Publications by authors named "Christina S Lee"

44 Publications

Culturally adapted evidence-based treatments for adults with substance use problems: A systematic review and meta-analysis.

Drug Alcohol Depend 2021 Jun 24;226:108856. Epub 2021 Jun 24.

Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA.

Background: This systematic review/meta-analysis aimed to synthesize empirical evidence from randomized controlled trials on the efficacy of culturally adapted interventions (CAIs) for substance use and related consequences for adults of color.

Methods: Six electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression to synthesize effect size estimates and conduct moderator analyses.

Results: Twenty-two studies met the inclusion criteria and were included in the review. The overall effect size was 0.23 (95 % Confidence Interval [CI] = 0.12, 0.35). The subgroup effect sizes for comparing CAIs with inactive controls and with active controls were 0.31 (CI = 0.14, 0.48) and 0.14 (CI=-0.02, 0.29), respectively. The effect sizes for alcohol use, illicit drug use, unspecified substance use outcomes, and substance use related consequences were 0.25 (CI = 0.08, 0.43), 0.35 (CI =-0.30, 1.00), 0.22 (CI=-0.17, 0.62), and 0.02 (CI=-0.11, 0.16), respectively. Moderator analysis showed that CAIs' effects might not vary significantly by treatment model, dose, country, follow-up assessment timing, participant age, or gender/sex.

Conclusions: Research on substance use interventions that are culturally adapted for people of color is growing, and more high-quality studies are needed to draw definitive conclusions about CAIs' treatment effects. Our study found CAIs to be a promising approach for reducing substance use and related consequences. We call for more efficacy/effectiveness and implementation research to further advance the development and testing of evidence-based CAIs that meet the unique needs and sociocultural preferences of diverse populations.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108856DOI Listing
June 2021

Structural racism and reflections from Latinx heavy drinkers: Impact on mental health and alcohol use.

J Subst Abuse Treat 2021 Aug 16;127:108352. Epub 2021 Mar 16.

Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Alpert Medical School of Brown University, 121 South Main St., Providence, RI 02912, USA.

Background: Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption.

Methods: Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis.

Results: Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood.

Conclusions: Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.
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http://dx.doi.org/10.1016/j.jsat.2021.108352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217720PMC
August 2021

Motivational interviewing telephone counseling to increase postpartum maintenance of abstinence from tobacco.

J Subst Abuse Treat 2021 Apr 22;132:108419. Epub 2021 Apr 22.

Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown School of Public Health, Providence, RI, USA. Electronic address:

Although many women quit smoking while pregnant, rates of relapse after delivery are high. We examined the effectiveness of motivational interviewing (MI) in maintaining postpartum abstinence from smoking among pregnant women who recently quit smoking (N = 382), randomized to receive five brief MI phone counseling calls or to a prenatal and postpartum care as usual control condition. Relapse to smoking was assessed at 3, 6, and 12 months postpartum based on self-report and urine cotinine. Cox regressions compared conditions on relapse outcomes and hazard ratio of total number of MI calls was examined to probe dose-response effects. Results revealed no difference in the hazard ratio of relapse between treatment condition and no dose-response effect of total number of MI calls. Phone counseling in the prenatal and postpartum period did not facilitate maintenance of abstinence among new mothers. Considerations for future intervention development studies on relapse prevention during the postpartum period are discussed.
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http://dx.doi.org/10.1016/j.jsat.2021.108419DOI Listing
April 2021

Examining client self-exploration in motivational interviewing: Preliminary psychometrics of an observational rating measure.

J Subst Abuse Treat 2021 Mar 5;129:108345. Epub 2021 Mar 5.

Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America. Electronic address:

Purpose: We examine in-session self-exploration among Latinx heavy drinkers who received a motivational interview (MI) to reduce heavy drinking. The goals of this study are to report the validity and reliability of an adaptation of the Global Client Rating for Self-Exploration from the Motivational Interviewing Skill Code (MISC SE).

Method: The study measured the MISC SE as three subscales (Emotional, Cognitive, New Learning/Developing Discrepancy SE) to assess underlying processes that might allow for higher predictive validity in relation to behavioral change (drinking) outcomes. The study created a dichotomous variable, Personally Relevant Vulnerable Making (PR-VM), to distinguish the disclosure of particularly sensitive material related to drinking behavior. The study used the measure of Everyday Discrimination as a criterion variable for the PR-VM measure. The study collected observationally rated data for n = 158 participants.

Results: Subscales showed moderate correlations with the MISC SE (r = 0.421 to 0.574, p < .001). The MISC SE was not associated with number of drinking days or percent heavy drinking days at 3-month follow-up. Cognitive and New Learning/Developing Discrepancy SE were associated with fewer drinking days (r = -0.247 to -0.266, p < .005), and Cognitive SE was associated with percent heavy drinking days (r = -0.169, p < .05), Subscale interrater reliability was comparable to the MISC SE (ICC = 0.72 to 0.86). The study observed higher mean scores on the Everyday Discrimination scale when session PR-VM was present than when not present (t (df = 118) = -3.02, p < .005).

