Rates Of Misuse Research Articles

Effects of child restraint misuse on dynamic performance

Objective: Estimates of child restraint misuse rates in the United States range from 49% to 95%, but not all misuse modes have similar consequences in terms of restraint effectiveness. A series of laboratory sled tests was conducted to determine the effects of common misuses and combinations of misuses, including loose harness, loose installation, incorrect installation angle, incorrect belt path, loose/no tether, and incorrect harness clip usage.Methods: Three commercial convertible child restraint models were loaded with the Hybrid III 3-year-old anthropomorphic test device (ATD) and secured by either LATCH or seat belt on a modified FMVSS No. 213 bench. Tests were conducted in forward-facing (FF) and rear-facing (RF) modes. The response variables included ATD accelerations, excursions, and restraint kinematics. Belt/LATCH loads, tether loads, ATD kinematics, and restraint structural response data were also documented. A fractional factorial test design on 8 factors was used to define an initial series of 32 tests. The first series also included 4 tests of correct CRS, 2 forward facing and 2 rearward facing. The analysis of those data determined the selection of conditions for the remaining 20 tests to focus on factors and interactions of high interest and significance.Results: In the RF condition, misrouting the LATCH belt or seat belt through the incorrect belt path was the only misuse that significantly affected outcomes of interest and was associated with high levels of undesirable CRS rotation. In FF tests, loose installation and tether misuse had large adverse effects on 3 of 4 key response variables.Conclusion: The study provides strong evidence for prioritizing tight restraint installation and proper tether use for FF restraints. In particular, use of the tether helped offset the adverse effects of loose installation or loose harness. Because the results show that performance of a RF child restraint system (CRS) installation is less affected by user error, they also provide support for extended RF restraint use. In addition, packaging convertible child restraints with the LATCH belt routed through the RF belt path could help prevent the most consequential RF CRS misuse.

Associations Between the Specialty of Opioid Prescribers and Opioid Addiction, Misuse, and Overdose Outcomes.

To examine associations between opioid prescriber specialty and patient likelihood of opioid use disorder (OUD), opioid misuse, and opioid overdose. Longitudinal retrospective study using Pennsylvania Medicaid data (2007-2015). We constructed an incident cohort of 432,110 enrollees initiating prescription opioid use without a history of OUD or overdose six months before opioid initiation. We attributed patients to one of 10 specialties using the first opioid prescriber's specialty or, alternatively, the specialty of the dominant prescriber writing the majority of the patient's opioid prescriptions. We estimated adjusted rates for OUD, misuse, and overdose, adjusting for demographic variables and medical (including pain) and psychiatric comorbidities. The unadjusted incidence rates of OUD, misuse, and overdose were 7.13, 4.73, and 0.69 per 100,000 person-days, respectively. Patients initiating a new episode of opioid treatment with Pain Medicine/Anesthesiology (6.7 events, 95% confidence interval [CI] = 5.5 to 8.2) or Physical Medicine and Rehabilitation (PM&R; 6.1 events, 95% CI = 5.1 to 7.2) had higher adjusted rates for OUD per 100,000 person-days compared with Primary Care practitioners (PCPs; 4.4 events, 95% CI = 4.1 to 4.7). Patients with index prescriptions from Pain Medicine/Anesthesiology (15.9 events, 95% CI = 13.2 to 19.3) or PM&R (15.8 events, 95% CI = 13.5 to 18.4) had higher adjusted rates for misuse per 100,000 person-days compared with PCPs (9.6 events, 95% CI = 8.8 to 10.6). Findings were largely similar when patients were attributed to specialty based on dominant prescriber. Differences in opioid-related risks by specialty of opioid prescriber may arise from differences in patient risk factors, provider behavior, or both. Our findings inform targeting of opioid risk mitigation strategies to specific practitioner specialties.

Characteristics and Impact of Disseminated Gonococcal Infection in the "Top End" of Australia.

