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Background: There is a lack of integrated treatment for chronic pain and opioid use disorder (OUD). Yoga and physical therapy (PT) may improve pain and physical function of people living with (PLW) chronic low back pain (CLBP) and may also reduce opioid craving and use, but PLW with OUD face barriers to accessing these interventions. We hypothesize that compared to treatment as usual (TAU), providing yoga and PT onsite at opioid treatment programs (OTPs) will be effective at improving pain, opioid use, and quality of life among people with CLBP and OUD, and will be cost-effective.Methods: In this hybrid type-1 effectiveness-implementation study, we will randomly assign 345 PLW CLBP and OUD from OTPs in the Bronx, NY, to 12 weeks of onsite yoga, onsite PT, or TAU. Primary outcomes are pain intensity, opioid use, and cost-effectiveness. Secondary outcomes include physical function and overall well-being.Discussion: This trial tests an innovative, patient-centered approach to combined management for pain and OUD in real-world settings. We rigorously examine the efficacy of yoga and PT onsite at OTPs as nonpharmacologic, cost-effective treatments among people with CLBP and OUD who face barriers to integrated care.

Objectives: Changes in health care delivery during the COVID-19 pandemic may have impacted opioid prescribing. This study evaluated the impact of restrictions on in-person care on opioid prescribing in the outpatient setting. The hypothesis was that after restrictions to in-person care were implemented, there would be a reduction in the number of chronic and non-chronic opioid prescriptions.Methods: An interrupted time series analysis was conducted to compare the number of weekly opioid prescriptions between baseline (1/1/2019-3/14/2020), restriction (3/15/2020-6/6/2020), and reopening (6/7/2020-10/31/2020) periods at outpatient practices within a health system in Bronx, NY. Analyses were stratified by prescription type (chronic if the patient had been prescribed opioids for >90 days, or non-chronic).Results: For chronic opioid prescriptions, the week restrictions were implemented, there was an increase in the number of prescriptions compared to what was predicted if there had been no interruption (34.8 prescriptions, 95% CI: 8.0, 61.7). Subsequently, the weekly trend in prescribing was not different in the restriction period or in the reopening period compared to the previous time periods. For non-chronic opioid prescriptions, during the restriction period, the weekly trend in prescribing decreased compared to baseline (−5.0 prescriptions/week, 95% CI: −9.0, −1.0). Subsequently, during the reopening period, the weekly trend in prescribing increased compared to the restriction period (6.4 prescriptions/week, 95% CI: 2.2, 10.7).Conclusions: Despite abrupt restrictions on in-person care, chronic opioid prescriptions did not decrease, which is evidence that providers evolved to meet patient needs. Changes in non-chronic prescriptions are likely related to patients electing not to pursue care for acute pain or challenges with appointment availability.

This study examined the role of cigarette smoking beginning in adolescence and extending to the fifth decade of life on insomnia at an average age of 43 years in the Children and Adults in the Community Study.

This study of female former and current smokers assessed the associations between voluntary smoking bans at home and in the car and smoking cessation, obesity, and self-control. Data from self-reported female smokers (N= 194) who were in a community-based random cohort at four points in time, from 1983 to 2009, were analyzed. These female participants (Mage = 63.7 yr.) were given self-administered questionnaires. Analyses showed that complete smoking bans at home and in the car were positively associated with a greater likelihood of smoking cessation. Complete smoking bans at home and in the car were positively associated with greater self-control. Public health policies should focus on the positive health effects of smoking bans on smoking cessation and greater self-control.

