Generational and Gender Patterns of Prescription Opioid Misuse Among Black Adults.

INTRODUCTION: Opioid-related overdose mortality disproportionally affects Black adults in Kentucky, particularly overdoses associated with prescription opioid misuse (POM). Black adults also face other consequences of POM, such as disparate health and legal outcomes. While several factors effect POM, such as generational factors and gender, these risk factors are understudied among Black adults with a history of POM. Current literature primarily focuses on White individuals who use opioids. METHOD: The present study qualitatively examined reasons for POM, prescription opioids misused, how prescription opioids are obtained, and initiation of POM among Black adults using thematic analysis. Participants included a sample (n = 39) of Black adults from a southern state, stratified by gender and age across four cohorts: born (1) 1995-2001, (2) 1980-1994, (3) 1970-1979, and (4) 1955-1969. RESULTS: Results revealed similarities and differences in these themes across age cohorts and gender. CONCLUSIONS: Implications for findings include the importance of culturally responsive interventions that utilize dual diagnosis treatment and idiographic approaches due to heterogeneous experiences with POM among Black adults.

Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians.

BACKGROUND: Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS: Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS: Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION: Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

Half of our sample of Black Americans who use opioids nonmedically had no knowledge of medications for opioid use disorder (MOUD).For those who knew about MOUD, most reported negative perceptions, including concerns about side effects of using MOUD and believing MOUD is equivalent to illicit drug use.The youngest age group endorsed the highest rates of negative perceptions relative to older age cohorts, indicating a need for intervention approaches tailored by age group.

PTSD diagnosis and nonmedical use of benzodiazepines among African American incarcerated men: the mitigating effect of John Henry active coping.

The current study examined the relationship between PTSD and nonmedical use of benzodiazepines (BZDs) based on level of John Henry Active Coping (JHAC) among African American incarcerated men. Data were derived from the Helping Incarcerated Men (HIM) Study (n = 208). Nonmedical use of BZDs was measured for the 30 days before incarceration. Current PTSD diagnosis and JHAC were determined using DSM-5 criteria and the JHAC Scale. Adjusted logistic regression analyses showed PTSD diagnosis was significantly associated with nonmedical BZD use (p = .011), but that JHAC did not significantly mitigate this relationship. African American incarcerated men may experience an unmet need with regards to mental health treatment.

Examining the Relationship between Discrimination and Prescription Drug Misuse: Findings from a National Survey of Black Americans.

Background: Research shows that substance use may be a way individuals cope with psychosocial stressors. Less is known about whether discrimination contributes to prescription drug misuse. Methods: Using a national sample of Black Americans, we examined whether two psychosocial stressors (i.e., everyday and lifetime major discrimination) were associated with lifetime prescription drug misuse (i.e., opioids, tranquilizers, sedatives, or stimulants). Results: Our logistic regression models separately examining the influence of everyday and major discrimination controlling for relevant demographic, health, and other drug use variables showed that only everyday discrimination was associated with higher odds of prescription drug misuse. In the model simultaneously considering both types of discrimination, only unit increases in everyday discrimination were associated with higher odds of prescription drug misuse. Conclusions: Encounters with everyday discrimination may be an important psychosocial stressor linked to prescription drug misuse in Black adults and possibly other racial-ethnic minorities. Intervention strategies aiming to reduce prescription drug misuse should consider developing ways to curb the negative health-related consequences of discriminatory experiences. Strategies to combat discrimination-related prescription drug misuse and limitations of this study are discussed.

Polysubstance use among frequent marijuana users: an examination of John Henryism Active Coping, psychiatric symptoms, and family social support among African American incarcerated men.

Incarcerated African American men who use marijuana are vulnerable to polysubstance use, which is associated with greater risk for negative health and psychosocial outcomes than marijuana use alone. It is imperative to understand risk and protective factors for polysubstance use among this vulnerable population to inform the development of culturally tailored substance use interventions. The current study examined the association between John Henryism Active Coping (JHAC), family social support, psychiatric symptoms, and polysubstance use among African American incarcerated men who frequently use marijuana. Results indicated that higher John Henryism Active Coping (JHAC) is associated with decreased likelihood of engaging in polysubstance use, while psychiatric symptoms are associated with increased likelihood of polysubstance use. Incorporating elements of JHAC into concurrent mental health and substance use treatment may reduce risk for overdose and reincarceration among African American incarcerated men upon release into the community.

Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life.

BACKGROUND: The misuse of prescription medications is an understudied topic among the non-Hispanic Black population in the U.S. Even less is known about the prevalence and correlates of misuse among African Americans and Afro-Caribbeans, despite documented differences in their substance use behaviors. OBJECTIVES: We aimed to examine the prevalence and correlates of lifetime prescription drug misuse among African Americans and Afro Caribbeans using data from the National Survey of American Life. METHODS: A national household probability sample of non-institutionalized African Americans and Afro Caribbeans from the Collaborative Psychiatric Epidemiology Surveys was used. Pooled and ethnicity-stratified logistic regressions were estimated. RESULTS: Findings showed no significant differences between African Americans (6.36%) and Afro-Caribbeans (5.71%) in lifetime prescription drug misuse. Several correlates were found to be associated with misuse among only African American or Afro-Caribbean respondents. CONCLUSIONS: While research has shown prescription drug misuse is an issue among Blacks overall, our results show that the role of ethnicity must not be overlooked, especially when tailoring prevention and intervention programs. Limitations of this study are discussed.

Sleep time differs among people who co-use cocaine and cannabis compared to people who only use cocaine.

OBJECTIVE: People who use cocaine experience numerous sleep problems and often use cannabis to mitigate these problems. However, co-using cocaine and cannabis may result in worse sleep outcomes when compared to using cocaine only. The current study examined group differences in subjective sleep outcomes among people who use cocaine and people who co-use cocaine and cannabis. METHODS: Participants were 82 individuals with cocaine use disorder who were enrolled in a randomized clinical trial for cocaine treatment. Sleep outcomes, assessed at baseline prior to treatment, were measured with the Saint Mary's Hospital Sleep Questionnaire and included total sleep time, perceived sleep quality, difficulty falling asleep, and daytime alertness. Analysis of covariance and Kruskal-Wallis tests were used to compare sleep outcomes between participants with urine samples that tested positive for both cocaine and cannabis at baseline, those who tested positive for cocaine only, and those who tested negative for all drugs. RESULTS: Total reported sleep time was highest among those with a drug negative urine, followed by those with a cocaine positive urine and those who tested positive for cocaine and cannabis. There were no differences in perceived sleep quality, difficulty falling asleep, or daytime alertness between groups. CONCLUSIONS: People who co-use cocaine and cannabis may report reduced sleep time relative to those who only use cocaine. Co-use of cannabis may exacerbate sleep difficulties in people who use cocaine by decreasing total sleep time, although it is important to note that the groups each reported similar sleep quality. Implications for treatment and directions for future research are discussed.

Racial identity, discrimination, and polysubstance use: Examining culturally relevant correlates of substance use profiles among Black young adults.

OBJECTIVES: Among Black Americans, young adulthood marks an important developmental period for the initiation of problematic substance use and related health disparities. Unique cultural factors, such as discrimination and racial identity, influence substance use during this period, but it is unknown whether they influence more severe patterns such as polysubstance use. The current study identifies prototypical patterns of substance use among Black young adults and examines whether cultural factors are associated with those patterns. DESIGN: The current study used latent class analysis to characterize prototypical substance use among a community-based sample of Black young adults (N = 147). Culturally relevant correlates of substance use classes (i.e., perceived discrimination and racial identity) were examined in univariate and multivariate models. RESULTS: Five profiles of substance use emerged, including three characterized by polysubstance use. In univariate models only, racial identity was differentially associated with membership in classes characterized by co-use of alcohol and cannabis. In both models, discrimination was significantly associated with membership in a class characterized by polysubstance use. CONCLUSION: Findings suggest a need to integrate cultural resilience factors into substance use interventions for Black young adults. Helping Black youth build coping skills for discrimination may also confer resilience against polysubstance use and associated health disparities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating the Feasibility of Implementing an HIV Prevention Intervention for Incarcerated African American Men: Lessons Learned From a Pilot Study.

This pilot study evaluated the feasibility of implementing an evidence-based, culturally adapted HIV intervention with substance-using African American men in a prison setting. We recruited 60, soon-to-be released African American male prisoners from a larger study (N = 211) to be randomly selected for participation in the group-based HIV intervention, Real Men Are Safe-Culturally Adapted (REMAS-CA). Participants who were not selected for participation in the intervention received standard Centers for Disease Control and Prevention HIV prevention counseling education, provided during participant assessment in the larger study. Nearly all of the participants who were selected to participate (87%) completed the REMAS-CA intervention. To examine feasibility, data were collected about any revisions made to the HIV intervention components for the prison setting, time needed to implement the program in full, details of implementing the intervention to ensure participation and maintain retention, and participant perception of the intervention. Revisions to the intervention included reducing the number of sessions from five to three, modifying the protocol language based on the setting, and removing six activities deemed inappropriate and/or unallowable by the prison officials. The cultural considerations and intervention, overall, were well received by the participants. However, several revisions made specific to the prison and its administration could affect the potential effectiveness of the intervention. Future research is needed to determine the effectiveness of REMAS-CA among this community.

Parent perceptions of restrictive feeding on the relationship between youth BMI z-score and weight control behavior use in African American youth: A mediational study.

BACKGROUND: Children with higher body weights engage in more healthy weight control behaviors (HWCBs) and unhealthy weight control behaviors (UWCBs) compared to healthy weight peers. Parent restrictive feeding (parental attempts to limit what and how much children eat in an effort to manage youth weight) has also been associated with youth weight. However, there is limited research on parental feeding practices among non-Caucasian samples, despite evidence that parental feeding may function differently across races. Therefore, the current study aimed to examine the mediating role of parent restrictive feeding on the relationship between youth body mass index (BMI) z-score and youth use of HWCBs and UWCBs among African American youth. METHODS: Measures were completed by youth (ages 10-13 years) and their parents at a pediatric primary-care appointment. Youth completed a weight control behavior questionnaire asking youth to answer whether or not they have engaged in specific behaviors to lose weight. Parents completed a questionnaire on parent-feeding practices. Youth height and weight were obtained from their medical records. RESULTS: Mediation models revealed parent restrictive feeding significantly mediated the relationship between youth BMI z-score and HWCB use, but not between youth BMI z-score and UWCB use. CONCLUSION: Results from the current study suggest parent restrictive feeding in African American populations may encourage health promoting youth weight management behaviors. Additional research is warranted to investigate how cultural factors may impact the relationships between parent restrictive feeding practices and youth weight control behaviors as there may be important clinical implications when working with diverse populations.

Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men.

BACKGROUND: Recent studies have demonstrated that nonmedical use of prescription opioids (NMUPO) is a national phenomenon affecting a multitude of subpopulations, including incarcerated African American men. However, there has been little investigation of the correlates of NMUPO among this population. OBJECTIVE: Grounded in primary socialization theory, the current study aimed to examine the association between family bonds, family history of prescription drug misuse, and mental health symptoms on NMUPO among African American incarcerated men. METHOD: A step-wise logistic regression was conducted to determine whether family and mental health factors affected the likelihood of lifetime NMUPO. RESULTS: Prescription drug misuse among immediate family members (p < 0.001) and lifetime experience of serious anxiety (p = 0.003) were significantly associated with an increased likelihood of NMUPO. Having a close personal relationship with one's father was significantly associated with a decreased likelihood of NMUPO (p = 0.034). CONCLUSIONS/IMPORTANCE: Risk and protective factors are identified that can be incorporated into interventions aimed at reducing or preventing NMUPO among African American men. Directions for future research on NMUPO among African American incarcerated men are discussed.

Psychometric properties of the Kids' Child Feeding Questionnaire-Restriction.

BACKGROUND: Research exploring parental restrictive feeding is mixed and shows that it both negatively and positively affects children's dietary intake. One hypothesis for these inconsistent findings is the use of parent-report vs. youth-report measures of parental restrictive feeding, but there are limited psychometrically-sound youth-report measures of this construct. Therefore, the current study aims to evaluate the psychometric properties of a measure of parent restrictive feeding practices, the Kids' Child Feeding Questionnaire-Restriction (KCFQ-R), from the youth perspective. METHODS: The 7-item, youth-report KCFQ-R is composed of the restriction subscale from the Kids' Child Feeding Questionnaire. This measure was completed by 225 youth attending a primary care appointment. RESULTS: Initial exploratory factor analysis and communalities yielded a single factor solution explaining 39.93% of the variability in the data. Internal consistency using the seven items was .73. The KCFQ-R demonstrated external validity through its significant relationship with parent concern about child overweight. CONCLUSIONS: Results provide preliminary support that the KCFQ-R is a psychometrically sound and reliable measure of youth-reported parental restrictive feeding practices. Given the mixed research on the effects of parent-reported parental feeding restriction on various child outcomes, this youth-report measure may help clarify these relationships. Future research should examine youth-report measures of other parent feeding domains.