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Category: Cutting Edge Literature
02/27/2023

Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples’ Prevention, Service, and Care

Crouch MC, Cheromiah Salazar MBR, Harris SJ, Rosich RM. Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples’ Prevention, Service, and Care. Chronic Stress (Thousand Oaks). 2023 Jan 18;7:24705470221149479. doi: 10.1177/24705470221149479. PMID: 36699807; PMCID: PMC9869198.

A qualitative study was conducted to understand the cultural practices and beliefs among American Indian and Alaskan Native (AI/AN) Elders about Alzheimer’s disease and related dementia (ADRD). Interviews investigated the etiology, course, treatment, and cultural meanings of ADRD as well as the social determinants of health related to ADRD and role of substance use disorder. AI/AN tribal Elders are identified as individuals who are designated culture bearers, wisdom holders, and role models in their respective communities. Twelve AI/AN Elders (mean age=73) who speak English participated in semi-structured interviews. The sample was predominantly female (66.7%), Athabascan Tribal heritage (58.3%) and retired (66.7%). All participants had a family member with ADRD but did not themselves have an ADRD diagnosis. Qualitative analyses identified 6 themes of etiology, barriers to treatment, and social determinants: (1) postcolonial distress; (2) substance misuse; (3) distrust of Western medicine; (4) structural inequities; (5) walking in two worlds; and, (6) decolonizing and indigenizing medicine. Findings highlight potential causal factors in disease development and manifestation as viewed by AI/AN Elders. This study exemplified historical and ongoing discrimination and stress in Western medicine and the importance of adopting a holistic view to address cultural health disparities.

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01/10/2023

Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent)

Bolinski F, Kleiboer A, Neijenhuijs K, Karyotaki E, Wiers R, de Koning L, Jacobi C, Zarski A, Weisel K, Cuijpers P, Riper H. Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent). J Med Internet Res 2022;24(12):e40892. DOI: 10.2196/40892

This study described recruitment challenges for a transdiagnostic, web-based prevention program and presented initial analysis on the intervention’s effectiveness on depression and anxiety symptoms. The study was a 3-arm randomized controlled trial with students (at least 16 years old) with subclinical symptoms of depression and anxiety to compare individually guided and automatically guided versions of ICare Prevent versus care as usual. ICare Prevent is a web-based and mobile-supported intervention for prevention of depression and anxiety. ICare Prevent is a 7-session web-based program (45-60 minutes each) and participants were instructed to complete 1-2 sessions weekly. ICare Prevent also provides elective modules and diaries that target factors common to mood and anxiety problems (i.e., sleep, alcohol use, positive activities). The individually guided version provided structured and personalized feedback on exercises and the automatically guided version provided standard and computerized feedback after each session. The study’s original recruitment goal was 252 student participants. Various strategies of recruitment were used, including social media campaigns on Facebook and Instagram, printed advertising at universities, paid participant platform, and other collaborations. Direct recruitment using students’ email addresses via the student administration was the most effective strategy. Despite these strategies, data was available for only 35 participants (individually guided: n=14, automatically guided: n=8, care as usual: n=13). Participants provided self-reported depression and anxiety symptoms at baseline, 6-month, and 12-month follow-up. Log data from the intervention platform showed low usage, with an average of 3 out of 7 sessions completed. Results did not show sufficient evidence of intervention effects on depression and anxiety over time in any intervention arm. Overall, recruitment for this population was challenging and more research is needed to identify factors to better engage college students in research studies.

