Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration

Congenital Syphilis-An Illustrative Review

Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing all over world with 700,000 to 1.5 million cases reported annually between 2016 and 2023. Despite the widespread availability of Penicillin, 2677 cases were reported in 2021 in the US. Clinical manifestations at birth can vary widely ranging from asymptomatic infection to stillbirth or neonatal death. Low birth weight, rash, hepatosplenomegaly, osteolytic bone lesions, pseudoparalysis, central nervous system infection, and long-term disabilities have been reported in newborns with congenital syphilis. Prevention of congenital syphilis is multifaceted and involves routine antenatal screening, timely treatment of perinatal syphilis with penicillin, partner tracing and treatment, and health education programs emphasizing safe sex practices and strategies to curb illicit drug use. Neonatal management includes risk stratification based on maternal syphilis history, evaluation (nontreponemal testing, complete blood counts, cerebrospinal fluid, and long-bone analysis), treatment with penicillin, and followup treponemal testing. Public health measures that enhance early detection during pregnancy and treatment with penicillin, especially in high-risk mothers, are urgently needed to prevent future cases of congenital syphilis.

The Tsunamic Model of LGBTQ+ Deaths of Despair: A Systemic Review to Identify Risk Factors for Deaths of Despair Among LGBTQ+ People

The term Deaths of Despair (DOD) was introduced to capture the phenomenon of mortality associated with suicide, drug overdose, and alcoholic liver disease. The LGBTQ+ population consistently evidences disproportionately high rates of DOD. This study reviewed the literature on DOD within this community to create a conceptual model that identifies risk factors that work together to potentiate DOD in the LGBTQ+ community. Ten DOD-Related Factors were identified and used to create The Tsunamic Model of LGBTQ+ Deaths of Despair. DOD-Related Factors include: (1) Stigma, (2) Demographics, (3) Identity Development, (4) Internalized Homophobia, (5) Depression, (6) Victimization, (7) Isolation/Rejection, (8) Sensation Seeking, (9) Risky Behavior, and (10) Uninformed Care. Each factor is associated with increased risk for DOD among the LGBTQ+ community. This model can help health professionals by providing a framework for prevention and early intervention programs.

Exploring Relationships Between State-Level LGBTQ Inclusivity and BRFSS Indicators of Mental Health and Risk Behaviors: A Secondary Analysis

OBJECTIVES

Minority Stress Theory suggests that repeated exposure to enacted stigma adversely affects mental health. States have wide authority to enact policies affecting the level of inclusivity experienced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) residents. The purpose of this study was to explore relationships between states' level of LGBTQ inclusivity and indicators of mental health/risk behaviors among an LGBTQ sample.

METHODS

The 2018 Human Rights Campaign State Equality Index (SEI) and the 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) were used to examine relationships between states' levels of LGBTQ inclusivity (predictor variable) and indicators of mental health/risk behaviors (outcome variables). Relationships were explored using descriptive statistics and survey-weighted logistic regression.

RESULTS

Lower state inclusivity increased odds of fair/poor general health (adjusted odds ratio [AOR]: 1.22, 95% confidence interval [CI]: 1.01-1.48), increased odds of poor mental health days (AOR: 1.34, 95% CI: 1.11-1.62), increased odds of smoking (AOR: 1.62, 95% CI: 1.27-2.07), and increased odds of heavy drinking (AOR: 1.54, 95% CI: 1.26-1.86) and binge drinking (AOR: 1.23, 95% CI: 1.01-1.49). State inclusivity did not influence odds of a depressive disorder diagnosis or driving under the influence of alcohol.

CONCLUSIONS

LGBTQ persons in restrictive states had increased odds of experiencing several indicators of mental health and risk behaviors. More research is needed to determine whether state policies affect other domains of LGBTQ persons' health. Health care providers should be mindful of LGBTQ persons' mental health/risk behaviors and the state policy environment, and should seek to implement mitigating health care strategies such as the use of validated assessment.

Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature

This systematic review provides a synthesis of the literature on brief alcohol intervention (BAI) implementation in medical settings. We utilized the Proctor et al. (2011) taxonomy of eight implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) to organize and describe the qualitative and quantitative literature regarding BAI implementation. An electronic search of the PubMed database identified 25 articles that met inclusion criteria. The study team independently assessed all articles for methodological quality, with the majority of studies rated as weak to moderate. Descriptive and narrative review of the included articles identified penetration and acceptability as the two most commonly reported implementation outcomes. Studies rarely reported other outcomes (e.g., fidelity, cost, sustainability, adoption). On average, studies utilized approximately six implementation strategies to facilitate implementation, with education (96%), quality management (64%), and planning (56%) strategies the most frequently reported. Promising evidence exists that patients and providers are accepting of BAI implementation efforts and implementation efforts are helpful in expanding the reach of BAIs. A theory-informed approach to selecting implementation strategies may enhance implementation success in future work. When reporting on implementation, all studies should provide detailed BAI descriptions and strategies to enhance replication efforts. We suggest study designs that balance practical outcomes with methodological rigor to maximize the quality of future studies and better inform implementation efforts.

The Emerging Intersection Between Injection Drug Use and Early Syphilis in Nonurban Areas of Missouri, 2012-2018

BACKGROUND

The national rate of syphilis has increased among persons who inject drugs (PWID). Missouri is no exception, with increases in early syphilis (ES), congenital syphilis, and PWID, especially in nonurban counties.

METHODS

Disease intervention specialist records for ES cases in Missouri (2012-2018) were examined. Drug use was classified as injection drug use (IDU) (opioid or methamphetamine) or non-IDU (opioid, methamphetamine, or cocaine). Rates were compared based on residence, sex of sex partner, and drug use.

RESULTS

Rates of ES in Missouri increased 365%, particularly in small metropolitan and rural areas (1170%). Nonurban areas reported a higher percentage of persons with ES who used injection drugs (12%-15%) compared with urban regions (2%-5%). From 2012 to 2018, women comprised an increasing number of ES cases (8.3%-21%); 93% of women were of childbearing age. Increasingly more women in rural areas with ES also reported IDU during this time (8.4%-21.1%).

CONCLUSIONS

As syphilis increases in small metropolitan and rural regions, access to high-quality and outreach-based sexual health services is imperative. Healthcare policy to equip health departments with harm reduction services and drug treatment resources offers an opportunity to impact both syphilis increases as well as health outcomes associated with IDU.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Practice: A Quality Improvement Project in the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network

The American Academy of Pediatrics recommends pediatric providers routinely screen for, assess, and treat substance use and substance use disorders among adolescents, a process called "Screening, Brief Intervention, and Referral to Treatment," or "SBIRT." Because there are limited data on how Maryland pediatric practices have adopted SBIRT, a quality improvement initiative was developed within the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network using a "Plan/Do/Study/Act" approach. A 2-part provider training was conducted regarding screening and motivational interviewing, and the "CRAFFT" screening tool was integrated into the practice's electronic medical record. Results from evaluation demonstrated significant improvements in provider knowledge, attitudes, and screening behavior. The association between substance use and sexual behavior suggests a need for further expansion of this model with inclusion of sexual health screening. Overall, this study demonstrates that SBIRT implementation into a general pediatric practice is highly feasible, acceptable, and shows preliminary effectiveness.

Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics

BACKGROUND

Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services.

METHODS

We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up.

RESULTS

In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01).

CONCLUSIONS

SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.