Racial Disparities in Patterns and Modes of Current and Daily Marijuana Use among Adults Living with Children

OBJECTIVE

This study sought to examine racial disparities in marijuana use among U.S. adults living with children.

METHODS

Data are drawn from the 2022 Behavioral Risk Factor Surveillance System to examine the prevalence of current (past month) and frequent (≥20 days in the last 30 days) marijuana use along with the mode of marijuana use by 7 racial and ethnic groups (non-Hispanic [NH] White, NH-Black, Hispanic, NH American Indian or Alaskan Native [AI/AN], NH-Asian, NH Native Hawaiian or other Pacific Islander only [NH/PI], and other/multiple races, n=22,659).

RESULTS

Compared to NH White adults with children, NH Black adults had a higher prevalence of current marijuana use (23.1% vs. 16.9%, p=0.003) and NH AI/AN adults had two times higher prevalence of frequent use (17.3% vs. 8.4%, p=0.0003). Adults living in recreational marijuana legal states (vs. no) were also more likely to report marijuana use, and there were significant age × race/ethnicity and education × race/ethnicity interactions (p<0.05) on marijuana use. Regarding the mode of use, racial minority users except Asians also reported a higher prevalence of smoking marijuana than their White counterparts.

CONCLUSIONS AND RELEVANCE

Substantial racial disparities in marijuana use patterns among adults who live with children highlight a potential risk for adolescents' health. Addressing these differences is essential for promoting equitable health outcomes in diverse communities.

Reevaluating the brain disease model of addiction

The brain disease model of addiction has dominated public and scientific discourse on addiction (termed substance use disorder [SUD] in the DSM-5) over the past 3 decades. The model framed addiction as a chronic and relapsing brain disease caused by structural and functional brain alterations. The purpose of this model was purportedly dual, as both an aetiological theory and a tool to reduce stigma. Weak empirical support and concerns about the model downplaying fundamental psychosocial causes of SUDs have led to stark disagreement as to whether addiction should be conceptualised as a brain disease. In this Personal View, we argue that the absence of an agreed, clear, and consistent definition of a brain disease-coupled with frequent recourse to concepts with divergent or shifting meaning-have obstructed productive debate and a coherent advance in knowledge and understanding of addiction. Borrowing from the philosophy of psychiatry, we show that both narrow and broad views of brain disease coexist and inform addiction research, though often implicitly and inconsistently. The narrow view of brain disease posits that a mental condition qualifies as a brain disease only if it manifests similarly to a paradigmatic brain disease, resulting from either known or unknown structural and functional damage. The broad view of brain disease suggests that brain disease status should be granted automatically to mental disorders, as all mental activity resides in the brain. We examine theoretical assumptions, empirical evidence, and treatment implications for each view and propose ways of moving beyond them.

Emerging from the shadows: A qualitative report with Panjabi women caregivers to partners with substance use disorder

This paper presents a qualitative report of semi-structured interviews with 10 Panjabi women who are caregivers to men (specifically husbands) with substance use disorder (SUD) in Surrey, British Columbia, Canada. Core themes identified depict the significant burden caregivers carry due to managing simultaneous financial and parenting duties, negative emotional impacts of caregiving, and attempts to conceal substance use by both the participants and their husbands. Despite this, all participants shared nuanced reasons to stay in their marriage, including for their children, for financial stability or to avoid stigmatization. Participants emphasized the need for culturally competent care, family involvement in SUD treatment, compassion toward people with SUD and increased resources for women caregivers.

Social and environmental adversity predict poor mental health in a Milwaukee, WI community sample

Racism functions as a system of continued devaluation, disempowerment, and inequitable allotment driven by racial hierarchy. Operating at multiple levels - individual, interpersonal, community, and societal - racism perpetuates significant mental and physical health disparities. Though evidence evinces the impact of racism across domains, few studies have assessed factors rooted in structural racism simultaneously and how they relate together to predict outcomes. The current study examines how racism impacts the mental health (MH) of Black Americans adults across multiple levels. Risk and protective factors were analyzed to understand the collective impact of racism in this population. Black adults (N = 400) in Milwaukee, WI completed a battery of surveys assessing demographic, mental health, behavioral health, physical/built environment, sociocultural environment, healthcare, and neighborhood context. Bivariate analyses, exploratory factor analyses (EFA), and general linear modeling were conducted, with anxiety, depression, and post-traumatic stress symptoms (PTSS) as outcomes. Participants (M = 43.8 years; 86.1 % earning <$40,000 annually) exhibited elevated depression, anxiety, and PTSD risk. All three mental health outcomes were positively correlated with alcohol/drug use, pain, exposure to violence, housing insecurity, racism-related vigilance, ethnic discrimination, and everyday discrimination while neighborhood social cohesion was negatively correlated. Depression was negatively correlated with social support (p < .05). EFA produced three factor clusters: Social & Environmental Adversity (SEA), Psychosocial Resilience (PR), and Substance Use (SU). SEA and SU were strongly and positively related to all MH outcomes (p < .001) but PR was not. Socioecological frameworks provide a more comprehensive method to evaluate the impact of racism and identify and address mental health disparities. In the current study, results showed that social and environmental factors predicted poor mental health and highlight a need to understand these factors collectively to inform intervention.

Outpatient Initiation of 7-Day Injectable Buprenorphine: A Direct-to-Inject Case Series

BACKGROUND

Buprenorphine is an effective treatment for opioid use disorder, but it can be challenging to avoid withdrawal in the process of buprenorphine initiation. After the recent FDA approval of 7-day long-acting injectable buprenorphine, some clinicians have used this formulation to start patients on buprenorphine without a prior sublingual "test dose." Very little is known about the feasibility of this practice in an outpatient setting.

