Browsing by keyword "Family Advisory Board & Young Adult Advisory Board, Transitions to Adulthood Center for Research"
Now showing items 1-9 of 9
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An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot TrialBACKGROUND: Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. OBJECTIVE: To address these challenges as well as their preferences for sexual and gender minority-targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy-based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). METHODS: Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. RESULTS: For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar's appearance and movements. CONCLUSIONS: Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar's movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers.
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Cardiovascular Risk Factors, Depression, and Alcohol Consumption During Joblessness and During Recessions in CARDIA Young AdultsResearch has shown that recessions are associated with lower cardiovascular mortality but unemployed individuals have a higher risk of cardiovascular disease (CVD) or death. We used data from eight consecutive exams (1985-2011) of the CARDIA cohort, modeled in fixed-effect panel regressions, to investigate simultaneously the associations of CVD risk factors with (a) the employment status of individuals, and (b) macroeconomic conditions prevalent at the state where the individual lives. We found that unemployed individuals had lower levels of blood pressure, HDL-cholesterol, and physical activity, and significantly higher depression scores, but they were like their counterparts in smoking status, alcohol consumption, LDL cholesterol levels, body mass index, and waist circumference. One percentage point higher unemployment rate at the state level was associated with lower systolic (-0.41 mmHg, 95%CI: -0.65, -0.17) and diastolic (-0.19, 95%CI: -0.39, 0.01) blood pressure, higher physical activity levels, higher depressive symptom scores, and lower waist circumference and smoking. We conclude that levels of CVD risk factors tend to improve during recessions, but mental health tends to deteriorate. Unemployed individuals are significantly more depressed, and likely have lower levels of physical activity and HDL.
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Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey StudyBACKGROUND: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. OBJECTIVE: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. METHODS: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. RESULTS: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. CONCLUSIONS: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection.
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Exploring Age Differences in the Experiences of Academic Supports Among College Students with Mental Health ConditionsCollege students with mental health conditions struggle to succeed academically potentially limiting their future. Previous research has shown that college students of all ages with mental health conditions under-utilize academic supports. However traditional (i.e. young adult) and non-traditional (i.e. older adult) students have different academic learning experiences and may also have different academic support experiences. This research explored the academic support experiences of young adult college students with mental health conditions and compared them to those of older adult college students with mental health conditions. A secondary analysis of a previously collected dataset on the academic experiences of college students with mental health conditions was conducted. The sample was limited to only current students at time of survey and respondents were categorized as either young adult (ages 18-24) or older adult (age 25 and over). Descriptive and exploratory quantitative analysis compared their mental health experiences, utilization of academic supports, and engagement on campus. Young adults were less likely to access formal disability services, less satisfied in their college experience and reported lower quality relationships with staff and faculty as compared to their older peers. Further investigation of the many potential reasons for these differences is warranted. As college student bodies become more diversified, staff and faculty need to recognize that student capacities and experience vary not just due to the potential impact of gender, race, or class, but also due to age and life experiences.
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Healthy Bodegas: Bringing the Community Together to Eat HealthierBackground: Colorectal cancer (CRC) incidence rates have remained stable in the United States (U.S.) the past 30 years, however, there has been a significant increase in CRC incidence among the millennial generation. The association between the Western diet and CRC, and racial and gender disparities in CRC is well-established. Public health and community efforts are needed to address barriers to healthy nutrition in this population. One identified barrier is food access in lower-income communities, sometimes called "food deserts." Local stores, or "bodegas," have potential to increase access to healthy affordable foods and contribute to risk reduction for the development of chronic diseases such as CRC. Objectives: Assess the effectiveness of the Healthy Bodega Initiative (HBI), designed to increase availability and promotion of healthy foods; engage community participation by mobilizing community-based organizations and local store owners to participate in the initiative; and, facilitate positive dietary changes. Methods: Guided by the Conceptual Logic Model of community-based participatory research, this study will evaluate the intervention through in-store observations and pre- and post-intervention surveys of participating store owners, in addition to surveys with customers at a subset of stores. Major findings: This study is in planning phases; no findings are available. Conclusions and implications: Prospective longitudinal research with long-term follow-up should be conducted to explore the social determinants affecting low-income populations, changes that result after improved access to healthy foods, and long-term disease outcomes.
