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154
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Introduction
I study technology as a way to identify and address non-treatment seeking persons with unhealthy substance use, particularly pregnant and postpartum women. For example, I conduct randomized trials testing electronic screening and brief intervention (with and without subsequent tailored messaging, such as text messages) in prenatal care clinics. I am also interested in factorial trials to identify active intervention elements (including facsimiles of common factors, as expressed through lifelike and interactive interventions); methods of identifying at-risk pregnant women, particularly given under-reporting of substance use; and studies of technology implementation in health care.
Additional affiliations
August 1999 - present
Publications
Publications (154)
Objective: Nonspecific relational factors, such as therapist empathy, play an important role in therapy effectiveness. Building on this literature, some researchers have attempted to incorporate relational factors into electronic brief interventions (e-BIs) by using interactive narrators to guide participants through the intervention. However, few...
Background
Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by challenges in integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics with full-time research assistants, as well...
Background and Objectives
The prevalence of cocaine use has increased in the United States, with an estimated 5.5 million people have used it at least once in 2019. We report trends in cocaine use for reproductive age females who participated in the National Survey on Drug Use and Health (NSDUH, 2005–2019).
Methods
Interviewers for NSDUH recruited...
Objective: Behavioral parent training programs show clear efficacy and effectiveness in response to young children’s disruptive behavior problems, but limitations in engagement and accessibility prevent many families from benefiting from these programs. The Parenting Young Children Check-up (PYCC) is a technology-based program designed to overcome...
Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Cent...
The COVID-19 pandemic and associated mitigation efforts created stress that threatened parent and child well-being. Conditions that increase stress within families heighten the likelihood of child abuse, but social support can mitigate the impact. This short-term investigation considered whether cumulative risk, COVID-19 specific risk, and emotiona...
Objective:
Single-substance exposure effects on neurodevelopmental outcomes, such as problem behavior and intelligence quotient (IQ), have been studied in children for decades. However, the long-term consequences of polysubstance exposure are poorly understood.
Study design:
Longitudinal neurodevelopmental data were gathered from cohorts across...
BACKGROUND
Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by under-reporting of substance use as well as by challenges integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics...
Objectives:
To predict behavioral disruptions in middle childhood, we identified latent classes of prenatal substance use.
Study design:
As part of the Environmental influences on Child Health Outcomes (ECHO) Program, we harmonized prenatal substance use data and child behavior outcomes from 2,195 women and their 6- to 11-year-old children acros...
Importance:
Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive develop...
Background
Prenatal alcohol exposure (PAE) can result in a range of adverse neonatal outcomes, including Fetal Alcohol Spectrum Disorder (FASD). This systematic review and meta-analysis sought to investigate the effectiveness of brief interventions (BIs) in eliminating or reducing 1) alcohol consumption during pregnancy; and 2) PAE-related adverse...
Introduction: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental...
BACKGROUND
Digital smoking cessation interventions can include a wide range of specific elements which range in intensity, duration, efficacy, attractiveness, and level of active involvement required from the user. Little is known regarding the extent to which the likelihood of engagement in a specific intervention element varies with either (a) le...
Background: Postpartum people with opioid use disorder (OUD) report feeling underprepared for the pregnancy to postpartum transition. We developed a novel, technology-delivered educational intervention for pregnant and parenting people with OUD to address this gap. This study provides a theoretically grounded assessment of the feasibility and accep...
Introduction
Approximately 1 in 7 pregnant women in the USA report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of conditions known as fetal alcohol spectrum disorders. Screening and Brief Intervention (SBI) has been recommended for pregnant women but h...
Introduction. Nearly 1 in 10 pregnant women in the U.S. report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of conditions known as Fetal Alcohol Spectrum Disorders (FASDs). Screening and Brief Intervention (SBI) has been recommended for pregnant women b...
Background
Prenatal alcohol exposure (PAE) can result in a range of adverse neonatal outcomes, including Fetal Alcohol Spectrum Disorder (FASD). This systematic review and meta-analysis sought to investigate the effectiveness of brief interventions (BIs) in eliminating or reducing 1) alcohol consumption during pregnancy; and 2) PAE-related adverse...