CASES

In this case series, we conducted a retrospective chart review of electronic health record data for all patients who were ordered 7-day long-acting injectable buprenorphine for a "direct-to-inject" initiation within a single public health system from January 1, 2024 to November 15, 2024. We excluded patients who received a cumulative dose of 4 mg or more of sublingual buprenorphine in the 24 hours before injection. We reported on chart-documented patient experiences after injection, whether patients returned to care, and retention on buprenorphine at 7- and 30-days post-injection. We identified 21 unique patients who received direct-to-inject buprenorphine in 22 attempts. In 17 (77%) attempts, the patient received no buprenorphine in the preceding 24 hours. In 5 (23%) attempts, patients received some buprenorphine in the preceding 24 hours (<4 mg) and/or had evidence of buprenorphine in a same-day urine drug screen. Patient experiences post-injection fit into 1 of 3 themes: "It felt fine" (n = 6), "I felt unwell but okay" (n = 13), and "It felt very rough" (n = 3). Most attempts resulted in buprenorphine treatment retention at 7 days (n = 17, 77%) and 30 days (n = 16, 73%) after injection.

DISCUSSION

Direct-to-inject buprenorphine was generally well tolerated, with excellent retention on buprenorphine at 7- and 30 days post-injection. Further research is needed to evaluate the correlation between preinjection patient characteristics (time since last use, level of withdrawal) and post-injection patient experience of withdrawal.

Perceived discrimination and coping with substance use among Asian Americans during the COVID-19 pandemic: a cross-sectional analysis

BACKGROUND

Race/ethnicity-related discrimination against Asian Americans increased during the COVID-19 pandemic. Previous studies have found an association between discrimination and use of alcohol and other drugs (AOD) as a form of coping. In this study, we evaluate the association of stress from race/ethnicity-related discrimination and coping with tobacco, alcohol, or cannabis (marijuana or cannabidiol) among Asian Americans during the pandemic.

METHODS

We used data from Asian American participants of the Asian American and Native Hawaiian/Pacific Islander (AA & NH/PI) COVID-19 Needs Assessment Project (n = 3,159). We measured COVID-19 discrimination by racial/ethnic discrimination perceived as the greatest stressor, whether racial/ethnic discrimination impacted participants' families, and perceived racial bias. Binary logistic regression examined the association between each AOD outcome, discrimination variables, and other COVID-19 stressors accounting for sociodemographic factors, physical and mental health, and survey medium.

RESULTS

Asian Americans used alcohol to cope with COVID-19 pandemic stressors (13.0%) followed by tobacco (4.3%) and cannabis (4.1%). About 24% of Asian Americans reported that racial/ethnic discrimination was the greatest source of stress. Racial/ethnic discrimination was only associated with cannabis use. However, COVID-19 stressors (aside from discrimination) were positively associated with all the AOD outcomes.

CONCLUSIONS

Asian Americans' AOD use for stress coping during the pandemic was prevalent. Perceived racial bias was associated with cannabis use, however other pandemic-induced stressors, not discriminatory in nature, were consistently associated with AOD use. Targeted research and policy efforts are warranted to address impacts from diverse stressors while tackling racism and substance use within Asian American communities to facilitate post-pandemic recovery.

Racial Disparities in Outpatient Substance Use Disorder Treatment Completion: Trends and Changes from 2004 to 2024

Racial disparities have been found in outpatient substance use disorder (SUD) treatment completion rates. Improvements in access to treatment have sought to decrease these disparities and increase treatment engagement and success. To understand outcomes among different racial groups across time, we assessed (1) completion rates, (2) racial representation among patients who have completed treatment, (3) general representation of racial groups within treatment, and (4) treatment length between 2004 and 2024. "Completion" is defined as "meeting all treatment goals". Chi-squared analyses suggest significant differences among racial groups within the completed (x215=158.0, p=<0.001), not-completed (x215=561.75, p=<0.001), and other (x215=186.19, p=<0.001) groups across time. Asian and Other/Multiracial patients experienced the greatest improvement in both representation within treatment overall and proportional representation within the "completer" group over time, despite their overall completion rates fluctuating. White and Black/African American patients decreased in representation, completion rates, and representation in the "completer" group over time, with a peak in 2004-2009. In terms of length of stay, White patients remained in treatment the longest across time, F(5, 4198) = 24.605, p < 0.011, and treatment length increased for other racial groups. While disparities in completion rates decreased and racial representation in treatment increased, discrepancies persist. We discuss these findings within the context of evolving patient populations and changes in treatment provision (e.g., harm reduction frameworks).

Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis

INTRODUCTION

Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual.

METHODS

Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income).

RESULTS

Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles.

CONCLUSIONS

Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.

Social complexity of a fentanyl vaccine to prevent opioid overdose conference proceedings: Radcliffe Institute for Advanced Study conference proceedings

Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies. In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows.

Systematic Review of Cocaine-Treatment Interventions for Black Americans

Evidence-based drug treatment studies that have shaped best practice in the United States demonstrate racial differences in effectiveness, with Black participants reporting worse outcomes compared to White participants. There are disproportionate cocaine-related overdose deaths impacting Black Americans, with limited information about interventions that serve them best. Culturally tailored treatment approaches, which incorporate participants' salient identities and experiences, have shown effectiveness in meta-analyses. Thus, this qualitative systematic review used PRISMA guidelines to identify both culturally universal and culturally tailored treatment intervention studies that addressed cocaine outcomes among Black Americans. 402 articles met initial criteria, 330 were reviewed by independent coders, and k=30 treatment approaches are described in the paper. Results indicate 72% of culturally tailored interventions were effective at reducing cocaine use, compared to 47% of culturally universal interventions. Implications for provision and funding of effective cocaine treatment interventions for Black Americans are critical to researchers, practitioners, and policymakers alike.

