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Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Bell K, John D, Marsch LA. Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study. J Subst Use Addict Treat 2024:209383. [PMID: 38670531 DOI: 10.1016/j.josat.2024.209383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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Nabunya P, Cavazos-Rehg P, Mugisha J, Kasson E, Namuyaba OI, Najjuuko C, Nsubuga E, Filiatreau LM, Mwebembezi A, Ssewamala FM. An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54635. [PMID: 38457202 PMCID: PMC10960218 DOI: 10.2196/54635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. OBJECTIVE The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths' outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. METHODS Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. RESULTS Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants' feedback. CONCLUSIONS This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54635.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Erin Kasson
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Claire Najjuuko
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Edward Nsubuga
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Lindsey M Filiatreau
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Kasson E, Szlyk HS, Li X, Constantino-Pettit A, Smith AC, Vázquez MM, Wilfley DE, Taylor CB, Fitzsimmons-Craft EE, Cavazos-Rehg P. Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches. Int J Eat Disord 2024. [PMID: 38445416 DOI: 10.1002/eat.24186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa M Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Byansi W, Howell TH, Filiatreau LM, Nabunya P, Kaiser N, Kasson E, Ssewamala FM, Cavazos-Rehg P. Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology. Child Youth Care Forum 2023; 52:1227-1247. [PMID: 38031566 PMCID: PMC10683936 DOI: 10.1007/s10566-023-09730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/04/2023]
Abstract
Background Adolescent girls in Uganda have four-fold HIV infections than adolescent boys. Several barriers to accessing comprehensive sexual health education exist for adolescent girls in Uganda, including unequal, social, and economic statuses, limited access to education and health care services, discrimination, and violence. Objective This study qualitatively examines sexual health behaviors and literacy among Ugandan adolescent girls and explores how technology may be leveraged to improve sexual and reproductive health outcomes in this population. Methods Four focus group discussions (FGDs) were conducted among 32 adolescent girls aged 14-17 years enrolled in Suubi mHealth. Participants were randomly selected from four secondary schools participating in a randomized clinical trial known as Suubi4Her (N = 1260). FGDs were conducted in the local language, audio-recorded, transcribed verbatim, and translated. Translated transcripts were imported into Dedoose for data management and coding. Emerging themes included Influences for Sex/Relationships, HIV Knowledge, and Sources of Sexual Health Information. Results Participants reported common influences for sexual engagement included seeking resource security, limited parental communication, and peer influences. Participants also demonstrated knowledge gaps, requesting information such as how to prevent unplanned pregnancies and HIV, endorsing sexual health myths, and describing limitations to accessing sexual health information. Conclusions Noticeable inconsistencies and limited access to information and resources regarding basic sexual health knowledge were reported, which inevitably increases adolescent girls' risks for adverse sexual and reproductive health outcomes. Developing culturally appropriate interventions may help advance the sexual and reproductive health needs of Ugandan adolescent girls.
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Affiliation(s)
- William Byansi
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Tyriesa Howard Howell
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Lindsey M. Filiatreau
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO 63130, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO 63110, USA
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Berg CJ, Schauer GL, Cavazos-Rehg P, Romm KF, Wang Y, Wysota CN, Duan Z, Henriksen L. Cannabidiol Marketing Strategies in the United States: An Analysis of Three Prominent Companies. Cannabis Cannabinoid Res 2023; 8:1150-1160. [PMID: 36169594 PMCID: PMC10714115 DOI: 10.1089/can.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The popularity and market for cannabidiol (CBD) products have expanded. Materials and Methods: Using Numerator advertising data from 2017 to 2021 regarding three popular CBD companies in the United States (Charlotte's Web, Green Roads, Medterra), we examined (1) general advertising characteristics (e.g., media channel, year); (2) ad content (i.e., themes of headlines and imagery); (3) themes of prominent sources (i.e., specific websites, magazines, etc.); and (4) ad expenditures. Results: Across companies during the study timeframe, there were 475 unique ads (i.e., unique content), 4767 ad occurrences, and $1,471,944 total expenditures. Charlotte's Web accounted for the greatest proportion of unique ads, ad occurrences, and expenditures (53.3%, 62.8%, and 70.3%, respectively), followed by Medterra (40.4%, 33.9%, and 28.5%) and Green Roads (6.3%, 3.3%, and 1.2%). The largest proportion of occurrences and expenditures were via online display (83.5%, 54.8%), followed by mobile (15.9%, 24.8%) and print (0.4%, 20.1%). Per ad occurrences and expenditures, ads prominently featured headline themes focused on brand/trust/quality (27.5%, 18.3%, respectively), wellness (17.5%, 17.7%), pain/sport (9.9%, 20.0%), and promotions (13.2%, 11.6%), in addition to visual themes of the product itself (74.3%, 78.5%) or with women (5.3%, 10.0%). The most prominent source themes were focused on health/wellness (21.0% of ad occurrences, 18.1% of expenditures), followed by other websites and search engines (18.3%, 11.2%), news/weather (12.9%, 21.3%), and entertainment/lifestyle/culture (12.6%, 28.0%). Despite some distinctions between companies, ad and source themes were similar. Conclusions: Regulatory efforts must be informed by ongoing surveillance of CBD marketing and how specific consumer subgroups are impacted by marketing exposure.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Gillian L Schauer
- Addictions, Drug & Alcohol Institute, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Szlyk HS, Gutierrez ZM, Peoples J, Baiden P, Doroshenko C, Li X, Cavazos-Rehg P. Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019. Am J Drug Alcohol Abuse 2023; 49:519-529. [PMID: 37506340 PMCID: PMC10979417 DOI: 10.1080/00952990.2023.2230611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need.Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need.Methods: The data came from the 2015-2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances.Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99).Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.
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Affiliation(s)
- Hannah S. Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | | | - JaNiene Peoples
- Brown School, Washington University in St. Louis; 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019
| | | | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Baiden P, Onyeaka HK, Aneni K, Wood B, LaBrenz CA, Muoghalu C, Peoples JE, Szlyk HS, Gobodzo EC, Baiden JF, Adeku Y, Mets VE, Brown FA, Cavazos-Rehg P. Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States. Drug Alcohol Depend 2023; 248:109894. [PMID: 37167795 PMCID: PMC11003345 DOI: 10.1016/j.drugalcdep.2023.109894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/28/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA.
| | - Henry K Onyeaka
- Harvard Medical School, Department of Psychiatry, Boston, MA02115, USA; Massachusetts General Hospital, Department of Psychiatry, Boston, MA02115, USA; McLean Hospital, Department of Psychiatry, Boston, MA02478, USA
| | | | - Bethany Wood
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129ArlingtonTX76019USA
| | - Chioma Muoghalu
- Plains Regional Medical Center, Clovis, New Mexico, NM88101, USA
| | - JaNiene E Peoples
- The Brown School at Washington University in St. Louis, One Brookings Drive, St. Louis, MO63130, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Box 8134, St. Louis, MO63110, USA
| | | | - John F Baiden
- East Airport International School, P.O. Box KAPM 57, KIA, Accra, Ghana
| | - Yvonne Adeku
- Western University, Department of Sociology, Social Science Centre, Room 5306, London, OntarioN6A 5C2, Canada
| | - Vera E Mets
- University of Ghana, Legon, Department of Social Work, P.O. Box LG 419, Legon, Accra, Ghana
| | - Fawn A Brown
- The University of Texas at Arlington, Department of Psychology, 501 Nedderman Dr, Box 19528, Arlington, TX76019, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Box 8134, St. Louis, MO63110, USA
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Kasson E, Filiatreau LM, Davet K, Kaiser N, Sirko G, Bekele M, Cavazos-Rehg P. Examining Symptoms of Stimulant Misuse and Community Support Among Members of a Recovery-Oriented Online Community. J Psychoactive Drugs 2023:1-11. [PMID: 37381990 PMCID: PMC10755072 DOI: 10.1080/02791072.2023.2228781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/28/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
Misuse of prescription and non-prescription stimulants and related overdose deaths represent a growing public health crisis that warrants immediate intervention. We examined 100 posts and their respective comments from a public, recovery-oriented Reddit community in January 2021 to explore content related to DSM-V stimulant use disorder symptoms, access and barriers to recovery, and peer support. Using inductive and deductive methods, a codebook was developed with the following primary themes: 1) DSM-V Symptoms and Risk Factors, 2) Stigma/Shame, 3) Seeking Advice or Information, 4) Supportive or Unsupportive Comments. In 37% of posts community members reported taking high doses and engaging in prolonged misuse of stimulants. Nearly half of posts in the sample (46%) were seeking advice for recovery, but 42% noted fear of withdrawal symptoms or a loss of productivity (18%) as barriers to abstinence or a reduction in use. Concerns related to stigma, shame, hiding use from others (30%), and comorbid mental health conditions (34%) were also noted. Social media content analysis allows for insight into information about lived experiences of individuals struggling with substance use disorders. Future online interventions should address recovery barriers related to stigma and shame as well as fears associated with the physical and psychological impact of quitting stimulant misuse.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Lindsey M. Filiatreau
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Kevin Davet
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Georgi Sirko
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Mehaly Bekele
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
- University of Southern California, Los Angeles, CA 90007
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
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Banks DE, Scroggins S, Paschke ME, Shacham E, Nance M, Cavazos-Rehg P, Winograd RP. Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011-2021. J Urban Health 2023; 100:436-446. [PMID: 37221300 PMCID: PMC10323067 DOI: 10.1007/s11524-023-00736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Abstract
The third wave of the opioid overdose crisis-defined by the proliferation of illicit fentanyl and its analogs-has not only led to record numbers of overdose deaths but also to unprecedented racial inequities in overdose deaths impacting Black Americans. Despite this racialized shift in opioid availability, little research has examined how the spatial epidemiology of opioid overdose death has also shifted. The current study examines the differential geography of OOD by race and time (i.e., pre-fentanyl versus fentanyl era) in St. Louis, Missouri. Data included decedent records from the local medical examiners suspected to involve opioid overdose (N = 4420). Analyses included calculating spatial descriptive analyses and conducting hotspot analyses (i.e., Gettis-Ord Gi*) stratified by race (Black versus White) and time (2011-2015 versus 2016-2021). Results indicated that fentanyl era overdose deaths were more densely clustered than pre-fentanyl era deaths, particularly those among Black decedents. Although hotspots of overdose death were racially distinct pre-fentanyl, they substantially overlapped in the fentanyl era, with both Black and White deaths clustering in predominantly Black neighborhoods. Racial differences were observed in substances involved in cause of death and other overdose characteristics. The third wave of the opioid crisis appears to involve a geographic shift from areas where White individuals live to those where Black individuals live. Findings demonstrate racial differences in the epidemiology of overdose deaths that point to built environment determinants for future examination. Policy interventions targeting high-deprivation communities are needed to reduce the burden of opioid overdose on Black communities.
