Behavioural disorders after prenatal exposure to anaesthesia for maternal surgery.

BACKGROUND: The association between prenatal exposure to general anaesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalising behavioural disorder diagnosis in the child has not been well-defined. METHODS: A nationwide sample of pregnant women linked to their liveborn infants was evaluated using the Medicaid Analytic eXtract (MAX, 1999-2013). Multivariate matching was used to match each child prenatally exposed to general anaesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children. The primary outcome was diagnosis of a disruptive or internalising behavioural disorder in children. Secondary outcomes included diagnoses for a range of other neuropsychiatric disorders. RESULTS: We matched 34,271 prenatally exposed children with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalising behavioural disorder (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.23-1.40). For secondary outcomes, increased hazards of disruptive (HR, 1.32; 95% CI, 1.24-1.41) and internalising (HR, 1.36; 95% CI, 1.20-1.53) behavioural disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32; 95% CI, 1.22-1.43), behavioural disorders (HR, 1.28; 95% CI, 1.14-1.42), developmental speech or language disorders (HR, 1.16; 95% CI, 1.05-1.28), and autism (HR, 1.31; 95% CI, 1.05-1.64). CONCLUSIONS: Prenatal exposure to general anaesthesia is associated with a 31% increased risk for a subsequent diagnosis of a disruptive or internalising behavioural disorder in children. Caution is advised when making any clinical decisions regarding care of pregnant women, as avoidance of necessary surgery during pregnancy can have detrimental effects on mothers and their children.

Prognosis and risk of suicide after cancer diagnosis.

INTRODUCTION: Suicide rates are elevated after cancer diagnosis. Existential distress caused by awareness of one's impending death is well-described in patients with cancer. The authors hypothesized that suicide risk is associated with cancer prognosis, and the impact of prognosis on suicide risk is greatest for populations with higher baseline suicide risk. METHODS: The authors identified patients (≥16 years old) with newly diagnosed cancers from 2000 to 2019 in the Surveillance, Epidemiology, and End Results database, representing 27% of US cancers. Multiple primary-standardized mortality ratios (SMR) were used to estimate the relative risk of suicide within 6 months of diagnosis compared to the general US population, adjusted for age, sex, race, and year of follow-up. Suicide rates by 20 most common cancer sites were compared with respective 2-year overall survival rates (i.e., prognosis) using a weighted linear regression model. RESULTS: Among 6,754,704 persons diagnosed with cancer, there were 1610 suicide deaths within 6 months of diagnosis, three times higher than the general population (SMR = 3.1; 95% confidence interval, 3.0-3.3). Suicide risk by cancer site was closely associated with overall prognosis (9.5%/percent survival deficit, R2  = 0.88, p < .0001). The association of prognosis with suicide risk became attenuated over time. For men, the risk of suicide increased by 2.8 suicide deaths per 100,000 person-years (p < .0001) versus 0.3 in women (p < .0001). The risk was also higher for persons ≥60 old and for the White (vs. Black) race. CONCLUSIONS: Poorer prognosis was closely associated with suicide risk early after cancer diagnosis and had a greater effect on populations with higher baseline risks of suicide. This model highlights the need for enhanced psychiatric surveillance and continued research in this patient population.

Dietary flavanols restore hippocampal-dependent memory in older adults with lower diet quality and lower habitual flavanol consumption.

Dietary flavanols are food constituents found in certain fruits and vegetables that have been linked to cognitive aging. Previous studies suggested that consumption of dietary flavanols might specifically be associated with the hippocampal-dependent memory component of cognitive aging and that memory benefits of a flavanol intervention might depend on habitual diet quality. Here, we tested these hypotheses in the context of a large-scale study of 3,562 older adults, who were randomly assigned to a 3-y intervention of cocoa extract (500 mg of cocoa flavanols per day) or a placebo [(COcoa Supplement and Multivitamin Outcomes Study) COSMOS-Web, NCT04582617]. Using the alternative Healthy Eating Index in all participants and a urine-based biomarker of flavanol intake in a subset of participants [n = 1,361], we show that habitual flavanol consumption and diet quality at baseline are positively and selectively correlated with hippocampal-dependent memory. While the prespecified primary end point testing for an intervention-related improvement in memory in all participants after 1 y was not statistically significant, the flavanol intervention restored memory among participants in lower tertiles of habitual diet quality or habitual flavanol consumption. Increases in the flavanol biomarker over the course of the trial were associated with improving memory. Collectively, our results allow dietary flavanols to be considered in the context of a depletion-repletion paradigm and suggest that low flavanol consumption can act as a driver of the hippocampal-dependent component of cognitive aging.