Conclusions: The subscale adaptation of the SE measure may provide a sensitive approach to understanding how self-exploration relates to behavior change in the context of MI.
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http://dx.doi.org/10.1016/j.jsat.2021.108345DOI Listing
March 2021

Comparing the effects of emotional disclosure and peer helping writing on psychological distress among Chinese international students: The moderating role of rumination.

J Clin Psychol 2021 Jul 6;77(7):1556-1572. Epub 2021 Apr 6.

Department of Applied Psychology, New York University Steinhardt, New York, New York, USA.

Objectives: This study tested the effects of emotional disclosure writing and peer helping writing in reducing psychological distress among Chinese international students. This study also examined whether rumination and ambivalence over emotion expression moderated the effects of emotional disclosure and peer helping writing.

Method: One hundred forty-four Chinese international students were randomly assigned to one of three conditions: emotional disclosure, peer helping, or neutral control writing. Participants completed two 20-min writing sessions and questionnaires at baseline, 2-month follow-up, and 4-month follow-up.

Results: We found no significant differences across the three writing conditions in levels of psychological distress over time. However, rumination emerged as a significant moderator in both emotional disclosure and peer helping intervention conditions. High ruminators generally experienced significant reductions in depressive symptoms, whereas low ruminators experienced increased depressive symptoms.

Conclusions: These findings demonstrate that the benefits of writing interventions may vary as a function of rumination.
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http://dx.doi.org/10.1002/jclp.23135DOI Listing
July 2021

Trends and correlates of Internet support group participation for mental health problems in the United States, 2004-2018.

J Psychiatr Res 2021 01 16;132:136-143. Epub 2020 Oct 16.

School of Social Work, Boston College, Boston, MA, 02467, United States.

Purpose: This study sought to examine the trends in Internet support group (ISG) participation among U.S. adults and to investigate the sociodemographic and behavioral health profiles of ISG participants.

Methods: Data was derived from the National Survey on Drug Use and Health (2004-2018, n = 625,883). Logistic regression was used to examine significance of trend year and correlates of ISG participation. Latent class analysis was conducted to identify subtypes of ISG participants.

Results: The proportion of U.S. adults participating in ISG increased significantly from 2.29% (2004-2007) to 3.55% (2016-2018). ISG participants were less likely to be male, 35 or older, be part of an ethnic/racial minority group, or have household incomes between $20,000 and $49,999. Black/African American participants and those classified as "other" race showed the largest percent increases, while Hispanics showed no change. ISG participants were more likely to have experienced a depressive episode and to have used cannabis. Three subtypes of ISG participants were identified, including the Lower Behavioral Health Risk group (62%), the Elevated Behavioral Health Risk group (24%), and the Depression, Cigarettes, and Cannabis group (14%).

Conclusion: Overall, we found an increasing trend in seeking mental health care through ISG among US adults since the early 2000s. While disparities among some disadvantaged groups such as Blacks/African Americans and individuals with lower household income were diminishing, continuing efforts to engage men, older adults, and Hispanics in ISG are needed. This investigation also identified distinct subtypes of ISG participants and provides important implications for future research on ISG.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566800PMC
January 2021

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers.

J Clin Psychol 2020 10 29;76(10):1832-1850. Epub 2020 May 29.

Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island.

Objective: Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators.

Methods: Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates.

Results: Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months).

Conclusions: Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.
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http://dx.doi.org/10.1002/jclp.22976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487011PMC
October 2020

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs.

J Consult Clin Psychol 2019 Sep;87(9):815-830

Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School.

Objective: This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored.

Method: Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months.

Results: Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]).

Conclusions: Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137580PMC
September 2019

G protein-coupled receptor kinase 5 modifies cancer cell resistance to paclitaxel.

Mol Cell Biochem 2019 Nov 30;461(1-2):103-118. Epub 2019 Jul 30.

Roseman University of Health Sciences School of Pharmacy, 11 Sunset Way, Henderson, NV, 89014, USA.

G protein-coupled receptor kinases (GRKs) phosphorylate the activated forms of G protein-coupled receptors (GPCRs), leading to receptor desensitization and internalization. In addition, GRKs can modify the activity of many non-GPCR-signaling pathways as well, controlling other cellular functions beyond that directly associated with a GPCR. In this report, we show that cervical cancer HeLa cells and breast cancer MDA MB 231 cells with reduced GRK5 expression display increased sensitivity to the apoptotic effects of paclitaxel (Taxol). This effect in cancer cells with low GRK5 levels could be because of blunted histone deacetylase 6 (HDAC6) activity that leads to an increase in α-tubulin acetylation levels, which augments paclitaxel sensitivity. We demonstrate that GRK5 and HDAC6 form a signaling complex in cells and in vitro. GRK5 phosphorylates HDAC6 at Ser-21 to promote its deacetylase activity. Therefore, the GRK5-HDAC6 interaction may contribute to paclitaxel resistance in cancer cells.
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http://dx.doi.org/10.1007/s11010-019-03594-9DOI Listing
November 2019

Brief Report: Low-Barrier Buprenorphine Initiation Predicts Treatment Retention Among Latinx and Non-Latinx Primary Care Patients.

