Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive ...behavioral therapy for insomnia CBT-I) among this racial minority population.
To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms.
In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study BWHS) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study.
Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep.
The primary outcome was insomnia severity (Insomnia Severity Index ISI). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE.
A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: -10.0 points; 95% CI, -11.2 to -8.7; SHUTi-BWHS: -9.3 points; 95% CI, -10.4 to -8.2) than those randomized to receive PE (-3.6 points; 95% CI, -4.5 to -2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 78.2% vs 70 of 108 64.8%; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (-10.4 points 95% CI, -11.4 to -9.4 vs -6.2 points 95% CI, -8.6 to -3.7).
In this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep.
ClinicalTrials.gov Identifier: NCT03613519.
Background Of outcomes related to excessive drinking, binge drinking accounts for approximately half of alcohol-attributable deaths, two thirds of years of potential life lost, and three fourths of ...economic costs. The extent to which the alcohol policy environment accounts for differences in binge drinking in U.S. states is unknown. Purpose The goal of the study was to describe the development of an Alcohol Policy Scale (APS) designed to measure the aggregate state-level alcohol policy environment in the U.S. and assess the relationship of APS scores to state-level adult binge drinking prevalence in U.S. states. Methods Policy efficacy and implementation ratings were developed with assistance from a panel of policy experts. Data on 29 policies in 50 states and Washington DC from 2000–2010 were collected from multiple sources and analyzed between January 2012 and January 2013. Five methods of aggregating policy data to calculate APS scores were explored; all but one was weighted for relative policy efficacy and/or implementation. Adult (aged ≥18 years) binge drinking prevalence data from 2001–2010 was obtained from the Behavioral Risk Factor Surveillance System surveys. APS scores from a particular state-year were used to predict binge drinking prevalence during the following year. Results All methods of calculating APS scores were significantly correlated ( r >0.50), and all APS scores were significantly inversely associated with adult binge drinking prevalence. Introducing efficacy and implementation ratings optimized goodness of fit in statistical models (e.g., unadjusted beta=−3.90, p <0.0001, R2 =0.31). Conclusions The composite measure(s) of the alcohol policy environment have internal and construct validity. Higher APS scores (representing stronger policy environments) were associated with less adult binge drinking and accounted for a substantial proportion of the state-level variation in binge drinking among U.S. states.
Introduction Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how ...adversity exposure in parents’ early lives may be related to later food insecurity for parents and their children. This study investigated the association between female caregivers’ adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms. Methods This study used cross-sectional data from 1,255 female caregivers of children aged <4 years surveyed in an urban clinical setting from March 2012 through June 2014. Measures included sociodemographic characteristics; caregivers’ ACEs, including abuse, neglect, and household dysfunction; depressive symptoms; and household and child food insecurity. Multinomial and logistic regression analyses assessed the relationship among ACEs, depressive symptoms, and household and child food security status. Results Caregiver depressive symptoms modified associations between ACEs and food insecurity level. After adjusting for covariates, caregivers reporting both depressive symptoms and four or more ACEs were 12.3 times as likely to report low food security (95% CI=6.2, 24.7); 28.8 times as likely to report very low food security (95% CI=12.8, 64.8); and 17.6 times as likely to report child food insecurity (95% CI=7.3, 42.6) compared with those reporting no depressive symptoms and no ACEs. Conclusions Depressive symptoms and ACEs were independently associated with household and child food insecurity, and depressive symptoms modified the association between ACEs and household and child food insecurity. Comprehensive policy interventions incorporating nutrition assistance and behavioral health may address intergenerational transmission of disadvantage.
Alcohol and firearms are commonly involved in suicide in the United States. State alcohol and firearm policies may impact alcohol and firearm related suicide, yet little is known about these ...relationships. This study examines relationships between state alcohol and firearm policies and suicides involving alcohol, guns, or both, and explores interactive policy associations.
Alcohol policies were assessed with the Alcohol Policy Scale. Firearm policies were assessed using the Gun Law Scorecard from Giffords Law Center. Suicide data from the National Violent Death Reporting System in 2015 covered 22 states. State- and individual-level GEE Poisson and logistic regression models assessed relationships between policies and firearm- and/or alcohol-involved suicides with a 1-year lag.
In 2015, there were 8996 suicide deaths with blood alcohol concentration test results in the 22 included states. Of those deaths, alcohol and/or firearms were involved in 5749 or 63.9%. Higher alcohol and gun law scores were associated with reduced incidence rates and odds of suicides involving either alcohol or firearms (adjusted incidence rate ratios IRR 0.72 (95% CI 0.63, 0.83) for alcohol policies, 0.86 (95% CI 0.82, 0.90) for firearm policies). Relationships were similar for suicides involving both alcohol and firearms, and there was an interactive effect, such that states with restrictive policies for both had the lowest rates of suicides involving alcohol or guns.