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Affiliation(s)
- Devin E Banks
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA.
| | - Stephen Scroggins
- College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
- Taylor Geospatial Institute, St. Louis, USA
| | - Maria E Paschke
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA
| | - Enbal Shacham
- College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
- Taylor Geospatial Institute, St. Louis, USA
| | - Melissa Nance
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA
| | | | - Rachel P Winograd
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, USA
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10
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Banks DE, Fentem A, Li X, Paschke M, Filiatreau L, Woolfolk C, Cavazos-Rehg P. Attitudes Toward Medication for Opioid Use Disorder Among Pregnant and Postpartum Women and People Seeking Treatment. J Addict Med 2023; 17:356-359. [PMID: 37267191 PMCID: PMC10248185 DOI: 10.1097/adm.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Pregnant and postpartum women and people (PPWP) who use opioids experience higher rates of morbidity, preterm labor, and stillbirth than those who do not. Although medication for opioid use disorder (MOUD) is the standard of treatment, utilization among PPWP has remained low because of MOUD stigma and misconceptions. The current report examined general and pregnancy-related MOUD attitudes, norms, and self-efficacy among PPWP seeking treatment. METHODS Participants (n = 33) receiving MOUD at a Midwestern clinic reported beliefs about MOUD in general using the Attitudes toward Methadone Questionnaire (modified to include all MOUD) and during pregnancy/postpartum using an investigator-generated scale based on previous research. Participants responded using a 5-point scale from "strongly agree" to "strongly disagree" with higher scores indicating more positive attitudes. Analyses examined the bivariate association of attitudes with MOUD subjective norms and self-efficacy, also measured via investigator-generated scales. RESULTS Respondents reported positive attitudes toward MOUD use during pregnancy, with most agreeing it was safe. However, up-to-half of participants reported uncertainty regarding the appropriate dosage of MOUD and its impact on the fetus and/or neonate. Both general and pregnancy/postpartum-related MOUD attitudes were positively associated with subjective norms toward MOUD. CONCLUSIONS Pregnant and postpartum women and people reported high uncertainty about MOUD use despite currently using it, emphasizing the need for strategies that assess and mitigate MOUD-related stigma. Findings suggest that familial support and stigma impact attitudes toward MOUD and highlight the importance of accurate psychoeducation and social supports for patients and their families to improve the acceptance and utilization of MOUD among PPWP.
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Affiliation(s)
- Devin E. Banks
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Andrea Fentem
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Xiao Li
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Maria Paschke
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Lindsey Filiatreau
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Candice Woolfolk
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Patricia Cavazos-Rehg
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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11
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Filiatreau LM, Tutlam N, Brathwaite R, Byansi W, Namuwonge F, Mwebembezi A, Sensoy-Bahar O, Nabunya P, Neilands TB, Cavazos-Rehg P, McKay M, Ssewamala FM. Effects of a Combination Economic Empowerment and Family Strengthening Intervention on Psychosocial Well-being Among Ugandan Adolescent Girls and Young Women: Analysis of a Cluster Randomized Controlled Trial (Suubi4Her). J Adolesc Health 2023; 72:S33-S40. [PMID: 37062582 PMCID: PMC10157657 DOI: 10.1016/j.jadohealth.2022.11.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/15/2022] [Accepted: 11/08/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Economic empowerment and family strengthening interventions have shown promise for improving psychosocial well-being in a range of populations. This study investigates the effect of a combination economic and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls and young women (AGYW). METHODS We harnessed data from a three-arm cluster randomized controlled trial among AGYW aged 14-17 years in 47 Ugandan secondary schools. Schools were randomized to either a youth development account intervention (YDA) [N = 16 schools], YDA plus a multiple family group intervention (YDA + MFG) [N = 15 schools], or bolstered standard of care (BSOC) [N = 16 schools]. We estimated the effect of each intervention (BSOC = referent) on three measures of psychosocial well-being: hopelessness (Beck's Hopelessness Scale), self-concept (Tennessee Self-Concept Scale), and self-esteem (Rosenberg Self-Esteem Scale) at 12 months following enrollment using multi-level linear mixed models for each outcome. RESULTS A total of 1,260 AGYW (mean age, 15.4) were enrolled-471 assigned to YDA (37%), 381 to YDA + MFG (30%), and 408 to usual care (32%). Over the 12-month follow-up, participants assigned to the YDA + MFG group had significantly greater reductions in hopelessness and improvements in self-esteem outcomes compared to BSOC participants. Those enrolled in the YDA arm alone also had significantly greater reductions in hopelessness compared to BSOC participants. DISCUSSION Combination interventions, combining economic empowerment (represented here by YDA), and family-strengthening (represented by MFG) can improve the psychosocial well-being of AGYW. The long-term effects of these interventions should be further tested for potential scale-up in an effort to address the persistent mental health treatment gap in resource-constrained settings.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Nhial Tutlam
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - William Byansi
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | | | - Ozge Sensoy-Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Mary McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri.
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12
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Kasson E, Filiatreau LM, Kaiser N, Davet K, Taylor J, Garg S, El Sherief M, Aledavood T, De Choudhury M, Cavazos-Rehg P. Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators. Subst Use Misuse 2023; 58:920-929. [PMID: 37021375 PMCID: PMC10464934 DOI: 10.1080/10826084.2023.2196574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Lindsey M. Filiatreau
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Kevin Davet
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Jordan Taylor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Talayeh Aledavood
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
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13
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Ranjit YS, Davis WM, Fentem A, Riordan R, Roscoe R, Cavazos-Rehg P. Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study. JMIR Hum Factors 2023; 10:e37351. [PMID: 36897632 PMCID: PMC10039403 DOI: 10.2196/37351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. OBJECTIVE This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. METHODS A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled "uMAT-R," a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an "e-coach" via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants' messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. RESULTS Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). CONCLUSIONS Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD.
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Affiliation(s)
- Yerina S Ranjit
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Warren M Davis
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Andrea Fentem
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
| | - Raven Riordan
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
| | - Rikki Roscoe
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, United States
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14
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Szlyk HS, Li X, Kasson E, Peoples JE, Montayne M, Kaiser N, Cavazos-Rehg P. How do teens with a history of suicidal behavior and self-harm interact with social media? J Adolesc 2023. [PMID: 36864641 DOI: 10.1002/jad.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. METHODS Teens aged 15-17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. RESULTS Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p = .02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p = .01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p = .03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. CONCLUSIONS This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.
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Affiliation(s)
- Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - JaNiene E Peoples
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mandy Montayne
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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15
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Szlyk HS, Li X, Filiatreau LM, Bierut LJ, Banks D, Cavazos-Rehg P. Principal component regression analysis of familial psychiatric histories and suicide risk factors among adults with opioid use disorder. J Psychiatr Res 2023; 159:6-13. [PMID: 36652753 PMCID: PMC10084714 DOI: 10.1016/j.jpsychires.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
This study explores familial psychiatric risk factors that are closely linked to suicide risk among patients with opioid use disorder (OUD) as measured by the Family History Assessment Module (FHAM). Data was derived from adults diagnosed with OUD (N = 389). To analyze the covariance between the 11 items of the FHAM, principal component analysis was applied to infer principal components (PC) scores. Log-binominal regression was conducted to quantify the associations between PC scores and mental health symptoms (e.g., lifetime suicidal attempt, P30D suicidal ideation, depression, and anxiety). Analyses revealed that the first 3 three PCs could account for 56% of the total variance of the FHAM items within the data. Family history of substance misuse (PC1) was positively associated with lifetime suicide attempts and severe anxiety. Family history of serious mental illness (PC2) and of suicidal behavior (PC3) were not significantly associated with any outcomes. Our findings suggest current suicide risk is associated with an array of familial psychiatric issues among people with OUD. However, family history of suicide attempts and death by suicide has less bearing on current suicide risk in OUD patients whereas family history of substance use confers significant risk. Findings underscore suicide-related preventive interventions as necessary components of treatment plans among people with OUD, who commonly report family histories of substance misuse.
