Faculty Bibliography

OBJECTIVES/OBJECTIVE:To estimate the effect of California's prescription drug monitoring program's (PDMP) registration mandate on use of the PDMP. METHODS:We evaluated the effect of California's mandatory PDMP registration law by fitting time series models on the percentage of clinicians registered for California's PDMP and the percentage of clinicians who were active PDMP users (users who created ≥ 1 patient prescription reports in a given month) from 2010 through 2017. We also compared PDMP use among early PDMP adopters (clinicians who registered > 8 months before the mandatory registration deadline) versus late adopters (clinicians who registered ≤ 8 months before the deadline). RESULTS:Mandatory registration was associated with increases in active PDMP users: 53.5% increase for prescribers and 17.9% for pharmacists. Early adopters were 4 times more likely to be active PDMP users than were late adopters. CONCLUSIONS:Mandatory registration was associated with increases in PDMP registration and use, but most new registrants did not become active users. Public Health Implications. Mandatory PDMP registration increases PDMP use but does not result in widespread PDMP usage by all clinicians prescribing controlled substances.

Background/UNASSIGNED:Despite insufficient evidence regarding its risks and benefits, marijuana is increasingly available and is aggressively marketed to the public. Objective/UNASSIGNED:To understand the public's views on the risks and benefits of marijuana use. Design/UNASSIGNED:Probability-based online survey. Setting/UNASSIGNED:United States, 2017. Participants/UNASSIGNED:16 280 U.S. adults. Measurements/UNASSIGNED:Proportion of U.S. adults who agreed with a statement. Results/UNASSIGNED:The response rate was 55.3% (n = 9003). Approximately 14.6% of U.S. adults reported using marijuana in the past year. About 81% of U.S. adults believe marijuana has at least 1 benefit, whereas 17% believe it has no benefit. The most common benefit cited was pain management (66%), followed by treatment of diseases, such as epilepsy and multiple sclerosis (48%), and relief from anxiety, stress, and depression (47%). About 91% of U.S. adults believe marijuana has at least 1 risk, whereas 9% believe it has no risks. The most common risk identified by the public was legal problems (51.8%), followed by addiction (50%) and impaired memory (42%). Among U.S. adults, 29.2% agree that smoking marijuana prevents health problems. About 18% believe exposure to secondhand marijuana smoke is somewhat or completely safe for adults, whereas 7.6% indicated that it is somewhat or completely safe for children. Of the respondents, 7.3% agree that marijuana use is somewhat or completely safe during pregnancy. About 22.4% of U.S. adults believe that marijuana is not at all addictive. Limitation/UNASSIGNED:Wording of the questions may have affected interpretation. Conclusion/UNASSIGNED:Americans' view of marijuana use is more favorable than existing evidence supports. Primary Funding Source/UNASSIGNED:National Heart, Lung, and Blood Institute.

Although peer behavior and parent-child-conflict have been associated with adolescent and young adults' behavior, prior studies have not adequately controlled for selection effects and other confounders, or examined whether associations change across the transition to adulthood or by race. Using annual data from young men followed from 17-26, within-individual change models examined whether substance use or offending increased in the year after boys began affiliating with friends who engaged in substance use/offending and/or experienced increased parent-son-conflict. Moderation analyses tested whether associations varied by age or race. Alcohol use, marijuana use, and offending (Black participants only) increased in the year after boys began affiliating with more peers who engaged in similar behaviors. Associations were strongest during adolescence for substance use. Parent-son conflict was not associated with the outcomes. Findings underscore the importance of developmental and racialized differences in understanding the role of social influences on young men's substance use and offending.

Most epidemiologic studies of physical activity measure either total energy expenditure or engagement in a single type of activity, such as walking. These approaches may gloss over important nuances in activity patterns. We performed a latent transition analysis to identify patterns of activity, as well as neighborhood and individual determinants of changes in those activity patterns, over 2 years in a cohort of 2,023 older adult residents of New York, New York, surveyed between 2011 and 2013. We identified 7 latent classes: 1) mostly inactive, 2) walking, 3) exercise, 4) household activities and walking, 5) household activities and exercise, 6) gardening and household activities, and 7) gardening, household activities, and exercise. The majority of subjects retained the same activity patterns between waves (54% unchanged between waves 1 and 2, 66% unchanged between waves 2 and 3). Most latent class transitions were between classes distinguished only by 1 form of activity, and only neighborhood unemployment was consistently associated with changing between activity latent classes. Future latent transition analyses of physical activity would benefit from larger cohorts and longer follow-up periods to assess predictors of and long-term impacts of changes in activity patterns.

