Maureen A Walton

University of Michigan | U-M · Addiction Research Center

Gamification, the application of gaming elements to increase enjoyment and engagement, has the potential to improve the effectiveness of digital health interventions, while the effectiveness of competition gamification components remains poorly understood on residency. To address this gap, we evaluate the effect of smartphone-based gamified team co...

Background: Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and cor...

Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recrui...

Purpose Cannabis use is common among emerging adults (ages 18-25), yet few prevention interventions have targeted this unique developmental period. Physical activity (PA) is an under-utilized intervention target for cannabis use, despite research showing its potential utility. Based on prior promising social media-delivered interventions targeting...

Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and fem...

Advances in mobile and wireless technologies offer tremendous opportunities for extending the reach and impact of psychological interventions and for adapting interventions to the unique and changing needs of individuals. However, insufficient engagement remains a critical barrier to the effectiveness of digital interventions. Human delivery of int...

Firearms are the leading cause of death for high-school age teens. To inform prevention efforts, we characterize the prevalence of healthcare provider (HCP) counseling of caregivers of teens around firearm safety, safety conversation elements, and caregiver receptivity towards counseling. A cross-sectional web survey (6/24/2020–7/22/2020) was condu...

The Helping to End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is rapidly developing 10 distinct evidence-based interventions for implementation in a variety of settings to prevent opioid misuse and opioid use disorder. One HPC objective is to compare intervention impacts on opioid misuse initiation, escalation, severity, and disorder a...

Purpose Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. Procedures Using social media advertisements to screen po...

Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been d...

Statement of Purpose Firearms are the leading cause of death for high-school aged youth, with firearm access the most significant risk factor for adolescent firearm injury. Parental rules regarding teen firearm access have not been previously characterized. We estimate prevalence of firearm safety/access rules among parents of high-school age teens...

Statement of Purpose The emergency department (ED) visit provides an opportunity for initiating opioid prevention interventions. This presentation describes baseline injury-related characteristics among a sample of adolescents and young adults in the ED enrolled in an opioid prevention trial. Methods/Approach Patients (ages 16–30) in the ED comple...

Background Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal interv...

Purpose Cannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform – social media – we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptabilit...

Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019–12/23/2019) of 2048 older adults (age 50–80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health...

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted-weekly, daily, or even many times a day. The microrandomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and...

Objective: Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets. Method: At an urban emergency department, research assistants recruited youth ages 14-24 repo...

Loneliness is a public health problem causing morbidity and mortality. Individuals with substance use problems are often lonelier than the general population. We evaluate the longitudinal associations between social influences, substance use, and loneliness among adolescents and young adults recruited from an urban Emergency Department (ED). We use...

Firearms are the leading cause of death among young adults. Given community violence is an important correlate of youth firearm carriage, we evaluated: 1) If the association between perceived community violence and firearm carriage is stronger when perceived police bias is greater; and 2) If this moderated association differs by race. Cross-section...

The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention...

Objective: Mobile technologies allow for accessible and cost-effective health monitoring and intervention delivery. Despite these advantages, mobile health (mHealth) engagement is often insufficient. While monetary incentives may increase engagement, they can backfire, dampening intrinsic motivations and undermining intervention scalability. Theor...

Background and objectives Youth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens). Methods The study was conducted i...

Background: Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. Objectives: To examine the translation of the SafERteens program into clinical care. Methods: Hospital staff provided input on implementation facilita...

Background: To identify critical periods for just-in-time adaptive interventions (JITAIs), we measured time-varying correlates of drinking (e.g. stress, mood) daily to predict near-term alcohol use. Methods: Emerging adults (aged 17–24; n = 51) who reported past-month alcohol use used SARA, an app use designed to assess substance use, for 30 days....

Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing...

Objective: Campus sexual assault (SA) prevention programs are widely implemented, despite few having strong empirical support. To inform the development and refinement of prevention programs, we collected pilot qualitative data to capture undergraduates' perspectives regarding desirable program characteristics. Participants: Undergraduates compl...

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted--weekly, daily, or even many times a day. The micro-randomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether a...

