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Goldstick JE, Carter PM, Whiteside L, Delgado MK, Stallworth P, Sullivan K, Childs M, Taga S, Cunningham RM. Firearm violence and associated factors among young adults presenting to emergency departments in three cities: Baseline results from Project SPARK. Prev Med 2024; 189:108124. [PMID: 39232991 DOI: 10.1016/j.ypmed.2024.108124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Recent shifts in U.S. violence dynamics call for updated violence epidemiology among general emergency department (ED) samples of young adults. Using baseline data from a multi-site longitudinal study of firearm violence prediction, we describe violence rates and associated factors. METHODS Staff approached age 18-24 entrants to Level-1 trauma centers in three cities (Flint, Seattle, Philadelphia; 7/2021-5/2023). Consenting participants completed a survey including validated measures of violence experience, firearm-related behaviors, substance use, mental health symptoms, peer/parental/familial behaviors, community violence, and attitudes/norms. We described the sample and examined factors associated with firearm assault (victimization/aggression, including threats). RESULTS Across sites, 1506 participants enrolled (41.7. % Black; 33.6 % White; 61.4. % female). Half of participants self-reported past-six-month violent victimization and/or aggression; non-partner violence, and violent victimization were most common. Over half of participants self-reported high-risk substance use, and over half screened positive for post-traumatic stress disorder, depression, and/or anxiety. About 14.4 % self-reported past-six-month firearm assault, and 5.9 % self-reported firearm violence (excluding threats). Adjusted analysis showed community violence exposure was most strongly associated with firearm assault; each one-point-increase corresponded to a 13.7 % (95 %CI: 10.4 %-16.9 %) absolute increase in firearm assault prevalence. Drug misuse, mental health symptoms, firearm carrying, retaliatory attitudes, prosocial attitudes, and family conflict were also associated with firearm assault. CONCLUSIONS Violence, including firearm assault, is common among young adults entering urban EDs, and is associated with several psychosocial factors. High rates of substance use and mental health symptoms underscore this as a high-need population. Leveraging this information could help tailor interventions and optimize resource allocation.
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Affiliation(s)
- Jason E Goldstick
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, United States of America; Institute for Firearm Injury Prevention, University of Michigan, 1109 Geddes Ave, Ann Arbor, MI, United States of America; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, United States of America; Institute for Firearm Injury Prevention, University of Michigan, 1109 Geddes Ave, Ann Arbor, MI, United States of America; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
| | - Lauren Whiteside
- School of Medicine, Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | - M Kit Delgado
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Philip Stallworth
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, United States of America; Institute for Firearm Injury Prevention, University of Michigan, 1109 Geddes Ave, Ann Arbor, MI, United States of America; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, United States of America
| | - Keara Sullivan
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, United States of America; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, United States of America
| | - Maya Childs
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sarah Taga
- School of Medicine, Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, United States of America; Institute for Firearm Injury Prevention, University of Michigan, 1109 Geddes Ave, Ann Arbor, MI, United States of America; Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
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Bonar EE, Goldstick JE, Tan CY, Bourque C, Carter PM, Duval ER, McAfee J, Walton MA. A remote brief intervention plus social media messaging for cannabis use among emerging adults: A pilot randomized controlled trial in emergency department patients. Addict Behav 2023; 147:107829. [PMID: 37598642 DOI: 10.1016/j.addbeh.2023.107829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Interventions addressing cannabis use among emerging adults (ages 18-25) are currently needed to prevent negative outcomes. Emergency Department (ED) visits provide an opportunity to initiate interventions. In this pilot study, we created a brief intervention (BI), extended with private social media messaging for emerging adult ED patients who use cannabis regularly. Study aims were to examine intervention feasibility, acceptability, and descriptive outcomes. METHODS We recruited and randomized N = 58 emerging adults (M age 21.5 years, 65.5% female) who used cannabis from an ED in-person and remotely after their ED visit (given COVID-19 restrictions). Participants randomized to the intervention (N = 30) received a Motivational Interviewing-based BI and 4 weeks of health coaching via private social media; control participants received a resource brochure and entertaining social media messaging. Follow-ups occurred at 1-month and 3-months. RESULTS Most intervention participants liked the BI (95.8%), found it helpful to discuss cannabis use in the BI (91.7%), and liked interacting with coaches on social media (86.3%). Social media content (e.g., video clips, images/still pictures/memes) were highly rated. Descriptively, the intervention group showed theory-consistent changes in importance of and intentions to change cannabis (increases vs. decrease/stability in control group), whereas findings for cannabis consumption/consequences were mixed. CONCLUSIONS This BI paired with social media messaging was acceptable in a sample of emerging adults from an ED who used cannabis regularly. Despite feasibility challenges due to COVID-19, this intervention warrants future investigation with a larger sample and longer follow-up period, with attention to the changing cannabis landscape when measuring outcomes.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA.
| | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Burlington Building, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA.
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
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Kontu M, Hakko H, Riala K, Riipinen P. Injuries, Poisonings, and Other External Causes of Morbidity among Drug Crime Offenders: A Follow-Up Study of Former Adolescent Psychiatric Inpatients. Eur Addict Res 2023; 29:194-201. [PMID: 37100043 DOI: 10.1159/000530122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/24/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Criminal offenders have high incidences of injury- and substance-related emergency department visits. Very few studies focus on drug crime offenders or the medical specialties involved in treating these offenders. We aimed to study how drug crime offenders' treatment events in specialized health care due to injuries, poisonings, or other external causes of morbidity differed from treatment of non-criminal controls and which of the medical specialties were involved in their care. METHODS The study population included 508 former adolescent psychiatric inpatients (age 13-17 years), who were followed up through Finnish national registers. A total of 60 had committed a drug crime during the 10-15 years' follow-up. They were matched with 120 non-criminal controls from the study population. Hazard ratios (HRs) with 95% confidence intervals (Cl) for drug crime offending were assessed using a Cox regression model. RESULTS Almost 90% of drug crime offenders had treatment events in specialized health care due to injuries, poisonings, and other external causes of morbidity, compared to 50% of non-criminals. The majority of the drug crime offenders had been treated for accidental injuries (65% vs. 29%; p < 0.001) in comparison to non-criminal controls. More drug crime offenders had been treated for intentional poisonings (42% vs. 11%; p < 0.001) than non-criminal controls. For drug crime offenders, the lifetime probability of a treatment event due to poisoning was almost doubled (HR: 1.89, 95% CI: 1.26-2.84; p = 0.002), and for treatments due to injury, there was a 2.5-fold increase (HR: 2.54, 95% CI: 1.69-3.82; p < 0.001) in comparison to non-criminal controls. CONCLUSION In emergency care, substance use screening and referral for appropriate psychiatric and substance abuse treatment services should be considered for all adolescents and young adults attending hospitals due to injuries or poisonings.
