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Balio CP, Mathis SM, Francisco MM, Meit M, Beatty KE. State Priorities and Needs: The Role of Block Grants. Public Health Rep 2023:333549231205338. [PMID: 37924249 DOI: 10.1177/00333549231205338] [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] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Block grant funding provides federal financial support to states, with increased flexibility as to how those funds can be allocated at the community level. At the state level, block grant amounts and distributions are often based on outdated formulas that consider population measures and funding environments at the time of their creation. We describe variation in state-level funding allocations for 5 federal block grant programs and the extent to which funding aligns with the current needs of state populations. METHODS We conducted an analysis in 2022 of state block grant allocations as a function of state-level characteristics for 2015-2019 for all 50 states. We provide descriptive statistics of state block grant allocations and multivariate regression models for each program. Models include base characteristics relevant across programs plus supplemental characteristics based on program-specific goals and state population needs. RESULTS Mean state block grant allocations per 1000 population by program ranged from $618 to $21 528 during 2015-2019. Characteristics associated with state allocations varied across block grants. For example, for every 1-percentage-point increase in the percentage of the population living in nonmetropolitan areas, Preventive Health and Health Services Block Grant funding was approximately $7 per 1000 population higher and Community Services Block Grant funding was approximately $40 per 1000 population higher. Few supplemental characteristics were associated with allocations. CONCLUSIONS Current block grant funding does not align with state characteristics and needs. Future research should consider how funds are used at the state level or allocated to local agencies or organizations and compare state block grant allocations with other types of funding mechanisms, such as categorical funding.
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Affiliation(s)
- Casey P Balio
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Stephanie M Mathis
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Margaret M Francisco
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Michael Meit
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Kate E Beatty
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
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Beatty KE, Mathis SM, McCurry AR, Francisco MM, Meit M, Wahlquist AE. The association between grandparents as caregivers and overdose mortality in Appalachia and non-Appalachia counties. Front Public Health 2023; 11:1035564. [PMID: 36908410 PMCID: PMC9992886 DOI: 10.3389/fpubh.2023.1035564] [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: 09/02/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Objective To assess the association of drug overdose mortality with grandparents serving as caregivers of children in Appalachia and non-Appalachia in the U.S. Methods This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and descriptive, bivariate, and multivariable statistics were applied. Multiple sociodemographic and geographic variables were included: median age of the population, percent of the population that is uninsured, percent of the population that is non-Hispanic white, teen birth rate, percent of high school dropouts, and rurality. Results The percent of grandparents as caregivers increased as the overdose mortality rate increased (p < 0.01). For every 1% increase in the overdose mortality rate, the percent of grandparents as caregivers increased by 56% in Appalachian counties compared to 24% in non-Appalachian counties. After adjusting for sociodemographic characteristics, the interaction between overdose mortality and Appalachian vs. non-Appalachian counties was no longer significant (p = 0.3). Conclusions Counties with higher overdose mortality rates had greater rates of grandparents as caregivers, with Appalachian counties experiencing greater rates of grandparents as caregivers than non-Appalachian counties. Sociodemographic characteristics that are often more prevalent in Appalachia may be driving the observed differences. Policy implications Policies and programs are needed to support grandparents providing caregiving for children impacted by substance use disorders including reform to federal child welfare financing to support children, parents, and grandparent caregivers such as kinship navigation, substance use treatment and prevention services, mental health services and in-home supports.
