Category 2
Behavioral Health, Mental Health, Substance Abuse, Opioid Epidemic

Background: With the future opening of the Purple Line (PL) light rail train (LRT) in Prince George’s (PG) County, Maryland, an area with 61% African American and 20% Hispanic residents, there may be transit induced gentrification (TIG), which could results in residential displacement and health impacts.

Goal: The GENTS Study will examine the effects of TIG on health outcomes, specifically stress and anxiety among PG County residents.

Objectives: The GENTS Study has (4) objectives.

1. To assess perceived TIG

2. To assess prevalence of stress and anxiety

3. To assess perceived TIG by race/ethnicity

4. To assess perceived TIG by stress and anxiety

Approach/Methods: The GENTS Study collected data from PG County residents through an online questionnaire which was administered by Qualtrics.com. This questionnaire was launched in March 2021. The GENTS questionnaire was designed using previously validated study instruments. Descriptive statistics and Chi Squares tests were used for data analysis.

Results: Up to date, the GENTS Study (n=106) includes 42% female; 58% male; 55% White, 34% African American; 12% Hispanic, and 79% Non-Hispanic participants. Preliminary results found that 78% of respondents feel stressed and 65% of respondents feel that they could not cope sometimes to very often. Over 80% of White respondents feel increasingly out of place and have observed changes to the sense of community in their neighborhoods compared to less than 20% of African American respondents. There is a dose response relationship between negative TIG perceptions and increasing stress level.

Importance to Public Health: LRT can create gentrification within neighborhoods that can impact social determinants of health and health outcomes. The gentrification that comes with the construction of LRT such as the PL can be beneficial to public health in terms of walkability and accessibility and improving one’s mental health, but it can also be detrimental because the possibility of displacement of residents can negatively impact mental health which can lead to negative health outcomes.

Background: Racial socialization encompasses the messages children are taught about their own race and relations between racial groups. Little is known about the impact of racial socialization on the long-term course of substance use or how racial socialization can protect against adversities commonly experienced by African Americans, including racial discrimination or growing up in a disadvantaged neighborhood environment.

Goal: Data is from the Woodlawn Study, a longitudinal dataset that followed an African American cohort in Chicago from 1st grade into midlife (n=1,242), with data collected at ages 6 (childhood), 16 (adolescence), 32 (young adulthood), and 42 (midlife).

Objectives: Thus, the present study aims to examine whether racial socialization buffers the relationships between A) neighborhood disadvantage and B) racial discrimination and substance use.

Approach/Methods: We explored aspects of racial socialization including racial pride, racial barriers, and racial colorblindness (which incorporates self-development and racial equality). Adjusted logistic regression analyses were conducted to identify how aspects of racial socialization interact with young adult racism, and young adult neighborhood disadvantage to impact substance use in midlife. We identified both main and interaction effects of racial socialization. Adjusted logistic regression analyses were conducted to identify how aspects of racial socialization interact with young adult racism, and young adult neighborhood disadvantage to impact substance use in midlife (i.e., marijuana use, cigarette smoking).

Results: In our unadjusted model, we found any racial socialization messages in young adulthood to be associated with decreased odds of drug abuse in midlife. In an adjusted model which considered the interaction between neighborhood disadvantage and any racial socialization, this interaction in young adulthood was significantly associated with decreased odds of drug abuse in midlife. When examining individual racial socialization messages, any messages about racial barriers in young adulthood were found to be associated with decreased odds of drug abuse in midlife.

Importance to Public Health: The current study extends scholarship by being one of the first to examine racial socialization as a protective factor on both individual and structural (neighborhood disadvantage) racism as well as testing the longitudinal effects of racial socialization.

Background: Drug- and alcohol-related morbidity and mortality are epidemics in the U.S., and disability status is an under-appreciated condition in health disparities research. Prior studies have reported an increased risk of death caused by substance misuse among adults with disabilities, which are broadly defined as being unable to work or having difficulty with daily activities. Few studies have reported the associations between specific types of disability and drug and alcohol misuse in a nationally representative sample.

Goal: To advance understanding of the association between disability status and drug and alcohol dependence and abuse.

