Behavior and Behavior Mechanisms Commons^™

Beyond Opioids: The Role Of Polysubstance Exposure In Neonatal Abstinence Syndrome Treatment And Hospitalization, Caelyn Harrison

Undergraduate Honors Theses

This thesis explores the impact of prenatal polysubstance exposure, specifically focusing on the need for pharmacological treatment for Neonatal Abstinence Syndrome (NAS) and the duration of their hospital stay. A retrospective analysis of 462 infants, including 121 exposed to polysubstances during pregnancy, showed significant associations between polysubstance exposure and adverse neonatal outcomes. Infants with prenatal polysubstance exposure were more likely to require pharmacological treatment for NAS (52.8%) compared to non-exposed infants (38.7%), as determined by chi-square analysis (χ²(1, N = 462) = 7.36, p = .007). Additionally, infants exposed to polysubstances experienced longer hospital stays on average (M = 14.88 …

Psychological Treatment Behind The Walls:Insights From The Inside, Rogelio Serrano

Psychology Division Scholarship

Repeated eras of mass incarceration, criminalization of marginalized communities, and substance use policies have created a revolving door of justice involved populations. The ever-increasing prison population has repeatedly become the largest contingency of mental health clientele for an overburdened mental health system. Those who work with formerly incarcerated individuals in the community often don’t know the unique set of challenges faced by practitioners within the system. Increased understanding and coordination of care can offer opportunities for sustained recovery and reduced levels of recidivism. In this presentation participants will learn about the unique insights on mental health treatment that can be …

Association Of Driving With Blood Delta-9-Tetrahydrocannabinol: A Systematic Review, Danial Behzad, Sampson Zhao, Reena Besa, Bruna Brands, Christine M. Wickens, Marilyn A. Huestis, Bernard Le Foll, Patricia Di Ciano

Institute of Emerging Health Professions Faculty Papers

IMPORTANCE: Driving under the influence of cannabis increases the risk of motor vehicle collisions. In some jurisdictions, deterrence rests on the ability to detect delta-9-tetrahydrocannabinol (THC) in blood. Recent evidence suggests that there may be a nuanced relationship of blood THC to driving.

OBJECTIVE: The purpose of this systematic review was to summarize all published papers investigating the presence of a linear relationship between blood THC and driving, primarily measured by simulated driving in the lab.

OUTCOMES: The main outcomes assessed included "weaving"/lateral control (eg, standard deviation of lateral position), speed, car following (following distance; coherence), reaction time, and overall …

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders, Hazem Alata, Hussein Bazzi, Saleh Al-Juburi, Angie Achkar, Liam Browning, Nicole Oska, Adam Chaban, Arash Javanbakht

Medical Student Research Symposium

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders

Introduction:

Substance use disorders (SUD) among Middle Eastern and North African (MENA) populations remain largely understudied, despite evidence of high prevalence rates and lower rates of treatment engagement. Unique cultural conceptualizations and beliefs surrounding substance use disorders may perpetuate stigma, further contributing to disparities in access to and utilization of treatment services. This study aims to explore the attitudes and perspectives of individuals from MENA communities regarding substance use disorders, with the goal of identifying and addressing barriers to treatment.

Methods:

An anonymous bilingual Qualtrics survey was administered, gathering responses from …

Reevaluating Informed Consent: Integrating Shared Decision-Making Into Spinal Surgery For Better Patient Outcomes., Jeffrey N Wang, Mohamed A Elhakeem, Matthew J Mesimer, Paul G Mastrokostas, Salman Ahmad, Tim Reed, Brandon Klein, Lucas E Bartlett, Adam D Bitterman, Andrew Megas

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Study Design: Narrative review.

Objectives: The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery?

Methods: N/A.

Results: SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, …

Hbv Transmission Knowledge Among Korean-American Chronic Hepatitis B Patients In The United States, Giyoung Lee, Hee-Soon Juon, Eunji Kim, Katherine C Smith, Hie-Won Hann, Mimi Chang, Ann C. Klassen

Division of Gastroenterology and Hepatology Faculty Papers

Chronic hepatitis B (CHB) is a condition that disproportionately affects Asian Americans in the United States. Knowledge of transmission is crucial for CHB patients to practice prevention methods to limit the spread of the hepatitis B virus (HBV), but also live their lives free from unwarranted fears or restrictions. Among Asian CHB patients, several misperceptions about HBV transmission have been identified. This analysis aims to assess the current state of HBV knowledge among a cohort of Korean-American CHB patients. This mixed-methods study includes 363 respondents who completed a survey in either Korean (N = 298) or English (N = 65) …

Quantifying Patient Preferences For Treatments For Refractory Chronic Spontaneous Urticaria, Olufemi Babalola, Richard W. Hass, John F Mcana, Manav Segal, Juan Marcos Gonzalez, Olajumoke Fadugba

College of Population Health Faculty Papers

BACKGROUND: In recent years, it has become increasingly common to incorporate the patient perspective into drug development and regulatory decision making.

