Faculty Bibliography
Searched for:
person:cerdam01 or freids01 or hamill07 or krawcn01
Total Results:
1284
Rural risk environments, opioid-related overdose, and infectious diseases: A multidimensional, spatial perspective
BACKGROUND:Much remains unknown in rural risk environments, despite a growing crisis in these areas. We adapt a risk environment framework to characterize rural southern Illinois and describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017. METHODS:Over two dozen risk environment variables are summarized across zip-code (n = 128) or county levels (n = 16) based on availability and theoretical relevance. We calculate data attribute associations and characterize spatial and temporal dimensions of longitudinal health outcomes and the rural risk environment. We then use a "regional typology analysis" to generate data-driven risk regions and compare health outcomes. RESULTS:Pervasive risk hotspots were identified in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. At-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape. CONCLUSIONS:Rural risk environment vulnerabilities and associated opioid-related health outcomes are multifaceted and spatially heterogeneous. More research is needed to better understand how refining geographies to more precisely define risk can support intervention efforts and further enrich investigations of the opioid epidemic.
PMID: 32513621
ISSN: 1873-4758
CID: 4841852
Trends in marijuana use in two Latin-American countries: an age, period, and cohort study
BACKGROUND AND AIMS/OBJECTIVE:Uruguay and Chile have the highest levels of marijuana use in Latin America and experienced consistent increases over the last 2 decades. We aim to calculate separate age-period-cohort (APC) effects for past-year marijuana use in Uruguay and Chile, which have similar epidemiologic and demographic profiles, but diverging paths in cannabis regulation. DESIGN/METHODS:Age, period and cohort study in which period and cohort effects were estimated as first derivative deviations from their linear age trend, separately by country and gender. SETTING/METHODS:Uruguay and Chile. PARTICIPANTS/METHODS:General population between 15 and 64 years of age. MEASUREMENTS/METHODS:Past-year marijuana use from household surveys with five repeated cross-sections between 2001-2018 in Uruguay (median n=4,616) and 13 between 1994-2018 in Chile (median n=15,895). FINDINGS/RESULTS:Marijuana use prevalence in both countries peaked at 20-24 years of age and increased consistently across calendar years. Period effects were strong and positive, indicating that increases in use were evident across age groups. Relative to 2006 (reference year), Chilean period effects were about 48% lower in 1994 and about four times higher in 2018; in Uruguay, these effects were about 56% lower in 2001 and almost quadrupled in 2018. We observed non-linear cohort effects in Chile, and similar patterns in Uruguay for the overall sample and women. In both countries, marijuana use increased for cohorts born between the mid-1970s and early 1990s even in the context of rising period effects. Prevalence was consistently larger for men, but period increases were stronger in women. CONCLUSIONS:Age-period-cohort effects on past-year marijuana use appear to have been similar in Chile and Uruguay, decreasing with age and increasing over time at heterogeneous growth rates depending on gender and cohort. Current levels of marijuana use, including age and gender disparities, seem to be associated with recent common historical events in these two countries.
PMID: 32196789
ISSN: 1360-0443
CID: 4353152
The Impact of Various Risk Assessment Time Frames on the Performance of Opioid Overdose Forecasting Models
BACKGROUND:An individual's risk for future opioid overdoses is usually assessed using a 12-month "lookback" period. Given the potential urgency of acting rapidly, we compared the performance of alternative predictive models with risk information from the past 3, 6, 9, and 12 months. METHODS:We included 1,014,033 Maryland residents aged 18-80 with at least 1 opioid prescription and no recorded death in 2015. We used 2015 Maryland prescription drug monitoring data to identify risk factors for nonfatal opioid overdoses from hospital discharge records and investigated fatal opioid overdose from medical examiner data in 2016. Prescription drug monitoring program-derived predictors included demographics, payment sources for opioid prescriptions, count of unique opioid prescribers and pharmacies, and quantity and types of opioids and benzodiazepines filled. We estimated a series of logistic regression models that included 3, 6, 9, and 12 months of prescription drug monitoring program data and compared model performance, using bootstrapped C-statistics and associated 95% confidence intervals. RESULTS:For hospital-treated nonfatal overdose, the C-statistic increased from 0.73 for a model including only the fourth quarter to 0.77 for a model with 4 quarters of data. For fatal overdose, the area under the curve increased from 0.80 to 0.83 over the same models. The strongest predictors of overdose were prescription fills for buprenorphine and Medicaid and Medicare as sources of payment. CONCLUSIONS:Models predicting opioid overdose using 1 quarter of data were nearly as accurate as models using all 4 quarters. Models with a single quarter may be more timely and easier to identify persons at risk of an opioid overdose.
