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McHugh C, Hu N, Georgiou G, Hodgins M, Leung S, Cadiri M, Paul N, Ryall V, Rickwood D, Eapen V, Curtis J, Lingam R. Integrated care models for youth mental health: A systematic review and meta-analysis. Aust N Z J Psychiatry 2024; 58:747-759. [PMID: 38847297 PMCID: PMC11370150 DOI: 10.1177/00048674241256759] [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: 08/31/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of integrated models of mental healthcare in enhancing clinical outcomes, quality of life, satisfaction with care and health service delivery outcomes in young people aged 12-25 years. A secondary objective was to identify common components of integrated mental health interventions. METHODS A systematic review and meta-analysis of studies published 2001-2023 that assessed clinical or health service use outcomes of integrated care, relative to treatment as usual, for any mental health condition in 12-25 years old accessing community-based care. RESULTS Of 11,444 titles identified, 15 studies met inclusion criteria and 6 studies were entered in the meta-analysis. Pooled effect size found integrated care was associated with a greater reduction in depressive symptoms relative to treatment as usual at 4-6 months (standardised mean difference = -0.260, 95% confidence interval = [-0.39, -0.13], p = 0.001). Of the seven studies reporting access or engagement, all reported higher rates of both in the intervention arm. The most frequent components of integration were use of a multidisciplinary team (13/15 studies), shared treatment planning (11/15) and workforce training in the model (14/15). CONCLUSIONS Integrated models of mental healthcare are associated with a small, but significant, increase in effectiveness for depressive symptoms relative to treatment as usual. Given integrated care may increase access and engagement, future research should focus on assessing the impact of integrated care in a wider range of settings and outcomes, including clinical and functional recovery, satisfaction with care and system-level outcomes such as cost-effectiveness.
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Affiliation(s)
- Catherine McHugh
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Nan Hu
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Gabrielle Georgiou
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hodgins
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Leung
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Mariyam Cadiri
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Nicola Paul
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
| | - Vikki Ryall
- Headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Debra Rickwood
- Headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jackie Curtis
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research, University of New South Wales, Sydney, NSW, Australia
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Sterling SA, Kline-Simon A, Metz VE, Eisenberg N, Grijalva C, Iturralde E, Charvat-Aguilar N, Berrios G, Braciszewski J, Beck A, Boggs J, Kuklinski M. Pilot Implementation of Guiando Buenas Decisiones, an Evidence-Based Parenting Program for Spanish-Speaking Families, in Pediatric Primary Care in a Large, U.S. Health System: A Qualitative Interview Study. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00796-w. [PMID: 39052125 DOI: 10.1007/s10935-024-00796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
Adolescent substance use is a significant public health problem in the United States and Hispanic youth engage in substance use services at lower rates than other groups. For this under-served group, prevention services delivered in non-stigmatized, non-specialty care settings may increase access to the services. We describe findings from a feasibility pilot of the implementation of a virtual version of Guiando Buenas Decisiones (GBD), a universal, group-based substance use prevention program for parents. It was conducted with Spanish-speaking families and delivered, virtually, in pediatric primary care in a large healthcare system in the U.S. Through qualitative interviews with pediatricians (n =7) and parents (n = 26), we explored potential barriers and facilitators of GBD enrollment and engagement. Parents and pediatricians alike noted the dearth of universal prevention programming in Spanish and that GBD could help address the need for linguistically appropriate programming. Parents liked the curriculum content, materials and videos; they felt the focus on strengthening family bonds, setting clear expectations and guidelines, the use of family meetings, and the positive tools provided for navigating family conflict were well-aligned with their cultural and family values. Feedback from parents was helpful for informing more personalized and attentive approaches to program outreach and recruitment methods, and for adaptation of recruitment fliers and letters. In this pediatric primary care context serving an underserved population, we found virtual GBD feasible to implement, acceptable and appealing to parents, and judged by pediatricians as a promising, much-needed addition to their prevention armamentarium.
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Affiliation(s)
- S A Sterling
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA.
