Approximately 1 in 5 adults in the U.S. identify as a caregiver. Caregiver is defined as providing care for friends, family members or others on a regular basis, who need medical care. Providing care may be rewarding, it may also be significant burden on the caregiver. Prior research has found that caregiver status has been linked to increase levels of stress. This may be of an increased burden in rural/non-metropolitan areas, where transportation is limited, along with other challenges including access to care, and other factors. The proposed study examines the association of caregiver status and substance use (marijuana, alcohol, and smoking) and depression among rural populations, using a nationally representative sample. We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults over the age of 18 years and extracted data for non-metropolitan/rural counties. Logistic regression analyses were conducted separately to test the association between self-identified caregiver status and three outcomes, including depression, current marijuana use, and current alcohol use. We controlled for past month alcohol use, income, race, educational status, and age. Caregiver status was identified based on providing care or assistance to a friend of family member over the last 30 days. Overall, 21.7% (n=13,653) of our participants self-identified as a caregiver, while 19.5% reported depression, past month alcohol use (48.2%) , past month smoking (13.5%), and past month marijuana use (4.2%). Self-identified caregiver status was associated with higher odds of depression (OR=1.51, 95% CI, 1.44,1.58), past month marijuana use (OR =1.74, 95% CI, 1.51, 2.01), and past month smoking (OR=1.38 95% CI, 1.31, 1.45). Self-identified caregiver status was not associated with past month alcohol use. The data indicates a need for intervention concerning caregivers in rural areas. These caregivers are working without fiscal compensation for their efforts, as a result, they are more likely to be suffering from depression, and use marijuana and/or tobacco, as a coping mechanism. A few feasible interventions which could be incorporated include professionally led group psycho-social support programs, expanding telehealth services, or developing a standardized protocol for the clinicians of the caregivers. If incorporated in rural areas, these interventions could have a significant impact on the mental/ physical health of caregivers in rural areas. For the areas which do have interventions in place for rural caregivers, expanding awareness and access to the impact of them should be explored.

The last few years have prompted empirical research about the COVID-19 pandemic. Undoubtedly, the pandemic has influenced a multitude of psychological constructs, including religiosity and substance use (Harper et al., 2020). Research about the effects of COVID-19 on religiosity and substance has been repeatedly demonstrated in the literature (Buchtova et al., 2022; Mosaval et al., 2022; Baillargeon et al., 2020). Although previous research has found relationships between these variables, no research exists about the potential connection between religiosity, substance use, and the COVID-19 pandemic. One of the purposes of this research study is to fill this existing gap in the literature. The COVID-19 pandemic has certainly exacerbated substance use and its complex facets. Additionally, the pandemic has negatively impacted several dimensions of substance use worldwide, including recovery meetings and communities, treatment services, and the cognitive and emotional functions of those with SUD and those who provide services to people with SUD (Palacio-Gonzalez et al., 2022; Mellis et al., 2021; Radfar et al., 2021; DeJong et al., 2022). Mellis et al. (2021) found that after the COVID-19 pandemic, individuals with a history of multiple SUDs reported more issues with telehealth and complications with accessing needed services. DeJong et al. (2021) highlighted the emotional aspects that people in recovery from SUD have faced since the COVID-19 pandemic. Substantial research regarding the negative relationship between religiosity and substance use exists. Religiosity is associated with a significant reduction in the rates of marijuana use, binge drinking, tobacco use, illicit drug use, and prescription drug use (Burdette et al., 2018; Edlund et al., 2010; Ford & Hill, 2012; Rivera et al., 2018). Johnson et al. (2008) found that negative beliefs about alcohol mediated the relationship between religious involvement and substance use. Additionally, the relationship between external religiosity and alcohol and tobacco use was moderated by internal religiosity, according to Marsiglia et al. (2011). These associations suggest that religiosity serves as a protective factor against substance use. Indeed, these findings are signified by Hai (2012) and Sartor et al. (2019), as they found that religiosity is a protective factor against marijuana and nicotine use. In the current study, we aim to investigate the moderating effects of COVID-19 on the relationship between intrinsic religious commitment and substance use using a simple moderation model conducted in PROCESS Macro by Hayes (2018). The model of religious commitment negatively predicting substance use, moderated by whether or not COVID-19 was occurring, was statistically significant, F(3, 436) = 9.71, p >.001, ∆R2 = .0625. This indicates that religiosity negatively predicts substance use, and COVID-19 significantly moderated the relationship. With these findings in mind, we propose that during COVID-19, when substance use increased, religious commitment served as a protective factor against increased use during COVID-19.