Objectives: To estimate the associations between specific disability types and self-reported drug and alcohol misuse among adults in nationally representative U.S. sample.

Approach/Methods: We analyzed responses from adults aged 18+ in the 2019 National Survey on Drug Use and Health, a cross-sectional survey of the U.S. civilian noninstitutionalized population (n=55,530). Respondents completed six standard survey questions on disabilities related to hearing, seeing, walking, cognitive impairment, and self-care limitations; indicator variables were used for each type of disability. Drug and alcohol dependence or abuse were defined based on DSM-IV criteria. We estimated logistic regression models, and covariates included age, sex, race/ethnicity, education, household income, psychological distress, and self-rated health.

Results: The prevalence of different types of disabilities ranged from 2.5% to 8.9%. The overall prevalence of dependence and abuse was 2.9% for drugs and 5.6% for alcohol. Adjusted for age, sex, and race/ethnicity, individuals with cognitive disabilities displayed 3.1 times the odds of drug misuse (95% Confidence Interval (CI)=2.6-3.8) and 2.2 times the odds of alcohol misuse (95% CI=1.9-2.6) compared to individuals without a cognitive disability. We identified smaller associations between seeing/hearing difficulties and drug (OR=1.4, 95% CI 1.1-1.8) and alcohol (OR=1.3, 95% CI=1.0-1.6) misuse, and between ambulatory difficulties and drug misuse (OR=2.0, 95% CI=1.3-2.9).

Importance to Public Health: The odds of having drug and alcohol misuse varies based on type of disability. To inform the development of priority populations and interventions related to drug- and alcohol-related dependence and abuse among adults with disabilities, it may be beneficial to disaggregate disabilities by type.

Background: One in three Latinos is an immigrant. Immigrants face particular stressors that are heightened by previous traumatic experiences before, during, and after migration. Mindfulness-Based Interventions (MBIs) have shown to be successful at reducing stress and strengthening mental health in diverse populations.

Goal: Pilot an adapted trauma-informed Mindfulness- Based Stress Reduction Program for Latino.

Knowledge about feasibility, acceptability, fidelity and appropriateness of Mindfulness interventions with Latino Immigrants could help improve programmatic mental health community programs for this population.

Objectives:

1. Use the Consolidated Framework for Implementation Research (CFIR) to examine the feasibility, acceptability, appropriateness, and fidelity of the Yo Soy Paz online program.

2. Examine the initial effects of the program on stress, mindfulness, mind-body connection, and subjective well-being using pre-post questionnaires.

Approach/Methods: The eight sessions pilot intervention will be delivered to three cohorts (n=40), including staff and parents of youth receiving services at Identity, a local community-based organization that serves Latino immigrants.

Results: The intervention has started and we expect to have results by June 2021. We will report on acceptability, feasibility, appropriateness, and fidelity of the intervention. We will report on changes in overall stress and perception of physical and mental health and mindfulness, subjective wellbeing and mind-body connection using the pre-post questionnaires.

Importance to Public Health: Knowledge about feasibility, acceptability, fidelity and appropriateness of Mindfulness interventions with Latino Immigrants could help improve programmatic mental health community programs for this population.

Background: The COVID-19 pandemic triggered an influx of global uncertainty, translating to an upsurge in psychological stressors and symptoms of anxiety. University student-athletes are among those vulnerable to mental health as they tend to experience mental health outcomes at rates that are equal to or greater than the general population.

Goal: The purpose of this study was to compare anxiety between collegiate student-athletes and non-athlete university students during the COVID-19 pandemic. The secondary purpose was to examine potential moderators of anxiety.

Objectives: It was hypothesized that symptoms of state anxiety would be higher among collegiate student-athletes. It was predicted that coping style would correlate with anxiety and that trauma-focused coping would be associated with higher levels of state anxiety among student-athletes. Lastly, a lack of social support (access and communication) during COVID-19 would be related to greater levels of anxiety among student-athletes compared to those who perceived their social support to be sufficient.

Approach/Methods: Data pertaining to demographics, sport participation, COVID-19 concerns, and symptoms of anxiety, depression, self-motivation, and coping were retrieved using survey methodology. Student-athletes (N=137) and non-student athletes (N=515) were included in analyses of trait anxiety (N=575), state anxiety (N=620), and coping (N=601).

