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BACKGROUND: Globally, Mexico is one of six countries with the highest level of firearm mortality. While previous studies have examined firearm mortality in Mexico before 2015, increases in violence since then highlight the need for an updated analysis. In this study, we examined changes in firearm-related deaths in Mexico from 2015 to 2022 and described these deaths by key demographic groups, incident location, and state of occurrence. Data came from Mexico's Instituto Nacional de Estadistica y Geografia (INEGI), a federal agency that collects and reports national population data. We used descriptive statistics to analyze rates, proportions, and percentage changes in firearm mortality, and we displayed temporal trends using time plots and special trends using maps. RESULTS: Firearm deaths increased in Mexico from 2015 to 2018 but slightly decreased from 2018 to 2022. Homicides presented the highest increase and the highest proportion of firearm-related deaths from 2015 to 2022. Victims were primarily males but rates among women increased at a higher proportion (99.5% vs 53.5%). One third of victims were 20-29y but rates among children and adolescents (10-9y) increased at a higher proportion. Most firearm-related deaths occurred in streets or public spaces but the percentage of incidents occurring in households have increased. State-level rates and percentage changes varied significantly. States with higher rates of firearm mortality coincide with those involving conflict among organized criminal organizations. CONCLUSION: Firearm mortality in Mexico is a major public health burden. The epidemiology of firearm-related deaths in Mexico varies by intent, demographics, location, and states. To mitigate this challenge, multiple solutions are required.
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Servicio de Urgencia en Hospital , Armas de Fuego , Violencia con Armas , Autoinforme , Humanos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Masculino , Femenino , Adulto Joven , Armas de Fuego/estadística & datos numéricos , Violencia con Armas/estadística & datos numéricos , Adolescente , Adulto , Seguridad , Heridas por Arma de Fuego/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The majority of adults suffering from alcohol use disorders (AUD) do not receive treatment. To address this gap in care, we must develop new models to increase identification, engagement and delivery of accessible and effective treatment. This paper describes the protocol for a randomized controlled trial (RCT) testing a novel telehealth treatment model for primary care patients with untreated AUD. METHODS: We aim to recruit 300 adults across 2 healthcare systems for this two-arm RCT. Participants, initially identified for recruitment based on AUD-related indicators in their electronic health record (EHR), are RCT-eligible if they meet AUD criteria (mild, moderate, severe), report ≥ 3 drinking days/week in past 30 days, and have not received AUD psychotherapy in the past 90 days. Participants are randomized to an intervention or enhanced usual care control (EUC) condition, both individually-delivered. The intervention includes a telephone-delivered motivational interviewing (MI) engagement session and 8 sessions of MI-Cognitive Behavioral Therapy (MI-CBT). EUC involves AUD psychoeducation, advice to reduce drinking and seek treatment, and provision of community resources. Outcomes will be measured at 3-, 6-, and 12-months; primary outcomes include: AUD psychotherapy initiation and engagement (within the study and external community) and alcohol consumption (percent drinking days and heavy drinking days). CONCLUSIONS: This study addresses whether proactive patient identification and engagement and delivery of patient-centered telehealth psychotherapy to patients with untreated AUD is effective in increasing treatment use and improving alcohol outcomes. If effective, this could be a highly scalable model for reducing the public health impact of AUD. TRIAL REGISTRATION: ClinicalTrials.gov # NCT05410561. University of Michigan HUM00204315. Ann Arbor VA IRB #1655886.