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Affiliation(s)
| | - Helina Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Kaisa Riala
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Goldstick JE, Bonar EE, Myers M, Bohnert ASB, Walton MA, Cunningham RM. Within-Person Predictors of Same-Day Alcohol and Nonmedical Prescription Drug Use Among Youth Presenting to an Urban Emergency Department. J Stud Alcohol Drugs 2022; 83:85-90. [PMID: 35040763 PMCID: PMC8819893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets. METHOD At an urban emergency department, research assistants recruited youth ages 14-24 reporting past-6-month substance use (n = 599; 58.8% male). Participants self-administered validated measures of alcohol consumption, cannabis use severity (quantity and consequences), mental health symptoms, and social influences at baseline and at four biannual follow-ups. In addition, participants completed Timeline Followback calendars that assessed same-day use of alcohol and prescription drugs. We used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency. RESULTS Between 6.0% (baseline) and 8.6% (6-month follow-up) of youth reported same-day alcohol use and NMPDU across follow-ups. Within-person increases in alcohol consumption, cannabis use severity, and depression and anxiety symptoms all corresponded to greater same-day alcohol and NMPDU frequency, with consistent findings across genders. Increased positive peer behaviors corresponded to decreased same-day use frequency among males but not females. Decreased parental support and increased delinquent peer exposures corresponded to greater same-day use frequency among females but not males. CONCLUSIONS Substance use and mental health symptom escalation are robust predictors of greater same-day use frequency, whereas the roles of social factors appear gender-specific. Interrupting worsening trajectories of substance use and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same-day use frequency.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Correspondence may be sent to Jason E. Goldstick at the Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, or via email at:
| | - Erin E. Bonar
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Matthew Myers
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Hurley Medical Center, Flint, Michigan
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Bonar EE, Walton MA, Carter PM, Lin LA, Coughlin LN, Goldstick JE. Longitudinal within- and between-person associations of substance use, social influences, and loneliness among adolescents and emerging adults who use drugs. ADDICTION RESEARCH & THEORY 2021; 30:262-267. [PMID: 37621927 PMCID: PMC10449059 DOI: 10.1080/16066359.2021.2009466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 08/26/2023]
Abstract
Loneliness is a public health problem causing morbidity and mortality. Individuals with substance use problems are often lonelier than the general population. We evaluate the longitudinal associations between social influences, substance use, and loneliness among adolescents and young adults recruited from an urban Emergency Department (ED). We use secondary data from a natural history study of N=599 youth (ages 14-24) who used drugs at baseline and completed biannual assessments for 24 months; 58% presented to the ED for an assault-related injury and a comparison group comprised 42% presenting for other reasons. Measures assessed cannabis use, alcohol use, and loneliness. Using GEE models, we evaluated the relationships between social influences (peers, parents), substance use, and loneliness via longitudinal data, de-coupling within- and between-person effects. Men reported lower loneliness over time. At the between-person level, individuals with greater alcohol and cannabis use severity and negative peer influences had greater loneliness; positive parental influences were associated with less loneliness. At the within-person level, greater alcohol use severity, negative peer influences, and parental substance use corresponded to increases in loneliness; positive parental influences corresponded to decreases in loneliness. Youth with more severe alcohol and cannabis use had greater loneliness over time. Within individuals, peer and parental social influences were particularly salient markers of loneliness. An ED visit provides an opportunity for linkage to personalized, supportive interventions to curtail negative outcomes of substance use and loneliness.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
- Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503
| | - Lewei A Lin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109
| | - Lara N Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
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Richards TN, Gillespie LK. Intimate Partner Violence Perpetration, Victimization, and Overlap Among Serious Juvenile Offenders: Trajectories of Emerging Adulthood. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10054-10079. [PMID: 31619108 DOI: 10.1177/0886260519881000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study uses group-based trajectory analysis and data from the Pathways to Desistance Study to examine the prevalence and patterns of intimate partner victimization, offending, and overlap among justice-involved adolescents (i.e., general offenders) who reported dating (n = 909); regression analysis was further utilized to assess predictors of intimate partner violence (IPV) group membership. Findings revealed that 40% of adjudicated youth reported IPV as a victim, an offender, or as both a victim and an offender during emerging adulthood. Findings also indicated that there was significant overlap between victimization and offending, and 5% of the sample was assigned to both the high-rate perpetration and victimization trajectory groups. Maternal hostility, alcohol use, and witnessing violence predicted higher rate perpetration and victimization overlap group membership compared with very-low-rate perpetration/victimization group membership. Implications for informing policy and future research are discussed.
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Ford JH, Zollinger TW, Zhang J, O'Neil J, Nelson DR, Steele GK. Trends in Depressed Mood and Suicidal Behaviors Among Female High School Students Who Engaged in Physical Fighting. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP4826-NP4849. [PMID: 30141730 DOI: 10.1177/0886260518790599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of this article is to identify prevalence changes in depressed mood/suicidal behaviors among female high school students reporting physical fighting. This research analyzed the national combined data set of the Youth Risk Behavior Surveillance (YRBS) cross-sectional surveys from 2001 to 2015. Logistic regression analyzed the time trends. Two multiple logistic regression models were built. A quadratic trend was present with an initial decrease followed by an increase 2009 to 2015 (p < .001). The odds and severity of depressed mood/suicidal behaviors were greater among female youths with four or more fights and for other violent events, which were even greater when accounting for electronic bullying. The odds of depressed mood/suicidal behaviors among female adolescents engaged in physical fighting has been increasing with electronic bullying contributing to polyvictimization.
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Affiliation(s)
- Janet H Ford
- Indiana University, Indianapolis, USA
- Eli Lilly and Company, Indianapolis, IN, USA
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Bonar EE, Cunningham RM, Sweezea EC, Blow FC, Drislane LE, Walton MA. Piloting a brief intervention plus mobile boosters for drug use among emerging adults receiving emergency department care. Drug Alcohol Depend 2021; 221:108625. [PMID: 33631541 PMCID: PMC8026691 DOI: 10.1016/j.drugalcdep.2021.108625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily focusing on drug use, with a secondary focus on condomless sex. We examined descriptive outcomes of alcohol, drug use, and condomless sex. PROCEDURES We recruited N = 63 emerging adults who used drugs (primarily cannabis) from an ED (72.4 % participation rate). Their mean age was 21.7 years (SD = 2.3); 67 % were female and 52.4 % were Black/African American. Participants randomized to the intervention (N = 31) received a BI and 28 days of tailored booster messaging (based on drug use motives) daily, and the control condition received a community resource brochure. A post-test occurred at 1-month with a follow-up at 2-months. RESULTS The intervention was well-received (83.9 % allocated completed the BI) with 79 % overall liking the BI and 71 % finding it helpful to discuss substances. Mean ratings of booster messages were >4.0 (5-point scale); 77 % liked the daily messages and 91 % found them helpful. Descriptively, the intervention group evidenced absolute reductions over time on alcohol outcomes, cannabis use, and condomless sex. CONCLUSIONS This BI with booster messages was feasible and acceptable in the target population of emerging adults who use drugs (i.e., mostly cannabis). This intervention model, initiated during a healthcare visit and accompanied by a clinician-extender, should be tested in a future fully-powered trial.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Emily C Sweezea
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI, 48109-2800, USA
| | - Laura E Drislane
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Department of Psychology and Philosophy, Sam Houston State University, 1901 Avenue I, Huntsville, TX, 77340, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA
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Sokol RL, Carter PM, Goldstick J, Miller AL, Walton MA, Zimmerman MA, Cunningham RM. Within-Person Variability in Firearm Carriage Among High-Risk Youth. Am J Prev Med 2020; 59:386-393. [PMID: 32430221 PMCID: PMC7483893 DOI: 10.1016/j.amepre.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Youth who carry firearms-and peers that surround them-are at increased risk for violent injuries. Because firearm carriage behaviors can change over time within an individual, it is important to identify individual and social-contextual determinants that explain this within-person variability in carriage. METHODS The authors identified individual and social-contextual determinants of firearm carriage in the past 6 months using multilevel logistic models on 5 waves of panel data from the Flint Youth Injury Study (n=597; ages 14-24 years), collected in 2009-2011 and analyzed in 2019. RESULTS Regarding within-person effects, when an individual had more positive peer affiliations than their average, their odds of carrying a firearm decreased (OR=0.88; 95% CI=0.81, 0.96). Conversely, an individual's odds of carrying a firearm increased when they had more negative peer affiliations (OR=1.08, 95% CI=1.02, 1.14), experienced more victimization (OR=1.03, 95% CI=1.01, 1.05), perceived greater community violence (OR=1.12, 95% CI=1.05, 1.21), or exhibited greater retaliatory attitudes (OR=1.10, 95% CI=1.01, 1.19) than their average. CONCLUSIONS Peer affiliations, victimization, community violence perceptions, and retaliatory attitudes explain within-person variability in firearm carriage. Strategies for reducing carriage among youth should consider individual- and environmental-level interventions to address these individual and social-contextual determinants.
