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BACKGROUND: Disparities in physical and mental health among Black, Indigenous, and People of Color (BIPOC) are well-documented and mirrored in the Veteran population. Chronic stress due to racism and discrimination is one possible mechanism driving these negative health outcomes. The Race-Based Stress and Trauma Empowerment (RBSTE) group is a novel, manualized, health promotion intervention designed to address the direct and indirect impacts of racism among Veterans of Color. This paper describes the protocol of the first pilot randomized controlled trial (RCT) of RBSTE. This study will examine the feasibility, acceptability, and appropriateness of RBSTE compared to an active control (an adaptation of Present-Centered Therapy; PCT) in a Veterans Affairs (VA) healthcare setting. A secondary aim is to identify and optimize strategies for holistic evaluation. METHODS: Veterans of Color (N = 48) endorsing perceived discrimination and stress will be randomized to RBSTE or PCT; both groups will be delivered in 8 weekly, 90-min virtual group sessions. Outcomes will include measures of psychological distress, discrimination and ethnoracial identity, holistic wellness, and allostatic load. Measures will be administered at baseline and post-intervention. CONCLUSION: This study will inform future interventions targeting identity-based stressors and represents an important step in advancing equity for BIPOC in medicine and research. CLINICAL TRIAL REGISTRATION NUMBER: NCT05422638.

Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (cardiovascular (CVD)) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. We examined the association of these classes with CVD risk factors in adulthood and subsequently, the same model accounting for SES-related factors. Tobacco smoking, overweight/obesity, and lifetime depression were each associated with higher odds of being in classes 2, 3, and 4 than class 1, respectively. These relationships held after adjusting for SES-related factors. Class 4 was associated with the most CVD risk factors, including high triglycerides and high cholesterol after controlling for SES-related factors. The consistent associations between tobacco smoking, overweight/obesity, and lifetime depression with each adverse ACE profile, even after controlling for SES, suggest behavioural CVD prevention programs should target these CVD risk factors simultaneously.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to the onset and exacerbation of mental health problems, such as stress, anxiety, and depression; yet stay-at-home-orders affected individuals' ability to make use of social support as a coping skill in managing distress. We aimed to evaluate how social support (emotional and instrumental) and biological sex were associated with stress, anxiety, and depression early in the COVID-19 pandemic.MethodsParticipants (n = 7256) had an average age of 50.13 years (SD = 16.75) and 51.6% were male. Using a cross-sequential design, seven cohorts of individuals completed baseline (T1) and one-month follow-up (T2) questionnaires online from March to July of 2020. We used a series of hierarchical regressions to identify types of social support (Brief-COPE, T1) associated with stress (Perceived Stress Scale-10, T1 and T2), anxiety and depression (Patient Health Questionnaire-4, T2).ResultsGreater emotional support was associated with less perceived stress, anxiety and depression (all ps

IntroductionAdverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups.Materials and methodsLatent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021.ResultsLatent class analysis revealed a four-class solution: (1) "Low adversity" (75.3%); (2) "Primarily household dysfunction" (9.0%); (3) "Primarily maltreatment" (10.7%); and (4) "Multiple adversity types" (5.1%). Compared to "Low adversity," members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income.ConclusionsDistinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.

The Index provides a current appraisal of workforce conditions and policies across states. It is divided into four topical chapters:1. About the Workforce provides a national snapshot of characteristics of the early educator workforce across settings and discusses state-level variation.2. Earnings and Economic Security provides national and state data on ECE workforce pay in relation to other occupations and presents new analyses of pay.3. Early Childhood Workforce Policies assesses state policies in five areas: qualifications and educational supports; work environments; compensation and financial relief strategies; workforce data; and financial resources.4. Family and Income Support Policies assesses state policies across occupations in two areas: income supports and health and well-being.These indicators represent opportunities for state policies that have the potential to enhance the lives of the many children and adults affected by ECE employment conditions. Throughout the Index we spotlight recent research or promising developments that advance new policies or improved conditions.

Notwithstanding valiant efforts and some significant progress over the past few decades, an early care and education (ECE) workforce data deficit has endured, with persistent shortcomings in our data collection efforts at the national and state levels. Yet the early childhood field needs data-driven policy solutions. Only data can reveal inequities in access to professional development and better working conditions for early educators and inequities in access to highly qualified, well-supported early educators for children. Only data can provide the information needed to advocate for change.As illustrated by the calls for better workforce data beginning in the 1970s, the time is long overdue to prioritize a more robust ECE workforce data agenda and to advocate for the necessary resources. Toward this agenda, we describe the existing data deficit and its consequences and outline the features of comprehensive and sound data. We apply these criteria to understand the strengths and challenges of workforce registries and surveys, the most common data collection mechanisms employed by states. We also highlight several promising practices in the states to combat these challenges.