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Alcoholismo , Terapia Cognitivo-Conductual , Entrevista Motivacional , Atención Primaria de Salud , Telemedicina , Adulto , Femenino , Humanos , Masculino , Alcoholismo/terapia , Terapia Cognitivo-Conductual/métodos , Entrevista Motivacional/métodos , Atención Primaria de Salud/organización & administración , Teléfono , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The study of firearm violence in Mexico has primarily focused on homicides and trafficking. Less attention has been given to understanding how firearms affect other crimes and facilitate criminal activity beyond drug markets. By analyzing two questions, this study explores the role of firearms in extortions perpetrated in Mexico from 2012 to 2021. Questions are: What is the likelihood of reporting extortions to the police if offenders exhibited firearms? What is the likelihood of compliance with demands when offenders are armed with firearms? We obtained data from Mexico's National Crime Victimization Surveys and analyzed 2,619 extortions reported from 2012 to 2021. To explore our research questions, we ran two binary logistic regressions. Our dependent variables were dichotomous (reported to police = 1, complied with demands = 1). The independent variables were weapon types (extortions involving firearms as the reference group). We controlled for victim demographics as well as crime characteristics. Our results indicate that 40% of these extortions (n = 1,058) were perpetrated with a firearm. Fifty-two percent of extortions were perpetrated by unarmed offenders (n = 1,348) and 8% (n = 213) were perpetrated with other weapons (no firearms). Models suggest that, when compared to extortions perpetrated by unarmed offenders or those exhibiting other weapons (no firearms), victims of extortions involving firearms are less likely to report these crimes to police, mainly because of fear of reprisal. Similarly, victims are more likely to comply with demands if offenders exhibit firearms. Findings highlight the role of firearms in criminal enterprises and support the need for a comprehensive policy agenda to address firearm violence in Mexico.
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BACKGROUND: Firearm manufacturing and imports grew in the US during the mid-2000s. We hypothesise those increases corresponded to increased international firearms trafficking and in turn were associated with increases in firearm homicides abroad. METHODS: We used the Global Burden of Disease database to quantify annual firearm and non-firearm homicide rates in Central American and Caribbean countries, 1991-2019. We obtained US firearm manufacturing and import data from the Bureau of Alcohol, Tobacco, Firearms and Explosives. We used two-way fixed effects regressions to estimate within-country associations between homicide rates (firearm and non-firearm) and US firearm manufacturing and imports. FINDINGS: Firearm homicide rates in Central American and Caribbean countries increased from 8.38/100K population in 2004 to 17.55/100 K in 2012 and remained steady thereafter. Those surges coincided with increases in US firearm manufacturing/imports (from 4.99 million in 2004 to 13.12 million in 2012). Non-firearm homicides remained roughly constant from 1991 to 2019. Adjusted analysis showed that an annual increase of one million firearms manufactured/imported in the US corresponded to an annual increase of 1.42 (95% CI 0.62 to 2.21) firearm homicides per 100 K in Central American and Caribbean countries. The corresponding change for non-firearm homicides was -0.18 (95% CI -1.46 to 1.11). We found country-to-country variability in these effects. INTERPRETATION: Increases in US firearm manufacturing/imports were associated with increases in firearm homicide rates in Central American and Caribbean countries but not associated with non-firearm homicides. The specificity to firearm homicides suggests possible international repercussions of increased firearm manufacturing and imports in the US implications are discussed.
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AIMS: High-intensity drinking (HID) is a pattern of risky drinking defined as at least 8 drinks (for women) or 10 drinks (for men) in a single episode. Individuals engaged in HID may be at greater risk for consequences, necessitating tailored interventions. Herein, we report the feasibility and acceptability of a social media-delivered 8-week intervention for emerging adults with recent HID. METHODS: Using social media advertising, we recruited 102 emerging adults who reported past-month HID. Average age was 20.0 year-olds (SD = 2.0); 51.0% were male. Most identified as White (64.7%; 14.7% Black/African American, 13.7% multiracial) and 26.5% identified as Hispanic/Latinx. Participants were randomized to an 8-week intervention delivered via Snapchat by health coaches (N = 50) or to a control condition (psychoeducational website referral; N = 52). Follow-ups occurred at 2 and 4 months post-baseline. RESULTS: The intervention was acceptable (85.1% liked it/liked it a lot) and there were high follow-up rates. Participants rated coaches as supportive (91.5%) and respectful (93.6%). Descriptively, helpfulness ratings were higher for non-alcohol-related content (e.g. stress; 59.6% very/extremely helpful) than alcohol-related content (40.4% very/extremely helpful). Regarding engagement, 86.0% engaged approximately weekly and 59.6% indicated they saved intervention snaps. Descriptive data showed reductions over time in several measures of alcohol consumption and consequences as well as cannabis-impaired driving and mental health symptoms. CONCLUSIONS: This 8-week social media intervention for HID was feasible and acceptable among emerging adults, supporting the benefit of future testing in a fully powered trial.