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01/03/2023

Effect of Mobile Phone App–Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials

Qin M, Chen B, Sun S, Liu X.Effect of Mobile Phone App–Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022;24(12):e39799 DOI: 10.2196/39799

A systematic review and meta-analysis was conducted to investigate the effectiveness of mobile phone app interventions on quality of life (QOL) and psychological outcomes in adult cancer patients. Researchers identified randomized controlled trial studies evaluating apps that targeted adults with cancer and QOL or psychological symptoms. In total, 30 randomized controlled trials with a total of 5,353 patients were included in the meta-analysis. App interventions included health education, physician-patient communication, or data management regarding patient self-monitoring behaviors. On average, interventions were conducted over 2.8 months. Compared with standard care, app interventions significantly improved QOL (Standardized Mean Difference (SMD)=0.39, p<.001) and self-efficacy (SMD=0.15, p=.03) and reduced anxiety (SMD=0.64, p<.001), depression (SMD=-0.33, p=.009), and distress (SMD=-0.34, p=.01) symptoms. Subgroup analyses were also conducted for intervention duration, type of cancer, theoretical approach, treatment category, and intervention delivery (interactive 2-way communication format versus 1-way communication format). Short-term (<3 months) interventions were found to have higher effectiveness compared to longer term interventions for QOL, anxiety and depression. However, given that only 9 studies were longer than 3 months, there is a need for further research on the long-term effects of these app interventions. Apps that included physician-patient communication and that were based on cognitive behavioral therapy were most effective for improving QOL and psychological outcomes. Overall, results provide evidence for the effectiveness of mobile phone app interventions on QOL and psychological outcomes, however caution is needed in the over-interpretation of findings due to high heterogeneity across the studies.

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12/22/2022

The Use of Close Friends on Instagram, Help-Seeking Willingness, and Suicidality Among Hong Kong Youth: Exploratory Sequential Mixed Methods Study

Chen S, Lam T, Lam K, Lo T, Chao D, Mak K, Lam E, Tang W, Chan H, Yip P. The Use of Close Friends on Instagram, Help-Seeking Willingness, and Suicidality Among Hong Kong Youth: Exploratory Sequential Mixed Methods Study. J Med Internet Res 2022;24(10):e37695 DOI: 10.2196/37695

This study examined youths’ private social media use via a new Instagram feature, Close Friends, and its relationship with online and offline help-seeking willingness and suicidality. The Close Friends Instagram feature allows private online interaction by permitting invited users only to view private posts. Forty youth participants aged 15-19 years old residing in Hong Kong were recruited. The motivations for using Close Friends and concerns regarding online expression were addressed in focus groups and individual interviews. A quantitative survey was also conducted among a larger sample of 1,676 students aged 15-19 years old in Hong Kong to examine the prevalence of Close Friends usage, online and offline help-seeking willingness, and suicide-related experiences. Focus group and interview data revealed common motives for using Close Friends to include interaction and seeking help from friends, release of negative emotions, and venting and self-expression. Survey results found 71% of youth use Close Friends and 46% use frequently. Overall, seeking help online was associated with higher risk of suicidality (Odds Ratio=1.50, 95% CI 1.04-2.15) and seeking help offline was associated with decreased suicidality (Odds Ratio=0.55, 95% CI 0.39-0.75). Close Friends users were significantly more likely to seek offline support than non-users, but frequent Close Friends users were more likely to seek help online and to be at higher risk of suicidality than non-users. Prevalent use of Close Friends represents an emerging trend for online expression and private conversation among youth. Excessive use of this feature may indicate more limited offline support or less desirable offline support for youth experiencing suicidality. Authors recommend future steps in determining the causal relationship between use of Close Friends and willingness to seek help.

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12/19/2022

An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach

Barr P, Haslett W, Dannenberg M, Oh L, Elwyn G, Hassanpour S, Bonasia K, Finora J, Schoonmaker J, Onsando W, Ryan J, Bruce M, Das A, Arend R, Piper S, Ganoe C. An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach. J Med Internet Res 2021;23(10):e25512 DOI: 10.2196/25512