Youth-to-youth empowerment study to support health equity for urban American Indian/Alaska Native and Black adolescents in Denver Metro, Colorado, USA: a mixed methods, youth-centred aetiological study protocol

Introduction

Promoting positive substance use and sexual health outcomes for urban American Indian and Alaska Native (AIAN) and Black youth requires multilevel approaches that address the underlying structural conditions that promote behavioural health inequities. However, researchers rarely employ this complex approach. Developing and operationalising a strengths-based conceptual framework grounded in the socioecological model is a critical first step to inform multilevel interventions to reduce these inequities.

Methods and analysis

Guided by the socioecological model, a youth-centred mixed methods approach will be employed to develop and evaluate a comprehensive multilevel conceptual framework of risks and protective factors associated with substance misuse and adverse sexual health behaviours among AIAN and Black youth of Denver Metro, Colorado. We will use multilevel structural equation modelling, with secondary and geographical data. The secondary data include the Healthy Kids Colorado Survey data (n=631 AIAN, n=5350 Black and n=30 557 non-Hispanic white), the Colorado Department of Education School View data (n=33 schools) and the American Community Survey data (n=73 neighbourhoods). We will also engage approximately 30 youth through scenario-based interviewing to capture perspectives on the constructs that are not captured in the secondary data. The quantitative and qualitative data will be integrated to elucidate a conceptual framework that will be used to develop and optimise a multilevel intervention to reduce adverse substance use and sexual health outcomes in AIAN and Black youth in Denver Metro, Colorado.

Ethics and dissemination

The results of the study will be shared at conferences, meetings and in published articles. Study findings will also be presented to the local community through presentations, social media, newsletters, flyers and brochures. The names of all participants, schools and neighbourhoods will be kept private. This study was approved by the Colorado Multiple Institutional Research Board (protocol number 21-4038).

Depressive symptoms, racism, and school belonging: examining correlates of substance use behaviors among Black college students

College is a context in which Black adults are at heightened risk for substance use behaviors and subsequently more harmful consequences. Increasingly, scholars are recognizing that to better understand shifts in patterns of substance use behaviors and health disparities among Black adults, mental health and racism are important factors to consider. Racism is multidimensional; thus, research is needed to investigate its multiple forms. Currently, it is unknown how the occurrence of depressive symptoms and various racism experiences influence patterns of substance use behaviors among Black college students. Further, while school belonging is evidenced to promote better health outcomes during adolescence, research is needed to understand school belonging in relation to substance use among Black college students. Using latent profile analysis (LPA), we identify patterns of substance use behaviors among Black college students (N = 152) and examine whether depressive symptoms, racism experiences (i.e., racial discrimination stress, internalized racism, negative police encounters), and school belonging are associated with the unique patterns. Latent profiles included indicators of substance use behavior frequency. Four patterns emerged: 1) low substance use, 2) predominant alcohol use, 3) co-use, 4) high polysubstance use. Depressive symptoms, internalized racism, and negative police encounters were significant correlates of patterns of substance use behaviors. School belonging, specifically, participation in student, cultural, spiritual, and Greek organizations, was also associated with profile membership. Findings suggest a need to integrate a broader understanding of how mental health and racism impacts the lives of Black college students, in addition to processes for supporting school belonging.

Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review

BACKGROUND

In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity.

OBJECTIVE

This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants.

METHODS

We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study's potential to facilitate insights into the impact of a TBI for members of specific URM groups.

RESULTS

Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups.

CONCLUSIONS

While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

Emergency care utilization in persons with substance related diagnoses

Background

Substance use is a significant contributor to emergency department (ED) visits. Little is known about ED utilization patterns of individuals with substance related diagnosis (SRD). We used electronic health records (EHR) from a large healthcare system in California to examine ED healthcare utilization and socio-demographic characteristics of individuals with SRDs.

Methods

We used EHR data on all adult patients in our health system from April 2012 through September 2019 to conduct adjusted logistic regression models to determine socio-demographic correlates of SRDs (e.g., use, misuse, dependence) and associations between having an SRD and receiving emergency care.

Results

Among the sample (n = 342,651), the majority were female (55.08 %), Non-Hispanic White (58.10 %), with mean age of 48.26 (SD = 18.10), and there were 18,015 (5.26 %) individuals with an SRD. Patients with an alcohol-related diagnosis had the highest odds of visiting the ED (aOR = 3.75), followed by those with opioid (aOR = 3.57) and stimulant-related diagnoses (aOR = 3.48). Individuals with an SRD were more likely to identify as male, Black/African American, Hispanic/Latinx, have no health insurance, and have a serious mental illness. In the adjusted model, those with an SRD were significantly more likely to have ever received emergency care (aOR 3.72 [95 % CI 3.62-3.84]) than those without an SRD.

Discussion

Our study found an association between having an SRD and utilizing emergency health services. Demographic characteristics suggest disparities exist for those with SRDs around gender, race/ethnicity, insurance status, and mental health. These data can help with screening and targeted responses to prevent or provide emergency care.