The "Top End" of Australia is presently experiencing a gonorrhea epidemic. Gonococcal infection is usually limited to mucosal tissues but can lead to disseminated gonococcal infection (DGI), joint destruction, and severe sepsis. This study aimed to explore the epidemiology, presentation, management, and health-care impact of DGI in the Top End of the Northern Territory. Health records of patients diagnosed with proven, probable, or possible DGI between January 2010 and September 2018 were analyzed retrospectively. One hundred six cases of DGI were identified. Ninety-four patients (88.7%) were Indigenous Australian. The incidence of proven and probable DGI in the Indigenous population was 27.1 per 100,000 person-years, compared with 7.1 in the Top End population overall. Of 7,540 laboratory-proven gonococcal notifications, 1.3% (n = 97) were complicated by DGI. The highest incidence was in the 15-19-year age-group. Thirteen cases (12.3%) occurred in patients younger than 15 years. High rates of comorbid alcohol misuse, diabetes, systemic lupus erythematosus, rheumatic fever, and complement deficiency were observed. The "classic triad" of tenosynovitis, dermatitis, and polyarthralgia was rare. Ninety-four patients (88.7%) presented with purulent arthritis. Disseminated gonococcal infection was estimated to cause at least 10.0% of nonpenetrating septic arthritis in the Top End and 1,234 days of hospitalization during the study period. DGI is an important cause of morbidity in the Top End, particularly in the young, remote Indigenous Australian population. Clinical presentation varies from classical teaching. Urgent action in the health and community sector is required, particularly for at-risk populations, to prevent further debilitating and costly complications of gonococcal infection.

Improving Mental Health Services for Immigrant, Racialized, Ethno-Cultural and Refugee Groups.

Mental health problems are common and have a significant impact on people and their families, communities and the economy. Sixty percent of the population risk of illness is linked to the social determinants of health, and immigrant, refugee, ethno-cultural and racialized (IRER) groups have more exposure to these social factors. But one size does not fit all; the actual rates of mental health, mental illness or substance misuse for any IRER group depend on a complex interplay between risks and resilience. Disparities in rates of mental health, rates of illness and service use exist for IRER populations in Canada. Moving toward equity requires action on the social determinants of health to promote mental wellness as well as targeted action to prevent mental illness and increase the rates of recovery. Equitable mental health services require culturally competent staff, with interventions that work effectively for differently cultural groups and a system that allows equitable access.

Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle-to Old-Aged Men: A Comparative Study of Adverse Events.

IntroductionSome previous studies reported recreational use of phosphodiesterase type 5 (PDE-5) inhibitors by ingesting the medicine with alcohol in patients with erectile dysfunction, but the rate of misuse in general population has never been researched.AimTo investigate the frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population. We secondarily analyzed the influence of alcohol on PDE-5 inhibitor.Methods325 men with erectile dysfunction (age 34–78) who received PDE-5 inhibitors at a single medical institution from January 2016–February 2018 were included in the study. All patients fulfilled a survey questionnaire assessing (i) average alcohol consumption amount, (ii) previous use of PDE-5 inhibitors with alcohol and purpose of concomitant alcohol use, (iii) and background knowledge about PDE-5 inhibitors' side effects.Main Outcomes MeasuresThe main outcome measure was frequency of concomitant alcohol consumption with PDE-5 inhibitors in the general male population.ResultsOverall 148 patients committed concomitant alcohol use (group 1), and 177 patients did not (group 2). No significant differences were observed between 2 groups regarding types of PDE-5 inhibitors used and underlying disease. Group 2 had significantly more patients with the correct knowledge concerning concomitant alcohol use than group 1 (24.9% vs 13.5%). Group 1 had more patients with average alcohol consumption >15 drinks/week (64.8% vs 14.1%). The reasons for concomitant alcohol use were curiosity (35.1%), enhancing sexual desire (27%) and recommendation from friends (16.9%). Group 1 showed significantly greater complications, including headache (23.6% vs 7.3%) and facial flushing (69.6% vs 12.4%), than group 2. 1 patient in group 1 experienced severe chest discomfort and underwent coronary artery angiography, but no severe obstructive lesion was observed.Conclusion45.5% of middle- to old-age men committed concomitant use of PDE-5 inhibitor with alcohol because of recreational purpose, and this alcohol abuse might lead to severe complications, including chest discomfort and dizziness.Kim JN, Oh JJ, Park DS, et al. Influence of Alcohol on Phosphodiesterase 5 inhibitors Use in Middle- to Old-Aged Men: A Comparative Study of Adverse Events. Sex Med 2019;7:425–432.