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Affiliation(s)
- Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8314, St. Louis, MO, 63130, USA.
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8314, St. Louis, MO, 63130, USA
| | - Lindsey M Filiatreau
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8314, St. Louis, MO, 63130, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8314, St. Louis, MO, 63130, USA
| | - Devin Banks
- Department of Psychological Sciences, University of Missouri - St. Louis, One University Blvd, Louis, MO, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8314, St. Louis, MO, 63130, USA
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16
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Baiden P, Cavazos-Rehg P, Szlyk HS, Onyeaka HK, Peoples JE, Kasson E, Muoghalu C. Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents: Findings from a Population-based Study. Subst Use Misuse 2023; 58:637-648. [PMID: 36803403 DOI: 10.1080/10826084.2023.2177963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents. METHODS Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization. RESULTS Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p < .001, 95% CI = 1.27-1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana. CONCLUSIONS Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Henry K Onyeaka
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, McLean Hospital, Boston, Massachusetts, USA
| | - JaNiene E Peoples
- The Brown School at Washington University in St. Louis, Missouri, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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17
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Baiden P, Szlyk HS, Peoples JE, Vázquez MM, Harrell DR, Cavazos-Rehg P. Association between sexual identity, health risk behaviors, and mental health outcomes among Black adolescents: Findings from a population-based study. Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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18
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Fentem A, Riordan R, Doroshenko C, Li X, Kasson E, Banks D, Winograd RP, Cavazos-Rehg P. Impact of the COVID-19 pandemic on burnout and perceived workplace quality among addiction treatment providers. Addict Sci Clin Pract 2023; 18:5. [PMID: 36670445 PMCID: PMC9854021 DOI: 10.1186/s13722-023-00361-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study examines the impact of the COVID-19 pandemic on work satisfaction, work-related stress, and perceived work quality among substance use treatment providers to better understand challenges faced among this group during the pandemic. METHODS Participants of this study were 91 addiction treatment providers (e.g., therapists, physicians, community support specialists, administrative staff) recruited from various treatment facilities (e.g., inpatient and outpatient settings). Mixed method analyses were conducted to assess self-reported burnout, sources of work-related stress, and perceived work quality during the pandemic. Responses from providers reporting COVID-19 related decreases in work quality were compared to responses from providers who reported their quality of work had increased or remained the same. RESULTS Results demonstrated half of providers (51%) reported their quality of work had decreased. This perceived decrease in quality of work was associated with higher levels of emotional exhaustion (M = 17.41 vs. M = 12.48, p = 0.002), workplace stress (M = 42.80 vs. M = 30.84, p = 0.001), as well as decreased enjoyment of work (83% vs. 51%, p = 0.001) and decreased personal accomplishment (M = 20.64 vs. M = 23.05 p = 0.001). Qualitative investigations further illustrated that increased hours, changes in work schedules, work-life balance challenges, difficulties with client communication, and increased client needs were contributing factors increasing stress/burnout and decreasing perceived work quality. CONCLUSIONS Addiction treatment providers experience high levels of burnout and workplace stress. Additionally, many individuals perceived a decrease in their quality of work during the COVID-19 pandemic. Addiction treatment facility administration should address these challenges to support the well-being of clinical staff and the clients they serve both during and after the COVID-19 pandemic.
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Affiliation(s)
- Andrea Fentem
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Raven Riordan
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Christine Doroshenko
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Xiao Li
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Erin Kasson
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
| | - Devin Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121 USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri St. Louis, 43 Benton Court, St. Louis, MO 63121 USA
| | - Patricia Cavazos-Rehg
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110 USA
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Hartz SM, Culverhouse RC, Mintz CM, Ellis MS, Kasper ZA, Cavazos-Rehg P, Grucza RA, Bierut LJ, Cicero TJ. Association between recent overdose and chronic pain among individuals in treatment for opioid use disorder. PLoS One 2022; 17:e0271379. [PMID: 36441691 PMCID: PMC9704550 DOI: 10.1371/journal.pone.0271379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic pain increases risk for opioid overdose among individuals with opioid use disorder. The purpose of this study is to evaluate the relationship between recent overdose and whether or not chronic pain is active. 3,577 individuals in treatment for opioid use disorder in 2017 or 2018 were surveyed regarding recent overdoses and chronic pain. Demographics from the 2017 Treatment Episode Data Set, which includes all U.S. facilities licensed or certified to provide substance use care, were used to evaluate the generalizability of the sample. χ2 tests and logistic regression models were used to compare associations between recent overdoses and chronic pain. Specifically, active chronic pain was associated with opioid overdose among people in treatment for opioid use disorder. Individuals with active chronic pain were more likely to have had a past month opioid overdose than those with no history chronic pain (adjusted OR = 1.55, 95% CI 1.16-2.08, p = 0.0003). In contrast, individuals with prior chronic pain, but no symptoms in the past 30 days, had a risk of past month opioid overdose similar to those with no history of chronic pain (adjusted OR = 0.88, 95% CI 0.66-1.17, p = 0.38). This suggests that the incorporation of treatment for chronic pain into treatment for opioid use disorder may reduce opioid overdoses.
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Affiliation(s)
- Sarah M. Hartz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Robert C. Culverhouse
- Department of Medicine and Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Matthew S. Ellis
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Zachary A. Kasper
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Richard A. Grucza
- Department of Family & Community Medicine, St. Louis University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Theodore J. Cicero
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
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Banks DE, Paschke ME, Li X, Fentem A, Rich A, Szlyk HS, Cavazos-Rehg P. Opioid Use Disorder and COVID-19: Treatment and Recovery Factors among Vulnerable Populations at the Intersection of Two U.S. Epidemics. J Psychoactive Drugs 2022; 54:300-308. [PMID: 35616267 PMCID: PMC9588537 DOI: 10.1080/02791072.2022.2079443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Social inequities made some sociodemographic groups - including those of older age, minoritized race/ethnicity, and low socioeconomic status - disproportionately vulnerable to morbidity and mortality associated with the opioid epidemic and COVID-19 pandemic. Given shared vulnerability to these public health crises, it is critical to understand how COVID-19 impacts substance use disorder (SUD) treatment and recovery among people with these characteristics. The current study examined COVID-19's perceived impact on treatment factors and psychosocial outcomes by sociodemographic vulnerability. Patients receiving SUD treatment with a history of opioid misuse were recruited. Participants completed self-report questionnaires regarding the impact of COVID-19 on treatment indicators and mood and substance use symptoms. Most participants reported that COVID-19 decreased their treatment access and quality. There were no sociodemographic differences in treatment factors. Those with high sociodemographic vulnerability reported greater pandemic-related increases in depression and demonstrated greater mood symptoms. Post-hoc analyses demonstrated that unmet basic needs were significantly associated with lower treatment access and quality, greater mood symptoms, and higher substance use. Findings suggest pandemic-related stressors and barriers affected those across the sociodemographic spectrum. Treatment systems must address socioeconomic barriers to care exacerbated by the pandemic and bolster integrated treatment options for opioid use and mood disorders.
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Affiliation(s)
- Devin E. Banks
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Maria E. Paschke
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Andrea Fentem
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Amanda Rich
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Hannah S. Szlyk
- School of Social Work, Rutgers, The State University of New Jersey, 120 Albany St, New Brunswick, NJ 08901
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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21
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Ziminski D, Szlyk HS, Baiden P, Okine L, Onyeaka HK, Muoghalu C, Cavazos-Rehg P. Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey. Psychiatry Res 2022; 312:114542. [PMID: 35461119 PMCID: PMC9531575 DOI: 10.1016/j.psychres.2022.114542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022]
Abstract
This study examined the association between self-reported sports- or physical activity-related concussion and symptoms of depression and suicidal behaviors (suicidal ideation, having a suicide plan, and suicide attempts). This study used data from the 2017 and 2019 Youth Risk Behavior Survey (YRBS), a biennial, school-based, nationally representative survey of U.S. students in grade levels 9 to 12 (N = 14,496). Multivariate logistical regression models assessed the association between self-reported sports-or physical activity-related concussions and suicidal behaviors among students, controlling for a range of demographic and psychosocial variables. Altogether, 13.6% of students reported a sports-or physical activity related concussion in the past 12 months. Among youth, sports-or physical activity related concussions were significantly associated with greater odds of symptoms of depression, suicidal ideation, making a suicide plan, and suicide attempts compared to other youth who did not experience sports- or physical activity-related concussion. Findings highlight increased risk for adverse mental health outcomes among students with sports-or physical activity related concussions. Providing resources for students to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to provide support for student emotional well-being.
