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Fliss MD, Cox ME, Proescholdbell S, Patel A, Smith M. Tying Overdose Data to Action: North Carolina's Opioid and Substance Use Action Plan Data Dashboard. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:831-834. [PMID: 37498535 PMCID: PMC10526884 DOI: 10.1097/phh.0000000000001796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
From 2000 to 2020, more than 28 000 North Carolina (NC) residents died of drug overdose. In response, NC Department of Health and Human Services worked with community partners to develop an Opioid and Substance Use Action Plan (OSUAP), now in its third iteration. The NC OSUAP data dashboard brings together data on 15 public health indicators and 16 local actions across 8 strategies. We share innovations in design, data structures, user tasks, and visual elements over 5 years of dashboard development and maintenance, with a special focus and supplemental material covering the technical details and techniques that dashboard design and implementation teams may benefit from.
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Austin AE, Shiue KY, Combs KG, Proescholdbell S, Cox ME, Naumann RB. Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina. Ann Epidemiol 2023; 85:88-92.e4. [PMID: 37196850 PMCID: PMC10184864 DOI: 10.1016/j.annepidem.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/22/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To examine racial and ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. METHODS We used North Carolina State Unintentional Drug Overdose Reporting System data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race and ethnicity during pre-COVID-19 (May 2019-February 2020) and COVID-19 periods (March 2020-December 2020). RESULTS For all racial and ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian and Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian and Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial and ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage of naloxone administered for most racial and ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). CONCLUSIONS Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed.
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Shiue KY, Naumann RB, Proescholdbell S, Cox ME, Aurelius M, Austin AE. Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015-2019. Prev Med 2022; 163:107217. [PMID: 35998765 DOI: 10.1016/j.ypmed.2022.107217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015-2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015-2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).
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Geary S, Proescholdbell S, Cox ME, Bell R. The Impact of the COVID-19 Pandemic on Disparities in Motor Vehicle Traffic Deaths and Injuries among North Carolina American Indians. N C Med J 2022; 83:361-365. [PMID: 37158553 DOI: 10.18043/ncm.83.5.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A Periodic Feature to Inform North Carolina Health Care Professionals About Current Topics in Health Statistics.
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Kafka JM, Moracco K(BE, Taheri C, Young BR, Graham LM, Macy RJ, Proescholdbell S. Intimate partner violence victimization and perpetration as precursors to suicide. SSM Popul Health 2022; 18:101079. [PMID: 35372658 PMCID: PMC8968650 DOI: 10.1016/j.ssmph.2022.101079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022] Open
Abstract
It remains unclear how often and under what circumstances intimate partner violence (IPV) precedes suicide. Available research on IPV and suicide focuses largely on homicide-suicide, which is a rare event (<2% of suicides). We focus instead on single suicides (i.e., suicides unconnected to other violent deaths), which are the most common type of fatal violence in the US. Unfortunately, information about IPV circumstances is often unavailable for suicides. To address this gap, we sought to identify the proportion of single suicides that were preceded by IPV in North Carolina (NC), to describe the prevalence of IPV victimization and perpetration as precursors to suicide, and to explore how IPV-related suicides differ from other suicides. We used data from the NC Violent Death Reporting System (2010–2017, n = 9682 single suicides) and hand-reviewed textual data for a subset of cases (n = 2440) to document IPV circumstances. We had robust inter-rater reliability (Kappa: 0.73) and identified n = 439 IPV-related suicides. Most were males who had perpetrated nonfatal IPV (n = 319, 72.7%) prior to dying by suicide. Our findings suggest that IPV was a precursor for at least 4.5% of single suicides. Next, we conducted logistic regression analyses by sex comparing IPV-related suicides to other suicides. For both men and women, IPV was more common when the person who died by suicide had recently disclosed suicidal intent, was younger, used a firearm, and was involved with the criminal legal system, even after controlling for covariates. We also found sex-specific correlates for IPV circumstances in suicide. Combined with homicide-suicide data (reported elsewhere), IPV is likely associated with 6.1% or more of suicides overall. Results suggest clear missed opportunities to intervene for this unique subpopulation, such as suicide screening and referral in IPV settings (e.g., batterer intervention programs, Family Justice Centers) that is tailored by sex. Intimate partner violence is a precipitating factor for 4.5% of single suicides. Most IPV-related single suicides were of men who perpetrated nonfatal IPV. Decedents in IPV-related suicides often used a firearm and disclosed intent. Integrated prevention strategies to target both IPV and suicide may be appropriate. When combined with homicide-suicide data, IPV influences 6.1% of suicides overall.
