Literature Collection

BACKGROUND: Integrating therapist-led sessions and Cognitive Behavioural Therapy (CBT) materials within one online platform may be effective for people with depression. A trial evaluating this mode of delivering CBT is being conducted. To maximize future trial recruitment and understand patients' views of health interventions, it is important to explore reasons for declining to participate. AIM: To explore patients' reasons for declining to participate in a trial of integrated online CBT for depression. DESIGN & SETTING: A mixed methods study collecting data from patients via questionnaires and telephone interviews at the three UK trial sites. METHOD: Individuals completed a short questionnaire about their reasons for not taking part in the trial. Telephone interviews further explored these reasons with a sub-group. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analysed thematically. RESULTS: Of 1799 patients who responded to an invitation to participate in the trial, 40.3% declined contact. The most common reasons were not wanting: to take part in research (n=387); therapy provided online (n=284); to receive CBT (n=262). Qualitative interviews with 15 'decliners' highlighted that decisions related to perceptions of eligibility, previous experiences of CBT and uncertainty about receiving CBT online. Personal circumstances, depressive symptoms or other mental health issues were also barriers to participation. CONCLUSION: Reasons given by primary care patients for not taking part in a trial of integrated online CBT suggest that, at the point of recruitment, it is important to discuss the patient's perceptions of their eligibility and whether they would accept the intervention being evaluated.

BACKGROUND AND AIMS: Youth aged 15-17 years are at high risk of tobacco, alcohol and drug use. Given the changing landscape with respect to availability, use of emerging products and regulatory environments, we examined patterns and correlates of polysubstance use among US youth aged 15-17 years. DESIGN: Cross-sectional self-reported data. SETTING: United States. PARTICIPANTS: A total of 6127 US youth aged 15-17 years from wave 1 (2013-14) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. MEASUREMENTS: Latent class analysis was used to identify subgroups of polysubstance use, including 12 tobacco products, alcohol, marijuana, prescription drugs and other drugs. Socio-demographic characteristics, residence in urban area, sensation-seeking, sexual orientation and internalizing and externalizing problems were examined as correlates. FINDINGS: Approximately 43.5% of 15-17-year-olds had used at least one substance in the past 12 months. A 5-class model was identified: class 1 'abstainers' (67.3%), class 2 'alcohol users' (19.2%), class 3 'alcohol, marijuana and tobacco (AMT(predominant AM) ) users' (8.2%), class 4 'alcohol, marijuana and tobacco (AMT(predominant T) ) users' (3.9%) and class 5 'alcohol, marijuana, tobacco and other drug (AMTOD) users' (1.4%). Abstainers were considered the reference class. Higher sensation-seeking scores, higher age and lower academic grades were each associated with greater likelihood of membership in all user classes. Gender, race/ethnicity, parents/guardians' education, residence in non-urban areas and sexual minority groups were associated with membership in some, but not all, user classes. Compared with no/low/moderate severity, high severity internalizing problems were associated with membership in classes 2, 3 and 5, whereas high severity externalizing problems were associated with membership in classes 3 and 5 only. CONCLUSIONS: There appear to be three heterogeneous polysubstance use classes among US youth aged 15-17 years. Correlates of substance use among US youth include higher sensation-seeking, poor academic performance, non-urban residence, minority sexual orientation and mental health problems.