Evaluating opioid overdose using the National Violent Death Reporting System, 2016.

BACKGROUND: Unintentional opioid overdose death rates have increased nearly 500% in Connecticut from 1999 to 2016, resulting in a major public health crisis. Two primary types of opioids have been implicated in these fatalities - illicit and pharmaceutical. The objective of this study is to describe the epidemiology of fatal unintentional opioid overdoses by type. METHODS: Using the National Violent Death Reporting System, rates of unintentional opioid-related overdose death in Connecticut were calculated. Demographic and contextual characteristics (e.g., substance misuse, mental health issues), and concomitant drug use (e.g., benzodiazepines, cocaine) were compared by opioid type. RESULTS: In 2016, 867 victims of fatal unintentional opioid overdose were identified in Connecticut. The majority of deaths involved illicit opioids (79.6%). Overall, victims were mostly male, white, non-Hispanic, and aged 25-54 years. Victim sex, age, and contextual characteristics differed significantly according to opioid type. For illicit opioid deaths, victims were predominantly male, aged 44 and under, and more often had a history of substance misuse. In contrast, among pharmaceutical opioid deaths, the split between males and females was significantly less pronounced, victims were mostly aged 45 and over, and mental health diagnoses, a physical health problem and concomitant drug use were more prevalent. CONCLUSIONS: Based on our findings, efforts to curb opioid-related overdose should be specific to opioid type. Interventions pertaining to pharmaceutical opioids should target females and older adults, whereas interventions for illicit opioid use should target younger audiences.

A dual-method approach to identifying intimate partner violence within a Level 1 trauma center.

BACKGROUND: Intimate partner violence (IPV) is a serious public health problem leading many health care organizations to recommend universal screening as part of standard health care practice. Prior work shows that most IPV victims and perpetrators are unidentified by health care staff. We sought to enhance the capacity of an urban trauma center to identify IPV using a dual-method screening tool, and to establish prevalence of IPV victimization and perpetration among this population. METHODS: Patients aged 18 and older were recruited from a Level 1 trauma center from May 2015 to July 2017. Participants were assessed for IPV using a touch-screen tablet and then via face-to-face assessment. The data were used to determine feasibility of this dual method and to establish prevalence of IPV in this sample. RESULTS: Of 586 eligible patients, 250 were successfully recruited for the study (43% response rate). Using the subscales of physical abuse, severe psychological abuse, and sexual coercion from the tablet-based Conflict Tactics Scale 2, 40% of women and 34% of men met criteria for IPV exposure in the past year and 35.6% of men and 50.6% of women met criteria using the face-to-face screen. In total, 102 patients (40.8%) screened positive using the dual method. CONCLUSION: This study reports on a dual method to improve screening and identification of IPV in a Level 1 trauma center. Ultimately, the dual screening method identified more victims than either method on its own. Our findings provide evidence to standardize universal screening in our trauma center. Moving forward, we will link screening results to medical record data to identify predictors of patients' current experiences of psychological and physical IPV. Our ultimate goal is to use these predictors to build a model for identifying patients who are at high risk for IPV victimization or perpetration. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Establishing the Prevalence of Intimate Partner Violence Among Hair Salon Clients.

This study determined prevalence of intimate partner violence (IPV) victimization among female clients at three hair salons in Connecticut using an anonymous tablet based screening tool. While many may assume that women receive services at hair salons, victims of IPV are often isolated by their partners and unable to access help. Of the 203 clients who participated, 40 (20%) had experienced IPV in her lifetime. In identifying the prevalence of IPV within the salon setting, this study provides support for community-based programs and supports their legitimacy as an important locus for identifying women experiencing IPV and connecting them to resources.