Faculty Bibliography

BACKGROUND:Between 2022 and 2023, overdose mortality decreased among non-Hispanic (NH) white people but stayed the same or increased among people of colour in the USA. County racialised economic segregation may contribute to overdose mortality. METHODS:measures, one for higher-income NH white and lower-income black residents and another for higher-income NH white and lower-income Hispanic residents. Models included random effects for county, year and county-year interaction, and fixed effects for proportion male, proportion aged 25-44, land area, state and year. We estimated relative risk (RR) by quintile (least vs most privileged) and the difference in overdose mortality per 100 000 (RD) had all counties shifted to the risk of the most advantaged counties (Q5). RESULTS:Counties with the highest proportion of lower-income racially minoritised residents (Q1) had an increased RR of overdose deaths compared with Q5 counties, both overall (aRRs 1.64 (1.51-1.78); 1.40 (1.29-1.52)), and among subgroups. Had all counties experienced the risk of Q5 counties, we estimated an average reduction in overdose deaths overall (RDs per 100 000: -7.20 (-8.25 to -6.10); -6.37 (-7.38 to -5.25)) and among subgroups. CONCLUSION/CONCLUSIONS:County racialised economic segregation was associated with overdose mortality risk in 2018-2022. Investment in evidence-based strategies to reduce overdose risk in places experiencing harms related to racialised economic segregation is critical.

OBJECTIVE:Maternal morbidity and mortality (MMM) rates from drug overdoses have increased, especially among pregnant and postpartum women aged 35-44. However, there is limited understanding of how current toxicology testing practices are implemented in hospital settings and how well they support, or undermine, linkage to care. The goal of the study is to understand variations in toxicology testing use among pregnant and postpartum women, explore hospital- and individual-level differences, and assess outcomes. METHODS:Using the Socio-cultural Framework for the Study of Health Service Disparities (SCF-HSD) we will perform a mixed-methods study to understand testing policies and practices in NY State. Aim 1 will employ multilevel statistical models using New York State Medicaid claims data (2021-2024) to identify predictors of perinatal toxicology testing and characterize hospital-level variation across hospitals. Aim 2 will involve one-on-one interviews with hospital administrators and clinical staff to document and analyze testing policies and practices, capturing diverse perspectives on testing rationales, attitudes, and adherence. Aim 3 will integrate quantitative and qualitative evidence through a mixed-methods design, incorporating perspectives of individuals with lived experience, via focus group sessions to inform and refine hospital policy recommendations. DISCUSSION/CONCLUSIONS:Our findings will inform how to improve disparities in toxicology testing for pregnant and postpartum women. Addressing these challenges requires shifting emphasis toward standardized, evidence-based toxicology testing protocols, strengthening pathways to supportive services, and advancing policy reforms that reduce stigma and inequities in care.

Asian American women are an understudied population facing a substantial mental health burden, largely driven by the increasing rates of gender- and race-based violence and discrimination. Perceived safety, a key factor influencing mental health, has been underexplored. This study aimed to 1) examine the relationship between perceived safety with mental health outcomes (i.e., depression and anxiety); 2) examine the link between safety-related behavioral modifications and mental health outcomes; and 3) explore the moderating effects of loneliness and resilience on these relationships, drawing from a community sample of n = 345 Asian American women. Perceived safety was defined as feeling safe in public spaces, transportation and neighborhoods. In our study, 28.7%, 56.2% and 20.6% of women reported feeling unsafe in public spaces, transportation and neighborhoods, respectively. Feeling unsafe in public spaces was associated with higher odds of depression (aOR=2.37, 95%CI: 1.40, 4.02) and anxiety (aOR=2.61, 95%CI: 1.56, 4.37). Avoiding public spaces, leaving home or transportation were linked to increased odds of depression (aOR=2.05, 95%CI: 1.23, 3.40; aOR=2.26, 95%CI: 1.37, 3.74; aOR=2.03, 95%CI: 1.16, 3.57, respectively) while only avoiding leaving home was associated with anxiety (aOR=2.04, 95%CI: 1.24, 3.36). Loneliness moderated the association between avoiding public spaces and anxiety: avoiding public spaces was significantly associated with greater odds of anxiety among women who were not lonely (aOR = 4.77, 95% CI: 1.24-18.34), but not among those who were lonely (aOR = 0.93, 95% CI: 0.53-1.64). Resilience did not moderate these relationships (all p > .050). Our findings highlight the mental health impacts associated with reduced perceptions of safety and safety-related behavioral modifications in this group, highlighting the pervasive fear experienced by Asian American women in their day-to-day lives, and emphasizing the need for targeted interventions to address the unique safety challenges faced by Asian American women.