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

INTRODUCTION

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

METHODS

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

RESULTS

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

CONCLUSION

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

Conceptual Framework for African American Kinship Caregiver's Susceptibility to Alzheimer's Disease

Kinship caregivers (e.g., grandparents raising grandchildren) have been increasing over the last several decades. Approximately 3.5 million grandparents and other relatives are the primary caregivers for their related children, and African Americans are more likely to be kinship caregivers than persons from other groups. Kinship caregivers face unique challenges, such as parenting for uncertain periods of time and often with insufficient financial resources and support, placing them at significant risk of stress. Given the findings linking chronic stress to Alzheimer's disease (AD), there is a need for research to identify possible stressors and mitigate risks for outcomes such as AD among kin caregivers. Additionally, research indicates that African Americans (AAs) experience unusually high levels of stress due to factors often associated with structural racism, and they are disproportionately affected by cardiovascular disease (CVD), which is often a consequence of stress and another risk factor for AD. Regrettably, AA kin caregivers often incur a host of negative stress-related outcomes, including poor physical and mental health. Thus, there is an urgent need for research to identify modifiable risk factors for both stress and CVD to potentially mitigate the onset of AD in this population. The purpose of this paper is to provide a conceptual framework to examine the links between African Americans who commit to the unselfish act of providing kinship caregiving and their susceptibility to AD. Future research should investigate modifiable mechanisms to reduce the risks of AD in African American caregivers.

The Mediating Effect of Depression on Perceived Discrimination and Persistent Prescription Opioid Use Among Puerto Rican Adults

BACKGROUND

Stress indicators, including perceived discrimination and depression, have been linked with chronic diseases. Studies have also linked persistent prescription opioid use (PPOU) with depression. With increasing numbers of opioid overdose deaths among Hispanics (predominantly Puerto Rican) in Massachusetts, investigating how perceived discrimination and depression affect PPOU is relevant to public health efforts to address the opioid crisis. This study examined the effect of depression on PPOU and whether depression mediated the association between perceived discrimination and PPOU among Puerto Rican adults.

METHODS

Data derived from a prospective population-based Boston Puerto Rican Health Study, at baseline and ~2- and ~6-year follow-up, were used to estimate the association between perceived discrimination and PPOU. Baron and Kenny's method was used to examine the potential mediating effect of depression.

RESULTS

A total of 798 Puerto Rican adults (aged 56.5 ± 7.5 years, 72.9% women) participated in the study at all three time points, and 6.5% used prescription opioids persistently. Both depressive symptoms (Center for Epidemiological Studies Depression Scale score range: 0-60; OR = 1.03, 95% CI [1.00, 1.05], p = .03) and perceived discrimination (yes/no; OR = 2.43, 95% CI [1.28, 4.61], p = .006) were associated with PPOU. Depressive symptomatology partially mediated the effect of perceived discrimination on PPOU, by 10.3%.

CONCLUSIONS

Among Puerto Rican adults in Massachusetts, depressive symptomatology partially explained the effects of perceived discrimination on PPOU. Other unidentified factors could play a role in the relationship between perceived discrimination and PPOU. Discussion on the potential risks of PPOU should be considered among underserved populations experiencing chronic pain, discrimination, and depressive symptoms.

Integrated Prevention Infrastructure: A Framework for Addressing Social Determinants of Health in Substance Use Policy Making

Substance use and misuse remain formidable public health challenges and are intricately linked to social determinants of health (SDOH). Addressing SDOH requires structural interventions along with clinical support to change relevant policies. In this article, the authors review structural interventions known as prevention infrastructures and provide a framework for considering how different models of prevention infrastructures can be used to address SDOH that contribute to substance use. In particular, they introduce a typology of prevention infrastructures and explain how different infrastructure types can affect policy decision making across contexts and how these models can interact with each other. Furthermore, they consider the importance of cultural responsiveness in the creation of effective infrastructures to support communities and policy makers within organizations and government.

Barriers to calling emergency services amongst people who use substances in the event of overdose: A scoping review

BACKGROUND

North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge.

METHODS

PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators.

RESULTS

An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points.

CONCLUSION

Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.

Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status

OBJECTIVES

Medications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections.

METHODS

Among all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences.

RESULTS

The overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall.

CONCLUSIONS

Substantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.

Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use

BACKGROUND

Variation in specialty treatment utilization for alcohol use disorder (AUD) by patient subgroups is poorly understood. This study examined whether and how patient risk profiles predict receipt of specialty treatment and whether there are disparities by race and ethnicity.

METHODS

This cohort study included 206,956 adults with heavy alcohol use (that which exceeded National Institute on Alcohol Abuse and Alcoholism guidelines) between June 1, 2013 and December 31, 2014, using electronic health record data from Kaiser Permanente Northern California. Five risk profiles (characterized by daily or weekly heavy drinking and level of health risks) were identified in latent class analysis. Logistic regression models were fit to examine associations between risk profiles, race, ethnicity, and receipt of specialty treatment (including addiction medicine, psychiatry, or integrated behavioral health visits, and AUD pharmacotherapy), adjusting for other patient characteristics. Variation in the association between risk profiles and receipt of specialty treatment by race/ethnicity was also examined.

RESULTS

Overall, 4.0% of patients received specialty treatment. Latino/Hispanic and Asian/Pacific Islander patients had lower odds of receiving specialty treatment than White patients (adjusted odds ratio [aOR] [95% CI] = 0.80 [0.75, 0.85], and 0.64 [0.59, 0.70], respectively). The substance use disorder and mental health disorder (SUD/MH) risk profile had the highest odds of receiving specialty treatment (10.46 [9.65, 11.34]). Associations between risk profiles and receipt of specialty treatment significantly differed by race/ethnicity. Black patients in the SUD/MH risk profile, and Hispanic/Latino patients in the risk profile with heavy daily drinking and more health risks, had lower odds of receiving specialty treatment than their White counterparts (adjusted ratio of odds ratios [aROR] [95% CI] = 0.69 [0.50, 0.94], and 0.79 [0.67, 0.92], respectively).

