Young Women and the Initiation Trajectory of Prescription Opioid Misuse

The most recent opioid epidemic in United States history emerged in the late 1980s and continues its destructive impact to this day. It has evolved into a devastating public health crisis with a broad range of medical, social, and economic consequences. This dissertation focuses on the “first wave” of this opioid epidemic characterized largely by the misuse of prescription opioids. The research questions here were focused on developing a greater understanding of the social processes involved in young women’s initiation of prescription opioid misuse (POM) during this first wave. The research methodology consisted of a cross-sectional, exploratory study using qualitative data collection and analytic methods in the grounded theory tradition. An ecosystems perspective was used in the categorization of findings at the individual, interpersonal, and community levels, and a description of the POM initiation trajectory experienced by participants is described. A grounded theory that emerged from these findings is presented, as are key themes that include the importance of an initiation trajectory as a concept replacing the term initiation; the impact of female gender on this particular initiation trajectory; the lack of evidence-based information about addiction across the prevention, treatment, and recovery landscape; key differences between POM and other substance misuse trajectories; the contribution of stigma as a barrier to accessing support for substance misuse; and an examination of the connections between boredom, lack of meaning and substance misuse outcomes. Study findings point to a set of recommendations for interventions at the individual, interpersonal, and community levels that can inform practice, policy, and research moving forward

Vagina

Writings and artwork promoting vaginal health and awareness.https://digitalcommons.chapman.edu/feminist_zines/1004/thumbnail.jp

Predictive Validity of a 2-Question Alcohol Screen at 1-, 2-, and 3-Year Follow-up.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs). Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up. Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P <.0001), and 3 years (P = .0005), as were the differences between moderate- and highest-risk drinkers at 1 and 2 years (P < .0001 and P = .0088, respectively) but not at 3 years (P = .0758). The best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60.0% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80.0% at 3 years) was achieved by using "lower risk" and higher as a cutoff for the prediction of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis. The NIAAA 2-question screen can accurately characterize adolescent risk for future AUDs. Future studies are needed to determine optimaluse of the screen

Adolescent Alcohol Use Predicts Cannabis Use over A Three Year Follow-Up Period

Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17 years old (n = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use

Solving the Problems of Economic Development Incentives

This paper reviews the research literature relevant to economic development incentives provided by state and local governments, and recommends reforms in these incentives. I argue that the main problem with current incentive policies is that state and local governments often provide incentives that are not in the best interest of that state or local area, for example that are excessively costly per job created, or that provide jobs that do not improve the job opportunities of local residents. I suggest that reforms should be "bottom-up" rather than "top-down." Regulation of incentives by the federal government may prevent both desirable and undesirable incentives. "Bottom-up" reforms would include more information on incentive offers, a budget constraint on the volume of incentives, stronger standards for job quality and job accessibility for the local unemployed, and better benefit-cost analyses of incentives. Copyright 2005 Blackwell Publishing Ltd..