Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

In September of 2015, SAMHSA awarded the Partnerships for Success (PFS) grant to the State of Alaska  Department of Health and Social Services, Division of Behavioral Health (DBH). The PFS grant program is  a five‐year effort that focuses on preventing and reducing substance use and building prevention  capacity at both the state and community levels. DBH provides leadership for the project and facilitates  the conduct of project activities by community‐level coalitions. Additionally, DBH contracted with the  Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA)  to conduct a comprehensive evaluation of the PFS project.   Using a data‐informed prioritization process to narrow the substance abuse focus of the grant, the State  Epidemiological Outcomes Workgroup chose two PFS priority areas: 1) non‐medical use of prescription  opioids among 12‐25 year olds; and 2) heroin use among 18‐25 year olds. Data on the use of and  consequences related to prescription opioids and heroin in Alaska are described below.  Partnerships for Success (PFS) Priority Area: Non‐Medical Use of Prescription Opioids  Data from the National Survey on Drug Use and Health (NSDUH) indicate that young adults aged 18‐25  consistently have the highest percentage of non‐medical use of prescription pain relievers in Alaska  compared to youth aged 12‐17 and adults aged 26 and older (see Figure 1).1,2,3 While small decreases in  use were observed among all age groups from 2009 to 2014, the age‐specific pattern remained  consistent.   Figure 1. Past year non‐medical use of prescription pain relievers in Alaska from 2009 to 2014 by age  Additional data requested from NSDUH (see Table 1) indicated no significant change in non‐medical use  of prescription pain reliever estimates among 12‐25 year olds in Alaska between years 2007‐2010 and  2011‐2014 but a decreasing trend was observed for past year use and past year prescription pain  reliever dependence or abuse.4 0 5 10 15 2009-2010 2011-2012 2013-2014 Percentage 12-17 years 18-25 years 26+ years 4 Table 1. Past year non‐medical use of prescription pain reliever estimates among individuals aged 12  to 25 in Alaska from 2007 to 2014  1 Dependence/abuse is based on definitions found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV)  Estimates of past year non‐medical use of prescription pain relievers among individuals aged 12 and  older in Alaska are slightly higher than national estimates but both follow a small decreasing trend in use  from 2009 to 2014 (see Figure 2).1,2,3 Figure 2. Past year non‐medical use of prescription pain relievers among individuals aged 12 and older in  the U.S. and Alaska from 2009 to 2014  Other indicators related to non‐medical use of prescription opioids in Alaska have also decreased slightly  or stabilized in recent years. Treatment admissions for synthetic opiates (opiates or synthetics including  Methadone, Oxycodone, or Oxycontin) as a primary, secondary, or tertiary substance of abuse have  stayed relatively stable from 2013 to 2015 (1,052 to 1,011 treatment admissions), according to the  Alaska Automated Information Management System (AKAIMS).5  Age‐adjusted overdose death rates in  Alaska have decreased from 11.2 per 100,000 in 2009 to 8.5 per 100,000 in 2015. Although overdose  deaths from prescription opioids are decreasing, Alaska still has higher rates of overdose deaths from  prescription opioids than the nation overall (7.3 vs. 5.1 per 100,000 in 2012).6 Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental  Health Services (Grant #SP020783) through the State of Alaska, Division of Behavioral Health Background / Survey Methods / Prescription Opioids / Heroin / Conclusion / Reference

Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.State of Alaska, Division of Behavioral Health Grant #SP020783Executive Summary / Introduction / Methodology / Results / Discussion / Reference

Correlates of Low-Fat Milk Consumption in a Multi-Ethnic Population

Objective: To assess the correlates of low-fat milk consumption in a multi-ethnic population. Design: Cross-sectional random digit dial telephone survey of adults residing in Hawaii. Setting & Participants: The survey was completed by 600 adults who consumed cow’s milk. Five ethnicities composed over 86% of the sample: Caucasian (36%), Hawaiian (17%), Japanese (18%), Filipino (10%), and Chinese (5%). The average age of participant was 45.6. 84% had completed high school and 35% had completed college. Variables Measured: All variables were self-reported. Type of milk consumed (high-fat vs. low-fat) was the dependent variable. Independent variables included age, gender, ethnicity, body mass, attitude, normative beliefs, and stage of change. Analysis: Chi-squares and logistic regression were used for the analysis (p < .05). Results: Younger and less educated people were less likely to drink low-fat milk, as were Native Hawaiians and Filipinos. In the multivariate analyses only attitudes, normative beliefs, and education were significant predictors. Conclusions and Implications: Attitudes and normative beliefs towards milk consumption explain more of the variance in type of milk consumption than demographic characteristics. This data indicates the feasibility of testing interventions designed to influence attitudes and normative beliefs towards low-fat milk consumption in Asian and Pacific Island communities

