Journal: American Journal of Preventive Medicine, 2022, doi: 10.1016/j.amepre.2021.11.015
Authors: April C. Wisdom, Madhumita Govindu, Stephen J. Liu, Christina M. Meyers, Jenelle L. Mellerson, Derrick W. Gervin, Lara DePadilla & Kristin M. Holland
Abstract:
Introduction: Adverse childhood experiences and overdose are linked in a cycle that affects individuals and communities across generations. The Centers for Disease Control and Prevention’s Overdose Data to Action cooperative agreement supports a comprehensive public health approach to overdose prevention and response activities across the U.S. Exposure to traumatic events during childhood can increase the risk for myriad health outcomes, including overdose; therefore, many Overdose Data to Action recipients leveraged funds to address adverse childhood experiences.
Methods: In 2021, an inventory of Overdose Data to Action‒funded activities implemented in 2019 and 2020 showed that 34 of the 66 recipients proposed overdose prevention activities that support people who have experienced adverse childhood experiences or that focus on preventing the intergenerational transmission of adverse childhood experiences. Activities were coded by adverse childhood experience prevention strategy, level of the social ecology, and whether they focused on neonatal abstinence syndrome.
Results: Most activities among Overdose Data to Action recipients occurred at the community level of the social‒ecologic model and under the intervene to lessen harms adverse childhood experience prevention strategy. Of the 84 adverse childhood experience‒related activities taking place across 34 jurisdictions, 44 are focused on neonatal abstinence syndrome.
Conclusions: Study results highlight the opportunities to expand the breadth of adverse childhood experience prevention strategies across the social ecology. Implementing cross-cutting overdose and adverse childhood experience‒related activities that span the social‒ecologic model are critical for population-level change and have the potential for the broadest impact. Focusing on neonatal abstinence syndrome also offers a unique intervention opportunity for both adverse childhood experience and overdose prevention.
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Journal: Tobacco Prevention & Cessation, 2022, doi: 10.18332/tpc/148245
Authors: Breesa Bennett, Katelyn F. Romm & Carla J. Berg
Abstract:
Introduction: COVID-19 impacted cigarette and e-cigarette use behaviors among some individuals. This study examined COVID-19 factors and prior substance use as predictors of cigarette and e-cigarette cessation and initiation among US young adults from before to during the COVID-19 pandemic.
Methods: We analyzed data from Wave 3 (Sept-Dec 2019) and Wave 5 (Sept-Dec 2020) of a 2-year, 5-wave longitudinal study of young adults across six US metropolitan areas. We examined COVID-19 news exposure, perceived smoking and e-cigarette use risk, and prior substance use, as predictors of cigarette and e-cigarette cessation and initiation, respectively.
Results: Of W3 cigarette users (n=516), 37.8% (n=195) quit cigarettes at W5; predictors of cessation included younger age, fewer days of W3 past-month cigarette use, and no W3 e-cigarette use. Of W3 e-cigarette users (n=687), 38.7% (n=266) quit e-cigarettes at W5; predictors included greater COVID-19 news exposure, fewer days of W3 past-month e-cigarette use, and no W3 cigarette use. Of W3 cigarette non-users (n=1693), 5.0% (n=85) initiated cigarettes at W5; predictors of initiation included younger age, lower perceived smoking risk, lifetime cigarette and e-cigarette use, and W3 e-cigarette use. Of W3 e-cigarette non-users (n=1522), 6.3% (n=96) initiated e-cigarettes at W5; predictors included younger age, less news exposure, lifetime cigarette and e-cigarette use, and W3 cigarette use.
Conclusions: These findings underscore the need to address cigarette and e-cigarette co-use and related risk perceptions in prevention and cessation interventions.
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Journal: Front Psychiatry, 2022, doi: 10.3389/fpsyt.2022.882486
Authors: Sharon Levy, Alyssa Fuller, Shawn Kelly, Julie Lunstead, Elissa R. Weitzman & John H. Straus
Abstract:
Background: Screening Brief Intervention Referral to Treatment (SBIRT) is recommended as a routine part of pediatric primary care, though managing patients with positive screens is challenging. To address this problem, the state of Massachusetts created a call line staffed by pediatric Addiction Medicine specialists to provide consultations to primary care providers and access to a behavioral health provider specially trained in managing adolescent substance use.
Objective: To describe the uptake and outcomes of a consultation call line and virtual counseling for managing substance use disorders (SUD) in pediatric primary care.
Methods: Service delivery data from consultations and counseling appointments were captured in an electronic database including substance, medication recommendations, level of care recommendations and number of counseling appointments completed for each patient. Summary data is presented here.
