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BACKGROUND: To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD: Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS: Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS: Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.
Assuntos
COVID-19 , Mão de Obra em Saúde , COVID-19/epidemiologia , Pessoal de Saúde/educação , Humanos , Pandemias , Estados Unidos , Recursos HumanosRESUMO
Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted life around the globe and has the potential to seriously impact alcohol consumption for individuals experiencing social isolation and pandemic-related stress. Evidence from prior epidemics suggests increased alcohol consumption during quarantine and times of high stress are associated with a greater chance of developing an alcohol use disorder (AUD). This study examines alcohol sales data to ascertain how individuals are interacting with alcohol during the pandemic.Materials and method: Monthly off premises alcohol sales data for select US alcoholic beverage control states were used to construct monthly sales patterns from 2015 to 2020. An independent samples t-test was used to determine if COVID-19 era alcohol sales were higher than those that occurred from 2015 to 2019.Results: Alcohol sales from March to August 2020 were significantly higher than sales from the same span of months from 2015 to 2019 (t=-2.47, p<.05). The associated monthly percentage increase in sales ranged from 14 to 44% with the overall trend indicating a move toward pre-pandemic sales totals.Conclusion: As COVID-19 continues to disrupt typical ways of being across the globe, the implications of increased sales of alcohol should not be overlooked. Taken together, the evidence on increased use during isolation and later AUD diagnosis coupled with the ABC state sales figures here, point to a potential increase in the development of AUD and an increase in alcohol-related harms.
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Bebidas Alcoólicas , COVID-19/epidemiologia , Comércio/tendências , Controle de Doenças Transmissíveis , Isolamento Social , Humanos , SARS-CoV-2 , Estados UnidosRESUMO
Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.
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Empoderamento , Qualidade de Vida , Cognição , Emoções , Feminino , Humanos , Masculino , PsicometriaRESUMO
BACKGROUND: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.
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Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Grupo Associado , Encaminhamento e Consulta , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Adulto , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Pessoa de Meia-Idade , New Jersey/epidemiologia , Overdose de Opiáceos/epidemiologia , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêuticoRESUMO
Importance: Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective: To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants: This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure: Hospital OORP implementation. Main Outcomes and Measures: The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results: A total of 12â¯046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance: In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
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Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Estados Unidos , Humanos , Masculino , Feminino , Assistência ao Convalescente , Estudos de Coortes , Estudos Retrospectivos , Alta do Paciente , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/terapia , Serviço Hospitalar de EmergênciaRESUMO
This study investigates how the relationship between dense concentrations of alcohol retailers and high rates of child maltreatment may be moderated by the presence of substance abuse service facilities. Using a cross-sectional design, the study utilized data from Bergen County, New Jersey on child maltreatment reports, alcohol-selling retailers, substance abuse service facilities, and the United States Census. Findings indicate child maltreatment rates were higher in neighborhoods with lower socioeconomic status and those with greater alcohol outlet density. Neighborhoods with easily accessed substance abuse service facilities had lower rates of child maltreatment. Additionally, the relationship between child maltreatment and alcohol outlet density was moderated by the presence of substance abuse service facilities. The study findings highlight the relevance of making primary prevention approaches readily available and using multi-sector collaboration to reduce child maltreatment.
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This study examined the geographic association between tobacco outlet density and the demographic indicators of median household income and percentage of Hispanic residents in New Jersey. Tobacco outlet density was assessed by examining all tobacco retailers licensed in 2004 in New Jersey, and demographic variables were based on the 2000 United States Census. Results indicated that the percentage of Hispanic residents and median household income were both salient predictors of tobacco outlet density. We also observed that income level moderated the relationship between the percentage of Hispanics residents and tobacco outlet density. Implications for environmentally based tobacco prevention and control initiatives are discussed.
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Comércio/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Renda/estatística & dados numéricos , Características de Residência/classificação , Fumar/etnologia , Indústria do Tabaco/estatística & dados numéricos , Análise por Conglomerados , Humanos , New Jersey , Fumar/economia , Fatores Socioeconômicos , Indústria do Tabaco/economiaRESUMO
Since 1998, the Hartford Partnership Program in Aging Education (HPPAE) has been implemented in over 70 graduate social work programs. This study examined whether program and individual student characteristics are associated with students' knowledge, skills, and values in aging. We conducted a secondary analysis of national program evaluation data. Results from hierarchical linear models indicated greater gains in knowledge of aging among full-time students, as well as students in programs that had defined field rotation models and/or that made greater use of geriatric social work competencies. Implications for efforts to enhance graduate social work education in aging are discussed.
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Serviço Social/educação , Idoso , Educação de Pós-Graduação/organização & administração , Educação de Pós-Graduação/normas , Avaliação Educacional , Feminino , Humanos , Masculino , Competência Profissional/normas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Serviço Social/normas , Estados UnidosRESUMO
This study analyzed associations between tobacco outlet density and demographic correlates (median household income and minority population percentages) within two New Jersey counties. The study was conducted using variables developed from state licenses for tobacco outlets and data from residential census tracts. Results showed that tracts with lower median household income and higher percentages of minority residents had greater densities of tobacco-selling retail outlets. Results also demonstrated that median household income was the strongest predictor of tobacco outlet density across both counties. Implications of the study and directions for future research, specifically the interaction between income and race/ethnicity, are discussed.
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Comércio/estatística & dados numéricos , Características de Residência , Indústria do Tabaco/estatística & dados numéricos , Humanos , Renda , Grupos Minoritários/estatística & dados numéricos , New Jersey/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/etnologia , Fatores Socioeconômicos , Indústria do Tabaco/economiaRESUMO
BACKGROUND: The spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services. METHODS: This is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services. RESULTS: Community social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services. CONCLUSIONS: Contrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.
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Acessibilidade aos Serviços de Saúde , Pobreza , Sistemas de Apoio Psicossocial , Características de Residência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , New HampshireRESUMO
The current study analyzes a sample of questions about drugs asked online by youth who participated in the National Institute on Drug Abuse's (NIDA) "Drug Facts Chat Day." The types of drugs youth asked about were coded into 17 substance categories, and the topics they raised were coded into seven thematic categories. The top five queried drugs were marijuana (16.4%), alcohol (8.5%), tobacco (6%), cocaine (5.7), and pharmaceutical drugs (4.5%). The effects of drug use, experience of being high, the addictiveness of drugs, pharmacology, and drug sales were among the more common types of questions to emerge but varied depending on the substance. These findings show the types of information young people are seeking about drugs and have clear implications to inform youth drug education programs.
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Comportamento de Busca de Informação , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Feminino , Humanos , Masculino , National Institute on Drug Abuse (U.S.) , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors. METHODS: Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions. RESULTS: While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion. CONCLUSION: Findings suggest that predictive characteristics vary according to diverter group.
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This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed.
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Bebidas Alcoólicas/provisão & distribuição , Maus-Tratos Infantis/estatística & dados numéricos , Proteção da Criança/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Consumo de Bebidas Alcoólicas , Criança , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Cidade de Nova Iorque , Características de Residência/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
PURPOSE: We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.