A qualitative assessment of key considerations for drug checking service implementation.

BACKGROUND: With many drug-related deaths driven by potent synthetic opioids tainting the illicit drug supply, drug checking services are becoming a key harm reduction strategy. Many drug checking technologies are available, ranging from fentanyl test strips to mass spectrometry. This study aimed to identify key considerations when implementing drug checking technologies and services to support harm reduction initiatives. METHODS: Key informant interviews were conducted with harm reduction stakeholders throughout Illinois. Participants included members of existing drug checking services and recovery centers. Interviews were recorded, transcribed, and coded by two researchers using the framework method. Findings were contextualized according to micro (client)-, meso (organization)-, and macro (policy)-level themes. RESULTS: Seven interviews were conducted with ten participants. Fourier transform infrared spectroscopy was consistently identified as a technology of choice given its accuracy, range of substance detection, portability, and usability. Recommendations included the use of confirmatory testing, which can help address the limitations of technologies and provide a mechanism to train technicians. Locations of drug checking services should maximize public health outreach and leverage existing harm reduction agencies and staff with lived experience, who are critical to developing trust and rapport with clients. Criminalization and loss of privacy were major concerns for clients using drug checking services. Additional issues included the need to raise awareness of the legitimacy of services through public support from governing bodies, and funding to ensure the sustainability of drug checking services. CONCLUSIONS: This research facilitated the identification of issues and recommendations from stakeholders around key considerations for the adoption of drug checking technologies, which not only included the cost and technical specifications of instrumentation, but also broader issues such as accessibility, privacy, and well-trained personnel trusted by clients of the service. Successful implementation of drug checking services requires knowledge of local needs and capacity and an in-depth understanding of the target population.

A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017-2018.

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

Fecal indicator bacteria, fecal source tracking markers, and pathogens detected in two Hudson River tributaries.

Volunteer monitoring in the Hudson River watershed since 2012 has identified that the Wallkill River and Rondout Creek tributary complex have elevated concentrations of the fecal indicator bacteria, enterococci. Concentrations of enterococci do not provide insight into the sources of pollution and are imperfect indicators of health risks. In 2017, the regular monthly volunteer monitoring campaign for culturable enterococci at 24 sites on the Wallkill and Rondout expanded to include: (1) culturable measurements of E. coli and quantification of E. coli and Enterococcus specific markers vis nanoscale qPCR, (2) microbial source tracking (MST) assays (avian, human, bovine, and equine) via real time PCR and nanoscale qPCR, and 3) quantification of 12 gastrointestinal pathogens including viruses, bacteria, and protozoa via nanoscale qPCR. Three human associated MST markers (HumM2, HF183, and B. theta) corroborated that human pollution was present in Rondout Creek and widespread in the Wallkill River. The presence of B. theta was associated with increased concentrations of culturable E. coli. Genes for adenovirus 40 and 41 conserved region, rotavirus A NSP3, E. coli eae and stx1, and Giardia lamblia 18S rRNA were detected in >45% of samples. Abundance of rotavirus A NSP3 genes was significantly correlated to the bovine marker gene, CowM3, though wild bird sources cannot be ruled out. This is the first study to investigate potential fecal pollution sources and pathogen concentrations in Hudson tributaries during the months of peak recreational use.

Spatial patterns of pharmaceuticals and wastewater tracers in the Hudson River Estuary.

The widespread use of pharmaceuticals by human populations results in their sustained discharge to surface waters via wastewater treatment plants (WWTPs). In this study, 16 highly prescribed pharmaceuticals were quantified along a 250 km transect of the Hudson River Estuary and New York Harbor to describe their sources and spatial patterns. Sampling was conducted over two dry weather periods in May and July 2016, at 72 sites which included mid-channel and nearshore sites, as well as locations influenced by tributaries and WWTP outfalls. The detection frequency of the study pharmaceuticals was almost identical between the May and July sampling periods at 55% and 52%, respectively. Six pharmaceuticals were measurable at 92% or more of the sites during both sampling periods, illustrating their ubiquitous presence throughout the study area. Individual pharmaceutical concentrations were highly variable spatially, ranging from non-detect to 3810 ng/L during the study. Major factors controlling concentrations were proximity and magnitude of WWTP discharges, inputs from tributaries and tidal mixing. Two compounds, sucralose and caffeine, were evaluated as tracers to identify wastewater sources and assess pharmaceutical behavior. Sucralose was useful in identifying wastewater inputs to the river and concentrations showed excellent correlations with numerous pharmaceuticals in the study. Caffeine-sucralose ratios showed potential in identifying discharges of untreated wastewater occurring during a combined sewage overflow event. Many of the study pharmaceuticals were present throughout the Hudson River Estuary as a consequence of sustained wastewater discharge. Whereas some concentrations were above published effects levels, a more complete risk assessment is needed to understand the potential for ecological impacts due to pharmaceuticals in the Hudson River Estuary.

