1
|
Fliss MD, Cox ME, Proescholdbell S, Patel A, Smith M. Tying Overdose Data to Action: North Carolina's Opioid and Substance Use Action Plan Data Dashboard. J Public Health Manag Pract 2023; 29:831-834. [PMID: 37498535 PMCID: PMC10526884 DOI: 10.1097/phh.0000000000001796] [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: 07/28/2023]
Abstract
From 2000 to 2020, more than 28 000 North Carolina (NC) residents died of drug overdose. In response, NC Department of Health and Human Services worked with community partners to develop an Opioid and Substance Use Action Plan (OSUAP), now in its third iteration. The NC OSUAP data dashboard brings together data on 15 public health indicators and 16 local actions across 8 strategies. We share innovations in design, data structures, user tasks, and visual elements over 5 years of dashboard development and maintenance, with a special focus and supplemental material covering the technical details and techniques that dashboard design and implementation teams may benefit from.
Collapse
Affiliation(s)
- Mike Dolan Fliss
- University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina (Dr Fliss); and Injury & Violence Prevention Branch, NC Division of Public Health, Raleigh, North Carolina (Dr Fliss, Mss Cox, Patel, and Smith, and Mr Proescholdbell)
| | | | | | | | | |
Collapse
|
2
|
Austin AE, Shiue KY, Combs KG, Proescholdbell S, Cox ME, Naumann RB. Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina. Ann Epidemiol 2023; 85:88-92.e4. [PMID: 37196850 PMCID: PMC10184864 DOI: 10.1016/j.annepidem.2023.05.008] [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: 09/19/2022] [Revised: 03/22/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To examine racial and ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. METHODS We used North Carolina State Unintentional Drug Overdose Reporting System data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race and ethnicity during pre-COVID-19 (May 2019-February 2020) and COVID-19 periods (March 2020-December 2020). RESULTS For all racial and ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian and Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian and Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial and ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage of naloxone administered for most racial and ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). CONCLUSIONS Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed.
Collapse
Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kristin Y Shiue
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine Gora Combs
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Rebecca B Naumann
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
3
|
Shiue KY, Naumann RB, Proescholdbell S, Cox ME, Aurelius M, Austin AE. Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015-2019. Prev Med 2022; 163:107217. [PMID: 35998765 DOI: 10.1016/j.ypmed.2022.107217] [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: 03/04/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015-2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015-2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).
Collapse
Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States.
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Michelle Aurelius
- Office of the Chief Medical Examiner, Division of Public Health, North Carolina Department of Health and Human Services, 4312 District Drive, Raleigh, NC 27607, United States
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, United States
| |
Collapse
|
4
|
Geary S, Proescholdbell S, Cox ME, Bell R. The Impact of the COVID-19 Pandemic on Disparities in Motor Vehicle Traffic Deaths and Injuries among North Carolina American Indians. N C Med J 2022; 83:361-365. [PMID: 37158553 DOI: 10.18043/ncm.83.5.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A Periodic Feature to Inform North Carolina Health Care Professionals About Current Topics in Health Statistics.
Collapse
Affiliation(s)
- Shana Geary
- Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services
| | - Scott Proescholdbell
- Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services
| | - Mary E Cox
- Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services
| | - Ronny Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine and director, Office of Cancer Health Equity, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Kafka JM, Moracco K(BE, Taheri C, Young BR, Graham LM, Macy RJ, Proescholdbell S. Intimate partner violence victimization and perpetration as precursors to suicide. SSM Popul Health 2022; 18:101079. [PMID: 35372658 PMCID: PMC8968650 DOI: 10.1016/j.ssmph.2022.101079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022] Open
Abstract
It remains unclear how often and under what circumstances intimate partner violence (IPV) precedes suicide. Available research on IPV and suicide focuses largely on homicide-suicide, which is a rare event (<2% of suicides). We focus instead on single suicides (i.e., suicides unconnected to other violent deaths), which are the most common type of fatal violence in the US. Unfortunately, information about IPV circumstances is often unavailable for suicides. To address this gap, we sought to identify the proportion of single suicides that were preceded by IPV in North Carolina (NC), to describe the prevalence of IPV victimization and perpetration as precursors to suicide, and to explore how IPV-related suicides differ from other suicides. We used data from the NC Violent Death Reporting System (2010–2017, n = 9682 single suicides) and hand-reviewed textual data for a subset of cases (n = 2440) to document IPV circumstances. We had robust inter-rater reliability (Kappa: 0.73) and identified n = 439 IPV-related suicides. Most were males who had perpetrated nonfatal IPV (n = 319, 72.7%) prior to dying by suicide. Our findings suggest that IPV was a precursor for at least 4.5% of single suicides. Next, we conducted logistic regression analyses by sex comparing IPV-related suicides to other suicides. For both men and women, IPV was more common when the person who died by suicide had recently disclosed suicidal intent, was younger, used a firearm, and was involved with the criminal legal system, even after controlling for covariates. We also found sex-specific correlates for IPV circumstances in suicide. Combined with homicide-suicide data (reported elsewhere), IPV is likely associated with 6.1% or more of suicides overall. Results suggest clear missed opportunities to intervene for this unique subpopulation, such as suicide screening and referral in IPV settings (e.g., batterer intervention programs, Family Justice Centers) that is tailored by sex. Intimate partner violence is a precipitating factor for 4.5% of single suicides. Most IPV-related single suicides were of men who perpetrated nonfatal IPV. Decedents in IPV-related suicides often used a firearm and disclosed intent. Integrated prevention strategies to target both IPV and suicide may be appropriate. When combined with homicide-suicide data, IPV influences 6.1% of suicides overall.
Collapse
Affiliation(s)
- Julie M. Kafka
- Department of Health Behavior, University of North Carolina - Gillings School of Global Public Health, Chapel Hill, NC, USA
- University of North Carolina Injury and Violence Prevention Research Center, NC, USA
- Corresponding author. 725 M.L.K. Jr Blvd, Chapel Hill, NC 27599, USA.
| | - Kathryn (Beth) E. Moracco
- Department of Health Behavior, University of North Carolina - Gillings School of Global Public Health, Chapel Hill, NC, USA
- University of North Carolina Injury and Violence Prevention Research Center, NC, USA
| | - Caroline Taheri
- Department of Health Behavior, University of North Carolina - Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Belinda-Rose Young
- Department of Health Behavior, University of North Carolina - Gillings School of Global Public Health, Chapel Hill, NC, USA
- University of North Carolina Injury and Violence Prevention Research Center, NC, USA
| | - Laurie M. Graham
- University of Maryland- School of Social Work, Baltimore, MD, USA
| | - Rebecca J. Macy
- University of North Carolina- School of Social Work, Chapel Hill, NC, USA
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| |
Collapse
|
6
|
Waltzman D, Sarmiento K, Daugherty J, Proescholdbell S. Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina. N C Med J 2022; 83:206-213. [PMID: 35504710 PMCID: PMC9340785 DOI: 10.18043/ncm.83.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence suggests that those who have sustained a traumatic brain injury (TBI) are at increased risk of adverse behaviors and health indicators, such as certain chronic physical and mental health conditions. However, little is known about the prevalence of these behaviors and health indicators among these individuals, information that could help decrease their risk of developing such conditions.METHODS Data (N = 4733) from the 2018 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to determine the prevalence of behaviors and health indicators among individuals who report having a lifetime history of TBI with loss of consciousness (LOC).RESULTS North Carolinians who report a lifetime history of TBI with LOC were at increased risk of reporting a range of 3 negative health behaviors: less than always seatbelt use (adjusted odds ratio [AOR] = 1.7; 95% confidence interval [CI] = 1.2-2.4), HIV risk behaviors (AOR = 1.7; 95% CI = 1.1-2.6), and reporting less than 7 hours of sleep (AOR = 1.5; 95% CI = 1.2-1.8); more difficulty obtaining health care (not seeing a doctor due to health care cost in the past 12 months [AOR = 1.3; 95% CI = 1.0-1.8]; not getting a routine medical check-up in the past 12 months [AOR = 1.5; 95% CI = 1.2-2.0]); worse self-reported health (fair or poor general health [AOR = 1.8; 95% CI = 1.4-2.3]); and reporting fair or poor mental health (AOR = 2.1; 95% CI = 1.6-2.8) compared with individuals who did not report a history of TBI.LIMITATIONS There are several limitations to the study, such as the sample being biased toward more severe brain injuries. Additionally, because the data in the BRFSS are retrospective and cross-sectional, it is not possible to determine temporality and causality between TBI history and the behaviors and health indicators examined.CONCLUSION Despite these limitations, this paper is one of the first to directly examine the association between history of TBI with LOC and a range of current behaviors and health care utilization. Assessing positive and negative behaviors and health indicators can help identify and tailor evidence-based interventions for those who have a history of TBI.
