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Epidemiology has long been concerned with understanding the causes of health and disease states so that we can improve the health of populations. Despite broad agreement on this definition of the field, we continue to debate certain core goals of epidemiology: whether epidemiology is a pragmatic science or not, which methods constitute epidemiologic methods, and what our gold-standard thinking should be to understand causation. We suggest that recognizing epidemiology as the quantitative heart of population health science can push these tensions aside and allow us to focus our science on the health of populations and on the processes that shape that health. Seeing epidemiology as the core quantitative health science has implications for the questions we ask, how we organize ourselves as a field, and how we train the next generation of epidemiologists., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Although the flipped classroom model has been widely adopted in medical education, reports on its use in graduate-level public health programs are limited. This study describes the design, implementation, and evaluation of a flipped classroom redesign of an introductory epidemiology course and compares it to a traditional model., Methods: One hundred fifty Masters-level students enrolled in an introductory epidemiology course with a traditional format (in-person lecture and discussion section, at-home assignment; 2015, N = 72) and a flipped classroom format (at-home lecture, in-person discussion section and assignment; 2016, N = 78). Using mixed methods, we compared student characteristics, examination scores, and end-of-course evaluations of the 2016 flipped classroom format and the 2015 traditional format. Data on the flipped classroom format, including pre- and post-course surveys, open-ended questions, self-reports of section leader teaching practices, and classroom observations, were evaluated., Results: There were no statistically significant differences in examination scores or students' assessment of the course between 2015 (traditional) and 2016 (flipped). In 2016, 57.1% (36) of respondents to the end-of-course evaluation found watching video lectures at home to have a positive impact on their time management. Open-ended survey responses indicated a number of strengths of the flipped classroom approach, including the freedom to watch pre-recorded lectures at any time and the ability of section leaders to clarify targeted concepts. Suggestions for improvement focused on ways to increase regular interaction with lecturers., Conclusions: There was no significant difference in students' performance on quantitative assessments comparing the traditional format to the flipped classroom format. The flipped format did allow for greater flexibility and applied learning opportunities at home and during discussion sections.

Competing Interests: None.

The number of students and disciplines requiring basic instruction in epidemiologic methods is growing. As a field, we now have a lexicon of epidemiologic terminology and particular methods that have developed and become canonical through the historical development of the field. Yet, many of our basic concepts remain elusive to some students, particularly those not pursuing a career in epidemiology. Further, disagreement and redundancy across basic terms limit their utility in teaching epidemiology. Many approaches to teaching epidemiology generally start with labeling key concepts and then move on to explain them. We submit that an approach grounded not in labels but in foundational concepts may offer a useful adjunct to introductory epidemiology education. We propose 7 foundational steps in conducting an epidemiologic study and provide examples of how these steps can be operationalized, using simple graphics that articulate how populations are defined, samples are selected, and individuals are followed to count cases. A reorganization of introductory epidemiology around core first principles may be an effective way forward for educating the next generation of public health scientists., (© The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study examines historical variation in age 18 to 26 binge drinking trajectories, focusing on differences in both levels of use and rates of change (growth) across cohorts of young adults over 3 decades. As part of the national Monitoring the Future Study, over 64,000 youths from the high school classes of 1976 to 2004 were surveyed at biennial intervals between ages 18 and 26. We found that, relative to past cohorts, recent cohorts both enter the 18 to 26 age band engaging in lower levels and exit the 18 to 26 age band engaging in higher levels of binge drinking. The reason for this reversal is that, relative to past cohorts, binge drinking among recent cohorts accelerates more quickly across ages 18 to 22 and decelerates more slowly across ages 22 to 26. Moreover, we found that historical increases in minimum legal drinking age account for a portion of the historical decline in age 18 level, whereas historical variation in social role acquisition (e.g., marriage, parenthood, and employment) accounts for a portion of the historical acceleration in age 18 to 22 growth. We also found that historical variation in the age 18 to 22 and age 22 to 26 growth rates was strongly and positively connected, suggesting common mechanism(s) underlie historical variation of both growth rates. Findings were generally consistent across gender and indicate that historical time is an important source of individual differences in young adult binge drinking trajectories. Beyond binge drinking, historical time may also inform the developmental course of other young adult risk behaviors, highlighting the interplay of epidemiology and etiology.

