Faculty Bibliography

BACKGROUND:The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program improves infant, child, and maternal outcomes. While Hispanic and non-Hispanic Black women have higher WIC participation, evaluations among non-Hispanic Asian and Native Hawaiian and Pacific Islander (NHPI) populations and among granular racial/ethnic subgroups (e.g., Chinese) are limited. OBJECTIVE:To evaluate WIC participation during pregnancy among broad racial/ethnic categories and granular racial/ethnic subgroups, overall and by maternal nativity. METHODS:We used birth certificates from the National Center for Health Statistics to evaluate 6,634,957 Medicaid-covered births (2018-2022). Using marginal effects from multivariable logistic regressions, we compared WIC participation during pregnancy among broad racial/ethnic categories and among granular subgroups of Hispanic, Asian, and NHPI women, overall and by maternal nativity. RESULTS:The overall rate of reported WIC participation was 60.1% and ranged from 46.4% (NHPI) to 66.9% (Hispanic) among broad racial/ethnic categories. The largest variation among granular racial/ethnic subgroups was within the Asian category (Other Asian [61.3%] vs Korean [36.5%]). Three broad racial/ethnic categories (White, NHPI, and Multiple Race) had higher rates among US- versus foreign-born women, and three broad racial/ethnic categories (Black, Asian, and Hispanic) had lower rates among US-born women. CONCLUSIONS:Understanding disparities in WIC participation may improve access to resources by facilitating tailored interventions to better serve underrepresented populations, such as by improving educational outreach or culturally tailoring food options. Given improvements in perinatal and infant outcomes associated with WIC, increases in WIC participation among minoritized populations may ultimately aid in addressing the large disparities in infant and maternal outcomes.

INTRODUCTION/BACKGROUND:Transition-age (TA) adults, aged 18-25, have the highest prevalence of substance use disorder (SUD) among all age groups yet they are less likely to seek treatment and more likely to discontinue it than older adults, making them a high-priority treatment population. While structural barriers and varying expectations of recovery may affect treatment initiation, insights from providers working with TA adults can reveal what further impels and impedes treatment engagement. METHODS:We conducted two focus groups with 14 front-line treatment providers, representing urban and rural outpatient, residential, and inpatient SUD care settings across New York State. Providers were selected through stratified sampling using restricted-access treatment registry data. A semi-structured interview guide facilitated discussions, and transcripts were analyzed to identify key themes. RESULTS:Providers report that TA adults prefer briefer, innovative treatment approaches over traditional modalities like A.A./12-step recovery, driven by a desire to rebuild their lives through education and career. Post-pandemic social disruptions were cited as exacerbating engagement challenges and increasing the need for integrating mental health support. Providers highlighted the potential of technology to enhance treatment engagement, though expressed concerns regarding social isolation and the fraying of childhood safety nets and support systems (e.g., housing) undermining successful treatment outcomes and transitions to adulthood more broadly. CONCLUSIONS:Providers report and perceive various challenges-unmet mental health needs, social alienation, and housing insecurity-that impede TA adults from successful SUD treatment. Understanding providers' perceptions of the needs of young adults can inform patient and clinical decision-making, lead to the development of innovative treatment approaches tailored to TA adults and contribute to improved health outcomes over the life course.

To synthesize the association between extreme ambient temperatures and the utilization of emergency healthcare services for substance use disorder (SUD). We performed a systematic literature review of original research published between 2000 and 2023 using five databases (PubMed, Embase, CINAHL, WoS, and Scopus) for literature search, and assessed study quality and risk of bias. A random-effects meta-analysis was conducted to calculate the odds ratios (OR) for SUD-related emergency healthcare service utilization during periods of extremely high or low ambient temperatures. Of 709 articles screened, eight studies met the eligibility criteria. Six studies focused on emergency department (ED) visits, while two examined on-site emergency care utilization. The risk of SUD-related ED visits was significantly higher when the mean ambient temperature was in the top 5% of the temperature distribution range (pooled OR = 1.11, 95% confidence interval [CI]: 1.07, 1.15). Conversely, the risk of SUD-related ED visits was lower when the mean temperature was in the bottom 5% of the distribution (pooled OR = 0.94, 95% CI: 0.89, 0.99). Our review showed the extremely high ambient temperature is associated with higher risk of SUD-related emergency healthcare service utilization. However, given the high heterogeneity observed across studies, these results should be interpreted with caution. Differences in study design, population characteristics, geographic region, and substance type may have contributed to this heterogeneity. Despite these differences, this finding highlights the importance of considering environmental factors in the management and prevention of SUD-related health issues.

BACKGROUND/UNASSIGNED:We investigated racial and ethnic disparities in telehealth counseling among Medicaid-insured patients in outpatient substance use disorder (SUD) treatment clinics and assessed whether the clinic-level proportion of Medicaid-insured patients moderated these disparities. METHODS/UNASSIGNED:Using New York State (NYS) Medicaid and statewide treatment registry data, we analyzed 24,814 admission episodes across 399 outpatient SUD clinics during the first 6 months of COVID-19 (April-September 2020). Our outcome measure was the number of tele-counseling sessions within the first 90 days of treatment. Key independent variables included beneficiary race/ethnicity and the clinic-level proportion of Medicaid-insured patients, divided into four quartiles: lowest, second, third, and highest. Mixed effects negative binomial models assessed the associations between race/ethnicity, Medicaid proportions, and telehealth use, with interaction terms evaluating the moderating role of Medicaid proportions. RESULTS/UNASSIGNED:Black and Latinx patients received fewer telehealth sessions than non-Latinx White patients, with adjusted incidence rate ratios (aIRRs) of 0.86 (95% CI: 0.82, 0.91) for Black patients and 0.93 (95% CI: 0.88, 0.98) for Latinx patients. Black patients at clinics with the highest Medicaid proportions had higher telehealth usage rates compared to those at clinics with the lowest Medicaid proportions (aIRR, 1.20; 95% CI, 1.03-1.41). Patients in clinics with the highest Medicaid proportions were more likely to use individual telehealth counseling (aIRR, 1.02-1.88; 95% CI, 1.01-3.04). CONCLUSIONS/UNASSIGNED:Significant racial disparities in telehealth use exist, with variations persisting across clinics with different Medicaid proportions. Targeted interventions are needed to address these access gaps.