The current study seeks to examine the relationship between family struggles, as measured by social class and parental marital status, and substance use among first-generation college students. 902 students from the University of Central Florida participated in an online questionnaire that assessed their social class, parents’ marital status, drug and alcohol use, as well as demographic variables. Results indicated a significant positive correlation between substance use and social class as well as generational status. Males were also more likely to use drugs and alcohol than females. A regression analysis indicated social class, gender, junior and senior academic years were all identified as significant predictors of drug and alcohol use, whereas college student generational status, parents’ marital status, freshmen and sophomore academic years were not. There are various possible explanations that may account for the reasoning behind first-generation students not being vulnerable to substance use, including extensive stressors specific to that population as discussed with previous literature. The findings of the current study can be implicated throughout counseling centers and prevention programs among college campuses in order to decrease the high prevalence of substance use among college students and prevent negative consequences.

BACKGROUND AND OBJECTIVES: Research on in utero opioid exposure impacts has focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts on fetal growth and newborn wellbeing have emerged, with inconsistencies likely driven by methodological issues. Our goal was to compare birth outcomes between newborns with prenatal opioid exposure and a matched control group. METHODS: Participants were identified manual review of electronic medical records of all deliveries over five years within a regional health system (6 delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal opioid exposure and 300 control newborns matched on exposure, medical, and background factors were included. Additional factors were statistically controlled. Outcomes included pregnancy/delivery complications, newborn size, and newborn health complications. RESULTS: Compared to biochemically verified controls, exposed newborns had higher rates of fetal growth restriction, weighed less, had decreased length and head circumference, and had higher rates of respiratory distress, sepsis, and jaundice. No significant differences in gestational length, Apgar scores, or neonatal hypoglycemia were found. Adjusted regression analyses revealed that compared to controls, those exposed had an average 150 g decrease in birth weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR = 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) increased risk for respiratory distress, and a thirty-fold (OR = 30.47) increased risk for sepsis. CONCLUSIONS: Results suggest significant pregnancy and newborn outcomes beyond NOWS following pregnancy opioid use, informing clinical screening and treatment decisions to enhance health and wellbeing in pregnancy, during the neonatal period, and beyond.

Introduction: Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. Methods: Thus, the current study utilized responses from the Treatment Episodes Data Set–Discharges, 2015–2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. Results: Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. Conclusions: The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.

Background and objectives: Research on in utero opioid exposure impacts has focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts on fetal growth and newborn wellbeing have emerged, with inconsistencies likely driven by methodological issues. Our goal was to compare birth outcomes between newborns with prenatal opioid exposure and a matched control group. Methods: Participants were identified via manual review of electronic medical records of all deliveries over five years within a regional health system (6 delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal opioid exposure and 300 control newborns matched on exposure, medical, and background factors were included. Additional factors were statistically controlled. Outcomes included pregnancy/delivery complications, newborn size, and newborn health complications. Results: Compared to biochemically verified controls, exposed newborns had higher rates of fetal growth restriction, weighed less, had decreased length and head circumference, and had higher rates of respiratory distress, sepsis, and jaundice. No significant differences in gestational length, Apgar scores, or neonatal hypoglycemia were found. Adjusted regression analyses revealed that compared to controls, those exposed had an average 150 g decrease in birth weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR = 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) increased risk for respiratory distress, and a thirty-fold (OR = 30.47) increased risk for sepsis. Conclusions: Results suggest significant pregnancy and newborn outcomes beyond NOWS following pregnancy opioid use, informing clinical screening and treatment decisions to enhance health and wellbeing in pregnancy, during the neonatal period, and beyond.

This paper reports on a meta-analysis performed on forty one studies evaluating classroom-based substance abuse primary prevention programs. Studies included were delivered in a classroom to the general student body, had a primary focus of substance abuse prevention, measured behavior change, and were published in peer-reviewed outlets between 2000 and 2011. Comprehensive Meta-Analysis was used to calculate a random effects Cohen’s d and moderator analyses. Results indicated a significant effect for alcohol (d=0.10) and tobacco (d=0.09) in multi-target interventions. Specific program components and characteristics associated with more effective prevention programs are discussed. Despite the best efforts of those who develop and deliver intervention programs, as a whole, the impact is smaller than “small.” New or evolved programs should seek to incorporate the best predictors of effectiveness thereby improving efficacy.