ObjectiveIn the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (

BackgroundPrevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US.MethodsWe examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl.ResultsThere was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p

BackgroundSubstance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality.MethodsVeterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR).ResultsAmong COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment.ConclusionsIn VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.

PurposeDepression is increasingly common among US adolescents; the extent to which social media exposure contributes to this increase remains controversial.MethodsWe used Monitoring the Future data from 8th and 10th grade students (n = 74,472), 2009-2017, to assess the relationship between daily social media use and depressive symptoms. Self-reported depressive symptom score (range: 4-20) was assessed continuously using a log-transformed outcome and at varying cut scores with logistic regression analyses. First, these outcomes were examined overall, comparing adolescents using social media daily to adolescents who were not. We then estimated predicted depressive symptom scores using 26 predictors in order to establish underlying depression risk. We partitioned students into depression risk quintiles to control for confounding due to underlying depression risk and examine heterogeneity in the association between social media use and depressive symptoms. Sensitivity analyses were used to test the robustness of results with different configurations of the predicted score model, and overall associations were examined in two-year groups to identify differences in effects.ResultsFor girls, in adjusted risk-stratified analysis, daily social media use was not associated with high (vs. low) depressive symptoms. For boys, results were inconsistent, suggesting a protective effect of daily social media use at some cut scores. Results were consistent across sensitivity analyses, and any potential harmful effects appear to be limited to 2009-2010, limiting the evidence supporting social media as a current risk factor for depressive symptoms.ConclusionsAmong US adolescents, daily social media use is not a strong or consistent risk factor for depressive symptoms.

PurposeThe purpose of this study was to estimate the effect of firearm involvement during violent victimization on the level of distress experienced and daily functioning within sociodemographic subgroups.MethodsWe used cross-sectional data from the National Crime Victimization Survey (n = 5698) and Targeted Maximum Likelihood Estimation. Sociodemographic subgroups were defined by age, race, sex, and socioeconomic position. Outcomes included experiencing the victimization as severely distressing and problems in the workplace or at school, or with peers or family.ResultsAmong people victimized with a firearm, nearly 40% experienced the victimization as severely distressing and 28% reported daily functioning problems as a result of the victimization, compared with 25% and 27% of those victimized without a firearm. In most of the subgroups examined, a greater proportion of people described the event as severely distressing when a firearm was involved in the victimization, ranging up to 19 percentage points higher among women and among black respondents (95% CI for women = 10%-28%; for blacks = 6%-31%).ConclusionsOur findings suggest an almost universal negative response to firearm involvement during a violent victimization as compared with violent victimizations involving other or no weapons. These findings highlight the need for efforts by medical and mental health practitioners to address the potential sequelae of experiencing severe distress during a firearm victimization.

Increasing alcohol outlet density is well-documented to be associated with increased alcohol use and problems, leading to the policy recommendation that limiting outlet density will decrease alcohol problems. Yet few studies of decreasing problematic outlets and outlet density have been conducted. We estimated the association between closing alcohol outlets and alcohol use and alcohol-related violence, using an agent-based model of the adult population in New York City. The model was calibrated according to the empirical distribution of the parameters across the city's population, including the density of on- and off-premise alcohol outlets. Interventions capped the alcohol outlet distribution at the 90th to the 50th percentiles of the New York City density, and closed 5% to 25% of outlets with the highest levels of violence. Capping density led to a lower population of light drinkers (42.2% at baseline vs. 38.1% at the 50th percentile), while heavy drinking increased slightly (12.0% at baseline vs. 12.5% at the 50th percentile). Alcohol-related homicides and nonfatal violence remained unchanged. Closing the most violent outlets was not associated with changes in alcohol use or related problems. Results suggest that focusing solely on closing alcohol outlets might not be an effective strategy to reduce alcohol-related problems.