Prevalance and course of tobacco use among individuals receiving coordinated specialty care for first-episode psychosis.

AIM: Tobacco use is decreasing among the general population, but persistent use among individuals in treatment for first-episode psychosis (FEP) remains a problem. This study aimed to measure the prevalence and course of tobacco use and explore the associations between tobacco use and clinical outcomes in a FEP sample located in New York State (NYS). METHODS: Participants (N = 870) were from the OnTrackNY system of coordinated specialty care clinics in NYS. Participant data were collected at admission to the program and at every 3 months of follow-up using standardized forms based on reports from clients, client families and chart review. Course of tobacco use was categorized into four groups: no-use, cessation, persistent and initiation over 1 year of follow-up. RESULTS: The prevalence of tobacco use was 12.8% at baseline and 19.9% at 1-year follow-up. Only 3.8% of tobacco users stopped by 1 year follow-up, and 4.9% initiated use. Urbanicity of clinic location (p < .001); age at admission (p = .044); gender (p = .015); ethnoracial group (p = .007); baseline education/employment status (p = .004); and baseline use of any non-tobacco substances (p < .001), including alcohol (p < .001) and cannabis (p < .001), were associated with tobacco course. Findings suggest an association between tobacco use and reduced improvement in symptoms. CONCLUSION: Despite a lower prevalence of tobacco use among OnTrack participants than in other comparable samples, tobacco cessation was minimal and more individuals initiated tobacco use than ceased over the course of follow-up. Efforts to implement tobacco cessation interventions in coordinated specialty care are warranted, since tobacco use is associated with poor health outcomes.

Does It Matter What Screener We Use? A Comparison of Ultra-brief PHQ-4 and E-mwTool-3 Screeners for Anxiety and Depression Among People With and Without HIV.

The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.

Experimentally exploring the potential behavioral effects of personalized genetic information about marijuana and schizophrenia risk.

Marijuana use may increase schizophrenia risk, and this effect may be genetically moderated. We investigated how hypothetical genetic test results indicating the presence or absence of heightened schizophrenia risk in reaction to marijuana use would affect attitudes toward marijuana use. In two experiments, participants were randomized to hypothetical scenarios in which genetic testing showed the presence or absence of a predisposition for marijuana use to increase their schizophrenia risk, or to a control condition with no mention of genetic testing. Experiment 1 used a sample of 801 U.S. young adults recruited via Amazon.com's Mechanical Turk platform. Experiment 2 replicated the same procedures with a nationally representative sample of 800 U.S. adults aged 18-30. In Experiment 1, those in the predisposition condition, compared to the control condition, rated the likelihood and importance of their avoiding marijuana as significantly higher, whereas those in the no-predisposition condition rated both as significantly lower. In experiment 2, these findings were largely replicated for the predisposition condition but not the no-predisposition condition, and prior marijuana use was a significant moderator, with the effects of the predisposition condition confined to participants who reported having used marijuana. If these results are predictive of responses to actual genetic testing, they suggest that genetic test results indicating that marijuana use will increase one's schizophrenia risk may incentivize abstinence, especially for those with prior marijuana use. Future research could further investigate whether genetic test results indicating the absence of such a predisposition might disincentivize abstinence from marijuana use.

Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders.

OBJECTIVE: Stepped mental health care requires a rapid method for nonspecialists to detect illness. This study aimed to develop and validate a brief instrument, the Mental Wellness Tool (mwTool), for identification and classification. METHODS: Cross-sectional development and validation samples included adults at six health facilities in Mozambique. Mini International Neuropsychiatric Interview diagnoses were the criterion standard. Candidate items were from nine mental disorder and functioning assessments. Regression modeling and expert consultation determined best items for identifying any mental disorder and classifying positives into disorder categories (severe mental disorder, common mental disorder, substance use disorder, and suicide risk). For validation, sensitivity and specificity were calculated for any mental disorder (index and proxy respondents) and disorder categories (index). RESULTS: From the development sample (911 participants, mean±SD age=32.0±11 years, 63% female), 13 items were selected-three with 0.83 sensitivity (95% confidence interval [CI]=0.79-0.86) for any mental disorder and 10 additional items classifying participants with a specificity that ranged from 0.72 (severe mental disorder) to 0.90 (suicide risk). For validation (453 participants, age 31±11 years, 65% female), sensitivity for any mental disorder was 0.94 (95% CI=0.89-0.97) with index responses and 0.73 (95% CI=0.58-0.85) with family proxy responses. Specificity for categories ranged from 0.47 (severe mental disorder) to 0.93 (suicide risk). Removing one item increased severe mental disorder specificity to 0.63 (95% CI=0.58-0.68). CONCLUSIONS: The mwTool performed well for identification of any mental disorder with index and proxy responses to three items and for classification into treatment categories with index responses to nine additional items.

