Faculty Bibliography

BACKGROUND:Transition-age (TA) adults are less likely than adults aged 26 and older to receive medications for opioid use disorder (MOUD), and among those treated, disproportionately receive naltrexone over more effective agonist MOUD (buprenorphine and methadone). Given that prescribers ultimately determine medication selection, understanding how age influences their clinical decisions is essential to addressing these disparities. This study examines how prescribers incorporate age into MOUD prescribing decisions for this developmentally vulnerable population. METHODS:Using 2022 New York State Medicaid claims, we identified MOUD prescribers with substantial experience (treating n ≥ 5 TA adults) and conducted semi-structured interviews with 18 outpatient prescribers (MD/DOs, NPs, PAs) from diverse geographic and clinical settings. We applied an inductive thematic analysis approach to explore how prescribers incorporated age and age-related factors into their clinical decision-making around MOUD. RESULTS:Most prescribers did not endorse chronological age as a factor influencing their prescribing patterns, but rather described tailoring treatment based on age-related factors more commonly seen in TA adults. These included developmental characteristics (perceived lack of commitment, peer influence), socioeconomic barriers (e.g., unreliable transportation leading to missed appointments), family influence, and concerns about MOUD dependence. In response to these age-related factors, prescribers implemented harm-reduction principles by adjusting MOUD type prescribing to accommodate TA adults' life-stage realities. In contrast, a small subset of prescribers explicitly cited chronological age as directly influencing MOUD prescribing, expressing hesitations about initiating buprenorphine or referring TA adults for methadone due to long-term dependence concerns. CONCLUSION/CONCLUSIONS:These findings suggest two key mechanisms through which age may influence MOUD prescribing disparities among TA adults: (1) prescribers' responses to age-related life-stage challenges (e.g., developmental and social factors, structural barriers) and (2) explicit prescriber age-based hesitancy about initiating long-term agonist maintenance in younger patients. The first mechanism appeared more influential than explicit hesitancy. These mechanisms may help explain documented disparities in MOUD type prescribed. Addressing these disparities may require multi-level interventions: prescriber education affirming agonist MOUD effectiveness for TA adults, efforts to reduce MOUD misconceptions among patients and families, peer-based approaches that leverage social influence positively, and flexible harm-reduction-oriented clinic policies that accommodate structural barriers while supporting access to evidence-based MOUD.

INTRODUCTION/UNASSIGNED:We synthesized evidence on racial disparities in perinatal toxicology testing among Black and White women and their infants in the United States, including testing practices and downstream consequences such as child welfare involvement. METHODS/UNASSIGNED:We systematically searched PubMed and PsycINFO for peer-reviewed studies published before January 2023 that examined perinatal toxicology testing and reported racial outcomes. Eligible studies assessed testing practices or related consequences. A random-effects meta-analysis estimated pooled rate ratios (RRs) and 95% confidence intervals (CIs) for disparities in testing. Thematic synthesis summarized qualitative findings on downstream outcomes. Sixteen studies (1993-2023) met inclusion criteria; six contributed to the meta-analysis, encompassing over 50 000 pregnant women and/or their infants. RESULTS/UNASSIGNED:Black women and their infants were significantly more likely to be tested than their White counterparts (RR = 2.58; 95% CI: 2.03-3.29). While recent studies suggest disparities in referral to child welfare services after positive tests may be narrowing, earlier research indicates disproportionate reporting and child removal among Black and Hispanic families. CONCLUSION/UNASSIGNED:Racial inequities in perinatal and infant toxicology testing persist, with implications for maternal and child health. Future research should investigate multilevel drivers of these disparities and inform equitable policy and practice.

Pregnant and birthing people with untreated substance use disorders (SUDs) face multiple risks of mortality and morbidity. Acute care settings (i.e., hospital inpatient, labor/delivery and emergency departments) are one opportunity to provide substance use services, but have had limited implementation. This scoping review synthesized studies that used an implementation science or quality improvement (QI) strategy to implement substance use services into acute care settings for pregnant or birthing people. Our aim was to 1) characterize the implemented strategies; 2) assess the inclusion of racial equity in study design and implementation; 3) summarize measures and outcomes used to evaluate implementation; and 4) identify reported barriers and facilitators to implementation. We searched MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsycINFO (Ovid) for published studies using keywords and structured vocabulary, and supplemented database searches with a grey literature search of conference proceedings. Two authors independently screened then extracted studies that met eligibility criteria. After removing 661 duplicates, we screened 1101 studies by title and abstract and excluded 1037. Thirty-six were excluded after full text review yielding 28 studies for extraction. Studies were observational (n = 20, 71%), QI (n = 7, 25%), and experimental (n = 1, 4%). Twenty (71%) focused on SUDs broadly; 8 (29%) targeted OUD. Five strategy types were identified: 1) education and learning collaboratives (n = 11, 39%); 2) clinical workflows and pathways (n = 7, 25%); 3) brief interventions (n = 2, 7%); 4) peer support (n = 4, 14%); and 5) structural changes (n = 4, 14%). Five studies (18%) considered racial and ethnic equity in design or implementation. Overall, studies highlight promising strategies to implement substance use services for pregnant and birthing people in acute care settings. However, many strategies were not rigorously evaluated and few considered racial and ethnic equity in design or implementation. Future research should focus on more rigorous evaluations of implementation strategies, measure downstream outcomes such as adoption and sustained use of substance use services, and apply a racial equity lens more explicitly.