Despite the rise in chronic, untreated opioid use among pregnant women, their rate of receiving medications for opioid use disorder (MOUD) has remained stagnant since the mid-1990s. Using retrospective cross-sectional substance use treatment admissions data from 2015 to 2019, we examined access to treatment for opioid use by pregnant adults across 48 U.S. states. We found that younger adults, Black women, those referred to treatment by a criminal justice agency (e.g., judge, probation officer), those reporting polysubstance use, and those receiving treatment in residential settings were far less likely to receive MOUD (i.e., methadone, buprenorphine, naltrexone). We used multilevel analysis to examine the structural influence of state-level reproductive rights policies on pregnant women's access to MOUD. Adjusted counterfactual predictions reveal being admitted to treatment in a severely restrictive state context results in a significant decline in the likelihood of receiving MOUD, from 67% to 29%. We estimate 12,609 additional pregnant women seeking treatment for opioid use would have accessed first-line opioid pharmacotherapy if individuals in restrictive states had accessed medication at the same rate as those in more supportive states. Taken together, these findings offer insights into how reproductive rights serve as a structural determinant of health and safeguard for opioid medication treatment. We discuss the consequences of reversing reproductive rights policies amidst rising rates of drug overdose deaths among pregnant women along with the growing availability of illegally manufactured opioid analogs, as well as psychostimulant co-use, re-shaping overdose risk patterns in the U.S.

INTRODUCTION/BACKGROUND:The COVID-19 pandemic has exposed various health risks and inequities experienced by international migrant workers. The number of migrant workers in the Republic of Korea (ROK) is rapidly growing and is expected to continue growing. Health related research on migrant workers in ROK is limited, especially among undocumented migrant workers who were more vulnerable to the pandemic. This study aims to examine the experiences of migrant workers and their knowledge and awareness of treatment and immigration policies during the pandemic. METHODS:We used data from the International Migrant Workers' COVID-19 Health Literacy and Access to Medical Care project, a cross-sectional survey conducted with international migrant workers residing in ROK in 2021 (n = 537). Descriptive statistics and multivariable regression models were employed to understand different demographic, occupational, and immigration factors affecting migrant workers' knowledge and awareness of treatment and immigration policies. RESULTS:Undocumented migrant workers had a longer length of residence in ROK and earned less compared to workers with work visa status. None of the undocumented migrant workers had access to health insurance since they were ineligible to enroll in the national health insurance scheme. In the early days of the pandemic, most undocumented migrant workers experienced a decrease in their average income. After adjusting for demographic differences and language proficiency, undocumented migrant workers (AOR: 0.41, 95% CI: 0.21, 0.78) were less likely to be aware of the policy allowing foreigners, including undocumented individuals, to access COVID-19 testing and treatment without the risk of deportation. Workers with a longer length of residence (AOR: 1.29, 95% CI: 1.09, 1.53) were more likely to be aware of this policy. CONCLUSION/CONCLUSIONS:Undocumented migrant workers were often less informed about COVID-19 policies. While most of the survey respondents were knowledgeable about governmental policies regarding COVID-19 treatment and immigration, our results reveal multiple occupational and health insurance vulnerabilities of undocumented migrant workers living in ROK. More attention is needed to understand healthcare service barriers and how to provide adequate resources for this vulnerable population.

BACKGROUND:Overdose death rates for Hispanic people rose 2010-2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people ("White"). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act ("ACA") should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids ("clients"). METHODS:We analyzed first annual ambulatory care episodes (TEDS-A, 2009-2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients. RESULTS:Among Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA. CONCLUSIONS:MOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states.

BACKGROUND:Addressing the persistent treatment gap in substance use disorder (SUD) remains a critical challenge, with only 13 % of Americans with SUDs receiving necessary treatment. We explored the complexities of engaging in SUD treatment from patients' perspectives and aims to provide a comprehensive understanding of their treatment experiences. METHODS:We conducted semi-structured interviews with 34 patients who had been attending outpatient SUD clinics in New York State for 6 or less months. Participants were recruited from seven clinics using purposive sampling. Interviews were conducted between June and August 2022. We conducted thematic analysis of coded data to explore patients' experiences and preferences while navigating their treatment journeys. RESULTS:Critical elements for a positive treatment experience included cultural humility, confidentiality, consistency, trust, peer counselors with SUD experience, a strong sense of connection, and addressing needs beyond clinical settings. These included assistance with housing and employment, participation in external clinic events, and access to amenities like coffee and snacks. Participants favored holistic treatment approaches integrating mental health and involving peer recovery counselors. However, participants also identified ineffective aspects, including rigid and generic approaches, stigmatizing attitudes, and challenges related to communities and environmental influences. CONCLUSION/CONCLUSIONS:The study highlights the multifaceted nature of outpatient SUD treatment, emphasizing the integration of patient-centered, holistic, and culturally competent approaches. Tailoring interventions to individual circumstances and acknowledging the diverse needs of patients are imperative for effective healthcare practices.