Collapse
Affiliation(s)
- Dana Waltzman
- Behavioral scientist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.
| | - Kelly Sarmiento
- Health communication specialist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Jill Daugherty
- Epidemiologist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Scott Proescholdbell
- Epidemiologist, North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, North Carolina
| |
Collapse
|
7
|
LeMasters K, Cox ME, Fliss M, Seibert J, Brown C, Proescholdbell S. Mental health emergency department visits: An exploration of case definitions in North Carolina. Am J Emerg Med 2022; 57:103-106. [DOI: 10.1016/j.ajem.2022.04.053] [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] [Received: 01/19/2022] [Revised: 04/08/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022] Open
|
8
|
Sivaraman JJC, Greene SB, Naumann RB, Proescholdbell S, Ranapurwala SI, Marshall SW. Association Between Medical Diagnoses and Suicide in a Medicaid Beneficiary Population, North Carolina 2014-2017. Epidemiology 2022; 33:237-245. [PMID: 34799475 PMCID: PMC10281339 DOI: 10.1097/ede.0000000000001439] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearms are used in about half of U.S. suicides. This study investigated how various medical diagnoses are associated with firearm and nonfirearm suicide. METHODS We used a case-control design including n = 691 North Carolina Medicaid beneficiaries who died from suicide between 1 January 2014 and 31 December 2017 as cases. We selected a total of n = 68,682 controls (~1:100 case-control ratio from North Carolina Medicaid member files using incidence density sampling methods). We linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). We matched cases and controls on number of months covered by Medicaid over the past 36 months. Analyses adjusted for sex, race, age, Supplemental Security Income status, the Charlson Comorbidity Index, and frequency of health care encounters. RESULTS The case-control odds ratios for any mental health disorder were 4.2 (95% confidence interval [CI]: 3.3, 5.2) for nonfirearm suicide and 2.2 (95% CI: 1.7, 2.9) for firearm suicide. There was effect measure modification by sex and race. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicide in men but did not differ substantially in women. The association of mental health and substance use diagnoses with suicides appeared to be weaker in Blacks (vs. non-Blacks), but the estimates were imprecise. CONCLUSION Behavioral health diagnoses are important indicators of risk of suicide. However, these associations differ by means of suicide and sex, and associations for firearm-related suicide are weaker in men than women.
Collapse
Affiliation(s)
- Josie J. Caves Sivaraman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Sandra B. Greene
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Rebecca B. Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Scott Proescholdbell
- North Carolina Department of Health and Human Services, Division of Public Health, Injury and Violence Prevention Branch
| | - Shabbar I. Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| |
Collapse
|
9
|
Caves Sivaraman JJ, Ranapurwala SI, Proescholdbell S, Naumann RB, Greene SB, Marshall SW. Suicide typologies among Medicaid beneficiaries, North Carolina 2014-2017. BMC Psychiatry 2022; 22:104. [PMID: 35144585 PMCID: PMC8832648 DOI: 10.1186/s12888-022-03741-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is a well-established need for population-based screening strategies to identify people at risk of suicide. Because only about half of suicide decedents are ever diagnosed with a behavioral health condition, it may be necessary for providers to consider life circumstances that may also put individuals at risk. This study described the alignment of medical diagnoses with life circumstances by identifying suicide typologies among decedents. Demographics, stressful life events, suicidal behavior, perceived and diagnosed health problems, and suicide method contributed to the typologies. METHODS This study linked North Carolina Medicaid and North Carolina Violent Death Reporting System (NC-VDRS) data for analysis in 2020. For suicide decedents from 2014 to 2017 aged 25-54 years, we analyzed 12 indicators of life circumstances from NC-VDRS and 6 indicators from Medicaid claims, using a latent class model. Separate models were developed for men and women. RESULTS Most decedents were White (88.3%), with a median age of 41, and over 70% had a health care visit in the 90 days prior to suicide. Two typologies were identified in both males (n = 175) and females (n = 153). Both typologies had similar profiles of life circumstances, but one had high probabilities of diagnosed behavioral health conditions (45% of men, 71% of women), compared to low probabilities in the other (55% of men, 29% of women). Black beneficiaries and men who died by firearm were over-represented in the less-diagnosed class, though estimates were imprecise (odds ratio for Black men: 3.1, 95% confidence interval: 0.8, 12.4; odds ratio for Black women: 5.0, 95% confidence interval: 0.9, 31.2; odds ratio for male firearm decedents: 1.6, 95% confidence interval: 0.7, 3.4). CONCLUSIONS Nearly half of suicide decedents have a typology characterized by low probability of diagnosis of behavioral health conditions. Suicide screening could likely be enhanced using improved indicators of lived experience and behavioral health.
Collapse
Affiliation(s)
- Josie J. Caves Sivaraman
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.26009.3d0000 0004 1936 7961Present Address: Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina USA
| | - Shabbar I. Ranapurwala
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Scott Proescholdbell
- grid.410399.60000 0004 0457 6816North Carolina Department of Health and Human Services, Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina USA
| | - Rebecca B. Naumann
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sandra B. Greene
- grid.10698.360000000122483208Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephen W. Marshall
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
10
|
Austin AE, Shanhan ME, Rosemond P, Berkoff MC, Joyner C, Proescholdbell S. Implementation of the North Carolina Plan of Safe Care in Wake County, North Carolina. N C Med J 2022; 83:67-74. [PMID: 34980658 DOI: 10.18043/ncm.83.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Comprehensive Addiction and Recovery Act (CARA) of 2016 amended the Child Abuse Prevention and Treatment Act (CAPTA), reinforcing and revising the requirement that states develop policies and procedures to address the needs of substance-affected infants and their caregivers. North Carolina's program, the North Carolina Plan of Safe Care (NC POSC), was implemented in August 2017 and involves coordination between multiple agencies.METHODS We conducted a quality improvement project to assess implementation of the North Carolina Plan of Safe Care in Wake County through interviews with key stakeholders involved in program delivery including health care providers (n = 7), child protective services social workers (CPS; n = 14), and care managers at Care Coordination for Children (CC4C; n = 10). We also analyzed data on Plan of Safe Care notifications to Wake County CPS from January 2018 to October 2019.RESULTS Several key themes emerged in stakeholder interviews, including 1) lack of awareness of the program among health care providers; 2) gaps in information sharing and communication between agencies; 3) concerns regarding CPS notifications for all substance exposure types, including prenatal exposure to medication for opioid use disorder (MOUD); 4) common family needs and service referrals; 5) challenges engaging with families; 6) lack of knowledge among health care providers and CPS social workers regarding CC4C; and 7) benefits of the program for infants and families. From January 2018 to October 2019, 91% of notifications for substance-affected infants received by Wake County CPS as part of the NC POSC were screened-in for a maltreatment assessment. Of those screened-in, more than two-thirds (70%) involved prenatal marijuana exposure only.LIMITATIONS This project was limited to one county.CONCLUSIONS As NC POSC implementation continues, further consideration of the infrastructure and guidance available to address the implementation challenges identified by stakeholders will be essential to meeting family needs and promoting infant safety and well-being.
