is an active area of research with inconsistent results. This study was the first to evaluate changes in healthcare utilization (including hospital encounters, inpatient visits, outpatient visits, and emergency visits) and charged amounts among supportive housing residents enrolled in a health coaching program. We utilized retrospective longitudinal medical claims data and a qualitative examination of participants' perceptions of the program's influence on their healthcare use. Zero-inflated negative binomial model and log-gamma models were used to assess change in count variables and charged amounts respectively. Although participants reported a positive impact of the program on their overall quality of life through improved health self-management strategies, the analysis of claims data showed no significant change in healthcare use and charged amounts in all analyses spanning 12 months prior to 24 months post enrollment. These findings may potentially demonstrate the success of health coaching programs in stabilizing healthcare utilization among individuals who otherwise might have increased their healthcare use over time. During interviews and focus groups, participants also shared personal and systems level challenges that influenced their healthcare use. The inclusion of a control group in future analyses would help measure the actual impact of health coaching on healthcare utilization measures among supportive housing residents with high health needs.Item Do Brief Alcohol Interventions Reduce Driving After Drinking Among College Students? A Two-step Meta-analysis of Individual Participant Data(Oxford University Press, 2021-02-16) Mun, Eun-Young; Li, Xiaoyin; Lineberry, Shelby; Tan, Zhengqi; Huh, David; Walters, Scott T.; Zhou, Zhengyang; Larimer, Mary E.; in Collaboration with Project, Integrate TeamAIMS: College students who drink are at an increased risk of driving after drinking and alcohol-involved traffic accidents and deaths. Furthermore, the persistence of driving after drinking over time underscores a need for effective interventions to prevent future drunk driving in adulthood. The present study examined whether brief alcohol interventions (BAIs) for college students reduce driving after drinking. METHODS: A two-step meta-analysis of individual participant data (IPD) was conducted using a combined sample of 6801 college students from 15 randomized controlled trials (38% male, 72% White and 58% first-year students). BAIs included individually delivered Motivational Interviewing with Personalized Feedback (MI + PF), Group Motivational Interviewing (GMI), and stand-alone Personalized Feedback (PF) interventions. Two outcome variables, driving after two+/three+ drinks and driving after four+/five+ drinks, were checked, harmonized and analyzed separately for each study and then combined for meta-analysis and meta-regression analysis. RESULTS: BAIs lowered the risk of driving after four+/five+ drinks (19% difference in the odds of driving after drinking favoring BAIs vs. control), but not the risk of driving after two+/three+ drinks (9% difference). Subsequent subgroup analysis indicated that the MI + PF intervention was comparatively better than PF or GMI. CONCLUSIONS: BAIs provide a harm reduction approach to college drinking. Hence, it is encouraging that BAIs reduce the risk of driving after heavy drinking among college students. However, there may be opportunities to enhance the intervention content and timing to be more relevant for driving after drinking and improve the outcome assessment and reporting to demonstrate its effect.Item Do brief motivational interventions increase motivation for change in drinking among college students? A meta-analysis of individual participant data(2022-08) Tan, Zhengqi; Mun, Eun-Young; Walters, Scott T.; Zhou, Zhengyang; Huh, David; Nandy, Rajesh R.Brief Motivational Interventions (BMIs) have been identified as one of the most effective individually focused alcohol intervention strategies for college students in the United States. Despite the central role of motivation for change in BMIs, whether BMIs increase motivation for change has rarely been investigated. The current study conducted a meta-analysis of individual participant data (IPD; 15 studies, N = 5,903) from Project INTEGRATE (Mun et al., 2015) to examine whether BMIs increase motivation for change in drinking. Different measures and responses used in the original trials were harmonized across studies, and effect size estimates were derived from a model that adjusted for baseline motivation and demographic variables for each study (step 1) and subsequently combined in a random-effects meta-analysis model (step 2). After adjustment for baseline levels of motivation level and demographic variables, the intervention effects of BMIs on motivation for change was not statistically significant (standard mean difference [SMD]: 0.026, 95% CI: [-0.001, 0.053], p = .06, k = 19). Subsequent metaregression analyses among BMI subtypes indicated that the intervention effect did not differ between individually delivered motivational interviewing with personalized feedback (MI+PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). Among all BMI subtypes, only GMI had a statistically significant intervention effect on motivation compared to controls (SMD: 0.055, 95% CI: [0.007, 0.103], p = .025, k = 5). Within the first three months post-intervention, there