Research News Roundup: December 15, 2022

    Collateral Consequences of the School-To-Prison Pipeline: Adolescent Substance Use and Developmental Risk

    Journal: Addictive Behaviors, 2023, doi: 10.1016/j.addbeh.2022.107524

    Authors: Seth J. Prins, Ruth T. Shefner, Sandhya Kajeepeta, Mark L. Hatzenbuehler, Charles C. Branas, Lisa R. Metsch & Stephen T. Russell


    Objective: The adolescent health consequences of the school-to-prison pipeline remain underexplored. We test whether initiating components of the school-to-prison pipeline-suspensions, expulsions, and school policing-are associated with higher school-average levels of student substance use, depressed feelings, and developmental risk in the following year.

    Method: We linked 2003-2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection from over 4,800 schools and 4,950,000 students. With lagged multi-level models, we estimated relationships between the school prevalence of total discipline, out-of-school discipline, and police-involved discipline, and standardized school-average levels of 6 substance use measures and 8 measures of developmental risk, respectively.

    Results: The prevalence of school discipline predicted subsequent school-mean substance use and developmental risk. A one-unit higher prevalence of total discipline predicted higher school levels (in standard deviations) of binge drinking alcohol (0.14, 95% CI: 0.11, 0.17), drinking alcohol (0.15, 95% CI: 0.12, 0.18), smoking tobacco (0.09, 95% CI: 0.06, 0.12), using cannabis (0.16, 95% CI: 0.14, 0.19), using other drugs (0.17, 95% CI: 0.14, 0.21), and violence/harassment (0.16, 95% CI: 0.12, 0.2). Total discipline predicted lower levels of reported community support (-0.07, 95% CI: -0.1, -0.05), feeling safe in school (-0.12, 95% CI: -0.16, -0.09), and school support (-0.16, 95% CI: -0.19, -0.12). Associations were greater in magnitude for more severe out-of-school discipline. Findings were inconsistent for police-involved discipline.

    Conclusion: Exclusionary school discipline and school policing-core elements of the school-to-prison pipeline-are previously unidentified population predictors of adolescent substance use and developmental risk.

    To read the full text of the article, please visit the publisher’s website.

    A Comparison of Cognitive Behavioral Therapy for Insomnia to Standard of Care in an Outpatient Substance Use Disorder Clinic Embedded within a Therapeutic Community: A RE-AIM Framework Evaluation

    Journal: Trials, 2022, doi: 10.1186/s13063-022-06885-7

    Authors: Traci J. Speed, Lisa Hanks, Gavin Turner, Evelyn Gurule, Alexandra Kearson, Luis Buenaver, Michael T. Smith & Denis Antoine


    Background: Rates of substance use disorders (SUDs) continue to rise in the USA with parallel rises in admissions to outpatient SUD treatment programs. Insomnia symptoms reduce treatment adherence, trigger relapse, and generally undermine SUD recovery efforts. Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia. No study has examined the effectiveness of CBT-I for individuals who recently entered an outpatient SUD treatment program embedded within a therapeutic community (i.e., long-term drug-free residential setting).

    Methods: A randomized controlled trial conducted at a SUD program embedded in a therapeutic community aimed to compare group-based CBT-I (gCBT-I) (N = 10) with the standard of care (SOC) (N = 11) among individuals who have SUDs and comorbid insomnia. We present a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework evaluation to provide empirical data on gCBT-I feasibility and facilitators and barriers of conducting an insomnia-focused clinical effectiveness study within a therapeutic community.

    Results: Participants in both study arms reported moderately severe insomnia symptoms at admission and reductions in insomnia symptoms over time. Among participants who completed the Insomnia Severity Index (ISI) beyond admission, ISI decreased to ≤ 8 (the clinical cutoff for mild insomnia) in 80% of individuals in the gCBT-I group compared with 25% of individuals in the SOC group. A RE-AIM framework evaluation showed initial success with Reach and Adoption while Implementation, and Maintenance were limited. Effectiveness was inconclusive because of challenges with recruitment, intervention integrity, and missing data that precluded meeting the planned recruitment and study aims and led to study termination. Coordination and communication with staff and leadership facilitated gCBT-I implementation, yet well-known CBT-I barriers including time- and resource-intensive sleep medicine training for interventionalists and maintenance of treatment integrity during an 8-week intervention limited gCBT-I sustainability.