Collapse
Affiliation(s)
- Anna E Austin
- Assistant professor, Department of Maternal and Child Health, Gillings School of Global Public Health and research scientist, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Meghan E Shanhan
- Assistant professor, Department of Maternal and Child Health, Gillings School of Global Public Health and research scientist, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paige Rosemond
- Director, Division of Child Welfare, Wake County Human Services, Raleigh, North Carolina
| | - Molly C Berkoff
- Pediatrician, Division of Child Welfare, Wake County Human Services, Raleigh, North Carolina; principal investigator/medical director, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Catherine Joyner
- Executive director, Child Maltreatment Prevention Leadership Team, Women's and Children's Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott Proescholdbell
- Epidemiology, surveillance, and informatics unit manager, Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| |
Collapse
|
11
|
Cox ME, Smith MA, Patel AR, Proescholdbell S, Bell RA. Sidebar: Community-driven Approaches to Preventing Overdoses Among American Indians. N C Med J 2021; 82:409-411. [PMID: 34750219 DOI: 10.18043/ncm.82.6.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary E Cox
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
| | - Margaret A Smith
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Amy R Patel
- Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott Proescholdbell
- Epidemiology, Surveillance and Informatics Unit, Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Ronny A Bell
- Department of Social Sciences and Health Policy Division of Public Health Sciences, Wake Forest School of Medicine; associate director, Community Outreach and Engagement and director, Office of Cancer Health Equity, Wake Forest Baptist Comprehensive Cancer Center; chair, North Carolina American Indian Health Board, Winston-Salem, North Carolina
| |
Collapse
|
12
|
Remch M, Mautz C, Burke EG, Junker G, Kaniuka A, Proescholdbell S, Marshall SW, Naumann RB. Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes. Am J Prev Med 2021; 61:619-627. [PMID: 34686299 DOI: 10.1016/j.amepre.2021.05.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Incarcerated individuals with mental health disorders are disproportionally sent to restrictive housing (i.e., solitary confinement), which is known to have deleterious impacts on mental health. In response, North Carolina's prison system developed Therapeutic Diversion Units, treatment-oriented units for incarcerated individuals with high mental health needs who cycle in and out of restrictive housing. This analysis compares the impact of restrictive housing and Therapeutic Diversion Units on infractions, mental health, and self-harm among incarcerated individuals. METHODS Data were 2016-2019 incarceration records from North Carolina prisons. Outcomes were rates of infractions, inpatient mental health admissions, and self-harm in restrictive housing and Therapeutic Diversion Units. Inverse probability of treatment weights was used to adjust for confounding, and Poisson regression with generalized estimating equations was used to estimate adjusted rate ratios. Analyses were conducted between January and December 2020. RESULTS The analytic sample was 3,480 people, of whom 463 enrolled in a Therapeutic Diversion Unit. Compared with Therapeutic Diversion Unit rates, the rate of infractions was 3 times as high in restrictive housing (adjusted rate ratio=2.99, 95% CI=2.31, 3.87), the inpatient mental health admissions rate was 3.5 times as high (adjusted rate ratio=3.57, 95% CI=1.97, 6.46), and the self-injury incident rate was 3.5 times as high (adjusted rate ratio=3.46, 95% CI=2.11, 5.69). CONCLUSIONS Therapeutic Diversion Unit use had strong impacts on infractions, mental health, and self-harm. Therapeutic Diversion Units provide a promising alternative to restrictive housing for individuals with mental health disorders.
Collapse
Affiliation(s)
- Molly Remch
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charles Mautz
- Division of Adult Correction and Juvenile Justice, North Carolina Department of Public Safety, Raleigh, North Carolina
| | - Emily G Burke
- Division of Adult Correction and Juvenile Justice, North Carolina Department of Public Safety, Raleigh, North Carolina
| | - Gary Junker
- Division of Adult Correction and Juvenile Justice, North Carolina Department of Public Safety, Raleigh, North Carolina
| | - Andrea Kaniuka
- Department of Public Health Sciences, College of Health and Human Services, The University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Scott Proescholdbell
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Stephen W Marshall
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Injury Prevention Research Center (IPRC), The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Injury Prevention Research Center (IPRC), The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
13
|
Shiue KY, Austin AE, Proescholdbell S, Cox ME, Aurelius M, Naumann RB. Literal text analysis of poly-class and polydrug overdose deaths in North Carolina, 2015-2019. Drug Alcohol Depend 2021; 228:109048. [PMID: 34601275 DOI: 10.1016/j.drugalcdep.2021.109048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/27/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The literal text on death certificates was leveraged to enhance the examination of trends in the specific drugs and drug combinations involved in North Carolina (NC) overdose deaths from 2015 to 2019. METHODS Using NC death certificate data, overdose deaths included those with a drug poisoning as the underlying ICD-10 cause-of-death code (n = 10,117). The literal text from three death certificate fields were searched for drug mentions by integrating a tool developed by the Council of State and Territorial Epidemiologists Overdose Subcommittee with search terms originating from a National Center for Health Statistics/Food and Drug Administration collaboration. Descriptive statistics were calculated to evaluate substance classes, specific drugs, and drug combinations most frequently involved in these deaths over time. RESULTS From 2015-2019, polydrug involvement in NC overdose deaths increased (71% in 2015 to 75% in 2019). During the study period, opioid involvement shifted from heroin and/or oxycodone in 2015 to predominantly fentanyl in 2019, with fentanyl involvement increasing from 15% to 58%. Psychostimulant involvement increased for both cocaine (2015: 21%, 2019: 35%) and methamphetamine (2015: 3%, 2019: 13%). Benzodiazepine involvement, including alprazolam and clonazepam, declined during the study period, while the involvement of alcohol and antiepileptics/sedative-hypnotics, specifically gabapentin, remained stable. The top polydrug combinations in 2019 were fentanyl + cocaine (15% of all overdose deaths), fentanyl + heroin (10%), fentanyl + cocaine + heroin (6%), and fentanyl + methamphetamine (4%). CONCLUSIONS Incorporation of literal text methodology into ongoing overdose surveillance can facilitate the identification of specific, emerging drugs and combinations and inform targeted overdose prevention approaches.
Collapse
Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States.
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Michelle Aurelius
- Office of the Chief Medical Examiner, Division of Public Health, North Carolina Department of Health and Human Services, 4312 District Drive, Raleigh, NC 27607, United States
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States
| |
Collapse
|
14
|
Fliss MD, Cox ME, Wallace JW, Simon MC, Knuth KB, Proescholdbell S. Measuring and Mapping Alcohol Outlet Environment Density, Clusters, and Racial and Ethnic Disparities in Durham, North Carolina, 2017. Prev Chronic Dis 2021; 18:E89. [PMID: 34554907 PMCID: PMC8462284 DOI: 10.5888/pcd18.210127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mike Dolan Fliss
- University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina.,North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina.,170 Rosenau Hall, CB #7400, 135 Dauer Dr, Chapel Hill, NC 27599 7400.
| | - Mary E Cox
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina
| | - John W Wallace
- North Carolina Institute for Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew C Simon
- North Carolina Institute for Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kendall B Knuth
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina.,Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia
| | - Scott Proescholdbell
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina
| |
Collapse
|
15
|
Austin AE, Bona VD, Cox ME, Proescholdbell S, Fliss MD, Naumann RB. Prenatal Use of Medication for Opioid Use Disorder and Other Prescription Opioids in Cases of Neonatal Opioid Withdrawal Syndrome: North Carolina Medicaid, 2016-2018. Am J Public Health 2021; 111:1682-1685. [PMID: 34383554 PMCID: PMC8589053 DOI: 10.2105/ajph.2021.306374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016-2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016-2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy.
Collapse
Affiliation(s)
- Anna E Austin
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| | - Vito Di Bona
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| | - Mary E Cox
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| | - Scott Proescholdbell
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| | - Michael Dolan Fliss
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| | - Rebecca B Naumann
- Anna E. Austin is with the Department of Maternal and Child Health, Gillings School of Global Public Health, and the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Vito Di Bona is with the North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Mary E. Cox and Scott Proescholdbell are with the Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Michael Dolan Fliss is with the Injury Prevention Research Center, University of North Carolina, Chapel Hill. Rebecca B. Naumann is with the Department of Epidemiology, Gillings School of Global Public Health and the Injury Prevention Research Center, University of North Carolina, Chapel Hill
| |
Collapse
|
16
|
Figgatt MC, Austin AE, Cox ME, Proescholdbell S, Marshall SW, Naumann RB. Trends in unintentional polysubstance overdose deaths and individual and community correlates of polysubstance overdose, North Carolina, 2009-2018. Drug Alcohol Depend 2021; 219:108504. [PMID: 33429292 PMCID: PMC8126267 DOI: 10.1016/j.drugalcdep.2020.108504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/17/2020] [Revised: 11/13/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Polysubstance involvement is increasing among fatal drug overdoses. However, little is known about the epidemiology of polysubstance drug overdoses. This paper describes emerging trends in unintentional polysubstance overdose deaths in North Carolina (NC) and examines associations with individual and community factors. METHODS Using 2009-2018 NC death certificate data, we identified unintentional drug overdose deaths and commonly involved substances (opioids, stimulants, benzodiazepines, alcohol, and antiepileptics). We examined polysubstance combinations, comparing opioid and non-opioid involved deaths. We examined individual level correlates from death certificate data and community level correlates from the American Community Survey and Robert Wood Johnson Foundation County Health Rankings to quantify associations. RESULTS From 2009-2018, 53 % of opioid and 19 % of non-opioid overdose deaths involved multiple substances. During this period, polysubstance overdose death increased dramatically, from 2.9 to 12.1 per 100,000 persons, with the greatest increases among drug combinations involving stimulants. The most common polysubstance combinations were: opioids and stimulants (12.1 % of overdose deaths); opioids and benzodiazepines (9.0 %); opioids and alcohol (5.1 %); opioids, stimulants, and benzodiazepines (3.1 %); and opioids, benzodiazepines, and antiepileptics (2.2 %). Compared to overdoses involving opioids alone, overdoses involving combinations of opioids, stimulants, and benzodiazepines involved younger individuals (53.7 % in 15-34 years of age vs. 40.7 %). Men comprised two-thirds of overdoses involving opioids alone, however, overdoses involving opioids, benzodiazepines, and antiepileptics were predominantly among women (60.6 %). CONCLUSIONS Polysubstance involvement has increased among overdose deaths in NC. These findings can be used to inform public health interventions addressing polysubstance deaths and associated individual and community level factors.
