Lydia Shrier - Academia.edu (original) (raw)

Papers by Lydia Shrier

mHealth, 2018

Background: Ecological momentary interventions (EMIs) influence behavior in real time, in real li... more Background: Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care. Methods: Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/ responsive motivational messaging] vs. No-messages (MET/momentary assessment) vs. MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling. Results: Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), Nomessages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up vs. baseline. Momentary marijuana desire declined more in MOMENT vs. MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, vs. MET-only. Conclusions: The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.

Addictive Behaviors, 2018

Marijuana is the most commonly used illicit drug in the United States, with the lifetime prevalen... more Marijuana is the most commonly used illicit drug in the United States, with the lifetime prevalence of use among U.S. high school students increasing from 22.7% in 1991 to 30.0% in 2015 (Miech, Johnston, O'Malley, Bachman, & Schulenberg, 2016). Marijuana use is associated with educational underachievement, cognitive impairment, diminished life satisfaction and achievement, chronic bronchitis, increased risk of psychosis disorder among those at risk, and addiction (Volkow, Compton, & Weiss, 2014). As commercial interests begin to promote and distribute marijuana, the public health experience with alcohol and tobacco has established the need to be proactive in identifying behavioral motivations for using marijuana, and monitoring health consequences associated with its use (Caulkins & Kilmer, 2016). 1.2 Affect and Marijuana Use Young people report a number of marijuana use motives, including social conformity, coping with negative affect, and sensory alteration (Aarons, Brown, Stice, & Coe, 2001; Simons, Correira, Carey, & Borsari, 1998). Affect-related motives for marijuana use seem to be particularly salient because tension reduction and relaxation motives have been associated with more frequent marijuana use (Buckner & Schmidt, 2008), and coping motives for marijuana use have been associated with psychopathology symptoms, and distress (Brodbeck, Matter, Page, & Moggi, 2007). The association between elevated negative affect, coping motives for using marijuana, and subsequent marijuana use is consistent with the self-medication hypothesis (Khantzian, 1997). Under the self-medication hypothesis, persons experiencing overwhelming affective

Adolescent Medicine Clinics, 2004

Psychometrika, 2016

Ecological Momentary Assessment (EMA) data consists of in-the-moment sampling several times per d... more Ecological Momentary Assessment (EMA) data consists of in-the-moment sampling several times per day aimed at capturing phenomena that are highly variable. When research questions are focused on the association between a construct measured repeatedly and an event that occurs sporadically over time interspersed between repeated measures, the data consist of correlated observed or censored times to an event. In such a case, specialized time-to-event models that account for correlated observations are required to properly assess the relationships under study. In the current study, we apply two time-to-event analysis techniques, proportional hazards and accelerated failure time modeling, to data from a study of affective states and sexual behavior in depressed adolescents and illustrate differing interpretations from the models.

Journal of Caffeine Research, 2015

Purpose: Pediatric caffeine use has become increasingly prevalent. The American Academy of Pediat... more Purpose: Pediatric caffeine use has become increasingly prevalent. The American Academy of Pediatrics discourages caffeine use by children and adolescents due to its adverse impact on sleep and blood pressure. The objective of this study was to measure prevalence of physical and emotional symptoms related to caffeine consumption among adolescents receiving primary care. Methods: A convenience sample of patients (N = 179; 73% female) aged 12-17 presenting for routine primary care completed the Composite International Diagnostic Interview Substance Abuse Module questionnaire, which included questions regarding use of caffeine. Descriptive statistics were used to summarize prevalence of caffeine use and caffeine-related symptoms. Associations of number of caffeine-related symptoms with age, gender, and race/ethnicity were also analyzed. Results: Sixty-seven percent of participants (n = 120) reported past 30-day caffeinated beverage consumption. Of those, 68% (n = 82) reported at least one symptom or problem attributed to caffeine use or withdrawal, including caffeine cravings, 24% (n = 29); frequent urination, 21% (n = 25); difficulty falling asleep, 18% (n = 22); and feeling anxious, 3.3% (n = 4). Conclusions: In our sample, caffeinated beverage consumption by adolescents was frequently associated with physical and emotional symptoms, as well as problems attributed to use.