Development, Psychopathology, and Ethnicity II: Psychiatric Disorders Among Young Adults.

OBJECTIVE: To estimate the prevalence of psychiatric disorders and their continuity since childhood among young adults from the same ethnic group living in 2 low-income contexts. METHOD: Young adults (N = 2,004; ages 15-29) were followed (82.8% retention) as part of the Boricua Youth Study, a study of Puerto Rican youths recruited at ages 5-13 in the South Bronx (SBx), New York, and Puerto Rico (PR). We estimated prevalence (lifetime; past year) of major depressive (MDD), mania, hypomania, generalized anxiety (GAD), tobacco dependence, and any other substance use disorders (SUD). RESULTS: The prevalence of every disorder was higher among young women from the SBx compared with those from PR (eg, 9.2% versus 4.1% past-year SUD; 14% versus 6.8% for MDD/GAD). Among SBx young men, tobacco dependence and illicit SUD were elevated. Across both contexts, men had higher adjusted odds of illicit SUD than women, while women had higher GAD than men. MDD did not differ by gender. Young adulthood disorders (except for alcohol use disorder and GAD) followed childhood disorders. For example, childhood externalizing disorders preceded both MDD (young men and women) and illicit SUD (young women only). CONCLUSION: Young women raised in a context where adversities like ethnic discrimination concentrate are at high risk for psychiatric disorders. In certain high-poverty contexts, young men may present with MDD as often as women. Interventions to prevent psychiatric disorders may need to address gender-specific processes and childhood disorders. However, SUD prevention among young men may need to address other factors.

Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5, a clinician-administered diagnostic interview.

AIM: In DSM-5, the definitions of substance use disorders (SUD) were changed considerably, yet little is known about the reliability of DSM-5 SUD and its new features. METHODS: The test-retest reliability of DSM-5 SUD and DSM-IV substance dependence (SD) was evaluated in 565 adult substance users, each interviewed twice by different clinician interviewers using the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). DSM-5 SUD and DSM-IV SD criteria were assessed for past year and lifetime, yielding diagnoses and severity levels for alcohol, tobacco, cannabis, cocaine, heroin, opioids, sedatives, hallucinogen, and stimulant use disorders. Cohen's and intraclass correlation coefficients (ICC) assessed reliability for categorical and graded outcomes, respectively. Factors potentially influencing reliability were explored, including inpatient vs. community participant, days between interviews gender, age, race/ethnicity, and SUD severity. RESULTS: DSM-5 SUD diagnoses had substantial to excellent reliability for most substances (κ = 0.63-0.94), and moderate for others (hallucinogens, stimulants, sedatives; κ = 0.50-0.59). For graded outcomes (DSM-5 SUD mild, moderate, severe; criteria count 0-11), reliability was substantial to excellent (ICC = 0.74-0.99). Comparisons of DSM-5 SUD and DSM-IV SD reliability showed few significant differences. Reliability of the DSM-5 craving criterion was excellent for heroin (κ = 0.84-0.95) and moderate to substantial for other substances (κ = 0.49-0.76). The only factor influencing reliability of SUD was severity, with milder disorders significantly more likely to be discordant between the interviews. CONCLUSION: Reproducibility is crucial to good measurement. In a large sample using rigorous methodology, diagnoses and dimensional measures from clinician-administered interviews for DSM-5 SUD were generally highly reliable.

Trends in the Prevalence of Current, Daily, and Nondaily Cigarette Smoking and Quit Ratios by Depression Status in the U.S.: 2005-2017.