was a decrease in SMD of 0.05 (95% CI: [0.01, 0.08]) in motivation per month. However, no statistically significant difference in the intervention effects was found between studies with short-term vs. long-term follow-up. Although the results from the current study do not support the hypothesis that BMIs improve motivation for change, the evidence as a whole suggests ways in which motivation may be improved following intervention and can be tested in future studies.Item Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness(John Wiley & Sons, Inc., 2021-03-03) Mun, Eun-Young; Li, Xiaoyin; Businelle, Michael S.; Hebert, Emily T.; Tan, Zhengqi; Barnett, Nancy P.; Walters, Scott T.BACKGROUND: Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self-reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self-reports via the Timeline Follow-Back (TLFB) among adults experiencing homelessness. METHODS: Forty-nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. RESULTS: EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. CONCLUSIONS: This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.Item Illicit Substance Use Among a Sample of Subsidized Housing Residents: Concordance, Longitudinal Trends, and Quality of Life(2019-05) Rendon, Alexis; Walters, Scott T.; Spence-Almaguer, Emily; Mun, Eun-Young; Livingston, Melvin D.; Suzuki, SumihiroThis three-paper model dissertation investigates issues related to self-reported substance use. Self-report is a less invasive and expensive method of collecting substance use behavior when compared to a toxicological test, but the self-report method has been shown to be unreliable in some populations. We found that self-report missed some use captured by a saliva toxicological test administered to a subsidized housing population enrolled in a technology-assisted health coaching program. Concordance was highest among marijuana users and increased over time. Higher rates of concordance were found when the recall window was expanded from a restricted biological recall window to match the toxicological test to the full 90 day window of the Timeline Follow-Back. Participants who reported using substances more frequently reported having more problems related to their substance use. We also found that both substance use problems and the frequency of consumption of a combined Other category of substances, including cocaine, amphetamine, methamphetamine, opiates, prescription pills, or phencyclidine were predictive of lower quality of life. This dissertation validates previous literature indicating that self-report is a fair to moderately good measure of actual substance use behavior in vulnerable populations that may intentionally or unintentionally misreport their substance use. Programs limited to self-reported measures may consider widening their recall windows to increase accuracy of self-report.Item Increases in social support co-occur with decreases in depressive symptoms and substance use problems among adults in permanent supportive housing: an 18-month longitudinal study(BioMed Central Ltd., 2021-01-06) Tan, Zhengqi; Mun, Eun-Young; Nguyen, Uyen-Sa D.T.; Walters, Scott T.BACKGROUND: Social support is a well-known protective factor against depressive symptoms and substance use problems, but very few studies have examined its protective effects among residents of permanent supportive housing (PSH), a housing program for people with a history of chronic homelessness. We utilized unconditional latent growth curve models (LGCMs) and parallel process growth models to describe univariate trajectories of social support, depressive symptoms, and substance use problems and to examine their longitudinal associations in a large sample of adults residing in PSH. METHODS: Participants were 653 adult PSH residents in North Texas (56% female; 57% Black; mean age: 51 years) who participated in a monthly health coaching program from 2014 to 2017. Their health behaviors were assessed at baseline and tracked every six months at three follow-up visits. RESULTS: Unconditional LGCMs indicated that over time, social support increased, whereas depressive symptoms and substance use problems decreased. However, their rates of change slowed over time. Further, in parallel process growth models, we found that at baseline, individuals with greater social support tended to have less severe depressive symptoms and substance use problems (coefficients: - 0.67, p < 0.01; - 0.52, p < 0.01, respectively). Individuals with a faster increase in social support tended to have steeper rates of reduction in both depressive symptoms (coefficient: - 0.99, p < 0.01) and substance use problems (coefficient: - 0.98, p < 0.01), respectively. CONCLUSIONS: This study suggests that plausibly, increases in social support, though slowing over time, still positively impact depressive symptoms and substance use problems among PSH residents. Future PSH programs could emphasize social support as an early component as it may contribute to clients' overall health.Item Lifestyle Factors and Depressive Symptoms Among Permanent Supportive Housing Residents(2020-05) Holmes, Esther J.; Walters, Scott T.Background: Depression is prevalent among low-income populations. Many lifestyle factors may influence depressive symptoms, including vegetable and fruit intake, physical activity, tobacco use, alcohol use, social support, and satisfaction with leisure