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Affiliation(s)
- Devon Ziminski
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901
| | - Hannah S. Szlyk
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901,Corresponding author: Dr. Hannah S. Szlyk, PhD, LCSW Social Work, Rutgers University: Rutgers The State University of New Jersey, 390 George Street, Rm. 807, New Brunswick, NJ 08901, United States, (H.S. Szlyk)
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019
| | - Lucinda Okine
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St. Los Angeles, CA 90089
| | - Henry K. Onyeaka
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA, USA, 02115
| | - Chioma Muoghalu
- Plains Regional Medical Center, Clovis, New Mexico, NM 88101,Duke University School of Medicine, Master of Management in Clinical Informatics, NC 27710
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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22
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Baiden P, Szlyk HS, Cavazos-Rehg P, Onyeaka HK, Peoples J, Kasson E. Use of electronic vaping products and mental health among adolescent high school students in the United States: The moderating effect of sex. J Psychiatr Res 2022; 147:24-33. [PMID: 35007808 PMCID: PMC8905685 DOI: 10.1016/j.jpsychires.2021.12.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022]
Abstract
Although studies have investigated the association between conventional tobacco smoking and mental health outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) and mental health among adolescents. This study aimed to investigate the cross-sectional association between EVPs use, symptoms of depression, and suicidal behaviors among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 14,285 adolescents (50.3% female) was analyzed using binary logistic regression. The outcome variables investigated were symptoms of depression, suicidal ideation, suicide plan, and suicide attempts, and the main explanatory variable was EVPs use. Of the 14,285 adolescents, 22.2%, 19.2%, and 58.8% were current, former and never users of EVPs, respectively. Controlling for other factors, current users of EVPs were significantly more likely to report having symptoms of depression (AOR = 1.82, 95% CI = 1.58-2.09), having suicidal ideation (AOR = 1.55, 95% CI = 1.30-1.86), making a suicide plan (AOR = 1.62, 95% CI = 1.34-1.97), or attempting suicide (AOR = 1.75, 95% CI = 1.41-2.18) when compared to never users of EVPs. Gender moderated the association between EVPs use, symptoms of depression, suicidal ideation, and suicide plan. Racial minority identity, sexual minority identity, sexual violence victimization, victim of school and cyberbullying, alcohol use, and cigarette smoking were all significantly associated with depression and suicidal behaviors. Study findings support the association between EVPs use and adolescent mental health. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying this association.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA.
| | - Hannah S. Szlyk
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Henry K. Onyeaka
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA, USA, 02115
| | - JaNiene Peoples
- The Brown School at Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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23
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Ren Y, Wu D, Singh A, Kasson E, Huang M, Cavazos-Rehg P. Automated Detection of Vaping-Related Tweets on Twitter During the 2019 EVALI Outbreak Using Machine Learning Classification. Front Big Data 2022; 5:770585. [PMID: 35224484 PMCID: PMC8866955 DOI: 10.3389/fdata.2022.770585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
There are increasingly strict regulations surrounding the purchase and use of combustible tobacco products (i.e., cigarettes); simultaneously, the use of other tobacco products, including e-cigarettes (i.e., vaping products), has dramatically increased. However, public attitudes toward vaping vary widely, and the health effects of vaping are still largely unknown. As a popular social media, Twitter contains rich information shared by users about their behaviors and experiences, including opinions on vaping. It is very challenging to identify vaping-related tweets to source useful information manually. In the current study, we proposed to develop a detection model to accurately identify vaping-related tweets using machine learning and deep learning methods. Specifically, we applied seven popular machine learning and deep learning algorithms, including Naïve Bayes, Support Vector Machine, Random Forest, XGBoost, Multilayer Perception, Transformer Neural Network, and stacking and voting ensemble models to build our customized classification model. We extracted a set of sample tweets during an outbreak of e-cigarette or vaping-related lung injury (EVALI) in 2019 and created an annotated corpus to train and evaluate these models. After comparing the performance of each model, we found that the stacking ensemble learning achieved the highest performance with an F1-score of 0.97. All models could achieve 0.90 or higher after tuning hyperparameters. The ensemble learning model has the best average performance. Our study findings provide informative guidelines and practical implications for the automated detection of themed social media data for public opinions and health surveillance purposes.
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Affiliation(s)
- Yang Ren
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, United States
| | - Dezhi Wu
- Department of Integrated Information Technology, University of South Carolina, Columbia, SC, United States
| | - Avineet Singh
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, United States
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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Berg CJ, Windle M, Dodge T, Cavazos-Rehg P, Yang YT, Ma Y, Haardörfer R. Marijuana Use and Increases in Use over Time among Young Adult College Students in the State of Georgia: Analyses of Sociocontexual Predictors. Subst Use Misuse 2022; 57:350-359. [PMID: 34913832 DOI: 10.1080/10826084.2021.2012691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While research has assessed correlates of marijuana use, there has been less focus on predictors of differing levels of changes in use during young adulthood, a critical period for use/escalation. OBJECTIVES We examined changes in marijuana use and related sociocontextual predictors (e.g., earlier-onset substance use, parental use, college type). METHODS Using data from Georgia college students (ages 18-25 years) in a 2-year, 6-wave longitudinal study (64.6% female, 63.4% White), 2-part random-effects modeling examined use at any assessment and number of days used. RESULTS Predictors of use status at any assessment included being male (OR = 1.87, 95%CI = [1.28-2.73]), Black (OR = 1.91, 95%CI = [1.15-3.19]), earlier-onset marijuana (OR = 2.63, 95%CI = [1.70-4.06]), cigarette (OR = 2.04, 95%CI = [1.19-3.48]), and alcohol users (OR = 1.49, 95%CI = 1.00-2.22]), parental tobacco (OR = 2.14, 95%CI = [1.18-3.86]) and/or alcohol use (OR = 1.55, 95%CI = [1.09-2.20]), and attending private (vs. public) institutions (OR = 1.68, 95%CI = [1.10-2.59]). Predictors of lower likelihood of use over time included being male (OR = 0.87, 95%CI = [0.77-0.98]), earlier-onset cigarette use (OR = 0.82, 95%CI = [0.68-0.98]), parental alcohol use (OR = 0.86, 95%CI = [0.77-0.97]), and private institution students (OR = 1.17, 95%CI = [1.02-1.34]). Predictors of more days used at baseline included being male (OR = 1.77, 95%CI = [1.40-2.23]), Black (OR = 1.42, 95%CI = [1.04-1.93]), earlier-onset marijuana (OR = 2.32, 95%CI = [1.78-3.01]) and alcohol users (OR = 1.29, 95%CI = [1.01-1.66]), and parental tobacco use (OR = 1.90, 95%CI = [1.32-2.73]). Predictors of fewer days used over time included being older (OR = 0.98, 95%CI = [0.97-1.00]), parental tobacco use (OR = 0.86, 95%CI = [0.78-0.95]), and attending private institutions (OR = 0.89, 95%CI = [0.83-0.93]). CONCLUSIONS Intervention efforts can be informed by current findings that correlates of baseline use (e.g., being male, attending private institutions) also predicted less use over time, and one's earlier use and parents' use of various substances impacted young adult use.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Michael Windle
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, School of Nursing, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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25
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Garg S, Taylor J, El Sherief M, Kasson E, Aledavood T, Riordan R, Kaiser N, Cavazos-Rehg P, De Choudhury M. Detecting risk level in individuals misusing fentanyl utilizing posts from an online community on Reddit. Internet Interv 2021; 26:100467. [PMID: 34804810 PMCID: PMC8581502 DOI: 10.1016/j.invent.2021.100467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Opioid misuse is a public health crisis in the US, and misuse of synthetic opioids such as fentanyl have driven the most recent waves of opioid-related deaths. Because those who misuse fentanyl are often a hidden and high-risk group, innovative methods for identifying individuals at risk for fentanyl misuse are needed. Machine learning has been used in the past to investigate discussions surrounding substance use on Reddit, and this study leverages similar techniques to identify risky content from discussions of fentanyl on this platform. METHODS A codebook was developed by clinical domain experts with 12 categories indicative of fentanyl misuse risk, and this was used to manually label 391 Reddit posts and comments. Using this data, we built machine learning classification models to identify fentanyl risk. RESULTS Our machine learning risk model was able to detect posts or comments labeled as risky by our clinical experts with 76% accuracy and 76% sensitivity. Furthermore, we provide a vocabulary of community-specific, colloquial words for fentanyl and its analogues. DISCUSSION This study uses an interdisciplinary approach leveraging machine learning techniques and clinical domain expertise to automatically detect risky discourse, which may elicit and benefit from timely intervention. Moreover, our vocabulary of online terms for fentanyl and its analogues expands our understanding of online "street" nomenclature for opiates. Through an improved understanding of substance misuse risk factors, these findings allow for identification of risk concepts among those misusing fentanyl to inform outreach and intervention strategies tailored to this at-risk group.
