Faculty Bibliography

BACKGROUND:Prevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. METHODS:We examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl. RESULTS:There was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p < 0.001) and in the number of pill seizures (from 68 to 635, β = 0.96, p < 0.01). The proportion of pills to total seizures more than doubled from 13.8% in 2018 Q1 to 29.2% in 2021 Q4 (β = 0.92, p < 0.001). Weight of powder fentanyl seizures increased from 298.2 kg in 2018 Q1 to 2416.0 kg in 2021 Q4 (β = 1.12, p = 0.01); the number of pills seized increased from 42,202 in 2018 Q1 to 2,089,186 in 2021 Q4 (β = 0.90, p < 0.001). CONCLUSIONS:Seizures of drugs containing fentanyl have been increasing in the US. Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as oxycodone or alprazolam are at risk for unintentional exposure to fentanyl.

BACKGROUND:Effective patient-provider communication (PPC) can improve clinical outcomes and therapeutic alliance. While PPC may have improved over time due to the implementation of various policies for patient-centered care, its nationwide trend remains unclear. OBJECTIVE:The objective of this study was to examine trends in PPC quality among US adults and whether trends vary with race-ethnicity. RESEARCH DESIGN/METHODS:A repeated cross-sectional study. PARTICIPANTS/METHODS:We examine noninstitutionalized civilian adults who made 1 or more health care visits in the last 12 months and self-completed the mail-back questionnaire in the Medical Expenditure Panel Survey, 2002-2016. MEASURES/METHODS:Outcomes include 4 top-box measures, each representing the odds of patients reporting that their providers always (vs. never, sometimes, usually) used a given communication behavior in the past 12 months regarding listening carefully, explaining things understandably, showing respect, and spending enough time. A linear mean composite score (the average of ordinal responses for the behaviors above) is also examined as an outcome. Exposures include time period and race-ethnicity. RESULTS:Among 124,158 adults (181,864 observations), the quality of PPC increases monotonically between 2002 and 2016 for all outcomes. Between the first and last periods, the odds of high-quality PPC increase by 37% [95% confidence interval (CI)=32%-43%] for listen, 25% (95% CI=20%-30%) for explain, 41% (95% CI=35%-47%) for respect, and 37% (95% CI=31%-43%) for time. The composite score increases by 3.24 (95% CI=2.87-3.60) points. While increasing trends are found among all racial groups, differences exist at each period. Asians report the lowest quality throughout the study period for all outcomes, while Blacks report the highest quality. Although racial differences narrow over time, most changes are not significant. CONCLUSIONS:Our findings suggest that providers are increasingly likely to use patient-centered communication strategies. While racial differences have narrowed, Asians report the lowest quality throughout the study period, warranting future research.

OBJECTIVE:Genetic risk scores (GRS) aid classification of diabetes type in White European adult populations. We aimed to assess the utility of GRS in the classification of diabetes type among racially/ethnically diverse youth in the U.S. RESEARCH DESIGN AND METHODS/METHODS:We generated type 1 diabetes (T1D)- and type 2 diabetes (T2D)-specific GRS in 2,045 individuals from the SEARCH for Diabetes in Youth study. We assessed the distribution of genetic risk stratified by diabetes autoantibody positive or negative (DAA+/-) and insulin sensitivity (IS) or insulin resistance (IR) and self-reported race/ethnicity (White, Black, Hispanic, and other). RESULTS:T1D and T2D GRS were strong independent predictors of etiologic type. The T1D GRS was highest in the DAA+/IS group and lowest in the DAA-/IR group, with the inverse relationship observed with the T2D GRS. Discrimination was similar across all racial/ethnic groups but showed differences in score distribution. Clustering by combined genetic risk showed DAA+/IR and DAA-/IS individuals had a greater probability of T1D than T2D. In DAA- individuals, genetic probability of T1D identified individuals most likely to progress to absolute insulin deficiency. CONCLUSIONS:Diabetes type-specific GRS are consistent predictors of diabetes type across racial/ethnic groups in a U.S. youth cohort, but future work needs to account for differences in GRS distribution by ancestry. T1D and T2D GRS may have particular utility for classification of DAA- children.

