Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year

BACKGROUND

Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups.

METHODS

MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders.

RESULTS

Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001).

CONCLUSION

Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients.

Racial/Ethnic and Gender Differences in Associations of Medication-Assisted Therapy and Reduced Opioid Use between Outpatient Treatment Admission and Discharge

Medication-assisted therapy (MAT) for opioid use disorders is an effective treatment strategy. Racial/ethnic and gender disparities in MAT utilization have been documented, but less is known about disparities in MAT outcomes. We used the Treatment Episodes Dataset-Discharges (TEDS-D; 2015- 2017) to identify outpatient treatment episodes with heroin or illicit opioids indicated at admission (n = 232,547). We used multivariate logistic regression to model the association between MAT and a reduction in opioid use between treatment admission and discharge. We explored moderation by race/ethnicity and gender by including an interaction term. We identified a strong moderating effect of race/ethnicity and gender. American Indian/Alaska Native (AI/AN) women demonstrated the strongest association between MAT (versus no MAT) and a reduction in opioid use (aOR = 6.05, 95% CI = 4.81- 7.61), while White men demonstrated the weakest association (aOR = 2.78, CI = 2.70- 2.87). Our findings could inform changes in clinical MAT settings that are based on harm reduction and the incremental transition from illicit opioids to medication-assistance among a diverse opioid use disorder population.

Carbonated beverages consumption among New Zealand youth and associations with BMI and waist circumference

AIM

The primary aim of this study was to describe the carbonated beverage (soft drink) consumption patterns of New Zealand (NZ) youth and to investigate the influence that home availability of soft drinks had on their consumption. A secondary aim was to determine if there was an association between soft drink consumption and body mass index (BMI) or waist circumference.

METHODS

Data from Youth '07, a nationally representative survey of the health and well-being of NZ youth, including 8,697 NZ students aged 13 to 17 years, were analysed.

RESULTS

The relevant data was available for 8697 students of whom 4633 identified as NZ European. 1621 Māori, 1.098 Asian, 834 Pacific, and 504 Other. Twenty nine percent (29%) were categorised as high consumers of soft drinks (>4 times a week), 45.4% were moderate consumers (1-3 times a week), and 25.6% were low consumers (had not consumed soft drinks in the past week). Male gender, Pacific ethnicity, and high deprivation were all significantly associated with being in the high consumer group. Fifty eight percent (58%) of children who reported that soft drinks were 'usually' available at home were in the high consumption group, compared to 15.1% of children who reported that these drinks were never available at home. After adjusting for possible confounders, waist circumference was significantly associated with soft drink consumption (p<0.05), however, BMI was not. Mean soft drink consumption for boys was 3.5 times per week and was 2.0 for girls.

CONCLUSION

This study provides detailed information on soft drink consumption patterns of NZ youth and highlights factors associated with high consumption. Moderating the availability of soft drinks in the home is likely to significantly reduce their consumption among NZ youth.

Under-reporting remains a key limitation of self-reported dietary intake: an analysis of the 2008/09 New Zealand Adult Nutrition Survey

BACKGROUND/OBJECTIVES

The most recent New Zealand Adult Nutrition Survey 2008/09 (ANS 08/9) revealed a decrease in reported energy intakes (EIs) compared with the previous 1997 National Nutrition Survey (NNS97). Conversely, measured body weights increased over the same period. We conducted an analysis on the ANS 08/9 data sets to evaluate reported EIs.

SUBJECTS/METHODS

Analysis was conducted on data from 3919 (1715 men and 2204 women aged > or = 15 years) survey participants who completed the 24-h dietary recall in the ANS 08/9. Under-reporting was assessed using the ratio of reported EI to estimated resting metabolic rate (EI:RMRest), and a cutoff limit of <0.9 (EI:RMRest) was used to identify low energy reporters (LERs). Results were examined by gender, body size, age and ethnicity.

RESULTS

The mean EI:RMRest (s.e.m.) was 1.34 (0.02) for men, and 1.23 (0.02) for women. Overall, 21% of men and 25% of women were classified as LERs. There was a greater prevalence of LERs among people with overweight (25%), or obesity (30%) than people with normal body weight (16%, P<0.001). The oldest age group (> or =65 years) had a greater prevalence of LERs (33%) compared with all other age groups (19-24%, P<0.001). Pacific people had a greater prevalence of LERs (33%) compared with Maori (26%, P=0.007) and European (23%, P<0.001). Compared with the NNS97, a substantial increase in the prevalence of LERs was evident in most subgroups.