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Affiliation(s)
- Rebeccah L Sokol
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Patrick M Carter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, School of Public Health, University of Michigan, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Stoddard SA, Meier-Austic E, Epstein-Ngo Q, Walton M, Carter PM, Heinze JE, Zimmerman MA, Cunningham R. Substance use and mental health predictors of patterns of non-partner youth violence among high-risk urban youth. Drug Alcohol Depend 2020; 213:108117. [PMID: 32585420 PMCID: PMC7736059 DOI: 10.1016/j.drugalcdep.2020.108117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner. METHODS Group-based trajectory modeling was used to identify longitudinal trajectories of non-partner violence in N = 599 youth (14-24 years old) at baseline, 6, 12, 18 and 24 month follow-ups. Multinomial logistic regression analyses were used to examine associations between baseline substance use and mental health conditions (i.e., anxiety, depression, and post-traumatic stress disorder [PTSD]), and non-partner violence trajectories. RESULTS Six trajectory groups were identified for non-partner violence. Binge drinking and cannabis, illicit drug, nonmedical prescription stimulant, and polysubstance use in the 30 days leading up to their initial ED visit were associated with the likelihood of medium to high non-partner violence group membership during the two years following their ED visit. Post-traumatic stress disorder (PTSD) and depression/anxiety at baseline were also associated with greater risk of belonging to medium to high non-partner violence trajectory groups. CONCLUSIONS Our findings highlight distinct trajectories of violent behavior, with roughly 60 % of young adults belonging to one of the non-partner violence groups. Although general trajectory trends were of decreasing violent behavior, the constellation of baseline risk factors differentially predicted group membership. These findings indicate that violence does not operate in a vacuum; interventions to reduce violence should also address previous trauma, substance use, and mental health issues.
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Affiliation(s)
- Sarah A. Stoddard
- School of Nursing, University of Michigan, 400 N Ingalls Room 4341, Ann Arbor, Michigan, 48109,University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109
| | - Elizabeth Meier-Austic
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
| | - Maureen Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, Michigan, 48109
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
| | - Justin E, Heinze
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Marc A. Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
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11
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Examining measurement reactivity in daily diary data on substance use: Results from a randomized experiment. Addict Behav 2020; 102:106198. [PMID: 31775064 DOI: 10.1016/j.addbeh.2019.106198] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 11/22/2022]
Abstract
The debate about whether measurement reactivity exists in daily diary research on substance use is still unsettled due to the issues of study design and statistical methodology. This study proposes a time-varying effect model (TVEM) that characterizes the trajectory of substance use behaviors with nonparametric functions determined by the data rather than imposes presumed parametric functions. It also allows researchers to investigate the effect of measurement reactivity on not only the likelihood of using substances but also the amount of substance use. The TVEM was applied to analyze diary data on alcohol and marijuana use collected from an experiment, which randomized 307 participants in Michigan into daily and weekly assessment schedules during 2014-2016. This study found short-term measurement reactivity on alcohol use, but did not find a significant reactivity effect on marijuana use. The daily group had smaller odds of abstinence from drinking but lower expected drinking quantity in the first week of assessment, which dissipated by the second week. The results indicate that although daily self-monitoring could have short-term reactivity on substance use behaviors that tend to fluctuate across days, such as alcohol use, it does not affect substance use behaviors that are quite consistent, such as marijuana use. Our findings imply that although daily monitoring of drinking may motivate people to reduce the quantity consumed once they start to drink, it may also arouse their desire to start drinking. Yet, both effects tend to last only one week, as participants accommodate to the monitoring by the second week.
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12
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Carter PM, Cranford JA, Buu A, Walton MA, Zimmerman MA, Goldstick J, Ngo Q, Cunningham RM. Daily patterns of substance use and violence among a high-risk urban emerging adult sample: Results from the Flint Youth Injury Study. Addict Behav 2020; 101:106127. [PMID: 31645000 PMCID: PMC6999833 DOI: 10.1016/j.addbeh.2019.106127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples. METHODS Within an RCT comparing ILM assessment/schedule methods, 162-participants completed daily IVR (n = 81) or SMS (n = 81) assessments measuring 19 substance use and violence (partner/non-partner) behaviors daily for 90-days. GLMMs characterized between- and within-person predictors of daily violence. RESULTS Participants [48.7%-female; age = 24.4; 62.3%-African-American; 66.7%-public assistance] completed an average of 46.5 daily reports [SD = 26.7]. Across 90-days, alcohol was characterized by episodic weekend use (average = 10 days-of-use, 34.4% drinking-days involved binge-drinking), while marijuana use was continuous (average = 27 days-of-use; 1.7 times/day), with no weekend differences. Among 118-violent conflicts, 52.5% occurred on weekends; 57.6% were with non-partners/peers; 61.0% involved perpetration/57.6% victimization; and 52.5% involved severe violence. For violence conflicts, 27.1% were preceded by alcohol/22.9% preceded by drug use. Between-person predictors of daily violence included retaliatory attitudes (AOR = 3.2) and anxiety (AOR = 1.1). Within-person predictors included weekends (AOR = 1.6), binge drinking (AOR = 1.9), non-medical prescription opioid use (AOR = 3.5) and illicit drug use (AOR = 8.1). CONCLUSION Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.
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Affiliation(s)
- Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Corresponding author at: Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan 48109, United States of America. (P.M. Carter)
| | - James A. Cranford
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
| | - Anne Buu
- Department of Health Behavior & Biological Sciences, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States of America
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America
| | - Marc A. Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Quyen Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
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13
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Goldstick JE, Walton MA, Bohnert ASB, Heinze JE, Cunningham RM. Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department. PLoS One 2019; 14:e0227140. [PMID: 31891632 PMCID: PMC6938309 DOI: 10.1371/journal.pone.0227140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age. Results We observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed. Conclusions Social influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Justin E. Heinze
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Hurley Medical Center, Department of Emergency Medicine, Flint, MI, United States of America
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14
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Dora-Laskey AD, Goldstick JE, Buckley L, Bonar EE, Zimmerman MA, Walton MA, Cunningham RM, Carter PM. Trajectories of Driving after Drinking among Marijuana-Using Youth in the Emergency Department: Substance Use, Mental Health, and Peer and Parental Influences. Subst Use Misuse 2019; 55:175-187. [PMID: 31502499 PMCID: PMC6980673 DOI: 10.1080/10826084.2019.1660675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions.