Improving Family Medicine Residents’ Opioid Prescribing: A Nurse Practitioner-Led Model

Academic family medicine teaching centers face distinct challenges with opioid prescribing, including higher rates of opioid misuse in resident patient populations and lower levels of experience managing chronic noncancer pain. To improve opioid prescribing practices in an academic family practice, we introduced and evaluated a nurse practitioner-led collaborative care model. After implementation of the model, we found a reduction in the average dose of opioids prescribed, increased use of urine drug tests and opioid treatment agreements, and fewer prescribers per patient. The nurse practitioner-led model was successfully implemented in an academic family practice with improvements in opioid prescribing and monitoring practices.

Maternity Care for Pregnant Women with Opioid Use Disorder: A Review.

Opioid misuse is a problem that is complex and widespread. Opioid misuse rates are rising across all US demographics, including among pregnant women. The opioid epidemic brings a unique set of challenges for maternity health care providers, ranging from ethical considerations to the complex health needs and risks for both woman and fetus. This article addresses care for pregnant women during the antepartum, intrapartum, and postpartum periods through the lens of the opioid epidemic, including screening and counseling, an interprofessional approach to prenatal care, legal considerations, and considerations for care during labor and birth and postpartum. Providers can be trained to identify at-risk women through the evidence-based process of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and connect them with the appropriate care to optimize outcomes. Women at moderate risk of opioid use disorder can be engaged in a brief conversation with their provider to discuss risks and enhance motivation for healthy behaviors. Women with risky opioid use can be given a warm referral to pharmacologic treatment programs, ideally comprehensive prenatal treatment programs where available (a warm referral is a term used when a provider, with the patient's permission, contacts another provider or another service him or herself rather than providing a phone number and referral number). Evidence regarding care for the pregnant woman with opioid use disorder and practical clinical recommendations are provided.

Medical Use and Misuse of Prescription Opioids in the US Adult Population: 2016-2017.

Objectives. To characterize prescription opioid medical users and misusers among US adults.Methods. We used the 2016-2017 National Surveys on Drug Use and Health to compare medical prescription opioid users with misusers without prescriptions, misusers of own prescriptions, and misusers with both types of misuse. Multinomial logistic regressions identified substance use characteristics and mental and physical health characteristics that distinguished the groups.Results. Among prescription opioid users, 12% were misusers; 58% of misusers misused their own prescriptions. Misusers had higher rates of substance use than did medical users. Compared with with-prescription-only misusers, without-and-with-prescription misusers and without-prescription-only misusers had higher rates of marijuana use and benzodiazepine misuse; without-and-with-prescription misusers had higher rates of heroin use. Compared with without-prescription-only misusers, without-and-with-prescription and with-prescription-only misusers had higher rates of prescription opioid use disorder. Most misusers, especially with-prescription-only misusers, used prescription opioids to relieve pain. Misusers were more likely to be depressed than medical users.Conclusions. Prescription opioid misusers who misused both their own prescriptions and prescription opioid drugs not prescribed to them may be most at risk for overdose. Prescription opioid misuse is a polysubstance use problem.

Grammatical accuracy in EAP writing

Accuracy in use of inflection is a defining feature of native and non-native academic writing. In EAP contexts, non-native texts are dominated by errors in use of tense and agreement, despite accuracy being an important element of text complexity and EAP teaching and assessment. An open question is to what degree the absence of inflection in the EAP learner's L1 resembling English tense and agreement is associated with inaccuracy. This study examined verb form errors in the EAP writing of L1 Chinese learners and assessed the degree to which errors stem from the absence of similar inflection in the L1. The use of three forms that are especially important in native and non-native academic writing, tense/agreement, passives, and modals, was analysed. These forms were especially relevant due to the fact that only modals and passives have cognates in English. Analyses show errors were most frequently omission and misuse. Errors with tense/agreement outnumbered both passives and modals, suggesting the former are especially difficult to master as cognate forms are absent in the L1. Furthermore, similar rates of misuse and omission were found across passives and modals, suggesting these forms are attainable. Implications for teacher-training, materials development, and error-correction are discussed.