CONCLUSIONS

Under-reporting of EI will continue to be a major limitation of nutrition surveys without technological innovation. Care should be taken when interpreting EI data.

Feasibility of a SenseCam-assisted 24-h recall to reduce under-reporting of energy intake

BACKGROUND/OBJECTIVES

The SenseCam is a camera worn on a lanyard around the neck that automatically captures point-of-view images in response to movement, heat and light (every 20-30 s). This device may enhance the accuracy of self-reported dietary intake by assisting participants' recall of food and beverage consumption. It was the objective of this study to evaluate if the wearable camera, SenseCam, can enhance the 24-h dietary recall by providing visual prompts to improve recall of food and beverage consumption.

SUBJECT/METHODS

Thirteen volunteer adults in Oxford, United Kingdom, were recruited. Participants wore the SenseCam for 2 days while continuing their usual daily activities. On day 3, participants' diets were assessed using an interviewer-administered 24-h recall. SenseCam images were then shown to the participants and any additional dietary information that participants provided after viewing the images was recorded. Energy and macronutrient intakes were compared between the 24-h recall and 24-h recall+SenseCam.

RESULTS

Data from 10 participants were included in the final analysis (8 males and 2 females), mean age 33 ± 11 years, mean BMI 25.9 ± 5.1 kg/m(2). Viewing the SenseCam images increased self-reported energy intake by approximately 1432 ± 1564 kJ or 12.5% compared with the 24-h recall alone (P=0.02). The increase was predominantly due to reporting of 41 additional foods (241 vs 282 total foods) across a range of food groups. Eight changes in portion size were made, which resulted in a negligible change to energy intake.

CONCLUSIONS

Wearable cameras are promising method to enhance the accuracy of self-reported dietary assessment methods.

Reduction in overweight and obesity from a 3-year community-based intervention in Australia: the 'It's Your Move!' project

'It's Your Move!' was a 3-year intervention study implemented in secondary schools in Australia as part of the Pacific Obesity Prevention In Communities Project. This paper reports the outcome results of anthropometric indices and relevant obesity-related behaviours. The interventions focused on building the capacity of families, schools and communities to promote healthy eating and physical activity. Baseline response rates and follow-up rates were 53% and 69% respectively for the intervention group (n=5 schools) and 47% and 66% respectively for the comparison group (n=7 schools). Statistically significant relative reductions in the intervention versus comparison group were observed: weight (-0.74 kg, P < 0.04), and standardized body mass index (-0.07, P<0.03), and non-significant reductions in prevalence of overweight and obesity (0.75 odds ratio, P=0.12) and body mass index (-0.22, P=0.06). Obesity-related behavioural variables showed mixed results with no pattern of positive intervention outcomes. In conclusion, this is the first study to show that long-term, community-based interventions using a capacity-building approach can prevent unhealthy weight gain in adolescents. Obesity prevention efforts in this important transitional stage of life can be successful and these findings need to be translated to scale for a national effort to reverse the epidemic in children and adolescents.

Experiences and challenges in implementing complex community-based research project: the Pacific Obesity Prevention in Communities project

Policy makers throughout the world are struggling to find effective ways to prevent the rising trend of obesity globally, particularly among children. The Pacific Obesity Prevention in Communities project was the first large-scale, intervention research project conducted in the Pacific aiming to prevent obesity in adolescents. The project spanned four countries: Australia, New Zealand, Fiji and Tonga. This paper reports on the strengths and challenges experienced from this complex study implemented from 2004 to 2009 across eight cultural groups in different community settings. The key strengths of the project were its holistic collaborative approach, participatory processes and capacity building. The challenges inherent in such a large complex project were underestimated during the project's development. These related to the scale, complexity, duration, low research capacity in some sites and overall coordination across four different countries. Our experiences included the need for a longer lead-in time prior to intervention for training and up-skilling of staff in Fiji and Tonga, investment in overall coordination, data quality management across all sites and the need for realistic capacity building requirements for research staff. The enhanced research capacity and skills across all sites include the development and strengthening of research centres, knowledge translation and new obesity prevention projects.