Collapse
Affiliation(s)
- Mary C Figgatt
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States.
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, United States.
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC, 27699-1915, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC, 27699-1915, United States
| | - Stephen W Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States.
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC, 27514, United States.
| |
Collapse
|
17
|
Waltzman D, Daugherty J, Sarmiento K, Proescholdbell S. Lifetime History of Traumatic Brain Injury With Loss of Consciousness and the Likelihood for Lifetime Depression and Risk Behaviors: 2017 BRFSS North Carolina. J Head Trauma Rehabil 2021; 36:E40-E49. [PMID: 32769836 PMCID: PMC7769859 DOI: 10.1097/htr.0000000000000603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/21/2022]
Abstract
OBJECTIVE Because of the growing concern about the potential effects of traumatic brain injuries (TBIs) on a child's developing brain and the potential impact of lifetime depression and risk behaviors associated with TBI, further exploration is warranted. SETTING AND PARTICIPANTS Data (N = 4917) from the 2017 North Carolina Behavioral Risk Factors Surveillance System (BRFSS). DESIGN Cross-sectional. MAIN MEASURES Examine whether a lifetime history of TBI with loss of consciousness (LOC) or having a history of TBI with LOC prior to 18 years of age was associated with a greater likelihood of lifetime depression, current binge drinking, and current cigarette and e-cigarette smoking. RESULTS Respondents with a history of TBI with LOC had 2.1 (95% CI, 1.6-2.8) times higher odds of lifetime depression and 1.7 to 1.8 (95% CI, 1.02-2.97) times higher odds of all risk behaviors than those without a lifetime history of TBI with LOC. There were no statistical differences between age of first TBI with LOC and lifetime depression, binge drinking, cigarette smoking, and e-cigarette use after controlling for key demographics. CONCLUSION These findings underscore the importance of increasing awareness among healthcare providers of the prevalence of lifetime depression and risk behaviors among individuals with a history of TBI and the need for improved screening and referrals to evidence-based services.
Collapse
Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Waltzman and Daugherty and Ms Sarmiento); and Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina (Mr Proescholdbell)
| | | | | | | |
Collapse
|
18
|
Singichetti B, Naumann RB, Sauber-Schatz E, Proescholdbell S, Marshall SW. Potential injuries and costs averted by increased use of evidence-based behavioral road safety policies in North Carolina. Traffic Inj Prev 2020; 21:545-551. [PMID: 33095063 PMCID: PMC8126265 DOI: 10.1080/15389588.2020.1824066] [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: 05/20/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.
Collapse
Affiliation(s)
- Bhavna Singichetti
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
| | - Rebecca B. Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
| | - Erin Sauber-Schatz
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention; United States Public Health Service; 4770 Buford Highway, N.E., Mailstop S106-9, Atlanta, GA 30341, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services; 5505 Six Forks Rd, Raleigh, NC 27609, United States
| | - Stephen W. Marshall
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
| |
Collapse
|
19
|
Naumann RB, Durrance CP, Ranapurwala SI, Austin AE, Proescholdbell S, Childs R, Marshall SW, Kansagra S, Shanahan ME. Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug Alcohol Depend 2019; 204:107536. [PMID: 31494440 PMCID: PMC8107918 DOI: 10.1016/j.drugalcdep.2019.06.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In August 2013, a naloxone distribution program was implemented in North Carolina (NC). This study evaluated that program by quantifying the association between the program and county-level opioid overdose death (OOD) rates and conducting a cost-benefit analysis. METHODS One-group pre-post design. Data included annual county-level counts of naloxone kits distributed from 2013 to 2016 and mortality data from 2000-2016. We used generalized estimating equations to estimate the association between cumulative rates of naloxone kits distributed and annual OOD rates. Costs included naloxone kit purchases and distribution costs; benefits were quantified as OODs avoided and monetized using a conservative value of a life. RESULTS The rate of OOD in counties with 1-100 cumulative naloxone kits distributed per 100,000 population was 0.90 times (95% CI: 0.78, 1.04) that of counties that had not received kits. In counties that received >100 cumulative kits per 100,000 population, the OOD rate was 0.88 times (95% CI: 0.76, 1.02) that of counties that had not received kits. By December 2016, an estimated 352 NC deaths were avoided by naloxone distribution (95% CI: 189, 580). On average, for every dollar spent on the program, there was $2742 of benefit due to OODs avoided (95% CI: $1,237, $4882). CONCLUSIONS Our estimates suggest that community-based naloxone distribution is associated with lower OOD rates. The program generated substantial societal benefits due to averted OODs. States and communities should continue to support efforts to increase naloxone access, which may include reducing legal, financial, and normative barriers.
Collapse
Affiliation(s)
- Rebecca B Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA.
| | - Christine Piette Durrance
- Department of Public Policy, University of North Carolina at Chapel Hill, 203 Abernethy Hall, CB #3435, Chapel Hill, NC 27599 USA.
| | - Shabbar I Ranapurwala
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA.
| | - Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA.
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, NC Department of Health and Human Services, 5505 Six Forks Road, Raleigh, NC 27609 USA.
| | - Robert Childs
- Formerly (and at time of this work): Consultant to North Carolina Harm Reduction Coalition, Currently: JBS International, Inc., 5515 Security Lane, Suite 800, North Bethesda, MD 20852 USA.
| | - Stephen W Marshall
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA.
| | - Susan Kansagra
- Chronic Disease and Injury Section, Division of Public Health, NC Department of Health and Human Services, 5505 Six Forks Road, Raleigh, NC 27609 USA.
| | - Meghan E Shanahan
- Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB #7505, Chapel Hill, NC 27599 USA.
| |
Collapse
|
20
|
Brinkley-Rubinstein L, Sivaraman J, Rosen DL, Cloud DH, Junker G, Proescholdbell S, Shanahan ME, Ranapurwala SI. Association of Restrictive Housing During Incarceration With Mortality After Release. JAMA Netw Open 2019; 2:e1912516. [PMID: 31584680 PMCID: PMC6784785 DOI: 10.1001/jamanetworkopen.2019.12516] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. OBJECTIVE To characterize the association of restrictive housing with reincarceration and mortality after release. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. EXPOSURES Restrictive housing during incarceration. MAIN OUTCOMES AND MEASURES Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. RESULTS From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). CONCLUSIONS AND RELEVANCE This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.
Collapse
Affiliation(s)
- Lauren Brinkley-Rubinstein
- Center for Health Equity Research, University of North Carolina at Chapel Hill
- Department of Social Medicine, University of North Carolina at Chapel Hill
| | - Josie Sivaraman
- Injury Prevention Center, University of North Carolina at Chapel Hill
| | - David L. Rosen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - David H. Cloud
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia
| | - Gary Junker
- North Carolina Department of Public Safety, Raleigh
| | | | | | - Shabbar I. Ranapurwala
- Injury Prevention Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| |
Collapse
|
21
|
Cox ME, Dzialowy N, Armstrong L, Proescholdbell S. Overdose Deaths and Acute Hepatitis Infections among American Indians in North Carolina. N C Med J 2019; 80:197-203. [PMID: 31278177 DOI: 10.18043/ncm.80.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Like the rest of the nation, North Carolina is experiencing the worst drug crisis in United States history, as deaths related to medication and drug overdoses are at an all-time high. Although the absolute numbers of deaths are highest among white populations, American Indians (AIs) experience disproportionally high rates.METHOD Using death certificate data, death rates due to unintentional medication and drug overdose were calculated for various races and ethnicities. Acute hepatitis B (HBV) and acute hepatitis C (HCV) rates were also calculated across racial and ethnic groups using data from the North Carolina Electronic Disease Surveillance System.RESULTS After adjusting for population size, AIs have as high or higher overdose death rates for all types of drugs except heroin, compared to other racial and ethnic groups. During the most recent 5 years of data (2012-2016), the highest rate of acute HCV infection occurred among AIs.LIMITATIONS Race/ethnicity data recorded on death certificates is often provided by family members and is difficult to verify independently. Another potential limitation is use of small numbers to calculate rates. Additionally, HBV and HCV are thought to be underreported.CONCLUSION Overdose death rates and rates of communicable diseases associated with injection drug use among AIs residing in North Carolina are as high as or higher than the overall North Carolina population. It is important to recognize and address these differences and provide prevention, harm reduction, and treatment services to all groups being impacted by the overdose epidemic.