INTRODUCTION: Cigarette smoking remains more common among individuals with depression. This study investigates whether cigarette quit ratios and cigarette use prevalence have changed differentially by depression status during the past decade. METHODS: National Survey on Drug Use and Health data (2005-2017) were analyzed in 2019. Respondents aged ≥12 years were included in analyses of smoking prevalence (n=728,691) and respondents aged ≥26 years were included in analyses of quit ratio (n=131,412). Time trends in smoking prevalence (current, daily, and nondaily) and quit ratio (former/lifetime smokers) were estimated, stratified by past-year depression. Adjusted analyses controlled for demographics. RESULTS: Smoking prevalence was consistently higher among those with depression than those without depression. From 2005 to 2017, nondaily smoking did not significantly change among individuals with depression (9.25% to 9.40%; AOR=0.995, 95% CI=0.986, 1.005), whereas it decreased from 7.02% to 5.85% among those without depression (AOR=0.986, 95% CI=0.981, 0.990). By contrast, daily smoking declined among individuals with (25.21% to 15.11%; AOR=0.953, 95% CI=0.945, 0.962) and without depression (14.94% to 9.76%; AOR=0.970, 95% CI=0.967, 0.973). The quit ratio increased among individuals with (28.61% to 39.75%; AOR=1.036, 95% CI=1.021, 1.052) and without depression (47.65% to 53.09%; AOR=1.013, 95% CI=1.009, 1.017), yet quit ratios were consistently lower for those with depression than those without depression. CONCLUSIONS: Quit ratios are increasing and smoking prevalence is decreasing overall, yet disparities by depression status remain significant. Disparities in quit ratio may be one contributing factor to the elevated prevalence of smoking among those with depression. Innovative tobacco control approaches for people with depression appear long overdue.

Developing a Scale to Measure Interprofessional Collaboration in HIV Prevention and Care: Implications for Research on Patient Access and Retention in the HIV Continuum of Care.

To adapt and validate a scale for measuring interprofessional collaboration in HIV prevention and care (IPC-HIV), primary survey data were collected (2012-2017) from 577 HIV service providers in 60 organizations in New York, New Jersey, and Michigan. Cross-sectional training data were used to develop the IPC-HIV scale. The model was validated by fitting the five-factor confirmatory factor-analysis model to a 30-item set. The scale measures five domains with reliable alpha coefficients: Interdependence, Professional Activities, Flexibility, Collective Ownership, and Reflection on Process. Correlations between subscales were significant (p < .05). The strongest correlation was between Reflection on Process and Collective Ownership subscale scores. Mean scores ranged lfrom 4.070 to 4.880, with the highest score for Flexibility across all locations. IPC-HIV is valid and reliable among HIV-prevention and care workers, and is recommended for examining the effect of IPC on patient access to HIV testing and primary care.

Double blind, two dose, randomized, placebo-controlled, cross-over clinical trial of the positive allosteric modulator at the alpha7 nicotinic cholinergic receptor AVL-3288 in schizophrenia patients.

Despite their theoretical rationale, nicotinic alpha-7 acetylcholine (nα7) receptor agonists, have largely failed to demonstrate efficacy in placebo-controlled trials in schizophrenia. AVL-3288 is a nα7 positive allosteric modulator (PAM), which is only active in the presence of the endogenous ligand (acetylcholine), and thus theoretically less likely to cause receptor desensitization. We evaluated the efficacy of AVL-3288 in a Phase 1b, randomized, double-blind, placebo-controlled, triple cross-over study. Twenty-four non-smoking, medicated, outpatients with schizophrenia or schizoaffective disorder and a Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) ≥62 were randomized. Each subject received 5 days of AVL-3288 (10, 30 mg) and placebo across three separate treatment weeks. The primary outcome measure was the RBANS total scale score, with auditory P50 evoked potential suppression the key target engagement biomarker. Secondary outcome measures include task-based fMRI (RISE task), mismatch negativity, the Scale for the Assessment of Negative Symptoms of Schizophrenia (SANS) and the Brief Psychiatric Rating Scale (BPRS). Twenty-four subjects were randomized and treated without any clinically significant treatment emergent adverse effects. Baseline RBANS (82 ± 17) and BPRS (41 ± 13) scores were consistent with moderate impairment. Primary outcomes were negative, with non-significant worsening for both active groups vs. placebo in the P50 and minimal between group changes on the RBANS. In conclusion, the results did not indicate efficacy of the compound, consistent with most prior results for the nα7 target.

Exposure to Surgery and Anesthesia in Early Childhood and Subsequent Use of Attention Deficit Hyperactivity Disorder Medications.

