Rethinking Data Collection Methods During the Pandemic: Development and Implementation of CATI for the All of Us Research Program.

The All of Us Research Program is a longitudinal cohort study aiming to build a diverse database to advance precision medicine. The COVID-19 pandemic hindered the ability of participants to receive in-person assistance at enrollment sites to complete digital surveys. Therefore, the program implemented Computer-Assisted Telephone Interviewing (CATI) to facilitate survey completion remotely to combat the disrupted data collection procedures. In January 2021, All of Us implemented a 1-year CATI Pilot supporting 9399 participants and resulting in 16 337 submitted surveys. The pilot showed that CATI was successful in increasing survey completion and retention activities for the All of Us Research Program, given the additional remote support offered to participants. Given the success of the CATI Pilot, multimodal survey administration will continue.

The Impact of COVID-19 on the All of Us Research Program.

The All of Us Research Program, a health and genetics epidemiologic data collection program, has been substantially affected by the coronavirus disease 2019 (COVID-19) pandemic. Although the program is highly digital in nature, certain aspects of the data collection require in-person interaction between staff and participants. Before the pandemic, the program was enrolling approximately 12,500 participants per month at more than 400 clinical sites. In March 2020, because of the pandemic, all in-person activity at program sites and by engagement partners was paused to develop processes and procedures for in-person activities that incorporated strict safety protocols. In addition, the program adopted new data collection methodologies to reduce the need for in-person activities. Through February 2022, a total of 224 clinical sites had reactivated in-person activity, and all enrollment and engagement partners have adopted new data collection methods that can be used remotely. As the COVID-19 pandemic persists, the program continues to require safety procedures for in-person activity and continues to generate and pilot methodologies that reduce risk and make it easier for participants to provide information.

Residential Transience Among Adults: Prevalence, Characteristics, and Association with Mental Illness and Mental Health Service Use.

This study examined the association between frequent residential mobility (i.e., residential transience) and mental illness, mental health service use, and unmet need for services. Data are from the 2010 to 2014 National Surveys on Drug Use and Health (n = ~ 229,600). Logistic regression models examined the relationship between proximal (past year) and distal (past 2-5 years) residential transience and past year any mental illness (AMI), serious mental illness (SMI), mental health service use among adults with mental illness, and unmet need for services. Adults with transience had greater odds of AMI and SMI than those without transience. Proximal and distal transience were unrelated to past year mental health service use among adults with mental illness, but the odds of unmet need for services were greater among adults with transience compared with those without, suggesting a level of unmet service need among those with transience.

Which mental disorders are associated with the greatest impairment in functioning?

OBJECTIVE: The objective of this study is to estimate the comparative associations of mental disorders with three measures of functional impairment: the Global Assessment of Functioning (GAF); the number of days in the past 12 months of total inability to work or carry out normal activities because of emotions, nerves, or mental health (i.e., days out of role); and a modified version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). METHODS: Secondary data analysis of the linked Mental Health Surveillance Study and the National Survey on Drug Use and Health (n = 5653), nationally representative population surveys conducted in the United States. Generalized linear models assessed the independent effects of mental disorders on each measure of functional impairment, controlling for mental disorder comorbidity, physical health disorders, and sociodemographic factors. RESULTS: The results varied across measures of functional impairment. However, mood disorders generally tended to be associated with the greatest functional impairment, anxiety disorders with intermediate impairment, and substance use disorders with the least impairment. All 15 disorders were significantly associated with the GAF score in multiple regression models, eight disorders were significantly associated with the WHODAS score, and three disorders were significantly associated with days out of role. CONCLUSIONS: Our results highlight the value of complementary measures of functional impairment.

Prevalence of alcohol dependence among US adult drinkers, 2009-2011.

INTRODUCTION: Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. METHODS: Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. CONCLUSION: Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.

Youth aggressive/disruptive behavior trajectories and subsequent gambling among urban male youth.