Collapse
Affiliation(s)
- Mary E Cox
- epidemiologist, Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Nicole Dzialowy
- epidemiologist, HIV/Viral Hepatitis Section, Communicable Disease Branch North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Lillie Armstrong
- program consultant, Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott Proescholdbell
- epidemiologist, Injury and Violence Prevention Branch, North Carolina Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| |
Collapse
|
22
|
Tanz LJ, Hoffman MN, Dandeneau D, Faigen Z, Moore Z, Proescholdbell S, Kansagra SM. Notes from the Field: Hurricane Florence-Related Emergency Department Visits - North Carolina, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:631-632. [PMID: 31318852 PMCID: PMC6657771 DOI: 10.15585/mmwr.mm6828a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
23
|
Harduar Morano L, Richardson D, Proescholdbell S. Descriptive evaluation of methods for identifying work-related emergency department injury visits. Am J Ind Med 2019; 62:568-579. [PMID: 31104330 DOI: 10.1002/ajim.22984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/11/2018] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.
Collapse
Affiliation(s)
- Laurel Harduar Morano
- Department of Emergency Medicine, Center for Health InformaticsUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - David Richardson
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel Hill North Carolina
| | - Scott Proescholdbell
- Injury and Violence Prevention BranchNC Division of Public HealthRaleigh North Carolina
| |
Collapse
|
24
|
Ranapurwala SI, Shanahan ME, Alexandridis AA, Proescholdbell S, Naumann RB, Edwards D, Marshall SW. Ranapurwala et al. Respond. Am J Public Health 2019; 109:e9-e10. [DOI: 10.2105/ajph.2018.304823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Shabbar I. Ranapurwala
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Meghan E. Shanahan
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Apostolos A. Alexandridis
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Scott Proescholdbell
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Rebecca B. Naumann
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Daniel Edwards
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| | - Stephen W. Marshall
- Shabbar I. Ranapurwala, Apostolos A. Alexandridis, Rebecca B. Naumann, and Stephen W. Marshall are with the Department of Epidemiology, University of North Carolina, Chapel Hill. Meghan E. Shanahan is with the Department of Maternal and Child Health, University of North Carolina. Scott Proescholdbell is with the Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh. Daniel Edwards Jr is with the Division of Adult Correction & Juvenile Justice, North Carolina Department
| |
Collapse
|
25
|
Cox ME, Dzialowy N, Armstrong L, Proescholdbell S. Trends in U.S. Drug Overdose Deaths. Ann Intern Med 2018; 169:355-356. [PMID: 30178015 DOI: 10.7326/l18-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mary E Cox
- North Carolina Division of Public Health, Raleigh, North Carolina (M.E.C., N.D.)
| | - Nicole Dzialowy
- North Carolina Division of Public Health, Raleigh, North Carolina (M.E.C., N.D.)
| | - Lillie Armstrong
- North Carolina Department of Health and Human Services, Raleigh, North Carolina (L.A., S.P.)
| | - Scott Proescholdbell
- North Carolina Department of Health and Human Services, Raleigh, North Carolina (L.A., S.P.)
| |
Collapse
|
26
|
Khatiwoda P, Proeschold-Bell RJ, Meade CS, Park LP, Proescholdbell S. Facilitators and Barriers to Naloxone Kit Use Among Opioid-Dependent Patients Enrolled in Medication Assisted Therapy Clinics in North Carolina. N C Med J 2018; 79:149-155. [PMID: 29735615 DOI: 10.18043/ncm.79.3.149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Naloxone-an opioid antagonist that reverses the effects of opioids-is increasingly being distributed in non-medical settings. We sought to identify the facilitators of, and barriers to, opioid users using naloxone kits in North Carolina.METHODS In 2015, we administered a 15-item survey to a convenience sample of 100 treatment seekers at 4 methadone/buprenorphine Medication Assisted Therapy (MAT) clinics in North Carolina.RESULTS Seventy-four percent of participants reported having ever gotten a naloxone kit; this percentage was higher for females (81%) than males (63%) (P = .06). The primary reason given for not having a kit was not knowing where to get one. Only 6% had heard of kits from the media and only 5% received one from a medical provider. Among kit recipients, 56% of both females and males reported mostly or sometimes carrying the kit, with additional participants reporting always. Reasons for not carrying a kit were no longer being around drugs, forgetting it, and the kit being too large. Men discussed the difficulties of carrying the naloxone kits, which are currently too large to fit in a pocket. Ninety-four percent of naloxone users reported intending to call emergency services in case of an overdose emergency.LIMITATIONS Study limitations included a small sample, participants limited to MAT clinics, and a predominantly white sample.CONCLUSIONS MAT treatment seekers reported a willingness to carry and use naloxone kits. Education, outreach, media, and medical providers need to promote naloxone kits. A smaller kit may increase the likelihood of men carrying one.
Collapse
Affiliation(s)
| | - Rae Jean Proeschold-Bell
- associate research professor, Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Durham, North Carolina
| | - Christina S Meade
- associate professor, Duke University School of Medicine, Duke Global Health Institute, Durham, North Carolina
| | - Lawrence P Park
- associate professor, Duke University School of Medicine, Duke Global Health Institute, Durham, North Carolina
| | - Scott Proescholdbell
- epidemiologist, Injury and Violence Prevention Branch, North Carolina Division of Public Health, Raleigh, North Carolina
| |
Collapse
|
27
|
Bixler D, Corby-Lee G, Proescholdbell S, Ramirez T, Kilkenny ME, LaRocco M, Childs R, Brumage MR, Settle AD, Teshale EH, Asher A. Access to Syringe Services Programs - Kentucky, North Carolina, and West Virginia, 2013-2017. MMWR Morb Mortal Wkly Rep 2018; 67:529-532. [PMID: 29746453 PMCID: PMC5944974 DOI: 10.15585/mmwr.mm6718a5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013-August 1, 2017. State-level data on the number of SSPs, client visits, and services offered were collected by each state through surveys of SSPs and aggregated in a standard format for this report. In 2013, one SSP operated in a free clinic in West Virginia, and SSPs were illegal in Kentucky and North Carolina; by August 2017, SSPs had been legalized in Kentucky and North Carolina, and 53 SSPs operated in the three states. In many cases, SSPs provide integrated services to address hepatitis and human immunodeficiency virus (HIV) infection, overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of IDU. Prioritizing development of SSPs with sufficient capacity, particularly in states with counties vulnerable to epidemics of hepatitis and HIV infection related to IDU, can expand access to care for populations at risk.
Collapse
|
28
|
Ringwalt C, Sanford C, Dasgupta N, Alexandridis A, McCort A, Proescholdbell S, Sachdeva N, Mack K. Community Readiness to Prevent Opioid Overdose. Health Promot Pract 2018; 19:747-755. [PMID: 29400083 DOI: 10.1177/1524839918756887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/27/2023]
Abstract
Effective community-based actions are urgently needed to combat the ongoing epidemic of opioid overdose. Community readiness (CR) has been linked to communities' support for collective action, which in turn has been associated with the success of community-wide prevention strategies and resulting behavior change. Our study, conducted in North Carolina, assessed the relationship between CR and two indices of opioid overdose. County-level data included a survey of health directors that assessed CR to address drug overdose prevention programs, surveillance measures of opioid overdose collected from death records and emergency departments, and two indicators of general health-related status. We found that counties' rates of CR were positively associated with their opioid-related mortality (but not morbidity) and that this relationship persisted when we controlled for health status. North Carolina counties with the highest opioid misuse problems appear to be the most prepared to respond to them.