- University of California, San Francisco, CA, USA.
| | - A Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
| | - V E Metz
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
| | - N Eisenberg
- Social Development Research Group, School of Social Work, University of Washington, Seattle, USA
| | - C Grijalva
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
| | - E Iturralde
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
- University of California, San Francisco, CA, USA
| | - N Charvat-Aguilar
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
| | - G Berrios
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda, Pleasanton, CA, 94588, USA
| | - J Braciszewski
- Social Development Research Group, School of Social Work, University of Washington, Seattle, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, USA
| | - A Beck
- Institute for Health Research, Kaiser Permanente Colorado, Lone Tree, USA
| | - J Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Lone Tree, USA
| | - M Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Karas D, Eggleston L, Goldman W, Bigham M, White PC. Substance Use Screening in a Large Pediatric Primary Care Network: A Quality Improvement Project. Pediatr Qual Saf 2024; 9:e745. [PMID: 38993273 PMCID: PMC11236405 DOI: 10.1097/pq9.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
Background This project aimed to introduce substance use screening, using the CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) screening tool, into the routine care of adolescents using quality improvement strategies and tools. Methods We expanded a single-site project showing the successful introduction of CRAFFT screening into adolescent care to include the entire 34-site primary care network of a children's hospital in Northeastern Ohio. We deployed quality improvement methodology to facilitate the acceptance and use of the screener. Data showing the percentage of eligible adolescents screened were collected and shared monthly with network providers. Results The single-site phase increased the screening rate from 3.5% to 72%. The percentage screened for the network phase rose from 0% to >90% in the first 2 months of the project and remained at that level. Of those screened, 85% were low risk, 3% were medium risk, and 2% were high risk. Ten percent of the results were not recorded in a way that allowed for post hoc risk assessment. During the network phase, 35,750 of 38,427 (93%) eligible patients completed the screening form. Conclusions This project resulted in the highly reliable use of the CRAFFT screener in a large primary care network.
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Affiliation(s)
- Dave Karas
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Lisa Eggleston
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - William Goldman
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Mike Bigham
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - P. Cooper White
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
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4
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Lanza HI, Waller K, Sevillano L. Bidirectional relationships between nicotine vaping and maladaptive eating behaviors among young adults. Addict Behav Rep 2024; 19:100547. [PMID: 38725608 PMCID: PMC11081782 DOI: 10.1016/j.abrep.2024.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Background Past research indicates that young adult cigarette smokers are at risk of engaging in maladaptive eating behaviors (MEBs); however, whether this relationship extends to nicotine vaping is unclear. The current study assessed bidirectional associations between four types of MEBs and nicotine vaping among young adults. Methods 1,303 young adults (20.5 ± 2.3 years; 63 % female) from a public, urban university were recruited and completed online surveys at six-month intervals from spring 2021 (W1) to spring 2023 (W5). Past 30-day nicotine vaping and four types of MEBs (susceptibility to external cues, emotional eating, routine restraint, and compensatory restraint) were evaluated. Results Longitudinal cross-lagged models examined the bidirectional relationships between past 30-day nicotine vaping and each type of MEB across five waves. Nicotine vaping predicted both susceptibility to external cues (β = 0.10, p <.05; Wave 2 to 3) and emotional eating (β = 0.08, p <.05; Wave 1 to 2). A significant cross-lag regression (Wave 4 to 5) showed nicotine vaping predicted to routine restraint (β = 0.08, p <.05), and routine restraint predicted to nicotine vaping (β = 0.12, p <.05). Conclusions Results indicated that nicotine vaping predicted MEBs; however, the type of MEB differed across waves, which may have been due to the COVID-19 pandemic context. Nicotine vaping predicted to MEBs reflecting vulnerability to the external environment and emotion regulation during a period of heightened restrictions, whereas later when pandemic restrictions had ceased nicotine vaping predicted only to routine restraint. Integrating research and practice on nicotine vaping and MEBs may inform public health efforts to decrease co-occurring health-risks in young adulthood.