More restrictive alcohol and firearm policies are associated with lower rates and odds of suicides involving alcohol or firearms, and alcohol and firearms, and may be a promising means by which to reduce suicide.
Motor vehicle crashes are a leading cause of injury death in the U.S. Restrictive alcohol policies protect against crashes involving alcohol above the legal blood alcohol concentration of 0.08%. ...Characteristics of motor vehicle crash fatalities involving blood alcohol concentrations below the limit and their relationships to alcohol control policies have not been well characterized.
Motor vehicle crash fatality data and crash and decedent characteristics from 2000 to 2015 came from the Fatality Analysis Reporting System and were analyzed in 2018–2019. Alcohol Policy Scale scores characterized alcohol policy environments by state-year. Generalized estimating equation alternating logistic regression models assessed these scores and the odds that a fatality involved alcohol below the legal threshold.
Of 612,030 motor vehicle crash fatalities, 223,471 (37%) died in alcohol-involved crashes, of which 33,965 (15% of alcohol-involved fatalities or 6% of all fatalities) had a blood alcohol concentration <0.08%. A 10 percentage point increase in Alcohol Policy Scale score, approximating the interquartile range among states, was associated with reduced odds of fatalities involving alcohol <0.08% vs 0.00% (AOR=0.91, 95% CI=0.89, 0.93). These findings held across multiple subgroup analyses by decedent and crash characteristics. Similar results were found for odds of alcohol involvement <0.05% vs 0.00% (AOR=0.90, 95% CI=0.88, 0.93), and ≥0.05% but <0.08% vs <0.05% (AOR=0.93, 95% CI=0.89, 0.96).
The number of lower blood alcohol concentration fatalities is substantial. States with more restrictive alcohol policies tend to have reduced odds of lower blood alcohol concentration motor vehicle crashes than states with weaker policies.
To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States.
In this repeated cross-sectional analysis, we used data from the Fatality Analysis ...Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level.
While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval CI = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively.
The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (
. 2021;111(11):1976-1985. https://doi.org/10.2105/AJPH.2021.306466).
Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and ...alcohol-related crash fatalities has not been characterized previously to date.
To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States.
This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale APS) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015.
Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration BAC ≥0.08%).
From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10-percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio aOR, 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10-percentage point increased APS score).
Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.
Alcohol Policies in U.S. States, 1999-2018 Blanchette, Jason G; Lira, Marlene C; Heeren, Timothy C ...
Journal of studies on alcohol and drugs,
01/2020, Letnik:
81, Številka:
1
Journal Article
Recenzirano
Odprti dostop
U.S. policymakers and public health practitioners lack composite indicators (indices) to assess and compare the restrictiveness of state-level alcohol policy environments, conceptualized as the ...presence of multiple policies in effect in a particular place and time. The purposes of this study were to characterize the alcohol policy environment in each U.S. state and Washington, DC, in 2018, and to examine changes during the past 20 years.
State-specific Alcohol Policy Scale (APS) scores from 1999 to 2018 were based on 29 policies, after weighting each present policy by its efficacy and degree of implementation. Modified APS scores were also calculated on the basis of two sets of mutually exclusive policy subgroups.
APS scores in 2018 varied considerably between states, ranging from 25.6 to 67.9 on a theoretical scale of 0 to 100; the median score was 43.5 (based on a 0-100 range), and 43 states had scores less than 50. The median change in state APS scores from 1999 to 2018 was positive (+4.9, range: -7.4 to +10.3), indicating increases in the restrictiveness of policy environments, with decreases in only five states. The increases in APS scores were primarily attributable to the implementation of stronger impaired-driving laws, whereas policies to reduce excessive drinking were unchanged. There was no correlation between states' excessive drinking policy scores and their impaired-driving scores (r = .05, p = .74).
Based on this policy scale, few states have restrictive policy environments. Although states adopted policies targeting impaired driving during the study period, there was no change in policies to reduce excessive drinking.
We examined the relationships of the state-level alcohol policy environment and policy subgroups with individual-level binge drinking measures.
We used generalized estimating equations regression ...models to relate the alcohol policy environment based on data from 29 policies in US states from 2004 to 2009 to 3 binge drinking measures in adults from the 2005 to 2010 Behavioral Risk Factor Surveillance System surveys.
A 10 percentage point higher alcohol policy environment score, which reflected increased policy effectiveness and implementation, was associated with an 8% lower adjusted odds of binge drinking and binge drinking 5 or more times, and a 10% lower adjusted odds of consuming 10 or more drinks. Policies that targeted the general population rather than the underage population, alcohol consumption rather than impaired driving, and raising the price or reducing the availability of alcohol had the strongest independent associations with reduced binge drinking. Alcohol taxes and outlet density accounted for approximately half of the effect magnitude observed for all policies.
A small number of policies that raised alcohol prices and reduced its availability appeared to affect binge drinking.
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