Journal of Adolescent Health, 2015

Adolescent medicine (Philadelphia, Pa.), 1999

Almost one million American adolescents become pregnant each year. Awareness of up-to-date contra... more Almost one million American adolescents become pregnant each year. Awareness of up-to-date contraceptive methods allows clinicians to appropriately counsel male and female adolescents, preferably prior to the onset of sexual activity. Abstinence, barrier methods, including the female condom and non-latex male condom, and hormonal methods, including oral contraceptive pills, injectables, and subdermal implants, are all suitable for adolescent use. New oral contraceptive pills with lower estrogen content or multiphasic hormone levels may ameliorate side effects, such as headache or breakthrough bleeding. Frank discussion of confidentiality and of the various contraceptive methods and their side effects allows adolescents to choose the best method for them, thus improving the likelihood of adherence.

Preventive Medicine, 2001

risk to optimize STD prevention strategies for adoles-Background. Adolescents are the population ... more risk to optimize STD prevention strategies for adoles-Background. Adolescents are the population at highcents. ᭧ 2001 American Health Foundation and Academic Press est risk for acquiring sexually transmitted diseases Key Words: adolescent; depressive symptoms; self-(STDs). Previous research has suggested that mental esteem; sexual risk behavior; sexually transmitted dishealth problems, including depression and low selfease; prevention. esteem, may play an important role in the development and maintenance of sexual risk behaviors. Methods. National Longitudinal Study of Adolescent Health data from baseline interviews of 7th-12th grad-INTRODUCTION ers reporting sexual intercourse in the preceding year were analyzed. Using logistic regression, associations Adolescents are the population at highest risk for of depressive symptoms, self-esteem, and substance acquiring sexually transmitted diseases (STDs) [1]. use with condom nonuse at last sexual intercourse and Risk factors for contracting an STD in this age group with ever having had an STD were explored separately include having multiple sexual partners, engaging in for each gender. unprotected sex, and having partners who are at high Results. Among boys (N ‫؍‬ 3,192), depressive symprisk for having an STD [2]. According to the 1999 Natoms were associated with an increased risk of condom tional Youth Risk Behavior Surveillance System, 49.9% nonuse at last sexual intercourse. The association of high school students have had sexual intercourse, between depressive symptoms and STD appeared to be with 42.0% of these students reporting condom nonuse mediated by alcohol and marijuana use. For girls (N ‫؍‬ with last sexual intercourse [3]. 3,391), depressive symptoms were associated with a history of STD, but not with condom nonuse. Self-Previous research has suggested that mental health esteem was not significant in any model that included problems, including depression and low self-esteem, depressive symptoms. may play an important role in the development and Conclusions. Adolescents with depressive symptoms maintenance of sexual risk behaviors [4-8]. Depressive are at risk for not using a condom and for having an symptoms occur frequently among adolescents [9], and STD. Further research is needed to elucidate the relamajor depression, dysthymia, and other mood disorders tionship among depression, substance use, and sexual are prevalent [10,11]. The lifetime prevalence of unipolar depression has been reported to be as high as 25.3% 1 This research was supported in part by the Charles A. Janeway in one longitudinal study of high school students [10].

Pediatric Annals, 2014

Adolescent substance use is common and is associated with serious mental, physical, and social ri... more Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care.