This study examines the association between aggressive/disruptive behavior development in two distinct developmental periods-childhood (i.e., Grades 1-3) and early adolescence (i.e., Grades 6-10)-and subsequent gambling behavior in late adolescence up to age 20. The sample consists of 310 urban males of predominately minority and low socioeconomic status followed from first grade to late adolescence. Separate general growth mixture models were estimated to explore the heterogeneity in aggressive/disruptive behavior development in the aforementioned two periods. Three distinct behavior trajectories were identified for each period: a chronic high, a moderate increasing, and a low increasing class for childhood, and a chronic high, a moderate increasing, followed by decreasing and a low stable class for early adolescence. There was no association between childhood behavior trajectories and gambling involvement. Males with a moderate behavior trajectory in adolescence where two times more likely to gamble compared to those in the low stable class (OR = 1.89, 95% CI = 1.11, 3.24). Those with chronic high trajectories during either childhood or early adolescence (OR = 2.60, 95% CI = 1.06, 6.38; OR = 3.19, 95% CI = 1.18, 8.64, respectively) were more likely to be at-risk/problem gamblers than those in the low class. Aggressive/disruptive behavior development in childhood and early adolescence is associated with gambling and gambling problems in late adolescence among urban male youth. Preventing childhood and youth aggressive/disruptive behavior may be effective to prevent youth problem gambling.

Patterns of cognitive impairments among heroin and cocaine users: the association with self-reported learning disabilities and infectious disease.

This study used data from six neuropsychological measures of executive function (EF) and general intellectual functioning (GIF) administered to 303 regular users of heroin and/or cocaine as indicators in a latent profile analysis (LPA). Results indicated the presence of three profiles: impaired GIF and EF profile (30.8%), intact GIF and EF profile (58.8%), and high GIF/intact EF profile (10.4%). Using a multinomial logistic regression, it was determined that individuals who reported being diagnosed with either a learning disability (LD) and/or attention-deficit/hyperactivity disorder (ADHD) were more likely to be in the impaired GIF and EF profile than other profiles. Results from a logistic regression indicated that the impaired GIF and EF profile was associated with a greater prevalence of past hepatitis B and/or C infection. Implication for harm reduction and treatment programs and the need to take into account individuals with LD and ADHD are discussed.

Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years - United States, 2015-2019.

PROBLEM/CONDITION: Suicidal thoughts and behaviors are important public health concerns in the United States. In 2019, suicide was the 10th leading cause of death among persons aged ≥18 years (adults); in that year, 45,861 adults died as a result of suicide, and an estimated 381,295 adults visited hospital emergency departments for nonfatal, self-inflicted injuries. Regional- and state-level data on self-inflicted injuries are needed to help localities establish priorities and evaluate the effectiveness of suicide prevention strategies. PERIOD COVERED: 2015-2019. DESCRIPTION OF SYSTEM: The National Survey on Drug Use and Health (NSDUH) is an annual survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects data on the use of illicit drugs, alcohol, and tobacco; initiation of substance use; substance use disorders and treatment; health care; and mental health. This report summarizes data on responses to questions concerning suicidal thoughts and behaviors contained in the mental health section among sampled persons aged ≥18 years in all 50 states and the District of Columbia. This report summarizes 2015-2019 NSDUH data collected from 254,767 respondents regarding national-, regional-, and state-level prevalence of suicidal thoughts, planning, and attempts by age group, sex, race and ethnicity, region, state, education, marital status, poverty level, and health insurance status. RESULTS: Prevalence estimates of suicidal thoughts and behaviors varied by sociodemographic factors, region, and state. During 2015-2019, an estimated 10.6 million (annual average) adults in the United States (4.3% of the adult population) reported having had suicidal thoughts during the preceding year. The prevalence of having had suicidal thoughts ranged from 4.0% in the Northeast and South to 4.8% in the West and from 3.3% in New Jersey to 6.9% in Utah. An estimated 3.1 million adults (1.3% of the adult population) had made a suicide plan in the past year. The prevalence of having made suicide plans ranged from 1.0% in the Northeast to 1.4% in the Midwest and West and from 0.8% in Connecticut and New Jersey to 2.4% in Alaska. An estimated 1.4 million adults (0.6% of the adult population) had made a suicide attempt in the past year. The prevalence of suicide attempts ranged from 0.5% in the Northeast to 0.6% in the Midwest, South, and West and from 0.3% in Connecticut to 0.9% in West Virginia. Past-year prevalence of suicidal thoughts, suicide planning, and suicide attempts was higher among females than among males, higher among adults aged 18-39 years than among those aged ≥40 years, higher among noncollege graduates than college graduates, and higher among adults who had never been married than among those who were married, separated, divorced, or widowed. Prevalence was also higher among those living in poverty than among those with a family income at or above the federal poverty threshold and higher among those covered by Medicaid or the Children's Health Insurance Program than among those with other types of health insurance or no health insurance coverage. INTERPRETATION: The findings in this report highlight differences in the adult prevalence of suicidal thoughts, plans to attempt suicide, and attempted suicide during the 12 months preceding the survey at the national, regional, and state levels during 2015-2019. Geographic differences in suicidal thoughts and behavior varied by sociodemographic characteristics and might be attributable to sociodemographic composition of the population, selective migration, or the local cultural milieu. These findings underscore the importance of ongoing surveillance to collect locally relevant data on which to base prevention and intervention strategies. PUBLIC HEALTH ACTION: Understanding the patterns of and risk factors for suicide is essential for designing, implementing, and evaluating public health programs for suicide prevention and policies that reduce morbidity and mortality related to suicidal thoughts and behaviors. State health departments and federal agencies can use the results from this report to assess progress toward achieving national and state health objectives in suicide prevention. Strategies might include identifying and supporting persons at risk, promoting connectedness, and creating protective environments.

