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Newberger NG, Ho D, Thomas ED, Goldstein SC, Coutu SM, Avila AL, Stein LAR, Weiss NH. Observations of substance use treatment engagement during the period of community re-entry following residential treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209430. [PMID: 38852820 DOI: 10.1016/j.josat.2024.209430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. METHOD This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. RESULTS Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). CONCLUSION Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.
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Affiliation(s)
- Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Emmanuel D Thomas
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stephen M Coutu
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Alyssa L Avila
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Lynda A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America; Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Cranston, RI, United States of America
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America.
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Patarino M, Wang ZC, Wong K, Lee SJ, Skillen E, Nag R, Baskin B, Schindler AG. Anxiety and risk-taking behavior maps onto opioid and alcohol polysubstance consumption patterns in male and female mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.22.609245. [PMID: 39229006 PMCID: PMC11370560 DOI: 10.1101/2024.08.22.609245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Polysubstance use is prevalent in the population but remains understudied in preclinical models. Alcohol and opioid polysubstance use is associated with negative outcomes, worse treatment prognosis, and higher overdose risk; but underlying mechanisms are still being uncovered. Examining factors that motivate use of one substance over another in different contexts in preclinical models will better our understanding of polysubstance use and improve translational value. Here we assessed baseline anxiety-like and locomotive behavior and then measured voluntary consumption of multiple doses of alcohol and fentanyl in group housed male and female mice using our novel Socially Integrated Polysubstance (SIP) system. Fifty-six male (n=32) and female (n=24) adult mice were housed in groups of 4 for one week with continuous access to food, water, two doses of ethanol (5% and 10%) and two doses of fentanyl (5 ug/ml and 20 ug/ml). Our analyses revealed sex differences across multiple domains - female mice consumed more liquid in the dark cycle, had higher activity, a higher preference for both ethanol and fentanyl over water, and their fentanyl preference increased over the seven days. We then used machine-learning techniques to reveal underlying relationships between baseline behavioral phenotypes and subsequent polysubstance consumption patterns, where anxiety-and risk-taking-like behavioral phenotypes mapped onto discrete patterns of polysubstance use, preference, and escalation. By simulating more translationally relevant substance use and improving our understanding of the motivations for different patterns of consumption, this study contributes to the developing preclinical literature on polysubstance use with the goal of facilitating better treatment outcomes and novel therapeutic strategies.
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Affiliation(s)
- Makenzie Patarino
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Ziheng Christina Wang
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Katrina Wong
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Suhjung Janet Lee
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Emma Skillen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Richa Nag
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Britahny Baskin
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Abigail G Schindler
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA 98195
- Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA 98195
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
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Strong SJ, Charles NE, Bullerjahn MR, Tennity C, O'Dell C, Cordova E. Confirming Eight-Factor Structure of the Substance Use Motives Measure in a Sample of US College Students. Psychol Rep 2024:332941241226901. [PMID: 38286987 DOI: 10.1177/00332941241226901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
The 2020 National Survey on Drug Use indicates nearly three quarters of individuals ages 18-25 have used substances in the past year. Research suggests individuals who use substances to cope with negative mood states are typically more substance-involved, report more psychological distress, and have a more extensive treatment history. Additionally, the high rate of polysubstance use among substance using adults in the U.S. highlights the need for broadband measures that can adequately capture use, consequences, and motivations for use of multiple substances. However, most measures assessing motives for use are typically substance specific. Recently, Biolcati and Passini (2019) developed a brief, but comprehensive model of broad substance use motives (i.e., Substance Use Motives Measure, SUMM) based on well-established motives questionnaires (e.g., DMQ-R, MMQ). They found support for their proposed eight-factor model in an online sample of Italian citizens (ages 18-60). No studies to date have examined the psychometric properties of the SUMM with an English-speaking or US college student sample. The current study evaluates the factor structure of the SUMM in a sample of 143 college students (74.8% female, 77.6% White, and 94.4% non-Hispanic/Latinx) at a large, southeastern university in the United States. Results of a confirmatory factor analysis showed support for the previously identified eight-factor structure for the SUMM, with acceptable model fit and internal consistency of each factor found. Findings support using the SUMM as a broad measure of substance use motives, but more research is needed to assess measurement invariance across different groups and to evaluate external, concurrent, and convergent validity using other well-established measures of substance use motives, severity, and psychiatric symptomatology.