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Affiliation(s)
- Kate E Beatty
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States.,Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Stephanie M Mathis
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
| | - Abby R McCurry
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, United States
| | - Margaret M Francisco
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States.,Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Michael Meit
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
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Abstract
Background: Prescription drug abuse is a public health problem in the United States and the region of Appalachia, specifically. Primary care and addiction medicine-as possible points of access for prescription drugs with abuse potential and points of intervention for prescription drug abuse-are among the medical fields at its forefront. Little is known, however, about perceptions of prescription drug abuse across the two patient populations. Objectives: The objective of this qualitative analysis was to explore perceptions of the scale and context of prescription drug abuse among primary care and addiction medicine patients in Appalachia. Methods: As part of a mixed methods study, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine in Central and South Central Appalachia from 2014 to 2015. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes. Results: Three themes were identified: (1) pervasiveness of prescription drug abuse, describing perceptions of its high prevalence and negative consequences; (2) routes and routine practices for prescription drug acquisition and distribution, describing perceptions of routes of access to prescription drugs and behaviors exhibited to acquire and distribute prescription drugs; and (3) rationales for prescription drug acquisition and distribution, describing perceptions of the two underlying reasons for these processes-tolerance/addiction and revenue source. Conclusions/Importance: Perceptions of prescription drug abuse among primary care and addiction medicine patients in Appalachia are multifaceted, especially regarding prescription drug acquisition and distribution. Clinical practice implications for mitigating prescription drug abuse are discussed.
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Affiliation(s)
- Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nicholas Hagemeier
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA.,Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kelly N Foster
- Department of Sociology and Anthropology, College of Arts and Sciences, East Tennessee State University, Johnson City, Tennessee, USA.,Applied Social Research Laboratory, East Tennessee State University, Johnson City, Tennessee, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
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Abstract
Background: Patients engaged in evidence-based opioid use disorder (OUD) treatment can obtain prescriptions for buprenorphine containing products from specially trained physicians that are subsequently dispensed by community pharmacists. Despite the involvement of physicians and community pharmacists in buprenorphine prescribing and dispensing, respectively, our understanding of their interactions in this context is limited. Objective: To qualitatively describe the communication and collaborative experiences between Drug Addiction Treatment Act 2000 (DATA)-waivered physicians and community pharmacists from the perspective of the physician. Methods: Ten key informant interviews were conducted with DATA-waivered physicians practicing in Northeast Tennessee. A semi-structured interview guide was used to explore communication and collaborative experiences between the physicians and community pharmacists. Interviews were audio recorded and transcribed verbatim. A coding frame was developed using concepts from the scientific literature and emerging codes from physician interviews. Interviews were coded using NVivo 11, with the data subsequently organized and evaluated for themes. Results: Four themes were identified: (1) mechanics of communication; (2) role specification and expectations; (3) education and understanding; and (4) climate of clinical practice. Physician-pharmacist communication primarily occurred indirectly through patients or staff and perceived challenges to collaboration included; lack of trust, stigma, and fear of regulatory oversight. Physicians also indicated the two professionals may lack clear roles and responsibilities as well as common expectations for treatment plans. Conclusions: Communication between DATA-waivered physicians and community pharmacists is influenced by multiple factors. Further research is warranted to improve physician-community pharmacist collaboration (PCPC) in the context of OUD pharmacotherapy and addiction treatment.
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Affiliation(s)
- Daniel J. Ventricelli
- Department of Pharmacy Practice and Administration,
Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104-4495, USA
| | - Stephanie M. Mathis
- Center for Prescription Drug Abuse Prevention and
Treatment, East Tennessee State University, College of Public Health 104 Lamb Hall,
P.O. Box 70623 Johnson City, TN 37614, USA
| | - Kelly N. Foster
- Department of Sociology & Anthropology, East Tennessee
State University, 223 Rogers-Stout Hall P.O. Box 70644 Johnson City, TN 37614-1702
USA
| | - Robert P. Pack
- Department of Community and Behavioral Health, East
Tennessee State University College of Public Health 104 Lamb Hall, P.O. Box 70623
Johnson City, TN 37614, USA
| | - Fred Tudiver
- Department of Family Medicine, East Tennessee State
University Quillen College of Medicine, P.O. Box 70300 Johnson City, TN 37614
USA
| | - Nicholas E. Hagemeier
- Department of Pharmacy Practice, East Tennessee State
University Gatton College of Pharmacy, P.O. Box 70657, Johnson City, TN 37614,