Results: Using multiple linear regression, student/athlete status was not associated with trait anxiety (p = 0.414) or state anxiety (p = 0.503), however, sex was (p = < 0.001). Coping flexibility (CF; p = < 0.001), forward focused coping (FFC; p = < 0.001), and trauma focused coping (TFC; p = 0.016) were related to state anxiety. There were no differences in coping between groups, however, TFC was significantly associated with state anxiety in non-student athletes (p = < 0.001). Communication from athletic directors (p = 0.010) and teammates (p = 0.033), as well as access to facilities/equipment/coaching (p = 0.036) were associated with state anxiety in student athletes. However, communication from coaches did not impact state anxiety (p = 0.545).

Importance to Public Health: Symptoms of anxiety during the pandemic were high, however, there were no differences between groups. FFC acts as a protective factor against anxiety in college-aged students and student-athletes, whereas TFC may worsen anxiety. Furthermore, access and communication are significant predictors of state anxiety in student-athletes revealing that social support is crucial in times of uncertainty.

Background: The COVID-19 stay-at-home orders, along with social distancing guidelines have impacted the mental wellbeing of vulnerable populations such as older adults.

Goal: This study aimed to explore if listening to classical music exhibited lower symptoms of anxiety and depression during the initial stages of the pandemic.

Objectives: We explored the impact of listening to classical music in lowering symptoms of depression and anxiety during the initial stages of the pandemic.

Approach/Methods: An online cross-sectional survey was conducted to collect data from North American adults (n=1132, 18-90+ years) during the initial stages of “lock-down” between April 9 -30, 2020. The survey included validated scales such as the short Geriatric Depression Scale (GDS-15), Geriatric Anxiety Scale (GAS), and questions about music listening (various genres) and music listening frequency. Independent t-tests were used to determine the impact of listening to classical music on the total scores of depression and anxiety controlling for specific age groups.

Results: Listening to classical music was associated with lower total GDS scores t (911) = 3.757, p < .001 in older adults aged 50-90+. Listening to classical music was not associated with lower GAS scores t (696) =1.296, p< 0.195 in older adults aged 50-90+.

Importance to Public Health: Listening to classical music may be a cost-effective method of lowering symptoms of depression during challenging times such as the COVID-19 pandemic.

Background: In 2015 the TOGETHER Relationship and Financial Education Program was delivered in a 20-hour format and was implemented and evaluated through a randomized control trial (RCT) in which the results indicated couples participating in the program improved individual well-being, stress management, relationship functioning, and financial self-efficacy. However, there was significant attrition from enrollment to workshop participation (30%), mostly due to couples’ challenges in committing to a 20-hour program (8 sessions). This led the program developers to reduce the program to 14 hours (6 sessions).

Goal: To determine if the 14-hour workshop is as effective as the 20-hour workshop.

Objectives: Evaluate the effectiveness of the 14-hour version by itself and in comparison with the 20-hour version by examining (a) whether there were any significant changes in males’ and females’ outcome variables (psychological distress, negative and positive conflict management, conflict management and relationship satisfaction, relationship quality, time shared with partner, difficulties paying bills, and budgeting) between pre-test (before workshop) and post-test (after workshop) for the 14-hour group; (b) whether such changes were significantly different from the 20-hour group pre-test-post-test changes.

Approach/Methods: Partners completed questionnaires (demographic survey and outcome measures) on tablets, independently and in front of a staff member, before the first workshop session (Pre-test) and on the last workshop session (Post-test). The 20-hour program enrolled 189 couples (133 completed the pre-test and 97 the post test) and the 14-hour program enrolled 320 couples (313 couples completed the pre-test and 236 the post-test). There were only significant differences across groups for monthly income above $4,000 and number of children.

Results: Multilevel modeling results, controlling for age, income, education, and number of children showed significant mean differences from pre to post-test in the 14-hour group for both genders: Decrease of psychological distress, negative conflict management, and difficulties in paying bills and increases in relationship quality, shared time with partner, positive conflict management, satisfaction with conflict management and the relationship, and budgeting. Pre-post test mean differences in the 14-hour group were not significantly different from the pre-post test mean differences in the 20-hour group except for women’s psychological distress that was significantly larger for the 14-hour group.