Alcohol, Drug and Sexual Risk Behavior Correlates of Recent Transactional Sex Among Female Black South African Drug Users.

Transactional sex among black South African women has become a mode of economic survival putting them at higher risk for HIV and other infectious disease. In order to inform HIV interventions, drug and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black, South African women in Pretoria were examined using log binomial regression. Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use (Adjusted Prevalence Ratio (APR)=1.3, 95% CI=1.1, 1.5) and knew of anyone who died of AIDS (APR =1.5, 95% CI 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR =0.6, 95% CI= 0.4, 0.8), condom use in their first sexual encounter (APR =0.7, 95% CI=0.6, 1.0) or reported a recent steady sexual partnership (APR =0.8, 95% CI=0.7, 0.9). Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

Adolescent drug dealing and race/ethnicity: a population-based study of the differential impact of substance use on involvement in drug trade.

BACKGROUND: Among adolescents, peers are an important source of drug procurement. However, little is known about factors associated with youths' involvement in drug trade. OBJECTIVES: The aim of the study is to identify substance use behaviors and contextual factors related to drug dealing among Black and White adolescents. METHODS: The sample consisted of 13,706 White and Black youths who completed the National Survey on Drug Use and Health. Separate backward logistic regression was used to identify substance use behaviors and contextual factors associated with drug dealing among Black and White youths. RESULTS: Among White youths, drug dealing was associated with use of marijuana, hallucinogens, cocaine, prescription drug misuse, availability of cocaine, and socioeconomic status (SES). Among Black youths, marijuana use and availability of crack and marijuana were associated with drug dealing. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: For White youths, substance use seems to be more relevant to drug dealing. Consequently, preventing and treating substance abuse may reduce involvement in the illegal distribution of drugs among White youths. More research is needed to identify risk and protective factors for drug dealing among Black adolescents.

The association between poly-substance use, coping, and sex trade among black South African substance users.

The current study examined the relationship between poly-substance use and sex trade among 343 black South African substance users recruited from the Pretoria region between 2002 and 2006 (57% males; mean age 24 years). The assessment comprised a HIV-risk behavior interview, urinalysis to confirm self-report of drug use, and an HIV test. Logistic regression analyses indicated poly-substance use was positively associated with sex trade among persons using drugs to cope with stress. Results indicate the importance of considering coping strategies as modifiable psychosocial factor related to sexual risk-taking behaviors and substance use. The study's implications and limitations are discussed.

Gender differences in the prevalence and behavioral risk factors of HIV in South African drug users.

South Africa continues to be the global epicenter of HIV infection. Further, extensive gender disparities in HIV infection exist with females four times as likely to be infected with HIV/AIDS as males (UNAIDS, AIDS epidemic update, 2006; WHO, Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2006). A cross-sectional collection of drug users recruited in the Pretoria region of South Africa (N = 385) was used to model HIV infection as a function of sexual risk behaviors and drug use as modified by gender. Receiving money from illicit sources and knowing someone with AIDS were loosely associated with HIV. Gender interactions were observed for age, cocaine use and condom use. Gender stratified analyses revealed that males who used condoms, were younger and tested negative for cocaine use were less likely to test positive for HIV. Findings suggest that males may have more control of risk behaviors and support the need for gender specific prevention strategies.