Background/UNASSIGNED:Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States. Purpose/UNASSIGNED:To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs. Data Sources/UNASSIGNED:Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists. Study Selection/UNASSIGNED:Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses. Data Extraction/UNASSIGNED:2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention. Data Synthesis/UNASSIGNED:Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation. Limitation/UNASSIGNED:Few studies, high ROB, and heterogeneous analytic methods and outcome measurement. Conclusion/UNASSIGNED:Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of "best practices" and complementary initiatives to address these consequences. Primary Funding Source/UNASSIGNED:National Institute on Drug Abuse and Bureau of Justice Assistance.

Background: Legalization of marijuana has been accompanied by a growing number of Americans using marijuana, marijuana-related media coverage and marketing directed at consumers. Thus, understanding the public's current perceptions of the risks and benefits of marijuana is important. National surveys have examined "perceived risks" (e.g., great risk, moderate risk, low risk) from marijuana use, but little is known about views towards several other important domains including beliefs about benefits, prevention of health problems, perceived risk compared to tobacco and wine, and societal effects (e.g. secondhand smoke or driving under the influence). To further our understanding of the public's views about the risks and benefits of marijuana use, we conducted a national survey of US adults. Methods: We developed a survey and specifically addressed content not covered by federally sponsored surveys. We surveyed 16,000 US adults 18 years and older in September 2017 using GFK's KnowledgePanel, a probability-based, nationally representative online sample of the US population. To assess the extent to which our respondents were comparable to those of the National Survey on Drug Abuse and Health (NSDUH), we compared their socio-demographic characteristics. Descriptive statistics were calculated for all items. For the multivariable logistic regression analyses, we combined respondents who agreed with a statement and compared their baseline characteristics to respondents with all other viewpoints. Results: The response rate was 56.3% (n=9,003). The mean age of the sample was 48 years. Respondents were 52% female and 64% white. Respondent socio-demographic characteristics were similar to NSDUH. About 80% of US adults identified at least one benefit of marijuana while 17% stated it had no benefit. A third of Americans believe that marijuana improves sleep and about half believe it offers relief from stress, anxiety, and depression. About 91% of US adults identified at least one risk from marijuana while 9% stated it had no risks. Over a quarter of US adults agreed that marijuana had preventive health benefits. A third of US adults believe that smoking one marijuana joint a day is safer than smoking one cigarette a day and that secondhand smoke from marijuana is safer than secondhand smoke from tobacco. About 1 in 8 Americans believe that smoking one marijuana joint per day is safer than drinking one glass of wine per day. A quarter of Americans believe it is safer to drive under the influence of marijuana compared to under the influence of alcohol. Younger Americans 18 to 34 years old were about three times more likely to view smoking one marijuana joint a day as safer than smoking one cigarette a day compared to adults 65 years and older [OR 3.09, 95% CI (2.64, 3.62)]. Conclusions: Americans have a more favorable view of marijuana use than is supported by current evidence, with many believing it is safer than alcohol or tobacco. These findings should be a cause for concern to US policymakers

BACKGROUND:Assaultive violence events are associated with increased risk for adverse psychiatric outcomes, including post-traumatic stress (PTS), depression, and generalized anxiety. Prior research has indicated that economic, legal, and social stressors that could follow assaultive events may explain the increased risk for adverse psychiatric outcomes, yet longitudinal studies have not adequately examined this pathway. In the current study, we aimed to address this limitation. METHODS:Participants (N = 1360) were part of a longitudinal population-based study of adults living in Detroit. At three waves, participants indicated their exposure to assaultive violence and economic, legal, and social stressors, and completed inventories of PTS, depression, and generalized anxiety. Longitudinal mediation models were used to test the hypothesized pathway from assaultive violence to each psychiatric outcome. RESULTS:The hypothesized models evidenced good fit with the data and, in each, the paths from Wave 1 (W1) assaultive violence to W2 stressors, and from W2 stressors to W3 symptoms were significant (range of Standardized Estimates: 0.09-0.15, all p < 0.01). Additionally, the indirect paths from W1 assaultive violence to W3 symptoms were significant (range of Standardized Estimates: 0.01-0.02, all p < 0.05). CONCLUSIONS:The findings illustrate that the economic, legal, and social stressors that could follow assaultive violence increase risk for a range of psychiatric symptoms. Although future research is needed, the results suggest that investment in interventions that prevent and mitigate assaultive violence survivors' exposure to such stressors may be an effective way to prevent mental illness in the aftermath of violent assaults.