This paper describes the user-centered development of HealthPAL, an audio personal health library for patients to collect and organize clinic audio recordings. Forty participants representative of older patients and caregivers were recruited from community settings. Participants gave feedback during 5 rounds of usability sessions. In the first three sessions, researchers used paper prototypes and focused on features to refine the user interface. In rounds 4 and 5, participants moved to low-fidelity and high-fidelity software versions of HealthPAL. Participants listened to a primary care visit recording before completing a series of typical user tasks (e.g., find where the provider describes a possible surgery). In the final session, patients’ actual primary care clinic visits were recorded. Perceived usability was collected at each session with the System Usability Scale and whether tasks were completed independently, with the assistance of a facilitator, or not completed. Results found usability increased over the rounds and in the final round where participants reported a score of 78.2 on average (range 20-100). By the final round, participants were able to complete most tasks (at least 88%) without any assistance. Participants also reported very positive perceptions of having a curated audio recording of a clinic visit. Concerns reported were related to privacy and computer literacy required to access recordings. Overall, HealthPAL was rigorously co-designed with patients and their caregivers; next steps include further field testing of the first patient-centered app to access recordings of clinic visits. Sharing visit audio recordings with patients is an emerging strategy for the goal of improving transparency and communication in healthcare.

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12/05/2022

A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial

Brody C, Chhoun P, Tuot S, Fehrenbacher A, Moran A, Swendeman D, Yi S. A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial. J Med Internet Res 2022;24(1):e27696 DOI: 10.2196/27696

This study evaluated the efficacy of the Mobile Link intervention to improve female entertainment workers’ (FEW) health through engagement and connection to HIV, sexual and reproductive health, and gender-based violence services. In Cambodia, FEWs are employed at karaoke bars, restaurants, bars, and massage parlors and many exchange sex to supplement their income. Researchers conducted a randomized controlled trial in the capital city and 3 other regions in Cambodia with high numbers of FEWs and HIV prevalence. Eligible participants were aged 18-30 years, working as a FEW, sexually active, and owned a mobile phone. Participants were randomized to the Mobile Link intervention arm (n=218) or to the control arm (standard care; n=170). For 60 weeks, participants in the Mobile Link arm received automated twice-weekly text messages and voice messages with health information and direct links to community outreach workers. Outcomes included self-reported HIV and sexually transmitted infection (STI) testing, condom use, and contraceptive use at baseline and 6- and 12-month follow up. Results showed significant improvements in HIV and STI testing, condom use, and contraceptive use in both arms. The Mobile Link intervention was effective in connecting FEWs with outreach workers – contact increased by 61% in the intervention arm compared to a decrease of 30% in the control arm. Additionally, participants in the intervention arm reported significant reductions in forced drinking behavior at work from supervisors or peers compared to those in the control arm. Although there were no differences in the main outcomes, the Mobile Link intervention may be helpful in linking to outreach workers and could be potentially implemented among other populations in Cambodia, perhaps as an adjunct to standard care. Future research may consider using longer-term messaging to increase access to services and impact health outcomes.

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11/29/2022

Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems

Kählke F, Buntrock C, Smit F, Ebert DD. Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems. npj Digit. Med. 5, 175 (2022). https://doi.org/10.1038/s41746-022-00702-w

A systematic review was conducted to summarize the cost-effectiveness of internet and mobile-based interventions (IMIs) for mental health disorders and symptoms. This review also assessed methodological quality of included studies. The literature search identified studies of psychological interventions provided in an online setting to treat mental health disorders or any type of psychological symptoms regardless of participant age. Studies had to be randomized controlled trials that included a full economic evaluation. A total of 4,044 articles were identified, of which 36 articles met eligibility criteria. Sixty-five economic evaluations were conducted. The most commonly targeted mental health problem was major depressive disorder or depressive symptoms, followed by anxiety. Cost-effectiveness was determined using the threshold of at or below £30,000 per quality-adjusted life year (QALY) gained. Overall, the majority of economic evaluations of IMIs (n=56) presented evidence of cost-effectiveness. Guided IMIs (i.e., interventions that include support by a provider via email, chat, or automated feedback delivery) were likely to be cost-effective in depression and anxiety studies. Methodological quality of the cost-effectiveness analyses was mostly evaluated as good, however a few studies showed high risk of bias. Researchers found high heterogeneity across studies due to factors such as costing methods, design, comparators, and outcomes used. Overall, these findings suggest the cost-effectiveness of IMIs and include new evidence in under-researched disorders such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), stress, and sleep. Future research is needed to continue to target underrepresented disorders (e.g., panic disorder and specific phobias), as well as research in low- and middle-income countries.