OBJECTIVE: This study aimed to measure and quantify patient preferences (priorities and trade-offs) for attributes that characterize current and emerging refractory chronic spontaneous urticaria (rCSU) treatments.

METHODS: Adult patients with self-reported rCSU symptoms completed an online discrete choice experiment survey. The survey included 10 questions that asked respondents to choose between 2 hypothetical rCSU treatment profiles having similar attributes with varying levels. The attributes included the following: chance of control of symptoms, time to symptom control, return of symptoms …

Adverse Childhood Experiences: Healing Through Storytelling And Mindful Narrative Therapy, Julie Kemp

Mindfulness Studies Theses

This study presents research about the nature and prevalence of adverse childhood experiences (ACEs), the mental and physical impacts to individuals exposed to ACEs, and incorporating mindfulness practices into therapeutic approaches to treating them, particularly Mindfulness-Based Narrative Therapy (MBNT). It is important because ACEs have become a global crisis, with the potential for interfering with psychological and physical development, early mortality, and other harmful life outcomes. This thesis provides critical information for mindfulness teachers and practitioners, therapists, educators, regulators, parents, and individuals subjected to ACEs.

The methodology includes extensive literature searches for narrative therapy and mindfulness-based interventions (MBIs) in peer-reviewed …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Assessing The Relationship Between Perceived Psychological And Physical Pain In Adults With Orthopedic Pain, Daniel C. Karimi Dehkordi

Honors Undergraduate Theses

Suicide remains a public health concern in the U.S., particularly among individuals experiencing chronic pain and psychological distress. This cross-sectional study investigated the relationship between perceived physical and psychological pain in 41 adults with chronic orthopedic conditions. The relationship between other risk and protective factors and perceived levels of pain distress was also examined. Results showed a significant positive correlation between psychological distress and physical pain (r(39) = 0.388, p < .05) and psychological distress and depressive/anxiety symptoms (r (39) = 0.477, p < .01). Psychological distress was moderately associated with feelings of hopelessness (r (39) = 0.403, p < .01), however, the relationship between physical pain and hopelessness was weak and nonsignificant (r (39) = -0.06, p = .71). Contrary to expectations, emotional support did not buffer the effects of psychological distress (r (39) = 0.07, p = 0.66). Mediational analysis confirmed that emotional support did not influence the relationship between physical pain and psychological distress (Beta (β) = -0.969, p = 0.572; Sobel Z = 0.5598, p = 0.575). Age was not correlated with psychological distress (r (39) = -0.24, p = 0.13) or mental health symptoms (r (39) = -0.05, p = .77). While there was no significant difference across sex, males reported higher mental health symptomatology and psychological distress scores than female counterparts. These findings underscore the direct impact of physical pain on psychological distress and challenge assumptions about the protective role of social support. The study highlights the need for integrated, multidisciplinary interventions targeting both physical and psychological pain to mitigate suicide risk among individuals with chronic orthopedic conditions. Future research should iii explore alternative support mechanisms and resilience-building strategies to address the complex interplay of pain, distress, and suicidality.

Weighted Family History Density Of Substance Use: Influence On Participant Substance Use Onset, Escalation, And Duration, Carleigh A. Litteral

Theses and Dissertations--Psychology

Substance use disorders impose a staggering toll on the United States (U.S.), straining healthcare systems, destabilizing communities, and profoundly impacting both individuals and families. Approximately one in six Americans aged 12 and older had a past-year substance use disorder in 2022 (Key Substance Use, 2022), and nearly one-third of adults experience a substance use disorder in their lifetime (Wu, 2010), contributing to an economic burden exceeding $400 billion annually (National Drug Threat Assessment, 2011). Family history of substance use disorders is a key predictor of vulnerability, with individuals who have affected relatives being 2–8 times more …

Improved Adherence To Lipid Screening In The Pediatric Cardiology Clinic: A Quality Improvement Project, Rachel Magnan, Thomas Murphy, Lauren Rosenthal, Aparna Prasad, Anjali Chelliah, Stuart Kaufman, Donna Timchak, Lindsey Mcphillips, Saira Siddiqui

Department of Pediatrics Faculty Papers

INTRODUCTION: Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.