activities. However, the influence of lifestyle factors on depressive symptoms among permanent supportive housing (PSH) residents is unclear. In addition, it is unclear if PSH residents with depressive symptoms are interested in working on lifestyle factors. Methods: A longitudinal analysis was conducted among 420 PSH residents participating in a technology-assisted health coaching program. Three timepoints were included, corresponding with the screening/baseline, six-month, and twelve-month assessment visits. The independent variables were total vegetable and fruit intake, physical activity, tobacco use, alcohol use, social support, and satisfaction with leisure activities. The dependent variable was depressive symptoms, measured by the 9-item Patient Health Questionnaire (PHQ-9). Covariates were race, sex, age, and visit. In addition, social support was examined as a potential effect modifier. Participants' interest in working on health areas was evaluated as well. Results: Moderate alcohol consumption predicted lower depressive symptoms compared with heavy alcohol consumption (b=-1.54, p=0.01). Additionally, the difference in depressive symptoms between non-consumers and heavy consumers of alcohol approached statistical significance with non-consumers of alcohol having less depressive symptoms than heavy consumers of alcohol (b = -.76, p = .07). High compared with low satisfaction with leisure activities (b=-0.83, p<0.0001) and high compared with low social support (b=-1.86, p<.0001) predicted lower depressive symptoms. Tobacco use was a marginally statistically significant predictor of depressive symptoms (b=0.92, p=0.05). Total vegetable and fruit intake and physical activity were not statistically significant predictors of depressive symptoms. Social support was not a statistically significant modifier of the effect of lifestyle factors on depressive symptoms. Participants with moderate, moderately severe, and severe depressive symptoms were most interested in working on diet, exercise, and substance use and least interested in working on social support and recreation/leisure activities. Conclusions: Alcohol use, tobacco use, social support, and satisfaction with leisure activities may influence depressive symptoms among PSH residents. However, participants may not be interested in working on social support and satisfaction with leisure activities. An ecological approach may be necessary to influence social support and satisfaction with leisure activities among PSH residents. Lifestyle interventions designed to reduce depressive symptoms among PSH residents should aim to increase PSH residents' social support and satisfaction with leisure activities.Item MULTIPLE FRUIT-FLAVORED ALCOHOLIC DRINK IN A CAN (MFAC) USE AMONG SUBSTANCE USING ADULTS ON PROBATION(2014-03) Rossheim, Matthew E.; Rodgriguez, Mayra; Walters, Scott T.; Lerch, Jennifer; Taxman, Faye S.Purpose (a): Over the last decade, an emerging class of large, canned alcohol products (e.g. Four Loko, Joose, Blast) have been marketed in the U.S. Research suggests that consumption of these MFAC products could contribute to hazardous alcohol consumption. However, little is known about their consumption and related harm. Methods (b): In Dallas, TX and Baltimore, MD, 211 interviews were conducted with adults on probation who were participating in a larger clinical trial. Inclusion criteria included (1) being on probation, (2) being 18 years or older, (3) speaking English, and (4) either (a) using any illicit drug in the past 90 days or (b) consuming 5 alcoholic drinks (or 4 for women) on a single occasion in the past 90 days. Results (c): For our analyses, we sub-selected individuals with a recent history of alcohol consumption; 143 participants (68%) consumed alcohol in the past 30 days. This sample was mostly black (71%) males (64%). Among this sample, 22 (15.4%) had consumed an MFAC in the past 30 days. A nearly equal proportion of black and white, Hispanic and non-Hispanic, and male and female participants reported consuming these products in this time period. Interestingly, individuals who reported being homeless in the past 30 days were nearly twice as likely to consume an MFAC during this time period compared to those who were not homeless (32% vs. 12%). Conclusions (d): Because of their marketing, these products were thought to largely appeal to youth. Among a national sample of underage youth who consumed alcohol in the past 30 days, 8% (6-11%, 95% CI) reported consuming at least one MFAC in the past 30 days. Recent consumption of MFACs among our sample of high-risk substance using individuals on probation is even greater than these rates. Given the inexpensive cost of per unit of alcohol and large number of calories these products afford, it is possible that these products provide lower socio-economic individuals with added benefits. An examination of the types of users might add to a small literature on how such products are attractive to different groups. Further work might be needed to compare this to other groups or a nationally representative sample.Item Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up(Oxford University Press, 2024-03-16) An, Jinghua; McDougall, Jean; Lin, Yong; Lu, Shou-En; Walters, Scott T.; Heidt, Emily; Stroup, Antoinette; Paddock, Lisa; Grumet, Sherry; Toppmeyer, Deborah; Kinney, Anita Y.PURPOSE: Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. METHODS: We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. RESULTS: At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. CONCLUSION: TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA. TRIAL REGISTRATION: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.Item Serious mental illness and negative substance use consequences among adults on probation(BioMed Central Ltd., 2018-03-22) Rossheim, Matthew E.; Livingston, Melvin D.; Lerch, Jennifer A.; Taxman, Faye S.; Walters, Scott T.BACKGROUND: Adults on probation are at greater risk of both using substances and having a mental disorder compared to the general population. Several theories explain the relationship between substance use and poor mental health. However, the interaction between substance use, mental health, and substance-related consequences is not well understood. A better understanding of this relationship may help treatment programs become more responsive to people with serious mental illness (SMI). METHOD: The current study used interview data from 313 adults on probation who reported recent substance use. We examined associations between SMI risk, substance use, and substance use consequences. RESULTS: A substantial proportion of the sample (37.5%) screened at risk of having a SMI. Adjusting for type and amount of substance use, those who screened at risk of having a SMI reported more negative substance use consequences. Significant interaction effects were observed between use of alcohol or opiates and SMI risk. Alcohol use was associated with more negative substance use consequences among those at risk of SMI, while opiate use was associated with more consequences among those not at risk. CONCLUSIONS: Programs are sorely needed to identify and treat adults with comorbid substance use and mental health symptoms, particularly for adults in the justice system. Clinicians should carefully consider how mental health may interact with substance use to exacerbate consequences.Item State Cannabis Laws, Risk Perceptions, and Delta-8 THC Use among Young Adults(2022-12) LoParco, Cassidy R.; Rossheim, Matthew; Walters, Scott T.; Zhou, ZhengyangBackground: Delta-8 THC, a federally unregulated psychoactive substance, has been rising in popularity. Although no prevalence data exist, calls to U.S. poison control have been increasing. Preliminary research indicates Google search trends relating to Delta-8 THC are higher in states where adult non-medical use of Delta-9 THC is not legal. Theoretical models posit that perceived risk is a theoretical antecedent of risk behavior. However, no research has examined associations between state cannabis laws, perceived risk, and Delta-8 THC use. Methods: Amazon MTURK was utilized to recruit participants aged 18-25-years-old to answer an online survey (n = 603 responses). Rigorous quality control methods were undertaken to ensure the quality of the data, resulting in a final analytic sample size of n = 166. Multivariable logistic regression models were used to examine whether the following factors were associated with the odds of using Delta-8 THC in the past year: 1) state Delta-8 THC laws, 2) state Delta-9 THC laws, 3) Delta-8 THC perceived susceptibility, 4) Delta-8 THC perceived severity, 5) Delta-9 THC perceived susceptibility, 6) Delta-9 THC perceived severity, and 7) past year Delta-9 THC use, adjusting for age, race/ethnicity, birth sex, and student status. Results: Almost one-quarter (22%) used Delta-8 THC in the past year. Associations between state cannabis laws (both Delta-8 and Delta-9 THC) and Delta-8 THC use were not statistically significant. Participants with higher levels of Delta-8 THC perceived susceptibility and Delta-9 THC perceived severity, and lower levels of Delta-8 THC perceived severity and Delta-9 THC perceived susceptibility, had significantly higher odds of using Delta-8 THC in the past year. Those who engaged in Delta-9 THC use in the past year had 14 times the odds of also engaging in Delta-8 THC use. Conclusions: This was the first study to examine how cannabis risk perceptions are associated with Delta-8 THC use. Findings indicated that most Delta-8 THC users were also users of Delta-9 THC, suggesting possible polysubstance use or substitution. Strong, statistically significant associations were observed between cannabis risk perceptions and Delta-8 THC use, which has important implications for harm reduction interventions. Future longitudinal research, with large nationally representative samples, is needed to fully understand associations and potential causality.Item Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial(Informa UK Limited, trading as Taylor & Francis Group, 2022-12-16) Le Compte, Circe G.; Lu, Shou-En; Ani, Julianne; McDougall, Jean; Walters, Scott T.; Toppmeyer, Deborah; Boyce, Tawny W.; Stroup, Antoinette; Paddock, Lisa; Grumet, Sherry; Lin, Yong; Heidt, Emily; Kinney, Anita Y.BACKGROUND: National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. PURPOSE: The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. METHODS: Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. RESULTS: CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. CONCLUSIONS: Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.)Trial registration: ClinicalTrials.gov identifier: NCT03326713.Item Use of a Health Advocacy Model for Survivors of Interpersonal Violence(MDPI, 2020-12-02) Grace, Jessica; Walters, Scott