BACKGROUND: Some recent clinical studies have found that early childhood exposure to anesthesia is associated with increased risks of behavioral deficits and clinical diagnoses of attention deficit hyperactivity disorder (ADHD). While diagnoses in claims data may be subject to inaccuracies, pharmacy claims are highly accurate in reflecting medication use. This study examines the association between exposure to surgery and anesthesia and subsequent ADHD medication use. METHODS: Longitudinal data for children enrolled in Texas and New York Medicaid from 1999 to 2010 were used. We assessed the association between a single exposure to anesthesia before age 5 years for 1 of 4 common pediatric surgical procedures (pyloromyotomy, inguinal hernia repair, circumcisions outside the perinatal period, and tonsillectomy and/or adenoidectomy) and persistent ADHD medication use (event defined as the initial ADHD medication prescription, and persistent use defined as filling 2 or more ≥30-day prescriptions between 6 months following surgery until censoring). Exposed children (n = 42,687) were matched on propensity score (ie, the probability of receiving surgery) estimated in logistic regression including sociodemographic and clinical covariates, to children without anesthesia exposure before age 5 years (n = 213,435). Cox proportional hazards models were used to evaluate the hazard ratio (HR) of ADHD medication use following exposure. Nonpsychotropic medications served as negative controls to determine if exposed children simply had higher overall medication use. RESULTS: Children with a single exposure to surgery and anesthesia were 37% more likely than unexposed children to persistently use ADHD medication (HR, 1.37; 95% confidence interval [CI], 1.30-1.44). The estimated HRs for common nonpsychotropic medication use following a single anesthetic exposure were 1.06 (95% CI, 1.04-1.07) for amoxicillin, 1.10 (95% CI, 1.08-1.12) for azithromycin, and 1.08 (95% CI, 1.05-1.11) for diphenhydramine. In comparison, the risk of using other psychotropic medication to treat conditions besides ADHD was also significantly higher, with HRs of 1.37 (95% CI, 1.24-1.51) for sedative/anxiolytics, 1.40 (95% CI, 1.25-1.58) for antidepressants, 1.31 (95% CI, 1.20-1.44) for antipsychotics, and 1.24 (95% CI, 1.10-1.40) for mood stabilizers. CONCLUSIONS: Medicaid-enrolled children receiving anesthesia for a single common pediatric surgical procedure under age 5 years were 37% more likely to require subsequent persistent use of ADHD medications than unexposed children. Because the increased use of ADHD medication is disproportionately higher than that of nonpsychotropic medications, unmeasured confounding may not account for all of the increase in ADHD medication use. By evaluating Medicaid data, this study assesses children who may be particularly vulnerable to neurotoxic exposures.

U.S. Adults With Pain, a Group Increasingly Vulnerable to Nonmedical Cannabis Use and Cannabis Use Disorder: 2001-2002 and 2012-2013.

OBJECTIVE: Given changes in U.S. marijuana laws, attitudes, and use patterns, individuals with pain may be an emerging group at risk for nonmedical cannabis use and cannabis use disorder. The authors examined differences in the prevalence of nonmedical cannabis use and cannabis use disorder among U.S. adults with and without pain, as well as whether these differences widened over time. METHODS: Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309) were analyzed using logistic regression. Risk differences of past-year nonmedical cannabis use, frequent (at least three times a week) nonmedical use, and DSM-IV cannabis use disorder were estimated for groups with and without moderate to severe pain, and these risk differences were tested for change over time. RESULTS: Any nonmedical cannabis use was more prevalent in respondents with than without pain (2001-2002: 5.15% compared with 3.74%; 2012-2013: 12.42% compared with 9.02%), a risk difference significantly greater in the 2012-2013 data than in the 2001-2002 data. The prevalence of frequent nonmedical cannabis use did not differ by pain status in the 2001-2002 survey, but was significantly more prevalent in those with than without pain in the 2012-2013 survey (5.03% compared with 3.45%). Cannabis use disorder was more prevalent in respondents with than without pain (2001-2002: 1.77% compared with 1.35%; 2012-2013: 4.18% compared with 2.74%), a significantly greater risk difference in the data from 2012-2013 than from 2001-2002. CONCLUSIONS: The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk. Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder.

Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002-2016.