Background: Limited research exists on the association between substance use disorders (SUDs) and dimensions of pregnancy intention. This study sought to examine the independent relationships between prepregnancy substance use and SUDs with pregnancy timing and intentions. Materials and Methods: Secondary analysis of data from three prenatal care s...
BACKGROUND
Perinatal substance use (SU) is prevalent and may increase risks to maternal and child health. Many pregnant and postpartum people do not seek treatment for SU due to fears of child removal. Home visiting (HV), a voluntary supportive program for high-risk families in the perinatal period, is a promising venue for addressing unmet SU need...
Background
Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal peri...
Technology Enhanced Screening and Supportive Assistance (TESSA) is program that includes a patient-facing mobile web app designed to identify primary care patients with a history of interpersonal violence (IPV). The implementation study included 1495 participants screened. Approximately one in four reported experiences with intimate partner violenc...
Background
Nonmedical use of prescription medications (NUPM) is a growing problem but little is known about its gender-specific mechanisms despite NIDA’s call for gender-stratified research over a decade ago. We explored gender differences in NUPM in a diverse sample of primary care patients.
Methods
N = 4,458 participants participated in an anony...
Approximately 83% of Emerging Adults (EAs) fail to meet glycemic recommendations, in part due to gaps in health care access and over-reliance on the emergency health care services. Developmental factors such as identity exploration, increasing independence, exploration of opportunities and choices, and decreasing reliance on parental oversight also...
Behavioral parent training programs show clear efficacy/effectiveness in response to young children’s disruptive behavior problems, but limitations in engagement and accessibility prevent many families from benefiting from these programs. The Parenting Young Children Check-up (PYCC) is a technology-based program being created to overcome these barr...
BACKGROUND
Digital interventions have been gaining momentum in behavioral health. There are no standard approaches or tools for creating digital behavioral interventions, so many clinical researchers find their own way to realize them. There is likely variability in how researchers conceive of digital interventions. Even when grounding these interv...
BACKGROUND
Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and/or adherence to recommended care. However, many research teams with interests in this area are unable to develop digital interventions due to the challenges...
Background:
Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-,...
Background:
Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to devel...
Smoking prevalence among individuals in substance use treatment remains higher than in the general population. Given that many smokers in substance use treatment are reluctant to quit smoking, it is important to understand the factors that impede smokers’ readiness to quit. The current study used baseline data from a randomized controlled trial inv...
Objective
To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unans...
The use of systematic dose-finding designs to develop behavioral health interventions is lacking. In contrast, drug development research consistently follows a prescribed, regulated, and iterative pathway that begins with empirically establishing optimal drug dose. Adapting dose-finding methodologies from the drug development literature offers seve...
Background: Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions lev...
Objective
This review aimed to examine key information regarding technology‐delivered interventions for patients with mental health and/or substance use disorders and to provide support for efforts by psychiatrists and other mental health professionals in recommending applications or helping to develop new technology‐delivered interventions.
Metho...
Background
Few computer-delivered brief intervention (CDBI) studies have evaluated participant satisfaction with individual elements of the intervention, or whether participant satisfaction impacts intervention outcomes. Purpose: This factorial trial examined whether subjective reactions to a CDBI for heavy drinking (1) varied depending on the pres...
BACKGROUND
Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leve...
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, an...
Unhealthy alcohol and drug use are common among adolescents. A range of evidence-based interventions are available, but are rarely accessed by adolescents because of barriers such as cost, limited dissemination, lack of motivation to change, and logistical obstacles such as lack of transportation. Technology-delivered approaches may facilitate rece...
Background:
The purpose of this study is to evaluate five self-report, non-proprietary questionnaires in the identification of substance use disorders [including alcohol, cannabis, opioids, and stimulants] among pregnant women.
Procedures:
A total of 1220 pregnant women completed the NIDA Quick Screen, CRAFFT, Substance Use Risk Profile-Pregnanc...
Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However, little is known about the neurodevelopmental consequences of prenatal opioid e...
