Faculty Bibliography

BACKGROUND:The United States opioid epidemic's reach is expanding. Rapidly scaling opioid overdose education and naloxone distribution (OEND) programs is essential within a multipronged public health response. Universities offer infrastructure with potential to support routine, widespread OEND program implementation among adolescents and young adults nationally, a priority population who could disseminate to broader networks and geographic communities. This important setting is underutilized, and critical gaps remain in understanding university-based OEND program adoption/implementation. METHODS:We conducted semi-structured, in-depth interviews (n = 21) among a purposively selected national sample of college health administrators to understand their perceptions of barriers/facilitators of implementing OEND programs at their universities and among universities nationally. The Consolidated Framework for Implementation Research guided data collection and inductive-deductive thematic analysis. RESULTS:Unexpected student opioid overdoses and deaths catalyzed university administration to implement OEND programming. Absent the urgency induced by such events and in contrast to the incidental exposure they implicate, administrations perceived the prevalence of opioid misuse within their student population as too low to justify OEND program implementation. For some, this reluctance to proactively implement OEND programming was heightened by a desire to avoid political controversy, related to stigma surrounding harm reduction. Participants described the need for campus partners to collaboratively navigate university administrations' inaction/opposition, and ultimately, spearhead implementation, often with external collaborators. Key roles among campus and external collaborators were identified, including (a) allowing students to access existing OEND programming prior to obtaining administrative approval for university-based implementation; (b) compiling data and anecdotal evidence to understand the campus substance use environment and sharing that information with administration to establish program need; (c) overcoming stigma and legal complexity of harm reduction programming; (d) overcoming funding/resource constraints and building capacity to sustain OEND programming. CONCLUSIONS:Our findings underscore complexities of university-based OEND program implementation while providing actionable insights to support its national scale-up. Building on identified distinctions between universities in the process of implementing OEND programming and those without intention to implement, future research should identify OEND programming implementation phase among universities nationally, advance understanding of implementation determinants and strategies distinguishing each phase, and establish best practices for OEND program implementation.

We characterize within-city life expectancy gaps and their correlation with social and environmental characteristics in 948 US cities. Life expectancy estimates were drawn from the US Life Expectancy Estimation Program. City life expectancy gaps were calculated by subtracting the lowest tract-level life expectancy estimate from the highest for each city. Correlations were established using Spearman's correlation coefficient. The average city-level life expectancy gap in our sample was 11.8 years. Life expectancy gaps were larger in cities with lower average life expectancy and were evident across the USA. Life expectancy gaps of a decade were seen even in smaller cities and in high life expectancy cities. Life expectancy gaps were most strongly correlated with racialized residential segregation, children in poverty, and household income. Significant between-neighborhood gaps in life expectancy exist across US cities. Life expectancy gaps present a compelling target for establishing robust health equity goals.

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.

BACKGROUND:Policymakers need research-informed guidance on leveraging national government funding to promote evidence-based practice (EBP) implementation, however empirical studies of policy financing strategies in implementation science remain limited. Major investments are already being made. Starting in 2012, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) funded state substance use service agencies to implement EBPs for youth substance use. We examined 19 states funded to implement the Adolescent Community Reinforcement Approach (A-CRA), an exemplar EBP selected by most states. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework, we sought to explain state-level variation in A-CRA reach (defined as the proportion of A-CRA certified providers) and to identify policy implications for improving EBP financing strategies. METHODS:We conducted an explanatory sequential mixed-method (QUAN→QUAL) comparative case study, treating each state as a case. States were categorized as achieving high, medium, and low reach during their grant periods using A-CRA certification records and state demographic data. We then synthesized available data (i.e., interviews with 33 state agency administrators, grant administrative records, other documents describing A-CRA implementation) to summarize grant activities completed and their quality, and factors potentially influencing reach in each state. Finally, we compared and contrasted state cases to identify policy implications through pattern matching techniques. RESULTS:We characterized the 19 states' reach levels as high (n = 7), medium (n = 5), and low (n = 7) and identified an average of 5 grant-related activities completed per state; the most common being A-CRA training to treatment organizations. Six states were case anomalies (e.g., low quantity and quality of activities, while achieving high reach). Most notably, we found that high-reach states had more specific, intentional, and explicit A-CRA implementation requirements for treatment organizations than did low- and medium-reach states. States were also more successful in achieving A-CRA reach when they reported proactively addressing implementation barriers (e.g., provider turnover, state leadership buy-in and support). CONCLUSIONS:Our mixed-method comparative case study advances policy-focused implementation research related to EBP financing strategies, demonstrating how examination of large-scale real-world funding initiatives can produce generalizable lessons. Our findings have implications for how future funding initiatives can facilitate EBP delivery to maximize reach.