Policy Evaluation During the Opioid Epidemic

This presentation provides an overview of research in Alaska's policy responses to rises in opioid use between 2016 and 2018. It outlines outcomes from qualitative analysis of interviews.Institute of Social and Economic Research (University of Alaska Anchorage) U.S. Department of Health and Human Services (SAMHSA #1U79SP020783

Promoting a Coordinated Multi-Site Evaluation for Community-Based Opioid Prevention Programs

The effectiveness of substance use prevention efforts is often difficult to measure over short grant cycles, especially for emerging issues such as prescription opioid misuse where data is less available and evidence-based strategies are not well understood. Coordinating state and community level evaluation efforts adds further complexity. Since 2016, six communities in Alaska, through a single federal funding stream, have worked to prevent opioid misuse among youth and young adults using policy, system, and environmental strategies. The project is focused on three key intervening variables to reduce prescription opioid misuse.The Alaska Partnerships for Success Project is funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (Grant #SP020783) through the State of Alaska, Division of Behavioral Health.Institute of Social and Economic Research (University of Alaska Anchorage) Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (Grant #SP020783

Alaska’s Partnerships for Success Grant ‐ Technical Report No.3

The opioid epidemic has continued in Alaska and nationwide. Information about the types of opioids that are misused first, the age of first use, and the circumstances and mode of initial and progressive use of opioids can help to inform effective prevention and early intervention efforts. These topics were explored during interviews with adults in Alaska who use heroin for the Partnerships for Success project. Results indicate that most participants were exposed to opioids through a legitimate prescription in their teens to early twenties for a severe injury or multiple surgeries before developing an addiction. Some obtained prescription opioids for misuse initially from social sources such as a friend, at a party, or stealing them from a neighbor. Only two participants began their use of opioids with heroin. All participants eventually went on to use heroin which became cheaper, more effective, and easier to obtain than prescription opioids. Few participants indicated that social influences, rather than price or availability, were a factor in their transition to heroin. Recommendations and an overview of recent state prevention initiatives and policy efforts related to the findings are presented.Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (Grant #SP020783) through the State of Alaska, Division of Behavioral Health

Effect of Item Order on Physical Activity Estimates Using the IPAQ

Objective: To investigate the effect of item order on physical activity (PA) estimates using the International Physical Activity Questionnaire – short form (last 7 day) telephone interview (IPAQ-S7T). Method: The IPAQ-S7T was conducted for Time 1 (Hawai`i) and sample 1 (Belgium). Then item order was reversed for Times 2, 3 (Hawai`i), and sample 2 (Belgium). Results: In Hawai`i, vigorous activity levels were higher, walking levels lower for Time 1, compared to Times 2 and 3. Moderate activity was higher at Time 1 than Time 3. The Belgium study reported higher levels of vigorous activity for sample 1, compared to sample 2. Total volume of PA across time points was unchanged for the Hawai`i study, but decreased with reversed items in the Belgium study. Conclusion: Item ordering affects the levels and duration of reported PA using the IPAQ-S7T. This warrants further research on order efficacy and whether other PA measures are affected

Correlates of Low-Fat Milk Consumption in a Multi-Ethnic Population

Abstract Objective: To assess the correlates of low-fat milk consumption in a multi-ethnic population. Design: Cross-sectional random digit dial telephone survey of adults residing in Hawaii. Setting & Participants: The survey was completed by 600 adults who consumed cow's milk. Five ethnicities composed over 86% of the sample: Caucasian (36%), Hawaiian (17%), Japanese (18%), Filipino (10%), and Chinese (5%). The average age of participant was 45.6. 84% had completed high school and 35% had completed college. Variables Measured: All variables were self-reported. Type of milk consumed (high-fat vs. low-fat) was the dependent variable. Independent variables included age, gender, ethnicity, body mass, attitude, normative beliefs, and stage of change. Analysis: Chi-squares and logistic regression were used for the analysis (p < .05). Results: Younger and less educated people were less likely to drink low-fat milk, as were Native Hawaiians and Filipinos. In the multivariate analyses only attitudes, normative beliefs, and education were significant predictors. Conclusions and Implications: Attitudes and normative beliefs towards milk consumption explain more of the variance in type of milk consumption than demographic characteristics. This data indicates the feasibility of testing interventions designed to influence attitudes and normative beliefs towards low-fat milk consumption in Asian and Pacific Island communities