BACKGROUND: The prevalence of cigarette smoking is nearly three times higher among persons who use cannabis and have cannabis use disorders (CUDs), relative to those who do not. The current study examined cigarette quit ratios from 2002 to 2016 among US adults with and without cannabis use and CUDs. METHODS: The current study analysed US adults aged 18 years and older from the National Survey on Drug Use and Health, an annual cross-sectional study. Quit ratios (ie, proportion of former smokers among ever-smokers) were calculated annually from 2002 to 2016. Time trends in quit ratios by cannabis use/CUDs were tested using logistic regression. RESULTS: In 2016, the quit ratios for people with any cannabis use (23%) and CUDs (15%) were less than half the quit ratios of those without cannabis use and CUDs (51% and 48%, respectively). After controlling for demographics and substance use disorders, the quit ratio did not change from 2002 to 2016 among persons with CUD, though it non-linearly increased among persons with cannabis use, without cannabis use and without CUDs. Quit ratios increased more rapidly among those who reported past-month cannabis use compared with those without past-month cannabis use. CONCLUSIONS: Cigarette smoking quit ratios remain dramatically lower among people who use cannabis and have CUDs and quit ratios did not change significantly from 2002 to 2016 among those with CUDs. Public health and clinical attention are needed to increase quit ratios and reduce harmful cigarette smoking consequences for persons with cannabis use and CUDs.

Interprofessional collaboration improves linkages to primary care: a longitudinal analysis.

The first steps of the HIV care continuum include patients finding access to HIV testing and primary care. Psychosocial providers ("providers"), such as social workers, health educators, and outreach workers comprise a workforce tasked with linking patients to HIV testing and primary care. This study examines longitudinal associations between provider- and organization-level factors and linkage to HIV testing and primary care. The sample included 245 providers in 36 agencies in New York City. We used longitudinal data (baseline and 12- and 24-months follow-ups) and multilevel ordinal logistic regression to examine associations between factors distributed in three theoretical socioecological domains: individual (demographic and HIV training characteristics); relationship (interprofessional collaboration); and agency (size and capacity), and frequency of HIV testing and primary care linkages. Approximately 30% of providers linked 20 or more patients to HIV testing or HIV primary care in the previous six months. Providers' higher endorsement of interprofessional collaboration at 12 months, formal HIV training, younger age, and Latinx ethnicity had higher odds of making more linkages to HIV testing and HIV primary care at 24 months. Training providers in interprofessional collaboration principles and practice and basic HIV knowledge may improve the frequency of linkages to HIV care continuum services.

Toward a Comprehensive Developmental Model of Prescription Opioid Use Disorder.

OBJECTIVE: To develop a comprehensive etiologic model of DSM-5 prescription opioid use disorder (POUD) based on Kendler and colleagues' development model for major depressive disorder. METHODS: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). Risk factors were divided into 4 developmental tiers (childhood/early adolescence, late adolescence, adulthood, past year). Hierarchical logistic regression models were used to examine the independent contribution of each risk factor. Separate models were built to predict 12-month nonmedical use of prescription opioids and risk of POUD among those with 12-month nonmedical use. RESULTS: After adjustment for other risk factors, the odds of past 12-month nonmedical use of prescription opioids were increased by history of trauma, social deviance, and use of drugs other than opioids in adulthood and by past-year pain, alcohol use disorder (AUD), tobacco use disorder, any Axis I disorder other than SUD, and number of stressful events. History of POUD in adulthood and pain, AUD, tobacco use disorder, and any Axis I disorder other than substance use disorders (SUD) in the past year increased the odds of 12-month POUD. History of SUD other than POUD in adulthood was associated with lower odds of POUD. For both outcomes, the effect of earlier development tiers was mediated by more proximal ones. CONCLUSIONS: A modification of Kendler and colleagues' model for major depressive disorder provides a useful foundation for a comprehensive developmental model of nonmedical opioid use and opioid use disorder.

Increasing Depression and Substance Use Among Former Smokers in the United States, 2002-2016.