Agent-based modeling is a computational approach in which agents with a specified set of characteristics interact with each other and with their environment according to predefined rules. We review key areas in public health where agent-based modeling has been adopted, including both communicable and noncommunicable disease, health behaviors, and social epidemiology. We also describe the main strengths and limitations of this approach for questions with public health relevance. Finally, we describe both methodologic and substantive future directions that we believe will enhance the value of agent-based modeling for public health. In particular, advances in model validation, comparisons with other causal modeling procedures, and the expansion of the models to consider comorbidity and joint influences more systematically will improve the utility of this approach to inform public health research, practice, and policy.

BackgroundAlcohol use is common among older adults, and this population has unique risks with alcohol consumption in even lower amounts than younger persons. No recent studies have estimated trends in alcohol use including binge alcohol use and alcohol use disorders (AUD) among older adults.MethodsWe examined alcohol use among adults age ≥50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD.ResultsThe prevalence of both past-month binge alcohol use and AUD increased significantly among adults age ≥50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p

Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. VHA electronic health records from 2005 to 2019 (N range, 4,332,165–5,657,277) were used to identify overall and age-group-specific (<35, 35–64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005–2014 (ICD-9-CM) and 2016–2019 (ICD-10-CM). Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005–2014: 1.91%, 95% CI=1.87–1.96; 2016–2019: 0.34%, 95% CI=0.29–0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders. The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population. [ABSTRACT FROM AUTHOR]

The article examines trends in suicide rates among Black females aged 15–84 in the U.S. from 1999 to 2020, revealing a notable increase from 2.1 to 3.4 per 100,000 during this period. Topics include a concentration of rising suicide rates among the youngest cohorts, with particular emphasis on the need for mental health care access and addressing structural racism, while also highlighting geographical variations that call for region-specific prevention efforts.

Although U.S. mental health treatment rates increased in the 2000s, gaps in treatment among racial-ethnic groups grew. Little is known, however, about national trends after 2012, when treatment access increased overall. This study assessed trends in racial-ethnic disparities in past-year treatment rates among people with a major depressive episode, serious psychological distress, or serious mental illness. National Survey on Drug Use and Health (2005–2019) data of adults with a past-year major depressive episode (N=49,791) or serious psychological distress (N=89,233) and of adults with past-year serious mental illness (N=24,944; 2008–2019) were analyzed. Linear risk regressions were used to model trends in past-year use of mental health treatment and included an interaction term between survey year and race-ethnicity. Treatment use prevalence (2005–2019) among marginalized individuals with a major depressive episode remained lower than that among White people. The magnitude of the disparity in treatment use between White and Hispanic people with major depressive episode decreased slightly (percentage-point difference=−25.1% to −14.9%), whereas the disparity in treatment use between White people and American Indian/Alaska Native people with serious mental illness increased significantly (percentage-point difference=23.4% to −12.2%), from 2005 to 2019. The magnitude of the disparities for other marginalized racial-ethnic groups did not meaningfully change. Racial-ethnic disparities in past-year mental health treatment use have persisted. Efforts to reduce disparities should consider structural barriers that hinder treatment use among marginalized groups. [ABSTRACT FROM AUTHOR]

Alcohol use, binge drinking, and alcohol use disorders have been increasing among older adults in the US population, including adults over 50 as well as adults over 65. Increases in consumption are sharper among women, and among those who use additional substances such as cannabis, and those who are relatively healthy in older adulthood (i.e. those without multimorbidites). This commentary describes these trends as well as provides hypotheses, and the data underlying them, for both supply-side (alcohol marketing and messaging) and demand-side (healthier aging, increased financial stress) potential drivers of these increases. The need for additional resources and focus on older adult drinking is increasingly urgent, as alcohol-attributable deaths escalate among older adults in the United States. • Older adults over the last 20 years are increasingly consuming alcohol, binge drinking, and reporting alcohol use disorders. • The magnitude of the increase is concentrated among women, and those with co-occurring other substance use such as cannabis. • Reasons for the increases are multifactorial and involve supply- and demand-side. • Since 1999, deaths fully attributable to alcohol in the United States have increased. [ABSTRACT FROM AUTHOR]