Social Psychiatry and Psychiatric Epidemiology, 2009

Background Research examining adolescent mood, stresses, and coping has tended to use retrospecti... more Background Research examining adolescent mood, stresses, and coping has tended to use retrospective questionnaires which are affected by recall biases. The aim of this study was to develop, pilot, and evaluate a youth-friendly mobile phone program to monitor, in real-time, young people's everyday experiences of mood, stress, and their coping behaviours. Method and design A momentary sampling program was designed for mobile phones, and ran for 7 days, administering a brief questionnaire four random times each day, capturing information on current activity, mood, responses to negative mood, stresses, alcohol and cannabis use. Eleven high school students reviewed the program in focus groups, and 18 students completed 7 days of monitoring. Results Engagement with the mobiletype program was high with 76% of 504 possible entries completed and 94% (17/18) of the participants reporting that the program adequately captured their moods, thoughts, and activities. The mobiletype program captured meaningful and analyzable data on the way young people's moods, stresses, coping strategies, and alcohol and cannabis use, vary both between and within individuals. Conclusions The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.

Substance Use & Misuse, 2013

Previous interventions for marijuana use have been administered out of the real-life contexts in ... more Previous interventions for marijuana use have been administered out of the real-life contexts in which use occurs. In 2010, we interviewed youth aged 15-24 years who use marijuana frequently (n = 8) and providers who treat them (n = 6) on the acceptability and utility of a mobile intervention involving momentary self-monitoring of use-related contexts and responsive motivational messaging following clinic-based brief motivational enhancement therapy. Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Results suggest that mobile technology is a promising tool for brief interventions to reduce youth marijuana use and warrants further development.

Sexual Health, 2007

Background: This exploratory study investigated young women’s perceptions of sexually transmissib... more Background: This exploratory study investigated young women’s perceptions of sexually transmissible infection (STI) testing received during gynaecological care. Correlates of the incorrect perception that STI testing occurred were assessed. Methods: Cross-sectional study of sexually active young women, age 18–24 years, attending a university healthcare setting for gynaecological care (n = 109). Two hundred and four women were approached and 87 were ineligible; of the remaining 117, 93.2% chose to enrol. Results: Of the women enrolled, 25.7% falsely perceived that they were STI tested (labelled ‘clean and clear’). Only approximately one in seven (14.7%) accurately understood the STI for which they were tested. In multivariate analyses, controlling for race, STI symptoms, depression, number of lifetime visits to the gynaecologist, and suspicion of current STI, three variables were significant: minority race (adjusted odds ratio (AOR) = 4.84, confidence interval (CI) = 1.38–16.96, P = ...

Journal of Women's Health, 2007

To examine bias and sexual harassment experiences of physician mothers and their physician daught... more To examine bias and sexual harassment experiences of physician mothers and their physician daughters; correlations of these experiences with career satisfaction, stress at work, stress at home, and percentage of women in specialty; and influences of the mother on her daughter's experiences. A convenience sample of 214 families with mother and daughter physicians was sent a 56-item survey that included questions on bias and sexual harassment experiences. Statistical comparisons were made within 136 dyads where both mother and daughter returned the questionnaire. Eighty-four percent of mothers and 87% of daughters responded. Mothers and daughters reported similarly high rates and severity of sexual harassment before medical school, while in residency/fellowship, while in practice/work setting, and by teachers and supervisors. Daughters reported higher rates of harassment during medical school and by patients, mothers by colleagues. Gender and racial/ethnic discrimination was lower for daughters compared with their mothers, but gender discrimination was still substantial. Compared with other daughters, daughters who experienced discrimination or sexual harassment reported lower career satisfaction and more stress at work and at home and worked in specialties with fewer women. Gender discrimination and sexual harassment remain entrenched in medical education and professional workplaces. Maternal role models and mentors were not as protective as anticipated. Leadership of medical institutions and professional associations must deal more effectively with persistent discrimination and harassment or risk the loss of future leaders.