Osteoporosis is prevalent among women 50 years of age and older and accounts for numerous fractures and the related deaths of many sufferers. In this study, 22.4% of the women reported having osteoporosis. Smoking contributes substantially to osteoporotic fractures. This study assessed how different trajectories of women's smoking, covering the ages 40 to 48 years, relate to osteoporosis at age 65. Trajectory analysis of tobacco use data reveals smoking patterns which may have differing relationships to osteoporosis. Logistic regression analyses revealed the varying relationships of different smoking patterns to osteoporosis. As hypothesized, the chronic/heavy smokers were significantly more likely than the non-smokers to report having osteoporosis. Quitters and moderate smokers did not differ significantly from non-smokers on the osteoporosis measure. Chronic/heavy smokers should not be the only focus of public health efforts to reduce smoking and the associated risks of osteoporosis. The findings also highlight the efficacy of women smokers quitting in their 40s in order to reduce their likelihood of contracting osteoporosis.

OBJECTIVE To investigate the relationship between early adolescent personal characteristics and the developmental trajectories of marijuana use extending from early adolescence to adulthood. DESIGN This study used a longitudinal design. Data were obtained using structured questionnaires administered by trained interviewers. SETTING Interviews were conducted in the participants' homes in upstate New York. PARTICIPANTS Participants were drawn from a randomly selected cohort and were studied prospectively since 1975 (T1) at a mean age of 6 years. The follow-up data used for this study were collected at 6 time points when the participants were aged between 14 and 37 years in 1983 (T2), 1985-1986 (T3), 1992 (T4), 1997 (T5), 2002 (T6), and 2005-2006 (T7). MAIN OUTCOME MEASURES Developmental trajectories of marijuana use. RESULTS Semiparametric group-based modeling and logistic regression analyses were used to analyze the data. The following 5 distinct trajectories of marijuana use were identified: nonusers or experimenters, occasional users, quitters or decreasers, increasing users, and chronic users. Chronic users compared with other groups studied (nonusers or experimenters, occasional users, quitters or decreasers, and increasing users) reported low self-control, externalizing behavior, and an orientation to sensation seeking. CONCLUSIONS Personal attributes of low self-control, externalizing behavior, and an orientation to sensation seeking have long-term predictive power for distinct trajectories of marijuana use over time. The importance of these findings for prevention and treatment programs is discussed.Arch Pediatr Adolesc Med. 2011;165(1):55-60--

This longitudinal (22 yr.) study examined several psychosocial predictors of higher than normal recommended Body Mass Index and aspects of neurocognitive dysfunction in a community-based sample of 470 participants interviewed in private during childhood, adolescence, emerging adulthood, and adulthood. Included were 5 psychosocial measures: Internalizing Behaviors (i.e., symptoms of internal distress), Educational Expectations and Aspirations (i.e., components of cognitive functioning), Impulsivity (i.e., emotional control), Body Mass Index (a measure of weight by height), and Aspects of Neurocognitive Dysfunction (e.g., memory). Results, based on Structural Equation Modeling., indicated that earlier Internalizing Behaviors, Low Educational Expectations and Aspirations, and Impulsivity predict greater Body Mass Index. Greater than normal Body Mass Index in the early 30s is associated with later Aspects of Neurocognitive Dysfunction in the middle 30s. Adolescent Internalizing Behaviors are also associated with Aspects of Neurocognitive Dysfunction in the middle 30s. Public health implications suggest increasing education about diet, health, and exercise to lessen or avoid aspects of neurocognitive dysfunction. Clinical implications suggest the importance of providing appropriate prevention and intervention for people with internalizing behaviors, impulsivity, and greater than recommended Body Mass Index.

Cigarette smoking and depressive symptoms have been shown to be related in previous research. This paper examined the relationship between cigarette smoking and depressive symptoms in a longitudinal sample of 688 adolescents and young adults through surveys conducted over 13 yr. The results indicate that a history of earlier cigarette smoking in adolescence predicts later depressive symptoms in the late twenties. The study also suggests that depressive symptoms during adolescence predict cigarette smoking in the late twenties but not above and beyond prior smoking. These results help clarify and expand current knowledge on the links between cigarette smoking and depression. The results point to several clinical implications for treatment of both cigarette smoking and depressive symptoms among both adolescents and young adults.