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Affiliation(s)
- Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Jordan Taylor
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | | | - Raven Riordan
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, United States of America
| | - Munmun De Choudhury
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
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26
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Sensoy Bahar O, Cavazos-Rehg P, Ssewamala FM, Abente B, Peer L, Nabunya P, Soto de Laurido LE, Betancourt TS, Bhana A, Edmond T. Training LEADers to Accelerate Global Mental Health Disparities Research (LEAD) Program: A Research Training Program Protocol. Front Public Health 2021; 9:749627. [PMID: 34858929 PMCID: PMC8631301 DOI: 10.3389/fpubh.2021.749627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: There is a critical need to address mental health needs across the globe, especially in low and middle-income countries where mental health disparities are pervasive, including among children. The global mental health disparities suggest an imperative for culturally and contextually-congruent mental health services models that expand upon the existing services and interventions for these groups. Rigorous research is a key tool in providing the scientific evidence to inform public policy and practice efforts to effectively address these needs. Yet, there is a limited number of researchers, especially those from diverse backgrounds, who study these issues. In this paper, we describe the "TrainingLEADers to Accelerate Global Mental Health Disparities Research" (LEAD) program, a research training program funded by the National Institute on Minority Health and Health Disparities and focused on global mental health disparities research for early career researchers from under-represented minority groups. Methods: The LEAD program is designed as a two-phase training program for advanced pre-doctoral students, postdoctoral fellows, and junior faculty from diverse backgrounds in the U.S., including groups underrepresented in biomedical, behavioral, clinical and social sciences research, interested in global mental health disparities research. Trainees are matched with mentors and participate in an intensive 12-week program. Discussion: The LEAD program seeks to provide a robust platform for the development, implementation and expansion of evidence-based culturally and contextually-congruent interventions and services models addressing global mental health disparities across the life cycle, especially in low-resource communities in the global context. By producing a sustainable network of well-trained investigators from underrepresented backgrounds, LEAD will potentially contribute to the shared lessons and efforts relevant to addressing global mental health disparities and improving care for vulnerable populations in low-resource settings.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Betsy Abente
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Laura Peer
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
- Centre for Rural Health-School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tonya Edmond
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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27
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Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Marsch LA. Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids. Prev Med 2021; 152:106783. [PMID: 34499972 PMCID: PMC8545866 DOI: 10.1016/j.ypmed.2021.106783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ23 = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ21 = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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Kasson E, Singh AK, Huang M, Wu D, Cavazos-Rehg P. Using a mixed methods approach to identify public perception of vaping risks and overall health outcomes on Twitter during the 2019 EVALI outbreak. Int J Med Inform 2021; 155:104574. [PMID: 34592539 DOI: 10.1016/j.ijmedinf.2021.104574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vaping product use (i.e., e-cigarettes) has been rising since 2000 in the United States. Negative health outcomes associated with vaping products have created public uncertainty and debates on social media platforms. This study explores the feasibility of using social media as a surveillance tool to identify relevant posts and at-risk vaping users. METHODS Using an interdisciplinary method that leverages natural language processing and manual content analysis, we extracted and analyzed 794,620 vaping-related tweets on Twitter. After observing significant increases in vaping-related tweets in July, August, and September 2019, additional human coding was completed on a subset of these tweets to better understand primary themes of vaping-related discussions on Twitter during this time frame. RESULTS We found significant increases in tweets related to negative health outcomes such as acute lung injury and respiratory issues during the outbreak of e-cigarette/vaping associated lung injury (EVALI) in the fall of 2019. Positive sentiment toward vaping remained high, even across the peak of this outbreak in July, August, and September. Tweets mentioning the public perceptions of youth risk were concerning, as were increases in marketing and marijuana-related tweets during this time. DISCUSSION The preliminary results of this study suggest the feasibility of using Twitter as a means of surveillance for public health crises, and themes found in this research could aid in specifying those groups or populations at risk on Twitter. As such, we plan to build automatic detection algorithms to identify these unique vaping users to connect them with a digital intervention in the future.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, USA
| | - Avineet Kumar Singh
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, USA
| | - Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dezhi Wu
- Department of Integrated Information Technology, University of South Carolina, Columbia, SC, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, USA
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Cavazos-Rehg P, Byansi W, Doroshenko C, Neilands TB, Anako N, Sensoy Bahar O, Kasson E, Nabunya P, Mellins CA, Ssewamala FM. Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda. Soc Sci Med 2021; 280:113946. [PMID: 34020312 DOI: 10.1016/j.socscimed.2021.113946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi + Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda. METHOD We utilized data from Suubi + Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N = 702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi + Adherence intervention on adolescents' mental health. RESULTS Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%. CONCLUSIONS Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
| | - William Byansi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Torsten B Neilands
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nnenna Anako
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA; Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Claude A Mellins
- Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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Cavazos-Rehg P, Byansi W, Xu C, Nabunya P, Bahar OS, Borodovsky J, Kasson E, Anako N, Mellins C, Damulira C, Neilands T, Ssewamala FM. The Impact of a Family-Based Economic Intervention on the Mental Health of HIV-Infected Adolescents in Uganda: Results From Suubi + Adherence. J Adolesc Health 2021; 68:742-749. [PMID: 32980245 PMCID: PMC7987910 DOI: 10.1016/j.jadohealth.2020.07.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE This study examines the extent to which three mental health measures (hopelessness, depression, and poor self-concept) are improved through a family-based economic intervention implemented among adolescents living with HIV in Uganda. METHODS We used repeated measures from Suubi + Adherence, a large-scale 6-year (2012-2018) longitudinal randomized controlled trial. Bivariate analyses were conducted to test for observable group differences between the intervention and control conditions. Multilevel piecewise repeated measure mixed models were then conducted to assess hypothesized time × intervention interaction in changes in hopelessness, depression, and self-concept using participant-specific follow-up intervals. RESULTS At 24-month postintervention initiation, adolescents in the intervention condition reported a statistically significant lower hopelessness score than adolescents in the control condition (4.79 vs. 5.56; p = .018; N = 358). At 36-month follow-up, the intervention condition reported a statistically significant lower score on depression in the depression subgroup (N = 344) than the control condition (4.94 vs. 5.81; p = .029). CONCLUSIONS The results indicate that family-based economic interventions such as Suubi + Adherence can effectively improve the mental health of adolescents living with HIV who evidenced mental health challenges at baseline. Given the promising positive effects of these interventions, at least in the short term, future studies should investigate strategies to promote the sustainability of these mental health benefits.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri,Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Jacob Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Nnenna Anako
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri,Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Claude Mellins
- Departments of Psychiatry and Sociomedical Sciences, Columbia University, New York, New York
| | - Christopher Damulira
- International Center for Child Health and Development, Masaka Field Office, Masaka, Uganda
| | - Torsten Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Cavazos-Rehg P, Xu C, Krauss MJ, Min C, Winograd R, Grucza R, Bierut LJ. Understanding barriers to treatment among individuals not engaged in treatment who misuse opioids: A structural equation modeling approach. Subst Abus 2021; 42:842-850. [PMID: 33617738 DOI: 10.1080/08897077.2021.1876199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Many individuals misusing opioids do not enter into treatment. The question of who enters into treatment for their opioid abuse and under what circumstances is complex and shaped by multiple factors. The objective of the current study is to explore the risk factors for wide-ranging and numerous barriers to treatment among social media users. Method: Opioid-related forums within a popular social media platform were used to recruit non-treatment engaged individuals (≥15 years) who had misused opioids in the past month (n = 144; 66% male; median age 28). Four treatment barrier factors were identified utilizing principle component analysis: (1) stigma, (2) awareness, (3) attitudinal, and (4) denial. A structural equation model (SEM) was then created to explore the risk factors for different types of barriers to OUD treatment. Results: The most common barriers among participants not engaged in treatment for their opioid misuse were the belief that one should be able to help themselves with their condition (66%), treatment was too expensive (63%), and worries about being labeled or judged (57%). Additionally, SEM results demonstrate stigma barriers, awareness, and attitudinal barriers were associated with mental health comorbidities, opioid abuse and dependence severity, and treatment history. Denial barriers, however, were only associated with treatment history, and structural/financial barriers were only associated with opioid abuse and dependence severity. Conclusions: Our research findings are relevant for underscoring the wide-ranging and numerous barriers to treatment faced by individuals misusing opioids that are especially concentrated among those who also struggle with comorbid mental illness.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caroline Min
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, St. Louis, MO, USA
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Cavazos-Rehg P, Li X, Kasson E, Kaiser N, Borodovsky JT, Grucza R, Chen LS, Bierut LJ. Exploring How Social Media Exposure and Interactions Are Associated With ENDS and Tobacco Use in Adolescents From the PATH Study. Nicotine Tob Res 2021; 23:487-494. [PMID: 32598479 PMCID: PMC7885778 DOI: 10.1093/ntr/ntaa113] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/23/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Tobacco use is a current public health epidemic that puts individuals at risk for many health conditions and diseases, and adolescents are at high risk for the initiation and persistence of tobacco use behaviors partly due to engagement with social media content. The objective of this study is to examine the association between engaging in social media behaviors and patterns of electronic nicotine delivery systems (ENDS) and tobacco use at a 1-year follow-up among 11 279 adolescents from the PATH study. METHODS Five social media variables were questioned at Wave 2 and then compared to ENDS and tobacco status transitions (i.e., initiation, persistence, and escalation) at a 1-year follow-up, respectively. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios and 95% confidence interval. RESULTS Passive behaviors on social media were related to higher likelihoods of starting to use ENDS and other tobacco products. Additionally, active behaviors on social media were related to higher likelihoods for the initiation and persistence of tobacco use. In particular, sending tobacco content to other users was further associated with a higher likelihood of escalation of tobacco product use. DISCUSSION Both exposure to and interactions with social media tobacco content had a significant impact on the patterns of ENDS and tobacco use in adolescents. Due to the amount of time adolescents spend engaging with online content, social media may be a critical place in which to intervene, possibly with the use of antitobacco or tobacco prevention messages. IMPLICATIONS The results of this study have implications for public health and the policies surrounding adolescents and their exposure to social media. Reducing the ENDS and tobacco content to which adolescents are exposed has the potential to decrease the instances of initiation and persistence of ENDS and tobacco use. Intervening on social media may prevent or slow the progression of ENDS and tobacco use, and increase motivation and actions toward the cessation of tobacco use in adolescents.