Am J Addict 2019 09 28;28(5):409-412. Epub 2019 Jun 28.

Department of Adult Medicine, South End Community Health Center, Boston, Massachusetts.

Background And Objectives: Patients are at risk of dropout while waiting for buprenorphine treatment. Study goals are to compare 3-month retention in two different methods to buprenorphine initiation among persons with opioid use disorder.

Methods: We compared 3-month treatment retention rates of low-barrier buprenorphine initiation (i.e., rapid induction) (n =58) or a traditional method of buprenorphine initiation ( n = 45) for persons with opioid use disorder seen at an urban community health center.

Results: Logistic regression revealed that low-barrier initiation had 11.11 greater odds of retention compared with traditional methods (p <0.001). Latinx patients benefited more than non-Latinx patients (OR = 14.79, p =.039).

Discussion And Conclusions: All patients were more likely to be retained using low-barrier initiation. A significantly larger effect on retention among Latinx patients was observed.

Scientific Significance: Rapid buprenorphine initiation increases treatment retention which improves treatment outcomes for persons with opioid use disorder. Study findings support a less restrictive services model that is even more effective for Latinx patients. (Am J Addict 2019;28:409-412).
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http://dx.doi.org/10.1111/ajad.12925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706284PMC
September 2019

Gender differences in drinking behavior among Latino/a heavy drinkers.

Int J Drug Policy 2019 02 24;64:79-86. Epub 2018 Dec 24.

Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.

Background: In the United States (U.S.), higher levels of acculturation have been associated with higher rates of heavy alcohol use more consistently among Latino women than among Latino men. This paper explores mechanisms underlying the link between acculturation and alcohol use among Latino/as in the U.S. We examine alcohol use expectancies and motives from the perspectives of the social cognitive theory of gender development.

Methods: Qualitative narratives data from six focus groups of individuals (total n = 37), who met criteria for heavy drinking (4/5 drinks/occasion for females/males), were examined separately by gender (18 females; 19 males). Coded narratives data were analyzed using a framework that compared lives in Latin America and in the U.S. Emergent themes were analyzed for their consistency across genders. Gender-specific themes were identified.

Results: Changes in family structure and the loss of social networks prompted divergent patterns of drinking among men and women, such that relative to patterns in their countries of origin, drinking among Latino women increased while it decreased among Latino men. Men and women reported drinking to replace missing social bonds, a motive not frequently reported in the literature on drinking motives. Women who engaged in heavy-drinking nonetheless described traditional gender role expectations after U.S. arrival. Only men endorsed positive alcohol expectancies in Latin America. Women reported drinking to alleviate psychological distress in the U.S.

Conclusions: Pre and post-immigration comparisons revealed different drinking trajectories among men and women after immigration to the U.S. These patterns appeared to be influenced by new social contexts and changes in familial expectations regarding women's roles. Future inquiry that examines gender-specific themes in alcohol expectancies and motives unique to the experience of immigration, is warranted.
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http://dx.doi.org/10.1016/j.drugpo.2018.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526373PMC
February 2019

Gender differences in drinking behavior among Latino/a heavy drinkers.

Int J Drug Policy 2019 02 24;64:79-86. Epub 2018 Dec 24.

Department of Psychiatry & Human Behavior, Center for Alcohol & Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.

Background: In the United States (U.S.), higher levels of acculturation have been associated with higher rates of heavy alcohol use more consistently among Latino women than among Latino men. This paper explores mechanisms underlying the link between acculturation and alcohol use among Latino/as in the U.S. We examine alcohol use expectancies and motives from the perspectives of the social cognitive theory of gender development.

Methods: Qualitative narratives data from six focus groups of individuals (total n = 37), who met criteria for heavy drinking (4/5 drinks/occasion for females/males), were examined separately by gender (18 females; 19 males). Coded narratives data were analyzed using a framework that compared lives in Latin America and in the U.S. Emergent themes were analyzed for their consistency across genders. Gender-specific themes were identified.

Results: Changes in family structure and the loss of social networks prompted divergent patterns of drinking among men and women, such that relative to patterns in their countries of origin, drinking among Latino women increased while it decreased among Latino men. Men and women reported drinking to replace missing social bonds, a motive not frequently reported in the literature on drinking motives. Women who engaged in heavy-drinking nonetheless described traditional gender role expectations after U.S. arrival. Only men endorsed positive alcohol expectancies in Latin America. Women reported drinking to alleviate psychological distress in the U.S.

