Faculty Bibliography

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

The objectives of this study were to: (1) describe the quantity and quality of social support networks of Latino immigrants living in a new receiving environment, and (2) determine the role such networks play in their HIV/STI risk behaviors, including substance use. Double incentivized convenience sampling was used to collect egocentric social support network data on 144 Latino immigrants. Latent class analysis was used for data reduction and to identify items best suited to measure quality and quantity of social support. Moderate and high quantity and quality of social support were protective of HIV/STI sexual risk behavior compared to low quantity and quality of support, after adjustment for gender, years in New Orleans and residing with family. Neither measure of social support was associated with binge drinking. The findings suggest that increased quantity and quality of social support decrease HIV/STI sexual risk behaviors but do not influence binge drinking. Interventions that improve the quantity and quality of social support are needed for Latino immigrants.

People in the US criminal justice system experience high rates of opioid use disorder, overdose, and other adverse outcomes. Expanding treatment is a key strategy for addressing the opioid epidemic, but little is known about whether the criminal justice system refers people to the highest standard of treatment: the use of the opioid agonist therapies methadone or buprenorphine. We used 2014 data from the national Treatment Episode Data Set to examine the use of agonist treatment among justice-involved people referred to specialty treatment for opioid use disorder. Only 4.6 percent of justice-referred clients received agonist treatment, compared to 40.9 percent of those referred by other sources. Of all criminal justice sources, courts and diversionary programs were least likely to refer people to agonist treatment. Our findings suggest that an opportunity is being missed to promote effective, evidence-based care for justice-involved people who seek treatment for opioid use disorder.

We described drug use, sex risk, and STI/HIV among men who have sex with men and women (MSMW) and their female partners. We used the Network, Norms and HIV/STI Risk among Youth (NNAHRAY) study to evaluate drug use, sex risk, and biologically-confirmed STI/HIV in (1) MSMW and men who had sex with men only (MSMO) versus men who had sex with women only (MSWO) and (2) female partners of MSMW versus female partners of MSWO (N = 182 men, 152 women). MSMW versus MSWO had 30 to 60% increased odds of substance use, over twice the odds of multiple partnerships, and almost five times the odds of sex trade and HIV infection. Female partners of MSMW versus female partners of MSWO had approximately twice the odds of substance use and 1.5-2 times the odds of multiple partnerships and sex trade. Interventions should address STI/HIV risk among MSMW and their female partners.

Background/UNASSIGNED:High numbers of human immunodeficiency virus type 1 (HIV-1) infections among people who inject drugs (PWID) have been diagnosed in Athens, Greece, since 2011. We aimed to trace the geographic origin of HIV-1 infection for migrants who inject drugs and to investigate whether transmissions occur more frequently among migrants than among Greek nationals. Methods/UNASSIGNED:Multiple cross-sectional studies were pooled to assemble all persons diagnosed with HIV-1 in Greece between 1 January 2011 and 31 October 2014. Phylogenetic analyses used maximum likelihood estimation. The hypothesis of ethnic compartmentalization was tested by reconstructing ancestral states of characters at the tips using the criterion of parsimony over a set of bootstrap trees. Results/UNASSIGNED:Of 2274 persons, 38.4% were PWID. Phylogenetic analyses showed the existence of 4 major PWID-specific local transmission networks (LTNs): CRF14_BG (437 [58.6%]), CRF35_AD (139 [18.6%]), subtype B (116 [15.6%]), and subtype A (54 [7.2%]). Of 184 non-Greek PWID, 78.3% had been infected within the PWID-LTNs. For 173 (94.3%), the origin of their infection was assumed to be in Greece (postmigration). For PWID infected within LTNs, transmissions for subtype A and CRF14_BG occurred more frequently among migrants than would be expected by chance (phyloethnic study). Conclusions/UNASSIGNED:Our analysis showed that the majority of infections among migrants occurred postmigration. The existence of significant transmission networking among migrants highlights that this population is a priority for HIV prevention. As molecular analysis can estimate the probable country of HIV infection, it can help to inform the design of public health strategies.

PURPOSE:This short communication examines the impact of the Patient Protection and Affordable Care Act (PPACA) on insurance coverage and substance use treatment access among persons with opioid use disorders. METHODS:Data came from the 2010-2015 National Surveys on Drug Use and Health. Among persons with heroin and opioid pain-reliever use disorders, measures of insurance coverage and treatment access were compared before and after the implementation of major PPACA provisions that expanded access to insurance in 2014. RESULTS:The prevalence of uninsured persons among those with heroin use disorders declined dramatically following PPACA implementation (OR 0.59, 95% CI 0.39-0.89), largely due to an increase in the prevalence of Medicaid coverage (OR 1.96, 95% CI 1.21-3.18). There was no evidence of an increase in the prevalence of treatment, but among persons who received treatment, there was an increase in the proportion whose treatment was paid for by insurance (OR 3.75, 95% CI 2.13-3.18). By contrast, there was no evidence the uninsured rate declined among persons with pain-reliever use disorders. CONCLUSIONS:The PPACA Medicaid expansion increased insurance coverage among persons with heroin use disorders, and likely plays an essential role in protecting the health and financial security of this high-risk group. More research is needed on the relationship between insurance acquisition and utilization of substance use treatment.

BACKGROUND:Marijuana use has been decreasing in the past several years among adolescents, though variation in the extent and rate of decrease across racial/ethnic groups is inadequately understood. METHODS:The present study utilized nationally-representative data in Monitoring the Future from 2006 to 2015 to examine trends over time in past 30-day marijuana use. We examine whether differences in trends over time by race and ethnicity also differ by individual-level, school-level, and state-level factors. Sample included 131,351 8th grade students, 137,249 10th grade students, and 123,293 12th grade students; multi-level models and difference-in-differences tests were used. RESULTS:In 10th grade, Black students had a positive linear increase in marijuana use (est=0.04, SE=0.01, p<0.001), and the magnitude of the increase was significantly greater than among non-Hispanic White students (est=0.38, SE=0.009, p<0.001). The increase trend among Black students was greater among those in large class sizes. In 12th grade, all racial ethnic groups except non-Hispanic Whites demonstrated a linear increase in prevalence across time. The magnitude of the increase among Hispanic students was greater among those in urban areas and large class sizes. The magnitude of the increase among Black students was greater in states with a medical marijuana law before 2006 (est=0.06, SE=0.03, p=0.02), among other state-level covariates. CONCLUSION/CONCLUSIONS:Together these results suggest that the next stage of public health approaches to reducing the harms associated with adolescent drug use should attend to shifting demographic patterns of use among adolescents and ensure that services and programmatic approaches to adolescent prevention are applied equitably.