ABSTRACT Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual’s positive and negative cognitions related to a behavior, and subsequent initiation of that behavior. Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents. Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11–2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10–5.68) or negative (OR = 1.93, 95% CI 1.03–3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03–4.17) compared to those with lower levels of negative implicit cognitions. Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes.

Background: Payers are increasingly interested in quality improvement for opioid use disorder (OUD) treatment, including incorporating patient experiences. Medicaid is the largest payer for OUD treatment, yet we know little about the treatment benefits Medicaid members report, how these vary across members, or changed with the COVID-19 pandemic.Objective: To examine Medicaid members' report of outpatient treatment benefits, employment, and housing outcomes before and during the pandemic.Methods: A representative sample of 1,032 Virginia Medicaid members (52% women) receiving OUD treatment completed a survey of treatment benefits, health status and social needs. A reported treatment benefit index was created based on seven self-reported items. Multivariable linear regression models, pooled and stratified by time (pre-COVID-19/COVID-19), assessed member characteristics associated with reported treatment benefit, employment and housing outcomes.Results: Members reported strong treatment benefit (mean: 21.8 [SD: 5.9] out of 28 points) and improvements in employment (2.4 [1.3] out of 5) and housing (2.8 [1.2] out of 5). After adjustment, mental distress (regression coefficient: -3.00 [95% CI:-3.97;-2.03]), polysubstance use (-1.25 [-1.99;-0.51]), and food insecurity (-1.00 [-1.71;-0.29]), were associated with decreased benefits from treatment. During COVID-19, justice-involved individuals reported decreased benefits (-2.17 [-3.54; -0.80]) compared to before the pandemic (-0.09 [-1.4-;1.24] p < .05).Conclusions: Medicaid members receiving outpatient OUD treatment reported positive treatment benefits, and housing and employment outcomes. However, those with comorbid health and social conditions often benefited the least. As payers move toward quality improvement and value-based purchasing initiatives, collecting and integrating patient reported outcomes into quality metrics is critical.

ABSTRACT Background: Peer recovery specialists (PRSs) are substance use service providers with lived experience in recovery. Although a large body of research demonstrates the efficacy of medications for opioid use disorder (MOUD), emerging research suggests PRSs’ attitudes toward MOUD are ambivalent or mixed. Few studies have quantitatively assessed factors influencing PRSs’ attitudes. Objectives: This study identifies personal and professional characteristics associated with attitudes toward MOUD among PRSs. Methods: PRSs working at publicly funded agencies in Michigan completed a self-administered web-based survey (N = 266, 60.5% women). Surveys assessed socio-demographics, treatment and recovery history, attitudes toward clients, and attitudes toward MOUD. Multiple linear regression was used to identify factors associated with attitudes toward MOUD. Results: A minority of PRSs (21.4%) reported a history of treatment with MOUD, while nearly two-thirds reported current 12-step involvement (62.5%). Compared to PRSs without a history of MOUD treatment, PRSs who had positive (b = 4.71, p < .001) and mixed (b = 3.36, p = .010) experiences with MOUD had more positive attitudes; PRSs with negative experiences with MOUD had less positive attitudes (b = −3.16, p = .003). Current 12-step involvement (b = −1.63, p = .007) and more stigmatizing attitudes toward clients (b = −.294, p < .001) were associated with less positive attitudes toward MOUD. Black PRSs had less positive attitudes than White PRSs (b = −2.50, p = .001), and women had more positive attitudes than men (b = 1.19, p = .038). Conclusion: PRSs’ attitudes toward MOUD varied based on the nature of their lived experience. Findings highlight considerations for training and supervising PRSs who serve individuals with opioid use disorder.

ABSTRACT Background: Research utilizing experimental tasks usually does not report estimates of internal reliability of measurement. However, modern measurement theories conceptualize reliability as sample dependent indicating that reliability should be empirically demonstrated in the samples used to make inferences. Objectives: Test whether confirmatory factor analytic (CFA) estimates of reliability can be applied to a commonly used task measuring response inhibition (the Stop Signal Task) to predict substance use (alcohol and cannabis) and mental health symptoms. Methods: Thirty-seven participants between the ages of 18–20 (72% female; 16% Asian, 3% Native American, 11% Black or African American, 59% White; 32% Latino/a/x) were recruited via social media advertisement and attended a laboratory visit. The Stop Signal Reaction Time (SSRT) was calculated as the outcome for three experimental blocks and used as indicators in a CFA. Results: CFA suggests the task yields reliable scores; factor loadings were statistically significant (p < .05) and substantial (standardized loadings ranged from .74 to .94). However, reliability increased across experimental blocks and error was non-trivial (ranging from 50% to 12% of the variance). The inhibition factor predicted higher maximum number of drinks consumed (β = .37, p < .05), higher frequency of cannabis use (β = .39, p < .05), and more cannabis use occasions within using days (β = .40, p < .05), as well as facets of mental health (anxious/depression, attention, and anxiety problems; all p’s < .05). Conclusion: Results support the utility of CFA to test for reliability of measurement, with the ability to inhibit dominant responses serving as a transdiagnostic correlate of substance use and mental health problems.