Conclusions: Pre and post-immigration comparisons revealed different drinking trajectories among men and women after immigration to the U.S. These patterns appeared to be influenced by new social contexts and changes in familial expectations regarding women's roles. Future inquiry that examines gender-specific themes in alcohol expectancies and motives unique to the experience of immigration, is warranted.
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http://dx.doi.org/10.1016/j.drugpo.2018.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526373PMC
February 2019

Immune thrombocytopenia is associated with persistently deranged fibrosis-related seromarker profiles but low bone marrow fibrosis grades: A 2-year observational study on thrombopoietin receptor agonist treatment.

Platelets 2019 2;30(2):222-228. Epub 2018 Jan 2.

d Department of Pediatrics, Division of Hematology/Oncology , Weill Cornell Medical College , New York, NY , USA.

Bone marrow (BM) fibrosis is a potential side effect of thrombopoietin receptor agonist (TPO-RA) treatment. We aimed to investigate stromal seromarker profiles and growth factors in order to elucidate pathogenic and dynamic aspects of immune thrombocytopenia (ITP)-related BM fibrosis before and during TPO-RA treatment. Connective tissue metabolites [procollagen I and III peptides (PINP/PIIINP); hyaluronan (HYA), C-terminal-telopeptide (ICTP), and fibrosis-related growth factors (transforming growth factor-beta (TGF-beta), HGF, basic fibroblast growth factor)] were measured in blood samples acquired before initiation of TPO-RA and subsequently at 6-month intervals for up to 2 years. BM fibrosis was graded MF-0 in 8 (18%), MF-1 30 (65%), and MF-2 8 (18%) in the last available BM biopsy. In the 21 patients having more than one biopsy, the grade of fibrosis from the first to the last available biopsy decreased in 2 (10%), remained unchanged in 15 (71%), and increased in 4 (19%). Pretreatment levels of PIIINP, PINP, ICTP, and HYA were significantly increased in ITP versus controls. PINP, PIIINP, and HYA decreased on TPO-RA; ICTP remained unchanged. PINP:ICTP was lower before and during treatment compared to controls. Pretreatment, TGF-beta was lower than in controls; HGF exhibited the opposite pattern. HYA, ICTP, and TGF-beta tended to increase while PINP and platelet-derived growth factor tended to decrease with increasing fibrosis grade. In conclusion, ITP is associated with deranged patterns of extracellular matrix seromarkers and growth factors, indicating that BM stromal remodeling is enhanced. During TPO-RA treatment for up to 2 years, this profile was partially reversed while mild BM reticulin fibrosis was still present in the majority of patients. These observations likely reflect a BM injury by autoimmunity that is modified by TPO-RA.
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http://dx.doi.org/10.1080/09537104.2017.1411586DOI Listing
April 2019

Treatment of Children with Persistent and Chronic Idiopathic Thrombocytopenic Purpura: 4 Infusions of Rituximab and Three 4-Day Cycles of Dexamethasone.

J Pediatr 2017 12;191:225-231

Division of Pediatric Hematology, Weill Cornell Medicine, New York, NY.

Objectives: To assess initial and long-term outcome of children with persistent/chronic idiopathic thrombocytopenic purpura (ITP) treated with 4 infusions of rituximab and three 4-day cycles of dexamethasone (4R+3Dex) including cohorts with most benefit and/or treatment associated toxicity.

Study Design: All pediatric patients with ITP at Weill-Cornell who received 4R+3Dex were included in this retrospective study. Duration was median time from first rituximab infusion to treatment failure. Patient cohort included 33 children ages 1-18 years with persistent/chronic ITP; 19 were female, 10 of whom were adolescents. Every patient had failed more than 1 and usually several ITP treatments.

Results: Children were treated with rituximab, 375 mg/m weekly for 4 weeks and three 4-day courses of dexamethasone 28 mg/m (40 mg max). Average age of nonresponders was 7.75 years, and initial responders averaged 12.7 years (P = .0073); 30% maintained continuing response at 60 months or last check-up. Eight of the 10 patients who underwent remission were female with ITP <24 months prior to initiating 4R+3Dex. All responding male patients except 2 relapsed.

Conclusions: Durable unmaintained ITP remission after 4R+3Dex was seen almost exclusively in female adolescents with <24 months duration of ITP. This provides a new therapeutic paradigm for a subpopulation with hard-to-treat chronic ITP. The pathophysiology of ITP underlying this distinction requires further elucidation.
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http://dx.doi.org/10.1016/j.jpeds.2017.08.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020036PMC
December 2017

Cross-Sectional Study of Risky Substance Use by Injured Emergency Department Patients.

West J Emerg Med 2017 Apr 13;18(3):345-348. Epub 2017 Mar 13.

Brown University, Department of Emergency Medicine, Providence, Rhode Island.

Introduction: Survey data regarding the prevalence of risky substance use in the emergency department (ED) is not consistent. The objective of this study was to identify the prevalence of risky substance use among injured ED patients based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.0). A secondary objective was to report on the feasibility of administering the ASSIST to this population, based on the time to conduct screening.