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Affiliation(s)
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Saunders EC, Moore SK, Walsh O, Metcalf SA, Budney AJ, Cavazos-Rehg P, Scherer E, Marsch LA. "It's way more than just writing a prescription": A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder. Addict Sci Clin Pract 2021; 16:8. [PMID: 33499938 PMCID: PMC7839299 DOI: 10.1186/s13722-021-00213-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA.
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine At Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, USA
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Monterubio GE, Fitzsimmons-Craft EE, Balantekin KN, Sadeh-Sharvit S, Goel NJ, Laing O, Firebaugh ML, Flatt RE, Cavazos-Rehg P, Taylor CB, Wilfley DE. Eating disorder symptomatology, clinical impairment, and comorbid psychopathology in racially and ethnically diverse college women with eating disorders. Int J Eat Disord 2020; 53:1868-1874. [PMID: 32918315 PMCID: PMC7669650 DOI: 10.1002/eat.23380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine eating disorder (ED) symptomatology, related clinical impairment, and comorbid psychopathology in college women with EDs across five racial and two ethnic groups. METHOD Participants were 690 women from 28 US universities who screened positive for an ED. Thirteen variables assessing ED symptoms, related clinical impairment, and comorbid psychopathology were compared across racial and ethnic groups using analyses of variance (ANOVAs) and independent samples t-tests. RESULTS Across racial groups, significant differences emerged in binge eating and laxative use. Asian women reported significantly more binge eating than White women (p < .01). Individuals self-identified as the "Other" racial group reported greater laxative use than Asian and White women (ps ≤ .01). No other significant differences emerged across all other variables (ps ≥ .13). Across ethnic groups, Hispanic women reported significantly more laxative use (p < .01), and more comorbid insomnia symptoms (p = .03) than non-Hispanic women. No other significant differences were observed (ps ≥ .24). DISCUSSION Findings suggest that binge eating, laxative use, and insomnia symptoms differ across racial and ethnic groups in US college women who screened positive for EDs. Findings can inform tailoring of ED screening to reduce current disparities in these underrepresented populations.
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Affiliation(s)
- Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine N Balantekin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- University of New York at Buffalo, Buffalo, New York, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Neha J Goel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Institue for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachael E Flatt
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Cavazos-Rehg P, Min C, Fitzsimmons-Craft EE, Savoy B, Kaiser N, Riordan R, Krauss M, Costello S, Wilfley D. Parental consent: A potential barrier for underage teens' participation in an mHealth mental health intervention. Internet Interv 2020; 21:100328. [PMID: 32528858 PMCID: PMC7276447 DOI: 10.1016/j.invent.2020.100328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We sought to examine whether underage adolescents displaying symptoms for a mental illness (i.e., an eating disorder) would be willing to obtain parental consent to participate in a study to test the efficacy of an evidence-based mobile mental health intervention targeting teens with eating disorders. METHODS The participants (n = 366) were 15 to 17 year-old English-speakers who post or follow social media accounts on Instagram that emphasize being thin as important or attractive. The participants were administered a survey through Qualtrics to assess eating disorder pathology, interest in trying an evidence-based mobile mental-health intervention, and comfort level with obtaining parental consent to partake in a research study about such an intervention. RESULTS About 85% of participants met clinical or subclinical criteria for an eating disorder; however, only 12% had received a treatment within the past six months. While 83% of participants were interested in trying a mobile health interventions app, only 35% indicated willingness to obtain parental consent to participate in a research study. The primary reasons presented for unwillingness to obtain consent included importance of retaining privacy and feeling that parents lack awareness or understanding about mental health issues. CONCLUSIONS While barriers exist to obtaining treatment for eating disorders, a mobile intervention app may close some of these gaps. Many underage participants indicated interest in obtaining such treatment, yet only a third were willing to obtain parental consent. Future studies should investigate how to reduce these barriers to obtaining parental consent to facilitate teen access to research and mobile mental health treatment.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caroline Min
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Bria Savoy
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Raven Riordan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shaina Costello
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Cavazos-Rehg P, Xu C, Kasson E, Byansi W, Bahar OS, Ssewamala FM. Social and Economic Equity and Family Cohesion as Potential Protective Factors from Depression Among Adolescents Living with HIV in Uganda. AIDS Behav 2020; 24:2546-2554. [PMID: 32095914 DOI: 10.1007/s10461-020-02812-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Adolescents living with HIV in Uganda are impacted by poverty and face a number of health and social challenges including access to medication, health complications, and social stigma. These stressors have been linked to depression, which can lead to lower HIV treatment adherence. This study seeks to determine how social and economic equity, family cohesion, and social supports may be related to depression among adolescents living with HIV. We used baseline data from the Suubi + Adherence study, a 5-year longitudinal randomized controlled trial among adolescents living with HIV in southwestern Uganda (n = 675; ages 10-16 years). Hierarchical logistic regression models were conducted separately among in-school adolescents and out-of-school adolescents to assess the hypothesized associations between economic and social equity, social support, and depression. About half of the participants meet the criteria for depression. Adolescents with depression were found to have fewer economic and social supports. Our findings indicate that social and economic equity [odds ratio (OR) = 0.85, 95% confidence interval (CI) 0.74, 0.99], family cohesion (OR = 0.94, 95% CI 0.91-0.96), and social support from friends (OR = 0.95, 95% CI 0.91-0.998) are associated with depression for in-school HIV infected adolescents and could be protective factors. The results of this study suggest that social and economic equity may play a protective role against depression and other poor mental health outcomes. Potential interventions for adolescents living with HIV should consider these social and familial factors as they may be protective of depression in this population.
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Cavazos-Rehg P, Xu C, Borodovsky J, Kasson E, Byansi W, Nabunya P, Bahar OS, Ssewamala FM. The impact of discomfort with HIV status and hopelessness on depressive symptoms among adolescents living with HIV in Uganda. AIDS Care 2020; 33:867-872. [PMID: 32551822 DOI: 10.1080/09540121.2020.1778625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Discomfort with and reluctance to disclose HIV status can lead to depression, social isolation, and poor medication adherence; we examined relationships among these variables within a sample of adolescents living with HIV in Uganda. Methods: We used baseline data from the Suubi + Adherence study, which recruited a total of 702 adolescents (ages 10-16 years) living with HIV in southwestern Uganda. Structural equation models were conducted separately among in-school adolescents and out-of-school adolescents to assess associations between discomfort level with HIV status and depressive symptoms and if this association was mediated by hopelessness. Results: Out-of-school adolescents had significantly higher depression scores compared with those in-school youth (M = 6.24 vs. M = 5.03, p < 0.001). Although high discomfort level with HIV status was significantly associated with higher depression scores among both in-school adolescents and out-of-school adolescents, this association among out-of-school adolescents (B = 0.49, 95%CI: 0.19, 0.79), was more substantial than for in-school adolescents (B = 0.10, 95%CI: 0.03, 0.17). Discussion: One's discomfort with their HIV status and the extent to which they are hopeful about the future can contribute to the development of depressive symptoms and these factors need to be considered in the development of assessments and interventions for the treatment of depression among adolescents living with HIV.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacob Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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Szlyk H, Deng J, Xu C, Krauss MJ, Cavazos-Rehg P. Leveraging social media to explore the barriers to treatment among individuals with depressive symptoms. Depress Anxiety 2020; 37:458-465. [PMID: 31943530 PMCID: PMC7239721 DOI: 10.1002/da.22990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/06/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Individuals with depression may not seek treatment for their symptoms due to several types of barriers to treatment. In support of the growing research on mental health care access and the role of social media, this study aimed to increase knowledge of these barriers among social media users. METHODS Participants were recruited from several social media platforms, including Instagram, Facebook, Twitter, Reddit, Tumblr, and online depression forums. Eligible participants had endorsed having posted about feeling sad or depressed on social media, or followed social media groups that post about depression-related topics. Participants completed an online survey about their depression symptoms, interest in treatment, and potential barriers to accessing treatment. RESULTS Of the participants reaching criteria for depression, those with major depression were more likely to seek out treatment, to report an unmet need for treatment, and have a higher risk of suicide. For participants with major depression, barriers to treatment were more likely to be attitudinal, while participants with mild depression experienced more structural barriers. CONCLUSIONS This study demonstrates several barriers to treatment that occur for individuals struggling with depression, and that online platforms are effective mediums to recruit individuals with depression symptoms who seek mental health support.
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Affiliation(s)
- Hannah Szlyk
- George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - John Deng
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110,George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Christine Xu
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110,George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Melissa J. Krauss
- George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Cavazos-Rehg P, Grucza R, Krauss MJ, Smarsh A, Anako N, Kasson E, Kaiser N, Sansone S, Winograd R, Bierut LJ. Utilizing social media to explore overdose and HIV/HCV risk behaviors among current opioid misusers. Drug Alcohol Depend 2019; 205:107690. [PMID: 31778902 PMCID: PMC6894427 DOI: 10.1016/j.drugalcdep.2019.107690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Opioid misuse has evolved into an American health crisis over the past decade, becoming a public health epidemic. Measures need to be taken to prevent overdoses by opioid misuse as well as prevent the transition into injection drug use, a high risk factor for contracting HIV/HCV. This study utilized social media to survey individuals currently misusing opioids to identify groups of individuals with different risk and use patterns. METHODS We recruited participants for our online survey from Reddit. Five risk behaviors were used to characterize overdose and HIV/HCV risk groups. Gender, age, and socioeconomic status were also included in the analyses, as well as items outlining social media use surrounding opioids. RESULTS Two groups of participants were characterized by high likelihoods of different combinations of risky behaviors: (1) Overdose Risk Group and (2) Sexual Risk Group. Those in the Overdose Risk Group were more likely to be younger in age and female, and this group was more likely to desire or be ready for treatment relative to the lowest risk group. Those in the Sexual Risk Group were more likely to be of a minority race/ethnicity, to desire or be ready for treatment, and to post more often on Reddit about opioid use. DISCUSSION The results of this study illustrate patterns of opioid use and risk behaviors to inform tailored outreach and treatment efforts for groups of opioid misusers and suggests the potential for utilizing social media as a tool to engage these individuals into treatment and recovery activities.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States.
