Faculty Bibliography

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.

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.

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.

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.