The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 2004

Your son is your son till he gets him a wife: but your daughter's your daughter all the days of h... more Your son is your son till he gets him a wife: but your daughter's your daughter all the days of her life" (17th century English proverb) "Women don't have penis envy, men do" (comedian Woody Allen)

mHealth, 2018

Background: Ecological momentary interventions (EMIs) influence behavior in real time, in real li... more Background: Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care. Methods: Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/ responsive motivational messaging] vs. No-messages (MET/momentary assessment) vs. MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling. Results: Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), Nomessages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up vs. baseline. Momentary marijuana desire declined more in MOMENT vs. MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, vs. MET-only. Conclusions: The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.

Addictive Behaviors, 2018

Marijuana is the most commonly used illicit drug in the United States, with the lifetime prevalen... more Marijuana is the most commonly used illicit drug in the United States, with the lifetime prevalence of use among U.S. high school students increasing from 22.7% in 1991 to 30.0% in 2015 (Miech, Johnston, O'Malley, Bachman, & Schulenberg, 2016). Marijuana use is associated with educational underachievement, cognitive impairment, diminished life satisfaction and achievement, chronic bronchitis, increased risk of psychosis disorder among those at risk, and addiction (Volkow, Compton, & Weiss, 2014). As commercial interests begin to promote and distribute marijuana, the public health experience with alcohol and tobacco has established the need to be proactive in identifying behavioral motivations for using marijuana, and monitoring health consequences associated with its use (Caulkins & Kilmer, 2016). 1.2 Affect and Marijuana Use Young people report a number of marijuana use motives, including social conformity, coping with negative affect, and sensory alteration (Aarons, Brown, Stice, & Coe, 2001; Simons, Correira, Carey, & Borsari, 1998). Affect-related motives for marijuana use seem to be particularly salient because tension reduction and relaxation motives have been associated with more frequent marijuana use (Buckner & Schmidt, 2008), and coping motives for marijuana use have been associated with psychopathology symptoms, and distress (Brodbeck, Matter, Page, & Moggi, 2007). The association between elevated negative affect, coping motives for using marijuana, and subsequent marijuana use is consistent with the self-medication hypothesis (Khantzian, 1997). Under the self-medication hypothesis, persons experiencing overwhelming affective

Adolescent Medicine Clinics, 2004

Psychometrika, 2016

Ecological Momentary Assessment (EMA) data consists of in-the-moment sampling several times per d... more Ecological Momentary Assessment (EMA) data consists of in-the-moment sampling several times per day aimed at capturing phenomena that are highly variable. When research questions are focused on the association between a construct measured repeatedly and an event that occurs sporadically over time interspersed between repeated measures, the data consist of correlated observed or censored times to an event. In such a case, specialized time-to-event models that account for correlated observations are required to properly assess the relationships under study. In the current study, we apply two time-to-event analysis techniques, proportional hazards and accelerated failure time modeling, to data from a study of affective states and sexual behavior in depressed adolescents and illustrate differing interpretations from the models.

Journal of Caffeine Research, 2015

Purpose: Pediatric caffeine use has become increasingly prevalent. The American Academy of Pediat... more Purpose: Pediatric caffeine use has become increasingly prevalent. The American Academy of Pediatrics discourages caffeine use by children and adolescents due to its adverse impact on sleep and blood pressure. The objective of this study was to measure prevalence of physical and emotional symptoms related to caffeine consumption among adolescents receiving primary care. Methods: A convenience sample of patients (N = 179; 73% female) aged 12-17 presenting for routine primary care completed the Composite International Diagnostic Interview Substance Abuse Module questionnaire, which included questions regarding use of caffeine. Descriptive statistics were used to summarize prevalence of caffeine use and caffeine-related symptoms. Associations of number of caffeine-related symptoms with age, gender, and race/ethnicity were also analyzed. Results: Sixty-seven percent of participants (n = 120) reported past 30-day caffeinated beverage consumption. Of those, 68% (n = 82) reported at least one symptom or problem attributed to caffeine use or withdrawal, including caffeine cravings, 24% (n = 29); frequent urination, 21% (n = 25); difficulty falling asleep, 18% (n = 22); and feeling anxious, 3.3% (n = 4). Conclusions: In our sample, caffeinated beverage consumption by adolescents was frequently associated with physical and emotional symptoms, as well as problems attributed to use.