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Affiliation(s)
- Aaron D Dora-Laskey
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
| | - Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
| | - Lisa Buckley
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- The University of Queensland, St. Lucia, Queensland, Australia
| | - Erin E Bonar
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- Hurley Medical Center, Flint, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Injury Prevention Center, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
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15
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Goldstick JE, Carter PM, Heinze JE, Walton MA, Zimmerman M, Cunningham RM. Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department. J Behav Med 2019; 42:635-645. [PMID: 31367929 PMCID: PMC6999855 DOI: 10.1007/s10865-019-00021-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
- University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
- Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
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16
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Liu W, Li R, Zimmerman MA, Walton MA, Cunningham RM, Buu A. Statistical methods for evaluating the correlation between timeline follow-back data and daily process data with applications to research on alcohol and marijuana use. Addict Behav 2019; 94:147-155. [PMID: 30611576 DOI: 10.1016/j.addbeh.2018.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/24/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Retrospective timeline follow-back (TLFB) data and prospective daily process data have been frequently collected in addiction research to characterize behavioral patterns. Although previous validity studies have demonstrated high correlations between these two types of data, the conventional method adopted in those studies was based on summary measures that may lose critical information and the Pearson's correlation coefficient that has an undesirable property. This study proposes the functional concordance correlation coefficient to address these issues. METHODS We use real data collected from a randomized experiment to demonstrate the applications of the proposed method and compare its analytical results with those of the conventional method. We also conduct a simulation study based on the real data to evaluate the level of overestimation associated with the conventional method. RESULTS The results of the real data example indicate that the correlation between these two types of data varies across substances (alcohol vs. marijuana) and assessment schedules (daily vs. weekly). Additionally, the correlations estimated by the conventional method tend to be higher than those estimated by the proposed method. The simulation results further show that the magnitude of overestimation associated with the conventional method is greatest when the true correlation is medium. CONCLUSIONS The findings of the real data example imply that daily assessments are particularly beneficial for characterizing more variable behaviors like alcohol use, whereas weekly assessments may be sufficient for low variation events such as marijuana use. The proposed method is a better approach for evaluating the validity of TLFB data.
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Ranney ML, Patena JV, Dunsiger S, Spirito A, Cunningham RM, Boyer E, Nugent NR. A technology-augmented intervention to prevent peer violence and depressive symptoms among at-risk emergency department adolescents: Protocol for a randomized control trial. Contemp Clin Trials 2019; 82:106-114. [PMID: 31129373 DOI: 10.1016/j.cct.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peer violence and depressive symptoms are increasingly prevalent among adolescents, and for many, use the emergency department (ED) as their primary source of healthcare. Brief in-person interventions and longitudinal text-message-based interventions are feasible, acceptable, and may be effective in reducing peer violence and depressive symptoms when delivered in the ED setting. This paper presents the study design and protocol for an in-ED brief intervention (BI) and text messaging program (Text). METHODS This study will be conducted in a pediatric ED which serves over 50,000 pediatric patients per year. Recruitment of study participants began in August 2018 and anticipated to continue until October 2021. The study will enroll 800 adolescents (ages13-17) presenting to the ED for any reason who self-report past-year physical peer violence and past-two week mild-to-moderate depressive symptoms. The study will use a factorial randomized trial to test both overall intervention efficacy and determine the optimal combination of intervention components. A full 2 × 2 factorial design randomizes patients at baseline to 1) BI or no BI; and 2) Text or no Text. Peer violence and depressive symptoms improvements will be measured at 2, 4, and 8 months through self-report and medical record review. DISCUSSION This study has important implications for the progress of the greater field of mobile health interventions, as well as for adolescent violence and depression prevention in general. This proposal has high clinical and public health significance with high potential scalability, acceptability, and impact.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street 2nd Floor, Providence, RI 02903, United States; Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - John V Patena
- Rhode Island Hospital, Department of Emergency Medicine, 593 Eddy Street, Providence, RI 02903, United States.
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Box G-5121-4, Providence, RI 02912, United States.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, 700 Butler Drive, Providence, RI 02906, United States.
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18
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Murphy S, Kruse M, Elklit A, Brink O. Risk factors for violence-related injuries in emergency departments: a Danish linkage study. Eur J Psychotraumatol 2019; 10:1606627. [PMID: 31143409 PMCID: PMC6522947 DOI: 10.1080/20008198.2019.1606627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries. Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark. Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders. Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence. Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.
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Affiliation(s)
- Siobhan Murphy
- National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Ask Elklit
- National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Ole Brink
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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19
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Ranney ML, Pittman SK, Dunsiger S, Guthrie KM, Spirito A, Boyer EW, Cunningham RM. Emergency department text messaging for adolescent violence and depression prevention: A pilot randomized controlled trial. Psychol Serv 2018; 15:419-428. [PMID: 30382737 DOI: 10.1037/ser0000193] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study's purpose was to evaluate feasibility and acceptability, obtain preliminary efficacy data, and evaluate predictors of improvement with iDOVE, a technology-augmented violence and depression prevention intervention for high-risk adolescents seen in the emergency department (ED). We conducted a pilot randomized controlled trial (RCT) with 116 English-speaking adolescents (ages 13-17 years), presenting to the ED for any reason, who reported past-year physical peer violence and current depressive symptoms. The cognitive-behavioral therapy- and motivational interviewing-based intervention consisted of a brief in-ED intervention session and 8 weeks of automated text-message daily mood queries and tailored responses. The control was a brief in-ED presentation and twice-weekly text messages on healthy behaviors. Follow-up was conducted at 8 and 16 weeks. Descriptive statistics, bivariate comparisons, mixed-effects longitudinal regression models, and latent class models (LCMs) were calculated. iDOVE had high acceptability and feasibility, with 86% of eligible youth consenting (n = 116), 95% completing 8-week follow-up, and 91% completing 16-week follow-up. High quantitative and qualitative satisfaction were reported by intervention and control participants. Comparing intervention to control, improved depressive symptoms (p = .07) and physical peer violence (p = .01) were observed among the more symptomatic youth in the intervention group (but no difference in symptoms between full intervention and control groups). LCMs showed that intervention responsiveness correlated with lower mood (measured through daily text messages) at Day 7 of the intervention. This RCT of a technology-augmented intervention shows high feasibility and acceptability and a promising signal of reduced violence among the highest-risk participants. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Megan L Ranney