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Waltzman D, Sarmiento K, Daugherty J, Proescholdbell S. Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina. N C Med J 2022; 83:206-213. [PMID: 35504710 PMCID: PMC9340785 DOI: 10.18043/ncm.83.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence suggests that those who have sustained a traumatic brain injury (TBI) are at increased risk of adverse behaviors and health indicators, such as certain chronic physical and mental health conditions. However, little is known about the prevalence of these behaviors and health indicators among these individuals, information that could help decrease their risk of developing such conditions.METHODS Data (N = 4733) from the 2018 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to determine the prevalence of behaviors and health indicators among individuals who report having a lifetime history of TBI with loss of consciousness (LOC).RESULTS North Carolinians who report a lifetime history of TBI with LOC were at increased risk of reporting a range of 3 negative health behaviors: less than always seatbelt use (adjusted odds ratio [AOR] = 1.7; 95% confidence interval [CI] = 1.2-2.4), HIV risk behaviors (AOR = 1.7; 95% CI = 1.1-2.6), and reporting less than 7 hours of sleep (AOR = 1.5; 95% CI = 1.2-1.8); more difficulty obtaining health care (not seeing a doctor due to health care cost in the past 12 months [AOR = 1.3; 95% CI = 1.0-1.8]; not getting a routine medical check-up in the past 12 months [AOR = 1.5; 95% CI = 1.2-2.0]); worse self-reported health (fair or poor general health [AOR = 1.8; 95% CI = 1.4-2.3]); and reporting fair or poor mental health (AOR = 2.1; 95% CI = 1.6-2.8) compared with individuals who did not report a history of TBI.LIMITATIONS There are several limitations to the study, such as the sample being biased toward more severe brain injuries. Additionally, because the data in the BRFSS are retrospective and cross-sectional, it is not possible to determine temporality and causality between TBI history and the behaviors and health indicators examined.CONCLUSION Despite these limitations, this paper is one of the first to directly examine the association between history of TBI with LOC and a range of current behaviors and health care utilization. Assessing positive and negative behaviors and health indicators can help identify and tailor evidence-based interventions for those who have a history of TBI.
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LeMasters K, Cox ME, Fliss M, Seibert J, Brown C, Proescholdbell S. Mental health emergency department visits: An exploration of case definitions in North Carolina. Am J Emerg Med 2022; 57:103-106. [DOI: 10.1016/j.ajem.2022.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/08/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022] Open
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Sivaraman JJC, Greene SB, Naumann RB, Proescholdbell S, Ranapurwala SI, Marshall SW. Association Between Medical Diagnoses and Suicide in a Medicaid Beneficiary Population, North Carolina 2014-2017. Epidemiology 2022; 33:237-245. [PMID: 34799475 PMCID: PMC10281339 DOI: 10.1097/ede.0000000000001439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearms are used in about half of U.S. suicides. This study investigated how various medical diagnoses are associated with firearm and nonfirearm suicide. METHODS We used a case-control design including n = 691 North Carolina Medicaid beneficiaries who died from suicide between 1 January 2014 and 31 December 2017 as cases. We selected a total of n = 68,682 controls (~1:100 case-control ratio from North Carolina Medicaid member files using incidence density sampling methods). We linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). We matched cases and controls on number of months covered by Medicaid over the past 36 months. Analyses adjusted for sex, race, age, Supplemental Security Income status, the Charlson Comorbidity Index, and frequency of health care encounters. RESULTS The case-control odds ratios for any mental health disorder were 4.2 (95% confidence interval [CI]: 3.3, 5.2) for nonfirearm suicide and 2.2 (95% CI: 1.7, 2.9) for firearm suicide. There was effect measure modification by sex and race. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicide in men but did not differ substantially in women. The association of mental health and substance use diagnoses with suicides appeared to be weaker in Blacks (vs. non-Blacks), but the estimates were imprecise. CONCLUSION Behavioral health diagnoses are important indicators of risk of suicide. However, these associations differ by means of suicide and sex, and associations for firearm-related suicide are weaker in men than women.