USA
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Mathis SM, Hagaman A, Hagemeier N, Baker K, Pack RP. Provider-patient communication about prescription drug abuse: A qualitative analysis of the perspective of prescribers. Subst Abus 2019; 41:121-131. [PMID: 31403901 DOI: 10.1080/08897077.2019.1635956] [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] [Indexed: 10/26/2022]
Abstract
Background: Provider-patient communication underpins many initiatives aimed at reducing the public health burden associated with prescription drug abuse in the United States. The purpose of this qualitative analysis was to examine the characteristics of provider-patient communication about prescription drug abuse from the perspective of prescribers. Methods: From 2014 to 2015, 10 semi-structured interviews were conducted with a purposive sample of prescribers from multiple professions and medical fields in Central and South Central Appalachia. The interviews were conducted using a guide informed by Social Cognitive Theory and community theory research, audio-recorded, and transcribed verbatim. Thematic analysis, facilitated by NVivo 10 software, was used to generate themes. Results: Prescribers described 3 primary communication patterns with patients related to prescription drug abuse-informative, counteractive, and supportive. Prescribers also reported multiple factors-personal (e.g., education, experiences, and feelings of tension) and environmental (e.g., relationship with a patient, clinical resources, and policies on controlled prescription drugs)-that affect provider-patient communication and, by association, delivery of patient care related to prescription drug abuse. Conclusions: The findings suggest that provider-patient communication about prescription drug abuse is multidimensional and dynamic, characterized by multiple communication patterns and contributory factors. They have implications for (1) research aimed at advancing theoretical understanding of prescriber prescription drug abuse communication behaviors with patients and (2) interventions aimed at strengthening prescriber prescription drug abuse communication behaviors with patients.
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Affiliation(s)
- Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Angela Hagaman
- College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nicholas Hagemeier
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
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Mathis SM, Hagemeier N, Hagaman A, Dreyzehner J, Pack RP. A Dissemination and Implementation Science Approach to the Epidemic of Opioid Use Disorder in the United States. Curr HIV/AIDS Rep 2019; 15:359-370. [PMID: 30069724 DOI: 10.1007/s11904-018-0409-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to (1) conceptualize the complexity of the opioid use disorder epidemic using a conceptual model grounded in the disease continuum and corresponding levels of prevention and (2) summarize a select set of interventions for the prevention and treatment of opioid use disorder. RECENT FINDINGS Epidemiologic data indicate non-medical prescription and illicit opioid use have reached unprecedented levels, fueling an opioid use disorder epidemic in the USA. A problem of this magnitude is rooted in multiple supply- and demand-side drivers, the combined effect of which outweighs current prevention and treatment efforts. Multiple primary, secondary, and tertiary prevention interventions, both evidence-informed and evidence-based, are available to address each point along the disease continuum-non-use, initiation, dependence, addiction, and death. If interventions grounded in the best available evidence are disseminated and implemented across the disease continuum in a coordinated and collaborative manner, public health systems could be increasingly effective in responding to the epidemic.
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Affiliation(s)
- Stephanie M Mathis
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
| | - Nicholas Hagemeier
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Angela Hagaman
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
| | | | - Robert P Pack
- College of Public Health, East Tennessee State University, Johnson City, TN, USA.
- Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to address infection with HIV and hepatitis C in the Appalachian region of the USA and the driving forces underlying this epidemic. We seek to discuss epidemiology of disease and the possible interventions to reduce incidence and burden of disease in this resource-limited area. RECENT FINDINGS The rise of the opioid crisis has fueled a rise in new hepatitis C infection, and a rise in new HIV infection is expected to follow. Injection drug use has directly contributed to the epidemic and continues to remain a risk factor. Men who have sex with men remains a significant risk factor for HIV acquisition as well. Progress has been made in the battle against HIV and, to a lesser extent, hepatitis C, but much more can be done. Limited data on co-infection with HIV/HCV are currently available for this at-risk region, but it is clear that Appalachia is highly vulnerable to co-infection outbreaks. A multipronged approach that includes advances in assessment of co-infection and education for both patients and clinicians can help to recognize, manage, and ideally prevent these illnesses.
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Affiliation(s)
- Jonathan P Moorman
- Center of Excellence in Inflammation, Infectious Diseases and Immunity, College of Medicine, East Tennessee State University, Johnson City, TN, USA. .,Department of Medicine, Division of Infectious Diseases, College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Matthew R Krolikowski
- Department of Medicine, Division of Infectious Diseases, College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
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