Prevalence and correlates of Hepatitis C among injection drug users: The significance of duration of use, incarceration and race/ethnicity.

The study examined associations between Hepatitis C (HCV) seropositivity and a lifetime history of jail or correctional facility incarceration among injection drug users. The sample consisted of 351 injection drug users recruited in inner-city neighborhoods of Baltimore. Multiple logistic regressions were fit to assess associations between HCV seropositivity and a lifetime history of incarceration for the total sample and stratified by race. Analyses demonstrated HCV nearly two times greater for whites than African Americans. In addition, HCV was 2.6 times greater in participants incarcerated in correctional facilities and HCV was 7.4 times greater in participants reporting more than 5 years of injection drug use compared to participants reporting less than 1 year of injection drug use. The study findings suggest that incorporating systematic HCV screening, prevention, and treatment programs within correctional systems represents a vital yet underutilized strategy to reduce HCV transmission in society as a whole.

Correlates of exposure to potentially traumatic experiences: Results from a national household survey.

OBJECTIVE: Prior studies have indicated that exposure to potentially traumatic events (PTEs) may increase the risk of poor mental and physical health outcomes. This study's main goal is to examine the association between PTE exposures and having any past year mental disorder, substance use disorder (SUD), or functional impairment and to explore the moderating effects of age and gender on these associations in a nationally representative sample of civilian adults living in U.S. households. METHOD: The sample included adults aged 18 or older (n = 5,653) from the 2008-2012 Mental Health Surveillance Study. RESULTS: PTE exposure was significantly associated with having any past year mental disorder and any past year SUD (odds ratio [OR] = 1.85, 95% CI [1.48, 2.32] and OR = 1.59, 95% CI [1.16, 2.18], respectively), as well as lower functioning scores as measured by the abbreviated World Health Organization Disability Assessment Schedule (WHODAS) and the Global Assessment of Functioning scale in models adjusted for sociodemographic characteristics. A single significant interaction (p = .002) indicated that the magnitude of the PTE exposure-WHODAS-measured functional impairment association was stronger among females than males. CONCLUSIONS: These findings from a nationally representative study of civilian adults living in U.S. households suggest that PTE exposure may have significant public health implications beyond those associated with the development of posttraumatic stress disorder. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trends in mental health service use by age among adults with serious mental illness.

PURPOSE: This study examines trends in mental health service use among 18- to 64-year-old adults with serious mental illness (SMI). METHODS: Data are from approximately 22,200 adults with SMI who participated in the National Survey on Drug Use and Health, an annual nationally representative survey of the U.S. civilian, noninstitutionalized population. A regression restricted spline modeled the trend in mental health service use by age among adults with SMI. RESULTS: Approximately 20 to 50% of adults with SMI did not receive past-year mental health services. The odds of past-year service use increased by 3% per year until age 52 years. CONCLUSIONS: From age 18 to 52 years, age incrementally increases the likelihood that an adult with SMI makes treatment contact.

Comorbid mental disorders among adults in the mental health surveillance survey.

PURPOSE: To examine the prevalence and correlates of mental disorder comorbidity in the adult U.S. household population. METHODS: Data are from a nationally representative sample of noninstitutionalized, civilian adults aged 18 years or older (n = 5653) who participated in the 2008-2012 Mental Health Surveillance Study. Mental disorders, including substance use disorders, were assessed by clinical interviewers using a semistructured diagnostic instrument. Analyses examined co-occurrence of mental disorders and associations with sociodemographic, functional impairment, and treatment correlates. RESULTS: Approximately one-third of adults (31.1%, or more than 15 million) with a past-year mental disorder had a co-occurring mental disorder. Correlates of comorbidity in adjusted models included being of young age, being of non-Hispanic white race/ethnicity, having low family income, and living in a large metropolitan area. Adults with comorbid mental disorders had lower mean levels of functioning and were more likely to report past-year treatment than adults with a single disorder; they also had higher estimates of past-year perceived unmet need for care (21.7% vs. 11.6%, P < .01). CONCLUSIONS: About one in three adults with a mental disorder have a co-occurring mental disorder. Elucidating factors associated with co-occurrence may lend clues to shared etiologies, help improve prevention efforts, facilitate early identification, and improve treatment regimens.