METHODS: All outpatient visits for patients 9-11 and 17-21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic …

Factors Associated With Receipt Of Tobacco Treatment Integrated With Nurse Navigation In A Centralized Lung Cancer Screening Program At An Urban Academic Medical Center, Christine S. Shusted, Sarah Mukhtar, James Lee, Brooke Ruane, Emily Muse, Lawrence Emeigh-Mcbride, Eboni Gatson-Anderson, Gregory C. Kane, Kuang-Yi Wen, Hee-Soon Juon, Julie A. Barta

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

PURPOSE: Optimal approaches for tobacco treatment counseling among individuals who currently smoke and are undergoing shared decision-making (SDM) and lung cancer screening (LCS) are unknown. The objective of this cross-sectional study was to determine the rate of reported interest in tobacco treatment counseling and pharmacotherapy among individuals who currently smoke and are receiving integrated nurse navigation for LCS and tobacco treatment in a centralized LCS Program.

METHODS: We identified individuals undergoing SDM through our centralized LCS Program between March 2021 and March 2022. The LCS Program tobacco treatment protocol includes counseling both in-person and via telephone during SDM, LCS results …

Parenting With Grace, Eva Nelson Cole

Capstone Projects and Master's Theses

Parents are often caught off guard by the upheaval of adding children to their lives. Feelings of guilt, shame, isolation, and depression can arise when parents are faced with the demands and stressors that come along with having children. Studies have shown that children who have distressed parents endure lasting negative outcomes that can extend into the primary school years (Mihelic et al., 2018). Educating parents and giving them some awareness about what to expect can make a real difference. To have these conversations, I created a two-part parenting workshop for new parents at Parents’ Place in Pacific Grove, CA. …

Identifying Barriers To Hepatitis B And Delta Screening, Prevention, And Linkage To Care Among People Who Use Drugs In Philadelphia, Pennsylvania, Usa, Beatrice Zovich, Catherine Freeland, Holly Moore, Kara Sapp, Anousha Qureshi, Amy Jessop, Rachel Holbert, Fiona Borondy-Jenkins, Quinn Plunkett, Chari Cohen

Student Papers, Posters & Projects

BACKGROUND: People who use drugs (PWUD) are at increased risk for blood-borne viruses, including hepatitis B (HBV) and delta (HDV). Despite the public health threats both viruses present, awareness remains low among at-risk communities and providers who serve them. This study assessed barriers to HBV and HDV prevention, diagnosis, and linkage to care, evaluated existing levels of knowledge, and identified educational needs and preferences among both PWUD and service providers.

METHODS: For this mixed-methods study, data were collected through an anonymous online provider-focused survey, and interviews with PWUD, non-medical staff, and healthcare providers at a harm reduction organization in Philadelphia, …

Convergence Of Alcohol Consumption And Dietary Quality In Us Adults Who Currently Drink Alcohol: An Analysis Of Two Core Risk Factors Of Liver Disease, Peng-Sheng Ting, Wei-Ting Lin, Suthat Liangpunsakul, Madeline Novack, Chiung-Kuei Huang, Hui-Yi Lin, Tung-Sung Tseng, Po-Hung Chen

School of Public Health Faculty Publications

BACKGROUND/OBJECTIVES: Alcohol consumption and poor dietary habits are on the rise in the United States, posing significant challenges to public health due to their contribution to chronic diseases such as liver failure. While associations between alcohol consumption patterns and diet quality have been explored, the relationship between specific alcoholic beverage types and diet quality remains underexamined. This study aims to compare diet quality among consumers of different alcoholic beverage types. METHODS: We conducted a cross-sectional analysis of 1917 current alcohol drinkers from the National Health and Nutrition Examination Survey (NHANES) who completed a 24 h dietary recall survey. Diet quality …

Demographic Characteristics, Perinatal Smoking Patterns, And Risk For Neonatal Health Complications Among Pregnant Smokers In The United States Who Begin Using Electronic Cigarettes During Pregnancy: A Descriptive Study Using Population-Based Surveillance Data., Hui Nian, Rachel Odland, Samantha Mindlin, Lin Ammar, Hilary Tindle, Angela M Miller, Kelli K Ryckman, Ethan Xie, Tina V Hartert, Brittney M Snyder, Steven M Brunwasser, Pingsheng Wu

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: Health agencies have called for research evaluating e-cigarette (EC) use in supporting prenatal smoking cessation. This study aimed to describe (1) the characteristics of smokers who begin using electronic cigarettes (ECs) during pregnancy, (2) how frequently smokers reduce or eliminate pre- and post-natal combustible cigarette (CC) use, and (3) the risk for neonatal health complications among smokers who initiate ECs during pregnancy.