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Affiliation(s)
- H. Isabella Lanza
- Department of Human Development, California State University, Long Beach, CA, United States
| | - Kailey Waller
- Department of Human Development, California State University, Long Beach, CA, United States
| | - Lalaine Sevillano
- School of Social Work, Portland State University, Portland, OR, United States
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5
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Hogue A, Porter NP, Ozechowski TJ, Becker SJ, O'Grady MA, Bobek M, Cerniglia M, Ambrose K, MacLean A, Hadland SE, Cunningham H, Bagley SM, Sherritt L, O'Connell M, Shrier LA, Harris SK. Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial. JMIR Res Protoc 2024; 13:e54486. [PMID: 38819923 PMCID: PMC11179044 DOI: 10.2196/54486] [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: 11/11/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. OBJECTIVE This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. METHODS The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. RESULTS This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. CONCLUSIONS SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54486.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | - Nicole P Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | | | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Megan A O'Grady
- University of Connecticut Health Center, Farmington, CT, United States
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | - Monica Cerniglia
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | - Kevin Ambrose
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | - Alexandra MacLean
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, United States
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Hetty Cunningham
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Sarah M Bagley
- Department of Pediatrics, Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
| | - Lon Sherritt
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Cornerstone Systems Northwest, Lynden, WA, United States
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Maddie O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lydia A Shrier
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Sion Kim Harris
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
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Haller J. Herbal Cannabis and Depression: A Review of Findings Published over the Last Three Years. Pharmaceuticals (Basel) 2024; 17:689. [PMID: 38931356 PMCID: PMC11206863 DOI: 10.3390/ph17060689] [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: 04/24/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Public perception contrasts scientific findings on the depression-related effects of cannabis. However, earlier studies were performed when cannabis was predominantly illegal, its production was mostly uncontrolled, and the idea of medical cannabis was incipient only. We hypothesized that recent changes in attitudes and legislations may have favorably affected research. In addition, publication bias against cannabis may have also decreased. To investigate this hypothesis, we conducted a review of research studies published over the last three years. We found 156 relevant research articles. In most cross-sectional studies, depression was higher in those who consumed cannabis than in those who did not. An increase in cannabis consumption was typically followed by an increase in depression, whereas withdrawal from cannabis ameliorated depression in most cases. Although medical cannabis reduced depression in most studies, none of these were placebo-controlled. In clinical studies published in the same period, the placebo also ameliorated depression and, in addition, the average effect size of the placebo was larger than the average effect size of medical cannabis. We also investigated the plausibility of the antidepressant effects of cannabis by reviewing molecular and pharmacological studies. Taken together, the reviewed findings do not support the antidepressant effects of herbal cannabis.
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Affiliation(s)
- Jozsef Haller
- Drug Research Institute, 1137 Budapest, Hungary;
- Department of Criminal Psychology, Faculty of Law Enforcement, Ludovika University of Public Service, 1083 Budapest, Hungary
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7
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Chen Q, Gopaldas M, Castillo F, Leckman-Westin E, Nunes EV, Levin FR, Finnerty MT. Prevalence of Opioid Use Disorder and Opioid Overdose Rates Among People With Mental Illness. Psychiatr Serv 2024:appips20230338. [PMID: 38650488 DOI: 10.1176/appi.ps.20230338] [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] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The authors examined the prevalence and correlates of co-occurring opioid use disorder and opioid overdose among individuals receiving psychiatric services. METHODS This was a cross-sectional study of adults with continuous enrollment in New York State Medicaid who received at least one psychiatric service in 2020 (N=523,885). Logistic regression models were used to examine the correlates of both opioid use disorder and overdose. RESULTS In the study sample, the prevalence rate of opioid use disorder was 8.1%; within this group, 7.7% experienced an opioid overdose in the study year. Opioid use disorder rates were lower among younger (18-24 years; 2.0%) and older (≥65 years; 3.1%) adults and higher among men (11.1%) and among those residing in rural areas (9.9%). Compared with Whites (9.4%), opioid use disorder rates were lower for Asian Americans (2.0%, adjusted odds ratio [AOR]=0.22) and Blacks (6.8%, AOR=0.76) and higher for American Indians (13.2%, AOR=1.43) and Hispanics (9.6%, AOR=1.29). Individuals with any substance use (24.9%, AOR=5.20), posttraumatic stress (15.7%, AOR=2.34), bipolar (14.9%, AOR=2.29), or anxiety (11.3%, AOR=2.18) disorders were more likely to have co-occurring opioid use disorder; those with conduct (4.5%, AOR=0.51), adjustment (7.4%, AOR=0.88), or schizophrenia spectrum (7.4%, AOR=0.87) disorders were less likely to have opioid use disorder. Those with suicidality (23.9%, AOR=3.83) or economic instability (23.7%, AOR=3.35) had higher odds of having opioid use disorder. Overdose odds were higher among individuals with suicidality (34.0%, AOR=6.82) and economic instability (16.0%, AOR=2.57). CONCLUSIONS These findings underscore the importance of providing opioid use disorder screening and treatment for patients receiving psychiatric services.