Automated tobacco assessment and cessation support for cancer patients.

BACKGROUND: Tobacco assessment and cessation support are not routinely included in cancer care. An automated tobacco assessment and cessation program was developed to increase the delivery of tobacco cessation support for cancer patients. METHODS: A structured tobacco assessment was incorporated into the electronic health record at Roswell Park Cancer Institute to identify tobacco use in cancer patients at diagnosis and during follow-up. All patients who reported tobacco use within the past 30 days were automatically referred to a dedicated cessation program that provided cessation counseling. Data were analyzed for referral accuracy and interest in cessation support. RESULTS: Between October 2010 and December 2012, 11,868 patients were screened for tobacco use, and 2765 were identified as tobacco users and were referred to the cessation service. In referred patients, 1381 of those patients received only a mailed invitation to contact the cessation service, and 1384 received a mailing as well as telephone contact attempts from the cessation service. In the 1126 (81.4%) patients contacted by telephone, 51 (4.5%) reported no tobacco use within the past 30 days, 35 (3.1%) were medically unable to participate, and 30 (2.7%) declined participation. Of the 1381 patients who received only a mailed invitation, 16 (1.2%) contacted the cessation program for assistance. Three questions at initial consult and follow-up generated over 98% of referrals. Tobacco assessment frequency every 4 weeks delayed referral in < 1% of patients. CONCLUSIONS: An automated electronic health record-based tobacco assessment and cessation referral program can identify substantial numbers of smokers who are receptive to enrollment in a cessation support service.

The role of parents and related factors on adolescent computer use.

BACKGROUND: Research suggested the importance of parents on their adolescents' computer activity. Spending too much time on the computer for recreational purposes in particular has been found to be related to areas of public health concern in children/adolescents, including obesity and substance use. DESIGN AND METHODS: The goal of the research was to determine the association between recreational computer use and potentially linked factors (parental monitoring, social influences to use computers including parents, age of first computer use, self-control, and particular internet activities). Participants (aged 13-17 years and residing in the United States) were recruited via the Internet to complete an anonymous survey online using a survey tool. The target sample of 200 participants who completed the survey was achieved. The sample's average age was 16 and was 63% girls. RESULTS: A set of regressions with recreational computer use as dependent variables were run. CONCLUSIONS: Less parental monitoring, younger age at first computer use, listening or downloading music from the internet more frequently, using the internet for educational purposes less frequently, and parent's use of the computer for pleasure were related to spending a greater percentage of time on non-school computer use. These findings suggest the importance of parental monitoring and parental computer use on their children's own computer use, and the influence of some internet activities on adolescent computer use. Finally, programs aimed at parents to help them increase the age when their children start using computers and learn how to place limits on recreational computer use are needed.

Adolescent computer use and alcohol use: what are the role of quantity and content of computer use?

The purpose of this study was to examine the relationship between computer use and alcohol use among adolescents. In particular, the goal of the research was to determine the role of lifetime drinking and past month drinking on quantity as measured by amount of time on the computer (for school work and excluding school work) and on content as measured by the frequency of a variety of activities on the internet (e.g., e-mail, searching for information, social networking, listen to/download music). Participants (aged 13-17 years and residing in the United States) were recruited via the internet to complete an anonymous survey online using a popular survey tool (N=270). Their average age was 16 and the sample was predominantly female (63% girls). A series of analyses was conducted with the computer use measures as dependent variables (hours on the computer per week for school work and excluding school work; various internet activities including e-mail, searching for information, social networking, listen to/download music) controlling for gender, age, academic performance and age of first computer use. Based on the results, past month drinkers used the computer more hours per week excluding school work than those who did not. As expected, there were no differences in hours based on alcohol use for computer use for school work. Drinking also had relationships with more frequent social networking and listening to/downloading music. These findings suggest that both quantity and content of computer use were related to adolescent drinking.

Gender-specific risk factors for suicidality among high school students.

This study examined differences in three major risk areas associated with suicidality (suicidal ideation and suicide attempts) separately by gender: 1) substance use, 2) aggression/victimization, and 3) risky sexual behaviors. This study is a secondary data analysis of the Youth Risk Behavior Surveillance (YRBS) survey, consisting of data collected from a nationally representative sample of high school students. Early alcohol onset, having had sex before age 13, injection drug use, and being forced to have sex were associated with suicidality across gender. Smoking in girls was associated with making a plan to attempt suicide and actual suicide attempts. Fighting was related to suicidality for girls, while fighting in school was related to suicidality for boys. The importance of examining risk factors for suicidality separately for boys and girls is discussed.

Risk factors for suicidality among a nationally representative sample of high school students.

Using the 2005 Youth Risk Behavior Surveillance data (n = 13,917) of high school students, we examined the association between four domains of risk factors (alcohol/drug use, aggression, HIV risk-related behaviors, and health problems) and indicators of suicidality (considering a suicide attempt, making a plan to attempt suicide, and actually attempting suicide). Logistic regressions showed that drug use (e.g., recent smoking, drinking before 13), victimization (e.g., threatened at school, hit by girl/boyfriend), risky sexual behavior (e.g., forced to have sex, used a condom) and two health problems (health as fair/poor, has disability/health problem) were associated with all three indicators of suicidality. These findings suggest that programs to prevent alcohol/drug use, address aggression, promote safety, and prevent unsafe sexual practices may also prevent suicidality.

A social influence model of alcohol use for inner-city adolescents: family drinking, perceived drinking norms, and perceived social benefits of drinking.

OBJECTIVE: Social influences to drink are important predictors of adolescent drinking. This study explored a social influence model of drinking among inner-city adolescents. We examined the role of family drinking and perceived drinking norms in predicting 1-year follow-up perceived social benefits of drinking and the relationship of perceived social benefits of drinking with 2-year follow-up adolescent drinking. METHOD: Participants in the present study were from the control schools of a randomized trial investigating the etiology and prevention of adolescent alcohol use. During a class period at baseline in seventh grade, participants completed a questionnaire that measured self-reported alcohol use and potential predictors. The panel sample consisted of 1,318 students from baseline (seventh grade), 1-year follow-up (eighth grade), and 2-year follow-up (ninth grade). RESULTS: Structural equation modeling found that both family drinking and perceived drinking norms affected the perceived benefits of drinking. In turn, the perceived benefits of drinking predicted subsequent drinking, controlling for earlier drinking. CONCLUSIONS: These results illuminate the importance of the perceived benefits of drinking, as well as social influences to drink, in adolescent drinking. Therefore, they should be incorporated into alcohol prevention programs.

Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents?

Past research related to alcohol advertising examined whether underage adolescents were targets of the alcohol industry and what impact such advertising had on adolescent drinking. The purpose of this study was to longitudinally examine the impact of media resistance skills on subsequent drinking among adolescents residing in inner-city regions of New York City. The study also tested whether drug skill refusal techniques (knowing how to say no to alcohol and other drugs) mediated the relationship between media resistance skills and adolescent drinking. A panel sample of baseline, one-year and two-year follow-ups (N=1318) from the control group of a longitudinal drug abuse prevention trial participated. A series of structural equations models showed that media resistance skills directly negatively predicted alcohol use 2 years later and that drug skill refusal techniques mediated this effect. Baseline media resistance skills were associated with one-year drug skill refusal techniques, which in turn negatively predicted two-year alcohol use. These findings provided empirical support for including media resistance skills and drug skill refusal techniques in alcohol prevention programs.

Impairment of executive cognitive functioning in males with fragile X-associated tremor/ataxia syndrome.

The fragile X-associated tremor/ataxia syndrome (FXTAS) is a recently identified phenotype associated with trinucleotide repeat expansions in the premutation range of the fragile X mental retardation 1 (FMR1) gene. In addition to progressive gait ataxia, action tremor, peripheral neuropathy, and parkinsonism, FXTAS involves impaired cognition. Our preliminary research suggests that executive cognitive functioning (ECF) is especially affected. In this study, a brief neuropsychological exam was administered to 33 men with FXTAS and 27 healthy controls. Compared with controls, individuals with FXTAS showed statistically significant impairments on measures from the Wechsler Adult Intelligence Scale, third edition (WAIS-III; verbal IQ, performance [nonverbal] IQ, verbal comprehension, perceptual organization, and processing speed). FXTAS subjects scored significantly lower on three of four measures of ECF and on two tests of information processing speed. The results provide evidence that FXTAS involves impairment of general intellectual functioning, with marked impairment of executive cognitive abilities. The pattern of cognitive performance is somewhat similar to that observed in the frontal variant of frontotemporal dementia and several of the spinocerebellar ataxias, but differs from the deficits observed in dementia of the Alzheimer type.

Do competence skills moderate the impact of social influences to drink and perceived social benefits of drinking on alcohol use among inner-city adolescents?

Only a few studies have found competence skills to be a protective factor against adolescent alcohol use; others did not find a direct effect on alcohol. A possible reason for this is that competence skills may moderate the effects of risk factors for alcohol use and that aspect has not been examined often or in a longitudinal design. This study tested whether several competence skills served either as direct protective factors against alcohol use or moderators of the impact of social risk factors on alcohol use. Participants (N = 1318) completed questionnaires that included measures of decision-making skills, refusal skill techniques, resisting media influences, friends' drinking and perceived social benefits of drinking, as well as current drinking amount and future drinking at baseline, one-year follow-up and two-year follow-up. Data analyses were conducted using multi-level mixed effects generalized linear models with random intercept. All the competence skills and the risk factors predicted current and future drinking. Several significant interactions were found between (1) perceived social benefits of drinking and decision-making skills, (2) perceived social benefits of drinking and refusal skill techniques and (3) friends' drinking and refusal skill techniques. Competence skills served as protective factors, as well as moderators. One possible reason that competence enhancement approaches to alcohol prevention are effective may be due to the inclusion of the competence skills component.

Which psychosocial factors moderate or directly affect substance use among inner-city adolescents?

Past etiology of adolescent substance use research concentrated on the main effects of various risk factors. The purpose of this study was to also longitudinally predict interactions on poly-drug use intensity and future smoking among inner-city adolescents. A panel sample of baseline, 1-year and 2-year follow-ups (N=1459) from the control group of a longitudinal smoking prevention trial participated. We focused on the main effects, as well as, interaction effects between psychosocial protective factors and various risk factors, including perceived norms of friends, peers and adults to use drugs. Significant effects were identified for intensity of poly-drug use and future smoking. The analysis of the poly-drug use outcome indicated that refusal assertiveness undermined perceived friends' drug use and siblings' smoking, and that low risk-taking undermined perceived friends' drug use. There was a main effect for low psychological wellness. The significant interactions between perceived friends' drug use with refusal assertiveness and decision-making skills were observed for future smoking. Moreover, perceived peer smoking norms, siblings' smoking, and high risk-taking also showed significant main effects for increasing future smoking.

Cognitive impairment in a 65-year-old male with the fragile X-associated tremor-ataxia syndrome (FXTAS).

OBJECTIVE: This is the first case report of a comprehensive neuropsychologic examination of an older man with the fragile X-associated tremor-ataxia syndrome (FXTAS). BACKGROUND: FXTAS, a newly identified phenotype affecting older male carriers of the fragile X premutation allele, is a progressive disorder marked by gait ataxia, action tremor, peripheral neuropathy, executive cognitive deficits, generalized brain atrophy, and neuronal and astrocytic intranuclear inclusion bodies throughout the brain. The patient previously had undergone neurologic evaluation, molecular analysis, and magnetic resonance imaging. METHOD: The patient was administered a neuropsychologic examination, assessing motor and somatosensory functioning, visual and spatial functioning, speech and language, attention, executive abilities, learning and memory, and reasoning. RESULTS: The patient showed a pattern of cognitive impairment characterized by essentially normal speech and language, moderately impaired control of attention, and moderate to severe deficits in working memory, executive functioning, and both declarative and procedural learning. Visual and spatial abilities were relatively unimpaired, and verbal reasoning was only mildly deficient. CONCLUSIONS: The findings suggest that a cognitive disorder, with especially marked executive cognitive function and memory deficits, accompanies FXTAS. The findings in FXTAS are compared with those in several other neurodegenerative disorders.

Impairment in the cognitive functioning of men with fragile X-associated tremor/ataxia syndrome (FXTAS).