Methods: This cross-sectional study used screening data from a randomized controlled trial. Injured ED patients completed the ASSIST on a tablet computer, and an ASSIST score was computed that indicated the need for a brief or intensive treatment intervention (risky use) for alcohol and other substances. For a subsample, data on time to complete each step of screening was recorded.

Results: Between July 2010 and March 2013, 5,695 patients completed the ASSIST. Most (92%) reported lifetime use of at least one substance and 51% reported current risky use of at least one substance. Mean time to complete the ASSIST was 5.4 minutes and screening was considered feasible even when paused for clinical care to proceed.

Conclusion: Estimates of risky substance use based on the ASSIST in our large sample of injured ED patients were higher than previously reported in other studies of ED patients, possibly due to the current focus on an injured population. In addition, it was feasible to administer the ASSIST to patients in the course of their clinical care.
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http://dx.doi.org/10.5811/westjem.2017.1.32180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391882PMC
April 2017

Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge.

Am J Addict 2017 Oct 21;26(7):667-672. Epub 2017 Mar 21.

Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island.

Objectives: Few studies have explored predictors of entry into and retention in buprenorphine treatment following linkage from an acute medical hospitalization.

Methods: This secondary analysis of a completed clinical trial focuses on medically hospitalized, opioid-dependent patients (n = 72) who were randomized to an intervention including buprenorphine induction and dose stabilization during hospitalization followed by post-discharge transition to office-based buprenorphine treatment (OBOT). Predictors included demographics, days hospitalized, prior buprenorphine/methadone treatment, PTSD symptoms, social support, and readiness for drug use cessation. Outcome variables were treatment entry and retention (number of days in OBOT).

Results: Previous buprenorphine treatment, more days hospitalized, and higher PTSD symptoms predicted OBOT entry. Prior treatment, older age, and non-minority status were associated with a higher mean number of days in OBOT.

Conclusions: OBOT may appeal to patients who have tried buprenorphine in other settings. Linking hospitalized patients to OBOT may improve utilization of addiction treatment.

Scientific Significance: Prior substance treatment, longer hospital stay, and mental health should be examined in future linkage studies. (Am J Addict 2017;26:667-672).
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http://dx.doi.org/10.1111/ajad.12533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608622PMC
October 2017

Characterization of the interplay between DNA repair and CRISPR/Cas9-induced DNA lesions at an endogenous locus.

Nat Commun 2017 01 9;8:13905. Epub 2017 Jan 9.

Editas Medicine, 11 Hurley Street, Cambridge, Massachusetts 02141, USA.

The CRISPR-Cas9 system provides a versatile toolkit for genome engineering that can introduce various DNA lesions at specific genomic locations. However, a better understanding of the nature of these lesions and the repair pathways engaged is critical to realizing the full potential of this technology. Here we characterize the different lesions arising from each Cas9 variant and the resulting repair pathway engagement. We demonstrate that the presence and polarity of the overhang structure is a critical determinant of double-strand break repair pathway choice. Similarly, single nicks deriving from different Cas9 variants differentially activate repair: D10A but not N863A-induced nicks are repaired by homologous recombination. Finally, we demonstrate that homologous recombination is required for repairing lesions using double-stranded, but not single-stranded DNA as a template. This detailed characterization of repair pathway choice in response to CRISPR-Cas9 enables a more deterministic approach for designing research and therapeutic genome engineering strategies.
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http://dx.doi.org/10.1038/ncomms13905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227551PMC
January 2017

Characterization of the interplay between DNA repair and CRISPR/Cas9-induced DNA lesions at an endogenous locus.

Nat Commun 2017 01 9;8:13905. Epub 2017 Jan 9.

Editas Medicine, 11 Hurley Street, Cambridge, Massachusetts 02141, USA.

The CRISPR-Cas9 system provides a versatile toolkit for genome engineering that can introduce various DNA lesions at specific genomic locations. However, a better understanding of the nature of these lesions and the repair pathways engaged is critical to realizing the full potential of this technology. Here we characterize the different lesions arising from each Cas9 variant and the resulting repair pathway engagement. We demonstrate that the presence and polarity of the overhang structure is a critical determinant of double-strand break repair pathway choice. Similarly, single nicks deriving from different Cas9 variants differentially activate repair: D10A but not N863A-induced nicks are repaired by homologous recombination. Finally, we demonstrate that homologous recombination is required for repairing lesions using double-stranded, but not single-stranded DNA as a template. This detailed characterization of repair pathway choice in response to CRISPR-Cas9 enables a more deterministic approach for designing research and therapeutic genome engineering strategies.
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http://dx.doi.org/10.1038/ncomms13905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227551PMC
January 2017

Development and Testing of a Conceptual Model Regarding Men's Access to Health Care.

Am J Mens Health 2017 Mar 3;11(2):262-274. Epub 2016 Oct 3.