    Conclusions: This analysis supports the feasibility of conducting behavioral sleep medicine research in outpatient SUD treatment programs embedded within therapeutic communities. Implementation of an insomnia-focused intervention was widely accepted by patients and providers and has potential to address insomnia symptoms in early SUD recovery. Addressing patient- and organizational-level implementation barriers may enhance the sustainability and scalability of sleep interventions and provide new hope to effectively treat insomnia among people living with SUDs.

    To read the full text of the article, please visit the publisher’s website.

    Journal: Journal of Medical Internet Research, 2022, doi: 10.2196/41527

    Authors: Thomas Patton, Daniela Abramovitz, Derek Johnson, Eric Leas, Alicia Nobles, Theodore Caputi, John Ayers, Steffanie Strathdee & Annick Bórquez


    Background: There is no recognized gold standard method for estimating the number of individuals with substance use disorders (SUDs) seeking help within a given geographical area. This presents a challenge to policy makers in the effective deployment of resources for the treatment of SUDs. Internet search queries related to help seeking for SUDs using Google Trends may represent a low-cost, real-time, and data-driven infoveillance tool to address this shortfall in information.

    Objective: This paper assesses the feasibility of using search query data related to help seeking for SUDs as an indicator of unmet treatment needs, demand for treatment, and predictor of the health harms related to unmet treatment needs. We explore a continuum of hypotheses to account for different outcomes that might be expected to occur depending on the demand for treatment relative to the system capacity and the timing of help seeking in relation to trajectories of substance use and behavior change.

    Methods: We used negative binomial regression models to examine temporal trends in the annual SUD help-seeking internet search queries from Google Trends by US state for cocaine, methamphetamine, opioids, cannabis, and alcohol from 2010 to 2020. To validate the value of these data for surveillance purposes, we then used negative binomial regression models to investigate the relationship between SUD help-seeking searches and state-level outcomes across the continuum of care (including lack of care). We started by looking at associations with self-reported treatment need using data from the National Survey on Drug Use and Health, a national survey of the US general population. Next, we explored associations with treatment admission rates from the Treatment Episode Data Set, a national data system on SUD treatment facilities. Finally, we studied associations with state-level rates of people experiencing and dying from an opioid overdose, using data from the Agency for Healthcare Research and Quality and the CDC WONDER database.

    Results: Statistically significant differences in help-seeking searches were observed over time between 2010 and 2020 (based on P<.05 for the corresponding Wald tests). We were able to identify outlier states for each drug over time (eg, West Virginia for both opioids and methamphetamine), indicating significantly higher help-seeking behaviors compared to national trends. Results from our validation analyses across different outcomes showed positive, statistically significant associations for the models relating to treatment need for alcohol use, treatment admissions for opioid and methamphetamine use, emergency department visits related to opioid use, and opioid overdose mortality data (based on regression coefficients having P≤.05).

    Conclusions: This study demonstrates the clear potential for using internet search queries from Google Trends as an infoveillance tool to predict the demand for substance use treatment spatially and temporally, especially for opioid use disorders.

    To read the full text of the article, please visit the publisher’s website.