Use and Misuse of Opioid Pain Medications by Pregnant and Nonpregnant Women

BackgroundThe use and misuse of opioid pain medication is a public health problem that has extended to pregnant women. Assessing both the use and misuse of opioid pain medication had been limited. AimsThe aim of the present study was to disseminate data from a national sample of pregnant and nonpregnant women, tracking the rate and predictors of opioid use and misuse. MethodsIn 2015 the National Survey on Drug Use and Health expanded the assessment of opioid pain reliever use and misuse. Here, a secondary analysis of 2 years of National Survey on Drug Use and Health expanded data assesses the use and misuse of opioids in pregnant and nonpregnant women ranging in age from 18 to 44 years (N = 46,229). ResultsOpioid medication use was reported by 31.89% of pregnant women and 38.87% of nonpregnant women. Race and pregnancy status were associated with risk, with pregnancy being protective and White women having significantly higher risk. ConclusionsThe high rates of use and misuse of opioids in pregnant women underscores a critical need for screening for opioid use and misuse, particularly among White women. Pregnancy provides a unique window of opportunity to educate, screen, and provide treatment.

Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China.

PurposeOveruse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients.MethodsMedical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use.ResultsA total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics.ConclusionOveruse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.

Alcohol use and consequences in matriculating US college students by prescription stimulant/opioid nonmedical misuse status

BackgroundUS college students have elevated prescription opioid and stimulant misuse rates, with frequent alcohol use and alcohol-related consequences (ARCs). To date, though, no research has examined relationships between opioid and/or stimulant misuse and alcohol quantity/frequency or ARC variables in college students. MethodsThe 2016–17 AlcoholEDU for College™, a web-based alcohol prevention program, provided data (n = 491,849). Participants were grouped into past 14-day: (1) no misuse; (2) opioid misuse only; (3) stimulant misuse only; and (4) combined misuse. Using multilevel logistic regressions, groups were compared on 14-day alcohol use odds, and among those with use, odds of any ARCs and specific ARCs (e.g., hangover). Multilevel negative binomial regressions compared group members with alcohol use on 14-day total drinks, maximum 24-h drinks and drinking days. ResultsAlcohol use and any ARCs odds were highest in the stimulant (odds ratios [OR] = 3.47 and 2.97, respectively) or opioid misuse only groups (ORs = 3.31 and 2.43, respectively), with the combined misuse group intermediate (ORs = 1.63 and 1.29; reference: no misuse). Mean 14-day drinks decreased from those with combined misuse, to those with stimulant misuse only, opioid misuse only and no misuse (8.22, 7.1, 6.67, and 4.71, respectively). ConclusionsCollege students engaged in 14-day stimulant and/or opioid misuse had higher odds of 14-day alcohol use, higher levels of alcohol use, and a greater likelihood of ARCs, versus students without misuse. These findings suggest that college students with any prescription misuse need alcohol screening, although those with poly-prescription misuse may not need more intensive alcohol interventions.

Prescription opioid misuse among U.S. Hispanics

BackgroundAs a risk factor for addiction, heroin use, and overdose, the misuse of prescription opioids represents a critical public health challenge. While public attention has primarily centered on opioid misuse among White individuals, less attention has been devoted to opioid misuse among one of the United States' fastest-growing demographic groups: Hispanic immigrants and their descendants. This study therefore examined prescription opioid misuse among U.S. Hispanic adults, with attention to within-group differences and the role of acculturation-related characteristics. MethodsData were derived from the 7037 U.S. Hispanic adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012−2013). Weighted proportions, adjusted odds ratios, and 95% confidence intervals were computed for past-year and lifetime prescription opioid misuse. Binomial logistic regression models examined the association between acculturation-related characteristics and prescription opioid misuse. ResultsPast-year prevalence of prescription opioid misuse among U.S. Hispanic adults was lower in the first generation (1.6%), compared with the second (4.1%), third (6.8%), and higher-than-third (6.2%) generations, and a similar pattern was observed for lifetime prevalence. Higher generation, greater English language orientation, and length of time living in the United States were significantly associated with higher odds of past-year and lifetime prescription opioid misuse. ConclusionsRelying solely on comparisons of prevalence between ethnic groups may obscure significant variations within ethnic groups. Second, third, and higher generation Hispanics are higher-risk subgroups, with rates of prescription opioid misuse approaching or surpassing the rates reported among non-Hispanic Whites.

