A Common Ground Gun Violence Prevention Policy Package.

In 2022 we conducted a literature review, surveyed 1078 gun owners, and conducted post-survey focus groups and interviews of gun owners and non-gun owners, to determine a common ground gun violence prevention (GVP) policy package. This allowed us to see policies that would save lives and be widely accepted: (1) violent misdemeanor laws, (2) state permit laws, combined with universal background checks; (3) red flag laws. Based on our review of relevant research, we conservatively estimate that in states without any of the policy package components, implementing this package would result in a 27.9% reduction in firearm deaths. We believe that polarization between firearm owners and non-firearm owners, which has thwarted a widely supported response to the problem of gun violence, is largely a harmful myth that can be overcome by including gun owners in the process of fashioning an effective policy approach.

Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients.

Importance: Evidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed. Objective: To develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients. Evidence Review: A process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale. Findings: Articles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream-used off-label for patients younger than 12 years and limited to nonsegmental vitiligo-were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources. Conclusions and Relevance: Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.

Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective.

INTRODUCTION: Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course. METHODS: Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates. RESULTS: During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities. CONCLUSION: This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.

Types and Brands of Derived Psychoactive Cannabis Products: An Online Retail Assessment, 2023.

Background: The 2018 Farm Bill led to new types of derived psychoactive cannabis products (DPCPs) being sold throughout the United States. This study describes the new types and brands of DPCPs sold online. Materials and Methods: In May 2023, data were recorded from three top-trafficked U.S.-based DPCP retail websites, including information about each product (N=804). Results: DPCP modalities included disposable vapes (43%), edibles (29%), vape carts (18%), pre-rolls (7%), flower (2%), dabs (1%), and vape pods (<1%). Among the 118 brands, the most common were Exhale, Delta Extrax, Cake, URB, Looper, and TRE House. There were 26 different intoxicating compounds overall, the most prevalent being: Delta-8 tetrahydrocannabinol (THC), THC-P, Delta-9 THC, HHC, THC-A, Delta-10 THC, THC-H, THC-B, THC-JD, THC-X, HHC-P, and Delta-11 THC. Overall, 54% of products were blends, containing two to eight different intoxicating compounds in a single product. Discussion: This is the first study to systematically assess DPCPs sold online. Most of the DPCP market is comprised of vapes and edibles, but these products contain a wide array of compounds and blends. Data from this diverse, rapidly evolving market are needed to examine its consumer impact and inform public health policies and programs.

Association Between Changes in Racial Residential Segregation and Trends in Racial Disparities in Early Mortality in 220 Metropolitan Areas, 2001-2018.

INTRODUCTION: Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018. METHODS: Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA. RESULTS: The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time. CONCLUSION: This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time.

Gun violence prevention policy: Perceived and actual levels of gun owner support.

Gun violence prevention is often viewed as polarizing, although gun owners actually support many gun safety policies. The aim of this paper was to investigate the relationship between gun owners' perceptions of other gun owners' support for gun policies and their own individual support for such policies. NORC at the University of Chicago, which uses a panel of adults recruited through probability sampling, conducted an online/phone survey of 1,078 adult gun owners. Respondents were asked about their individual support for seven gun safety policies and their perceptions of other gun owners' support for those policies. We used two-sample t-tests and multivariate logistic regression analyses to explore the relationship between perceived and individual support. We found that gun owners underestimated fellow gun owners' support for gun violence prevention policy, especially if they personally opposed that policy. Gun owners' perception of fellow gun owners' support for a policy was significantly associated with the likelihood of individual support for that policy for all laws examined. These findings have important implications for correcting misperceptions of the level of gun owner support for gun safety policies as well as conducting and targeting educational campaigns to respond to and correct media misinformation.

Structural racism and racial health disparities at the state level: A latent variable approach.

Introduction Structural racism is increasingly being recognized as a fundamental cause of racial health disparities. We used a novel measure of structural racism at the state level to examine the relationship between structural racism and disparities in death rates from firearm homicide, infant mortality, HIV, diabetes, stroke, hypertension, asthma, and kidney disease between non-Hispanic Black and non-Hispanic White people in the United States. Methods We used confirmatory factor analysis to measure the latent construct of structural racism for all 50 states. The model included seven indicators across the structural racism domains of residential segregation, economic status/employment, education, incarceration, political participation and representation, environmental racism, and racial equity inclusion. Weights for each of the indicators were determined by examining alternative models and selecting the model with the best fit statistics. The resulting factor scores, representing the level of structural racism in each state across the seven domains, were then used as predictor variables in a series of linear regressions with the ratio of Black to White death rates for each health outcome as the dependent variables. Results We found significant relationships between higher levels of the latent structural racism measure and greater disparities between non-Hispanic Black and non-Hispanic White people in age-adjusted death rates for firearm homicide, infant mortality, HIV, asthma, and obesity. The magnitude of this relationship was greatest for firearm homicide, with each one standard deviation increase in a state's structural racism factor score being associated with an increase of 4.54 (95% CI, 2.91-6.17) in that state's Black-White firearm homicide rate ratio. Conclusions This research provides further evidence that structural racism is a fundamental cause of racial health disparities and that to repair these inequities, macro-level changes in societal structures, institutions, resource allocation, representation, and power will be necessary.

