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Incidence, prevalence, and persistence of substance use differ by
generation and by substance. Understanding how each generation
uses alcohol and other drugs, why, and how health is implicated is
critical for public health. The presentation will overview what we
know about current trends in substance use, how rates are organized by age, period, and cohort, and how these trends are shaping public
health overall.
This presentation highlights the role of primary care setting as a conduit for evidence-based intervention access for families. In addition, attention will be given the need to focus on system level interventions to reduce the need for families and youth to be “resilient.”
Dr. Kaliamurthy’s presentation examines a case involving an adolescent who sought treatment within a pediatric health care system for fentanyl use. The focus is on the challenges identified in delivering care to adolescents with opioid use disorder. He also highlights barriers to treatment that must be overcome to deliver the minimum necessary care to ensure engagement in medication treatment for opioid use disorder and reducing overdose risk.
Dr. Graham’s presentation describes the development of the first
vaping cessation intervention for adolescents and young adults,
presents the results of two randomized clinical trials evaluating the
effectiveness of the program, and discusses ongoing work to disseminate the program to young people across the U.S.
In their complementary presentations, Drs. Hammond and Hinckley discuss the association between cannabis use and suicide-related outcomes among youth and young adults. Dr. Hammond presents findings from a study that used 20 years of national mortality data to examine the impact of medical and recreational cannabis legalization on suicide-related mortality among US 12-to-25-year-olds, focusing on variations by age, sex, race, and ethnicity. These findings are discussed within the context of current medical literature on cannabis policy effects and health disparities, with an emphasis on mechanisms, vulnerable
subgroups, and legislative reform. Dr. Hinckley presents data from a secondary analysis of the National Comorbidity Survey-Adolescent Supplement, involving youth aged 13-18. This study explores the association between cannabis use, major depressive disorder, and suicidal behavior. Findings are considered within existing literature to further understand how cannabis use and depression together may increase suicide risk among youth.
The objectives of this talk include 1) Describe the unique risk and protective factors
for substance use among Black adolescents; 2) Examine the evidence for culturally sensitive interventions for substance use prevention among Black adolescents; and
3) Identify opportunities for culturally tailored digital interventions for substance
use prevention among Black adolescents with a specific focus on family-based
interventions.
Transition Age Youth (TAY), aged 18-25 years, face barriers to medication treatment for opioid use disorder (MOUD) resulting in lower retention. We evaluated OUD prevalence and MOUD receipt comparing TAY to adults aged 26 or older residing in rural settings.
Electronic Health Records (October 2019 – January 2021) for 36,762 patients across six primary care clinics involved in a large feasibility trial (CTN-0102) in US rural communities were analyzed. All clinics implemented a standardized intervention. Mixed effects logistic/linear regression estimated odds of OUD diagnosis among all patients; and among those with OUD, the odds of receiving MOUD and days prescribed MOUD during the 15-month study period, comparing age categories (TAY=18-25 years vs. adults 26 or older). Covariates included gender, race, ethnicity, mental health comorbidities, and insurance status.
OUD prevalence was 2.82% among TAY (n=3,122) and 3.24% among adults aged 26 or older (n=33,208). After adjusting for covariates and clustering, TAY had significantly lower odds of OUD diagnosis compared to adults 26 years or older (OR=0.58, 95% CI 0.45 to 0.73). There were no significant differences in MOUD receipt between age groups. Compared to adults 26 or older, TAY with OUD had significantly fewer MOUD days during the study, -43.81 days (-76.85 to -10.77).
Conclusions: While no differences were observed in MOUD prescription receipt between TAY and adults 26 or older, TAY with OUD had fewer total days prescribed MOUD indicating lower retention. Further research generalizable to rural communities is needed to assess retention among rural TAY with OUD.
Related protocols: CTN-0102
This presentation reviews the role of Community-Based Participatory Research (CBPR) principles and practices in the implementation of evidence-based and/or community-informed practices. It will include illustrations from current and recent studies of community engagement in identification of barriers and facilitators, co-design of implementation strategies, and conduct of formative evaluations of implementation process and outcomes using the RAPICE (Rapid Assessment Procedures-Informed Community Ethnography) methodology.
This presentation focuses on barriers faced by youth involved in the legal system to access treatment, ongoing efforts going across Indiana to improve training in evidence-based treatment, as well as implementation strategies to improve treatment.
Dr. Ken Carpenter’s more recent community-based work has focused on developing resources that can be utilized by parent peer support networks to help bring evidence-informed concepts and skills to families impacted by substance use problems. He will present on pilot programs directed towards engaging families outside of the clinical service framework. The discussion will include lessons learned from these projects, continued efforts to grow a parent-to-parent support community, and the continued challenges that come along with supporting parent-to-parent efforts to promote evidence informed concepts and strategies in the context of community-based groups.
Presenter: Katherine Elkington, PhD, Associate Professor of Medical Psychology (in Psychiatry), Columbia University and New York State Psychiatric Institute
Dr. Elkington describes multi-level barriers to treatment for justice-involved youth, explores the integrated use of the Behavioral Health Care Cascade and ecological theory to conceptualize points of intervention, and describes initial findings from two different interventions that target various aspects of the justice, behavioral health, and family/youth-systems to improve treatment
access.
Presenter: Elizabeth Barnert, MD, MPH, MS, Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles
The objectives of Dr. Barnert’s talk are to 1) Describe the health needs, service utilization, and predictors of successful linkages to care for transition aged youth (TAY) participating in a community health worker based reentry intervention; 2) Explore clients’ perspectives about their health and social experiences during reentry, so as to inform intervention approaches; and 3) Discuss a model intervention approach tailored for TAY undergoing reentry to address substance misuse, recidivism, and related health and social outcomes.
Presented by: Marina Toulu-Shams, PhD, Professor, Dept of Psychiatry and Behavioral Sciences, Weill Institute of Infant, Child and Adolescent Psychiatry, Dept of Psychiatry, University of California, San Francisco
Dr. Marina Tolou-Shams, trained as a pediatric and forensic psychologist, is a clinician-scientist. She leads the UCSF Juvenile Justice Behavioral Health lab whose mission is to improve behavioral health outcomes for youth who come into contact with the juvenile justice, child welfare, and foster care systems (https://jjbh.org/). Her NIH-funded research focuses on improving youths’ physical, mental, and emotional health, reducing drug and alcohol use, reducing HIV/STI risk behaviors, and increasing access to evidence-based care with particular emphasis on leveraging technology to achieve these outcomes. One study is a pilot trial of SMS text-messaging platform to engage court-involved youth in substance use or dual diagnosis treatment services. A second developmental study takes a mixed-methods, multi-informant participatory research approach to developing and testing a Foster Care Family Navigator model to improve youth mental health outcomes.
The objectives of the presentation are to:
- understand the substance use and mental health intervention needs of justice-involved youth;
- identify barriers to behavioral health care access and engagement; and,
- discuss ways that technology may hold promise for improving justice-involved youth’s behavioral health and legal outcomes.
This presentation describes a program of research focused on increasing the uptake of effective services for youth with or at risk of substance use disorders. The presentation introduces both patient-focused dissemination (e.g., technology-assisted interventions, direct-to-consumer marketing) and provider- and organization-focused (e.g., multi-level implementation strategy) strategies. Fundamentals of dissemination and implementation science, as well as priorities for future research, are also discussed.