AIMS AND METHODS: Pregnant women using CCs exclusively during prepregnancy, who participated in a U.S. surveillance study, were classified by their reported late-pregnancy smoking behavior as CC-exclusive users, EC initiators, or quitters. EC initiators were further subclassified …

Emotional Overeating And Eating Motives During Covid-19 In Polish Women: Intergroup Comparison Among Participants In Various Body Mass Index Categories, Adriana Modrzejewska, Justyna Modrzejewska, Kamila Czepczor-Bernat, Julia Wyszomirska

Baltic Journal of Health and Physical Activity

Introduction: Taking into account the situation of the COVID-19 pandemic and the ac-companying lockdown resulting in increased negative emotions, it is interesting to learn about eating motives and behaviors and check their intensity. The aim of this study was to investigate the differences between Polish women in various body mass index categories in terms of eating motives and emotional overeating during the COVID-19 pandemic. Material and methods: This study sample comprised 1,447 women (M_age = 31.34 ± 11.05; M_BMI = 23.79 ± 4.59). The research used the following tools: the Eating Motivation Survey, the Emotional Overeating Questionnaire, and …

Impact Of A Suicide Prevention Learning Module For Firearm Training Courses In Louisiana, Claire Houtsma, Lauren Reyes, Katherine Macwilliams, Gala True

School of Medicine Faculty Publications

Background: Firearm suicide is a leading cause of death in the United States. Suicide prevention experts have advocated for upstream interventions that can be implemented prior to the development of suicidal thoughts, particularly those that focus on lethal means safety (LMS; e.g., increasing secure firearm storage). To reach firearm owners with LMS messaging, researchers have developed suicide prevention training content which can be incorporated into firearm training courses. However, no study to date has evaluated impact of such training on firearm course students’ subsequent knowledge, attitudes, and openness related to secure firearm storage. Thus, the current study sought to examine …

Digital Health Research Symposium: Closing Panel Commentary, Judd E. Hollander, Kristin L. Rising, Brian M. Dougan

Department of Emergency Medicine Faculty Papers

No abstract provided.

Evaluating Attitudes On Health-Seeking Behavior Among A Network Of People Who Inject Drugs, Ayako Shimada, Ashley Buchanan, Natallia Katenka, Benjamin Skov, Gabrielle Lemire, Stephen Kogut, Samuel Friedman

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

People who inject drugs (PWID) are often members of HIV/AIDS risk networks, where individuals engage in sexual and injection risk behavior. Engagement in HIV care is important for this population. Low socioeconomic status, stigmatization, and lack of access to medical care often complicate successful engagement in the HIV cascade of care for PWID. This study investigates how individual’s attitudes about how much control they have over HIV/AIDS risk in their life (i.e., locus of control and self-blame) affect health-seeking behavior in PWID participants and their community members. We applied causal inference methodology to PWID HIV risk networks ascertained from the …

Framing The Path To Fitness: Age Differences In Response To Framed Exercise Messages, Iliya Sherif, David B. Taullahu, Alyssa R. Minton, Joseph A. Mikels

DePaul Discoveries

Physical activity is one of the most protective health behaviors one can engage in, yet 75% of active adults in the US, meaning those who exercise regularly, fall short of the recommended levels of physical activity, with an even greater percentage of older adults living inactive lives, meaning they exercise minimally and engage in prolonged sedentary behavior (CDC, 2019). The goal of the current study was to explore different types of message framing targeted at encouraging older and younger adults to exercise. We recruited older adults (n = 184; Mage = 69.45 years, age range: 65- 80 years) and younger …

Financial Incentives For Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial, Darla Kendzor, Michael Businelle, Summer Frank-Pearce, Joseph Waring, Sixia Chen, Emily Hébert, Michael Swartz, Adam Alexander, Munjireen Sifat, Laili Kharazi Boozary, David Wetter

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions.

OBJECTIVES: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES.

DESIGN, SETTING, AND PARTICIPANTS: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024.