Although computer delivered brief interventions (CDBIs) have been effective in reducing alcohol use, few studies have examined which components of CDBIs are most associated with drinking reductions. The current factorial trial deconstructed a brief alcohol intervention into component parts to identify main and interaction effects on drinking outcom...
Background and aims:
The accuracy of current screening instruments for identification of substance use in pregnancy is unclear, particularly given methodological shortcomings in existing research. This diagnostic accuracy study compared five existing instruments for ability to identify illicit drug, opioid and alcohol use, under privacy expectatio...
Aims
To determine the cost‐effectiveness of electronic‐ and clinician‐delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers.
Design
Cost‐effectiveness analysis based on a randomized controlled trial.
Setting
New Haven, Connecticut, USA.
Part...
Background:
Women are at highest risk for development of a substance use disorder during their reproductive years. We recently evaluated the efficacy of an electronic screening, brief intervention and referral to treatment (e-SBIRT) and a clinician-delivered SBIRT (SBIRT) compared with enhanced usual care (EUC) for reducing overall substance use a...
BACKGROUND
Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them.
OBJECTIVE
Objective: The present investigation evaluated engagement in the 5-a-Da...
Background:
Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them.
Objective:
This study aimed to evaluate engagement in the 5-a-Day Parenting program, a tec...
Electronic delivery of Screening, Brief Intervention, and Referral to Treatment (e-SBIRT) may be a low-cost and high-reach method for screening and brief intervention in health care settings. However, its relative acceptability, ability to build a therapeutic alliance, and delivery of key intervention components compared to in-person SBIRT (SBIRT)...
Background:
There are at present no evidence-based interventions for marijuana use during pregnancy, despite it being by far the most commonly used illicit drug during pregnancy. Lack of treatment-seeking, combined with implementation challenges, has limited the extent to which at-risk women receive interventions of any kind. This study sought to e...
Background:
The extent to which participants in randomized clinical trials (RCTs) resemble their broader target groups is of particular concern when studying stigmatized conditions such as substance use disorders (SUDs). The present study compared patients who enrolled in a 4-arm clinical trial of SBIRT (screening, brief intervention, and referral...
UNSTRUCTURED
The use of mobile health (mHealth) interventions has risen dramatically over the past two decades. It is important to consider mHealth intervention research within the broader therapy outcome literature. Among other key findings, this broader literature suggests that common relationship factors such as empathy, positive regard, and gen...
The use of mobile health (mHealth) interventions has risen dramatically over the past two decades. It is important to consider mHealth intervention research within the broader therapy outcome literature. Among other key findings, this broader literature suggests that common relationship factors such as empathy, positive regard, and genuineness may...
INTRODUCTION
Substance use during pregnancy has known harmful effects for both the mother and fetus. Few substance use screening tools have been evaluated in pregnancy and only one has been validated against a biochemical assay. The current study sought to examine predictors of false negative screens using the most sensitive of five tested screener...
Background:
Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect...
Parent training programs promote positive parenting and benefit low-income children, but are rarely used. Internet-based delivery may help expand the reach of parent training programs, although feasibility among low-income populations is still unclear. We examined the feasibility of Internet-based parent training, in terms of Internet access/use an...
Background:
Screening, Brief Intervention, and Referral to Treatment may reduce substance misuse but has received minimal study among women treated in reproductive health settings.
Objective:
To determine whether Screening, Brief Intervention and Referral to Treatment delivered either electronically or by clinician is more effective than enhance...
Background:
Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy.
Objective:
The objective of the study was to evaluate, among pregnant women and prenatal care...
Objective:
Even moderate alcohol consumption during pregnancy can pose risks to the fetus, making reliable and consistent detection of drinking in pregnancy critical. Ethyl glucuronide (EtG) and ethyl sulfate (EtS) have shown some ability to detect lower levels of drinking, but the sensitivity of commercial EtG/EtS testing to lower levels of drink...
Early home visitation (EHV) for child maltreatment prevention is widely adopted but has received inconsistent empirical support. Supplementation with interactive software may facilitate attention to major risk factors and use of evidence-based approaches. We developed eight 20-min computer-delivered modules for use by mothers during the course of E...
