Examining Associations of Coping Strategies with Stress, Alcohol, and Substance use among College Athletes: Implications for Improving Athlete Coping

Mental health challenges and substance use are common among college athletes, yet few studies have been conducted to understand substance use as a coping strategy. The pressures of collegiate athletics - including commitments to training, travel, and competition - can contribute to maladaptive coping among college athletes, including alcohol and other substance use. An online survey was completed by 188 college athletes competing across NCAA/NJCAA divisions at six institutions in the United States to examine factors associated with substance use coping and whether specific strategies of coping were associated with risk of substance use. Alcohol and drug use were assessed using the CRAFFT Screening Test, NIDA-Modified ASSIST, and Alcohol Use Disorders Identification Test. Coping was assessed with the Coping Orientation to Problems Experienced Inventory, stress was assessed using an adapted Graduate Stress Inventory, athletics-related anxiety was assessed with the Sport Anxiety Scale, and perceived control of stress was assessed using the Perceived Control Questionnaire. Older athletes, men, and those with higher stress were more likely to use substances to cope. Higher behavioral disengagement, higher substance use coping, and lower religious coping were associated with increased likelihood of binge drinking and substance-related risk behaviors. These findings point to the importance of developing targeted interventions aimed at addressing stress and facilitating healthy coping to reduce problematic drinking and substance use among college athletes

A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): study protocol for a pilot randomized controlled trial.

BACKGROUND: HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counseling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. METHODS: A pilot randomized control trial will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). A total of 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A subset of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. DISCUSSION: ANC provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot trial will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.

RISE-EM: Resident Instruction in Social Emergency Medicine, a Cohort Study of a Novel Curriculum

There is recognition in the field of emergency medicine (EM) that social determinants of health (SDoH) are key drivers of patient care outcomes. Leaders in EM are calling for curricula integrating SDoH assessment and intervention, public health, and multidisciplinary approaches to EM care throughout medical school and residency. This intersection of SDoH and the emergency care system is known as social emergency medicine (SEM). Currently, there are few resources available for EM training programs to integrate this content; as a result, few EM trainees receive adequate education in SEM. To address this gap, we developed a four-part training in SEM tailored to EM residency programs and medical schools. This curriculum, known as RISE-EM (Resident Instruction in Social Emergency Medicine), uses video lectures, case examples, and group discussions to engage trainees and develop competency in providing sound care that is grounded in evidence-based principles of SEM. In the current study, we tested RISE-EM by delivering the video lectures to residents and medical students in two training programs. We administered pre- and post-course knowledge tests and a post-course participant attitudes survey to assess the acceptability and potential efficacy of the program for improving SEM knowledge and attitudes among EM learners. We found it to be both feasible and acceptable to introduce SEM content in residency conferences, with preliminary data showing statistically significant improvement in knowledge of the content and self-efficacy to apply it to their clinical practice. In summary, RISE-EM has been highly valued by EM learners and viewed as a strong supplement to their existing training, and it has been shown to successfully improve SEM knowledge and attitudes

Stress, Anxiety, Binge Drinking, and Substance Use Among College Student-Athletes: A Cross-Sectional Analysis

The immense pressure faced by college student-athletes to balance participation in sports with other responsibilities can contribute to unhealthy coping behaviors including alcohol and drug use. We administered online surveys to 188 college student-athletes to examine stress, athletics-related anxiety, and perceived control of stress as predictors of binge drinking, substance use, and associated risk behaviors. Participants rated athletics as the second greatest source of stress in their lives, trailing only academics. Athletics-related anxiety was a significant predictor of cannabis use and substance-related risk behaviors, and represents an understudied area in the literature. Reports of alcohol and drug use in our sample were comparable to national surveys of student-athletes, but opioid misuse was troublingly high. Participants over the age of 21 and males were more likely to report substance use and risk behaviors. Athletes are susceptible to orthopedic injury and associated pain, which may lead to early exposure to opioids with high potential for abuse. Interventions for this population must target social contributors to substance use among student-athletes, opioid prescription and misuse as a gateway to opioid use disorders, and untreated anxiety as a potential driver of substance use, including anxiety associated with athletic performance

Incorporating Comprehensive Counselling and Guidance Models into School Curricula in Sub-Saharan Africa

There is an increasing body of evidence demonstrating the psychological and social challenges that afflict school-age children in sub-Saharan Africa. In spite of widespread calls to provide counselling and guidance services in schools, efforts at expanding these services remain fragmented and under-resourced. Grounded in both empirical and theoretical literature, this article calls for integration of counselling and guidance through a whole-school approach. Utilizing critical aspects of child and adolescent developmental theory, we summarize the current state of counselling and guidance in the region, evaluate attempts at integration, and propose adoption of a comprehensive guidance and counselling model into school curricula

Provider perspectives on screening and treatment for opioid use disorder and mental health in HIV care: A qualitative study.

BackgroundHIV, opioid use disorder (OUD), and mental health challenges share multiple syndemic risk factors. Each can be effectively treated with routine outpatient appointments, medication management, and psychosocial support, leading implementers to consider integrated screening and treatment for OUD and mental health in HIV care. Provider perspectives are crucial to understanding barriers and strategies for treatment integration.MethodsWe conducted in-depth qualitative interviews with 21 HIV treatment providers and social services providers (12 individual interviews and 1 group interview with 9 participants) to understand the current landscape, goals, and priorities for integrated OUD, mental health, and HIV care. Providers were purposively recruited from known clinics in Mecklenburg County, North Carolina, U.S.A. Data were analyzed using applied thematic analysis in the NVivo 12 software program and evaluated for inter-coder agreement.ResultsParticipants viewed substance use and mental health challenges as prominent barriers to engagement in HIV care. However, few organizations have integrated structured screening for substance use and mental health into their standard of care. Even fewer screen for opioid use. Although medication assisted treatment (MAT) is effective for mitigating OUD, providers struggle to connect patients with MAT due to limited referral options, social barriers such as housing and food insecurity, overburdened staff, stigma, and lack of provider training. Providers believed there would be clear benefit to integrating OUD and mental health treatment in HIV care but lacked resources for implementation.ConclusionsIntegration of screening and treatment for substance use and mental health in HIV care could mitigate many current barriers to treatment for all three conditions. Efforts are needed to train HIV providers to provide MAT, expand resources, and implement best practices

"At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania.

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment