Faculty Bibliography

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.

BACKGROUND:Our previous research has found low and stable mean drug treatment coverage among people who inject drugs (PWID) across 90 large US metropolitan statistical areas (MSAs) during 1993-2002. This manuscript updates previous estimates of change in drug treatment coverage for PWID in 90 MSAs during 1993-2007. METHODS:Our drug treatment sample for calculating treatment coverage includes clients enrolled in residential or ambulatory inpatient/outpatient care, detoxification services, and methadone maintenance therapy at publicly- and privately-funded substance abuse agencies receiving public funds. Coverage was measured as the number of PWID in drug treatment, calculated by using data from the Substance Abuse and Mental Health Service Administration, divided by numbers of PWID in each MSA. We modeled change in drug treatment coverage rates using a negative binomial mixed-effects model. Fixed-effects included an intercept and a main effect for time. Incidence rate ratios (IRR) were calculated for both average change from 1993 to 2007 and MSA-specific estimates of change in coverage rates. RESULTS:On average over all MSAs, coverage was low in 1993 (6.1%) and showed no improvement from 1993 to 2007 (IRR = 0.99; 95% CI, 0.86, 1.2). There was modest variability across MSAs in coverage in 1993 (log incidence rate SD = 0.36) as well as in coverage change from 1993 to 2007 (log IRR SD = 0.32). In addition, results indicate significant variability among MSAs in coverage. CONCLUSIONS:Inadequate treatment coverage for PWID may produce a high cost to society in terms of the spread of overdose mortality and injection-related infectious diseases. A greater investment in treatment will likely be needed to have a substantial and more consistent impact on injection drug use-related harms. Future research should examine MSA-level predictors associated with variability in drug treatment coverage.

Incarceration is strongly associated with post-release STI/HIV risk. One pathway linking incarceration and STI/HIV risk may be incarceration-related dissolution of protective network ties. Among African American men released from prison who were in committed partnerships with women at the time of incarceration (N = 207), we measured the association between committed partnership dissolution during incarceration and STI/HIV risk in the 4 weeks after release. Over one-quarter (28%) experienced incarceration-related partnership dissolution. In adjusted analyses, incarceration-related partnership dissolution was strongly associated with post-release binge drinking (adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI); 1.4-15.5). Those who experienced incarceration-related partnership dissolution were much more likely to engage in multiple/concurrent partnerships or sex trade defined as buying or selling sex (64%) than those who returned to the partner (12%; AOR 20.1, 95% CI 3.4-175.6). Policies that promote maintenance of relationships during incarceration may be important for protecting health.

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.

PURPOSE OF REVIEW/OBJECTIVE:The social networks of people who inject drugs (PWID) have long been studied to understand disease transmission dynamics and social influences on risky practices. We illustrate how PWID can be active agents promoting HIV, HCV, and overdose prevention. RECENT FINDINGS/RESULTS:We assessed drug users' connections and interactions with others at risk for HIV/HCV in three cities: New York City (NYC), USA (n = 539); Pereira, Colombia (n = 50); and St. Petersburg, Russia (n = 49). In all three cities, the majority of participants' network members were of a similar age as themselves, yet connections across age groups were also present. In NYC, knowing any opioid user(s) older than 29 was associated with testing HCV-positive. In NYC and St. Petersburg, a large proportion of PWID engaged in intravention activities to support safer injection and overdose prevention; in Pereira, PWID injected, had sex, and interacted with other key groups at risk. People who use drugs can be active players in HIV/HCV and overdose risk- reduction; their networks provide them with ample opportunities to disseminate harm reduction knowledge, strategies, and norms to others at risk. Local communities could augment prevention programming by empowering drug users to be allies in the fight against HIV and facilitating their pre-existing health-protective actions.

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

INTRODUCTION AND AIMS/OBJECTIVE:Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern. DESIGN AND METHODS/METHODS:Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time-varying covariates in all models. RESULTS:We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15-1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26-1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47-3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26-13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29-3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11-2.06, P < 0.01). DISCUSSION AND CONCLUSIONS/CONCLUSIONS:Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding-the bi-directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non-medical use of tranquilisers and prescription opioids. [Castaldelli-Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In-transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000-000].