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Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional SurveyBackground: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. Objective: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. Methods: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. Results: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). Conclusions: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management.
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Predictors of outpatient mental health clinic follow-up after hospitalization among Medicaid-enrolled young adultsAIM: To assess demographic and clinical predictors of outpatient mental health clinic follow-up after inpatient psychiatric hospitalization among Medicaid-enrolled young adults. METHODS: Using logistic regression and administrative claims data from the Maryland public mental health system and Maryland Medicaid for young adults ages 18-26 who were enrolled in Medicaid (N = 1127), the likelihood of outpatient mental health follow-up within 30 days after inpatient psychiatric hospitalization was estimated . RESULTS: Only 51% of the young adults had any outpatient mental health follow-up visits within 30 days of discharge. Being black and having a co-occurring substance use disorder diagnosis were associated with a lower probability of having a follow-up visit (OR = 0.60, P < 0.01 and OR = 0.36, P < 0.01, respectively). In addition, those who utilized any outpatient public mental health services during the 180 days prior to their index hospitalization (N = 625, 55.4%) were more likely to have a follow-up visit than those without prior outpatient use (OR = 2.45, P < 0.01). Prior Medicaid-reimbursed primary care visits were not significantly associated with follow-up. CONCLUSIONS: In this predominantly urban, low-income statewide sample of young adults hospitalized for serious psychiatric conditions, half did not connect with an outpatient mental healthcare provider following their discharge. Outpatient transition supports may be especially needed for young adults who were not receiving outpatient services prior to being admitted for psychiatric inpatient care, as well as for young adults with substance use disorders and African Americans.
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Testing Whether Multisystemic Therapy for Emerging Adults Can Reduce Their Justice System InvolvementDrs. Maryann Davis of the Transitions to Adulthood Center for Research at the University of Massachusetts Medical School and Ashli Sheidow and Michael McCart of the Oregon Social Learning have previously demonstrated that Multisystemic Therapy for Emerging Adults (MST-EA) is an intervention that successfully engages and retains young adults with serious mental health conditions in treatment. This Research in the Works is about a new trial awarded by NIMH called Effectiveness Trial of Treatment to Reduce Serious Antisocial Behavior in Emerging Adults with Mental Illness. This study builds on Drs. Davis and Sheidow’s previous work and is a randomized controlled trial comparing outcomes of 240 participants assigned to either the MST-EA intervention or enhanced treatment as usual. This study will determine if MST-EA is a more effective treatment than the enhanced usual treatment for this population. Currently, there is no intervention with proven efficacy to reduce criminal behavior for emerging adults with serious mental health conditions and this study is an important step in developing one.
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Variations in Sleep Characteristics and Glucose Regulation in Young Adults With Type 1 DiabetesCONTEXT: Short sleep duration and sleep disruptions are associated with impaired glucoregulation in type 1 diabetes (T1D). However, the mechanistic pathways between sleep and glucose variability remain unclear. OBJECTIVE: To determine within- and between-person associations between objective sleep-wake characteristics and glucose variability indices. METHODS: Multilevel models were used to analyze concurrent sleep and glucose patterns over 7 days in 42 young adults with T1D in their natural home environment. Young adults with T1D (mean age 22.2 +/- 3.0 years, HbA1c 7.2%, 32.6% male) for at least 6 months with no other medical or major psychiatric comorbidity were included. Sleep-wake characteristics were measured via wrist actigraphy and glucose variability indices via a continuous glucose monitor (CGM). RESULTS: Lower sleep efficiency predicted higher glucose variability (less time in range beta = 0.011 and more time in hyperglycemia beta = -0.011) within-person. A longer wake after sleep onset and more sleep disruptions were associated with higher glucose variability between persons (beta = 0.28 and 0.31). Higher glucose variability predicted poorer sleep within-person (delayed bedtime, waketime, mid-sleep time, and lower sleep efficiency), while higher glucose variability was associated with poorer sleep and more sleep disruptions between persons (lower sleep efficiency, longer wake after sleep onset, and a higher sleep fragmentation index). CONCLUSION: Clinicians can address the reciprocal nature of the sleep-glucose relationship by optimizing sleep and targeting efforts toward a euglycemic range overnight. Sleep habits are a modifiable personal target in diabetes care.