4 Northeastern University, Boston, MA, USA.

Epidemiologic data suggest men often experience excessive morbidity and early mortality, possibly compromising family and community health over the lifespan. Moreover, the negative financial/economic consequences affected by poor male health outcomes also has been of great concern in the United States and abroad. Early and consistent access to preventative health care may improve health outcomes; however, men are far less likely to access these services. The purpose of this study was to understand what factors preclude men from accessing health care. We surveyed 485 participants using a 58-item online survey built from a conceptual model previously developed by the researchers using hegemonic masculinity theory, the theory of normative contentment, and the health belief model. For men, three items significantly ( ps < .05) predicted whether they had seen a health care provider in the past year: "I/Men do not access healthcare because I do not think there is anything wrong with me," "My health is only about me," and "I/Men do not access healthcare because most men in my family do not access healthcare." Other correlations of practical significance also were noted. Results suggest gender norms and masculine ideals may play a primary role in how men access preventative health care. Future programming targeting males should consider barriers and plan programs that are gender-sensitive in addition to being gender-specific. Clinical implications are discussed.
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http://dx.doi.org/10.1177/1557988316671637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675291PMC
March 2017

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol.

Contemp Clin Trials 2016 09 24;50:193-200. Epub 2016 Aug 24.

Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main St., Providence, RI 02912, USA; Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA.

Background: The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult.

Objective: The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI.

Methods And Design: CAMI2, a large, 12month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition.

Summary: The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063031PMC
http://dx.doi.org/10.1016/j.cct.2016.08.013DOI Listing
September 2016

Gender and duration of disease differentiate responses to rituximab-dexamethasone therapy in adults with immune thrombocytopenia.

Am J Hematol 2016 09 20;91(9):907-11. Epub 2016 Jun 20.

Division of Hematology-Oncology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York.

Adults often develop chronic immune thrombocytopenia (ITP) for which treatment order is uncertain. Rituximab and three cycles of dexamethasone (4R + 3Dex) improve treatment responses and short-term disease control but long-term outcome is not known. In adults with ITP treated with 4R + 3D, we sought long-term outcome and associated prognostic variables. Forty-nine adults treated at Weill-Cornell received 4R + 3Dex. Their clinical characteristics were reviewed. Duration was median time to treatment failure; Kaplan-Meier estimates were developed. Vbeta Tcell receptor (VBTCR) repertoire was obtained after treatment in 36 patients. Patients were adults with ITP 18-64 years old, median age 37. The 27 females were twice as likely to have an ongoing response to 4R + 3Dex (44.1%) as males (19.6%; P = 0.009). For ITP duration <12 months, 52.7% of patients had continuing responses to 4R + 3Dex compared to 15.3% of patients with diagnosis >12 months (P = 0.02). Females with ITP duration of <12 months had continuing responses in 78.6%, compared to males with <12 months duration of ITP (21.2%). For patients with disease duration <12 months, 67% of females had continuing responses, compared to 31% of males (P = 0.004). Post-treatment polyclonal VBTCR was seen in 9/10 continuing responders (six female, three male) but only 13/26 relapsers/nonresponders (P = 0.068). Durable remissions after treatment with 4R + 3Dex were more frequent in female patients with <12 months of ITP duration and those with polyclonal VBTCR after treatment, emphasizing the roles of duration of disease, gender and T cells in chronic ITP. Differences in pathophysiology of ITP by gender and by duration of ITP require further study. Am. J. Hematol. 91:907-911, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ajh.24434DOI Listing
September 2016

Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial.

Addict Res Theory 2016 Jan 28;24(1):69-79. Epub 2015 Jul 28.

Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA; Providence Veterans Affairs Medical Center, Providence, RI, USA.

Background: Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms.

Methods: Participants ( = 100) completed measures at baseline.

Results: Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men.

Discussion: Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.
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http://dx.doi.org/10.3109/16066359.2015.1072517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724423PMC
January 2016

Participant report of therapist-delivered active ingredients in a telephone-delivered brief motivational intervention predicts taking steps towards change.

Addict Res Theory 2015;23(5):421-428. Epub 2015 Apr 22.

Emergency Medicine, Injury Prevention Center, Brown University, Providence, RI, USA.

Objective: Given the widespread potential for disseminating Motivational Interviewing (MI) through technology, the question of whether MI active ingredients are present when not delivered in person is critical to assure high treatment quality. The Participant Rating Form (PRF) was developed and used to evaluate therapist-delivered active ingredients in phone-delivered MI with hazardous drinking Emergency Department patients.

Method: A factor analysis of all PRFs completed after receiving one call (=256) was conducted. Multiple regression analysis was used to examine whether PRF factors predicted a measure of motivation to change -- taking steps-at the second call (=214).

Results: The majority of participants were male (65%), with a mean age of 32 years and with an average alcohol ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) score of 20.5 ( = 7.1). Results of the factor analysis for the PRF revealed Relational (working collaboration) and Technical (MI behaviors) factors. After controlling for demographics, alcohol severity, and baseline readiness, the technical factor predicted self-report of increased taking steps towards change while the relational factor did not explain any additional variance.