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Trastornos Mentales , Medios de Comunicación Sociales , Adulto , Humanos , Masculino , Femenino , Adulto Joven , Proyectos Piloto , Emociones , Consumo de Bebidas Alcohólicas/terapiaRESUMEN
Importance: Evidence suggests that opioid prescribing was reduced nationally following the 2016 release of the Guideline for Prescribing Opioids for Chronic Pain by the US Centers for Diseases Control and Prevention (CDC). State-to-state variability in postguideline changes has not been quantified and could point to further avenues for reducing opioid-related harms. Objective: To estimate state-level changes in opioid dispensing following the 2016 CDC Guideline release and explore state-to-state heterogeneity in those changes. Design, Setting, and Participants: This cross-sectional study included information on opioid prescriptions for US individuals between 2012 and 2018 from an administrative database. Serial cross-sections of monthly opioid dispensing trajectories in each US state and the District of Columbia were analyzed using segmented regression to characterize preguideline dispensing trajectories and to estimate how those trajectories changed following the 2016 guideline release. Data were analyzed January to March 2023. Exposure: The March 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Main Outcomes and Measures: Four measures of opioid dispensing: opioid dispensing rate per 100â¯000 persons, long-acting opioid dispensing rate per 100â¯000 persons, high-dose (90 or more morphine milligram equivalents [MME] per day) dispensing rate per 100â¯000 persons, and average per capita MME. All measures were calculated monthly, from January 2012 through December 2018. Results: Data from approximately 58â¯900 retail pharmacies were included in analysis, representing approximately 92% of US retail prescriptions. The overall monthly dispensing rate in the US in early 2012 was approximately 7000 per 100â¯000 population. Following the 2016 guideline release, the already-decreasing slope accelerated nationally for the overall dispensing rate (preguideline slope, -23.19; postguideline slope, -48.97; change in slope, 25.97 [95% CI, 18.67-32.95]), long-acting dispensing rate (preguideline slope, -1.03; postguideline slope, -5.94; change in slope, 4.90 [95% CI, 4.26-5.55]), high-dose dispensing (preguideline slope, -3.52; postguideline slope, -7.63; change in slope, 4.11 [95% CI, 3.49-4.73]), and per-capita MME (preguideline slope, -0.22; postguideline slope, -0.58; change in slope, 0.36 [95% CI, 0.30-0.42]). For all outcomes, nearly all states showed analogous acceleration of an already-decreasing slope, but there was substantial state-to-state heterogeneity. Slope changes (preguideline - postguideline slope) ranged from 9.15 (Massachusetts) to 74.75 (Mississippi) for overall dispensing, 1.88 (Rhode Island) to 13.41 (Maine) for long-acting dispensing, 0.71 (District of Columbia) to 13.68 (Maine) for high-dose dispensing, and 0.06 (Hawaii) to 0.91 (Arkansas) for per capita MME. Conclusions and Relevance: The 2016 CDC Guideline release was associated with broad reductions in prescription opioid dispensing, and those changes showed substantial geographic variability. Determining the factors associated with these state-level differences may inform further improvements to ensure safe prescribing practices.