INTRODUCTION: Mental health and substance use problems are associated with smoking relapse among former smokers. Yet, little is known about the prevalence of mental health and substance use among former smokers in the U.S. In addition, it is unknown whether the prevalence of these conditions has changed over time as former U.S. smokers have grown to outnumber current U.S. smokers. This study, which was conducted in 2018 and 2019, examined the prevalence and trends over time in depression (2005-2016), marijuana use (2002-2016), and alcohol use problems (2002-2016) among former U.S. smokers. METHODS: The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study. Data from U.S. individuals who were aged ≥18 years in 2002-2016 were included. Former smokers were defined as having smoked ≥100 lifetime cigarettes and no past-year cigarettes. RESULTS: From 2005 to 2016, the prevalence of major depression increased from 4.88% to 6.04% (AOR=1.01, 95% CI=1.00, 1.03, p=0.04). From 2002 to 2016, past-year marijuana use rose from 5.35% to 10.09% (AOR=1.08, 95% CI=1.07, 1.09, p<0.001) among former smokers. Past-month binge alcohol use also increased from 17.22% to 22.33% (AOR=1.03, 95% CI=1.02, 1.04, p<0.001), although the prevalence of past-year alcohol abuse or dependence did not change. CONCLUSIONS: Depression and substance use, which are factors associated with increased risk for cigarette use relapse, appear to be increasing over time among former U.S. smokers. Increased awareness of these trends may be important for clinical and public health efforts to direct attention to conditions potentially threatening sustained abstinence among former smokers.

Treatment of Common Mental Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.

OBJECTIVE: This study analyzed past 12-month disorder-specific mental health treatment patterns of common DSM-5 disorders in the United States. METHODS: Nationally representative face-to-face household survey data from structured diagnostic interviews of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (n = 36,309) were used to estimate percentages of respondents with 12-month DSM-5 mood, anxiety, and substance use disorders who received disorder-specific treatment during the 12 months before the interview. RESULTS: The percentage receiving treatment was highest for mood disorders (37.8%; 95% CI, 36.1%-39.6%), followed by anxiety disorders (24.1%; 95% CI, 22.6%-25.6%), and lowest for substance use disorders (18.8%; 95% CI, 17.8%-19.8%). Among anxiety disorders, panic disorder (47.9%; 95% CI, 43.9%-52.0%) had the highest treatment rate, and among substance use disorders, tobacco use disorder (20.3%; 95% CI, 19.0%-21.7%) had the highest treatment rate. Adults with mood and anxiety disorders (53.1%; 95% CI, 49.7%-56.4%) were more likely than those with only mood (32.0%; 95% CI, 29.5%-34.6%) or only anxiety (13.2%; 95% CI, 11.6%-15.0%) disorders to receive any mental health treatment. Lack of insurance coverage was associated with significantly lower odds of treatment for all disorders except specific phobia (0.55; 95% CI, 0.30-1.03), drug use disorders other than tobacco (0.80; 95% CI, 0.47-1.36), and alcohol use disorder (1.52; 95% CI, 1.12-2.07). CONCLUSIONS: Most adults with common mental disorders in the United States were not treated for their disorders, and treatment rates varied considerably across disorders and sociodemographic groups, with particularly low rates of treatment for substance use disorders. Policy and clinical interventions are needed to promote greater access to treatment of adults with common substance use, anxiety, and mood disorders.

E-cigarette Use Among Young Adults in the U.S.

INTRODUCTION: Use of e-cigarettes is increasing among young adults in the U.S. Whether e-cigarette use serves as an aid to smoking reduction or cessation among young adults remains a matter of contention. This analysis examines patterns of e-cigarette use in relation to cigarette smoking in a nationally representative sample of U.S. young adults. METHODS: Data were analyzed from nationally representative U.S. adults, aged 18 to 35years (N=12,415), in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Logistic regression assessed associations between e-cigarette use and smoking intensity, continuity, and reduction while controlling for several potential confounding factors. Data were analyzed in 2018. RESULTS: Among cigarette smokers, e-cigarette use was associated with higher odds of tobacco use disorder (AOR=2.58, 95% CI=1.73, 3.83) and daily cigarette smoking (AOR=1.67, 95% CI=1.73, 3.83). Among adults aged 26-35years, e-cigarette use was also associated with heavy cigarette smoking (AOR=2.01, 95% CI=1.09, 3.74). Among lifetime smokers, e-cigarette use was associated with lower odds of stopping smoking (AOR=0.14, 95% CI=0.08, 0.23) and lower odds of a 50% reduction in cigarettes smoked per day (AOR=0.63, 95% CI=0.43, 0.93). Only 13.1% of young adults who ever used e-cigarettes reported using them to help stop or quit smoking. CONCLUSIONS: Use of e-cigarettes by U.S. young adults, most of which is not intended to help reduce smoking, is related to more rather than less frequent and intensive cigarette smoking.