Evaluation of the Living 4 Life project: a youth-led, school-based obesity prevention study

The Living 4 Life study was a youth-led, school-based intervention to reduce obesity in New Zealand. The study design was quasi-experimental, with comparisons made by two cross-sectional samples within schools. Student data were collected at baseline (n=1634) and at the end of the 3-year intervention (n=1612). A random-effects mixed model was used to test for changes in primary outcomes (e.g. anthropometry and obesity-related behaviours) between intervention and comparison schools. There were no significant differences in changes in anthropometry or behaviours between intervention and comparison schools. The prevalence of obesity in intervention schools was 32% at baseline and 35% at follow-up and in comparison schools was 29% and 30%, respectively. Within-school improvements in obesity-related behaviours were observed in three intervention schools and one comparison school. One intervention school observed several negative changes in student behaviours. In conclusion, there were no significant improvements to anthropometry; this may reflect the intervention's lack of intensity, insufficient duration, or that by adolescence changes in anthropometry and related behaviours are difficult to achieve. School-based obesity prevention interventions that actively involve young people in the design of interventions may result in improvements in student behaviours, but require active support from leaders within their schools.

Outcome results for the Ma'alahi Youth Project, a Tongan community-based obesity prevention programme for adolescents

Tonga has a very high prevalence of obesity with steep increases during youth, making adolescence a critical time for obesity prevention. The Ma'alahi Youth Project, the Tongan arm of the Pacific Obesity Prevention in Communities project, was a 3-year, quasi-experimental study of community-based interventions among adolescents in three districts on Tonga's main island (Tongatapu) compared to the island of Vava'u. Interventions focused mainly on capacity building, social marketing, education and activities promoting physical activity and local fruit and vegetables. The evaluation used a longitudinal design (mean follow-up duration 2.4 years). Both intervention and comparison groups showed similar large increases in overweight and obesity prevalence (10.1% points, n = 815; 12.6% points, n = 897 respectively). Apart from a small relative decrease in percentage body fat in the intervention group (-1.5%, P < 0.0001), there were no differences in outcomes for any anthropometric variables between groups and behavioural changes did not follow a clear positive pattern. In conclusion, the Ma'alahi Youth Project had no impact on the large increase in prevalence of overweight and obesity among Tongan adolescents. Community-based interventions in such populations with high obesity prevalence may require more intensive or longer interventions, as well as specific strategies targeting the substantial socio-cultural barriers to achieving a healthy weight.

The Pacific Obesity Prevention in Communities project: project overview and methods

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community-based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity-building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio-cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi-country collaboration to build research capacity; testing a capacity-building approach in ethnic groups with very high obesity prevalence; costing complex, long-term community intervention programmes; systematically studying the powerful socio-cultural influences on weight gain; and undertaking a participatory, national, priority-setting process for policy interventions using simulation modelling of cost-effectiveness of interventions.

Trends in body mass index and waist circumference among New Zealand adolescents, 1997/1998-2005

The objective of the current study is to examine changes in body mass index (BMI) and waist circumference among New Zealand adolescents between 1997/1998 and 2005. Data were drawn from two cross-sectional studies of high school students in an economically disadvantaged region of Auckland. In total, 608 adolescents from the 1998 survey and 897 adolescents from the 2005 survey participated. The prevalence of obesity increased from 19.4% in 1997/1998 to 30.7% in 2005. The mean BMI among adolescents significantly increased from 25.3 in 1997/1998 to 27.2 in 2005, with the greatest increases at the high end of the distribution. Increases in BMI did not differ by age, gender or ethnicity. The mean waist circumference increased from 76.2 cm in 1997/1998 to 89.4 cm in 2005, with increases in waist circumference measurements at all points in the distribution. The prevalence of obesity is increasing rapidly in this sample of ethnically diverse adolescents. Corresponding increases in waist circumference measurements suggest that this population of New Zealand adolescents are at increased risk for related chronic conditions.

Binge eating disorder, weight control self-efficacy, and depression in overweight men and women

OBJECTIVE

To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization.

DESIGN

Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss.

SUBJECTS

A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization.

MEASUREMENTS

Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline.

RESULTS

Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men.

CONCLUSION

Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

Determination of isoetharine in plasma by reversed-phase chromatography with amperometric detection

A reversed-phase liquid chromatographic method for the determination of isoetharine in blood plasma, utilizing amperometric detection, is described. Plasma samples were extracted utilizing an ion-pair reagent, di-(2-ethylhexyl)phosphoric acid, to concentrate the catecholamine. Only minor differences were observed in the relative bioavailability of isoetharine hydrochloride and isoetharine mesylate after oral administration to rats. Observed plasma levels, at 1 hr after oral medication, were highly variable in dose-ranging studies at doses of 800-2500 mg/kg/day for 2 weeks.