- Emergency Digital Health Innovation Program, Department of Emergency Medicine, Alpert Medical School, Brown University
| | - Sarah K Pittman
- Emergency Digital Health Innovation Program, Department of Emergency Medicine, Alpert Medical School, Brown University
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School, Brown University
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts-Worcester
| | - Rebecca M Cunningham
- Injury Control Research Center, Department of Emergency Medicine, University of Michigan
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20
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Carter PM, Dora-Laskey AD, Goldstick JE, Heinze JE, Walton MA, Zimmerman MA, Roche JS, Cunningham RM. Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury. Am J Prev Med 2018; 55:812-821. [PMID: 30344036 PMCID: PMC6246796 DOI: 10.1016/j.amepre.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment. METHODS Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression. RESULTS In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest. CONCLUSIONS Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01152970.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Aaron D Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Justin E Heinze
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jessica S Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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21
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Goldstick JE, Bohnert KM, Davis AK, Bonar EE, Carter PM, Walton MA, Cunningham RM. Dual Trajectories of Depression/Anxiety Symptoms and Alcohol Use, and their Implications for Violence Outcomes Among Drug-Using Urban Youth. Alcohol Alcohol 2018; 53:659-666. [PMID: 29846511 PMCID: PMC6454556 DOI: 10.1093/alcalc/agy036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/04/2018] [Indexed: 12/14/2022] Open
Abstract
AIM To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using youth seeking care from an urban emergency department (ED), their baseline correlates and co-occurring trajectories of severe violence. SHORT SUMMARY There were five characteristic dual trajectories of alcohol use and depression/anxiety symptoms. Community violence exposure was highest among individuals with high-depression/anxiety symptom trajectories. Individuals with concurrently high-alcohol use and depression/anxiety symptom trajectories reported that the most delinquent peer affiliations, and had the highest rates of severe violence over time. METHODS We analyzed data from 599 drug-using (primarily marijuana) youth ages 14-24 (349 assault-injured) recruited from December 2009 to September 2011 into a 24-month longitudinal study at a Level-1 ED in Flint, Michigan. Youth self-reported substance use, depression and anxiety symptoms, peer/parental behaviors, and severe violence involvement at baseline and four biannual follow-up assessments. Bivariate latent trajectory models identified homogeneous groups with similar trajectories on alcohol use and anxiety/depression symptoms; we compared baseline characteristics of each trajectory group and concurrent trajectories of severe violence (victimization and aggression). RESULTS Our model identified five trajectory groups: Low drinking/No symptoms (LN; 10.4%; n = 62), No drinking/Moderate symptoms (NM; 15.7%; n = 94), Low drinking/Moderate symptoms (LM; 30.2%; n = 181), Low drinking/High symptoms (LH; 16.4%; n = 98) and High drinking/High symptoms (HH; 27.5%; n = 164). The HH group was characterized by more delinquent peer associations, and rates of community violence were higher among the high symptom groups. The HH group had the highest severe violence perpetration and victimization rates across time points; the LH group had similar violence rates to the LM and NM groups and the LN group had the lowest violence rates across time. CONCLUSIONS Among drug-using youth, alcohol use interventions could benefit from a focus on peer influences, and those with a joint focus on violence involvement may be improved via inclusion of content related to mental health and community violence exposure.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA,Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, USA,Corresponding author: Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, USA. Tel: +734-936-9312; Fax: +734-764-2020; E-mail:
| | - Kipling M Bohnert
- Department of Psychiatry, University of Michigan Addiction Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, USA,VA Center for Clinical Management Research, Department of Veterans Affairs, 2800 Plymouth Road, Ann Arbor, MI, USA
| | - Alan K Davis
- Department of Psychiatry, University of Michigan Addiction Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, USA,Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, USA
| | - Erin E Bonar
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan Addiction Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, USA
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA,Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Maureen A Walton
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan Addiction Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Dr, Ann Arbor, MI, USA,Injury Prevention Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, 1415 Washington Heights, Ann Arbor, MI, USA,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA,Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, USA
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22
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Roche JS, Clery MJ, Carter PM, Dora-Laskey A, Walton MA, Ngo QM, Cunningham RM. Tracking Assault-injured, Drug-using Youth in Longitudinal Research: Follow-up Methods. Acad Emerg Med 2018; 25:1204-1215. [PMID: 30381864 PMCID: PMC6494734 DOI: 10.1111/acem.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. METHODS The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months. RESULTS A total of 599 patients (ages 14-24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per follow-up time frame to complete a follow-up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts. CONCLUSIONS The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.
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Affiliation(s)
- Jessica S. Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Michael J. Clery
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
| | - Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Aaron Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd, Ann Arbor, Michigan 48109
| | - Quyen M. Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI 48109-1290
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109
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23
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Eisman AB, Ngo QM, Kusunoki YY, Bonar EE, Zimmerman MA, Cunningham RM, Walton MA. Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk. HEALTH EDUCATION & BEHAVIOR 2018; 45:625-634. [PMID: 29199476 PMCID: PMC6551613 DOI: 10.1177/1090198117741941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth. Participants were youth ( N = 599) ages 14 to 24 years ( M = 20.05, SD = 2.42) presenting to an urban emergency department with a Level 1 trauma designation as part of a prospective cohort study and followed-up for 24 months. We used logistic regression to examine the probability of reporting SV during the 24-month follow-up based on baseline reports of community and peer violence exposure, accounting for previous SV victimization, substance use, and sociodemographic characteristics. Among youth presenting to an urban emergency department, 22% of youth not seeking care for a sexual assault reported any lifetime SV (forced and/or substance-induced sexual intercourse) at baseline. During the 24-month follow-up, 12% reported SV victimization. We found high community violence exposure (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.01, 8.68]) and peer violence exposure (OR = 1.58, 95% CI [1.19, 2.08]) were associated with increased odds of reporting SV during follow-up in addition to previous SV victimization (OR = 2.71, 95% CI [1.45, 5.09]). Sex, age, parent education, and alcohol or other drug use at baseline were not associated with odds of SV during follow-up. Investigating interconnections between SV victimization and other forms of violence across socioecological levels provides an opportunity to advance SV research and identify promising avenues for prevention based on other violence prevention research. Future strategies for SV prevention that incorporate community and peer components as well as SV-specific content may help reduce SV victimization among youth living in urban, disadvantaged communities.