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Caves Sivaraman JJ, Ranapurwala SI, Proescholdbell S, Naumann RB, Greene SB, Marshall SW. Suicide typologies among Medicaid beneficiaries, North Carolina 2014-2017. BMC Psychiatry 2022; 22:104. [PMID: 35144585 PMCID: PMC8832648 DOI: 10.1186/s12888-022-03741-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is a well-established need for population-based screening strategies to identify people at risk of suicide. Because only about half of suicide decedents are ever diagnosed with a behavioral health condition, it may be necessary for providers to consider life circumstances that may also put individuals at risk. This study described the alignment of medical diagnoses with life circumstances by identifying suicide typologies among decedents. Demographics, stressful life events, suicidal behavior, perceived and diagnosed health problems, and suicide method contributed to the typologies. METHODS This study linked North Carolina Medicaid and North Carolina Violent Death Reporting System (NC-VDRS) data for analysis in 2020. For suicide decedents from 2014 to 2017 aged 25-54 years, we analyzed 12 indicators of life circumstances from NC-VDRS and 6 indicators from Medicaid claims, using a latent class model. Separate models were developed for men and women. RESULTS Most decedents were White (88.3%), with a median age of 41, and over 70% had a health care visit in the 90 days prior to suicide. Two typologies were identified in both males (n = 175) and females (n = 153). Both typologies had similar profiles of life circumstances, but one had high probabilities of diagnosed behavioral health conditions (45% of men, 71% of women), compared to low probabilities in the other (55% of men, 29% of women). Black beneficiaries and men who died by firearm were over-represented in the less-diagnosed class, though estimates were imprecise (odds ratio for Black men: 3.1, 95% confidence interval: 0.8, 12.4; odds ratio for Black women: 5.0, 95% confidence interval: 0.9, 31.2; odds ratio for male firearm decedents: 1.6, 95% confidence interval: 0.7, 3.4). CONCLUSIONS Nearly half of suicide decedents have a typology characterized by low probability of diagnosis of behavioral health conditions. Suicide screening could likely be enhanced using improved indicators of lived experience and behavioral health.
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Austin AE, Shanhan ME, Rosemond P, Berkoff MC, Joyner C, Proescholdbell S. Implementation of the North Carolina Plan of Safe Care in Wake County, North Carolina. N C Med J 2022; 83:67-74. [PMID: 34980658 DOI: 10.18043/ncm.83.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Comprehensive Addiction and Recovery Act (CARA) of 2016 amended the Child Abuse Prevention and Treatment Act (CAPTA), reinforcing and revising the requirement that states develop policies and procedures to address the needs of substance-affected infants and their caregivers. North Carolina's program, the North Carolina Plan of Safe Care (NC POSC), was implemented in August 2017 and involves coordination between multiple agencies.METHODS We conducted a quality improvement project to assess implementation of the North Carolina Plan of Safe Care in Wake County through interviews with key stakeholders involved in program delivery including health care providers (n = 7), child protective services social workers (CPS; n = 14), and care managers at Care Coordination for Children (CC4C; n = 10). We also analyzed data on Plan of Safe Care notifications to Wake County CPS from January 2018 to October 2019.RESULTS Several key themes emerged in stakeholder interviews, including 1) lack of awareness of the program among health care providers; 2) gaps in information sharing and communication between agencies; 3) concerns regarding CPS notifications for all substance exposure types, including prenatal exposure to medication for opioid use disorder (MOUD); 4) common family needs and service referrals; 5) challenges engaging with families; 6) lack of knowledge among health care providers and CPS social workers regarding CC4C; and 7) benefits of the program for infants and families. From January 2018 to October 2019, 91% of notifications for substance-affected infants received by Wake County CPS as part of the NC POSC were screened-in for a maltreatment assessment. Of those screened-in, more than two-thirds (70%) involved prenatal marijuana exposure only.LIMITATIONS This project was limited to one county.CONCLUSIONS As NC POSC implementation continues, further consideration of the infrastructure and guidance available to address the implementation challenges identified by stakeholders will be essential to meeting family needs and promoting infant safety and well-being.