People who experience structural violence are an increased risk for health conditions including HIV and Hepatitis C. Particularly they are at greater risk for experiencing known syndemic interactions between these two chronic infectious diseases. The risks are mediated bio-socially through the ways that structural inequality increases social and biological vulnerability to illness and suffering. Structural inequalities, or experiences of structural violence shape environments of risk; environments of risks increase social and biological vulnerability to the structures of risk promoting syndemic interactions between biological, behavioral, and psychological conditions. The lived experiences of people diagnosed with a combination of HIV, HCV, and mental health conditions (MHC) (e.g., mood disorders and depression) are, however, thus far understudied. Many aspects and consequences of structural violence and social suffering; poverty, homelessness, substance use, lack of access to healthcare, and structural risks for HIV, HCV, MHC and interactions between the three. Through this mixed-methods, primarily qualitative, ethnographic fieldwork with individuals in the Boston area living with HIV, HCV, or both HIV and HCV, or suffering from MHC I ethnographically explore people’s perceptions of their vulnerability to these syndemic interactions. I also investigate their experiences of being at-risk for these conditions. Through this process, I seek to illuminate individuals’ understandings of the impact structures of risk (i.e., substance use, food insecurity and unstable housing) have on lived experiences with HIV/HCV, HIV/MHC, and HCV/MHC syndemics. The perceptions of the lived realities of disease-behavioral-psychological interactions and health consequences are analyzed in the context of substance use. Substance use’s biological and social dimensions have a role in promoting syndemic interactions for each of the syndemics experienced within this population. Therefore, substance use is a syndemogenic factor because of its role as a mediator for environments of risks, and as a structural risk factor in all three of these syndemics. These interactions, and consequential health outcomes, in sufferers’ own words, enrich the landscape of syndemics research, producing a clearer picture regarding the structures of risks affecting this vulnerable group in the greater Boston area.

Comorbid substance use disorders (SUDs) are highly prevalent in bipolar disorder (BD), with up to 60% of individuals with BD developing an SUD at some point in their lifetime. In addition, research suggests that individuals with this comorbid presentation (BD+SUD) typically have worse outcomes -- including increased mortality, morbidity, and functional impairment -- than individuals with BD alone. Given the increased illness burden associated with BD+SUD, I conducted a systematic review evaluating existing psychosocial treatments for individuals with these comorbidities. Results from this review indicated that no existing psychosocial treatments for these comorbid conditions effectively target both the substance use and mood domain of symptoms. An alternative path to treatment development is to identify mechanisms that underlie BD+SUD that can subsequently be targeted in treatment. Accordingly, I evaluated impairments in risk avoidance (a tendency to engage in a persistent pattern of problematic behaviors despite negative outcomes resulting from such behaviors) as a potential mechanism underlying negative illness outcomes in BD+SUD. Participants with BD (n = 45) or BD+SUD (n = 31) in a relatively euthymic mood state completed clinical risk behavior assessments, laboratory-based risk avoidance assessments, and neurocognitive assessments in a single study session. I hypothesized that the BD+SUD group would exhibit increased clinical risk behaviors, increased impairments on laboratory-based measures of risk avoidance, and increased deficits on neurocognitive assessments relative to the bipolar disorder alone group. Contrary to my hypotheses, results indicated a lack of notable between-group differences in clinical risk behaviors, laboratory-based risk avoidance assessments, and neurocognitive assessments, with the exception of self-reported executive dysfunction which was elevated among individuals with BD+SUD. Collapsing across group, I found that increased discounting of delayed rewards, older age, and an earlier age of (hypo)mania onset predicted increased clinical risk behaviors. These findings underscore the potential importance of delay discounting as a mechanistic target for reducing clinical risk behaviors among individuals with BD both with and without comorbid SUDs. I also discuss the neurocognitive correlates of delay discounting and interventions for addressing delay discounting as potential new directions for treating the disability associated with BD.

Indiana University-Purdue University Indianapolis (IUPUI) / AIM People with marginalized sexual orientations experience mental health and substance use problems at a higher rate compared to heterosexuals. Experiences of discrimination have been identified as a significant factor in explaining such disparities, and a growing body of literature has developed seeking to explore the contexts in which discrimination occurs. However, one context that is understudied is the online environment. Based on Meyer’s (2003) Minority Stress Model (MSM), it is postulated that specific proximal group-specific processes mediate the relationship between discrimination and health outcomes, with other social factors providing protective effects. However, research is sparse empirically investigating different mechanisms, consequences, and potential modifying factors for sexual minority young adults experiencing online heterosexist discrimination (OHD). Thus, the current study aims to explore experiences of OHD among young adults. METHODS Using the MSM as a guiding framework, the study examined proximal factors of internalized heterosexism, online concealment, and rejection sensitivity as mechanisms underlying the effect of OHD on health outcomes and online social support as a moderating factor. 383 young adults (18-35) with marginalized sexual orientations were recruited from an introductory psychology subject pool, two online crowdsourcing platforms (Prolific, MTurk), and the community. They completed measures of OHD, online social support, online concealment, rejection sensitivity, internalized heterosexism, psychological distress, and substance use. RESULTS Path analyses in Mplus revealed that two proximal stressors (rejection sensitivity, sexual orientation concealment) were positively related to psychological distress as a result of OHD. Sexual orientation concealment was associated with increased risk for cannabis use due to OHD. Online social support from LGBTQ+ peers did not buffer these relationships. CONCLUSION The MSM is a viable guiding framework in exploring OHD. Rejection sensitivity and online sexual orientation concealment are important constructs to consider for future research and may be ideal treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.