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Analgésicos Opioides , Dolor Crónico , Humanos , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Estudios Transversales , Pautas de la Práctica en Medicina , Endrín/análogos & derivados , Endrín/uso terapéutico , Guías de Práctica Clínica como Asunto , Centers for Disease Control and Prevention, U.S.RESUMEN
Firearm homicides are increasing in the United States, and firearm homicides are a critical driver of racial health disparities. One such disparity that has received limited attention is excess firearm homicides among Hispanics, relative to White Non-Hispanics; comprehensively characterising this disparity is the purpose of this brief report. Using data from CDC WONDER, we examined temporal trends (2012-2021) in firearm homicide rate disparities between Hispanics and White Non-Hispanics in the U.S. Focusing on recently elevated rates (2018-2021), we estimated this disparity across demographics (gender, age, urbanicity, and race), and across U.S. states. These data clearly show nearly universal excess firearm homicide among Hispanics, relative to White Non-Hispanics, with larger differences among men, younger age groups, and in metropolitan areas. Similarly, nearly all states show higher rates of firearm homicide among Hispanics, relative to White Non-Hispanics, though the magnitude of the difference varies substantially.
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Armas de Fuego , Suicidio , Heridas por Arma de Fuego , Masculino , Humanos , Estados Unidos/epidemiología , Homicidio , Hispánicos o Latinos , BlancoRESUMEN
In 2020, firearm injury became the leading cause of death in U.S. children and adolescents. This study examines sequelae of firearm injury among children and adolescents in terms of health care costs and use within a family over time using an event study design. Using data from a large U.S. commercial insurance company from 2013 to 2019, we identified 532 children and adolescents aged 1-19 years who experienced any firearm-related acute hospitalization or emergency department (ED) encounter and 1667 of their family members (833 parents and 834 siblings). Outcomes included total health care costs, any acute hospitalization and ED visits (yes/no), and number of outpatient management visits, each determined on a quarterly basis 2 years before and 3 years after the firearm injury. Among injured children and adolescents, during the first quarter after the firearm injury, quarterly total health care costs were $24,018 higher than pre-injury; probability of acute hospitalization and ED visits were 27.9% and 90.4% higher, respectively; and number of outpatient visits was 1.8 higher (p < .001 for all). Quarterly total costs continued to be elevated during the second quarter post-injury ($1878 higher than pre-injury, p < .01) and number of outpatient visits remained elevated throughout the first year post-injury (0.6, 0.4, and 0.3 higher in the second through fourth quarter, respectively; p < .05 for all). Parents' number of outpatient visits increased during the second and third years after the firearm injury (0.3 and 0.5 higher per quarter than pre-injury; p < .05). Youth firearm injury has long-lasting impact on health care within a family.
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INTRODUCTION: Interventions addressing cannabis use among emerging adults (ages 18-25) are currently needed to prevent negative outcomes. Emergency Department (ED) visits provide an opportunity to initiate interventions. In this pilot study, we created a brief intervention (BI), extended with private social media messaging for emerging adult ED patients who use cannabis regularly. Study aims were to examine intervention feasibility, acceptability, and descriptive outcomes. METHODS: We recruited and randomized N = 58 emerging adults (M age 21.5 years, 65.5% female) who used cannabis from an ED in-person and remotely after their ED visit (given COVID-19 restrictions). Participants randomized to the intervention (N = 30) received a Motivational Interviewing-based BI and 4 weeks of health coaching via private social media; control participants received a resource brochure and entertaining social media messaging. Follow-ups occurred at 1-month and 3-months. RESULTS: Most intervention participants liked the BI (95.8%), found it helpful to discuss cannabis use in the BI (91.7%), and liked interacting with coaches on social media (86.3%). Social media content (e.g., video clips, images/still pictures/memes) were highly rated. Descriptively, the intervention group showed theory-consistent changes in importance of and intentions to change cannabis (increases vs. decrease/stability in control group), whereas findings for cannabis consumption/consequences were mixed. CONCLUSIONS: This BI paired with social media messaging was acceptable in a sample of emerging adults from an ED who used cannabis regularly. Despite feasibility challenges due to COVID-19, this intervention warrants future investigation with a larger sample and longer follow-up period, with attention to the changing cannabis landscape when measuring outcomes.