ABSTRACT Background: There is a yet unmet opportunity to utilize data on taxes and individual behaviors to yield insight for analyzing studies involving alcohol and cigarette use. Objectives: To inform the direction and strength of their mutual associations by leveraging the fact that taxation can affect individual consumption, but individual consumption cannot affect taxation. Methods: We linked state-level data on cigarette and beer taxes in 2009–2020 with individual-level data on self-reported current cigarette and alcohol use from the Behavioral Risk Factor Surveillance System, a telephone survey by the Centers for Disease Control and Prevention that is representative of the population of each state in the United States. We constructed linear and logistic models to examine associations between a $1 increase in cigarette taxes per pack and a $1 increase in beer taxes per gallon and self-reported cigarette use and alcohol consumption (assessed as any current intake, average drinks/day, heavy drinking, and binge drinking), adjusting for survey year and individual characteristics. Results: Among 2,968,839,352 respondents (49% male), a $1 increase in beer taxes was associated with .003 (95% confidence interval [CI] −.013, .008) fewer drinks/day and lower odds of any drinking (odds ratio [OR] = .81 95%CI .80, .83), heavy drinking (OR = .96 95%CI .93, .99), binge drinking (OR = .82 95%CI .80, .83), and smoking (OR = .98 95%CI .96, 1.00). In contrast, a $1 increase in cigarette taxes was associated with lower odds of smoking (OR = .94 95%CI .94, .95) but .007 (95%CI .005, .010) more drinks/day, and higher odds of any drinking (OR = 1.10 95%CI 1.10, 1.11), heavy drinking (OR = 1.02 95%CI 1.01, 1.02), and binge drinking (OR = .82 95%CI .80, .83). Conclusion: Higher beer taxes were associated with lower odds of drinking and smoking, but higher cigarette taxes were associated with lower odds of smoking and higher alcohol consumption. These results suggest that alcohol intake may be a determinant of cigarette use rather than cigarette use as a determinant of alcohol intake.

ABSTRACT Background: Opioid treatment programs (OTPs) permit patients to ingest daily methadone doses unsupervised and away from the clinic, a strategy that enhances treatment access and convenience but has the potential for mismanagement. Objective: This retrospective review, conducted during the COVID-19 pandemic (5/2020–1/2022), evaluates the feasibility and acceptability of a commercially available electronic pillbox to safely administer methadone take-home tablets in a large community-based OTP (census >500 people). Methods: Study participants (n = 24; 54% male, 46% female; M age = 63 years) had recently received more take-homes per visit to support national social distancing directives, and were instructed that they could maintain these privileges by agreeing to use the pillbox. Results: Results demonstrate good demand feasibility as most participants (71%) agreed to use the pillbox. Good implementation feasibility was observed through safe and reliable delivery of most take-home tablets, with a staff support line to resolve technical issues. Acceptability was modest as six participants (25%) requested to return the pillbox despite losing some take-home privileges. Conclusion: Results support continued use and study of the electronic pillbox to safely deliver and increase access to methadone take-home doses.

ABSTRACT Background: A Zoom-based website was developed in 2020 that offers continuous access to online Narcotics Anonymous (NA) meetings for the first time. This website provides immediate access for persons with substance use disorder to support abstinence from substance-related addictive disorders. Objectives: This study is designed to characterize attendees employing this online format; to evaluate their experiences for gaining support to maintain abstinence; and to compare the 24/7 experience to face-to-face (FF) meetings they attend. Methods: An anonymous 33-item survey was made available on the 24/7 NA website that links to the 24/7 meetings. Persons accessing the site could choose to fill out the survey. Results: 530 respondents completed the survey (64.9% female/35.1% male). Most had stable prior involvement in NA. They had attended more 24/7 meetings (14.9, SD 19.7) than FF meetings (4.6, SD 7.8) in the previous month. 86% had previously attended FF meetings, 48% had served as sponsors, and 92% reported that the 24/7 meetings were more comfortable for them than the FF meetings (p < .001, Cohen’s d = 0.65) and more supportive of abstinence (p < .001, Cohen’s d = 0.91). Of the respondents, 8% were still using drugs, of whom 52% had previously completed some of the Twelve Steps. Conclusions: The 24/7 format provides a new and easily accessible way for NA members to gain support for abstinence and is positively rated by attendees seeking support for recovery from substance use disorders. It may serve as a valuable adjunct to the traditional FF format.

ABSTRACT Background: Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood. Objectives: To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use. Methods: We analyzed longitudinal data from a cohort of youth who use drugs aged 14–24 (n = 599; 58% male) presenting to an urban emergency department between 2009–2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age. Results: Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87–0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10–1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21–1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36–1.97 and RR:1.58, 95% CI:1.35–1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57–0.84, p < .05). Conclusions: Tailored interventions may address gender differences in coping with experiencing violence – including interventions that promote parental support among males and reduce influence from parental substance use among females.