Collapse
Affiliation(s)
| | | | - Nabarun Dasgupta
- 1 University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Agnieszka McCort
- 1 University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Nidhi Sachdeva
- 2 NC Department of Health and Human Services, Raleigh, NC, USA
| | - Karin Mack
- 3 Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
29
|
Hedegaard H, Schoenbaum M, Claassen C, Crosby A, Holland K, Proescholdbell S. Issues in Developing a Surveillance Case Definition for Nonfatal Suicide Attempt and Intentional Self-harm Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Coded Data. Natl Health Stat Report 2018:1-19. [PMID: 29616901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Suicide and intentional self-harm are among the leading causes of death in the United States. To study this public health issue, epidemiologists and researchers often analyze data coded using the International Classification of Diseases (ICD). Prior to October 1, 2015, health care organizations and providers used the clinical modification of the Ninth Revision of ICD (ICD-9-CM) to report medical information in electronic claims data. The transition in October 2015 to use of the clinical modification of the Tenth Revision of ICD (ICD-10-CM) resulted in the need to update methods and selection criteria previously developed for ICD-9-CM coded data. This report provides guidance on the use of ICD-10-CM codes to identify cases of nonfatal suicide attempts and intentional self-harm in ICD-10-CM coded data sets. ICD-10-CM codes for nonfatal suicide attempts and intentional self-harm include: X71-X83, intentional self-harm due to drowning and submersion, firearms, explosive or thermal material, sharp or blunt objects, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, and other specified means; T36-T50 with a 6th character of 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, which are included if the 5th character is 2), intentional self-harm due to drug poisoning (overdose); T51-T65 with a 6th character of 2 (except for T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9, which are included if the 5th character is 2), intentional self-harm due to toxic effects of nonmedicinal substances; T71 with a 6th character of 2, intentional self-harm due to asphyxiation, suffocation, strangulation; and T14.91, Suicide attempt. Issues to consider when selecting records for nonfatal suicide attempts and intentional self-harm from ICD-10-CM coded administrative data sets are also discussed.
Collapse
|
30
|
Hume B, Gabella B, Hathaway J, Proescholdbell S, Sneddon C, Brutsch E, Hedin R, Drucker CJ. Assessment of Selected Overdose Poisoning Indicators in Health Care Administrative Data in 4 States, 2012. Public Health Rep 2017. [PMID: 28633003 DOI: 10.1177/0033354917718061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/15/2022] Open
Abstract
OBJECTIVES In 2012, a consensus document was developed on drug overdose poisoning definitions. We took the opportunity to apply these new definitions to health care administrative data in 4 states. Our objective was to calculate and compare drug (particularly opioid) poisoning rates in these 4 states for 4 selected Injury Surveillance Workgroup 7 (ISW7) drug poisoning indicators, using 2 ISW7 surveillance definitions, Option A and Option B. We also identified factors related to the health care administrative data used by each state that might contribute to poisoning rate variations. METHODS We used state-level hospital and emergency department (ED) discharge data to calculate age-adjusted rates for 4 drug poisoning indicators (acute drug poisonings, acute opioid poisonings, acute opioid analgesic poisonings, and acute or chronic opioid poisonings) using just the principal diagnosis or first-listed external cause-of-injury fields (Option A) or using all diagnosis or external cause-of-injury fields (Option B). We also calculated the high-to-low poisoning rate ratios to measure rate variations. RESULTS The average poisoning rates per 100 000 population for the 4 ISW7 poisoning indicators ranged from 11.2 to 216.4 (ED) and from 14.2 to 212.8 (hospital). For each indicator, ED rates were usually higher than were hospital rates. High-to-low rate ratios between states were lowest for the acute drug poisoning indicator (range, 1.5-1.6). Factors potentially contributing to rate variations included administrative data structure, accessibility, and submission regulations. CONCLUSIONS The ISW7 Option B surveillance definition is needed to fully capture the state burden of opioid poisonings. Efforts to control for factors related to administrative data, standardize data sources on a national level, and improve data source accessibility for state health departments would improve the accuracy of drug poisoning surveillance.
Collapse
Affiliation(s)
- Beth Hume
- 1 Department of Public Health, Injury Surveillance Program, Office of Statistics and Evaluation, Boston, MA, USA
| | - Barbara Gabella
- 2 Department of Public Health and Environment, Denver, CO, USA
| | - Jeanne Hathaway
- 1 Department of Public Health, Injury Surveillance Program, Office of Statistics and Evaluation, Boston, MA, USA
| | - Scott Proescholdbell
- 3 Division of Public Health, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Raleigh, NC, USA
| | - Cristy Sneddon
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Elizabeth Brutsch
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Riley Hedin
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| | - Christopher J Drucker
- 4 Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT, USA
| |
Collapse
|
31
|
Ising A, Proescholdbell S, Harmon KJ, Sachdeva N, Marshall SW, Waller AE. Use of syndromic surveillance data to monitor poisonings and drug overdoses in state and local public health agencies. Inj Prev 2017; 22 Suppl 1:i43-9. [PMID: 27044495 DOI: 10.1136/injuryprev-2015-041821] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/19/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The incidence of poisoning and drug overdose has risen rapidly in the USA over the last 16 years. To inform local intervention approaches, local health departments (LHDs) in North Carolina (NC) are using a statewide syndromic surveillance system that provides timely, local emergency department (ED) and Emergency Medical Services (EMS) data on medication and drug overdoses. OBJECTIVE The purpose of this article is to describe the development and use of a variety of case definitions for poisoning and overdose implemented in NC's syndromic surveillance system and the impact of the system on local surveillance initiatives. DESIGN, SETTING, PARTICIPANTS Thirteen new poisoning and overdose-related case definitions were added to NC's syndromic surveillance system and LHDs were trained on their use for surveillance purposes. Twenty-one LHDs were surveyed on the utility and impact of these new case definitions. RESULTS/CONCLUSIONS Ninety-one per cent of survey respondents (n = 29) agreed or strongly agreed that their ability to access timely ED data was vital to inform community-level overdose prevention work. Providing LHDs with access to local, timely data to identify pockets of need and engage stakeholders facilitates the practice of informed injury prevention and contributes to the reduction of injury incidence in their communities.
Collapse
Affiliation(s)
- Amy Ising
- Department of Emergency Medicine, Carolina Center for Health Informatics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Scott Proescholdbell
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina, USA
| | - Katherine J Harmon
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Nidhi Sachdeva
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna E Waller
- Department of Emergency Medicine, Carolina Center for Health Informatics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
32
|
Dasgupta N, Funk MJ, Proescholdbell S, Hirsch A, Ribisl KM, Marshall S. Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality. Pain Med 2016; 17:85-98. [PMID: 26333030 DOI: 10.1111/pme.12907] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/17/2015] [Accepted: 08/02/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Previous studies examining opioid dose and overdose risk provide limited granularity by milligram strength and instead rely on thresholds. We quantify dose-dependent overdose mortality over a large spectrum of clinically common doses. We also examine the contributions of benzodiazepines and extended release opioid formulations to mortality. DESIGN Prospective observational cohort with one year follow-up. SETTING One year in one state (NC) using a controlled substances prescription monitoring program, with name-linked mortality data. SUBJECTS Residential population of North Carolina (n = 9,560,234), with 2,182,374 opioid analgesic patients. METHODS Exposure was dispensed prescriptions of solid oral and transdermal opioid analgesics; person-years calculated using intent-to-treat principles. Outcome was overdose deaths involving opioid analgesics in a primary or additive role. Poisson models were created, implemented using generalized estimating equations. RESULTS Opioid analgesics were dispensed to 22.8% of residents. Among licensed clinicians, 89.6% prescribed opioid analgesics, and 40.0% prescribed ER formulations. There were 629 overdose deaths, half of which had an opioid analgesic prescription active on the day of death. Of 2,182,374 patients prescribed opioids, 478 overdose deaths were reported (0.022% per year). Mortality rates increased gradually across the range of average daily milligrams of morphine equivalents. 80.0% of opioid analgesic patients also received benzodiazepines. Rates of overdose death among those co-dispensed benzodiazepines and opioid analgesics were ten times higher (7.0 per 10,000 person-years, 95 percent CI: 6.3, 7.8) than opioid analgesics alone (0.7 per 10,000 person years, 95 percent CI: 0.6, 0.9). CONCLUSIONS Dose-dependent opioid overdose risk among patients increased gradually and did not show evidence of a distinct risk threshold. There is urgent need for guidance about combined classes of medicines to facilitate a better balance between pain relief and overdose risk.