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Affiliation(s)
- Andria B. Eisman
- Department of Health Behavior and Health Education, School
of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Quyen M. Ngo
- Department of Emergency Medicine, University of Michigan
Medical School, Ann Arbor, MI, USA
| | - Yasamin Y. Kusunoki
- Department of Systems, Populations and Leadership,
University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of
Michigan Health System, Ann Arbor, MI, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, School
of Public Health, University of Michigan, Ann Arbor, MI USA,University of Michigan Injury Center, Ann Arbor, MI,
USA,Michigan Youth Violence Prevention Center, Ann Arbor, MI,
USA
| | - Rebecca M. Cunningham
- Department of Health Behavior and Health Education, School
of Public Health, University of Michigan, Ann Arbor, MI USA,Department of Emergency Medicine, University of Michigan
Medical School, Ann Arbor, MI, USA,University of Michigan Injury Center, Ann Arbor, MI,
USA,Michigan Youth Violence Prevention Center, Ann Arbor, MI,
USA,Department of Emergency Medicine, Hurley Medical Center,
Flint, MI, USA
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of
Michigan Health System, Ann Arbor, MI, USA,University of Michigan Injury Center, Ann Arbor, MI,
USA
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24
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Purtle J, Carter PM, Cunningham R, Fein JA. Treating Youth Violence in Hospital and Emergency Department Settings. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2018; 27:351-363. [PMID: 29462525 PMCID: PMC7182089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor, Michigan
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- Michigan Youth Violence Prevention Center; University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Joel A. Fein
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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Goldstick JE, Heinze J, Ngo Q, Hsieh HF, Walton MA, Cunningham RM, Zimmerman MA. Perceived Peer Behavior and Parental Support as Correlates of Marijuana Use: The Role of Age and Gender. Subst Use Misuse 2018; 53:521-531. [PMID: 28857637 PMCID: PMC5766400 DOI: 10.1080/10826084.2017.1342660] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Parental support and perceptions of peer behavior on substance use are well-studied, but precisely how their associations vary as a function of age, and how those age-specific patterns vary by gender, remain unknown components of the developmental process underlying substance use. METHODS Using data from an 18-year longitudinal study of predominantly African-American students at high-risk for high school dropout in Flint, Michigan (baseline average age = 14.8 years), we examined longitudinal associations between past 30-day marijuana use and three self-reported variables: perceived friend drug use, perceived friend aggression, parental support. We used varying-coefficient regression models to semiparametrically estimate how covariate effects on past 30-day marijuana use vary smoothly as a function of age; gender differences in these age-specific coefficient trajectories were also tested. RESULTS In the unadjusted tests, the risk-enhancing effect of perceived friend drug use decreased with age in both genders, but the effect of perceived friend aggression varied only in females; in both cases, gender differences were not significant. In males, parental support had protective effects that decreased with age. The effect of both parental support differed in females, with less protective baseline effects and no evidence of age-variation. Adjusted models simultaneously including both friend and parental variables produced qualitatively similar results. CONCLUSIONS Prevention strategies focusing on social exposures may be more effective if they are age- and gender-specific. In particular, interventions focusing on perceived peer behaviors may be more appropriate during adolescence, and those involving parental relationships may be more appropriate for males.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Injury Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Justin Heinze
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Quyen Ngo
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Injury Research Center, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Research on Women and Gender, Ann Arbor, Michigan, USA
| | - Hsing-Fang Hsieh
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Maureen A. Walton
- Injury Research Center, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Youth Violence Prevention Center, Ann Arbor, Michigan, USA
| | - Marc A. Zimmerman
- Injury Research Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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26
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Heard-Garris NJ, Roche J, Carter P, Abir M, Walton M, Zimmerman M, Cunningham R. Voices from Flint: Community Perceptions of the Flint Water Crisis. J Urban Health 2017; 94:776-779. [PMID: 28409360 PMCID: PMC5722721 DOI: 10.1007/s11524-017-0152-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We describe the self-reported socioeconomic and health impacts, as well as the coping mechanisms employed by a drug-using cohort of adults during the Flint water crisis (FWC) in Flint, Michigan. Participants from an ongoing longitudinal Emergency Department study were contacted between April 2016 and July 2016 and completed a survey focusing on exposure, consequences, and coping strategies. One hundred thirty-three participants (mean age = 26, 65% African-American, 61% public assistance) completed the survey (37.9% response rate). Of these, 75% reported exposure to water with elevated lead levels. Of these, 75% reported additional monthly expenses resulting from exposure. Almost 40% of parents reported changes in their children's health and 65% reported changes to their health since the FWC. Participants indicated the use of both positive (e.g., advice from trusted neighbors, 99.0%) and negative coping mechanisms (e.g., increased substance use, 20.0%) in response to this public health emergency. High-risk Flint residents reported multiple social, economic, and health-related consequences stemming from the FWC. Policymakers should consider additional resources for those affected, including increased access to mental health to aid recovery within the community.
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Affiliation(s)
- Nia Jeneé Heard-Garris
- The Robert Wood Johnson Foundation Clinical Scholars Program at the University of Michigan Medical School, North Campus Research Complex 2800 Plymouth Road Building 10, Room G016, Ann Arbor, 48109, MI, USA.
| | - Jessica Roche
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
| | - Patrick Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA
| | - Maureen Walton
- University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, 48109, MI, USA
| | - Marc Zimmerman
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, 48109, MI, USA
| | - Rebecca Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, 48109, MI, USA
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Carter PM, Walton MA, Goldstick J, Epstein-Ngo QM, Zimmerman MA, Mercado MC, Williams AG, Cunningham RM. Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis. Prev Med 2017; 102:112-119. [PMID: 28729199 PMCID: PMC5774663 DOI: 10.1016/j.ypmed.2017.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/17/2017] [Accepted: 07/12/2017] [Indexed: 12/14/2022]
Abstract
Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Quyen M Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Institute for Research on Women and Gender, University of Michigan, 204 S. State Street, Ann Arbor, MI 48109, United States
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States
| | - Melissa C Mercado
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-64, Atlanta, GA 30341-3717, United States
| | - Amanda Garcia Williams
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-64, Atlanta, GA 30341-3717, United States; Epidemic Intelligence Service, Epidemiology Workforce Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-92, Atlanta, GA 30329-4027, United States
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States
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Buu A, Massey LS, Walton MA, Cranford JA, Zimmerman MA, Cunningham RM. Assessment methods and schedules for collecting daily process data on substance use related health behaviors: A randomized control study. Drug Alcohol Depend 2017. [PMID: 28651151 PMCID: PMC5548619 DOI: 10.1016/j.drugalcdep.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Interactive voice response (IVR) and short message service (SMS) systems have been used to collect daily process data on substance use. Yet, their relative compliance, use patterns, and user experiences are unknown. Furthermore, recent studies presented the potential of a hybrid weekly protocol requiring recall of behaviors in past week right after the weekend, in order to reduce the concerns about low compliance and measurement reactivity associated with daily data collection and also provide high quality data on the peak of use. METHODS This study randomized substance users to four (2×2) assessment groups with different combinations of assessment methods (IVR or SMS) and schedules (daily or weekly). The compliance rates and use patterns during the experimental period of 90days and user experiences reported after the period were compared across the groups. RESULTS When IVR was assigned, the weekly schedule generated a higher compliance rate than the daily schedule. When SMS was used, however, the assessment schedule did not have an effect on compliance. While both the daily and weekly surveys via IVR can be completed within a short time, the weekly survey administered via SMS took much longer than its daily counterpart. Such an increased time consumption may offset the benefit of a less frequent assessment schedule. CONCLUSIONS IVR is a better choice for delivering the hybrid protocol of weekly collection of daily process data because of its higher compliance rate, shorter duration, and lower likelihood of interruption during data collection.
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Affiliation(s)
- Anne Buu
- Department of Health Behavior and Biological Sciences, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
| | - Lynn S. Massey
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Maureen A. Walton
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - James A. Cranford
- Addiction Research Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, 2800 Plymouth Rd, Bldg 10-G080, Ann Arbor, MI 48109
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Myers RK, Vega L, Culyba AJ, Fein JA. The Psychosocial Needs of Adolescent Males Following Interpersonal Assault. J Adolesc Health 2017; 61:262-265. [PMID: 28526371 PMCID: PMC5522768 DOI: 10.1016/j.jadohealth.2017.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE We examined the self-identified, postassault psychosocial needs of male adolescents to guide recovery and healing after being seen in an emergency department (ED) for a violence-related injury. METHODS We analyzed deidentified data from 49 adolescent male adolescents who participated in a postdischarge case management program following a violence-related injury. Descriptive statistics summarized youths' demographic characteristics and self-identified needs and goals for postassault recovery. RESULTS Most participants (80%) were treated for nonpenetrating injuries and discharged from the ED (76%). Nearly two thirds of youth reported clinically significant traumatic stress symptoms and 89% self-identified mental health needs following injury. Legal and educational needs were also commonly identified. CONCLUSIONS Despite experiencing minor physical injuries, assault-injured youth report clinically significant traumatic stress symptoms and recognize postinjury mental health needs. Results suggest that youth-focused early intervention services, particularly related to mental health, are acceptable and desired by youth soon after a violent injury.