Disorders associated with fragile X syndrome involve a trinucleotide (CGG) repeat expansion in the FMR1 gene. Recently, a progressive movement disorder (fragile X-associated tremor/ataxia syndrome [FXTAS]) has been identified in premutation carriers, persons with 55 to 200 CGG repeats. In addition to ataxia, action tremor, and Parkinsonism, early case reports suggested that FXTAS involves impaired cognition, but the precise nature of the impairment has not been elucidated. In this first, preliminary study of the subject, circumscribed aspects of cognitive functioning were examined in 25 men with FXTAS. Subjects' performance on the cognitive tests was compared with normative data. Scores on two measures of executive cognitive functioning showed a high prevalence of substantial impairment. Capacity for inhibition was severely affected in one-quarter of this highly educated sample; information processing speed was profoundly impaired in most subjects. Although mean verbal and performance IQ scores were not significantly different from the general population, they were quite low given the sample's educational level. Cognitive and functional impairment was greater for men with more CGG repeats, although number of repeats was not associated with age of onset of either tremor or ataxia. The results provide evidence that FXTAS involves marked impairment of executive cognitive abilities.

Effect of the fragile X status categories and the fragile X mental retardation protein levels on executive functioning in males and females with fragile X.

The effects of a fragile X disorder on executive function impairment were assessed in 144 extended families, which included individuals with fragile X premutation and full mutation and their relatives without fragile X. A modification of the maximum-likelihood estimators for pedigree data, as well as ordinal logistic regression, were used in data analysis. The most outstanding deficit, occurring especially in males, involved impaired capacity to use an intention to regulate purposeful behavior. This deficit occurred independently of general cognitive impairment but was related to depletion of fragile X mental retardation 1 gene protein product. The other executive function deficits were accounted for by the general cognitive impairment. Possible mechanisms of the effect of fragile X premutation on impairments of executive functioning are considered.

Predicting smoking among rural adolescents: social and cognitive processes.

Although considerable literature can be found concerning the etiology of cigarette smoking, a major gap exists pertaining to predictors of adolescent smoking for rural populations in the United States. To address this gap in the literature, the present study focused on rural adolescents and investigated a model of social and cognitive cross-sectional predictors of smoking. Gender-specific differences in etiology were examined by testing the same model separately for boys and girls. Seventh graders (N=1,673) residing in northeastern Iowa self-reported smoking, peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, life skills, prosmoking attitudes, risk-taking tendency, and family management practices. Data were collected during a class period in 36 junior high schools. Peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, prosmoking attitudes, and risk-taking tendency were associated cross-sectionally with smoking. As for gender-specific effects, family management skills, life skills, and risk-taking tendency were concurrently related to smoking for girls only. Based on the results of the present study and on prevention research, it would appear that smoking prevention programs for rural adolescents would benefit from incorporating normative education, drug refusal training, parent skills training, and competence enhancement skills training.

A mediational model of the relationship between linguistic acculturation and polydrug use among Hispanic adolescents.

Hispanic seventh and eighth graders (N=1,038) in 22 New York City middle or junior high schools completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana use), linguistic acculturation (language use with parents), perceived peer smoking norms, perceived peer drinking norms, and psychological distress. Students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents. Bilingual students perceived that a higher proportion of their peers drink than those who spoke Spanish with their parents, and this higher perception of their peers' drinking was associated with greater polydrug use controlling for linguistic acculturation. In the final model, linguistic acculturation was no longer significant and peer drinking norms predicted polydrug use, peer drinking norms mediated the relationship between linguistic acculturation and polydrug use, but not peer smoking norms and psychological distress.

Effect of the deficits of fragile X mental retardation protein on cognitive status of fragile x males and females assessed by robust pedigree analysis.

The effect of the fragile X mental retardation 1 (FMR1) gene product (fragile X mental retardation protein [FMRP]) deficits on Full-Scale IQ (FSIQ) and FSIQ-adjusted Wechsler subtests and index scores in fragile X disorder were assessed using a robust modification of the maximum likelihood estimators for pedigree data. The results from 144 extended families have demonstrated a linear effect of progressively reduced levels of FMRP on the FSIQ and all subtest and summary scores in either gender. The effect of FMRP in decreasing FSIQ-adjusted subtest scores was highly significant for Digit Span, Symbol Search, Object Assembly, and Picture Arrangement, with a consistent trend in both genders. Heritability for FSIQ and unadjusted subtest scores estimated from the covariance model did not exceed 50% and varied widely from the highest for Verbal score to the lowest for Picture Completion score. Possible mechanisms by which FMRP deficit impacts on specific weaknesses in fragile X are considered on the basis of present data.