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11/21/2022

Use of telemedicine for opioid use disorder treatment – Perceptions and experiences of opioid use disorder clinicians

Riedel L, Uscher-Pines L, Mehrotra A, Busch AB, Barnett ML, Raja P, & Huskamp HA. (2021). Use of telemedicine for opioid use disorder treatment – Perceptions and experiences of opioid use disorder clinicians. Drug and Alcohol Dependence, 228, 108999–108999. https://doi.org/10.1016/j.drugalcdep.2021.108999

Researchers conducted a national online survey to assess clinician use of and perspectives about telemedicine for opioid use disorder (OUD) during the COVID-19 pandemic. Clinicians, including psychiatrists, nurse practitioners, primary care providers, and physician assistants, were recruited from WebMD/Medscape’s online panel (N=602). The survey focused on the use of telemedicine to treat OUD in the last month. Questions included clinician training, patient population served, OUD visit delivery, barriers to telemedicine, and opinions on effectiveness of telemedicine. Findings showed that on average 57% of visits were via telemedicine. The majority of clinicians (63%) reported telemedicine was as effective as in-person care. Ninety percent said they were comfortable using video for clinically stable patients and 49% said the same for clinically unstable patients. Seventy percent of clinicians preferred to return to in-person care following the pandemic, but 95% wanted to continue to offer telemedicine in some form. Significantly higher comfort levels were found among clinicians with at least 30% of their patient caseload composed of those with OUD compared to clinicians with fewer patients with OUD. Further, clinicians with at least 60% Medicaid and uninsured patients were significantly more likely to have conducted visits via audio-only methods and also preferred to continue using telemedicine after the pandemic compared to those with fewer Medicaid patients. These findings could inform how telemedicine is used for OUD treatment moving forward; however, there remains uncertainty about the use of audio-only visits and reimbursement levels.

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11/14/2022

Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors

Gabrielli J, Corcoran E, Genis S, McClure AC, Tanski SE. Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors. J Youth Adolescence 51, 100–113 (2022). https://doi.org/10.1007/s10964-021-01397-0

This study described alcohol brand depictions in television and evaluated the impact of exposure to these depictions on adolescent drinking outcomes. Ten popular scripted television series, broadcast, cable, or online, were content coded for alcohol depictions. Appearances of alcohol brands were coded based on logo/name and salience (how notable the brand appearance was in the series). Adolescents and young adults aged 15-23 years old (N=2,012) were recruited to complete online surveys and interviews at baseline and follow-up one year later. During the interviews and surveys, alcohol consumption, brand affiliation (usual brand to drink), and television exposure to alcohol brands (based on how often they watched the ten content coded series) was assessed. On average, alcohol brands appeared more than twice per episode and Budweiser brand appeared the most often across all television series. The majority (77%) of adolescents reported having seen at least one of the ten television series. Adjusting for covariates (i.e., peer/parent drinking, sensation seeking, alcohol brand exposure in movies), higher exposure to brand appearances in television was associated with alcohol outcomes. Higher number of television alcohol brand appearances was associated with adolescent brand affiliation; television brand exposure was associated with drinking initiation and harmful drinking behaviors. Overall, these results suggest the influence that marketing, through streaming media, has on youth viewers’ alcohol use behavior. Future studies should assess mechanisms such as subjective norms and beliefs to better inform interventions that might mitigate the risks associated with media depictions of alcohol. Additionally, alcohol marketing should be further evaluated to consider strategies to limit the negative impact of media exposure.

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