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Affiliation(s)
- Rachel K Myers
- Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Laura Vega
- Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alison J Culyba
- Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel A Fein
- Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Two-Year Trajectories of Sexual Risk Behaviors Among Drug-Using Adolescents and Emerging Adults in an Urban Community. AIDS Behav 2017; 21:2069-2078. [PMID: 27714523 DOI: 10.1007/s10461-016-1570-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among 14-24 year-olds who used drugs and were recruited from an emergency department, we examined 2-year trajectories of sexual risk behaviors. We hypothesized that those in higher risk trajectories would have more severe substance use, mental health concerns, and dating violence involvement at baseline. Analyses identified three behavioral trajectories. Individuals in the highest risk trajectory had a more severe profile of baseline alcohol use, marijuana use, dating violence involvement, and mental health problems. Future research will examine longitudinal differences in risk factors across trajectories. Understanding risk factors for sexual risk behavior trajectories can inform the delivery and tailoring of prevention interventions.
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Goldstick JE, Carter PM, Walton MA, Dahlberg LL, Sumner SA, Zimmerman MA, Cunningham RM. Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk. Ann Intern Med 2017; 166:707-714. [PMID: 28395357 PMCID: PMC5697901 DOI: 10.7326/m16-1927] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a clinical screening tool to identify high-risk youth. OBJECTIVE To derive a clinically feasible risk index for firearm violence. DESIGN 24-month prospective cohort study. SETTING Urban, level 1 ED. PARTICIPANTS Substance-using youths, aged 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non-assault-injured youth enrolled from September 2009 through December 2011. MEASUREMENTS Firearm violence (victimization/perpetration) and validated questionnaire items. RESULTS A total of 599 youths were enrolled, and presence/absence of future firearm violence during follow-up could be ascertained in 483 (52.2% were positive). The sample was randomly split into training (75%) and post-score-construction validation (25%) sets. Using elastic-net penalized logistic regression, 118 baseline predictors were jointly analyzed; the most predictive variables fell predominantly into 4 domains: violence victimization, community exposure, peer influences, and fighting. By selection of 1 item from each domain, the 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived. SaFETy was associated with firearm violence in the validation set (odds ratio [OR], 1.47 [95% CI, 1.23 to 1.79]); this association remained (OR, 1.44 [CI, 1.20 to 1.76]) after adjustment for reason for ED visit. In 5 risk strata observed in the training data, firearm violence rates in the validation set were 18.2% (2 of 11), 40.0% (18 of 45), 55.8% (24 of 43), 81.3% (13 of 16), and 100.0% (6 of 6), respectively. LIMITATIONS The study was conducted in a single ED and involved substance-using youths. SaFETy was not externally validated. CONCLUSION The SaFETy score is a 4-item score based on clinically feasible questionnaire items and is associated with firearm violence. Although broader validation is required, SaFETy shows potential to guide resource allocation for prevention of firearm violence. PRIMARY FUNDING SOURCE National Institute on Drug Abuse R01024646.
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Affiliation(s)
- Jason E Goldstick
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Patrick M Carter
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Maureen A Walton
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Linda L Dahlberg
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Steven A Sumner
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Marc A Zimmerman
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
| | - Rebecca M Cunningham
- From University of Michigan School of Medicine and University of Michigan School of Public Health Ann Arbor, Michigan; Centers for Disease Control and Prevention, Atlanta, Georgia; and Hurley Medical Center, Flint, Michigan
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Bonar EE, Cunningham RM, Collins RL, Cranford JA, Chermack ST, Zimmerman MA, Blow FC, Walton MA. Feasibility and Acceptability of Text Messaging to Assess Daily Substance Use and Sexual Behaviors among Urban Emerging Adults. ADDICTION RESEARCH & THEORY 2017; 26:103-113. [PMID: 29632458 PMCID: PMC5889069 DOI: 10.1080/16066359.2017.1310205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Daily process research can help distinguish causal relationships between substance use and sexual risk behaviors in high-risk groups, such as urban emerging adults. We employed text messaging to assess 18-25 year-olds' daily substance use and sexual risk behaviors over 28 days. We describe the implementation of this method, attitudes regarding the daily surveys, and correlates of survey completion. METHOD We recruited 111 emerging adults from an urban Emergency Department in a resource-limited area who reported recent drug use and unprotected sex (Mage=22.0; 53.2% female; 45.1% African American; 43.2% receiving public assistance). RESULTS Respondents completed M=18.0 (SD = 8.7) of 28 daily surveys (27 items each). Participants completing a 1-month follow-up found the surveys not at all/only a little annoying (90.3%) and were comfortable with questions about drugs/alcohol (97.9%) and sex (94.6%). Completion was higher on weekdays versus weekends, and earlier in the study. Daily survey completion was unrelated to same-day substance use measured by the Timeline Follow Back at follow-up; polysubstance use and drinks consumed were associated with lower odds of next-day completion. School enrollment, public assistance, unlimited texting plan, lower baseline alcohol use, and depression symptoms at follow-up were associated with higher completion. Technology difficulties were commonly mentioned barriers to completion. CONCLUSIONS Participants in this urban, resource-constrained sample found the daily text message methodology acceptable for reporting sensitive information. With rapid advancements in technologies and increased accessibility, text messaging remains a promising methodology for the study of daily processes in substance use and HIV risk behaviors. Keywords: text messaging; assessment; emerging adults; substance use; risky sex; mobile technology.
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Affiliation(s)
- Erin E. Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
- Emergency Medicine, Hurley Medical Center, 1Hurley Plaza, Flint, MI 48503
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, 14260
| | - James A. Cranford
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Marc A. Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
| | - Frederic C. Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Maureen A. Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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Walton MA, Epstein-Ngo Q, Carter PM, Zimmerman MA, Blow FC, Buu A, Goldstick J, Cunningham RM. Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences. Drug Alcohol Depend 2017; 173:117-125. [PMID: 28219802 PMCID: PMC5366264 DOI: 10.1016/j.drugalcdep.2016.11.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 01/14/2023]
Abstract
AIMS This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development. METHODS Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups. RESULTS Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group). CONCLUSIONS Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.