Is cocaine desire reduced by N-acetylcysteine?

OBJECTIVE: Animal models suggest that N-acetylcysteine inhibits cocaine-seeking. The present pilot study evaluated whether N-acetylcysteine would suppress reactivity to cocaine-related cues in cocaine-dependent humans. METHOD: In this double-blind, placebo-controlled trial, 15 participants received N-acetylcysteine or placebo during a 3-day hospitalization. Participants were crossed over to receive the opposite condition on a second, identical 3-day stay occurring 4 days later. During each hospital stay, participants completed a cue-reactivity procedure that involved collecting psychophysical and subjective data in response to slides depicting cocaine and cocaine use. RESULTS: While taking N-acetylcysteine, participants reported less desire to use and less interest in response to cocaine slides and watched cocaine slides for less time. CONCLUSIONS: The inhibition of cocaine cue reactivity is consistent with existing preclinical data and supports the use of N-acetylcysteine as a treatment for cocaine dependence.

An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: a pilot study.

Recent preclinical studies implicate N-acetylcysteine (NAC), a cysteine prodrug, as a potential medication for preventing relapse to cocaine use; however, little is known about the safety and tolerability of NAC in cocaine-dependent subjects in an outpatient setting. This pilot study examines the safety and tolerability of 3 doses of NAC for the treatment of cocaine dependence. Twenty three treatment-seeking cocaine-dependent patients participated in a 4-week medication trial and received NAC at doses of 1200 mg/day, 2400 mg/day or 3600 mg/day. Results suggested that the three doses were well tolerated. Overall, the retention rates appeared to favor higher doses of NAC (2400 mg/day and 3600 mg/day). The majority of subjects who completed the study (n=16) either terminated use of cocaine completely or significantly reduced their use of cocaine during treatment. Overall the findings suggest that it is feasible to treat cocaine-dependent treatment seekers with N-acetylcysteine on an outpatient basis.

Characteristics of cocaine- and marijuana-dependent subjects presenting for medication treatment trials.

Evaluation of the characteristics of individuals presenting for substance abuse treatment can provide important information to help focus treatment services. In this study, demographic and clinical characteristics of individuals presenting for medication trials for the treatment of cocaine or marijuana dependence were compared. Marijuana-dependent subjects were generally younger than cocaine-dependent subjects, more likely to be Caucasian, and completed more years of education. Marijuana-dependent subjects also reported significantly more days using than cocaine-dependent subjects, as well as higher levels of craving. Some differences in psychiatric symptomatology were also noted, with cocaine-dependent subjects more likely to report anxiety symptoms and marijuana-dependent subjects reporting more past depressive episodes. Past and current other drug use was similar between the two groups. These results highlight the significant impairments associated with marijuana and cocaine dependence.

Trends in cigarette use, by serious psychological distress status in the United States, 1998-2013.

OBJECTIVES: The study compared trends in current and heavy cigarette smoking between adults with and without serious psychological distress (SPD). METHODS: This study examined data from 480,024 adults aged 18years or older in the 1998-2013 National Health Interview Survey (NHIS) public use files. SPD is defined as having a Kessler-6 score of 13 or higher in the past month. Trends in the prevalence of current smoking and heavy smoking for 2-year time periods were assessed among those with versus those without SPD using logistic regression; tests of interaction terms determined whether smoking trends differed by SPD status. RESULTS: The prevalence of current smoking decreased over time among adults without SPD (adjusted odds ratio [AOR]=0.97, 95% CI=0.97-0.98), but remained stable among adults with SPD (AOR=1.01, 95% CI=0.99-1.03). Both groups had significant declines in heavy smoking over time; however, the rates of decline were greater among adults without versus with SPD (AOR=0.87, 95% CI=0.86-0.88 and AOR=0.91, 95% CI=0.88-0.94, respectively). CONCLUSIONS: The prevalence of current smoking is not declining among adults with SPD, and the prevalence of heavy smoking is not declining as quickly among adults with SPD as compared with those without SPD. Smoking cessation efforts may need to target these populations and tailor programs accordingly.