Using a Latent Variable Method to Develop a Composite, Multidimensional Measure of Structural Racism at the City Level.

INTRODUCTION: Although structural racism is strongly related to racial health disparities, we are not aware of any composite, multidimensional measure of structural racism at the city level in the United States. However, many of the policies, programs, and institutions that create and maintain structural racism are located at the city level. To expand upon previous research, this paper uses a novel measure to measure structural racism at the city level for the non-Hispanic Black population. METHODS: We used confirmatory factor analysis to model the latent construct of structural racism for 776 U.S. cities. The model included six indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status. We generated factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each city. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS: There were profound differences in the magnitude of structural racism across cities. There were also striking differences in the magnitude of the racial disparity in firearm homicide across cities. Structural racism was a significant predictor of the magnitude of these racial disparities in firearm homicide. Each one standard deviation increase in the structural racism factor score increased the firearm homicide rate ratio by a factor of approximately 1.2 (95% confidence interval, 1.1-1.3). CONCLUSIONS: These new measures can be utilized by researchers to relate structural racism to racial health disparities at the city level.

Gun owners' assessment of gun safety policy: their underlying principles and detailed opinions.

BACKGROUND: While gun owners are frequently surveyed, we are not aware of any study that has examined principles held by gun owners that underlie their gun policy opinions, or their opinions about specific provisions of each policy. To find the common ground between gun owners and non-gun owners, this paper aims to answer the following: (1) What underlying principles affects gun owner support for gun policies; (2) how do gun owners' attitudes change depending on the specific provisions within these policies? METHODS: In May 2022, a survey was administered by NORC at the University of Chicago and completed by adult gun owners (n = 1078) online or by phone. Statistical analyses were performed using STATA. The survey used a 5-point Likert scale to evaluate gun owners' principles and attitudes toward firearm regulation, such as red flag laws, and possible provisions to these policies. Focus groups and interviews were conducted with 96 adult gun owners and non-gun owners to further clarify points in the survey for the former and to ascertain support for the same policies and their potential provisions for the latter. RESULTS: The principle that gun owners identified with the most concerned keeping guns out of the hands of those with an increased risk for violence. There was significant overlap among gun owners and non-gun owners on policy support, especially with this central theme that those with a history of violence should be prevented from accessing a firearm. The degree of support for policies was different depending on what provisions were said to be included in the policy. For example, the degree of support for universal background checks ranged from 19.9 to 78.4% depending on the details of the legislation. CONCLUSION: This research demonstrates common ground between gun owners and non-gun owners: It informs the gun safety policy community about gun owners' views and principles on gun safety policy and which policy provisions impact their support for a given law. This paper suggests that an effective, mutually agreed upon gun safety policy is possible.

Proceedings of the 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference.

The 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference occurred November 3-5, 2022 in Bethesda, Maryland. This conference was the first in-person PeDRA conference after 2 years of a virtual format due to COVID-19. Fittingly, given the effects of the pandemic, the conference theme was "Reimagining Community." The conference included presentations and panel sessions on finding individual and collective purpose, leveraging community in pursuit of a shared goal, and creating a community of resources in collaboration with NIH. The goal of this meeting was to connect clinicians, basic scientists, patients, patient advocates, and industry partners. The reimagined community of pediatric dermatology research is a synergistic space for all members to better understand, prevent, treat, and cure dermatologic diseases and conditions in children. This two-and-a-half-day conference with over 300 attendees featured educational seminars including a keynote address, didactic lecture and panel sessions, skill-building workshops, 13 topic-specific breakout sessions, and an interactive poster session where 108 active and finished research projects could be discussed.

The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes.

