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Applications of agent-based modeling in trauma research

Tracy, Melissa; Gordis, Elana; Strully, Kate; Marshall, Brandon D L; Cerdá, Magdalena
Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing trauma research; Method: We provide an overview of agent-based modeling for trauma research, including a discussion of the model development process, ABM as a complement to other causal inference and complex systems approaches in trauma research, and past ABM applications in the trauma literature; Results: We use existing ABM applications to illustrate the strengths of ABM for trauma research, including incorporating interactions between individuals, simulating processes across multiple scales, examining life-course effects, testing alternate theories, comparing intervention strategies in a virtual laboratory, and guiding decision making. We also discuss the challenges of applying ABM to trauma research and offer specific suggestions for incorporating ABM into future studies of trauma and violence; Conclusion: Agent-based modeling is a useful complement to other methodological advances in trauma research. We recommend a more widespread adoption of ABM, particularly for research into patterns and consequences of individual traumatic experiences across the life course and understanding the effects of interventions that may be influenced by social norms and social network structures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMCID:10030380
PMID: 36136775
ISSN: 1942-969x
CID: 5524472

State-Level History of Overdose Deaths Involving Stimulants in the United States, 1999‒2020

Kline, David; Bunting, Amanda M; Hepler, Staci A; Rivera-Aguirre, Ariadne; Krawczyk, Noa; Cerda, Magdalena
PMID: 37556789
ISSN: 1541-0048
CID: 5594992

Estimating Causal Effects of HIV Prevention Interventions with Interference in Network-based Studies among People Who Inject Drugs

Lee, TingFang; Buchanan, Ashley L; Katenka, Natallia V; Forastiere, Laura; Halloran, M Elizabeth; Friedman, Samuel R; Nikolopoulos, Georgios
Evaluating causal effects in the presence of interference is challenging in network-based studies of hard-to-reach populations. Like many such populations, people who inject drugs (PWID) are embedded in social networks and often exert influence on others in their network. In our setting, the study design is observational with a non-randomized network-based HIV prevention intervention. Information is available on each participant and their connections that confer possible HIV risk through injection and sexual behaviors. We considered two inverse probability weighted (IPW) estimators to quantify the population-level spillover effects of non-randomized interventions on subsequent health outcomes. We demonstrated that these two IPW estimators are consistent, asymptotically normal, and derived a closed-form estimator for the asymptotic variance, while allowing for overlapping interference sets (groups of individuals in which the interference is assumed possible). A simulation study was conducted to evaluate the finite-sample performance of the estimators. We analyzed data from the Transmission Reduction Intervention Project, which ascertained a network of PWID and their contacts in Athens, Greece, from 2013 to 2015. We evaluated the effects of community alerts on subsequent HIV risk behavior in this observed network, where the connections or links between participants were defined by using substances or having unprotected sex together. In the study, community alerts were distributed to inform people of recent HIV infections among individuals in close proximity in the observed network. The estimates of the risk differences for spillover using either IPW estimator demonstrated a protective effect. The results suggest that HIV risk behavior could be mitigated by exposure to a community alert when an increased risk of HIV is detected in the network.
PMCID:10798667
PMID: 38250709
ISSN: 1932-6157
CID: 5624602

Typology of laws restricting access to methadone treatment in the United States: A latent class analysis

Conway, Anna; Krawczyk, Noa; McGaffey, Frances; Doyle, Sheri; Baaklini, Vanessa; Marshall, Alison D; Treloar, Carla; Davis, Corey S; Colledge-Frisby, Samantha; Grebely, Jason; Cerdá, Magdalena
BACKGROUND:In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership. METHODS:A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated. RESULTS:States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22). CONCLUSIONS:States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.
PMID: 37540917
ISSN: 1873-4758
CID: 5625682

Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens

Friedman, Samuel R; Perlman, David C; Paraskevis, Dimitrios; Feldman, Justin
The AIDS and COVID-19 pandemics demonstrated that nations at similar economic development levels varied widely in their capacity to protect the health of their residents. For AIDS, Britain and Australia brought gay representatives into official counsels and adopted harm reduction far more rapidly than the United States or Spain, and East African countries responded more effectively than South Africa or the Democratic Republic of the Congo. National responses to COVID-19 varied widely, with New Zealand, China, and Vietnam more effective than Italy, Brazil, or the United States. Further, as phylogenetic research has demonstrated, these pandemics spread from one country to another, with those that responded poorly acting as sources for mutations and potentially sources of transmission to countries with more effective responses. Many observers expressed surprise at the poor responses of the United States to COVID-19, but in retrospect the cutbacks in public health funding at state and national levels made it clear that this was a predictable weakness even in addition to the political vacillations that crippled the US and Brazilian responses. In a time of global sociopolitical and climate instability, it is important to measure and conduct research into spatial and time variations in 1. public health and medical funding, 2. social influence networks, social cohesion and trust, and stigmatization, 3. income inequality, 4. social conflict, and 5. other factors that affect responsiveness to pandemics.
PMCID:10457759
PMID: 37623983
ISSN: 2076-0817
CID: 5598982

Variation in HIV Transmission Behaviors Among People Who Use Drugs in Rural US Communities

Jenkins, Wiley D; Friedman, Samuel R; Hurt, Christopher B; Korthuis, P Todd; Feinberg, Judith; Del Toro-Mejias, Lizbeth M; Walters, Suzan; Seal, David W; Fredericksen, Rob J; Westergaard, Ryan; Miller, William C; Go, Vivian F; Schneider, John; Giurcanu, Mihai
IMPORTANCE:People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood. OBJECTIVE:To examine the association of characteristics of rural PWUD with HIV transmission behaviors. DESIGN, SETTING, AND PARTICIPANTS:In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included. EXPOSURES:Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected. MAIN OUTCOMES AND MEASURES:Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed. RESULTS:Of 3048 rural PWUD (mean [SD] age, 36.1 [10.3] years; 225 American Indian [7.4%], 96 Black [3.2%], and 2576 White [84.5%] among 3045 with responses; and 1737 men [57.0%] among 3046 with responses), most participants were heterosexual (1771 individuals [86.8%] among 2040 with responses) and single (1974 individuals [68.6%] among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals [84.9%] with responses) and condomless sex (1406 of 1757 individuals [80.0%] with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals [41.8%] with responses) and transactional sex (230 of 1799 individuals [12.8%] with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean [SD] age ranged from 34.5 [10.0] years in Wisconsin to 39.7 [11.0] years in Illinois; P < .001). In multivariable modeling, younger age (adjusted odds ratio [aOR] for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs. CONCLUSIONS AND RELEVANCE:This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.
PMCID:10442709
PMID: 37603331
ISSN: 2574-3805
CID: 5598312

Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019

Fink, David S; Malte, Carol; Cerdá, Magdalena; Mannes, Zachary L; Livne, Ofir; Martins, Silvia S; Keyhani, Salomeh; Olfson, Mark; McDowell, Yoanna; Gradus, Jaimie L; Wall, Melanie M; Sherman, Scott; Maynard, Charles C; Saxon, Andrew J; Hasin, Deborah S
OBJECTIVES/OBJECTIVE:This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18-34, 35-64, and 65-75 years), sex, and race, and ethnicity. METHOD/METHODS:VHA electronic health records from 2008 to 2019 were used to identify the percentage of unique VHA patients seen each year at an ED, received a UDS, and screened positive for cannabis. Trends in cannabis-positive UDS were examined by age, race and ethnicity, and sex within age groups. RESULTS:Of the VHA ED patients with a UDS, the annual prevalence positive for cannabis increased from 16.42% in 2008 to 27.2% in 2019. The largest increases in cannabis-positive UDS were observed in the younger age groups. Male and female ED patients tested positive for cannabis at similar levels. Although the prevalence of cannabis-positive UDS was consistently highest among non-Hispanic Black patients, cannabis-positive UDS increased in all race and ethnicity groups. DISCUSSION/CONCLUSIONS:The increasing prevalence of cannabis-positive UDS supports the validity of previously observed population-level increases in cannabis use and cannabis use disorder from survey and administrative records. Time trends via UDS results provide additional support that previously documented increases in self-reported cannabis use and disorder from surveys and claims data are not spuriously due to changes in patient willingness to report use as it becomes more legalized, or due to greater clinical attention over time.
PMID: 37418654
ISSN: 1935-3227
CID: 5524562