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Cox ME, Smith MA, Patel AR, Proescholdbell S, Bell RA. Sidebar: Community-driven Approaches to Preventing Overdoses Among American Indians. N C Med J 2021; 82:409-411. [PMID: 34750219 DOI: 10.18043/ncm.82.6.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Remch M, Mautz C, Burke EG, Junker G, Kaniuka A, Proescholdbell S, Marshall SW, Naumann RB. Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes. Am J Prev Med 2021; 61:619-627. [PMID: 34686299 DOI: 10.1016/j.amepre.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Incarcerated individuals with mental health disorders are disproportionally sent to restrictive housing (i.e., solitary confinement), which is known to have deleterious impacts on mental health. In response, North Carolina's prison system developed Therapeutic Diversion Units, treatment-oriented units for incarcerated individuals with high mental health needs who cycle in and out of restrictive housing. This analysis compares the impact of restrictive housing and Therapeutic Diversion Units on infractions, mental health, and self-harm among incarcerated individuals. METHODS Data were 2016-2019 incarceration records from North Carolina prisons. Outcomes were rates of infractions, inpatient mental health admissions, and self-harm in restrictive housing and Therapeutic Diversion Units. Inverse probability of treatment weights was used to adjust for confounding, and Poisson regression with generalized estimating equations was used to estimate adjusted rate ratios. Analyses were conducted between January and December 2020. RESULTS The analytic sample was 3,480 people, of whom 463 enrolled in a Therapeutic Diversion Unit. Compared with Therapeutic Diversion Unit rates, the rate of infractions was 3 times as high in restrictive housing (adjusted rate ratio=2.99, 95% CI=2.31, 3.87), the inpatient mental health admissions rate was 3.5 times as high (adjusted rate ratio=3.57, 95% CI=1.97, 6.46), and the self-injury incident rate was 3.5 times as high (adjusted rate ratio=3.46, 95% CI=2.11, 5.69). CONCLUSIONS Therapeutic Diversion Unit use had strong impacts on infractions, mental health, and self-harm. Therapeutic Diversion Units provide a promising alternative to restrictive housing for individuals with mental health disorders.
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Shiue KY, Austin AE, Proescholdbell S, Cox ME, Aurelius M, Naumann RB. Literal text analysis of poly-class and polydrug overdose deaths in North Carolina, 2015-2019. Drug Alcohol Depend 2021; 228:109048. [PMID: 34601275 DOI: 10.1016/j.drugalcdep.2021.109048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The literal text on death certificates was leveraged to enhance the examination of trends in the specific drugs and drug combinations involved in North Carolina (NC) overdose deaths from 2015 to 2019. METHODS Using NC death certificate data, overdose deaths included those with a drug poisoning as the underlying ICD-10 cause-of-death code (n = 10,117). The literal text from three death certificate fields were searched for drug mentions by integrating a tool developed by the Council of State and Territorial Epidemiologists Overdose Subcommittee with search terms originating from a National Center for Health Statistics/Food and Drug Administration collaboration. Descriptive statistics were calculated to evaluate substance classes, specific drugs, and drug combinations most frequently involved in these deaths over time. RESULTS From 2015-2019, polydrug involvement in NC overdose deaths increased (71% in 2015 to 75% in 2019). During the study period, opioid involvement shifted from heroin and/or oxycodone in 2015 to predominantly fentanyl in 2019, with fentanyl involvement increasing from 15% to 58%. Psychostimulant involvement increased for both cocaine (2015: 21%, 2019: 35%) and methamphetamine (2015: 3%, 2019: 13%). Benzodiazepine involvement, including alprazolam and clonazepam, declined during the study period, while the involvement of alcohol and antiepileptics/sedative-hypnotics, specifically gabapentin, remained stable. The top polydrug combinations in 2019 were fentanyl + cocaine (15% of all overdose deaths), fentanyl + heroin (10%), fentanyl + cocaine + heroin (6%), and fentanyl + methamphetamine (4%). CONCLUSIONS Incorporation of literal text methodology into ongoing overdose surveillance can facilitate the identification of specific, emerging drugs and combinations and inform targeted overdose prevention approaches.