Worldwide, over half of all individuals with dementia are undiagnosed. In the United States, racial, ethnic, and economic inequities mirror global findings, with higher rates of missed and delayed diagnosis and poorer diagnostic quality among minoritized and disadvantaged groups. For example, delayed diagnosis is more prevalent among people identifying as non-Hispanic Black or Latino than non-Hispanic White. Systematic efforts to improve detection can increase diagnosis rates; there is broad consensus that earlier detection and initiation of focused care and support services benefit both affected individuals and their loved ones. Systemic under-detection and its contributions to persistent population-level suffering underscore the importance of early detection of dementia as a key public health issue. Improving early detection calls for comprehensive, coordinated responses from local, regional, and national public health systems in partnership with health care delivery systems and community-based organizations. The Public Health Center of Excellence on Early Detection of Dementia (PHCOE on EDD), funded by the Centers for Disease Control and Prevention (CDC), is a national resource to promote understanding and implementation of evidence-based and evidence-informed public health strategy for early detection of dementia. We, together with the PHCOEs on Dementia Risk Reduction and Dementia Caregiving, and nearly four dozen state and local initiatives, seek to operationalize the priorities of the Building Our Largest Dementia Infrastructure for Alzheimer's Act and National Healthy Brain Initiative, established by federal legislation in 2018 and 2024. Our efforts support the CDC's mandate to build a national public health infrastructure for brain health and dementia.

OBJECTIVES/OBJECTIVE:To describe the screening processes for opioid use disorder by jails in localities with high concentrations of opioid involved overdose deaths. METHODS:A secondary data analysis of structured interviews on opioid use disorder practices from 185 jails in the United States was conducted. Descriptive statistics detailed jail screening characteristics, and bivariate statistics examined the association between screening characteristics and annual jail population. RESULTS:The majority of jails in high-overdose-burden localities had screening protocols in place for opioid use disorder (95.1%). The protocols varied, with most jails reporting the use of substance use (85.4%) or opioid use (77.0%) specific screeners. Yet few jails used validated screening tools (23.3%) and instead relied on agency or state-specific tools (89.0%). Significant differences by annual jail population were found related to who conducted screenings, such that the use of medical staff for screening (P<0.01) and clinical assessments (P<0.05) was more likely among larger jails. CONCLUSIONS:Screening and assessment of opioid use disorder is essential for individuals in jails, given the disproportionate burden of the disorder. Jails tended to rely on agency-created tools over the use of validated screeners, and more efforts may be needed to close the research-practice divide.

BackgroundCommunity health workers (CHW) can perform unique functions to facilitate the implementation of evidence-based interventions for infection-related cancer prevention and control, and alleviate minoritized and immigration-related disparities.PurposeWe describe the implementation evaluation of three CHW-delivered infection-related cancer programs focused on Asian American (AA) communities in New York City: 1) a H. pylori treatment adherence program for Chinese and Korean Americans; 2) a HPV screening program for Muslim Americans; and 3) a hepatitis B screening, linkage to care, and treatment program for AA and other priority communities.MethodsWe conducted semi-structured key informant interviews with multi-level stakeholders from the programs.ResultsLessons learned include the importance of: 1) sustaining engagement and buy-in from implementation partners; 2) prioritizing recipient- and deliverer-centeredness; 3) fostering program flexibility to accommodate multiple implementation settings and to meet dynamic community resources and priorities; and 4) understanding interoperability between the CHW-delivered intervention and the inner setting for effective program implementation.ConclusionsThese findings can inform other efforts to implement CHW-delivered community-clinical cancer programs for AA and other underserved communities to advance health equity.

Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.

Federal minimum standards for collecting and reporting race and ethnicity data implicitly categorize diverse individuals into broad, monolithic categories. Despite advancements in policy and practice and calls for inclusive research, data equity remains a significant issue in aging-related health research. Racially and ethnically diverse older adults are underrepresented in health research and rarely disaggregated by ethnicity in data collection, analysis, and reporting of aging-related health outcomes. Data disaggregation offers a promising approach to advancing data equity in aging research. We searched the National Institute on Health RePORT Expenditures and Results (NIH RePORTER) database to identify extramural National Institute on Aging (NIA) grants from 1985 to 2024 that proposed disaggregating race and ethnicity data for aging-related research. We found only 12 NIA-funded awards, visually demonstrating how understudied data disaggregation is within the field of aging. Most disaggregation-focused grants were awarded from 2015 onwards (92%), with 42% being R01 grants. Enhancing methodological rigor in demographic data collection and reporting reflective of the diversifying aging population is crucial for data equity. We conclude with recommendations to advance aging health research and highlight considerations and ethical issues for data disaggregation for historically surveilled racial and ethnic minoritized communities.

There is an urgent need to ensure the opioid overdose reversal agent naloxone is available to protect youth given the increasing rates of overdose among this population. Through a public-academic partnership, overdose education and naloxone distribution training were provided to nonmedical public school staff in New York City. School staff were invited to a 90-minute in-person training. Consented participants took a pre- and post-survey to assess their overdose knowledge, confidence, and substance use stigma. A majority of respondents had never received training on how to identify an opioid overdose (70.7%) or how to administer naloxone (73.5%). Participants' overdose knowledge, including recognition of the signs of an overdose, response actions, and confidence to respond, significantly increased pre- to post-training. Participants' stigmatization of drug use significantly decreased following the training. Naloxone access and opioid overdose response training for nonmedical school staff is an acceptable and effective solution to expand overdose response. The significant reduction in participants' stigmatization of drug use suggests overdose education and naloxone training that address stigma may help prevent unnecessary mortality among youth.