AIMS: While several studies have examined the impact of individual indicators of structural racism on single health outcomes, few have explicitly modeled racial disparities in a wide range of health outcomes using a multidimensional, composite structural racism index. This paper builds on the previous research by examining the relationship between state-level structural racism and a wider array of health outcomes, focusing on racial disparities in mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, and kidney disease. METHODS: We used a previously developed state structural racism index that consists of a composite score derived by averaging eight indicators across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; and (5) education. Indicators were obtained for each of the 50 states using Census data from 2020. We estimated the Black-White disparity in each health outcome in each state by dividing the age-adjusted mortality rate for the non-Hispanic Black population by the age-adjusted mortality rate for the non-Hispanic White population. These rates were obtained from the CDC WONDER Multiple Cause of Death database for the combined years 1999-2020. We conducted linear regression analyses to examine the relationship between the state structural racism index and the Black-White disparity in each health outcome across the states. In multiple regression analyses, we controlled for a wide range of potential confounding variables. RESULTS: Our calculations revealed striking geographic differences in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Higher levels of structural racism were significantly associated with greater racial disparities in mortality for all but two of the health outcomes. CONCLUSIONS: There is a robust relationship between structural racism and Black-White disparities in multiple health outcomes across states. Programs and policies to reduce racial heath disparities must include strategies to help dismantle structural racism and its consequences.

Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide.

INTRODUCTION: Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population. METHODS: We used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS: Our calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide. CONCLUSIONS: These new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.

Defining patient-centered research priorities in pediatric dermatology.

BACKGROUND/OBJECTIVES: Patient and caregiver perspectives are critical in understanding dermatologic disease impact, presentation, and management in children. The Pediatric Dermatology Research Alliance (PeDRA) Patient Advisory Committee (PtAC), a group of patient representatives and parents of children with cutaneous disease, pursued a multistep, iterative, consensus-building process to identify comprehensive, high-priority research needs. METHODS: Building on discussions at the 2020 PeDRA Annual Conference, a research prioritization survey was developed and completed by PtAC members. Survey themes were aggregated and workshopped by the PtAC through a series of facilitated calls. Emerging priorities were refined in collaboration with additional PeDRA patient community members at the 2021 PeDRA Annual Conference. Subsequently, a final actionable list was agreed upon. RESULTS: Fourteen PtAC members (86.7% female) representing patients with alopecia areata, atopic dermatitis, vascular birthmarks, congenital melanocytic nevi, ectodermal dysplasias, epidermolysis bullosa, Gorlin syndrome, hidradenitis suppurativa, ichthyosis, pemphigus, psoriasis, Sturge-Weber syndrome, and pachyonychia congenita completed the survey. Following serial PtAC meetings, 60 research needs were identified from five domains: psychosocial challenges, health care navigation/disease management, causes/triggers, treatments to preserve or save life, and treatments to preserve or save quality of life. CONCLUSIONS: Many pediatric dermatology research priorities align across affected communities and may drive meaningful, patient-centric initiatives and investigations.

Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States.

Importance: Firearms are easily transported over state borders; hence permissive firearm laws in one state may have an interstate association with firearm-related deaths in nearby states. Objectives: To examine whether certain firearm laws have an interstate association with firearm-related deaths in nearby states. Design, Setting, and Participants: This cross-sectional observational study used data on state firearm-related deaths in the 48 contiguous states of the US between January 1, 2000, and December 31, 2019. A spatial autoregressive model with fixed effects for state and year was used to evaluate within-state, interstate, and overall associations between firearm laws and firearm-related deaths. Analyses were performed during January 2022. Exposures: The following 9 types of laws were evaluated: universal background checks for all firearms purchase, background checks for handgun sales at gun shows, license requirement to purchase all firearms, state dealer license requirement for handgun sales, requirement of retaining records of handgun sales, ban on purchasing a handgun on behalf of another, prohibition of firearm possession by persons who committed violent misdemeanors, required relinquishment of firearms for persons becoming prohibited from possessing them, and discretion in granting a concealed carry permit. Main Outcomes and Measures: State-level total firearm-related death rates, suicide rates, and homicide rates. Results: In sum, the study period included 662 883 firearm-related deaths of all intents. License requirement for firearm purchase had a within-state association (effect size, -1.79 [95% CI, -2.73 to -0.84]), interstate association (effect size, -10.60 [95% CI, -17.63 to -3.56]), and overall association (effect size, -12.38 [95% CI, -19.93 to -4.83]) per 100 000 population decrease in total firearm-related deaths. This law also had within-state association (effect size, -1.26 [95% CI, -1.72 to -0.80]), interstate association (effect size, -9.01 [95% CI, -15.00 to -3.02]), and overall association (effect size, -10.27 [95% CI, -16.53 to -4.01]) per 100 000 population decrease in firearm-related homicide. Conclusions and Relevance: The findings of this pooled cross-sectional analysis suggest that certain firearm laws in one state were associated with other states' firearm-related deaths. Synergic legislative action in adjacent states, federal firearm legislation, and measures that reduce migration of firearms across state borders should be part of the overarching strategy to prevent firearm-related deaths.

Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak.