This report was produced in collaboration with the National Institute for Early Education Research.This brief is the first resource in a three-part series on pre-K teacher compensation parity, jointly undertaken by CSCCE and NIEER. The brief develops a framework for understanding pre-K teacher compensation parity in contrast to other forms of compensation improvement for pre-K teachers and provides a summary of the current landscape of state policies, detailed further in the companion piece Teacher Compensation Parity Policies and State-Funded Pre-K Programs.

Objective: To assess the feasibility of a brief, self-guided, Internet-based version of the mantram repetition program (MRP) for undergraduate students, a population with mental health challenges and high reliance on Internet-based resources. Participants: Undergraduate students (n = 60) receiving course credit had a mean age of 20.66 years and primarily identified as female (84.5%) and Asian (55.9%). Methods: MRP was taught through four video modules. Participants completed module 1 at timepoint 1 (T1), modules 2-4 one week later (T2), and questions about their practice one week following (T3). Results: Most (88.3%) participants completed all four video modules and 76.7% completed T3 questions. At T3, 80.4% of participants endorsed using mantram repetition, practicing 4.46 days/week and 3.26 times/day on average. Conclusions: A self-guided, Internet-delivered MRP is feasible for undergraduate students. Further research is needed to establish its utility for managing psychological challenges in college students. [ABSTRACT FROM AUTHOR]

Objective: To determine risk factors of medical adherence and describe strategies to increase adherence in patients with chronic rhinologic disease. Data Sources: PubMED, SCOPUS, CINAHL, and Cochrane. Review Methods: Systematic review of 4 databases (PubMED, SCOPUS, CINAHL, Cochrane) from inception of databases to September 1, 2022 to identify studies that evaluated factors related to and affected by medical adherence in patients with chronic rhinologic disease. Results: Of 1491 studies screened, 25 studies met inclusion criteria. Of these, 7 studies described how sensory attributes of intranasal sprays affect adherence, including odor, taste, aftertaste, and side effects. Five studies described record keeping diaries/notification systems to improve adherence, with demonstration of web‐based platforms to send reminders as well as keep record of medication usage to improve adherence. Eight studies described patient‐specific risk factors to nonadherence, with demonstration of increased age and conscientious personalities correlating with medical adherence. Five studies looked at pediatric patients specifically, with adherence rates in children parallelling that of adults. Additionally, nonadherence in children may have greater implications for school performance. Conclusion: Overall, adherence to topical medical therapy in patients with chronic rhinologic disease is affected by patient‐related and medication‐specific factors which should be considered when counseling patients. Web‐based diary or notification systems may help increase adherence. Additionally, children are equally adherent to topical medical therapy as adults and nonadherence may have negative implications for school performance. [ABSTRACT FROM AUTHOR]

Objectives: This secondary analysis examined five facets of mindful awareness as potential moderators of clinical outcomes using data from a randomized controlled trial (RCT) that compared Mantram Repetition Program (MRP) with present-centered therapy (PCT) in veterans with post-traumatic stress disorder (PTSD). Methods: Data were examined from 173 veterans with military-related PTSD randomly assigned to receive eight sessions of MRP (n = 89) or PCT (n = 84). Clinician-administered and self-report measures of mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), PTSD severity, insomnia symptoms, and depression symptoms, and were obtained pre- and post-intervention. Hierarchical regressions were used to test for FFMQ moderation on clinical outcomes within the two treatment groups. Results: For those with greater ability to "describe their internal experience" (+1 standard deviation [SD]), MRP was associated with lower PTSD hyperarousal symptoms post-intervention than PCT (p < 0.001). For those with lower "nonreactivity to internal stimuli" (-1 SD), MRP was associated with greater reductions in PTSD avoidance and numbing symptoms and insomnia compared with PCT (all ps < 0.002). Conclusions: Pre-intervention mindfulness domains of "describe" and "nonreactivity to inner experience" differentially predicted improvements in PTSD and insomnia symptoms for MRP as compared with PCT subjects. The FFMQ may be an important tool for predicting patient preparedness for mindfulness-based interventions, such as MRP. [ABSTRACT FROM AUTHOR]

This brief, Educator Expectations, Qualifications, and Earnings: Shared Challenges and Divergent Systems in ECE and K-12 focuses in depth on two specific aspects of personnel systems – educator qualification requirements and earnings – and includes new assessments based on updated data.Accompanying the brief is a chart, Comparison of Personnel Systems for K-12 and Early Childhood Teachers: Qualifications and Compensation, which provides an overview of the characteristics of teachers in K-12 and ECE.This brief builds on a previous report, Building a Skilled Teacher Workforce: Shared and Divergent Challenges in Early Care and Education and in Grades K-12, which was released in 2014.

The Index provides a current appraisal of workforce conditions and policies across states. It is divided into three topical sections: earnings and economic security; early childhood workforce policies; and family and income support policies across occupations. In the section on earnings and economic security, we provide national and state-level data on ECE workforce pay in relation to other occupations, noting changes over time. For the remaining two sections, we have identified measurable indicators of state policy for each topic, grouped by categories within each section. These indicators represent opportunities for state policies that have the potential to enhance the lives of the many children and adults affected by ECE employment conditions. Data sources are described within each section of the Index and we spotlight recent research or promising developments that advance new policies or improved conditions.

