Assessing the association between the strength of state policies on school drug prevention and substance use disorders.

BACKGROUND: Adolescent substance use has been linked to numerous adverse health, social, and educational outcomes. While there have been intensive resources placed in school-based prevention programs, the association of these policies on prevention outcomes is still unclear. State variation in policies provides an opportunity to assess the influence of school-based prevention programs. OBJECTIVES: To examine the association between the strength of state high school-based prevention programing and the prevalence of substance use disorders among adolescents ages 14-17 in the United States. METHODS: National Survey on Drug Use and Health (NSDUH) data with state-level identifiers were merged with National Association of State Boards of Education (NASBE) information on school-based prevention policy strength, categorized into "required," "recommended," and "no policy." Unadjusted comparisons and multilevel random intercept linear regression models were estimated to assess the change in rates of substance abuse or dependence from pre- to post- policy implementation, accounting for the nesting of individuals within states. RESULTS: Rates of alcohol and tobacco abuse/dependence were significantly lower in states that required an alcohol prevention curriculum. After covariate adjustment, rates of alcohol abuse/dependence remained significantly lower in those states. CONCLUSIONS: Reinforcing alcohol prevention messaging in school appears to have a modest association with decreased rates of adolescent alcohol use disorders, possibly in part due to a different approach to the curriculum. For other substances, policy requirements appear to be less effective in reducing the prevalence of adolescent substance use disorders, suggesting that more targeted messaging with higher-risk students may be required.

Organizational Intent, Organizational Structures, and Reviewer Mental Models Influence Mortality Review Processes.

Objective: To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used. Methods: We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site's mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings. Results: Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or "signals." Conclusion: Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process.

Adaptation and Pilot Testing of the Women's Recovery Group for Young Adults (WRG-YA).

Gender specific substance use disorder treatment has demonstrated promise in adult women, but is relatively unexplored in young adults. To address the specific needs of young adult females, the manual-based Women's Recovery Group (WRG) was adapted for women ages 18-25. Treatment engagement and retention, group cohesiveness, satisfaction, and substance use outcomes were measured during group treatment and at 1-month follow up. This pilot supports the feasibility and initial acceptability of the adapted form of the WRG for young adults. Data from this study may inform future gender specific treatment approaches for substance use disorders in younger populations.

Perceived Parental Knowledge and Adolescent Substance Use Outcomes.

BACKGROUND: Whether parental permission of alcohol and other drug use in a home environment is protective against substance-related negative outcomes remains controversial. We investigated substance use at home, with or without parental knowledge, and its association with substance-related consequences. METHODS: The sample consisted of 21,207 U.S. students in the 6th to 12th grades surveyed between 2009 and 2017. Substance use patterns and rates of negative outcomes were analyzed by comparing groups of participants who had not used at home, or had used at home with and/or without parental knowledge. RESULTS: Adolescents who used substances at home without parental knowledge used alcohol and substances in greater amounts, and tended to have more negative outcomes than those who did not. Students who had not used at home or had used only with parental knowledge tended to have lower levels of use and negative outcomes. CONCLUSIONS: Using at home without parental knowledge was a consistent risk factor for substance-related negative outcomes. These results highlight the importance of screening adolescents for the use of alcohol or drugs in the home without parental knowledge, as well as attempting to prevent substance use in the household.

Substance Use Among College Students.

U.S. college campuses have witnessed a national increase of cannabis, stimulant, and illicit drug use among students over the past decade. Substance use among college students is associated with numerous negative outcomes including lower academic performance, a higher probability of unemployment after graduation, and an increased risk of committing and experiencing sexual assault. Several risk factors for substance use are specific to this population, including an affiliation with Greek life, perception of high academic pressure, and peer pressure. Students with problematic substance use also face unique challenges in planning treatment, including aspects of confidentiality, financial constraints, and potential university oversight and involvement. This article highlights the prevalence of substance use on college campuses and describes some of the specific challenges and approaches to treatment in this population, including screening tests and interventions for specific substances used on college campuses and evidence-based substance use programming for college students.

Correlation Between Brain Tissue Damage and Inertial Cavitation Dose Quantified Using Passive Cavitation Imaging.

Focused ultrasound (FUS)-induced cavitation-mediated brain therapies have become emerging therapeutic modalities for neurologic diseases. Cavitation monitoring is essential to ensure the safety of all cavitation-mediated therapeutic techniques as inertial cavitation can be associated with tissue damage. The objective of this study was to reveal the correlation between the inertial cavitation dose, quantified by passive cavitation imaging (PCI), and brain tissue histologic-level damage induced by FUS in combination with microbubbles. An ultrasound image-guided FUS system consisting of a single-element FUS transducer (1.5 MHz) and a co-axially aligned 128-element linear ultrasound imaging array was used to perform FUS treatment of mice. Mice were sonicated by FUS with different peak negative pressures (0.5 MPa, 1.1 MPa, 4.0 MPa and 6.5 MPa) in the presence of systemically injected microbubbles. The acoustic emissions from the FUS-activated microbubbles were passively detected by the imaging array. The pre-beamformed channel data were acquired and processed offline using the frequency-domain delay, sum and integration algorithm to generate inertial cavitation maps. All the mice were sacrificed after the FUS treatment, and their brains were harvested and processed for hematoxylin and eosin staining. The obtained inertial cavitation maps revealed the dynamic changes of microbubble behaviors during FUS treatment at different pressure levels. It was found that the inertial cavitation dose quantified based on PCI had a linear correlation with the scale of histologic-level tissue damage. Findings from this study suggested that PCI can be used to predict histologic-level tissue damage associated with the FUS-induced cavitation.