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Fliss MD, Cox ME, Wallace JW, Simon MC, Knuth KB, Proescholdbell S. Measuring and Mapping Alcohol Outlet Environment Density, Clusters, and Racial and Ethnic Disparities in Durham, North Carolina, 2017. Prev Chronic Dis 2021; 18:E89. [PMID: 34554907 PMCID: PMC8462284 DOI: 10.5888/pcd18.210127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Austin AE, Bona VD, Cox ME, Proescholdbell S, Fliss MD, Naumann RB. Prenatal Use of Medication for Opioid Use Disorder and Other Prescription Opioids in Cases of Neonatal Opioid Withdrawal Syndrome: North Carolina Medicaid, 2016-2018. Am J Public Health 2021; 111:1682-1685. [PMID: 34383554 PMCID: PMC8589053 DOI: 10.2105/ajph.2021.306374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016-2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016-2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy.
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Figgatt MC, Austin AE, Cox ME, Proescholdbell S, Marshall SW, Naumann RB. Trends in unintentional polysubstance overdose deaths and individual and community correlates of polysubstance overdose, North Carolina, 2009-2018. Drug Alcohol Depend 2021; 219:108504. [PMID: 33429292 PMCID: PMC8126267 DOI: 10.1016/j.drugalcdep.2020.108504] [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: 07/17/2020] [Revised: 11/13/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Polysubstance involvement is increasing among fatal drug overdoses. However, little is known about the epidemiology of polysubstance drug overdoses. This paper describes emerging trends in unintentional polysubstance overdose deaths in North Carolina (NC) and examines associations with individual and community factors. METHODS Using 2009-2018 NC death certificate data, we identified unintentional drug overdose deaths and commonly involved substances (opioids, stimulants, benzodiazepines, alcohol, and antiepileptics). We examined polysubstance combinations, comparing opioid and non-opioid involved deaths. We examined individual level correlates from death certificate data and community level correlates from the American Community Survey and Robert Wood Johnson Foundation County Health Rankings to quantify associations. RESULTS From 2009-2018, 53 % of opioid and 19 % of non-opioid overdose deaths involved multiple substances. During this period, polysubstance overdose death increased dramatically, from 2.9 to 12.1 per 100,000 persons, with the greatest increases among drug combinations involving stimulants. The most common polysubstance combinations were: opioids and stimulants (12.1 % of overdose deaths); opioids and benzodiazepines (9.0 %); opioids and alcohol (5.1 %); opioids, stimulants, and benzodiazepines (3.1 %); and opioids, benzodiazepines, and antiepileptics (2.2 %). Compared to overdoses involving opioids alone, overdoses involving combinations of opioids, stimulants, and benzodiazepines involved younger individuals (53.7 % in 15-34 years of age vs. 40.7 %). Men comprised two-thirds of overdoses involving opioids alone, however, overdoses involving opioids, benzodiazepines, and antiepileptics were predominantly among women (60.6 %). CONCLUSIONS Polysubstance involvement has increased among overdose deaths in NC. These findings can be used to inform public health interventions addressing polysubstance deaths and associated individual and community level factors.
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Waltzman D, Daugherty J, Sarmiento K, Proescholdbell S. Lifetime History of Traumatic Brain Injury With Loss of Consciousness and the Likelihood for Lifetime Depression and Risk Behaviors: 2017 BRFSS North Carolina. J Head Trauma Rehabil 2021; 36:E40-E49. [PMID: 32769836 PMCID: PMC7769859 DOI: 10.1097/htr.0000000000000603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Because of the growing concern about the potential effects of traumatic brain injuries (TBIs) on a child's developing brain and the potential impact of lifetime depression and risk behaviors associated with TBI, further exploration is warranted. SETTING AND PARTICIPANTS Data (N = 4917) from the 2017 North Carolina Behavioral Risk Factors Surveillance System (BRFSS). DESIGN Cross-sectional. MAIN MEASURES Examine whether a lifetime history of TBI with loss of consciousness (LOC) or having a history of TBI with LOC prior to 18 years of age was associated with a greater likelihood of lifetime depression, current binge drinking, and current cigarette and e-cigarette smoking. RESULTS Respondents with a history of TBI with LOC had 2.1 (95% CI, 1.6-2.8) times higher odds of lifetime depression and 1.7 to 1.8 (95% CI, 1.02-2.97) times higher odds of all risk behaviors than those without a lifetime history of TBI with LOC. There were no statistical differences between age of first TBI with LOC and lifetime depression, binge drinking, cigarette smoking, and e-cigarette use after controlling for key demographics. CONCLUSION These findings underscore the importance of increasing awareness among healthcare providers of the prevalence of lifetime depression and risk behaviors among individuals with a history of TBI and the need for improved screening and referrals to evidence-based services.
