Purpose: Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). Methods: We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). Results: We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation f 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). Conclusions: Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females. (C) 2020 Society for Adolescent Health and Medicine. All rights reserved.

Over 18 million adolescents use the emergency department (ED) each year. High risk of unintended pregnancy is associated with frequent use of the ED and lack of a primary care provider, making the ED visit an important potential site for intervention. With few adolescent preventive health interventions being implemented and evaluated in the ED setting, the description of the rigorous development of an ED-based pregnancy prevention intervention can guide future adolescent emergency medicine researchers. The objective of this study is to describe a systematic approach, intervention mapping, to develop a theory-based, user-informed, digital intervention aiming to increase contraception use among adolescent female ED patients at high risk of unintended pregnancy. We followed the 6 iterative steps of intervention mapping to create a blueprint for designing, implementing, and evaluating an ED-based, digital, pregnancy prevention intervention: (1) Developed a Logic Model of the Problem—teen pregnancy in the ED setting—based on a needs assessment; (2) Stated the outcomes and objectives of our intervention via a Logic Model of Change, including our theoretical framework; (3) Developed the pregnancy prevention curriculum and plan, including the digital strategy and brand; (4) Produced the intervention, including designing the branched-logic texting algorithms, website, videos, and cartoons; (5) Planned program use, such as implementation strategies in the ED setting; and (6) Developed an evaluation plan. Using the process of intervention mapping, we developed Dr. Erica (Emergency Room Intervention to improve the Care of Adolescents). Dr. Erica is a relatable, empathetic, straightforward and reliable virtual female doctor who sends 10 weeks of personalized and interactive evidence-based text messages that aim to promote healthy sexual behaviors and decrease teen pregnancy risk. Texts are based on key stakeholder input, participatory design, and the Social Cognitive Theory as well as incorporate social media, relatable characters and Motivational Interviewing techniques. Following the outline of intervention mapping led to the development of a theory-based, user-informed, digital pregnancy prevention intervention. Outlining this method may be helpful to future investigators interested in designing and evaluating adolescent preventive health interventions in both the acute and outpatient setting.

Impairments in response inhibition and salience attribution (iRISA) have been proposed to underlie the clinical symptoms of drug addiction as mediated by cortico-striatal-thalamo-cortical networks. The bulk of evidence supporting the iRISA model comes from neuroimaging research that has focused on cortical and striatal influences with less emphasis on the role of the thalamus. Here, we highlight the importance of the thalamus in drug addiction, focusing on animal literature findings on thalamic nuclei in the context of drug-seeking, structural and functional changes of the thalamus as measured by imaging studies in human drug addiction, particularly during drug cue and non-drug reward processing, and response inhibition tasks. Findings from the animal literature suggest that the paraventricular nucleus of the thalamus, the lateral habenula and the mediodorsal nucleus may be involved in the reinstatement, extinction and expression of drug-seeking behaviours. In support of the iRISA model, the human addiction imaging literature demonstrates enhanced thalamus activation when reacting to drug cues and reduced thalamus activation during response inhibition. This pattern of response was further associated with the severity of, and relapse in, drug addiction. Future animal studies could widen their field of focus by investigating the specific role(s) of different thalamic nuclei in different phases of the addiction cycle. Similarly, future human imaging studies should aim to specifically delineate the structure and function of different thalamic nuclei, for example, through the application of advanced imaging protocols at higher magnetic fields (7 Tesla).This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.