Background: Understanding time trends in risk factors for substance use may contextualize and explain differing time trends in substance use. Methods: We examined data (N = 536,291; grades 8/10/12) from Monitoring the Future, years 1991-2019. Using Latent Profile Analyses, we identified six time use patterns: one for those working at a paid job and the other five defined by levels of socialization (low/high) and engagement in structured activities like sports (engaged/disengaged), with the high social/engaged group split further by levels of unsupervised social activities. We tested associations between time use profiles and past two-week binge drinking as well as past-month alcohol use, cigarette use, cannabis use, other substance use, and vaping. We examined trends and group differences overall and by decade (or for vaping outcomes, year). Results: Prevalence of most substance use outcomes decreased over time among all groups. Cannabis use increased, with the largest increase in the group engaged in paid employment. Vaping substantially increased, with the highest nicotine vaping increase in the high social/engaged group with less supervision and the highest cannabis vaping increase in the highly social but otherwise disengaged group. Substance use was lowest in the low social groups, highest in the high social and employed groups. Conclusions: While alcohol, cigarette, and other substance use have declined for all groups, use remained elevated given high levels of social time, especially with low engagement in structured activities or low supervision, or paid employment. Cannabis use and vaping are increasing across groups, suggesting the need for enhanced public health measures. [ABSTRACT FROM AUTHOR]

Purpose: The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic is associated with worsening mental health among young adults, but further research is necessary to quantify the associations with depression and anxiety. Methods: Using Monitoring the Future data (N = 1244 young adults, modal age: 19, Fall 2020 supplement), we examined internalizing symptoms (Patient Health Questionnaire‐8 and Generalized Anxiety Disorder Scale‐7 separately), dividing the sample into those without clinically significant scores, significant scores but minimal pandemic‐attributed symptoms, and significant scores with substantial pandemic‐attributed symptoms. Logistic regression analyses linked demographic factors, pandemic‐related experiences, and coping methods to symptom groups. Results: Internalizing symptoms were highly prevalent, with many occurring among a majority at least several days over the past 2 weeks. Major changes in education, employment, and resource availability predicted elevated symptom risk (e.g., lacking a place to sleep or money for rent, gas, or food led to 4.43 [95% confidence interval: 2.59–7.55] times the risk of high depressive symptoms significantly attributed to the pandemic). High internalizing symptoms were linked to underutilization of healthy coping behaviors, substance use overutilization, and dietary changes. High depressive and anxious symptoms attributed to the pandemic were marked by high levels of taking breaks from the news/social media and contacting healthcare providers. Conclusions: The pandemic's associations with young adults' depressive and anxious symptoms warrants urgent attention through improved mental health treatment infrastructure and stronger structural support. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.Aims: To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.Method: Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.Results: Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease.Conclusions: In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.Declaration Of Interest: I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee. [ABSTRACT FROM AUTHOR]

Background: Prevention of PTSD requires identification of subpopulations contributing most to the population burden of PTSD. This study examines the relative contribution of subthreshold PTSD and probable PTSD on future PTSD in a representative military cohort.Methods: We analyze data on 3,457 U.S. National Guard members from the state of Ohio, assessed by telephone annually from 2008 to 2014. At each wave, participants were classified into one of three groups based on the PTSD Checklist: probable PTSD (DSM-IV-TR criteria), subthreshold PTSD (Criterion A1, at least one symptom in each cluster, symptom lasting longer than 30 days, and functional impairment), and no PTSD. We calculated the exposure rate, risk ratio (RR), and population attributable fraction (PAF) to determine the burden of future probable PTSD attributable to subthreshold PTSD compared to probable PTSD.Results: The annualized prevalence of subthreshold PTSD and probable PTSD was respectively 11.9 and 5.0%. The RR for probable PTSD was twice as great among respondents with probable PTSD the prior interview than that of those with subthreshold PTSD (7.0 vs. 3.4); however, the PAF was considerably greater in participants with subthreshold PTSD the prior interview (PAF = 35%; 95% confidence interval (CI) = 26.0-42.9%) than in those with probable PTSD (PAF = 28.0%; 95% CI = 21.8-33.8%). Results were robust to changes in subthreshold PTSD definition.Conclusions: Subthreshold PTSD accounted for a substantial proportion of this population's future PTSD burden. Population-based preventive interventions, compared to an approach focused exclusively on cases of diagnosable PTSD, is likely to affect the greatest reduction in this population's future PTSD burden. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To conduct a systematic review and meta‐analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past‐month marijuana use prevalence among adolescents. Methods: A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta‐analyzed. Estimates of MML effects on any past‐month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non‐MML states over comparable time‐periods. These estimates were standardized and entered into a meta‐analysis model with fixed‐effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F‐test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Results: None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non‐MML states for marijuana use prevalence among adolescents. The meta‐analysis yielded a non‐significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non‐MML states on pre‐MML differences and all found higher rates of past‐month marijuana use in MML states pre‐MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non‐significant results, although limited heterogeneity may warrant further study. Conclusions: Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions. [ABSTRACT FROM AUTHOR]