    Racial/Ethnic Residential Segregation and the Availability of Opioid and Substance Use Treatment Facilities in US Counties, 2009-2019

    Journal: SSM – Population Health, 2022, doi: 10.1016/j.ssmph.2022.101289

    Authors: Michael DiNardi, William L. Swann & Serena Y. Kim


    Deaths due to synthetic opioids have increased at higher rates for Blacks and Hispanics than for Whites in the last decade. Meanwhile, Blacks and Hispanics experience lower opioid treatment rates and have less availability of medication-assisted treatment (MAT) via office-based buprenorphine in their counties compared to Whites. Racial/ethnic residential segregation is a recognized barrier to equal availability of MAT, but little is known about how such segregation is associated with opioid and substance use treatment availability over time and across Census regions and urban-rural lines. We combined data from the Substance Abuse and Mental Health Services Administration’s National Survey of Substance Abuse Treatment Services for 2009, 2014, and 2019 with the 5-year American Community Surveys of 2009, 2014, and 2019 to examine associations between residential segregation indices of dissimilarity and interaction and substance use treatment facilities per 100,000 population, including those providing MAT, in US counties. Estimating county-level two-way fixed effects models and controlling for county-level covariates, we find modest evidence of associations. Despite mostly null findings, an increased likelihood of exposure of Whites to Blacks in a county is associated with fewer substance use treatment facilities per 100,000, particularly those providing MAT via buprenorphine and located in Northeastern and Midwestern counties. Also, a more unequal distribution of Hispanics is associated with fewer facilities per 100,000 providing MAT, and this association is strongest in Southern and Western counties. These associations are driven by recent years (2014-2019) when synthetic opioids became the leading cause of opioid mortality and Blacks and Hispanics began dying at faster rates than Whites. Mixed evidence, however, tempers conclusions for how residential segregation drives racial/ethnic disparities in MAT availability.

    To read the full text of the article, please visit the publisher’s website.

    Tobacco Whack-A-Mole: A Consumption Taxonomy of Cigar & Other Combustible Tobacco Products among a Nationally Representative Sample of Young Adults

    Journal: Internal Journal of Environmental Research & Public Health, 2022, doi: 10.3390/ijerph192215248

    Authors: Kymberle Landrum Sterling, Katherine Masyn, Stephanie Pike Moore, Craig S. Fryer, Erika Trapl, Ce Shang & Douglas Gunzler


    Introduction: Little filtered cigars and cigarillos (LCCs) are consumed infrequently, co-administered with marijuana, and concurrently used with other tobacco products. Reliance on the past 30-day use estimate, a marker of tobacco user status, may underestimate the dynamic nature of intermittent LCC and other tobacco product use. We developed a framework to capture the intermittent nature of exclusive LCC use and dual/poly use with cigarettes and large cigars using broader timing of last product use categories and product use modality (e.g., with marijuana).

    Methods: Data come from the baseline C’RILLOS study, a U.S. nationally representative sample of young adults aged 18-34 (n = 1063) collected in October 2019. We developed a consumption taxonomy framework that accounted for respondents’ modality of LCC use (i.e., use with tobacco, LCC-T, or use with marijuana as blunts, LCC-B), the exclusive use of LCCs and other tobacco products (i.e., cigarettes, and large cigars) or their co-use and the timing of last product use (i.e., ever and past 30 days, past 3 months, past 6 months, greater than 6 months).

    Results: Seventy-five percent of our sample reported ever use of any combustible tobacco product, including LCCs. The most common ever use pattern was poly use of LCC-T + LCC-B + cigarettes (16%). Our consumption taxonomy framework demonstrated the fluid nature of combustible tobacco product use among LCC users. For instance, among past 30-day cigarette users, 48% reported using LCC-T, 39% reported using LCC-B, and 32% reported using large cigars in the past 3 months or more.

    Discussion: The tobacco use field currently classifies ‘tobacco users’ based on the product they smoked in the past 30 days. Any tobacco product use beyond the past 30-day period is considered ‘discontinued use’ and not the focus of intervention or tobacco regulatory science decisions. We documented the substantial proportion of young adult LCC, cigarette, and large cigar users who either exclusively or dual/poly used these combustible products in recent (e.g., past 3 months) periods. To prevent underestimation of use, surveillance measures should assess the use modality, timing of last product use, and exclusive/multiple product use to more accurately identify the smoking status of young adult LCC users.

    To read the full text of the article, please visit the publisher’s website.