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States.
| | - Melissa J. Krauss
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Austin Smarsh
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Nnenna Anako
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States; George Warren Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States.
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States.
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States.
| | - Samantha Sansone
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States.
| | - Rachel Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134, United States.
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Yan H, Fitzsimmons-Craft EE, Goodman M, Krauss M, Das S, Cavazos-Rehg P. Automatic detection of eating disorder-related social media posts that could benefit from a mental health intervention. Int J Eat Disord 2019; 52:1150-1156. [PMID: 31381168 PMCID: PMC6790146 DOI: 10.1002/eat.23148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Online forums allow people to semi-anonymously discuss their struggles, often leading to greater honesty. This characteristic makes forums valuable for identifying users in need of immediate help from mental health professionals. Because it would be impractical to manually review every post on a forum to identify users in need of urgent help, there may be value to developing algorithms for automatically detecting posts reflecting a heightened risk of imminent plans to engage in disordered behaviors. METHOD Five natural language processing techniques (tools to perform computational text analysis) were used on a data set of 4,812 posts obtained from six eating disorder-related subreddits. Two licensed clinical psychologists labeled 53 of these posts, deciding whether or not the content of the post indicated that its author needed immediate professional help. The remaining 4,759 posts were unlabeled. RESULTS Each of the five techniques ranked the 50 posts most likely to be intervention-worthy (the "top-50"). The two most accurate detection techniques had an error rate of 4% for their respective top-50. DISCUSSION This article demonstrates the feasibility of automatically detecting-with only a few dozen labeled examples-the posts of individuals in need of immediate mental health support for an eating disorder.
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Affiliation(s)
- Hao Yan
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
| | | | - Micah Goodman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Melissa Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Sanmay Das
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Berg CJ, Henriksen L, Cavazos-Rehg P, Schauer GL, Freisthler B. Point-of-sale marketing and context of marijuana retailers: Assessing reliability and generalizability of the marijuana retail surveillance tool. Prev Med Rep 2018; 11:37-41. [PMID: 29984136 PMCID: PMC6030680 DOI: 10.1016/j.pmedr.2018.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/06/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
As recreational marijuana expands, standardized surveillance measures examining the retail environment are critical for informing policy and enforcement. We conducted a reliability and generalizability study using a previously developed tool involving assessment of a sample of 25 randomly selected Seattle recreational marijuana retailers (20 recreational; 5 recreational/medical) in 2017. The tool assessed: 1) contextual/neighborhood features (i.e., facilities nearby); 2) compliance/security (e.g., age-of-sale signage, age verification); and 3) marketing (i.e., promotions, product availability, price). We found that retailers were commonly within two blocks of restaurants (n = 23), grocery stores (n = 17), liquor stores (n = 13), and bars/clubs (n = 11). Additionally, two were within two blocks of schools, and four were within two blocks of parks. Almost all (n = 23) had exterior signage indicating the minimum age requirement, and 23 verified age. Two retailers had exterior ads for marijuana, and 24 had interior ads. Overall, there were 76 interior ads (M = 3.04; SD = 1.84), most commonly for edibles (n = 28). At least one price promotion/discount was recorded in 17 retailers, most commonly in the form of loyalty membership programs (n = 10) or daily/weekly deals (n = 10). One retailer displayed potential health harms/warnings, while three posted some health claim. Products available across product categories were similar; we also noted instances of selling retailer-branded apparel/ paraphernalia (which is prohibited). Lowest price/unit across product categories demonstrated low variability across retailers. This study documented high inter-rater reliability of the surveillance tool (Kappas = 0.73 to 1.00). In conclusion, this tool can be used in future research and practice aimed at examining retailers marketing practices and regulatory compliance.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3300 Hillview Ave, suite 120, Palo Alto, CA 94304, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, United States
| | - Gillian L Schauer
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States
| | - Bridget Freisthler
- College of Social Work, Ohio State University, 1947 College Road, Columbus, OH 43210, United States
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Berg CJ, Payne J, Henriksen L, Cavazos-Rehg P, Getachew B, Schauer GL, Haardörfer R. Reasons for Marijuana and Tobacco Co-use Among Young Adults: A Mixed Methods Scale Development Study. Subst Use Misuse 2018; 53:357-369. [PMID: 28792283 PMCID: PMC5890801 DOI: 10.1080/10826084.2017.1327978] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Marijuana-tobacco co-use has increased recently, particularly in young adults. OBJECTIVES We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities. METHODS Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section. RESULTS Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other's use, using one to reduce the other's use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% smokeless, 23.7% e-cigarettes, and 30.4% hookah. Four subscale factors emerged: (1) Instrumentality, indicating synergistic effects; (2) Displacement, indicating using one product to reduce/quit the other; (3) Social context, indicating use in different settings/social situations; and (4) Experimentation, indicating experimentation with both but no specific reasons for co-use. These subscales demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives, respectively; perceptions of tobacco and marijuana; and parental and friend use. Including these subscales in regressions predicting nicotine dependence and days of marijuana use significantly contributed to each model. CONCLUSIONS These findings might inform theoretical frameworks upon which marijuana-tobacco co-use occurs and direct future intervention studies.
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Affiliation(s)
- Carla J Berg
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Jackelyn Payne
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Lisa Henriksen
- b Stanford Prevention Research Center, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Patricia Cavazos-Rehg
- c Department of Psychiatry , Washington University School of Medicine in St. Louis , St. Louis , Missouri , USA
| | - Betelihem Getachew
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Gillian L Schauer
- d Department of Health Services, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Regine Haardörfer
- a Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
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Krauss MJ, Rajbhandari B, Sowles SJ, Spitznagel EL, Cavazos-Rehg P. A latent class analysis of poly-marijuana use among young adults. Addict Behav 2017; 75:159-165. [PMID: 28756354 DOI: 10.1016/j.addbeh.2017.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/27/2017] [Accepted: 07/13/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With more states legalizing marijuana use, the marijuana industry has grown, introducing a variety of marijuana products. Our study explores the use of multiple marijuana products (poly-marijuana use) and the characteristics associated with this behavior. METHODS Past-month marijuana users aged 18-34years were surveyed online via an existing online panel (n=2444). Participants answered questions about past-month use of three types of marijuana (plant-based, concentrates, edibles), marijuana use patterns, and driving after use. Latent class analysis was used to identify subgroups of marijuana users. RESULTS Four classes of marijuana users were identified: Light plant users, who used only plant-based products infrequently and were unlikely to drive after use (32%); Heavy plant users, who used mainly plant-based products frequently, multiple times per day, and were likely to drive after use (37%); Plant and concentrates users, who used plant-based products heavily and concentrates at least infrequently, used multiple times per day, and were likely to drive after use (20%); Light plant and edibles users, who used both products infrequently and were unlikely to drive after use (10%). Those in legal marijuana states were more likely to belong to the poly-marijuana groups. DISCUSSION Our findings reflect the increase in popularity of new marijuana products in legal states and suggest that heavy user groups, including concentrates users, are associated with driving after use. As various forms of marijuana use increases, monitoring and surveillance of the use of multiple types of marijuana will be important for determining potential varying impacts on physiological and social consequences.