Importance to Public Health: This shorter version of the TOGETHER program seems to be as effective in helping partners improve their individual well-being, strengthen their relationship, and improve their financial literacy. These outcomes may play a key role in reducing disparities for financially distressed couples and their families. The shorter version eliminates the barrier of time commitment for couples to participate in the program, making it more accessible particularly for couples with long working hours but that are unable to afford therapy and financial counseling services.

Background: The health of rural youth has disproportionately impacted by the COVID-19 pandemic due to increased stressors contributing to poor mental health and substance use. Fostering socio-emotional skills can help youths to cope with stressful circumstances and reduce substance use in the long term, yet little is known about the effects of online socio-emotional skills interventions in rural youth.

Goal: This study evaluates the preliminary outcomes and the barriers and facilitators for online implementation of two evidence-informed programs on socio-emotional skills for youth. The programs were implemented during the COVID-19 pandemic.

Objectives:

1. Assess changes in knowledge and skills in youth-related to the programs.

2. Assess barriers and facilitators to implement online programs for rural youth that foster socio-emotional skills and substance use awareness.

Approach/Methods: Pre and post data were collected for the This is Not About Drugs (TINAD) program (1 hour, N= 92) and the high school Botvin LifeSkills program (10 modules, N=125). The research team also conducted individual interviews with Educators (n=3) regarding the facilitators and barriers for online implementation.

Results:

Botvin LifeSkills Program

Post-test results indicated an increase in knowledge (p=0.006) but no significant change in anti-drug attitudes and other life skills, such as drug refusal skills, relaxation, self-control skills.

TINAD

For TINAD, we found increased knowledge in the pre-post test. Additionally, 89.65% of youth reported feeling more willing to talk to someone when concerned about themselves or someone else, and 84.48% reported that they were less likely to misuse prescription drugs.

Educators

Educators highlighted program implementation barriers and facilitators in four areas: working with partners, working with students, adapting the program for online delivery and dealing with technology.

Importance to Public Health: Outcomes suggest that online format to teach socio-emotional skills could be useful to increase knowledge, but this delivery format may have its limits developing skills or changing attitudes in youths.

The rural context poses unique barriers and facilitators that need to be addressed to improve outcomes.

Background: The prevalence of mental health problems, such as depression and suicide, is higher in Bangladesh than the global rate. The incidence of mental health problems in Bangladesh is highest in young adulthood and often occurs in university students who face increased stress in the academic environment. However, no studies to date examine how students may cope or treat increased stressors, this project aims to fill this gap.

Goal: The proposed study will utilize a multi-method design informed by Self-Determination Theory to explore motivational factors for mental health practices, such as coping skills, and professional services, such as therapy.

Objectives: To determine the answers to the following questions

1. What mental health practices are a sample of Bangladeshi university students engaging in?

2. What motivates Bangladeshi university students to use mental health practices?

Approach/Methods: Cross-sectional online survey analysis; descriptive analysis

Results: The majority of students surveyed had depressive symptomology, but were also resilient. They engaged in both maladaptive and adaptive coping mechanisms, and a small percentage engaged in mindfulness activities. Though the majority of students reported that they needed help with their mental health in the past year, only a small percentage (5%) of students engaged in clinical mental health services. Many students reported seeking non-clinical support from friends. Preliminary results suggest that the role of autonomy is a motivator in engaging in clinical and non-clinical mental health practices. Competency and relatedness toward others do not seem to have a significant association to actual engagement of behavior.

Importance to Public Health: In Bangladesh, specifically, the third decade of life was found as the most vulnerable period of life (Arafat, 2018). Studies have found that persons of 20–30 years are dying of suicide more than any other age group (Khan 2002; Arafat 2017). As such it is important to identify motivators toward help-seeking, in order to develop interventions to promote such actions.

Background: Since many African and Caribbean parents immigrate to the US for better education and economic opportunities, parents may have high career expectations for their children. In some cases, parental career expectations are STEM focus and do not align with the desires of their children. This study examines the impact of living up to parental expectations and differential career expectations on student perceived stress among first and second-generation African and Caribbean college students. By understanding this relationship, we can better provide resources and support for students in this situation.