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Affiliation(s)
- Stephanie J Strong
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Nora E Charles
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Cassidy Tennity
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Chloe O'Dell
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Emily Cordova
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Mahu IT, Conrod PJ, Barrett SP, Sako A, Swansburg J, Stewart SH. The four-factor personality model and its qualitative correlates among opioid agonist therapy clients. Front Psychiatry 2023; 14:1129274. [PMID: 37363172 PMCID: PMC10289030 DOI: 10.3389/fpsyt.2023.1129274] [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: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice. Method Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis. Results Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected. Conclusion Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.
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Affiliation(s)
- Ioan T. Mahu
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Patricia J. Conrod
- Ste-Justine Hospital, Centre de Recherche, Montreal, QC, Canada
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC, Canada
| | - Sean P. Barrett
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Aïssata Sako
- Quebec-Atlantic Node, Canadian Research Initiative in Substance Misuse, Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Jennifer Swansburg
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
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5
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Ellis JD, Lister JJ, Wohl MJA, Greenwald MK, Ledgerwood DM. Exploring potential moderators of depressive symptoms and treatment outcomes among patients with opioid use disorder. Addict Behav 2023; 140:107604. [PMID: 36621047 PMCID: PMC9911368 DOI: 10.1016/j.addbeh.2022.107604] [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] [Received: 06/07/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depressive symptoms are common in patients seeking medication treatment for opioid use disorder (MOUD treatment) and decrease quality of life but have been inconsistently related to opioid treatment outcomes. Here, we explore whether depressive symptoms may only be related to adverse treatment outcomes among individuals reporting high opioid use-related coping motives (i.e., use of opioids to change affective states) and high trait impulsivity, two common treatment targets. METHODS Patients seeking MOUD treatment (N = 118) completed several questionnaires within two weeks of their treatment intake. Treatment outcomes (opioid-positive urine screens and days retained in treatment) were extracted from treatment records. Moderation analyses controlling for demographic characteristics and main effects were conducted to explore interaction effects between depressive symptoms and two distinct moderators. RESULTS Depressive symptoms were only related to opioid use during early treatment among patients reporting high opioid use-related coping motives (B = 2.67, p =.004) and patients reporting high trait impulsivity (B = 2.01, p =.039). Further, depressive symptoms were only inversely related to days retained among individuals with high opioid use-related coping motives (B = -10.12, p =.003). CONCLUSIONS Individuals presenting to treatment with opioid-related coping motives and/or impulsivity in the context of depressive symptoms may confer unique risk for adverse treatment outcomes. Clinicians may wish to consider these additive risk factors when developing their treatment plan.
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Affiliation(s)
- Jennifer D Ellis
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
| | - Jamey J Lister
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States; School of Social Work, Wayne State University, Detroit, MI, United States.