Conclusions: Our study adds to the growing literature investigating patient perspectives of therapist skill as a source of information to better understand MI active ingredients. The PRF is a feasible instrument for measuring the patient's experience of phone-based MI. Results indicate that MI active ingredients of change (relational and technical components) were present in the telephone intervention as hypothesized. Clinical Trial Registration # 01326169.
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http://dx.doi.org/10.3109/16066359.2015.1025062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592139PMC
April 2015

Assessing treatment fidelity in a cultural adaptation of motivational interviewing.

J Ethn Subst Abuse 2015 ;14(2):208-19

a Northeastern University , Boston , Massachusetts.

The efficacy of motivational interviewing (MI) for addictions is well documented. Grounding MI in social/cultural priorities may enhance treatment response. We evaluate the method of assessing competence using the motivational interviewing treatment integrity system (MITI) for standard MI and culturally adapted MI (CAMI) delivered to Latino heavy drinkers. Twenty audiotapes (MI, n = 10; CAMI, n = 10) were MITI coded by two raters unaware of treatment assignment. Inter-rater reliabilities were excellent (.78-.99) except for CAMI complex reflections, global ratings of empathy, and MI spirit. The MITI reliably evaluates MI and CAMI treatment fidelity. Future research should investigate lower reliabilities for MI global and complex reflections cross-culturally.
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http://dx.doi.org/10.1080/15332640.2014.973628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594845PMC
February 2016

Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration.

Haematologica 2014 Jul 18;99(7):1264-71. Epub 2014 Apr 18.

Departments of Pediatrics and Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway.

Adults with newly diagnosed or persistent immunothrombocytopenia frequently relapse upon tapering steroids; adults and children with chronic disease have an even lower likelihood of lasting response. In adults with newly-diagnosed immunothrombocytopenia, two studies showed that dexamethasone 40 mg/day × four days and 4 rituximab infusions were superior to dexamethasone alone. Studies have also shown three cycles of dexamethasone are better than one and patients with persistent/chronic immunothrombocytopenia respond less well to either dexamethasone or rituximab. Therefore, 375 mg/m(2) × 4 rituximab was combined with three 4-day cycles of 28 mg/m(2) (max. 40 mg) dexamethasone at 2-week intervals and explored in 67 ITP patients. Best long-term response was assessed as complete (platelet count ≥ 100 × 10(9)/L) or partial (50-99 × 10(9)/L). Only 5 patients had not been previously treated. Fifty achieved complete (n=43, 64%) or partial (n=7, 10%) responses. Thirty-five of 50 responders maintained treatment-free platelet counts over 50 × 10(9)/L at a median 17 months (range 4-67) projecting 44% event-free survival. Duration of immunothrombocytopenia less than 24 months, achieving complete responses, and being female were associated with better long-term response (P<0.01). Adverse events were generally mild-moderate, but 3 patients developed serum sickness and 2 colitis; there were no sequelae. Dexamethasone could be difficult to tolerate. Fourteen patients became hypogammaglobulinemic and half had increased frequency of minor infections; 9 of 12 evaluable patients recovered their IgG levels. Rituximab combined with three cycles of dexamethasone provides apparently better results to reported findings with rituximab alone, dexamethasone alone, or the combination with one cycle of dexamethasone. The results suggest medical cure may be achievable in immunothrombocytopenia, especially in women and in patients within two years of diagnosis. (clinicaltrials.gov identifier:02050581).
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http://dx.doi.org/10.3324/haematol.2013.103291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077090PMC
July 2014

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort.

Public Health Nutr 2015 Feb 8;18(3):464-73. Epub 2014 Apr 8.

4Department of Clinical Laboratory and Nutritional Sciences,University of Massachusetts Lowell,3 Solomont Way,Suite 4,Lowell,MA 01854,USA.

Objective: There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.

Design: Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.

Setting: Greater Boston area, MA, USA.

Subjects: Puerto Rican adults (n 1292), aged 45-75 years.

Results: Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.

Conclusions: High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.
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http://dx.doi.org/10.1017/S1368980014000433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860821PMC
February 2015

Bone marrow fibrosis in 66 patients with immune thrombocytopenia treated with thrombopoietin-receptor agonists: a single-center, long-term follow-up.

Haematologica 2014 May 24;99(5):937-44. Epub 2014 Jan 24.