Results: In all, there were 407 encounters to 108 unique families, including 128 consultations and 279 counseling visits in a one-year period. The most common substances mentioned by healthcare providers were cannabis (64%), nicotine (20%), alcohol (20%), vaping (9%) and opioids (5%). Management in primary care was recommended for 87 (68%) of the consultations. Medications for SUD treatment were recommended for 69 (54%) consultations including two for opioid use disorder.
Conclusion: We found that both a statewide consultation call line and virtual counseling to support SBIRT in pediatric primary care were feasible. The majority of consultations resulted in recommendations for treatment in primary care.
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Journal: International Journal of Environmental Research & Public Health, 2022, doi: 10.3390/ijerph19105846
Authors: Crystal Lin, Shivani Mathur Gaiha & Bonnie Halpern-Felsher
Abstract:
E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess the extent of nicotine dependence among US AYA (ages 13-24) by e-cigarette device type, we conducted a large, national, cross-sectional survey (n = 4351) and used the Hooked on Nicotine Checklist (HONC) to assess levels of nicotine dependence among those who had used disposable, pod-based, and/or mods/other e-cigarette devices in the past 30 days. We also examined HONC scores among those who had used combustible cigarettes in the past 30 days, whether with or without using e-cigarettes. Patterns of nicotine dependence were comparable across those who had used a combustible cigarette and/or e-cigarette in the past 30 days, with 91.4% of combustible cigarette users, 80.7% of disposable e-cigarette users, 83.1% of pod-based e-cigarette users, and 82.5% of mods/other e-cigarette users showing signs of nicotine dependence, as measured by endorsing at least one HONC symptom. This pattern persisted when analyses were restricted to e-cigarette only users, with more than 70% of all e-cigarette only past-30-day users endorsing at least one HONC symptom, across all types of devices. A thorough understanding of the extent and presentation of nicotine dependence among AYA will help researchers, public health officials, and clinicians recognize and manage AYA nicotine dependence.
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Journal: JAMA Network Open, 2022, doi: 10.1001/jamanetworkopen.2022.13014
Authors: Augustin G. L. Vannier, Jessica E. S. Shay, Vladislav Fomin, Suraj J. Patel, Esperance Schaefer, Russell P. Goodman & Jay Luther
Abstract:
Importance: Alcohol-associated liver disease (ALD) is one of the most devastating complications of alcohol use disorder (AUD), an increasingly prevalent condition. Medical addiction therapy for AUD may play a role in protecting against the development and progression of ALD.
Objective: To ascertain whether medical addiction therapy was associated with an altered risk of developing ALD in patients with AUD.
Design, setting, and participants: This retrospective cohort study used the Mass General Brigham Biobank, an ongoing research initiative that had recruited 127 480 patients between its start in 2010 and August 17, 2021, when data for the present study were retrieved. The mean follow-up duration from AUD diagnosis was 9.2 years. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes were used to identify ALD and AUD diagnoses.
Exposures: Medical addiction therapy was defined as the documented use of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen. Patients were considered to be treated if they initiated medical addiction therapy before the relevant outcome.
Main outcomes and measures: Adjusted odds ratios (aORs) for the development of ALD and hepatic decompensation were calculated and adjusted for multiple risk factors.
Results: The cohort comprised 9635 patients with AUD, of whom 5821 were male individuals (60.4%), and the mean (SD) age was 54.8 (16.5) years. A total of 1135 patients (11.8%) had ALD and 3906 patients (40.5%) were treated with medical addiction therapy. In multivariable analyses, medical addiction therapy for AUD was associated with decreased incidence of ALD (aOR, 0.37; 95% CI, 0.31-0.43; P < .001). This association was evident for naltrexone (aOR, 0.67; 95% CI, 0.46-0.95; P = .03), gabapentin (aOR, 0.36; 95% CI, 0.30-0.43; P < .001), topiramate (aOR, 0.47; 95% CI, 0.32-0.66; P < .001), and baclofen (aOR, 0.57; 95% CI, 0.36-0.88; P = .01). In addition, pharmacotherapy for AUD was associated with lower incidence of hepatic decompensation in patients with cirrhosis (aOR, 0.35; 95% CI, 0.23-0.53, P < .001), including naltrexone (aOR, 0.27; 95% CI, 0.10-0.64; P = .005) and gabapentin (aOR, 0.36; 95% CI, 0.23-0.56; P < .001). This association persisted even when medical addiction therapy was initiated only after the diagnosis of cirrhosis (aOR, 0.41; 95% CI, 0.23-0.71; P = .002).
Conclusions and relevance: Results of this study showed that receipt of medical addiction therapy for AUD was associated with reduced incidence and progression of ALD. The associations of individual pharmacotherapy with the outcomes of ALD and hepatic decompensation varied widely.
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