Background/Significance: During the COVID-19 pandemic, people with substance use disorders have experienced increased rates of overdose, decreased access to substance use disorder treatment, and increased risk for adverse COVID outcomes (NIDA, 2020). Throughout the pandemic, NYU Langone Health has continued using the Tobacco, Alcohol, and Prescription Substance (TAPS) screening tool for all inpatient admissions in order to identify and provide proactive consultation to hospitalized patients at risk for substance use disorders.
Method(s): We conducted a retrospective review of adult inpatient medical and surgical admissions to NYU Langone Health, using data collected from a pre-defined Epic report based on TAPS documentation. We compared groups pre-COVID-19 pandemic (defined as 9/2018-9/2019) and during COVID-19 pandemic (defined as 3/2020-3/2021) for the following outcomes: (1) nursing compliance rate with TAPS administration, (2) prevalence of patients with substance use disorders as measured by positive TAPS screen, and (3) severity of alcohol use disorder among patients with TAPS positive for alcohol.
Result(s): During the pre-COVID-19 period, 24,057 patients were screened with a compliance rate of 90% and a positivity rate of 6% (N=1673). ICU compliance was 84%. Prevalence of patients at risk for various substance use disorders was as follows: 4.3% (N=1027) alcohol, 1.5% (N=357) cannabis, 0.32% (N=78) heroin, 0.24% (N=57) opiates, 0.15% (N=35) sedatives, 0.48% (N=116) stimulants, and 0.01% (N=3) prescription stimulants. Of positive alcohol screens, 26.7% (274/1027) represented the highest severity of use (Alcohol Score 4). During the COVID-19 period, 17,931 patients were screened with a compliance rate of 82% and positivity rate of 6% (N=1374). ICU compliance was 74%. Prevalence of patients at risk for various substance use disorders was as follows: 4.3% (N=772) alcohol, 1.5% (N=272) cannabis, 0.60% (N=108) heroin, 0.26% (N=46) opiates, 0.20% (N=35) sedatives, 0.69% (N=124) stimulants, and 0.04% (N=7) prescription stimulants. Of positive alcohol screens, 41.2% (318/772) were highest severity. We were unable to meaningfully test for significant given limitations of Epic datasets and variability in unit composition and staffing throughout COVID-19 period.
Discussion(s): There was decreased compliance with TAPS administration during COVID-19 as compared to pre-COVID-19, as well as overall low compliance in ICUs during both time periods. There were similar rates of positive screens for all substance use disorders pre-COVID-19 and during COVID-19, with an increase in positive heroin and other opiate screens during COVID-19. Among patients with positive alcohol screens, there was increased severity of alcohol scores during COVID-19 relative to pre-COVID-19. Conclusion/Implications: These results suggest a change in patterns of substance use during the COVID-19 pandemic, consistent with findings from prior studies of increased opioid overdoses (Slavova 2020, Georgia Department of Public Health 2020) and severity of substance use (NIDA 2020). Poor ICU compliance suggests increased barriers to TAPS administration in patients with critical illness and/or altered mental status, which may lead to decreased identification and treatment of patients at increased risk for substance use disorders. These results may inform clinical practice and future studies regarding utilization of TAPS screen and proactive addiction psychiatry consultation service in acute care settings. References: 1. NIDA. 2020, September 14. Addressing the Unique Challenges of COVID-19 for People in Recovery. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2020/09/addressing-u nique-challenges-covid-19-people-in-recovery on 2021, March 15 2. Slavova, S., Rock, P., Bush, H. M., Quesinberry, D., & Walsh, S. L. (2020). Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug and alcohol dependence, 214, 108176. 3. Georgia Department of Public Health. 2020, June 19. Suspected Drug Overdose Increases in Georgia Amid COVID-19. Retrieved from https://www.drugabuse.gov/sites/default/files/suspected_drug_overdos e_increases_in_georgia_amid_covid-19_1.pdf
Copyright

BACKGROUND:Substance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality. METHODS:Veterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR). RESULTS:Among COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment. CONCLUSIONS:In VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.

OBJECTIVE:Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives. DESIGN AND METHODS/METHODS:Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry. RESULTS:The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk. CONCLUSION/CONCLUSIONS:As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry.

BACKGROUND:Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics. OBJECTIVES:To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics. DESIGN:Electronic medical record review of abnormal screening mammograms. SUBJECTS:Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337). MAIN MEASURES:Our outcome was delay in follow-up of an abnormal mammogram of 60 days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors. KEY RESULTS:Only 45% of MM patients had obtained recommended follow-up within 60 days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively. CONCLUSIONS:A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.

BACKGROUND:Protective behavioral strategies (PBS) have been shown to be useful for reducing excessive alcohol use and alcohol-related problems. However, research on the explanatory factors of PBS is limited. This paper prospectively examines the contribution of perceived efficacy of PBS in reducing alcohol-related consequences and perceived descriptive norms of close peers´ PBS use in young adults. The mediating role of perceived efficacy of PBS between descriptive norms of PBS use and personal PBS use is also examined. METHOD:Targeted sampling was used to recruit a community-based sample of 339 young Spanish adults aged 18-25 years, who completed baseline and two-month follow-up questionnaires. Three types of PBS (serious harm reduction-SHR, manner of drinking-MOD, and stopping/limiting drinking-SLD) were measured. RESULTS:Both perceived efficacy and descriptive norms at baseline were positively associated with personal PBS use (SHR, MOD and SLD) at follow-up. A partial mediation effect of perceived efficacy between descriptive norms and personal PBS use was found for the three PBS subscales. CONCLUSIONS:Our findings support the usefulness of correcting misperceptions of PBS use by peers in interventions aimed at reducing excessive drinking and alcohol-related consequences in young adults in the community. Moreover, PBS perceived efficacy should be included as a component of these interventions.