CONCLUSIONS

This study provides new insights into racial/ethnic disparities in specialty treatment utilization for alcohol problems. Findings may help inform strategies for tailoring interventions to address heavy alcohol use.

Evaluating generative AI responses to real-world drug-related questions

Generative Artificial Intelligence (AI) systems such as OpenAI's ChatGPT, capable of an unprecedented ability to generate human-like text and converse in real time, hold potential for large-scale deployment in clinical settings such as substance use treatment. Treatment for substance use disorders (SUDs) is particularly high stakes, requiring evidence-based clinical treatment, mental health expertise, and peer support. Thus, promises of AI systems addressing deficient healthcare resources and structural bias are relevant within this domain, especially in an anonymous setting. This study explores the effectiveness of generative AI in answering real-world substance use and recovery questions. We collect questions from online recovery forums, use ChatGPT and Meta's LLaMA-2 for responses, and have SUD clinicians rate these AI responses. While clinicians rated the AI-generated responses as high quality, we discovered instances of dangerous disinformation, including disregard for suicidal ideation, incorrect emergency helplines, and endorsement of home detox. Moreover, the AI systems produced inconsistent advice depending on question phrasing. These findings indicate a risky mix of seemingly high-quality, accurate responses upon initial inspection that contain inaccurate and potentially deadly medical advice. Consequently, while generative AI shows promise, its real-world application in sensitive healthcare domains necessitates further safeguards and clinical validation.

Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure

The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5 year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.

The NCCB Case Example: Reflections on a Successful Fourteen-Year CBPR Partnership

The Newark Community Collaborative Board (NCCB) is in its fourteenth year of operation with nine successful research projects and more than six million dollars in funding. The NCCB began with a community needs assessment in Newark, New Jersey, that led to the subsequent establishment of a community collaborative board (CCB) of consumers, researchers, service providers, and residents committed to advocating for health equity through community engagement and research informed by critical thinking. This paper explores the NCCB's history and processes that allowed conducting community-based participatory research (CBPR) to reduce inequities related to social determinants of health (SDH). This conceptual manuscript draws on data from NCCB meeting minutes and a group interview with three of the five founding members. We detail the collaborative process used to develop and assess Community Wise, a multilevel, group-based intervention designed to reduce substance use among formerly incarcerated men in Newark, funded by the National Institutes of Health. Review of documentation and interview transcripts revealed the following key ingredients for success: 1) Having a north star; 2) Functional diversity; 3) Challenges as learning opportunities; 4) Board structure and healthy relationships; and 5) Funding and resources. The NCCB has undergone multiple transformations, including a name change to the New Jersey Critical Consciousness Collaborative Board (NJ-3CB), representing its growth from being a small local board to becoming part of a network of community collaborative boards across the United States and a chapter of the global campaign against racism. These and future transitions will help sustain the collaborative journey.

How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders?

BACKGROUND

Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown.

METHODS

Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share").

RESULTS

The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only.

CONCLUSIONS

Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.

Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model

ISSUES

To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors.

APPROACH

Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors.

KEY FINDINGS

Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder.

IMPLICATIONS

There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement.

CONCLUSION

There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.

Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts

Importance

Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap.

Objectives

To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt.

Design, Setting, and Participants

This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023.

Exposure

Demographic and clinical factors potentially associated with posthospitalization MOUD receipt.

Main Outcomes and Measures

The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually.

Results

Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates.

Conclusions and Relevance

This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.

A systematic review of validity of US survey measures for assessing substance use and substance use disorders

BACKGROUND

The steep rise in substance use and substance use disorder (SUD) shows an urgency to assess its prevalence using valid measures. This systematic review summarizes the validity of measures to assess the prevalence of substance use and SUD in the US estimated in population and sub-population-based surveys.

METHODS

A literature search was performed using nine online databases. Studies were included in the review if they were published in English and tested the validity of substance use and SUD measures among US adults at the general or sub-population level. Independent reviews were conducted by the authors to complete data synthesis and assess the risk of bias.

RESULTS

Overall, 46 studies validating substance use/SUD (n = 46) measures were included in this review, in which 63% were conducted in clinical settings and 89% assessed the validity of SUD measures. Among the studies that assessed SUD screening measures, 78% examined a generic SUD measure, and the rest screened for specific disorders. Almost every study used a different survey measure. Overall, sensitivity and specificity tests were conducted in over a third of the studies for validation, and 10 studies used receiver operating characteristics curve.

CONCLUSION

Findings suggest a lack of standardized methods in surveys measuring and reporting prevalence of substance use/SUD among US adults. It highlights a critical need to develop short measures for assessing SUD that do not require lengthy, time-consuming data collection that would be difficult to incorporate into population-based surveys assessing a multitude of health dimensions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022298280.