Stimulant Diversion Risk Among College Students Treated for ADHD: Primary Care Provider Prevention Training

ObjectiveTo address increasing rates of stimulant misuse in college students, this study developed an evidence-based, brief clinical practice intervention for primary care providers (PCPs) to reduce stimulant medication diversion among young adults with attention-deficit/hyperactivity disorder (ADHD). MethodsCollege students (N-114; 18–25 years; 68% attending universities; 24% attending community college) treated for ADHD with a stimulant and their PCPs across six practices participated in this initial, uncontrolled study of pre- to post-intervention change. An educational workshop providing strategies aimed at reducing stimulant diversion was developed and delivered to providers and staff across all practices (50% pediatric; 50% family medicine). Patients and providers completed baseline and post intervention surveys. ResultsDiversion was relatively infrequent, 16.7% at baseline and 14.9% post-intervention, respectively. Statistically significant decreases from baseline to post-intervention were found for three diversion risk factors: (1) number of times approached to divert, (2) intent to share, sell, or trade stimulants, and (3) disclosure of stimulant use. Providers and staff reported mostly high satisfaction with the training. ConclusionsThis study provides initial evidence for a PCP-delivered intervention to reduce stimulant diversion. Research is needed on the efficacy of targeting college students directly, working with pharmacies and student health centers, and preventing misuse among teenagers.

Sexual minority disparities in opioid misuse, perceived heroin risk and heroin access among a national sample of US adults

BackgroundLesbian, gay and bisexual (LGB) adults have elevated use of many substances compared to heterosexual adults, yet LGB disparities in specific types of opioid misuse and perceived opioid risk have not been fully characterized. MethodsData on 126,463 adults (including 8241 LGB adults) were from the 2015–2017 National Survey of Drug Use and Health. Logistic regression was used to estimate lesbian/gay (L/G) and bisexual disparities (relative to same-gender heterosexuals) for: lifetime prescription pain reliever misuse, heroin use and injection heroin use; past-year opioid misuse and opioid use disorder (OUD); and perceived risk of and access to heroin. ResultsAll LGB subgroups had elevated lifetime pain reliever misuse rates relative to same-gender heterosexuals. Lifetime heroin use was elevated among LGB women and bisexual men; bisexual women had 4 times the odds of injection heroin use. LGB women and gay men had 1.4–2.4 times the odds of past-year opioid misuse; bisexual women had 2.5 times the odds of OUD. LGB women reported both lower perceived risk of trying heroin and greater perceived heroin access. ConclusionsLifetime and past-year opioid misuse is elevated among LGB adults. Bisexual women are particularly at-risk, uniquely exhibiting disparities on high-risk injection use and OUD. Lower perceived risk of and greater access to heroin among LGB women may play a role in the onset or continuation of opioid misuse. Opioid misuse disparities among LGB adults are of substantial concern given the resultant elevated risk for fatal and non-fatal opioid overdose.

Dancing with Deterrents: Understanding the Role of Abuse-Deterrent Opioid Formulations and Naloxone in Managing Cancer Pain.

Prescription opioids are commonly prescribed for the relief of many kinds of pain syndromes, including cancer pain. In order to combat the growing rates of abuse and misuse of prescription opioids, the Centers for Disease Control and Prevention, along with the U.S. Food and Drug Administration and multiple pharmaceutical companies, have implemented many risk mitigation strategies. Abuse-deterrent drug delivery technology and more consistent prescribing of the opioid antagonist, naloxone, are two of the mechanisms of reducing harm in patients on chronic opioid therapy. Abuse-deterrent technology is implemented into different commercially available opioid products with the intent of discouraging manipulation of the opioid or making the use of the manipulated opioid less appealing. Use of the opioid antagonist, naloxone, for reversal of intentional or unintentional opioid overdose is a safe and effective means to reduce potential risk in patients who are on opioids for pain management. These mechanisms have multiple advantages and limitations that influence their practical use specifically in patients with cancer pain. Patients with cancer pain have unique therapeutic needs and goals, and their balance of treatment risks and benefits differs from that of other kinds of chronic pain disorders. This article provides an overview of the advantages and limitations of these specific harm-reduction strategies and provides guidance on how to practically utilize them when caring for patients with cancer pain. IMPLICATIONS FOR PRACTICE: Treating cancer pain has important and unique considerations compared with other chronic, noncancer pain disorders. The use of risk mitigation strategies for opioid prescribing as promoted by the Centers for Disease Control and Prevention does not translate seamlessly to patients with cancer. It is crucial to be wary of the advantages and pitfalls of all risk mitigation strategies related to opioid use in patients with cancer pain. Careful examination of patient-specific risks and benefits should always be considered when implementing pharmacologic treatment and harm-reduction strategies for the management of cancer pain.