| | - Michael J A Wohl
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
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Florimbio AR, Coughlin LN, Bauermeister JA, Young SD, Zimmerman MA, Walton MA, Bonar EE. Risky Drinking in Adolescents and Emerging Adults: Differences between Individuals Using Alcohol Only versus Polysubstances. Subst Use Misuse 2022; 58:211-220. [PMID: 36537360 PMCID: PMC9877190 DOI: 10.1080/10826084.2022.2152192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups. METHODS Participants (N = 955; ages 16-24; 54.5% female) who reported recent risky drinking completed measures of alcohol/substance use, alcohol-related consequences, drinking motives, alcohol PBS, mental health symptoms, and emotion dysregulation. Participants were in the polysubstance group if they reported using at least one other substance (e.g., cannabis, stimulants) in addition to alcohol in the past three months. Chi-square and t-tests examined differences between the two groups and multiple regression analyses examined correlates of risky drinking. RESULTS Most participants (70.4%, n = 672) reported polysubstance use; these individuals engaged in riskier patterns of drinking, experienced more alcohol-related consequences, used fewer PBS, had stronger drinking motives (enhancement, social, coping), endorsed more mental health symptoms, and reported more emotion dysregulation. Regression models showed that emotion dysregulation significantly associated with risky drinking in the alcohol-only group; conformity and coping motives, alcohol PBS, and anxiety symptoms significantly associated with risky drinking in the polysubstance group. CONCLUSIONS Among risky drinking youth, results indicated youth engaging in polysubstance use have greater comorbidities and individual-level factors associated with risky drinking than youth who consume alcohol only. These findings may inform the tailoring of interventions for individuals who engage in risky drinking and polysubstance use.
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Affiliation(s)
- Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean D. Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Informatics, University of California, Irvine, Irvine, CA, USA
| | - Marc A. Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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7
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Rhed BD, Harding RW, Marks C, Wagner KT, Fiuty P, Page K, Wagner KD. Patterns of and Rationale for the Co-use of Methamphetamine and Opioids: Findings From Qualitative Interviews in New Mexico and Nevada. Front Psychiatry 2022; 13:824940. [PMID: 35418887 PMCID: PMC8995976 DOI: 10.3389/fpsyt.2022.824940] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Methamphetamine use and methamphetamine-involved deaths have increased dramatically since 2015, and opioid-related deaths now frequently involve methamphetamine. Nevada and New Mexico are states with elevated rates of opioid and methamphetamine use. In this paper, we report results from a qualitative analysis that examined patterns of methamphetamine and opioid co-use over participants' lifespan, factors that influence those patterns, and implications for health outcomes among users. Methods Project AMPED was a multisite, mixed-methods study of methamphetamine use in Northern New Mexico and Northern Nevada. Between December 2019 and May 2020, qualitative interview participants were asked to describe their patterns of and reasons for co-administration of opioids and methamphetamine. Results We interviewed 21 people who reported using methamphetamine in the past 3 months. Four primary patterns of methamphetamine and opioid co-use were identified: [1] using both methamphetamine and heroin, either simultaneously or sequentially (n = 12), [2] using methamphetamine along with methadone (n = 4), [3] using prescription opioids and methamphetamine (n = 1), and [4] using only methamphetamine (n = 4). Among those who used methamphetamine and heroin simultaneously or sequentially, motivations drew from a desire to enhance the effect of one drug or another, to feel the "up and down" of the "perfect ratio" of a goofball, or to mitigate unwanted effects of one or the other. Among those who used methamphetamine and methadone, motivations focused on alleviating the sedative effects of methadone. Conclusion To address the emergent trend of increasing methamphetamine-related deaths, researchers, health care professionals, and community health workers must acknowledge the decision-making processes behind co-use of opioids and methamphetamine, including the perceived benefits and harms of co-use. There is an urgent need to address underlying issues associated with drug use-related harms, and to design interventions and models of treatment that holistically address participants' concerns.
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Affiliation(s)
- Brittany D Rhed
- Division of Social Behavioral Health and Health Administration and Policy, School of Public Health, University of Nevada, Reno, NV, United States
| | - Robert W Harding
- Division of Social Behavioral Health and Health Administration and Policy, School of Public Health, University of Nevada, Reno, NV, United States
| | - Charles Marks
- Division of Social Behavioral Health and Health Administration and Policy, School of Public Health, University of Nevada, Reno, NV, United States
| | - Katherine T Wagner
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Phillip Fiuty
- Santa Fe Mountain Center, Santa Fe, NM, United States
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Karla D Wagner
- Division of Social Behavioral Health and Health Administration and Policy, School of Public Health, University of Nevada, Reno, NV, United States
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