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Affiliation(s)
- Melissa J Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
| | - Biva Rajbhandari
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Shaina J Sowles
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Edward L Spitznagel
- Department of Mathematics, Washington University School of Medicine, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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Berg CJ, Henriksen L, Cavazos-Rehg P, Schauer GL, Freisthler B. The development and pilot testing of the marijuana retail surveillance tool (MRST): assessing marketing and point-of-sale practices among recreational marijuana retailers. Health Educ Res 2017; 32:465-472. [PMID: 29237032 PMCID: PMC5914449 DOI: 10.1093/her/cyx071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
As recreational marijuana expands, it is critical to develop standardized surveillance measures to study the retail environment. To this end, our research team developed and piloted a tool assessing recreational marijuana retailers in a convenience sample of 20 Denver retailers in 2016. The tool assesses: (i) compliance and security (e.g. age-of-sale signage, ID checks, security cameras); (ii) marketing (i.e. promotions, product availability and price) and (iii) contextual and neighborhood features (i.e. retailer type, facilities nearby). Most shops (90.0%) indicated the minimum age requirement, all verified age. All shops posted interior ads (M = 2.6/retailer, SD = 3.4), primarily to promote edibles and other non-smoked products. Price promotions were common in shops (73.7%), 57.9% used social media promotions and 31.6% had take-away materials (e.g. menus, party promotions). Nearly half of the shops (42.1%) advertised health claims. All shops offered bud, joints, honey oil, tinctures, kief, beverages, edibles and topicals; fewer sold clones and seeds. Six shops (31.6%) sold shop-branded apparel and/or paraphernalia. Prices for bud varied within and between stores ($20-$45/'eighth', ∼3.5 g). Twelve were recreational only, and eight were both recreational and medicinal. Liquor stores were commonly proximal. Reliability assessments with larger, representative samples are needed to create a standardized marijuana retail surveillance tool.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Lisa Henriksen
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3300 Hillview Ave, suite 120, Palo Alto, CA 94304, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Gillian L Schauer
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Bridget Freisthler
- College of Social Work, Ohio State University, 1947 College Road, Columbus, OH 43210, USA
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Chacon V, Arriaza A, Cavazos-Rehg P, Barnoya J. Availability, Price, and Packaging of Electronic Cigarettes and E-Liquids in Guatemala City Retailers. Nicotine Tob Res 2017; 20:253-257. [DOI: 10.1093/ntr/ntx071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/22/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Violeta Chacon
- Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala
| | - Astrid Arriaza
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Joaquin Barnoya
- Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
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Cabrera-Nguyen EP, Cavazos-Rehg P, Krauss M, Bierut LJ, Moreno MA. Young Adults' Exposure to Alcohol- and Marijuana-Related Content on Twitter. J Stud Alcohol Drugs 2016; 77:349-53. [PMID: 26997194 DOI: 10.15288/jsad.2016.77.349] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Twitter is among the most popular social media platforms used by young adults, yet it has been underutilized in substance use research compared with older platforms (e.g., MySpace and Facebook). We took a first step toward studying the associations between exposure to pro-alcohol- and marijuana-related content among young adults via Twitter and current heavy episodic drinking and current marijuana use, respectively. METHOD We conducted an online survey of 587 (254 men, 333 women) Twitter users between ages 18 and 25 years in February 2014 using an online survey system that has been previously used in research on health behaviors and attitudes. RESULTS Current heavy episodic drinking was significantly associated with higher levels of exposure to pro-alcohol content. Similarly, current marijuana use was significantly associated with higher levels of exposure to pro-marijuana content. CONCLUSIONS Our findings suggest that in-depth research regarding young adults' exposure to pro-alcohol- and marijuana-related content via Twitter may provide a foundation for developing effective prevention messages on this social media platform to counter the pro-alcohol and marijuana messages.
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Affiliation(s)
- E Peter Cabrera-Nguyen
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri
| | - Melissa Krauss
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri
| | - Megan A Moreno
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Plunk AD, Agrawal A, Tate WF, Cavazos-Rehg P, Bierut LJ, Grucza RA. Did the 18 Drinking Age Promote High School Dropout? Implications for Current Policy. J Stud Alcohol Drugs 2016; 76:680-9. [PMID: 26402348 DOI: 10.15288/jsad.2015.76.680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Disagreement exists over whether permissive minimum legal drinking age (MLDA) laws affected underage adolescents (e.g., those age 17 years with the MLDA of 18). We used MLDA changes during the 1970s and 1980s as a natural experiment to investigate how underage exposure to permissive MLDA affected high school dropout. METHOD MLDA exposure was added to two data sets: (a) the 5% public use microdata samples of the 1990 and 2000 censuses (n = 3,671,075), and (b) a combined data set based on the 1991-1992 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC; n = 16,331). We used logistic regression to model different thresholds of MLDA on high school dropout. We also estimated models conditioned on demographic variables and familial risk of developing alcohol problems. RESULTS Only the MLDA of 18 predicted high school dropout. Exposure was associated with 4% and 13% higher odds of high school dropout for the census and NLAES/NESARC samples, respectively. We noted greater impact on women (5%-18%), Blacks (5%-19%), and Hispanics (6%). Self-report of parental alcohol problems was associated with 40% higher odds, which equals a 4.14-point increase in dropout rate for that population. CONCLUSIONS The MLDA of 18 likely had a large impact on high school dropout rates, suggesting that the presence of legal-aged peers in a high school setting increased access to alcohol for younger students. Our results also suggest that policy can promote less dangerous drinking behavior even when familial risk of alcohol use disorders is high.
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Affiliation(s)
- Andrew D Plunk
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - William F Tate
- Department of Education, Washington University in St. Louis, St. Louis, Missouri
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Cabrera-Nguyen EP, Cavazos-Rehg P, Krauss M, Kim Y, Emery S. Awareness and Use of Dissolvable Tobacco Products in the United States. Nicotine Tob Res 2015; 18:857-63. [PMID: 26391580 DOI: 10.1093/ntr/ntv212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/10/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Little is known about dissolvable tobacco products (DTPs) compared with other alternative tobacco products (ATPs) like e-cigarettes and snus. We sought to understand US adults' awareness and use of DTPs. METHODS A nationally representative sample of US adults (age ≥ 18 years, N = 17 522) completed an online survey in March 2013 assessing their awareness and use of DTPs. RESULTS Approximately 16% of all respondents were aware of DTPs. Few reported ever using DTPs (1.6%). DTP awareness among all respondents was greatest among males, younger adults, current and former smokers, never married respondents, blacks and Latinos, and those who used other ATPs. Among current smokers, DTP awareness was greatest for males, younger adults, blacks and Latinos, those who used other ATPs, and Southerners. DTP use among all respondents was greatest among males, younger adults, Lesbian, Gay, Bisexual, and Transgender (LGBT) respondents, former and current smokers, and those who used other ATPs. Among current smokers, DTP use was greatest among males, younger adults, LGBT respondents, those who used other ATPs, those who intended to quit, and those who received medical advice to quit. CONCLUSIONS DTP awareness and use have increased since 2009. DTPs are being used as smoking cessation aids thereby increasing risk of polytobacco use. Medical professionals should emphasize use of empirically-supported smoking cessation aids when advising patients to quit. Regulations are needed to prevent tobacco company promotion of DTPs as smoking cessation aids and to inform consumers of the risks associated with DTPs and polytobacco use. Increased national surveillance of DTP use is recommended.
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Affiliation(s)
| | | | - Melissa Krauss
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Yoonsang Kim
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Sherry Emery
- School of Public Health, University of Illinois College of Medicine at Chicago, Chicago, IL
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Abstract
OBJECTIVES We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population-level surveys. SETTING State-level data across the USA. PARTICIPANTS Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). PRIMARY AND SECONDARY OUTCOME MEASURES (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new screening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. RESULTS Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, while interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. CONCLUSIONS Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, but may complement, traditional data collection and analysis about cancer screening and related interests.
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Affiliation(s)
- M Schootman
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
| | - A Toor
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA
| | - P Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - D B Jeffe
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - A McQueen
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - J Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - N O Davidson
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Cavazos-Rehg P, Krauss M, Grucza R, Bierut L. Characterizing the followers and tweets of a marijuana-focused Twitter handle. J Med Internet Res 2014; 16:e157. [PMID: 24974893 PMCID: PMC4090385 DOI: 10.2196/jmir.3247] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/16/2014] [Accepted: 04/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background Twitter is a popular social media forum for sharing personal experiences, interests, and opinions. An improved understanding of the discourse on Twitter that encourages marijuana use can be helpful for tailoring and targeting online and offline prevention messages. Objectives The intent of the study was to assess the content of “tweets” and the demographics of followers of a popular pro-marijuana Twitter handle (@stillblazingtho). Methods We assessed the sentiment and content of tweets (sent from May 1 to December 31, 2013), as well as the demographics of consumers that follow a popular pro-marijuana Twitter handle (approximately 1,000,000 followers) using Twitter analytics from Demographics Pro. This analytics company estimates demographic characteristics based on Twitter behavior/usage, relying on multiple data signals from networks, consumption, and language and requires confidence of 95% or above to make an estimate of a single demographic characteristic. Results A total of 2590 tweets were sent from @stillblazingtho during the 8-month period and 305 (11.78%) replies to another Twitter user were excluded for qualitative analysis. Of the remaining 2285 tweets, 1875 (82.06%) were positive about marijuana, 403 (17.64%) were neutral, and 7 (0.31%) appeared negative about marijuana. Approximately 1101 (58.72%) of the positive marijuana tweets were perceived as jokes or humorous, 340 (18.13%) implied that marijuana helps you to feel good or relax, 294 (15.68%) mentioned routine, frequent, or heavy use, 193 (10.29%) mentioned blunts, marijuana edibles, or paraphernalia (eg, bongs, vaporizers), and 186 (9.92%) mentioned other risky health behaviors (eg, tobacco, alcohol, other drugs, sex). The majority (699,103/959,143; 72.89%) of @stillblazingtho followers were 19 years old or younger. Among people ages 17 to 19 years, @stillblazingtho was in the top 10% of all Twitter handles followed. More followers of @stillblazingtho in the United States were African American (323,107/759,407; 42.55%) or Hispanic (90,732/759,407; 11.95%) than the Twitter median average (African American 22.4%, inter-quartile ratio [IQR] 5.1-62.5%; Hispanic 5.4%, IQR 3.0-10.8%) and among Hispanics, @stillblazingtho was in the top 30% of all Twitter handles followed. Conclusions Young people are especially responsive to social media influences and often establish substance use patterns during this phase of development. Our findings underscore the need for surveillance efforts to monitor the pro-marijuana content reaching young people on Twitter.
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