Understanding differences in prescription drug misuse between two Texas border communities

ABSTRACT Objectives: The misuse of prescription drugs in the U.S. is an alarming public health crisis. Prior research at the U.S.-Mexico border has found high rates of prescription drug misuse, but with rates varying significantly across border communities. We aimed to examine a model of permissive climate measures and stress exposures as potential mediators of community differences in prescription drug misuse at the U.S.-Mexico border. Design: We analyzed data from the U.S.-Mexico Study of Alcohol and Related Conditions (UMSARC). Household, in-person interviews were conducted with Mexican-origin residents of the Texas border cities Laredo (n = 751) and Brownsville/McAllen (n = 814). Interviews assessed past-year misuse of any and pain-reliever prescription drugs. Drug availability, neighborhood safety, exposure to violence/crime, and social support were examined as potential mediators. Analyses were stratified by gender and employed regressions and mediation analysis with Mplus. Results: The past-year prevalence of any prescription drug misuse in Laredo was 26.3% among women and 24.4% among men, and in Brownsville/McAllen was 12.4% among men, and 6.7% among women. Mediation analysis revealed site effects via some of the hypothesized risk factors for men, but not for women. Specifically, for men, site effects on any and pain reliever prescription drug misuse were partially mediated via high drug availability and low family support. Conclusions: Past-year prescription drug misuse was over 3 times the 2015 national prevalence among both men and women in Laredo and calls for immediate attention. Findings regarding the model suggest drug availability and social support may be relevant to understanding community differences in prescription drug misuse among men living at the border, and that additional factors should be investigated to understand misuse among women living at the border.

Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men

Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association’s National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.

Design of a Metered-Dose Inhaler Actuated by Shape Memory Alloy

The global prevalence of asthma and chronic obstructive pulmonary disease (COPD) is on the order of hundreds of millions of individuals. The most common treatment approach is to take a self-administered inhaled medication. This study focuses on pressurized metered-dose inhalers (MDIs) where, unfortunately, rates of mishandling and misuse are extremely high and lead to improper treatment. One significant challenge results from the timing miscoordination of the medicine dispersion and inhalation breath. To address this, this study demonstrates the feasibility of automating the timing of the medicine dispersion by integrating a shape memory alloy (SMA) actuator and a differential pressure sensor into the casing of a traditional MDI. The approach is to measure the vacuum pressure created by an inspiratory breath, evaluate criteria indicating an acceptable breath, and if those criteria are met, heat the SMA actuator to depress the cartridge and disperse medicine. To meet actuation requirements and reliably depress the inhaler cartridge, two concepts for configuring an SMA wire were designed and compared with respect to complexity, actuation timing, and energy consumption. The proposed concept was able to disperse medicine in 263 ms, averaged over 100 actuations on a single battery charge, facilitating the early dispersion of medicine during an inhalation breath. By describing the design process of an SMA-actuated MDI that does not result in a significant increase of its weight or size, this study provides a practical technological approach for reducing the improper treatment of asthma and COPD due to timing miscoordination.

The Opioid Crisis: A Contextual Framework and Call for Systems Science Research

Context: The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis, as interpersonal relationships and the conditions of the community and society people live in. Despite efforts to tackle the issue, the rates of opioid misuse, non-fatal overdose, and overdose death remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realized. Broader systems policies, especially those that emphasize prevention, could more effectively intervene in this crisis. Methods: In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualize the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal, and societal levels. Findings: Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment. Conclusions: Future research can elucidate the interconnections among the risk factors as well as leverage systems science tools (e.g., simulation modeling) to uncover the complexities of the crisis, and help evaluate, analyze, and forecast the effectiveness of ongoing and new policy interventions. We explain and call for the need for more systems science approaches in opioid research.