BACKGROUND:Pregnant and parenting women with substance use disorders (SUDs) face complex and overlapping challenges, including substance use, legal issues, housing instability, and trauma. Effective interorganizational collaboration is critical but often hindered by fragmented care and resource limitations. This study explores the key barriers and facilitators that impact collaborative efforts among healthcare providers, government agencies, and community organizations in addressing SUD among pregnant and parenting women. METHODS:This qualitative study was conducted in New York State between April 2022 and April 2023. The study focused on organizations that provide services to pregnant and parenting women with SUDs, including government agencies, SUD treatment centers, healthcare settings, and community-based care organizations. Semi-structured, one-on-one interviews were conducted with staff to explore how their organizations coordinate care. Thematic analysis was used to identify patterns related to interorganizational collaboration. Primary data were collected through interviews with 30 staff members across multiple stakeholder groups: child welfare services (n = 8), criminal legal agencies (n = 5), health agencies (n = 3), healthcare service settings (n = 4), SUD treatment programs (n = 6), and community-based organizations (n = 4). Interviews lasted approximately one hour and focused on organizational roles, referral processes, and coordination efforts in serving the target population. RESULTS:Collaborative care was primarily facilitated through referral networks, case management teams, and the presence of embedded healthcare professionals. However, these systems were frequently limited by fragmented communication, stigmatizing attitudes, and insufficient resources. Organizational facilitators included co-located healthcare staff within child welfare services and formalized partnerships across sectors. Key barriers included staffing shortages, burnout, and misalignment of organizational goals. At the individual level, collaboration often depended on informal relationships and staff-driven initiatives, though interdisciplinary knowledge gaps remained a significant challenge. CONCLUSIONS:Improving service coordination for pregnant and parenting women with SUDs will require stronger organizational infrastructure, investment in cross-sector communication strategies, and deliberate efforts to address stigma. Future research should explore models that support sustained, formalized interagency partnerships to enhance care integration.

PURPOSE/OBJECTIVE:Moving beyond existing research that typically focuses on a single form of violence, the current study adopts a holistic approach to examine psychosocial factors associated with intimate partner violence (IPV) and hate-motivated violence against Asian American women, as well as related mental and behavioral health outcomes. METHODS:This cross-sectional study was conducted between August 2022 and June 2023 among 345 community-based adult Asian American women. Multivariable Firth logistic regression models were used to address study aims. RESULTS:The prevalence of violence was high: 55.1% experienced hate-motivated verbal assault, 32.2% sexual IPV, 16.3% physical IPV, and 11.4% hate-motivated physical assault. These violent experiences were significantly associated with increased odds of depression, anxiety, cigarette, alcohol, and non-medical substance use. Sexual minority status was linked to greater odds of all IPV types (adjusted odds ratios [aORs] = 1.96-2.51). Childhood abuse was associated with all IPV types and hate-motivated verbal assault (aORs = 1.96-4.84). Tangible social support was linked to reduced odds of physical IPV (aOR = 0.39, 95% confidence interval [CI]: 0.18-0.87) and co-occurring physical and sexual IPV (aOR = 0.33, 95% CI: 0.14-0.77). Loneliness was associated with greater odds of all IPV types and hate-motivated physical assault (aORs = 2.13-4.96). CONCLUSION/CONCLUSIONS:Findings highlight the substantial burden of violence and its mental and behavioral health impacts among Asian American women, emphasizing the urgent need for continued research efforts to inform culturally appropriate prevention strategies to effectively address violence for this underserved population.