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COVID-19 , Cannabis , Alucinógenos , Medios de Comunicación Sociales , Humanos , Adulto , Femenino , Adolescente , Adulto Joven , Masculino , Proyectos Piloto , Intervención en la Crisis (Psiquiatría) , Servicio de Urgencia en HospitalRESUMEN
BACKGROUND: Drug overdose (OD) deaths in the U.S. continue to rise. After opioids, benzodiazepines (BZD) are the medication most commonly involved in prescription overdoses, yet OD risk factors among those prescribed BZD are not well understood. Our objective was to examine characteristics of BZD, opioid, and other psychotropic prescriptions associated with increased drug OD risk following a BZD prescription. METHODS: We completed a retrospective cohort study using a 20% sample of Medicare beneficiaries with prescription drug coverage. We identified patients with a BZD prescription ("index") claim between 1 April 2016 and 31 December 2017. In the 6 months pre-index, those without and with BZD claims comprised incident and continuing cohorts, which were split by age (incident < 65 [n = 105,737], 65 + [n = 385,951]; continuing < 65 [n = 240,358], 65 + [n = 508,230]). Exposures of interest were: average daily dose and days prescribed of the index BZD; baseline BZD medication possession ratio (MPR) for the continuing cohort; co-prescribed opioids and psychotropics. Our primary outcome was a treated drug OD event (including accidental, intentional, undetermined, or adverse effect) within 30 days of the index BZD, examined using Cox proportional hazards. RESULTS: Among incident and continuing BZD cohorts, 0.78% and 0.56% experienced an OD event. Compared to 14-30 days, a < 14-day fill corresponded to higher OD risk in incident (< 65 adjusted hazard ratio [aHR] 1.16 [95% CI 1.03-1.31]; 65 + : aHR 1.21 [CI 1.13-1.30]) and continuing (< 65: aHR 1.33 [CI 1.15-1.53]; 65 + : aHR 1.43 [CI 1.30-1.57]) cohorts. Among continuing users, lower baseline exposure (i.e., MPR < 0.5) was associated with increased OD risk for those < 65 (aHR 1.20 [CI 1.06-1.36]); 65 + (aHR 1.12 [CI 1.01-1.24]). Along with opioids, concurrent antipsychotic use and antiepileptic use were associated with elevated risk of OD in all 4 cohorts (e.g., aHRs for the continuing 65 + cohort: opioid, 1.73 [CI 1.58-1.90]; antipsychotic, 1.33 [CI 1.18-1.50]; antiepileptic, 1.18 [1.08-1.30]). CONCLUSIONS: In both the incident and continuing cohorts, patients dispensed fewer days' supply were at increased OD risk; those in the continuing cohort with more limited baseline BZD exposure were also at elevated risk. Concurrent medication exposures including opioids, antipsychotics, and antiepileptics were associated with short-term elevated OD risk.
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Antipsicóticos , Sobredosis de Droga , Humanos , Adulto , Anciano , Estados Unidos/epidemiología , Estudios de Cohortes , Benzodiazepinas/efectos adversos , Analgésicos Opioides/efectos adversos , Estudios Retrospectivos , Anticonvulsivantes/uso terapéutico , Antipsicóticos/uso terapéutico , Medicare , Sobredosis de Droga/epidemiología , Sobredosis de Droga/tratamiento farmacológico , PrescripcionesRESUMEN
INTRODUCTION: Despite promising reductions in mortality from infectious diseases, premature death is a still major public health problem in Brazil. However, little is known about which diseases and injury mechanisms are the main causes of premature death. This paper aimed to detail the trends in leading causes of death among children and adolescents in Brazil. METHODS: Data were extracted from medical death certificates from the Brazilian Mortality Information System for children and adolescents aged 1-19 years for 2000-2020. The 10 leading causes of death for children and adolescents were defined using primary cause of death codes, grouped by death for diseases and mechanism for injury, according to the ICD-10. All analyses were completed in 2022. RESULTS: From 2000 through 2020, there was a total of 772,729 child and adolescent deaths in Brazil. Despite an overall 34% reduction in child and adolescent mortality from 2000 to 2020, improvements were less pronounced for injury-related deaths than for communicable diseases. Therefore, by 2020, over half of deaths were from injury-related causes. Firearm-related injury was by far the leading cause, accounting for 21% of all deaths. There was a 38% reduction in firearm deaths in the last 4 years against a previously increasing trend, and homicide accounted for over 90% of all firearm deaths because suicide by firearm was rare. CONCLUSIONS: Injury-related deaths among children and adolescents are a growing concern in Brazil, and firearms are the current leading cause of child and adolescent death.