Objective: Cannabis use is broadly associated with risky sexual behaviors, but evidence regarding how cannabis is related to condomless sex at the individual level is mixed. A better understanding of the context in which cannabis use is occurring, that is, why individuals are using cannabis on a particular day, could help clarify these relationshi...

Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with...

Background: Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster session...

BACKGROUND Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions...

Statement of purpose Preventing opioid misuse and opioid use disorder (OUD) is necessary given the opioid epidemic. Prevention programs for adolescents/young adults are needed to alter risk trajectories. We developed interventions using telemedicine (synchronous video conference) and a patient portal-like messaging system to address risk factors fo...

Statement of purpose To use longitudinal data collected from youth presenting to an urban emergency department to determine predictors of within-person changes in alcohol and prescription opioid same day use frequency. Methods/Approach Research assistants recruited youth age 14–24 reporting past-six-month substance use into the Flint Youth Injury...

Statement of purpose Estimate frequency of drug use disorder (DUD), multiple substance co-diagnosis network characteristics, and predictors of DUD among youth entering an urban emergency department (ED). Methods/Approach Drug-using youth age 14–24 (n=599; 349 assault-injured) presenting to a Level-1 ED were recruited. Participants were contacted a...

Background: The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI t...

Background The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use. Methods Res...

Purpose There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily foc...

Background Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use–related consequences. Objective This...

Background and aims: Research from cohorts of individuals with recreational cannabis use indicates that cannabis withdrawal symptoms are reported by more than 40% of those using regularly. Withdrawal symptoms are not well understood in those who use cannabis for medical purposes. Therefore, we prospectively examined the stability of withdrawal sym...

BACKGROUND Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use–related consequences. OBJECTIVE This...

Objectives: To evaluate motivations for firearm possession among urban young adults and determine if differences emerge between parents and non-parents, and to identify if storage practices differed according to motivation for firearm possession and parenting status. Methods: We used cross-sectional data among young adults seeking urban emergenc...

Objective Same day use of alcohol and cannabis is prevalent among emerging/young adults and increases the risk for negative consequences. Although motives for alcohol and cannabis use are well-documented, specific motives on co-use days are under-investigated. We examined differences in motives on single substance use (i.e. alcohol or cannabis) ver...

Objective: Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining...

Introduction Youth who carry firearms—and peers that surround them—are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. Methods The authors identifie...

Statement-of-Purpose Despite a 30% reduction nationwide in new opioid prescriptions since 2012, prescription opioid overprescribing, as well as opioid misuse and overdose remain significant U.S. public health issues. To address a deficit in educational resources/tools for clinical providers and their patients, the Injury Prevention Center (UM-IPC),...

The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorder...

Purpose: The National Guard provides critical support both domestically and abroad with soldiers dispersed throughout America and spanning the urban-rural continuum. To determine if location-specific interventions may be needed, we compared the prevalence and severity of cannabis and alcohol use among National Guard members across localities. Met...

“Stealthing” is a form of sexual violence wherein a sexual partner purposefully removes a condom during penetration without the receptive partner’s knowledge. Given the role of substance use in sexual violence broadly, we examined demographic and substance use correlates of stealthing perpetration (SP) and victimization (SV) among emerging adults....

Introduction: Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. Methods: Urban-rural t...

The debate about whether measurement reactivity exists in daily diary research on substance use is still unsettled due to the issues of study design and statistical methodology. This study proposes a time-varying effect model (TVEM) that characterizes the trajectory of substance use behaviors with nonparametric functions determined by the data rath...

Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations...

Background: Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficaci...

BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficaciou...

Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking...

Objective: Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples. Metho...

Background and aims: Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use, and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when rel...

Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among chil...

Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals’ transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, a...

Objective: This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders. Method: Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire...

Aim: Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems. Findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgroups. To inform models of substance use risk, we identified empirical patterns of...

Objective: To examine the efficacious components of a computer-delivered brief intervention (CBI) for reducing marijuana use among adults presenting to a low-income urban emergency department (ED), which a prior report found to decrease marijuana use at a 6-month follow-up. Method: Participants were 237 ED patients reporting recent drug use (46%...