Collapse
|
33
|
Scott SA, Proescholdbell S. Informing Best Practice With Community Practice: The Community Change Chronicle Method for Program Documentation and Evaluation. Health Promot Pract 2016; 10:102-10. [DOI: 10.1177/1524839907307677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health promotion professionals are increasingly encouraged to implement evidence-based programs in health departments, communities, and schools. Yet translating evidence-based research into practice is challenging, especially for complex initiatives that emphasize environmental strategies to create community change. The purpose of this article is to provide health promotion practitioners with a method to evaluate the community change process and document successful applications of environmental strategies. The community change chronicle method uses a five-step process: first, develop a logic model; second, select outcomes of interest; third, review programmatic data for these outcomes; fourth, collect and analyze relevant materials; and, fifth, disseminate stories. From 2001 to 2003, the authors validated the use of a youth empowerment model and developed eight community change chronicles that documented the creation of tobacco-free schools policies (n = 2), voluntary policies to reduce secondhand smoke in youth hangouts (n = 3), and policy and program changes in diverse communities (n = 3).
Collapse
Affiliation(s)
| | - Scott Proescholdbell
- North Carolina Division of Public Health, Chronic Disease
and Injury Section, Raleigh, North Carolina
| |
Collapse
|
34
|
Ringwalt C, Schiro S, Shanahan M, Proescholdbell S, Meder H, Austin A, Sachdeva N. The use of a prescription drug monitoring program to develop algorithms to identify providers with unusual prescribing practices for controlled substances. J Prim Prev 2016; 36:287-99. [PMID: 26143508 DOI: 10.1007/s10935-015-0397-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/23/2022]
Abstract
The misuse, abuse and diversion of controlled substances have reached epidemic proportion in the United States. Contributing to this problem are providers who over-prescribe these substances. Using one state's prescription drug monitoring program, we describe a series of metrics we developed to identify providers manifesting unusual and uncustomary prescribing practices. We then present the results of a preliminary effort to assess the concurrent validity of these algorithms, using death records from the state's vital records database pertaining to providers who wrote prescriptions to patients who then died of a medication or drug overdose within 30 days. Metrics manifesting the strongest concurrent validity with providers identified from these records related to those who co-prescribed benzodiazepines (e.g., valium) and high levels of opioid analgesics (e.g., oxycodone), as well as those who wrote temporally overlapping prescriptions. We conclude with a discussion of a variety of uses to which these metrics may be put, as well as problems and opportunities related to their use.
Collapse
Affiliation(s)
- Christopher Ringwalt
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Sharon Schiro
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Meghan Shanahan
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Harold Meder
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Austin
- North Carolina Division of Public Health, Raleigh, NC, USA
| | - Nidhi Sachdeva
- North Carolina Division of Public Health, Raleigh, NC, USA
| |
Collapse
|
35
|
Fleming E, Proescholdbell S, Sachdeva N, Alexandridis AA, Margolis L, Ransdell K. North Carolina's Operation Medicine Drop: Results From One of the Nation's Largest Drug Disposal Programs. N C Med J 2016; 77:59-62. [PMID: 26763245 DOI: 10.18043/ncm.77.1.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In 2013, a total of 1,085 North Carolina residents died due to unintentional poisoning; 91% of these deaths were attributed to medications or drugs (over-the-counter, prescription, or illicit). Proper disposal of unused, unneeded, and/or expired medications is an essential part of preventing these unintentional deaths, as well as averting the other adverse consequences of these drugs on the environment and population health. METHODS Operation Medicine Drop is a medication take-back program coordinated by Safe Kids North Carolina, a county-level, coalition-based injury prevention organization. The Operation Medicine Drop program and event registration system were used to review and validate the number of events, the counties where the events were held, and the number of unit doses (pills) collected from March 2010 to June 2014. SAS version 9.4 was used to generate basic counts and frequencies of events and doses, and ArcGIS version 10.0 was used to create the map. RESULTS From March 2010 to June 2014, Operation Medicine Drop held 1,395 events with 245 different participating law enforcement agencies in 91 counties in North Carolina, and it collected 69.6 million unit doses of medication. More than 60 local Safe Kids North Carolina community coalitions had participated as of June 2014. Every year, Operation Medicine Drop has witnessed increases in events, participating agencies, participating counties, and the number of doses collected. CONCLUSION Operation Medicine Drop is an excellent example of a successful and ongoing collaboration to improve public health. Medication take-back programs may play an important role in preventing future overdose deaths in North Carolina.
Collapse
Affiliation(s)
- Eleanor Fleming
- chronic disease epidemiologist, Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; chronic disease epidemiologist, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott Proescholdbell
- epidemiologist, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Nidhi Sachdeva
- program manager, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Apostolos A Alexandridis
- graduate research assistant, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lewis Margolis
- associate professor, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly Ransdell
- deputy director, Office of State Fire Marshal, North Carolina Department of Insurance, Raleigh, North Carolina
| |
Collapse
|
36
|
Austin A, Herrick H, Proescholdbell S. Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay, and Bisexual Individuals. Am J Public Health 2016; 106:314-20. [PMID: 26691127 PMCID: PMC4815563 DOI: 10.2105/ajph.2015.302904] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [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] [Accepted: 09/07/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs). METHODS Data were from the 2012 North Carolina, 2011 Washington, and 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29,690 heterosexual respondents. RESULTS LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated. CONCLUSIONS The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes.
Collapse
Affiliation(s)
- Anna Austin
- At the time of the study, Anna Austin and Scott Proescholdbell were with the Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Harry Herrick was with the Behavioral Risk Factor Surveillance System, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Harry Herrick
- At the time of the study, Anna Austin and Scott Proescholdbell were with the Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Harry Herrick was with the Behavioral Risk Factor Surveillance System, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Scott Proescholdbell
- At the time of the study, Anna Austin and Scott Proescholdbell were with the Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Harry Herrick was with the Behavioral Risk Factor Surveillance System, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| |
Collapse
|
37
|
Austin A, Herrick H, Proescholdbell S, Simmons J. Disability and Exposure to High Levels of Adverse Childhood Experiences: Effect on Health and Risk Behavior. N C Med J 2016; 77:30-36. [PMID: 26763241 DOI: 10.18043/ncm.77.1.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Indexed: 06/05/2023]
Abstract
BACKGROUND Health disparities among persons with disabilities have been previously documented. However, there is little research specific to adverse childhood experiences (ACEs) in this population and how ACE exposure affects health outcomes in adulthood. METHODS Data from the 2012 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to compare the prevalence of ACEs between adults with and without disabilities and high ACE exposure (3-8 ACEs). Adjusted risk ratios of health risks and perceived poor health by disability status were calculated using predicted marginals. RESULTS A higher percentage of persons with disabilities (36.5%) than those without disabilities (19.6%) reported high ACE exposure. Among those with high ACE exposure, persons with disabilities were more likely to report several ACE categories, particularly childhood sexual abuse. In adjusted analyses, persons with disabilities had an increased risk of smoking (relative risk [RR] = 1.29; 95% CI, 1.10-1.51), poor physical health (RR = 4.34; 95% CI, 3.08-6.11), poor mental health (RR = 4.69; 95% CI, 3.19-6.87), and doctor-diagnosed depression (RR = 2.16; 95% CI, 1.82-2.56) compared to persons without disabilities. LIMITATIONS The definition of disability derived from the BRFSS survey does not allow for those with disabilities to be categorized according to physical disabilities versus mental or emotional disabilities. In addition, we were unable to determine the timing of ACE exposure in relation to disability onset. CONCLUSIONS A better understanding of the life course associations between ACEs and disability and the impact of exposure to multiple types of childhood adversity on disability and health is needed to inform research and services specific to this vulnerable population.