Critical Dialogue and Capacity-Building Projects Reduced Alcohol and Substance Use in a Randomized Clinical Trial Among Formerly Incarcerated Men

Background: Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration). Objective: We randomized participants to one of 16 intervention conditions using a 24 full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no QLW sessions), (3) capacity building projects (CBP; six weekly 1-hour-long group sessions vs. no CBP sessions), and (4) delivery by a trained peer versus licensed facilitators. Outcome was percentage of days in which participants used alcohol, cocaine, opioid, and/or cannabis in previous 30 days. Results: Intent-to-treat analysis did not meet a priori component selection criteria due to low intervention attendance. After controlling for intervention group attendance (percentage of sessions attended), peer-delivered CD and CBP produced statistically and clinically significant main and interaction effects in ASU over 5 months. Per the multiphase optimization strategy framework, we selected peer-delivered CD and CBP for inclusion as the optimized version of the intervention with a cost of US$1,380 per 10 individuals. No adverse intervention effects occurred. Conclusion: CD and CBP were identified as the only potentially effective intervention components. Future research will examine strategies to improve attendance and test the optimized intervention against standard of care in a randomized-controlled-trial.

The Health Disparities Research Industrial Complex

Research focused on health disparities-whether relating to one's race/ethnicity, gender expression, sexual orientation, citizenship status, income level, etc.-constitutes a large, generative, and highly profitable portion of scholarship in academic, clinical, and government settings. Health disparities research is expressed as a means of bringing greater attention to, and ultimately addressing via evidence-based implementation science, acts of devaluation and oppression that have continually contributed to these inequities. Philosophies underlying health disparities research's expansive and growing presence mirror the formal logic and ethos of the Military Industrial Complex and the Prison Industrial Complex. The "Health Disparities Research Industrial Complex," operationalized in this article, represents a novel mutation and extension of these complexes, primarily being enacted through these three mechanisms: 1) The construction and maintenance of beliefs, behaviors, and policies in healthcare, and society more broadly, that create and sustain disadvantages in minority health; 2) the creation and funding of research positions that inordinately provide non-minoritized people and those without relevant lived experiences the ability to study health disparities as "health equity tourists"; and 3) the production of health disparities research that, due to factors one and two, is incapable of fully addressing the disparities. In this piece, these and other core elements of the Health Disparities Research Industrial Complex, and the research bubble that it has produced, are discussed. Additionally, strategies for reducing the footprint and impact of the Health Disparities Research Industrial Complex and better facilitating opportunities for meaningful implementation in the field are presented.

Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies

INTRODUCTION

The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis.

AREAS COVERED

In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field.

EXPERT OPINION

Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.

The impact of cultural identity, parental communication, and peer influence on substance use among Indigenous youth in Canada

Heavy drinking and smoking have been found to be among the leading causes of morbidity and mortality within Indigenous youth in North America. The focus of this study was to examine the relative roles of cultural identity, parent-child communication about the harms of substance use (SU), and perception about peers' opinions on heavy drinking and cigarette smoking among Indigenous youth. Strong Indigenous cultural identity, parent-child communication about SU, and affiliation with peers who do not use and/or who disapprove of substance use were all expected to reduce risk for heavy drinking and smoking. Substance use beliefs were hypothesized to mediate these effects. Youth (N  =  117; Mage  =  14.07; grades 6-11) from two Indigenous communities in Quebec completed self-reports. Consistent with the hypotheses, strong cultural identity predicted increased negative beliefs about substance use, which predicted reduced drinking and smoking. Similarly, affiliating with peers who did not use alcohol predicted decreased positive beliefs about alcohol use, which predicted reduced drinking. Affiliating with peers who did not smoke cigarettes predicted reduced cigarette smoking. Parental influences were not supported in this model. Intervention strategies may benefit from targeting cultural identity, peer groups, and substance use beliefs among Indigenous youth.

Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults

OBJECTIVE

We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample.

RESEARCH DESIGN AND METHODS

Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract-level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners' Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population.

RESULTS

Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = -0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = -0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = -0.17; P < 0.001), unemployment (r = -0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population.

CONCLUSIONS

Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.

Substance use stigma: A systematic review of measures and their psychometric properties

Background

Instruments to measure substance use stigma are emerging, however little is known regarding their psychometric properties. While research has evolved to view substance use stigma as a context sensitive international phenomenon that is embedded within cultures, validated self-report measures are lacking and comprehensive reviews of the existing measures are extremely limited. In this systematic review of substance use stigma and shame measures, we aim to contextualize results from existing research, lay the groundwork for future measurement development research, and provide a thorough resource for research scientists currently designing studies to measure substance use stigma.

Methods

We searched three databases using Boolean search terms for psychometric evaluations of measures of substance use stigma and shame and evaluated the quality/psychometric properties using an adaptation of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guidelines.

Results

We identified 18 measures of substance use stigma. Overall, most measures had minimal psychometric assessments and none of the measures met all domains of the COSMIN measure quality criteria. However, most studies reported satisfactory factor analyses and internal consistency scores.

Conclusions

Most measures of substance use stigma and shame had psychometric assessment across a limited range of criteria and no measures of structural substance use stigma were found. The most reported psychometric properties were structural validity and convergent validity. We suggest future researchers investigate test-retest reliability and cross-cultural validity for existing substance use stigma measures, as well as develop and evaluate novel measures assessing structural stigma of substance use.

Sociodemographic and patient reported outcomes by racial and ethnicity status among participants in a randomized controlled trial for methamphetamine use disorder

Background

There has been a significant increase in methamphetamine use and methamphetamine use disorder (Meth UD) in the United States, with evolving racial and ethnic differences.

Objectives

This secondary analysis explored racial and ethnic differences in baseline sociodemographic and clinical characteristics as well as treatment effects on a measure of substance use recovery, depression symptoms, and methamphetamine craving among participants in a pharmacotherapy trial for Meth UD.

Methods

The ADAPT-2 trial (ClinicalTrials.gov number, NCT03078075; N=403; 69% male) was a multisite, 12-week randomized, double-blind, trial that employed a two-stage sequential parallel design to evaluate the efficacy of combination naltrexone (NTX) and oral bupropion (BUP) vs. placebo for Meth UD. Treatment effect was calculated as the weighted mean change in outcomes in the NTX-BUP minus placebo group across the two stages of treatment.