Background: Driving under the influence of cannabis (DUIC) is a public health concern among those using medical cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among medical cannabis users with chronic pain. Methods: Adults (N = 790) seeking medical cannabis cer...

Background: Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not...

Aims: Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. Methods: Participants (ages 14-2...

This report details the 10 leading causes for the 20,360 deaths of children and adolescents in the United States in 2016. The analysis also includes trends over time and comparisons among countries.

Background: Retrospective timeline follow-back (TLFB) data and prospective daily process data have been frequently collected in addiction research to characterize behavioral patterns. Although previous validity studies have demonstrated high correlations between these two types of data, the conventional method adopted in those studies was based on...

Background: The primary aim of this study was to examine the efficacy of two motivational interviewing-based alcohol brief interventions (BIs) among adults presenting to an emergency department (ED). The secondary aim was to evaluate moderators of intervention effects. Methods: Participants were 750 ED patients reporting recent alcohol misuse. P...

Introduction: Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-us...

Objectives Violence is one of the leading causes of death among youth ages 14 to 24. Hospital‐ and emergency department (ED)‐based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence‐based best practices. Retention of study participan...

This study examines alcohol consumption, anxiety, trait mindfulness, and physical and sexual dating violence aggression (PDV and SDV) among 735 emerging adults (18-25 years) in an urban emergency department. Of the total sample, 27.2% perpetrated PDV and 16.5% perpetrated SDV. Alcohol was positively associated with PDV/SDV. Anxiety was positively a...

Purpose: Overdose from alcohol and/or drugs kills tens of thousands of Americans annually, with a large number of deaths attributed to opioid pain medications. Addiction treatment patients are known to be at high risk for overdose; however, the relationship between pain and overdose history within this group is understudied, especially in relation...

Preventing sexual assault in college and university settings is an important public health priority. The college campus is a high-risk setting for experiencing sexual assault while at university. Many campuses utilise brief educational programmes to prevent sexual assault, but these programmes are rarely evaluated. In this paper, we provide a progr...

Aim: Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems, particularly among individuals from under-resourced urban communities. However, findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgrou...

Objectives: With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months. Methods: ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were random...

Aim: To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using youth seeking care from an urban emergency department (ED), their baseline correlates and co-occurring trajectories of severe violence. Short summary: There were five characteristic dual trajectories of alcohol use and depression/anxiety symptoms. C...

Study objective: Pregnant and non-pregnant populations in the US report marijuana as the most commonly used illicit drug. Patterns of marijuana use and psychosocial correlates are unclear among non-treatment seeking teenage girls. Design, setting and participants: The objective of this study was to use cross-sectional data to examine the psychos...

Objective: Traumatic brain injury (TBI) and persistent postconcussion symptoms (PPCS) are associated with increased substance use among veterans. Each factor is independently associated with the perpetration of violence; however, little is known about the associations TBI and PPCS have with violence among substance users. This study examined the di...

Background: Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline ma...

Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between video gaming and aggression have not controlled for other well-known violence correlates (e.g....

Objectives: Drugged driving [DD] is a public health concern, particularly among emerging adults who have the highest rates of drug use. Understanding involvement with DD could inform prevention efforts for this population. We evaluated the prevalence of, motives for, and correlates of past-year DD among emerging adults from an urban, under-resourc...

Purpose: Perpetration of violent behavior begins to increase in adolescence and peaks in young adulthood (e.g., age 18-29) before decreasing by the early 30s. Considerable variability in reported perpetration, targets, and severity of violence suggests youth may change their violent behavior patterns over time. Methods: We use latent transition...

We examined whether acceptability of non-abstinence treatment outcome goals varied as a function of a patient’s severity of diagnosis (ICD-10 Harmful Use vs. Dependence Syndrome), finality of outcome goal (intermediate vs final), and type of substance (e.g., tobacco, alcohol, cannabis), among addiction treatment providers in Ukraine. We surveyed 44...

Background: Drug use is an established risk factor for HIV. Brief Interventions (BIs) targeting reductions in both drug use and HIV risk behaviors may help curtail these related epidemics. The present study evaluates the impact of BIs for drug use and HIV risk reduction on sexual HIV risk behaviors among a primarily marijuana-using sample during a...