No abstract

Identification of new medications for alcohol use disorder (AUD) is important for improving treatment options. Baclofen, a GABAB agonist, has been identified as a potential pharmacotherapy for AUD. In a 16-week double-blind, randomized, placebo-controlled trial, we investigated 30 and 90 mg/day of baclofen compared to placebo and examined effects of dose, sex, and level of pretreatment drinking. One hundred and twenty participants with DSM-IV alcohol dependence (age 46.1 (sd = 10.1) years, 51.7% male) were randomized after exclusion for unstable medical/psychiatric illness and/or dependence on drugs other than nicotine. Seventy-three participants completed the trial. A main effect of baclofen was found [%HDD (F(2,112) = 4.16, p = 0.018, d = 0.51 95%CI (0.06–0.95), 13.6 fewer HDD) and %ABST (F(2,112) = 3.68, p = 0.028, d = 0.49 95%CI (0.04–0.93), 12.9 more abstinent days)] and was driven by the 90 mg/day dose. A sex × dose interaction effect was present for both %HDD (F(2,110) = 5.48, p = 0.005) and %ABST (F(2,110) = 3.19, p = 0.045). Men showed a marginally positive effect for 90 mg/day compared to PBO (%HDD t(110) = 1.88, p = 0.063, d = 0.36 95%CI (−0.09–0.80), 15.8 fewer HDD days; %ABST t(110) = 1.68 (p = 0.096, d = 0.32 95%CI (−0.12–0.76), 15.7 more ABST)) with no effect for 30 mg/day. Women showed a positive effect for 30 mg/day (%HDD, t(110) = 3.19, p = 0.002, d = 0.61 95%CI (0.16–1.05), 26.3 fewer HDD days; %ABST t(110) = 2.73, p = 0.007, d = 0.52 95%CI (0.07–0.96), 25.4 more ABST days) with marginal effects for 90 mg/day on %ABST (p = 0.06) with drop-outs/dose reduction from sedative side-effects of 59% in women at 90 mg/day compared to 5% for men. These findings support the hypothesis that baclofen has efficacy in AUD and suggest that dose and sex be further explored as potential moderators of baclofen response and tolerability.

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by “liking” a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.

Previously we found that late pregnancy total and free thyroxine (TT4, FT4) concentrations were negatively related to greater pre and/or postpartum depressive symptoms. In a much larger cohort, the current study examined whether these thyroid indices measured earlier in the third trimester (31-33 weeks) predict subsequent perinatal depression and anxiety ratings as well as syndromal depression. Thyroid-binding globulin (TBG) concentrations increase markedly during pregnancy and may be an index of sensitivity to elevated estrogen levels. TBG was examined in this study because prior findings suggest that postpartum depression is related to sensitivity to mood destabilization by elevated sex hormone concentrations during pregnancy. Our cohort was 199 euthyroid women recruited from a public health obstetrics clinic (63.8% Hispanic, 21.6% Black). After screening and blood draws for hormone measures at pregnancy weeks 31-33, subjects were evaluated during home visits at pregnancy weeks 35-36 as well as postpartum weeks 6 and 12. Evaluations included psychiatric interviews for current and life-time DSM-IV psychiatric history (M.I.N.I.-Plus), subject self-ratings and interviewer ratings for depression and anxiety (Edinburgh Postnatal Depression Scale, Montgomery-Ǻsberg Depression Rating Scale; Spielberger State-Trait Anxiety Inventory, Hamilton Anxiety Inventory), as well as a standardized interview to obtain life-time trauma history. Numerous covariates were included in all regression analyses. Trauma and major depression history were robustly significant predictors of depression and anxiety ratings over the study period when these variables were analyzed individually or in a combined model including FT4 or TBG (p<.001). When analyzed alone, FT4 levels were a less strong but still significant predictor of all depression and anxiety ratings (p<.05) while TBG levels was a significant or nearly significant predictor of most ratings. FT4, TBG and trauma history, but not major depression history, were significant individual predictors of syndromal depression during the study period (p<.05) in single predictor models. In models combining each with trauma and major depression history, FT4 and TBG generally were not significantly predictive of depression or anxiety ratings, and FT4 was also not a significant predictor of syndromal depression: however, in the combined model TBG was a particularly strong predictor of perinatal syndromal depression (p=.005) and trauma history was also significant (p=.016). Further study of the interactions among TBG, FT4, sex hormones, trauma history and perinatal depression may provide insights into the pathophysiological basis of individual variance in vulnerability to mood destabilization by the hormone conditions of pregnancy.