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Affiliation(s)
- Qingxian Chen
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Manesh Gopaldas
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Felipe Castillo
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Edward V Nunes
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Frances R Levin
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
| | - Molly T Finnerty
- New York State Office of Mental Health, Albany (Chen, Leckman-Westin, Finnerty); Division of Substance Use Disorders, New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Gopaldas, Castillo, Nunes, Levin); School of Public Health, State University of New York at Albany, Albany (Leckman-Westin); Department of Child and Adolescent Psychiatry, New York University, New York City (Finnerty)
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Mennis J, Stahler GJ, Coffman DL. Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization. Subst Use Misuse 2024; 59:962-970. [PMID: 38297820 DOI: 10.1080/10826084.2024.2310500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Purpose: State-level prevalence data are used to investigate whether recreational cannabis legalization moderates the mediated pathway from the perception of low risk of harm, to cannabis use, to cannabis use disorder (CUD) treatment admissions, among adolescents (age 12-17) in the US. Methods: Annual state prevalence measures of perception of low risk, cannabis use, and CUD treatment admissions between 2008 and 2019 (N = 542 state-year observations) were collected from the National Survey on Drug Use and Health (NSDUH) and the Treatment Episode Dataset - Admissions (TEDS-A). A two-way fixed effects (state and year) moderated mediation model was used to test whether recreational legalization moderated the indirect effect of perception of low risk on treatment admissions via cannabis use. Results: A positive indirect effect of perceiving cannabis as low risk on CUD treatment admissions via cannabis use was observed prior to legalization but not afterwards. After legalization, the positive association of perceiving cannabis as low risk with cannabis use was strengthened, and the positive association of cannabis use with treatment admissions was suppressed, as compared to before legalization. Discussion: Recreational legalization may alter the social acceptability and medical self-administration of cannabis, potentially leading to CUD treatment utilization decline among adolescents even as risk factors for CUD increase. Linking recreational cannabis legalization to advancing awareness of the health risks associated with adolescent cannabis use and promoting adolescent CUD treatment engagement through mHealth approaches and primary care providers are key to addressing potential adolescent health challenges brought about by expanding cannabis legalization.
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Affiliation(s)
- Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania, USA
| | - Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania, USA
| | - Donna L Coffman
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
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9
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DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
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Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Hadland SE. Filling in the Gaps: Building the Evidence Base for Screening, Brief Intervention, and Referral to Treatment in Adolescents. J Adolesc Health 2022; 71:S1-S4. [PMID: 36122964 PMCID: PMC10245381 DOI: 10.1016/j.jadohealth.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Scott E. Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, 175 Cambridge St, 5th Floor, Boston, MA 02114
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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11
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Irwin CE. The Evidence for SBIRT in Adolescents. J Adolesc Health 2022; 71:385-386. [PMID: 36122999 DOI: 10.1016/j.jadohealth.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
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