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Armas de Fuego , Suicidio , Heridas por Arma de Fuego , Niño , Humanos , Adolescente , Lactante , Causas de Muerte , Brasil/epidemiología , HomicidioRESUMEN
BACKGROUND: Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD. METHODS: A retrospective cohort study using a 20% sample of Medicare beneficiaries with Part D prescription drug coverage. Patients with a BZD prescription ("index") between 1 April 2016 and 31 December 2017 contributed to incident (n=379,273) and continuing (n=509,634) cohorts based on prescriptions during a 6-month pre-index baseline. Exposures were index BZD average daily dose and days prescribed; baseline BZD medication possession ratio (MPR) (for the continuing cohort); and co-prescribed central nervous system-active medications. Outcome was a treated fall-related injury within 30 days post-index BZD, examined using Cox proportional hazards adjusting for demographic and clinical covariates and the dose prescribed. RESULTS: Among incident and continuing cohorts, 0.9% and 0.7% experienced fall injury within 30 days of index. In both cohorts, injury risk was elevated immediately post-index among those prescribed the lowest quantity: e.g., for <14-day fill (ref: 14-30 days) in the incident cohort, risk was 37% higher the 10 days post-fill (adjusted hazard ratio [HR] 1.37 [95% confidence interval [CI] 1.19-1.59]). Risk was elevated immediately post-index for continuing users with low baseline BZD exposure (e.g., for MPR <0.5 [ref: MPR 0.5-1], HR during days 1-10 was 1.23 [CI 1.08-1.39]). Concurrent antipsychotics and opioids were associated with elevated injury risk in both cohorts (e.g., incident HRs 1.21 [CI 1.03-1.40] and 1.22 [CI 1.07-1.40], respectively; continuing HRs 1.23 [1.10-1.37] and 1.21 [1.11-1.33]). CONCLUSIONS: Low baseline BZD exposure and a small index prescription were associated with higher fall injury risk immediately after a BZD fill. Concurrent exposure to antipsychotics and opioids were associated with elevated short-term risk for both incident and continuing cohorts.
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Antipsicóticos , Medicamentos bajo Prescripción , Humanos , Anciano , Estados Unidos/epidemiología , Benzodiazepinas/efectos adversos , Analgésicos Opioides , Estudios de Cohortes , Estudios Retrospectivos , Medicare , PrescripcionesRESUMEN
Purpose of Review: Community violence is a serious public health problem, and generational investments are being made to address it. Agent-based models (ABMs) are computational tools that can help to optimize allocation of those investments, analogous to how computer simulation models, broadly, have informed decision making in other fields, such as infectious disease control. In this review, we describe ABMs, explain their potential role in community violence research, discuss recent studies that have applied ABMs to community violence, and point to opportunities for further progress. Recent Findings: We identified three recent studies that applied ABMs to community violence research, which points to the paucity of this line of work. Each of these works leverages a major advantage of ABMs-their ability to study the natural evolution of a process governed by the actions of autonomous agents, and how that evolution changes under counterfactual conditions, such as different intervention strategies (e.g., violence interruption), and policy changes (e.g., alcohol outlet licensing policies). Summary: ABMs continue to be an underutilized tool for the study of community violence. Their increased use could add important information to help stakeholders decide between competing intervention strategies in terms of their costs and the overall resulting changes in violence rates. In addition, ABMs have value in identifying unintended changes/diffusions resulting from interventions. Regardless of the application, ABMs can only be impactful if stakeholders believe and use the information, pointing to the importance of engaging policy makers and other stakeholders in the model formulation process when possible.