T.; Gallegos, Irene; Thompson, Erika L.; Spence, Emily E.This article examines the implementation of a health advocacy model designed for survivors of interpersonal violence (IPV) in a metropolitan area of North Texas. Using a framework influenced by motivational interviewing, solution-focused therapy, and trauma-informed care, this program engaged IPV survivors in creating health and safety goals. Goal attainment scaling was used to track progress after each health advocacy encounter. Clients could set their own goals for healthcare, self-care, and safety. The program served 419 clients and 648 goals were set by clients at the first visit. Among all goals, 89% selected goals focused on healthcare, with 47% of those selecting obtaining health insurance or coverage as a need. These results demonstrate the need for an enhanced healthcare response for this population. The remaining goals selected were self-care (7%) and safety (3%). The design of the health advocacy intervention shows promise towards filling the gaps between IPV and healthcare service delivery systems.Item Using machine learning to identify predictors of imminent drinking and create tailored messages for at-risk drinkers experiencing homelessness(Elsevier Inc., 2021-04-20) Walters, Scott T.; Businelle, Michael S.; Suchting, Robert; Li, Xiaoyin; Hebert, Emily T.; Mun, Eun-YoungAdults experiencing homelessness are more likely to have an alcohol use disorder compared to adults in the general population. Although shelter-based treatments are common, completion rates tend to be poor, suggesting a need for more effective approaches that are tailored to this understudied and underserved population. One barrier to developing more effective treatments is the limited knowledge of the triggers of alcohol use among homeless adults. This paper describes the use of ecological momentary assessment (EMA) to identify predictors of "imminent drinking" (i.e., drinking within the next 4 h), among a sample of adults experiencing homelessness and receiving health services at a homeless shelter. A total of 78 mostly male (84.6%) adults experiencing homelessness (mean age = 46.6) who reported hazardous drinking completed up to five EMAs per day over 4 weeks (a total of 4557 completed EMAs). The study used machine learning techniques to create a drinking risk algorithm that predicted 82% of imminent drinking episodes within 4 h of the first drink of the day, and correctly identified 76% of nondrinking episodes. The algorithm included the following 7 predictors of imminent drinking: urge to drink, having alcohol easily available, feeling confident that alcohol would improve mood, feeling depressed, lower commitment to being alcohol free, not interacting with someone drinking alcohol, and being indoors. The research team used the results to develop intervention content (e.g., brief tailored messages) that will be delivered when imminent drinking is detected in an upcoming intervention phase. Specifically, we created three theoretically grounded message tracks focused on urge/craving, social/availability, and negative affect/mood, which are further tailored to a participant's current drinking goal (i.e., stay sober, drink less, no goal) to support positive change. To our knowledge, this is the first study to develop tailored intervention messages based on likelihood of imminent drinking, current drinking triggers, and drinking goals among adults experiencing homelessness.Item WHAT REMINDERS DO PROBATIONERS WANT TO ASSIST WITH PROBATION AND TREATMENT GOALS?(2014-03) Spohr, Stephanie A.; Walters, Scott T.; Rodriguez, Mayra; Lerch, Jennifer; Taxman, FayePurpose (a): The development of new web-based interventions provide increased opportunities for delivering text or email reminders around health behavior goals. The purpose of this study was to examine the role of text messaging and email reminders to assist probationers in reaching probation and substance abuse treatment goals. Methods (b): Sample consists of probationers (n=49) in Dallas and Baltimore participating in a randomized controlled trial of in person vs. computer interventions to increase probation compliance. Data from the computer arm were analyzed to determine probationer preference on goal content, timing and reminder method (text, email, or none). Reminder preferences were analyzed according to gender, risk level, age and ethnicity. Results (c): Overall, probationers set an average of 3.80 goals between probation-related (M=1.94, SD=1.03) and treatment-related (M=1.86, SD=1.21) goals. When given the option for electronic reminders, 47% (n=23) opted for no reminder, 24% (n=12) selected email reminder and 29% (n=14) selected text message reminder. Sixty percent of participants over age 35 selected electronic reminders compared to only 46% of those 35 and under. Low-moderate risk offenders (65%) were more willing to select electronic reminders than high risk offenders (35%) but there was no difference in the number of goals selected, (M=3.78, SD=2.06) and (M=3.81, SD=1.91) respectively. Conclusions (d): Persuasive technologies have not been utilized within a criminal justice sample. The use of electronic messaging provides a promising avenue for future behavioral change interventions. Information about probationer preferences for goal reminders, the method of delivery, and timing may help to increase the effectiveness of these interventions.