The Comparative Effectiveness of Core Versus Core+Enhanced Implementation Strategies in a Randomized Controlled Trial to Improve Substance Use Treatment Receipt among Justice-Involved Youth

Journal: BMC Health Services Research, 2022, doi: 10.1186/s12913-022-08902-6

Authors: Danica K. Knight, Steven Belenko, Michael L. Dennis, Gail A. Wasserman, George W. Joe, Gregory A. Aarons, … Aaron Hogue


Background: Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.

Methods: Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.

Results: Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems.

Conclusions: Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

To read the full text of the article, please visit the publisher’s website.

Sports Team Participation and Vaping Among High School Students: 2015–2019

Journal: Pediatrics, 2023, doi: 10.1542/peds.2021-055565

Authors: Eli Rapoport, Meng’ou Zhu, Duy Pham, Sarah A. Keim & Andrew Adesman


Background and Objectives: Electronic vapor products (EVPs) have gained popularity among adolescents despite the health risks. This study aimed to evaluate whether sports team participation, a well-established protective factor against cigarette use, is similarly associated with decreased EVP use.

Methods: This cross-sectional study analyzed the 2015–2019 Youth Risk Behavior Survey cohorts. Survey-weighted logistic regressions investigated associations between sports team participation and past 30-day exclusive cigarette use, exclusive EVP use, and dual cigarette/EVP use among US high school students, adjusting for sex, grade, and survey year.

Results: The analytic cohort included 16 790 sports team participants (1.7% exclusive cigarette users, 18.3% exclusive EVP users, 5.5% dual users) and 13 972 nonparticipants (3.1% exclusive cigarette users, 13.4% exclusive EVP users, 7.6% dual users). Sports team participation was associated with lower odds of cigarette use (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.48-0.71) and dual use (aOR, 0.74; 95% CI, 0.63-0.88) and higher odds of EVP use (aOR, 1.39; 95% CI, 1.25-1.54). Among exclusive cigarette users and exclusive EVP users, sports team participation was associated with lower odds of frequent (≥20 days in the past month) than intermittent (1-19 days in the past month) cigarette use (aOR, 0.30; 95% CI, 0.19-0.49) and EVP use (aOR, 0.74; 95% CI, 0.61-0.91), respectively.

Conclusions: Our findings suggest that risk profiles for cigarette and EVP use differ with respect to sports team participation. Given the health risks associated with EVP use, aggressive efforts must be taken to educate student athletes about the health risks of EVP use.

To read the full text of the article, please visit the publisher’s website

How the Identity of Substance Users Shapes Public Opinion on Opioid Policy

Journal: Political Behavior, 2022, doi: 10.1007/s11109-022-09845-8

Authors: Justin de Benedictis-Kessner & Michael Hankinson


How do media portrayals of potential policy beneficiaries’ identities sway public support for these policies in a public health setting? Using a pre-registered vignette experiment, we show that the racial identity of substance users depicted in news media shapes public opinion on policies to address the opioid crisis. People display biases in favor of their own racial identity group that manifest in their support for both treatment-based policies and punitive policies. We show that these biases may be moderated by the type of initial drug used by a substance user and associated levels of perceived blame. Extending theories of group politics, we also assess favoritism based on gender and residential context identities, but find no such biases. These results highlight the continued centrality of race in the formation of policy preferences.

To read the full text of the article, please visit the publisher’s website.

Building Equitable Community-Academic Partnerships for Opioid Recovery Research: Lessons Learned from Stakeholder Engagement with Peer and Provider Organizations

Journal: Journal of Community Engagement and Scholarship (JCES), 2022; doi: 10.54656/jces.v15i1.479

Authors: Jon N. Gilgoff, Eunsong Park, Julvette Price, Tiffinee Scott, Tyrell Moyd, Katie Rouse, … Fernando A. Wagner

Abstract: Forming equity-based community-academic partnerships focused on recovery research is a time- consuming and challenging endeavor, but one well worth the care and effort required. Through building trusting relationships, vital research collaborations emerge, which are driven by expressed community needs and supported with university resources. This article describes the stakeholder engagement process utilized by a university-based and opioid-focused initiative entitled Innovations in Recovery through Infrastructure Support (IRIS). IRIS developed a diverse and representative network of clinical providers, peer recovery workers, academics, and other behavioral health leaders. The process was informed by community-based participatory research (CBPR) practices and principles aimed at creating equitable partnerships. Lessons learned include the need to reshape the relationship between research and the community through an acknowledgment of harms committed by academia, as well as the importance of maintaining an approach of humility, accountability, and patience with the partnership process. Concrete benefits that go beyond the long-term promise of change, including compensating partners financially for their time, help ensure equity. A commitment to always asking “Who’s missing?” and then filling those gaps builds a broad network inclusive of the various constituencies that make up the recovery support system. As IRIS builds on these lessons learned and plans next steps, we share our experience to support others engaged in forming community-academic partnerships through deep stakeholder engagement and use of participatory approaches within and outside of recovery research.

To read the full text of the article, please visit the publisher’s website.

The Role of Trauma and Positive Youth Development in Polysubstance Use among Rural Middle School Students: A Latent Class Analysis

Journal: BMC Public Health, 2022, doi: 10.1186/s12889-022-14795-1

Authors: Andrew P. Zervos, Devon J. Hensel, Rebecca James, Abby Hunt & Mary A. Ott


Background: Rural youth often begin developing polysubstance use and other risk behaviors during middle school. However, little polysubstance use research focuses on rural middle school youth. Our research uses Latent Class Analysis to understand existing patterns of rural middle school polysubstance use and risk and protective factors associated with polysubstance use.

Methods: We used survey data from a rural middle school pregnancy prevention program (N = 2,708). The survey included measures of demographics, lifetime substance use, trauma (adverse childhood experiences and bullying victimization) and aspects of youth development (parent communication on drugs and alcohol, parent connectedness and school connectedness). We used latent class analysis to produce participant polysubstance use profiles and multinomial regression to examine associations between polysubstance use, demographics, trauma and aspects of youth development.

Results: We categorized our participants into four latent classes. Our analysis classified 2.2% of participants as Regular Polysubstance users, 6.9% as Polysubstance experimenters, 19% as Vape + Alcohol experimenters and 71.9% as Non-Users. More adverse childhood experiences were associated with greater risk of polysubstance use and experimentation. Bullying was positively associated with greater risk of vape and alcohol experimentation. Higher reported parental and school connectedness were associated with lower risk of high frequency polysubstance use. Higher reported school connection was also associated with lower risk of polysubstance experimentation.

Conclusion: Rural substance use prevention programs should begin during middle school, as polysubstance use development is common among rural middle schoolers. These programs should be trauma informed and focus on connectedness as a modifiable factor to reduce risk of polysubstance use development.

To read the full text of the article, please visit the publisher’s website.