Background and objectives:
The majority of individuals in substance use disorder (SUD) treatment also smoke cigarettes; yet, the availability of smoking cessation services in SUD treatment remains limited. In this study, we developed and piloted a brief intervention for smokers in SUD treatment intended to motivate engagement in tobacco quitline t...
Computer-delivered, brief interventions (CDBIs) have been an increasingly popular way to treat alcohol use disorders; however, very few studies have examined which characteristics of CDBIs maximize intervention effectiveness. The literature has consistently demonstrated that therapist empathy is associated with reduced substance use in in-person th...
Introduction:
Although effective treatments exist, most women who smoke during pregnancy neither seek nor receive treatment. Complementary and alternative medicine (CAM) treatments (eg, mindfulness, yoga, and acupuncture) may be attractive, low-cost options that can be used to assist a large proportion of pregnant women with smoking cessation.
Me...
There has been a rapid increase in the development of technological innovations to reduce the escalation and impact of alcohol problems among adolescents and adults. Technology-based interventions offer the possibility of reaching individuals who otherwise might not seek treatment, (e.g., those in remote areas, those not perceiving a need for treat...
Purpose:
This paper reports expert opinion on e-health intervention characteristics that enable effective communication of characteristics across the diverse field of e-health interventions. The paper presents a visualization tool to support communication of the defining characteristics.
Methods:
An initial list of e-health intervention characte...
Background:
African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transit...
Child maltreatment is associated with increased risk of substance abuse in adulthood. However, prior investigations have not examined substance use specifically in pregnancy and have relied on self-report of substance use. The present study addresses these gaps via secondary analysis of 295 primarily low-income, Black postpartum women who agreed to...
Objective:
Computerized brief interventions are a promising approach for integrating substance use interventions into primary care settings. We sought to examine the effectiveness of a computerized brief intervention for illicit drug misuse, which prior research showed performed no worse than a traditional in-person brief intervention.
Methods:...
Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, Brief Intervention and Referral to treatment (SBIRT) is an evidence-based approach to manage substance use. In September 2012, the US Centers fo...
Background and objectives:
To investigate the factor structure of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).
Methods:
Secondary analysis on an adult primary care sample (N = 2,599).
Results and discussion:
Factor analysis of the tobacco, alcohol, and cannabis items did not yield an acceptable oblique, three-factor...
Introduction and aims:
Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-mi...
Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that...
Background:
Ethyl Glucoronide (EtG) and Ethyl Sulfate (EtS) have shown promise as biomarkers for alcohol and may be sensitive enough for use with pregnant women in whom even low-level alcohol use is important. However, there have been reports of over-sensitivity of EtG and EtS to incidental exposure to sources such as alcohol-based hand sanitizer....
This conceptual review addresses the need for a "portfolio of models of delivery" for parent training services for young children, with a focus on two bodies of literature: barriers that prevent traditional parent training and emerging and novel approaches to parent training that overcome barriers. Traditional, face-to-face parent training programs...
Pediatric settings are a promising venue for detecting and responding to behavioral health problems in young children, in part by promoting evidence-based parenting strategies. Technology in pediatrics could enhance the feasibility of behavioral health services within pediatrics, but must first be accepted by pediatricians and parents. This report...
Purpose: The purpose of this study was to assess the feasibility of a three-session computer intervention to improve diabetes management among African-American youth with type 1 diabetes. Methods: The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills model of health behavior change and Motiva...
Background
Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility an...
Parental monitoring of daily diabetes care is a significant predictor of glycemic control; yet, parents commonly withdraw their involvement as youth enter adolescence, particularly non-white caregivers. Brief motivation-enhancing interventions have successfully targeted parental monitoring for children with behavioral difficulties and for health-re...
The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving...
This article presents the American Professional Society on the Abuse of Children (APSAC) Task Force report on the evidence-based service planning (EBSP) approach to child welfare services (CWS) plans and recommendations for practice. The focus of the policy report is on formal psychosocial services. CWS plans prescribe services to promote core chil...