Journal of Adolescent Health, 2015

Adolescent medicine (Philadelphia, Pa.), 1999

Almost one million American adolescents become pregnant each year. Awareness of up-to-date contra... more Almost one million American adolescents become pregnant each year. Awareness of up-to-date contraceptive methods allows clinicians to appropriately counsel male and female adolescents, preferably prior to the onset of sexual activity. Abstinence, barrier methods, including the female condom and non-latex male condom, and hormonal methods, including oral contraceptive pills, injectables, and subdermal implants, are all suitable for adolescent use. New oral contraceptive pills with lower estrogen content or multiphasic hormone levels may ameliorate side effects, such as headache or breakthrough bleeding. Frank discussion of confidentiality and of the various contraceptive methods and their side effects allows adolescents to choose the best method for them, thus improving the likelihood of adherence.

Preventive Medicine, 2001

risk to optimize STD prevention strategies for adoles-Background. Adolescents are the population ... more risk to optimize STD prevention strategies for adoles-Background. Adolescents are the population at highcents. ᭧ 2001 American Health Foundation and Academic Press est risk for acquiring sexually transmitted diseases Key Words: adolescent; depressive symptoms; self-(STDs). Previous research has suggested that mental esteem; sexual risk behavior; sexually transmitted dishealth problems, including depression and low selfease; prevention. esteem, may play an important role in the development and maintenance of sexual risk behaviors. Methods. National Longitudinal Study of Adolescent Health data from baseline interviews of 7th-12th grad-INTRODUCTION ers reporting sexual intercourse in the preceding year were analyzed. Using logistic regression, associations Adolescents are the population at highest risk for of depressive symptoms, self-esteem, and substance acquiring sexually transmitted diseases (STDs) [1]. use with condom nonuse at last sexual intercourse and Risk factors for contracting an STD in this age group with ever having had an STD were explored separately include having multiple sexual partners, engaging in for each gender. unprotected sex, and having partners who are at high Results. Among boys (N ‫؍‬ 3,192), depressive symprisk for having an STD [2]. According to the 1999 Natoms were associated with an increased risk of condom tional Youth Risk Behavior Surveillance System, 49.9% nonuse at last sexual intercourse. The association of high school students have had sexual intercourse, between depressive symptoms and STD appeared to be with 42.0% of these students reporting condom nonuse mediated by alcohol and marijuana use. For girls (N ‫؍‬ with last sexual intercourse [3]. 3,391), depressive symptoms were associated with a history of STD, but not with condom nonuse. Self-Previous research has suggested that mental health esteem was not significant in any model that included problems, including depression and low self-esteem, depressive symptoms. may play an important role in the development and Conclusions. Adolescents with depressive symptoms maintenance of sexual risk behaviors [4-8]. Depressive are at risk for not using a condom and for having an symptoms occur frequently among adolescents [9], and STD. Further research is needed to elucidate the relamajor depression, dysthymia, and other mood disorders tionship among depression, substance use, and sexual are prevalent [10,11]. The lifetime prevalence of unipolar depression has been reported to be as high as 25.3% 1 This research was supported in part by the Charles A. Janeway in one longitudinal study of high school students [10].

Pediatric Annals, 2014

Adolescent substance use is common and is associated with serious mental, physical, and social ri... more Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care.