Background: Much of the existing animal literature on the devaluation task suggests that prior repeated exposure to drugs of abuse during adulthood can impair goal-directed action, but the literature on human drug users is mixed. Also, the initiation of drug use often occurs during adolescence, but examinations of the effects of drug exposure during adolescence on behavior in the devaluation task are lacking. Methods: We examined whether repeated exposure during adolescence to amphetamine (3 mg/kg injections every-other day from post-natal day 27-45) or ketamine (twice daily 30 mg/kg injections from post-natal day 35-44) would impair behavior in a devaluation test when tested drug-free in adulthood. Rats were trained to press a left lever with a steady cue-light above it for one reinforcer and a right lever with a flashing cue-light above it for a different reinforcer. We tested whether any impairments in goal-directed action could be overcome by compensation between strategies by giving rats information based on lever-location and cue-lights during the test that was either congruent (allowing compensation) or incongruent (preventing compensation between strategies) with the configurations during training. Results: Our results provided no evidence for impairment of goal-directed action during adulthood after adolescent amphetamine or ketamine exposure. Conclusions: We discuss possible reasons for this discrepancy with the prior literature, including (1) the age of exposure and (2) the pattern in the previous literature that most previous demonstrations of drug exposure impairing devaluation in laboratory animals may be attributed to either drug-associated cues present in the testing environment and/or accelerated habit learning in tasks that predispose laboratory animals towards habit formation with extended training (with training procedures that should resist the formation of habits in the current experiment). However, additional research is needed to examine the effects of these factors, as well a potential role for the particular doses and washout periods to determine the cause of our finding of no devaluation impairment after drug exposure. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical ImplicationsOlder Veterans are at elevated risk for psychological distress and may encounter barriers to accessing mental health services. Compassion Meditation (CM) promotes positive emotions and outcomes among distressed individuals; thus, we conducted a preliminary feasibility study of CM among distressed older Veterans.Participants included 25 Veterans aged 55+ (M = 69.0, SD = 10.6) with anxiety and/or depressive symptoms, recruited from primary care, mostly male (76.0%), and White (60.0%). CM consisted of 10 groups, which were transitioned from in-person to telehealth due to COVID-19. Feasibility indices included rates of intervention initiation and completion, and attendance. Participants completed measures of symptom severity and well-being pre- and post-intervention.Of 25 enrolled participants, 88.0% (n = 22) attended at least one session, and 52% (n = 13) completed the intervention (attended six or more sessions). Among intervention completers, the average number of sessions attended was 9.46. Seven Veterans withdrew from intervention due to difficulties engaging via telehealth.These findings support the feasibility of CM training in older Veterans with psychological distress, though dropouts highlighted potential need for additional strategies to facilitate telehealth participation.Older Veterans appear amenable to meditation-based practices, provided they are easy to access. [ABSTRACT FROM AUTHOR]

Background: Current psychological trauma-focused interventions have left a gap for individuals who may not be ready for trauma-focused treatment and/or who present with other forms of clinically significant distress, such as subthreshold post-traumatic stress disorder (PTSD). Emotion regulation is a possible transdiagnostic mechanism of change that may promote and maintain some of the varied mental health problems related to trauma exposure. Aims: This study examines the feasibility and initial impact of two brief emotion regulation skill trainings targeting different processes hypothesized to reduce trauma-related problems, compared with an active control. Method: Subjects (n = 156) were randomized to receive one of three brief internet-based trainings: (1) skill training on accepting emotions, (2) skill training on changing emotions, or (3) stress psychoeducation (control). Participants completed measures of emotion regulation, mindfulness, and affect intensity 24 hours pre- and immediately post-training. Results: Results suggested that a brief internet-based skills training programme was feasible and acceptable, with 91.9% completing the training programme to which they were randomized. Results showed that participants in all conditions demonstrated significant decreases in emotion regulation problems over time; yet these improvements did not vary by condition. Participants in the Change condition with higher PTSD symptoms were significantly more likely to have greater increases in positive affect compared with those with lower PTSD symptoms. Conclusions: Although the three conditions did not show different outcomes, all three brief internet-delivered trainings were feasible. Results provide direction for future studies to evaluate the delivery of emotion regulation skills in individuals with trauma-related distress. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p less than 0.001, b = 6.25, 95% CI [3.06, 9.44], and other measures. In addition, significantly more patients treated with CPT were classified as "recovered" or "improved" at discharge, [chi][superscript 2](1, N = 197) = 4.93, p = 0.032. Conclusions: There is still room for improvement, as substantial numbers of veterans continue to experience significant symptoms even after treatment with CPT in a residential program. However, CPT appears to produce significantly more symptom improvement than treatment conducted before the implementation of CPT. The implementation of this empirically supported treatment in VHA settings is both feasible and sustainable and is likely to improve care for male veterans with military-related PTSD. (Contains 3 tables.)