PMID: 32925472
ISSN: 1537-1948
CID: 4592582
Financial Payments to Teaching Hospitals by Companies Marketing Opioids [Letter]
PMID: 31848860
ISSN: 1525-1497
CID: 4255332
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States
INTRODUCTION/BACKGROUND:Incident HIV infections persist in the United States (U.S.) among marginalized populations. Targeted and cost-efficient testing strategies can help in reaching HIV elimination. This analysis compares the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. METHODS:We performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men. All occurred at the same academic medical centre during the following times: routine testing, 2011 to 2016; MPS, 2013 to 2016; SN: 2013 to 2014. Costs were in 2016 dollars and included personnel, HIV testing, training, materials, overhead. Outcomes included cost per test, HIV-positive test and new diagnosis. Sensitivity analyses were performed to assess the impact of population demographics. RESULTS:The RS programme completed 57,308 HIV tests resulting in 360 (0.6%) HIV-positive tests and 165 new HIV diagnoses (0.28%). The MPS completed 146 HIV tests, resulting in 79 (54%) HIV-positive tests and eight new HIV diagnoses (5%). The SN strategy completed 508 HIV tests, resulting in 210 (41%) HIV-positive tests and 37 new HIV diagnoses (7.2%). Labour accounted for the majority of costs in all strategies. The estimated cost per new HIV diagnosis was $16,773 for the RS programme, $61,418 for the MPS programme and $15,683 for the SN testing programme. These costs were reduced for the RS and MPS strategies in sensitivity analyses limiting testing efficacy to the highest prevalence patient populations ($2,841 and $33,233 respectively). CONCLUSIONS:The SN strategy yielded the highest proportion of new diagnoses, followed closely by the MPS programme. Both the SN strategy and RS programme were comparable in the cost per new diagnosis. A simultaneous approach that consists of RS in combination with SN testing may be most effective for identifying new HIV infections in settings with heterogeneous epidemics with both high rates of HIV prevalence and HIV testing.
PMCID:7594703
PMID: 33119195
ISSN: 1758-2652
CID: 4660392
Adolescent-Serving Addiction Treatment Facilities in the United States and the Availability of Medications for Opioid Use Disorder
PURPOSE/OBJECTIVE:Adolescents with opioid use disorder are less likely than adults to receive medications for opioid use disorder (MOUD), yet we know little about facilities that provide addiction treatment for adolescents. We sought to describe adolescent-serving addiction treatment facilities in the U.S. and examine associations between facility characteristics and offering MOUD, leading to informed recommendations to improve treatment access. METHODS:This cross-sectional study used the 2017 National Survey of Substance Abuse Treatment Services. Facilities were classified by whether they offered a specialized adolescent program. Covariates included facility ownership, hospital affiliation, insurance/payments, government grants, accreditation/licensure, location, levels of care, and provision of MOUD. Descriptive statistics and logistic regression compared adolescent-serving versus adult-focused facilities and identified characteristics associated with offering maintenance MOUD. RESULTS:Among 13,585 addiction treatment facilities in the U.S., 3,537 (26.0%) offered adolescent programs. Adolescent-serving facilities were half as likely to offer maintenance MOUD as adult-focused facilities (odds ratio, .53; 95% confidence interval, .49-.58), which was offered at 23.1% (816) of adolescent-serving versus 35.9% (3,612) of adult-focused facilities. Among adolescent-serving facilities, characteristics associated with increased unadjusted odds of offering maintenance MOUD were nonprofit status, hospital affiliation, accepting insurance (particularly, private insurance), accreditation, Northeastern location, or offering inpatient services. CONCLUSIONS:The one-quarter of U.S. addiction treatment facilities that serve adolescents are half as likely to provide MOUD as adult-focused facilities, which may explain why adolescents are less likely than adults to receive MOUD. Strategies to increase adolescent access to MOUD may consider insurance reforms/incentives, facility accreditation, and geographically targeted funding.