INTRODUCTION: In August 2019, an outbreak of "e-cigarette or vaping product use-associated lung injury" (EVALI) prompted many states and health organizations to warn against the use of electronic cigarettes, or e-cigarettes, due to the presumed link between e-cigarette use and the illness. However, it was later shown that vitamin E acetate, a component of some illicit vaporizable THC products, was the causative agent in this outbreak. METHODS: We conducted a series of cross-sectional surveys of the websites of all state departments of health to determine how they communicated the risk of e-cigarette use during and after the EVALI outbreak. We then paired this analysis with data from the 2016 through 2020 Behavioral Risk Factor Surveillance System to measure changes in cigarette and e-cigarette use. RESULTS: Website data from 24 states was available for analysis at all three time points of interest, and BRFSS data was only available for 8 of these states. We found that by January 2020, a majority of the states surveyed did not list vaporizable THC use as a cause of EVALI; however, differences in state messaging did not appear to be associated with changes in e-cigarette and cigarette use. CONCLUSIONS: Given the number of states that did not appear to update their messaging regarding the cause of EVALI, we believe that states should re-evaluate this messaging to accurately communicate the risks of e-cigarette use.

The effectiveness of value-based messages to engage gun owners on firearm policies: a three-stage nested study.

BACKGROUND: Although gun owners overwhelmingly support violence prevention policies, they are hesitant to speak up publicly to advocate for these policies. We tested a series of communication messages on gun owners' level of support for various firearm violence prevention policies and on their willingness to engage in gun violence prevention advocacy. METHODS: We conducted three consecutive experiments, testing a total of thirteen messages on a sample of gun owners over 18 years old who live in the U.S. The first was a random experiment, the second a quasi-experiment, and the third a randomized control trial. The goal of having these varied methods was to develop messages applicable to different contexts with different levels of information about the audience. RESULTS: The most effective message was a script showing respect for gun owners' decisions to purchase a firearm and proposing a balanced policy roadmap to end gun violence, which led to an increase in gun owner's willingness to engage in eight different advocacy activities. We also found a value-based message conveying loyalty to increase support for domestic violence related prohibitions and willingness to engage in advocacy for gun violence prevention policies. CONCLUSIONS: Public health professionals need to develop communication strategies that are aligned with gun owners' values and that affirm respect for gun culture and for gun owners' decisions to own a gun.

Distinct groups of firearm owners with differential risk for suicide in the United States: A latent class analysis.

Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having unique characteristics that could be used to customize suicide prevention efforts. We conducted a nationally-representative survey of 2646 firearm owners to assess individual suicide risk, suicide risk factors, and demographic characteristics. A Latent Class Analysis identified unique segments of firearm owners at increased risk of suicide with similar underlying suicide risk factors and demographic characteristics. We found almost one in ten (9.6%) of firearm owners were at increased risk of suicide with 25% reporting suicide ideation, 6.6% reporting suicide planning, and 1.8% reporting previous suicide attempts. We identified three unique groups of firearm owners with higher than average suicide risk. Relative to other groups of firearm owners, one at-risk group were more affluent with a history of adverse experiences and mental health challenges, a second group had more male veterans with high levels of alcohol consumption, and third group had more non-heterosexual women who experienced trauma. We conclude that there are three unique groups of firearm owners with higher than average suicide risk with very different characteristics. In addition to broad suicide prevention efforts, customized firearm suicide prevention programs should be developed individually for these different firearm-owning populations, taking into consideration the unique suicide risk factors and demographics of each group.

Effect of flavored E-cigarette bans in the United States: What does the evidence show?

The United States federal government, along with many state and local governments, have passed restrictions on electronic cigarette ("e-cigarette") sales with the stated purpose of preventing youth use of these products. The justification for these restrictions includes the argument that youth e-cigarette use will re-normalize youth smoking, leading to increased rates of cigarette smoking by teenagers. However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.

Combining electron spin resonance spectroscopy with scanning tunneling microscopy at high magnetic fields.

The continuous increase in storage densities and the desire for quantum memories and computers push the limits of magnetic characterization techniques. Ultimately, a tool that is capable of coherently manipulating and detecting individual quantum spins is needed. Scanning tunneling microscopy (STM) is the only technique that unites the prerequisites of high spatial and energy resolution, low temperature, and high magnetic fields to achieve this goal. Limitations in the available frequency range for electron spin resonance STM (ESR-STM) mean that many instruments operate in the thermal noise regime. We resolve challenges in signal delivery to extend the operational frequency range of ESR-STM by more than a factor of two and up to 100 GHz, making the Zeeman energy the dominant energy scale at achievable cryogenic temperatures of a few hundred millikelvin. We present a general method for augmenting existing instruments into ESR-STM to investigate spin dynamics in the high-field limit. We demonstrate the performance of the instrument by analyzing inelastic tunneling in a junction driven by a microwave signal and provide proof of principle measurements for ESR-STM.