Goal: To explore the perceived rates of parental expectations and how it may impact the student’s stress.

Objectives:

• To examine the relationship between parental expectations and students’ stress.

• To understand the impact of differential career expectations and students' stress.

Approach/Methods: Participants who were at least eighteen years old, enrolled as an undergraduate student at UMD and identified as “first or second-generation” African or Caribbean Americans completed an online survey. Participants were average age 21, 70% were seniors, 30% reported changing their major, and 70% reported moving to the US for job/economic opportunities and over half (64%) African. The key variables included: perception of parental expectations, living up to parental expectations, and perceived stress. At the conclusion, participants were entered into a raffle for one of four $15 Amazon gift cards.

Results: About half (44%) reported differential career expectations from their parents, describing their parents as wanting them to obtain STEM careers such as doctor, lawyer, or engineer. Others quoted parents wanting them to be happy, and it is their sole choice. Despite the small sample size, we found 61% reported high endorsement of living up to parental expectations. However, no relationship between perceived stress and parental expectations was observed (p=.386) .

Importance to Public Health: Current research findings seem to emphasize the impact of parental expectations of their children’s academic career goals on college students’ psychological distress. Although our findings did not show correlation on perceived stress, sample size and the rate of differential career expectations warrant further investigation. By understanding the relationship between the impact of parental expectations of their children’s academic career goals on college students’ psychological distress, we will be able to better provide resources and support for students dealing with these circumstances.

Background: Maryland is one of the top states affected by the opioid epidemic, and rural areas are disproportionately affected by this public health problem. As part of a technical assistance grant, our team (MarylandROTA) delivered evidence-based programs and trainings related to opioid prevention and treatment for individuals, practitioners, and communities in rural Maryland.

Goal: The purpose of this project was to increase community awareness and capacity to address issues related to substance use, mental health, and opioid epidemic in rural Maryland.

Objectives: The specific tasks for this technical assistance grant was to deliver evidence-based programs and set curriculums to individuals and practitioners working with rural residents in Maryland.

Approach/Methods: We delivered evidence-based and evidence-informed curriculums, such as Mental Health First Aid and Regrounding Our Response Series, to individuals and practitioners working with rural residents in Maryland. At the end of the sessions, participants were asked to complete an online satisfaction survey.

Results: During 2019-2020, our team delivered 74 sessions to a total of 2147 participants. The overall response rate was 44.2%. Majority of our respondents were female (68.3%), White (76.4%), and had at least a Bachelor's degree (54.0%). The two most common professions were social worker (15.8%) and educator (9.3%). 88.7% of the participants were satisfied with the overall quality of the sessions, 82.3% agreed that the sessions would benefit their professional development and/or practice, and 90.4% said they would recommend the events to a colleague. Participants generally found the sessions to be very informative and appreciated the professionalism from the educators.

Importance to Public Health: While our team faced unforeseen challenges associated with the COVID-19 pandemic (i.e., evidence-based programs not being ready to be implemented online), the online delivery of the programs allowed us to have a wider reach. Technical assistance and online delivery of evidence-based programs may be one useful and efficient way to increase community awareness and capacity in rural communities, and continued efforts on partnerships and tailored programs are needed.

Background: Individuals with mental illness or substance use disorders who struggle with barriers around the social determinants of health are likely to have decreased access to primary care or behavioral health specialist. Research supports a correlation between various social determinants of health and high emergency department (ED) utilization.

Goal: Evaluation findings, which will assist in seeking program funds, will be based on a mixed-methods approach.

Objectives: This evaluation examines the program’s effectiveness from the program staff and patient perspectives.

Approach/Methods: Evaluation findings, which will assist in seeking program funds, will be based on a mixed-methods approach. The project will include existing quantitative program data and in-depth interview data.

Results: Due to the ongoing nature of this research, there are currently no findings to present.

Importance to Public Health: Integrating behavioral and primary care provides a unique opportunity to improve population health outcomes. In an integrated setting, providers have more opportunities to address mental health diagnoses, stigmas, and provide treatment that can help decrease adverse long-term health outcomes.