PMID: 32336560
ISSN: 1879-1972
CID: 4411752
Medical Marijuana Laws and Driving Under the Influence of Marijuana and Alcohol
BACKGROUND AND AIMS/OBJECTIVE:Medical marijuana law (MML) enactment in the US has been associated with increased cannabis use but lower traffic fatality rates. We assessed the possible association of MML and individual-level driving under the influence of cannabis (DUIC), and also under the influence of alcohol (DUIA). DESIGN AND SETTING/METHODS:Three cross-sectional U.S. adult surveys: The National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the NESARC-III (2012-2013). PARTICIPANTS/METHODS:The total n was 118,497: 41,764, 41,184 and 35,549 from NLAES, NESARC, and NESARC-III. MEASUREMENTS/METHODS:Across the three surveys, similar questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule assessed DUIC and DUIA. Ever-MML states enacted MML between 1991-1992 and 2012-2013 (overall period). Early-MML states enacted MML between 1991-1992 and 2001-2002 (early period). Late-MML states enacted MML between 2001-2002 and 2012-2013 (late period). MML effects on change in DUIC and DUIA prevalence were estimated using a difference-in-differences specification to compare changes in MML and other states. FINDINGS/RESULTS:From 1991-1992 to 2012-2013, DUIC prevalence nearly doubled (from 1.02% to 1.92%), increasing more in states that enacted MML than other states (difference-in-differences [DiD]=0.59%; 95%CI=0.06%-1.12%). Most change in DUIC prevalence occurred between 2001-2002 and 2012-2013. DUIC prevalence increased more in states that enacted MML 2001-2002 to 2012-2013 than in never-MML states (DiD=0.77%; 95%CI= -0.05%-1.59%), and in two early-MML states, California (DiD=0.82; 95%CI=0.06-1.59) and Colorado (DiD=1.32; 95%CI=0.11-2.53). In contrast, DUIA prevalence appeared unrelated to MML enactment. CONCLUSIONS:Medical marijuana law enactment in US states appears to have been associated with increased prevalence of driving under the influence of cannabis, but not alcohol.
PMID: 32141142
ISSN: 1360-0443
CID: 4340002
Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory
We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18} eV based on 215 030 events. New results are presented: at about 1.3×10^{19} eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19} eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18} eV is [5.66±0.03(stat)±1.40(syst)]×10^{53} erg Mpc^{-3}.
PMID: 33016715
ISSN: 1079-7114
CID: 5910932
Journal of acquired immune deficiency syndromes. JAIDS. 2020:85(1):39-45.DOI: 10.1097/QAI.0000000000002395
Trends in State Policy Support for Sexual Minorities and HIV-Related Outcomes among Men Who Have Sex with Men in the United States, 2008-2014
BACKGROUND:To examine trends in state-level policy support for sexual minorities and HIV outcomes among MSM. METHODS:This longitudinal analysis linked state-level policy support for sexual minorities (N=94 Metropolitan Statistical Areas [MSAs] in 38 states) to 7 years of data (2008-2014) from CDC on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (e.g., non-discrimination laws including sexual orientation as a protected class) from 1999-2014, deriving 3 latent groups: consistently low policy support; consistently high policy support; and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM; late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within three months of HIV diagnosis) per 10,000 MSM; AIDS diagnoses per 10,000 MSM with HIV; and AIDS-related mortality per 10,000 MSM with AIDS. RESULTS:Compared to MSAs in states with low levels and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses (Risk Difference [RD]=-37.9, 95% Confidence Interval [CI]: -54.7, -21.0), late diagnoses (RD=-12.5, 95% CI: -20.4, -4.7), and AIDS-related mortality (RD=-33.7, 95% CI: -61.2, -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to policy climate. CONCLUSION/CONCLUSIONS:State-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
PMID: 32398556
ISSN: 1944-7884
CID: 4438062
COVID-19 and the health of people who use drugs: What is and what could be?
SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting 'complex adaptive systems': that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.
PMID: 33183679
ISSN: 1873-4758
CID: 4679912