INTRODUCTION/BACKGROUND:The United States is facing an opioid use disorder (OUD) epidemic, marked by unprecedented overdose death rates. In New York State, synthetic opioids significantly contribute to the increasing overdose deaths, disproportionately impacting Black and Latinx communities. There is an urgent need to address issues related to equitable access to and the quality of care provided by substance use disorder (SUD) treatment programs. In light of this, the Quality Measurement and Management Research Center (QM2-RC) brought together an academic-government partnership to develop a person-centered quality measurement system and to assess its impact on a statewide treatment system that serves approximately 180,000 individuals per year. METHODS AND ANALYSIS/METHODS:The QM2-RC encompasses three interconnected projects (Project 1, 2, and 3) aimed at developing a quality management strategy and evaluating its impact on system performance across New York State. This report specifically focuses on Project 3, which involves a stepped-wedge trial with 35 clinics receiving a quality management intervention that includes performance coaching. This intervention will be compared to a treatment-as-usual (TAU) condition for clinics not participating in the trial. Administrative data will be utilized to monitor outcomes over four years. The coaching intervention, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) model, emphasizes interpreting quality measures and applying insights to enhance care. Coaches will provide support on data utilization, patient-centered care, harm reduction strategies, and the use of patient monitoring tools. The trial aims to evaluate clinic staff and leadership attitudes, experiences, and behaviors through surveys, semi-structured interviews, and external facilitator notes. Primary clinic outcomes will be assessed through adverse events, decreased clinic rates of substance use related emergency department visits and hospitalizations as well as mortality among patients within the first 12 months after admission to treatment after adjusting for individual and community level characteristics. This study is being developed over a multi-year period and will be informed by a mixed-methods approach incorporating multiple data sources, qualitative interviews, patient and clinic surveys. The study is being conducted in partnership with New York State Office of Addiction Services and Supports (OASAS) and will be informed by input from patient, providers, health insurers, family members and local governing units. DISCUSSION/CONCLUSIONS:Project 3 of the QM2 study specifically targets key barriers in measuring the quality of SUD treatment, including technological limitations, unvalidated measures, workforce data literacy, and concerns about fairness in assessing clinical complexity. Through the implementation of a stepped-wedge trial involving 35 clinics, the project aims to develop new quality measures, offer performance feedback, and engage clinic leadership and staff in efforts to improve practices. The ultimate goal of Project 3 is to overcome these barriers, promote person-centered care, and improve SUD treatment practices across New York State.

OBJECTIVE:Analyze existing hospital-level policies in New York City (NYC) regarding substance use and substance use disorders (SUDs) during the perinatal period to provide a comprehensive guide for hospital-level policy development, ensuring equitable maternal screening for substance use and SUDs. METHODS:Maternal toxicology policies were collected from eight NYC health systems between 1/1/2021 and 12/31/2022. One policy focused exclusively on neonate toxicology testing and thus was excluded. The remaining seven policies were de-identified and underwent a qualitative thematic content analysis using the Health Equity Impact Assessment framework. Two researchers conducted the thematic analysis, and two others reviewed identified themes for distinctions between policies. RESULTS:Seven hospital-level policies identified four distinct policy approaches (Types A, B, C, and D). The policies varied in their approach to prenatal substance use and SUD identification, highlighting gaps in knowledge and lack of standard guidelines. The different approaches involved combinations of standardized screening tools, toxicology tests, social service referrals, and patient consent procedures, among others. Researchers found that some policies may inadvertently reinforce stigma and bias due to a focus on high-risk characteristics not necessarily indicative of substance use or SUDs. CONCLUSION/CONCLUSIONS:Multidisciplinary-informed evidence-based guidelines are needed to address substance use and SUDs during pregnancy. Our findings support the integration of evidence-based screening, brief intervention, and referral to treatment (SBIRT) into policies, and discourage sole reliance on toxicology tests for SUD identification. The study's findings can potentially guide the development of equitable and clinically useful maternal substance use and SUD policies, thereby improving dyad outcomes.

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.