Results

Of the 403 participants in the ADAPT-2 trial, the majority (65%) reported non-Hispanic White, while 14%, 11% and 10% reported Hispanic, non-Hispanic Black, and non-Hispanic other racial and ethnic categories respectively. At baseline non-Hispanic Black participants reported less severe indicators of methamphetamine use than non-Hispanic White. Treatment effects for recovery, depression symptoms and methamphetamine cravings did not significantly differ by race and ethnicity.

Conclusions

Although we found racial and ethnic differences at baseline, our findings did not show racial and ethnic differences in treatment effects of NTX-BUP on recovery, depression symptoms and methamphetamine cravings. However, our findings also highlight the need to expand representation of racial and ethnic minority groups in future trials.

Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage

BACKGROUND

Little research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors.

METHOD

This cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015-2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps.

RESULTS

Sexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39-2.89; Bisexual: AOR = 2.35, 95% CI = 1.77-3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33-4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26-1.78).

CONCLUSION

The results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.

Exploring the Link: Health Insurance Coverage and Historical Substance Use Patterns Among U.S. Adults-A NHANES-Based Analysis

This study analyzed the NHANES database (2016-2018), investigating substance use patterns among 6,108 U.S. adults (18-64 years), with a focus on health insurance, race/ethnicity, age, gender, and socioeconomic status. Among participants, 1,063 reported a history of substance use. A key finding was the correlation between health insurance coverage and substance use history; notably, 80% of those with a history of substance use were insured. Non-Hispanic Whites represented a significant proportion (76%) of substance users, exceeding their population representation. Age and gender differences were prominent, with older adults (50-64 years) comprising 41% of substance users, and males accounting for 61%. The study's reliance on self-reported substance use history from NHANES may introduce measurement bias. Such bias necessitates careful interpretation of the data, considering variations across demographic and socioeconomic variables. Logistic regression analysis revealed that lacking health insurance increased the odds of a history of substance use (OR = 1.43, p < .01). The interaction between insurance coverage and race/ethnicity was not significant. These findings underscore the multifaceted nature of substance use, highlighting the need for comprehensive public health strategies to address the diverse factors influencing substance use behaviors.

Understanding the Behavioral Health Risk Factors that African American and Latinx Women Experience within a National Context

In an effort to address social determinants of health and to reduce barriers to care, there have been increased attempts to understand and mitigate public health concerns in ethnic minority communities. As knowledge increases regarding the impact of health disparities on ethnic minority communities, social workers practice knowledge must expand to include intersectional approaches and methods that are inclusive of mechanisms that address inconsistencies in access to health care. Using the 2018 National Survey on Drug Use and Health (NSDUH), this study examined behavioral health and psychosocial risk factors that African American and Latinx women (n = 7008) experienced and identified how these factors are associated with self-reported overall health. Results indicated that overall health and wellbeing is linked to psychosocial risk factors, such as depression, substance use, and even age for African American and Latinx women.

Progression of Comorbid Depression and Substance Use among Racially Diverse Adults

Comorbidity of depression and substance abuse is common and a major public health burden. Studies of this form of comorbidity in racial and ethnic minoritized (REM) populations are minimal and have mixed findings. The present study examined the effect of general risk factors (family bonding, supervision, involvement, peer delinquency), depression risk factors (caregiver depression), and substance use risk factors (adult family members, sibling, and peer substance use) in early adolescence (~ ages 13-14) on comorbid depression and substance use in later adolescence (~ ages 15-17) and adulthood (~ ages 29-31) and continuity in comorbidity from adolescence to adulthood. Longitudinal data on 1000 Black (n = 680) Hispanic (n = 170) and White (n = 150) individuals came from the Rochester Youth Development Study. Participants were interviewed 14 times over 17 years beginning in 1988. General risk factors predicted comorbidity across racial/ethnic groups. Substance specific risk predicted comorbidity among Black and Hispanic individuals whereas depression specific risk was predictive among White individuals. Adolescent comorbidity predicted comorbidity in adulthood across race. These findings highlight the importance of substance use intervention for racial and ethnic minoritized individuals and mental health risk factors in Whites. The continuity of comorbidity from adolescence to adulthood highlights the importance of targeting adolescents for intervention to prevent long-term manifestation of this form of comorbidity and its associated consequences.

Closing the Digital Divide in Interventions for Substance Use Disorder

Digital health interventions are exploding in today's medical practice and have tremendous potential to support the treatment of substance use disorders (SUD). Developers and healthcare providers alike must be cognizant of the potential for digital interventions to exacerbate existing inequities in SUD treatment, particularly as they relate to Social Determinants of Health (SDoH). To explore this evolving area of study, this manuscript will review the existing concepts of the digital divide and digital inequities, and the role SDoH play as drivers of digital inequities. We will then explore how the data used and modeling strategies can create bias in digital health tools for SUD. Finally, we will discuss potential solutions and future directions to bridge these gaps including smartphone ownership, Wi-Fi access, digital literacy, and mitigation of historical, algorithmic, and measurement bias. Thoughtful design of digital interventions is quintessential to reduce the risk of bias, decrease the digital divide, and create equitable health outcomes for individuals with SUD.