INTERVENTIONS: Participants were randomized to usual care (UC) for smoking cessation (counseling …

Getting Precise About Gender And Sex Measurement: A Primer For Epidemiologists, Arjee J. Restar, Elle Lett, Neia Prata Menezes, Andrea R. Molino, Tonia C. Poteat, Lorraine Dean, Jennifer L. Glick, Kellan E. Baker, S Wilson Cole

School of Public Health Faculty Publications

Accurately measuring gender and sex is crucial in public health and epidemiology. Iteratively reexamining how variables-including gender and sex-are conceptualized and operationalized is necessary to achieve impactful research. Reexamining gender and sex advances epidemiology toward its goals of health promotion and disease elimination. While we cannot reduce the complexities of sex and gender to simply an issue of measurement, striving to capture these concepts and experiences accurately must be an ongoing dialogue and practice-to the benefit of the field and population health. We assert that epidemiology must counteract misconceptions and accurately measure gender and sex in epidemiology. We aim to …

Investigating Risk Factors For Racial Disparity In E-Cigarette Use With Path Study, Amy Liu, Kennedy Dorsey, Almetra Granger, Ty Runet Bryant, Tung Sung Tseng, Michael Celestin, Qingzhao Yu

School of Public Health Faculty Publications

Background: Previous research has identified differences in e-cigarette use and socioeconomic factors between different racial groups However, there is little research examining specific risk factors contributing to the racial differences. Objective: This study sought to identify racial disparities in e-cigarette use and to determine risk factors that help explain these differences. Methods: We used Wave 5 (2018–2019) of the Adult Population Assessment of Tobacco and Health (PATH) Study. First, we conducted descriptive statistics of e-smoking across our risk factor variables. Next, we used multiple logistic regression to check the risk effects by adjusting all covariates. Finally, we conducted a mediation …

Trends In Substance Use And Mental Health Among Adolescents In Georgia, 2002-2022, Saumya S. Palipudi, Bangaru Talli Palipudi, Murty Komanduri

Georgia Public Health Association Annual Meeting & Conference

Background: While substance use and absence of mental health disorders among youth in the United States (US) have declined over the past two decades, post COVID-19 pandemic, these conditions have increased significantly with notable disparities, and witnessed a crisis in public health. In 2022, 24.7% or 6.1 million adolescents aged 12 to 17 in the US had either Major Depressive Episodes (MDE) or Substance Use Disorder (SUD) and 3.7 percent had both in the prior year². Increased stress, lack of peer connections, parental abuse, and poor mental health conditions were attributed to this increase in substance use^{3-7 …}

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

Rowan-Virtua Research Day

According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

What Is The Impact Of Marijuana Usage On Sexual Dysfunction Among Individual And How Do Factors Such As Frequency Of Use, Dosage, And Duration Of Marijuana Consumption Influence Sexual Function, Zachary A. Harris, Russell Levi, Saad Ahmed

Rowan-Virtua Research Day

Sexual health is an integral piece of human vitality, encompassing a multitude of psychological & physiological factors. There has been an unprecedented amount of interest surrounding cannabis and its impact on sexual function in the past decade. The interplay between the acceptance of cannabis and its widespread use presents the need for research into the correlation between cannabis and sexual health outcomes. The primary components of cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC) have attracted scrutiny for their potential effects on sexual function. Anecdotal accounts suggest heightened sexual desire and pleasure, however there are conflicting reports raising concerns regarding performance issues …

The Effect Of Covid-19 Pandemic On Sanitation Practices And Anxiety In The General Population, Leah Cliatt, Joanna Petrides

Rowan-Virtua Research Day

Background: Illness anxiety and fear of contracting coronavirus increased considerably during the COVID-19 pandemic. The media, being in lockdown, and cyberchondria had the largest impact on the population’s anxiety surrounding illness. While this kind of reaction to illness is expected during the pandemic, there is limited data on post-pandemic illness anxiety levels in the general population. Patients’ perception of disease impacts medicine at every level; medical professionals need to understand the concerns and fears of their patients in order to treat the post-pandemic patient. We hypothesized that sanitation practices and anxiety surrounding illness have not returned to baseline pre-COVID-19 …

Review Of Missing Data Elements For Client Enrollment In The Minority Aids Initiative For High-Risk Men Of Nj, Vrushank Shah

Rowan-Virtua Research Day

The Minority AIDS Initiative study funded in NMI seeks to enhance healthcare outcomes for underserved individuals. Implementing outreach programs, the initiative provides healthcare and post-treatment follow-up to this demographic. The proposed project, a component of this study, concentrates on individuals with substance abuse disorder, specifically targeting those who have been onboarded but subsequently lost to follow-up. In the United States, approximately 20 million people are diagnosed with substance abuse disorder, yet in 2016, only 3.8 million received treatment. Within this cohort, between 20% and 70% of individuals undergoing residential substance abuse treatment disengage before completion. Various factors hinder the sustained …