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Importance: In 2016, the Centers for Disease Control and Prevention (CDC) released the evidence-based Guideline for Prescribing Opioids for Chronic Pain. How the release of this guideline coincided with changes in nonopioid pain medication prescribing rates remains unknown. Objective: To evaluate changes in nonopioid pain medication prescribing after the 2016 CDC guideline release and to assess the heterogeneity in these changes as a function of patient demographic and clinical characteristics. Design, Setting, and Participants: This cohort study constructed 7 (4 preguideline and 3 postguideline) annual cohorts using claims data from the national Optum Clinformatics Data Mart Database for the period January 1, 2011, through December 31, 2018. The cohorts included adults with commercial insurance, no cancer or palliative care claims, and 2 years of continuous insurance enrollment. Individuals could qualify for inclusion in multiple cohorts. Each cohort covered a 2-year period, with year 1 as the baseline period used to calculate opioid exposure and other clinical characteristics and year 2 as the follow-up period used to calculate prescribing outcomes. Data were analyzed in March 2022. Exposures: The CDC guideline, which was released in March 2016. Main Outcomes and Measures: The primary outcome was receipt of any nonopioid pain medication prescriptions (analgesics or antipyretics, anticonvulsants, antidepressants, and nonsteroidal anti-inflammatory drugs) during the follow-up period. This postguideline prescribing pattern was compared with estimates based on the preguideline prescribing pattern, and then the differences were stratified by patient clinical characteristics (chronic pain, recent opioid exposure, substance use disorder, anxiety disorder, and mood disorder). Results: A total of 15â¯879â¯241 individuals (2015 mean [SD] age, 50.2 [18.6] years; 8 298 271 female patients [52.3%]) qualified for inclusion in 1 or more cohorts. Logistic regression models showed that nonopioid pain medication prescribing odds were higher by 3.0% (95% CI, 2.6%-3.3%) in postguideline year 1, by 8.7% (95% CI, 8.3%-9.2%) in postguideline year 2, and by 9.7% (95% CI, 9.2%-10.3%) in postguideline year 3 than the preguideline pattern-based estimates. The magnitude of the postguideline departures from the preguideline pattern varied by several clinical characteristics (chronic pain, recent opioid exposure, anxiety disorder, and mood disorder). The largest departure was found among those with chronic pain, with postguideline prescribing being higher than estimated in postguideline year 2 (13.6%; 95% CI, 12.7%-14.6%) and postguideline year 3 (14.9%; 95% CI, 13.8%-16.0%). Conclusions and Relevance: Results of this study showed increases in nonopioid pain medication prescribing after the release of the 2016 CDC guideline, suggesting that the guideline may be associated with an increase in guideline-concordant care, but additional studies are needed to understand the role of other secular changes in the opioid policy landscape and other sources of nonopioid medication use.
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Analgésicos no Narcóticos , Dolor Crónico , Adulto , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Estudios de Cohortes , Prescripciones de Medicamentos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
PURPOSE: Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. PROCEDURES: Using social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability. RESULTS: The interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition. CONCLUSIONS: Among this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use. TRIAL REGISTRATION: ClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.
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Entrevista Motivacional , Medios de Comunicación Sociales , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Humanos , Motivación , Trastornos Relacionados con Sustancias/complicaciones , Adulto JovenAsunto(s)
Causas de Muerte , Adolescente , Causalidad , Causas de Muerte/tendencias , Niño , Humanos , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: Cannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform - social media - we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial. PROCEDURES: For NCT04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months. RESULTS: The intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40). CONCLUSIONS: This social media intervention for emerging adults' cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.