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Singichetti B, Naumann RB, Sauber-Schatz E, Proescholdbell S, Marshall SW. Potential injuries and costs averted by increased use of evidence-based behavioral road safety policies in North Carolina. TRAFFIC INJURY PREVENTION 2020; 21:545-551. [PMID: 33095063 PMCID: PMC8126265 DOI: 10.1080/15389588.2020.1824066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.
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Naumann RB, Durrance CP, Ranapurwala SI, Austin AE, Proescholdbell S, Childs R, Marshall SW, Kansagra S, Shanahan ME. Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug Alcohol Depend 2019; 204:107536. [PMID: 31494440 PMCID: PMC8107918 DOI: 10.1016/j.drugalcdep.2019.06.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. METHODS One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. RESULTS The rate of OOD in counties with 1-100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95% CI: $1,237, $4882). CONCLUSIONS Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers.
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Brinkley-Rubinstein L, Sivaraman J, Rosen DL, Cloud DH, Junker G, Proescholdbell S, Shanahan ME, Ranapurwala SI. Association of Restrictive Housing During Incarceration With Mortality After Release. JAMA Netw Open 2019; 2:e1912516. [PMID: 31584680 PMCID: PMC6784785 DOI: 10.1001/jamanetworkopen.2019.12516] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. OBJECTIVE To characterize the association of restrictive housing with reincarceration and mortality after release. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. EXPOSURES Restrictive housing during incarceration. MAIN OUTCOMES AND MEASURES Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. RESULTS From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). CONCLUSIONS AND RELEVANCE This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.
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Cox ME, Dzialowy N, Armstrong L, Proescholdbell S. Overdose Deaths and Acute Hepatitis Infections among American Indians in North Carolina. N C Med J 2019; 80:197-203. [PMID: 31278177 DOI: 10.18043/ncm.80.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Like the rest of the nation, North Carolina is experiencing the worst drug crisis in United States history, as deaths related to medication and drug overdoses are at an all-time high. Although the absolute numbers of deaths are highest among white populations, American Indians (AIs) experience disproportionally high rates.METHOD Using death certificate data, death rates due to unintentional medication and drug overdose were calculated for various races and ethnicities. Acute hepatitis B (HBV) and acute hepatitis C (HCV) rates were also calculated across racial and ethnic groups using data from the North Carolina Electronic Disease Surveillance System.RESULTS After adjusting for population size, AIs have as high or higher overdose death rates for all types of drugs except heroin, compared to other racial and ethnic groups. During the most recent 5 years of data (2012-2016), the highest rate of acute HCV infection occurred among AIs.LIMITATIONS Race/ethnicity data recorded on death certificates is often provided by family members and is difficult to verify independently. Another potential limitation is use of small numbers to calculate rates. Additionally, HBV and HCV are thought to be underreported.CONCLUSION Overdose death rates and rates of communicable diseases associated with injection drug use among AIs residing in North Carolina are as high as or higher than the overall North Carolina population. It is important to recognize and address these differences and provide prevention, harm reduction, and treatment services to all groups being impacted by the overdose epidemic.
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Tanz LJ, Hoffman MN, Dandeneau D, Faigen Z, Moore Z, Proescholdbell S, Kansagra SM. Notes from the Field: Hurricane Florence-Related Emergency Department Visits - North Carolina, 2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:631-632. [PMID: 31318852 PMCID: PMC6657771 DOI: 10.15585/mmwr.mm6828a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Harduar Morano L, Richardson D, Proescholdbell S. Descriptive evaluation of methods for identifying work-related emergency department injury visits. Am J Ind Med 2019; 62:568-579. [PMID: 31104330 DOI: 10.1002/ajim.22984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.
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Ranapurwala SI, Shanahan ME, Alexandridis AA, Proescholdbell S, Naumann RB, Edwards D, Marshall SW. Ranapurwala et al. Respond. Am J Public Health 2019; 109:e9-e10. [DOI: 10.2105/ajph.2018.304823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cox ME, Dzialowy N, Armstrong L, Proescholdbell S. Trends in U.S. Drug Overdose Deaths. Ann Intern Med 2018; 169:355-356. [PMID: 30178015 DOI: 10.7326/l18-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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