Background College-aged women and men are at increased risk of acquiring human papillomavirus (HPV) and are considered an important catch-up population for HPV vaccination. Technology provides an attractive platform for HPV vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose of this pilot study was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students.Methods A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized by coin flip to receive one of two cancer prevention programs (i.e., HPV vaccination [intervention] or healthy weight [control]). Both programs contained eight technology-mediated health promotion sessions, including weekly emails and private Facebook group posts. Participants completed a pre- and post-test web-based survey and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics for quantitative data and thematic review for qualitative data.Results Knowledge of HPV and HPV vaccination improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by “liking” a post or comment or posting a comment. Participants reported that Facebook was easy to use and encouraged interaction, which contributed to the success of the intervention.Conclusion Participants demonstrated robust engagement and high treatment satisfaction. Objective measures and qualitative open-ended assessment of the intervention showed high levels of engagement with the electronic newsletters and Facebook group. This pilot study suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.

Objective Weight control programs that incorporate group sessions produce greater weight losses, but this has not been explored in the context of online programs. Further, counselor‐crafted self‐monitoring feedback is a core element of lifestyle interventions, although pre‐scripted, modular feedback which does not require detailed counselor review may adequately promote weight loss. The current study explored the weight losses achieved in an online program that included facilitated group sessions, as well as outcomes when counselor‐crafted self‐monitoring feedback was provided. Methods A 2 × 2 pilot factorial randomized participants (90% women) with overweight/obesity ( N = 73) to facilitated group sessions (yes/no) and type of feedback (counselor‐crafted/pre‐scripted, modular) within a 16‐week online behavioral weight control program. Weight change outcomes were collected digitally. Treatment engagement and intervention delivery time were also tracked. Results Individuals offered weekly facilitated online group sessions lost more weight (−5.3% ± 4.9%) than those receiving the same digital program without group sessions (−3.1% ± 4.0%; p = 0.04). Those receiving group sessions also demonstrated significantly greater treatment engagement. Individuals receiving pre‐scripted, modular feedback lost significantly more weight (−5.3% ± 4.8%) than those receiving the more traditional counselor‐crafted feedback (−3.1% ± 4.1%; p = 0.04), but treatment engagement did not differ between conditions. However, interventionist time required to provide feedback was markedly lower for pre‐scripted than counselor‐crafted feedback (1.4 vs. 3.5 h per participant over 16 weeks, respectively, p = 0.01). Conclusions Incorporating weekly facilitated online group sessions significantly increased weight losses achieved in a digital lifestyle program. Further, pre‐scripted, modular feedback required significantly less staff time than counselor‐crafted feedback without diminishing weight losses. Thus, group sessions and pre‐scripted feedback warrant consideration when designing digital lifestyle programs.

SummaryObjectiveInternet delivery of behavioural weight control interventions offers potential for broad geographic reach and accessibility, but weight losses online fall short of those produced with the same programme delivered in‐person. This pilot study examined feasibility and preliminary efficacy of a video‐based platform for delivering weekly chat as part of a 6‐month, 24‐session online group behavioural weight control programme compared with the established text‐based format, which has produced the best online weight losses to date.MethodWomen with obesity (N = 32) were randomized to either (a) weekly video group chat sessions and provided with a cellular‐enabled scale (Video) or (b) Text‐based weekly chat sessions and given a digital scale (Text) and followed for 6 months to determine weight loss and treatment engagement.ResultsWomen randomized to the ideo condition lost more weight than those in the Text condition (−5.0 ± 6.0% vs. −3.0 ± 4.1%, respectively) at 6 months, although the difference was not statistically significant. However, women in the Video condition had significantly greater treatment engagement, with greater self‐monitoring and website utilization than those in the Text condition.ConclusionsVideoconference delivery of group‐based online weight control accompanied by a cellular‐connected scale may promote greater treatment engagement and weight loss than text‐based chat. A larger, adequately powered study is warranted to determine which elements drive these enhanced treatment outcomes.

Objective Dietary self‐monitoring is consistently related to both short‐ and long‐term weight loss, but typically declines over time. Adopting an abbreviated approach to self‐monitoring might reduce burden and potentially increase engagement while maintaining efficacy. Methods Using a Delphi‐type study, experts were queried about abbreviated self‐monitoring approaches that might best balance efficacy and burden and asked to identify when these approaches might best be implemented within a behavioral weight loss program. Experts were surveyed three times until consensus was reached. Results Experts identified three main categories of promising strategies for abbreviated self‐monitoring regardless of whether individuals have been successful with weight loss or full dietary self‐monitoring: (1) self‐weighing only, (2) reducing the foods/beverages self‐monitored to those that are often less routine and higher in caloric density, and (3) reducing the number of days per week to engage in full dietary self‐monitoring. Experts recommended transitioning to abbreviated self‐monitoring after 2 weeks of no self‐monitoring among individuals who were struggling and after reaching 5%–10% weight loss among successful individuals. Conclusions These expert opinions offer a foundation to experimentally manipulate promising strategies for reducing burden and increasing long‐term engagement in self‐monitoring, with a goal of enhancing long‐term weight control.