Social Psychiatry and Psychiatric Epidemiology, 2009

Background Research examining adolescent mood, stresses, and coping has tended to use retrospecti... more Background Research examining adolescent mood, stresses, and coping has tended to use retrospective questionnaires which are affected by recall biases. The aim of this study was to develop, pilot, and evaluate a youth-friendly mobile phone program to monitor, in real-time, young people's everyday experiences of mood, stress, and their coping behaviours. Method and design A momentary sampling program was designed for mobile phones, and ran for 7 days, administering a brief questionnaire four random times each day, capturing information on current activity, mood, responses to negative mood, stresses, alcohol and cannabis use. Eleven high school students reviewed the program in focus groups, and 18 students completed 7 days of monitoring. Results Engagement with the mobiletype program was high with 76% of 504 possible entries completed and 94% (17/18) of the participants reporting that the program adequately captured their moods, thoughts, and activities. The mobiletype program captured meaningful and analyzable data on the way young people's moods, stresses, coping strategies, and alcohol and cannabis use, vary both between and within individuals. Conclusions The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.

Substance Use & Misuse, 2013

Previous interventions for marijuana use have been administered out of the real-life contexts in ... more Previous interventions for marijuana use have been administered out of the real-life contexts in which use occurs. In 2010, we interviewed youth aged 15-24 years who use marijuana frequently (n = 8) and providers who treat them (n = 6) on the acceptability and utility of a mobile intervention involving momentary self-monitoring of use-related contexts and responsive motivational messaging following clinic-based brief motivational enhancement therapy. Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Results suggest that mobile technology is a promising tool for brief interventions to reduce youth marijuana use and warrants further development.

Sexual Health, 2007

Background: This exploratory study investigated young women’s perceptions of sexually transmissib... more Background: This exploratory study investigated young women’s perceptions of sexually transmissible infection (STI) testing received during gynaecological care. Correlates of the incorrect perception that STI testing occurred were assessed. Methods: Cross-sectional study of sexually active young women, age 18–24 years, attending a university healthcare setting for gynaecological care (n = 109). Two hundred and four women were approached and 87 were ineligible; of the remaining 117, 93.2% chose to enrol. Results: Of the women enrolled, 25.7% falsely perceived that they were STI tested (labelled ‘clean and clear’). Only approximately one in seven (14.7%) accurately understood the STI for which they were tested. In multivariate analyses, controlling for race, STI symptoms, depression, number of lifetime visits to the gynaecologist, and suspicion of current STI, three variables were significant: minority race (adjusted odds ratio (AOR) = 4.84, confidence interval (CI) = 1.38–16.96, P = ...

Journal of Women's Health, 2007

To examine bias and sexual harassment experiences of physician mothers and their physician daught... more To examine bias and sexual harassment experiences of physician mothers and their physician daughters; correlations of these experiences with career satisfaction, stress at work, stress at home, and percentage of women in specialty; and influences of the mother on her daughter's experiences. A convenience sample of 214 families with mother and daughter physicians was sent a 56-item survey that included questions on bias and sexual harassment experiences. Statistical comparisons were made within 136 dyads where both mother and daughter returned the questionnaire. Eighty-four percent of mothers and 87% of daughters responded. Mothers and daughters reported similarly high rates and severity of sexual harassment before medical school, while in residency/fellowship, while in practice/work setting, and by teachers and supervisors. Daughters reported higher rates of harassment during medical school and by patients, mothers by colleagues. Gender and racial/ethnic discrimination was lower for daughters compared with their mothers, but gender discrimination was still substantial. Compared with other daughters, daughters who experienced discrimination or sexual harassment reported lower career satisfaction and more stress at work and at home and worked in specialties with fewer women. Gender discrimination and sexual harassment remain entrenched in medical education and professional workplaces. Maternal role models and mentors were not as protective as anticipated. Leadership of medical institutions and professional associations must deal more effectively with persistent discrimination and harassment or risk the loss of future leaders.

The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 2004

Your son is your son till he gets him a wife: but your daughter's your daughter all the days of h... more Your son is your son till he gets him a wife: but your daughter's your daughter all the days of her life" (17th century English proverb) "Women don't have penis envy, men do" (comedian Woody Allen)