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Affiliation(s)
- Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute on Women and Gender Studies, University of Michigan, 500 South State St., Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anne Buu
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Room 4346, Ann Arbor, MI 48109, USA
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
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Ehrlich PF, Roche JS, Cunningham RM, Chermack ST, Carter PM, Booth BM, Blow F, Barry K, Walton MA. Underage drinking, brief interventions, and trauma patients: Are they really special? J Trauma Acute Care Surg 2016; 81:149-55. [PMID: 27120317 PMCID: PMC4915985 DOI: 10.1097/ta.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. METHODS Patients (aged 14-20 years) in the emergency department screening positive for risky drinking (Alcohol Use Disorders Identification Test-Consumption score) completed a baseline assessment, were randomized to conditions (a standalone computer-delivered BI [n = 277], a therapist-delivered BI [n = 278], or a control condition [n = 281]), and completed a 3-month follow-up. This secondary analysis of Project U-Connect examined regression models (controlling for baseline values) to examine the main effects of injury and the interaction effects of injury by BI condition on alcohol consumption and consequences. RESULTS Among 836 youth enrolled in the randomized controlled trial (mean age, 18.6 years; 51.6% were male; 79.4% were white), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p < 0.001) and have higher alcohol consumption (p < 0.01), but were less likely to misuse prescription drugs (p = 0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. CONCLUSIONS A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for emergency department presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at 3-month follow-up. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Affiliation(s)
- Peter F Ehrlich
- From the Injury Center (P.F.E., J.S.R., R.M.C., P.M.C., B.M.B., F.B., M.A.W.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine (J.S.R., R.M.C., P.M.C.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center (J.S.R., R.M.C., P.M.C., M.A.W.), University of Michigan School of Public Health, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry (S.T.C., F.B., K.B., M.A.W.), University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs (S.T.C., F.B., M.A.W.), Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry College of Medicine, University of Arkansas for Medical Sciences, (B.M.B.), Little Rock, Arkansas; Section of Pediatric Surgery (P.F.E.), CS Mott Children's Hospital, Department of Surgery, University of Michigan School of Medicine, Ann Arbor Michigan; and Institute for Healthcare Policy and Innovation (R.M.C., F.B.), University of Michigan, Ann Arbor, Michigan
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Ranney ML, Patena JV, Nugent N, Spirito A, Boyer E, Zatzick D, Cunningham R. PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients. Gen Hosp Psychiatry 2016; 39:32-8. [PMID: 26786845 PMCID: PMC4779373 DOI: 10.1016/j.genhosppsych.2015.12.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is often underdiagnosed and undertreated among adolescents. The objective of this analysis was to describe the prevalence and correlates of symptoms consistent with PTSD among adolescents presenting to an urban emergency department (ED). METHODS A cross-sectional survey of adolescents aged 13-17 years presenting to the ED for any reason was conducted between August 2013 and March 2014. Validated self-report measures were used to measure mental health symptoms, violence exposure and risky behaviors. Multivariate logistic regression analysis was performed to determine adjusted differences in associations between symptoms consistent with PTSD and predicted correlates. RESULTS Of 353 adolescents, 23.2% reported current symptoms consistent with PTSD, 13.9% had moderate or higher depressive symptoms and 11.3% reported past-year suicidal ideation. Adolescents commonly reported physical peer violence (46.5%), cyberbullying (46.7%) and exposure to community violence (58.9%). On multivariate logistic regression, physical peer violence, cyberbullying victimization, exposure to community violence, female gender and alcohol or other drug use positively correlated with symptoms consistent with PTSD. CONCLUSIONS Among adolescents presenting to the ED for any reason, symptoms consistent with PTSD, depressive symptoms, physical peer violence, cyberbullying and community violence exposure are common and interrelated. Greater attention to PTSD, both disorder and symptom levels, and its cooccurring risk factors is needed.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI 02903, USA; Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - John V Patena
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - Nicole Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Worcester, 55 Lake Avenue, North Worcester, MA 01655, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Avenue, Seattle, WA 98102, USA.
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA; Injury Control Research Center, University of Michigan, Ann Arbor, MI 48109-2800, USA.
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Carter PM, Walton MA, Roehler DR, Goldstick J, Zimmerman MA, Blow FC, Cunningham RM. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics 2015; 135:805-15. [PMID: 25847808 PMCID: PMC4411782 DOI: 10.1542/peds.2014-3572] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk for firearm violence among high-risk youth after treatment for an assault is unknown. METHODS In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months). RESULTS A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22). CONCLUSIONS High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
| | - Maureen A Walton
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Douglas R Roehler
- University of Michigan Injury Center, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and
| | - Marc A Zimmerman
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; National Serious Mental Illness Treatment, Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; and
| | - Rebecca M Cunningham
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Cunningham RM, Carter PM, Ranney M, Zimmerman MA, Blow FC, Booth BM, Goldstick J, Walton MA. Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr 2015; 169:63-70. [PMID: 25365147 PMCID: PMC4306452 DOI: 10.1001/jamapediatrics.2014.1900] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Violence is a leading cause of morbidity and mortality among youth, with more than 700000 emergency department (ED) visits annually for assault-related injuries. The risk for violent reinjury among high-risk, assault-injured youth is poorly understood. OBJECTIVE To compare recidivism for violent injury and mortality outcomes among drug-using, assault-injured youth (AI group) and drug-using, non-assault-injured control participants (non-AI group) presenting to an urban ED for care. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled in a prospective cohort study from December 2, 2009, through September 30, 2011, at an urban level I ED and followed up for 24 months. We administered validated measures of violence and substance use and mental health diagnostic interviews and reviewed medical records at baseline and at each point of follow-up (6, 12, 18, and 24 months). EXPOSURE Follow-up over 24 months. MAIN OUTCOMES AND MEASURES Use of ED services for assault or mortality measured from medical record abstraction supplemented with self-report. RESULTS We followed 349 AI and 250 non-AI youth for 24 months. Youth in the AI group had almost twice the risk for a violent injury requiring ED care within 2 years compared with the non-AI group (36.7% vs 22.4%; relative risk [RR], 1.65 [95% CI, 1.25-2.14]; P<.001). Two-year mortality was 0.8%. Poisson regression modeling identified female sex (RR, 1.30 [95% CI, 1.02-1.65]), assault-related injury (RR, 1.57 [95% CI, 1.19-2.04), diagnosis of a drug use disorder (RR, 1.29 [95% CI, 1.01-1.65]), and posttraumatic stress disorder (RR, 1.47 [95% CI, 1.09-1.97]) at the index visit as predictive of ED recidivism or death within 24 months. Parametric survival models demonstrated that assault-related injury (P<.001), diagnosis of posttraumatic stress disorder (P=.008), and diagnosis of a drug use disorder (P= .03) significantly shortened the expected waiting time until the first ED return visit for violence or death. CONCLUSIONS AND RELEVANCE Violent injury is a reoccurring disease, with one-third of our AI group experiencing another violent injury requiring ED care within 2 years of the index visit, almost twice the rate of a non-AI comparison group. Secondary violence prevention measures addressing substance use and mental health needs are needed to decrease subsequent morbidity and mortality due to violence in the first 6 months after an assault injury.
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Affiliation(s)
- Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor2Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor3Department of Health Behavior and Health Education, University of Michigan Sc
| | - Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor2Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of P
| | - Megan Ranney
- Injury Prevention Center, Department of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor3Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor5Michigan Youth Violence Prevention Center, University
| | - Fred C Blow
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor6Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor8National Serious Mental Illness Treatment, Resource and Ev
| | - Brenda M Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor
| | - Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, Ann Arbor5Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor6Addiction Research Center, Department of Psychiatry, University
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