Correction to: Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science

McGinty, Emma E; Seewald, Nicholas J; Bandara, Sachini; Cerdá, Magdalena; Daumit, Gail L; Eisenberg, Matthew D; Griffin, Beth Ann; Igusa, Tak; Jackson, John W; Kennedy-Hendricks, Alene; Marsteller, Jill; Miech, Edward J; Purtle, Jonathan; Schmid, Ian; Schuler, Megan S; Yuan, Christina T; Stuart, Elizabeth A
PMID: 37395869
ISSN: 1573-6695
CID: 5524552

Hepatitis C Virus in people with experience of injection drug use following their displacement to Southern Ukraine before 2020

Yakovleva, Anna; Kovalenko, Ganna; Redlinger, Matthew; Smyrnov, Pavlo; Tymets, Olga; Korobchuk, Anna; Kotlyk, Lyudmyla; Kolodiazieva, Anna; Podolina, Anna; Cherniavska, Svitlana; Antonenko, Petro; Strathdee, Steffanie A; Friedman, Samuel R; Goodfellow, Ian; Wertheim, Joel O; Bortz, Eric; Meredith, Luke; Vasylyeva, Tetyana I
BACKGROUND:Due to practical challenges associated with genetic sequencing in low-resource environments, the burden of hepatitis C virus (HCV) in forcibly displaced people is understudied. We examined the use of field applicable HCV sequencing methods and phylogenetic analysis to determine HCV transmission dynamics in internally displaced people who inject drugs (IDPWID) in Ukraine. METHODS:In this cross-sectional study, we used modified respondent-driven sampling to recruit IDPWID who were displaced to Odesa, Ukraine, before 2020. We generated partial and near full length genome (NFLG) HCV sequences using Oxford Nanopore Technology (ONT) MinION in a simulated field environment. Maximum likelihood and Bayesian methods were used to establish phylodynamic relationships. RESULTS:Between June and September 2020, we collected epidemiological data and whole blood samples from 164 IDPWID (PNAS Nexus.2023;2(3):pgad008). Rapid testing (Wondfo® One Step HCV; Wondfo® One Step HIV1/2) identified an anti-HCV seroprevalence of 67.7%, and 31.1% of participants tested positive for both anti-HCV and HIV. We generated 57 partial or NFLG HCV sequences and identified eight transmission clusters, of which at least two originated within a year and a half post-displacement. CONCLUSIONS:Locally generated genomic data and phylogenetic analysis in rapidly changing low-resource environments, such as those faced by forcibly displaced people, can help inform effective public health strategies. For example, evidence of HCV transmission clusters originating soon after displacement highlights the importance of implementing urgent preventive interventions in ongoing situations of forced displacement.
PMCID:10316605
PMID: 37400776
ISSN: 1471-2334
CID: 5538802

Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020

Castillo-Carniglia, Alvaro; Rivera-Aguirre, Ariadne; Santaella-Tenorio, Julian; Fink, David S; Crystal, Stephen; Ponicki, William; Gruenewald, Paul; Martins, Silvia S; Keyes, Katherine M; Cerdá, Magdalena
BACKGROUND:Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS:Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS:Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS:Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
PMID: 36943813
ISSN: 1531-5487
CID: 5524512