Collapse
Affiliation(s)
- Anna Austin
- CDC/CSTE applied epidemiology fellow, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Harry Herrick
- survey analyst, Statistical Services Branch, State Center for Health Statistics, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott Proescholdbell
- head, Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Jacqueline Simmons
- disability and health specialist, Office on Disability and Health, Women and Children's Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| |
Collapse
|
38
|
DeFiore-Hyrmer J, Proescholdbell S, Bonta P. 0031 National violent death reporting system-what’s next? A panel session coordinated by the NVDRS special interest group (SIG). Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.3] [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: 11/04/2022]
|
39
|
Austin A, Herrick H, Proescholdbell S. 0018 Adverse childhood experiences, sexual orientation, and adult health: an analysis of north carolina, washington, and wisconsin behavioural risk factor surveillance system data. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.16] [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: 11/03/2022]
|
40
|
Proescholdbell S, Hedegaard H, Johnson R, Dao D, Hume B, Brutsch E. 0030 Making your worklife easier: resources and tools to efficiently respond to injury data requests. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.22] [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: 11/03/2022]
|
41
|
Austin A, Proescholdbell S, Holt C. Traumatic brain injuries in North Carolina. N C Med J 2015; 76:119-122. [PMID: 25856360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Anna Austin
- Injury Epidemiology and Surveillance Unit, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Scott Proescholdbell
- Injury Epidemiology and Surveillance Unit, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA.
| | - Carolina Holt
- Injury Epidemiology and Surveillance Unit, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| |
Collapse
|
42
|
Austin A, Proescholdbell S, Norwood T. 0017 Violent deaths among first responders: using north carolina violent death reporting system data to inform injury programs. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Sachdeva N, Bryson A, Massey J, Zuskov D, Moore E, Soora S, Proescholdbell S. 0032 Building capacity among local health departments to disseminate naloxone to community members in north carolina. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.23] [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: 11/03/2022]
|
44
|
Harmon K, Ising A, Proescholdbell S, Barnett C, Marshall S, Waller A. 0035 Development of 12 poisoning and drug overdose case definitions for use with emergency department data in North Carolina. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
45
|
Zane D, VanderWerf-Hourigan L, Brown S, Proescholdbell S. 0027 Strengthening disaster injury epidemiology capacity: update on potential responses to various disasters. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041602.20] [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: 11/03/2022]
|
46
|
Abstract
Evaluating program impact is a critical aspect of public health. Utilizing Geographic Information Systems (GIS) is a novel way to evaluate programs which try to reduce residential fire injuries and deaths. The purpose of this study is to demonstrate the application of GIS within the evaluation of a smoke alarm installation program in North Carolina. This approach incorporates national fire incident data which, when linked with program data, provides a clear depiction of the 10 years impact of the Get Alarmed, NC! program and estimates the number of potential lives saved. We overlapped Get Alarmed, NC! program installation data with national information on fires using GIS to identify homes that experienced a fire after an alarm was installed and calculated potential lives saved based on program documentation and average housing occupancy. We found that using GIS was an efficient and quick way to match addresses from two distinct sources. From this approach we estimated that between 221 and 384 residents were potentially saved due to alarms installed in their homes by Get Alarmed, NC!. Compared with other program evaluations that require intensive and costly participant telephone surveys and/or in-person interviews, the GIS approach is inexpensive, quick, and can easily analyze large disparate datasets. In addition, it can be used to help target the areas most at risk from the onset. These benefits suggest that by incorporating previously unutilized data, the GIS approach has the potential for broader applications within public health program evaluation.
Collapse
Affiliation(s)
- Thomas Dudley
- Injury and Violence Prevention Branch, NC Department of Health and Human Services, 5505 Six Forks Road, Bldg. 1, A-2, Raleigh, NC 27609, USA.
| | | | | | | |
Collapse
|
47
|
Langley R, Mack K, Haileyesus T, Proescholdbell S, Annest JL. National estimates of noncanine bite and sting injuries treated in US Hospital Emergency Departments, 2001-2010. Wilderness Environ Med 2014; 25:14-23. [PMID: 24433776 DOI: 10.1016/j.wem.2013.08.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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: 03/26/2013] [Revised: 06/21/2013] [Accepted: 08/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). METHODS The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. RESULTS From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9-447.3). Insects accounted for 67.5% (95% CI, 45.8-89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8-27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold-from 2156 visits in 2007 to 15,945 visits in 2010. CONCLUSIONS This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually.
Collapse
Affiliation(s)
- Ricky Langley
- North Carolina Department of Health and Human Services, Raleigh, NC.
| | - Karin Mack
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tadesse Haileyesus
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Joseph L Annest
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
48
|
Modarai F, Mack K, Hicks P, Benoit S, Park S, Jones C, Proescholdbell S, Ising A, Paulozzi L. Relationship of opioid prescription sales and overdoses, North Carolina. Drug Alcohol Depend 2013; 132:81-6. [PMID: 23399467 DOI: 10.1016/j.drugalcdep.2013.01.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [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: 09/26/2012] [Revised: 01/05/2013] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC). METHODS Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010. RESULTS Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r=0.68, p=0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses. CONCLUSIONS Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data.
Collapse
Affiliation(s)
- F Modarai
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Hwy, Mailstop F-62, Atlanta, GA 30341, United States.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Dailey NJM, Norwood T, Moore ZS, Fleischauer AT, Proescholdbell S. Evaluation of the North Carolina Violent Death Reporting System, 2009. N C Med J 2012; 73:257-262. [PMID: 23033709] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Violence is a leading cause of death in North Carolina. The North Carolina Violent Death Reporting System (NC-VDRS) is part of the National Violent Death Reporting System (NVDRS), which monitors violent deaths and collects information about injuries and psychosocial contributors. Our objective was to describe and evaluate the quality, timeliness, and usefulness of the system. METHODS We used the Centers for Disease Control and Prevention's guidelines for evaluating public health surveillance systems to assess the system. We performed subjective assessment of system attributes by reviewing system documents and interviewing stakeholders. We estimated NC-VDRS's reporting completeness using a capture-recapture method. RESULTS Stakeholders considered data provided by NC-VDRS to be of high quality. Reporting to the national system has taken place before the specified 6-month and 18-month deadlines, but local stakeholder reports have been delayed up to 36 months. Stakeholders reported using NC-VDRS data for program planning and community education. The system is estimated to capture all NVDRS-defined cases, but law enforcement officers report only 61% of suicides. LIMITATIONS The law enforcement agencies we interviewed may not be representative of all participating agencies in the state. Data sources used to assess completeness were not independent. CONCLUSION NC-VDRS is useful and well-accepted. However, completeness of suicide reporting is limited, and reporting to local stakeholders has been delayed. Improving these limitations might improve the usefulness of the system for planning and appropriately targeting violence prevention interventions.
Collapse
|
50
|
Kandra KL, Goldstein AO, Proescholdbell S. Variables associated with use and susceptibility to use of cigarettes among North Carolina adolescents: results from the 2007 statewide survey of high school students. N C Med J 2011; 72:13-19. [PMID: 21678684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND As North Carolina works to sustain recent reductions in smoking among adolescents, more knowledge is needed to design effective prevention programs. This study examined the variables associated with use and susceptibility to use of cigarettes use among North Carolina students in high school (ie, grades 9-12). METHODS Data were collected from the 2007 North Carolina Youth Tobacco Survey (NCYTS). The NCYTS is a biannual public school- and charter school-based survey of North Carolina students in grades 6-12. Seventy-four of 115 school districts from 3 distinct geographic regions of the state were selected for participation in the 2007 NCYTS. The survey was completed by 3,364 students (81.6%) at participating high schools, for an overall completion rate of 78.3% among all North Carolina high school students. Logistic regression models examined variables associated with current use of cigarettes, ever having used cigarettes (also referred to as "ever use"), and susceptibility to use of cigarettes. All analyses included sampling weights, which enabled results to be generalized to all high school students in North Carolina. RESULTS A total of 48.9% of students reported ever use, 19.0% were classified as current users, and 33.5% were classified as susceptible to use. Females, nonminorities, and older students had higher odds than males, minorities, and younger students, respectively, of being a current smoker. Minorities, however, had higher odds than nonminorities of ever smoking. Use of other forms of tobacco increased the odds of current use and ever use of cigarettes. Agreement with the statement that smoking makes one look cool or fit in increased the odds of being susceptible to smoking. Having a willingness to wear an item promoting a tobacco company and having close friends who smoked individually increased the odds of each of the 3 outcomes. LIMITATIONS Data are from a cross-sectional survey conducted every other year, in which students self-report use of, attitudes about, and perceptions about tobacco products. CONCLUSIONS Many variables should be taken into account to optimize efforts to prevent tobacco use, countermarket campaigns, and policy initiatives in North Carolina.
Collapse
Affiliation(s)
- Kelly L Kandra
- Department of Psychology, Benedictine University, 5700 College Rd, Lisle, IL 60532, USA.
| | | | | |
Collapse
|