IMPORTANCE/UNASSIGNED:Asian language speakers with limited English proficiency (LEP) face significant barriers to accessing adequate mental health care. Despite worsening mental health outcomes for this population, there is limited research examining the availability of Asian language mental health treatment in the US. OBJECTIVE/UNASSIGNED:To quantify trends and analyze disparities in the geographic availability of Asian language mental health treatment from 2015 to 2024. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study of US mental health facilities from April 30, 2015, to December 9, 2024, used longitudinal data from the nationally representative Mental Health and Addiction Treatment Tracking Repository linked with county-level demographic data from the 2023 American Community Survey. Facilities were included if they completed the National Mental Health Services Survey or the National Substance Use and Mental Health Services Survey. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes included the annual proportion of mental health facilities offering Asian language services and the proportion of counties with at least 1 such facility. For 2024, facility-level characteristics associated with Asian language services were assessed and geographic mismatches between service availability and the proportion of Asian language-speaking individuals with LEP were mapped. RESULTS/UNASSIGNED:The study included 3847 mental health facilities. Of these, 214 facilities (5.6%) offered services in at least 1 Asian language in 2024 (including Arabic, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Tagolog, and Vietnamese). The proportion peaked at 265 facilities (6.9%) in 2021, then declined from 2022 to 2024. The number of counties with at least 1 facility with Asian language services was 98 (6.3%) in 2024. Facilities offering Asian language services were concentrated in metropolitan areas (208 [97.2%]), particularly in California (57 [26.6%]) and the Northeast (52 [24.3%]). Rural areas lacked such services (3 of 485 rural facilities [0.6%] in 2024), even in counties with substantial populations of Asian language-speaking individuals with LEP (0 of 5 facilities). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study found a persistent geographic mismatch between the mental health needs of Asian language-speaking individuals with LEP and the availability of appropriate linguistic services. The gap was pronounced in rural areas. The findings suggest that policies aimed at expanding the behavioral health workforce and increasing access to culturally and linguistically competent services to reduce ongoing disparities in mental health outcomes and access to care are urgently needed.

BACKGROUND:National drug policies vary widely across countries, shaped by historical, institutional, economic, and social factors. However, the role of cultural values in shaping drug policies remains underexplored. This study applies Hofstede's cultural dimensions index to assess associations between national cultural norms and Global Drug Policy Index (GDPI) scores. METHODS:We conducted a cross-national comparative analysis using data from 25 countries with both GDPI scores and Hofstede's cultural dimension scores in 2021. The dependent variable was the GDPI overall score and four sub-indices: Absence of Extreme Sentencing, Proportionality of the Criminal Justice Response, Health and Harm Reduction, and Access to Controlled Medicines. Independent variables included four Hofstede dimensions: Power Distance, Individualism, Masculinity, and Uncertainty Avoidance. Control variables included GDP per capita (log), cannabis prevalence, continent dummies, and opium/coca production status. Ordinary least squares (OLS) regressions with robust standard errors were used. RESULTS:Higher Power Distance was associated with lower overall GDPI scores (β = -0.296, p = 0.015), as well as with the Absence of Extreme Sentencing, and Access to Controlled Medicines indicators, suggesting that hierarchical societies tend to adopt more punitive and restrictive drug policies. Uncertainty Avoidance was positively associated with Access to Controlled Medicines (β = 0.234, p = 0.051). Higher cannabis prevalence showed consistent positive associations with progressive policy outcomes, while regional variation was evident, particularly in Europe and the Americas. CONCLUSION/CONCLUSIONS:This study highlights the role of cultural values in shaping national approaches to drug policy, with power distance and uncertainty avoidance emerging as significant factors. Higher cannabis prevalence, a reflection of the epidemiological context, was also associated with more progressive policy outcomes. Policymakers should consider cultural and public health factors when designing drug strategies, particularly in hierarchical societies, where specific reforms may be needed to limit punitive laws and expand access to essential treatments.

INTRODUCTION/BACKGROUND:In recent years, higher rates of overdose deaths have been observed among Black individuals in the United States compared to individuals who are white or other races, as part of the potent fourth wave of the opioid epidemic. However, much of the research addressing this surge has focused on Black individuals in urban areas, despite evidence that usage and overdose rates are accelerating among rural Black People Who Use Drugs (PWUD), a gap we aim to fill here via a qualitative assessment. METHODS:Between September 2023 and June 2024, we conducted semi-structured interviews with a sample of Black adult PWUD who live in rural southern Illinois. The interviews were evaluated using abductive analytic methods. FINDINGS/RESULTS:In general, participants highlighted exposure to parental substance use and poor mental health as key factors contributing to drug use initiation. Participants further described their social networks as small, emphasizing a desire to stay hidden to avoid social scrutiny. Finally, participants had mixed feelings about the nature and value of medications for opioid use disorder (e.g., buprenorphine, methadone, etc.) and expressed limited knowledge about where to access harm reduction resources like naloxone. CONCLUSIONS:Rural Black PWUD may experience complex early-life exposures to substance use and later-life challenges in terms of communal integration due to stigma and structural disenfranchisment. These dynamics may specifically prevent the manifestation of strong support networks and engagement with treatment and harm reduction.