Thrombopoietin-receptor agonists increase platelet counts by stimulating the thrombopoietin receptor. Bone marrow fibrosis has been reported in patients receiving thrombopoietin-receptor agonists. This study determined the extent of myelofibrosis, its clinical relevance, and incidence of phenotypic or karyotypic abnormalities in patients with immune thrombocytopenia treated with thrombopoietin-receptor agonists. The grade of myelofibrosis was assessed before (n=15), during (n=117) and after (n=9) treatment in bone marrow biopsies from 66 patients. The proportion of bone marrow biopsies showing no fibrosis (myelofibrosis grade 0) decreased from 67% pre-treatment to 22% at last biopsy, of which 59% had grade 1 myelofibrosis and 18% had grade 2 myelofibrosis. The median duration of treatment with thrombopoietin-receptor agonists to last bone marrow biopsies was 29 months; patients who had two or more biopsies significantly more frequently had myelofibrosis grades 2/3 in the last bone marrow biopsies as compared to the first. Older age was associated with higher grades of fibrosis. No differences in blood counts or lactate dehydrogenase levels were found between patients with myelofibrosis grades 0/1 and those with grade 2. No clonal karyotypic or immunophenotypic abnormalities emerged. This study found that thrombopoietin-receptor agonists induce myelofibrosis grades 2/3 in approximately one-fifth of patients with immune thrombocytopenia, increasingly with >2 years of treatment with thrombopoietin-receptor agonists. Annual/biannual follow-up with bone marrow biopsies is, therefore, recommended in patients being treated with thrombopoietin-receptor agonists in order to enable prompt discontinuation of these drugs should grades 2/3 myelofibrosis develop. Discontinuation of thrombopoietin-receptor agonists may prevent development of clinical manifestations by stopping progression of fibrosis in grade 2/3.
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http://dx.doi.org/10.3324/haematol.2013.098921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008112PMC
May 2014

Culturally adapted motivational interviewing for Latino heavy drinkers: results from a randomized clinical trial.

J Ethn Subst Abuse 2013 ;12(4):356-73

a Northeastern University , Boston , Massachusetts.

A randomized clinical trial of culturally adapted and unadapted motivational interviewing to reduce drinking and related problems among heavy drinking Latinos assessed 57 participants at baseline and at 2 (86% retention) and 6 months (84% retention) after treatment. Significant decreases across both treatments were found in heavy drinking days per month and drinking consequences (p < .001), with greater reductions for drinking consequences for culturally adapted motivational interviewing at 2 months (p = .009) and continuing reductions in culturally adapted motivational interviewing at 6 months. Findings provide preliminary support for the value of cultural adaptation to enhance the efficacy of motivational interviewing with Latino heavy drinkers.
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http://dx.doi.org/10.1080/15332640.2013.836730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976969PMC
July 2014

Acculturation stress and drinking problems among urban heavy drinking Latinos in the Northeast.

J Ethn Subst Abuse 2013 ;12(4):308-20

a Bouvé College of Health Sciences, Northeastern University , Boston , Massachusetts.

This study investigates the relationship between the level of acculturation and acculturation stress and the extent to which each predicts problems related to drinking. Hispanics who met criteria for hazardous drinking completed measures of acculturation, acculturation stress, and drinking problems. Sequential multiple regression was used to determine whether the levels of self-reported acculturation stress predicted concurrent alcohol problems after controlling for the predictive value of the acculturation level. Acculturation stress accounted for a significant variance in drinking problems, while adjusting for acculturation, income, and education. Choosing to drink in response to acculturation stress should be an intervention target with Hispanic heavy drinkers.
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http://dx.doi.org/10.1080/15332640.2013.830942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976985PMC
July 2014

Project reduce: reducing alcohol and marijuana misuse: effects of a brief intervention in the emergency department.

Addict Behav 2013 Mar 23;38(3):1732-9. Epub 2012 Sep 23.

Department of Emergency Medicine, Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States.

Study Objective: Brief interventions (BI) for alcohol misuse and recently for marijuana use for emergency department patients have demonstrated effectiveness. We report a 12-month outcome data of a randomized controlled trial of emergency department (ED) patients using a novel model of BI that addresses both alcohol and marijuana use.

Methods: ED research assistants recruited adult patients who admitted alcohol use in the last month, and marijuana use in the last year. In the ED, patients received an assessment of alcohol and marijuana use and were randomized to treatment (n=249) or standard care (n=266). Treatment consisted of two sessions of BI. At 3 and 12months, both groups had an assessment of alcohol and marijuana use and negative consequences of use.

Results: 515 patients were randomized. We completed a 12-month follow-up assessments on 83% of those randomized. Measures of binge drinking and conjoint marijuana and alcohol use significantly decreased for the treatment group compared to the standard care group. At 12-month binge alcohol use days per month in the treatment group were (M=0.72:95% CI=0.36-1.12) compared to standard care group (M=1.77:95% CI=1.19-1.57) Conjoint use days in the treatment group (M=1.25.1:95% CI=0.81-1.54) compared to standard care group (M=2.16:95% CI=1.56-2.86). No differences in negative consequences or injuries were seen between the treatment and standard care groups.

Conclusions: BI for alcohol and marijuana decreased binge drinking and conjoint use in our treatment group. BI appears to offer a mechanism to reduce risky alcohol and marijuana use among ED patients but expected reductions in consequences of use such as injury were not found 12months after the ED visit.
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http://dx.doi.org/10.1016/j.addbeh.2012.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558591PMC
March 2013
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