Substance Use in Pregnancy and Its Impact on Communities of Color

Stigma toward pregnant and postpartum people who use drugs is common and seeks to define addiction as a moral weakness rather than a chronic medical illness that requires resources and treatment. More concerning is the additive impact of substance use and racial discrimination, whose intersections present particularly challenging circumstances. In this article, the authors review the history of substance use in the United States and focus on 3 substances of abuse that illustrate the inequity faced by pregnant person of color who use drugs.

Cultural considerations for substance use and substance use disorders among Black men

There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.

Addressing experiences of trauma within Indigenous-focused substance use residential treatment: a systematic review and environmental scan

Indigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms.

Mexican-origin parent and child reported neighborhood factors and youth substance use

Background

Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use.

Methods

Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use.

Results

Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use.

Conclusion

The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.

Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis

OBJECTIVE

To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking.

METHODS

The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted.

RESULTS

A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking.

CONCLUSIONS FOR PRACTICE

Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.

Associations between partisan media consumption, opioid use disorder stigma, and opioid policy support: An exploration of the media's role in the ongoing opioid epidemic

We report on a preliminary investigation into the relationship between partisan media consumption (PMC) among U.S. adults and their (1) opioid use disorder (OUD) stigma, (2) national OUD policy support (e.g., Medicaid coverage for OUD treatment), (3) local OUD policy support (e.g., safe injection sites), (4) discriminatory OUD policies (e.g., denying housing), and (5) carceral OUD policies (e.g., jailing people who use opioids). We performed a cross-sectional survey of a nationally-representative sample of U.S. adults (n = 6,515) from October 1-November 19, 2021. We surveyed a sample of U.S. adults ages 18 and older drawn from NORC's AmeriSpeak® Panel. AmeriSpeak is a probability-based ongoing panel of over 40,000 households designed to represent the U.S. household population. Cross-sectional analyses revealed significant relationships between PMC and OUD stigma (b = 0.29, p <.001, CI95 = 0.14,0.43), support for national (b = -0.31, p <.01, CI95 = -0.54,-0.09) and local policy responses (b = -0.38, p <.001, CI95 = -0.59,-0.17), and support for discriminatory opioid use disorder policies (b = 0.27, p <.01, CI95 = 0.07,0.45). After controlling for self-reported political affiliation and other potential covariates, Republican-leaning media consumption was significantly associated with increased OUD stigma, less support for national and local harm reduction or rehabilitative policies, and more support for discriminatory policies against individuals experiencing OUD. The opposite associations were observed for Democratic-leaning media consumption. Markers for racism mediated the relationship between PMC and support for carceral policies (indirect path b = -0.41,p <.001, CI95 = -0.50,-0.31). Our results indicate that public health advocates must collaborate with conservative leaders to find bipartisan common ground for targeted communication campaigns.

Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019

OBJECTIVES

This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18-34, 35-64, and 65-75 years), sex, and race, and ethnicity.

METHOD

VHA electronic health records from 2008 to 2019 were used to identify the percentage of unique VHA patients seen each year at an ED, received a UDS, and screened positive for cannabis. Trends in cannabis-positive UDS were examined by age, race and ethnicity, and sex within age groups.

RESULTS

Of the VHA ED patients with a UDS, the annual prevalence positive for cannabis increased from 16.42% in 2008 to 27.2% in 2019. The largest increases in cannabis-positive UDS were observed in the younger age groups. Male and female ED patients tested positive for cannabis at similar levels. Although the prevalence of cannabis-positive UDS was consistently highest among non-Hispanic Black patients, cannabis-positive UDS increased in all race and ethnicity groups.

DISCUSSION

The increasing prevalence of cannabis-positive UDS supports the validity of previously observed population-level increases in cannabis use and cannabis use disorder from survey and administrative records. Time trends via UDS results provide additional support that previously documented increases in self-reported cannabis use and disorder from surveys and claims data are not spuriously due to changes in patient willingness to report use as it becomes more legalized, or due to greater clinical attention over time.

Associations among discrimination, psychological functioning, and substance use among US Black adults aged 18-28: Moderation by racial attribution and sex

INTRODUCTION

Discrimination is associated with poor mental health and substance use among Black Americans, but research is needed on mediators and moderators of these relationships. This study tested whether: 1) discrimination is associated with current alcohol, tobacco (cigarette or e-cigarette), and cannabis use among US Black emerging adults; 2) psychological distress (PD) and positive well-being (PW) are mediators of discrimination-substance use relationships; and 3) these relationships are moderated by sex and attributions to discrimination (racial vs. nonracial).

METHODS

Using data from a 2017 US nationally representative survey, we conducted bivariate and multiple-group moderated mediation analyses among 1118 Black American adults aged 18-28. The study assessed discrimination and attribution to discrimination using the Everyday Discrimination scale, past 30-day PD with the Kessler-6 scale, and past 30-day PW with the Mental Health Continuum Short Form. We utilized probit regression for all structural equation models and adjusted final models for age.

RESULTS

Discrimination was positively associated with past 30-day cannabis and tobacco use directly and indirectly through PD in the overall model. Among males who reported race as the sole/main attribution to discrimination, discrimination was positively associated with alcohol, cannabis, and tobacco use through PD. Among females who reported race as the sole/main attribution to discrimination, discrimination was positively associated with cannabis use through PD. Discrimination was positively associated with tobacco use among those who reported nonracial attributions to discrimination and with alcohol use among those whose attribution was not assessed. Discrimination was positively associated with PD among those who reported race as a secondary attribution to discrimination.

CONCLUSIONS

Discrimination specifically attributed to race may contribute to greater PD and in turn alcohol, cannabis, and tobacco use among Black emerging adults, especially males. Future substance use prevention and treatment efforts targeted to Black American emerging adults may benefit from addressing racial discrimination and PD.