Despite a well-established social gradient for many mental disorders, there is evidence that individuals near the middle of the social hierarchy suffer higher rates of depression and anxiety than those at the top or bottom. Although prevailing indicators of socioeconomic status ( SES) cannot detect or easily explain such patterns, relational theories of social class, which emphasise political-economic processes and dimensions of power, might. We test whether the relational construct of contradictory class location, which embodies aspects of both ownership and labour, can explain this nonlinear pattern. Data on full-time workers from the National Epidemiologic Survey on Alcohol and Related Conditions ( n = 21859) show that occupants of contradictory class locations have higher prevalence and odds of depression and anxiety than occupants of non-contradictory class locations. These findings suggest that the effects of class relations on depression and anxiety extend beyond those of SES, pointing to under-studied mechanisms in social epidemiology, for example, domination and exploitation. [ABSTRACT FROM AUTHOR]

No population-representative US study has examined how lifetime exposure to gender-based violence (GBV) is related to a broad range of mood/anxiety and substance use disorders. The current study advances the literature by examining the relative contributions of developmental timing of earliest GBV exposure and amount of lifetime GBV exposure on risk for eight mood/anxiety and ten substance use disorders. Participants were 20,089 women from wave 2 (2004-2005) of the National Epidemiologic Survey of Alcohol and Related Conditions. Women reporting lifetime GBV (25%; n = 5284) had 3.6 and 2.5 times the odds of meeting lifetime mood/anxiety and substance use disorder criteria, respectively. Number of types and number of incidents of GBV were associated with risk for both types of disorders in a dose-response fashion; when examined simultaneously, number of types of GBV was the stronger predictor of mood/anxiety and substance use disorders. Relative to those who first experienced GBV during adulthood, first exposure during childhood and adolescence was associated with increased risk for mood/anxiety and substance use disorders. One in four women reported lifetime GBV, which had pernicious effects on mood/anxiety and substance use disorders, particularly for women who had experienced multiple types of GBV. The GBV effect varied by developmental period of exposure. Prevention of GBV is critical to reducing its burden. Among those exposed to GBV, clinicians should consider assessing a range of disorders and providing integrated treatment targeting multiple outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study. Design Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities. Setting National Epidemiologic Survey on Alcohol and Related Conditions ( NESARC). Participants NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence ( n = 1172) and nicotine dependence ( n = 4017). Measurements Alcohol Use Disorder and Associated Disabilities Interview Schedule ( AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce). Findings Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio ( AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence ( AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence ( AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence ( AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk ( AOR = 1.19-1.36; 95% CI = 1.11-1.56). Conclusions A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence. [ABSTRACT FROM AUTHOR]

Objectives. We examined whether neighborhood social characteristics (income distribution and family fragmentation) and physical characteristics (clean sidewalks and dilapidated housing) were associated with the risk of fatalities caused by analgesic overdose. Methods. In a case-control study, we compared 447 unintentional analgesic opioid overdose fatalities (cases) with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities (controls) occurring in 59 New York City neighborhoods between 2000 and 2006. Results. Analgesic overdose fatalities were less likely than nonoverdose unintentional fatalities to have occurred in higher-income neighborhoods (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.70, 0.96) and more likely to have occurred in fragmented neighborhoods (OR = 1.35; 95% CI = 1.05, 1.72). They were more likely than heroin overdose fatalities to have occurred in higher-income (OR = 1.31; 95% CI = 1.12, 1.54) and less fragmented (OR = 0.71; 95% CI = 0.55, 0.92) neighborhoods. Conclusions. Analgesic overdose fatalities exhibit spatial patterns that are distinct from those of heroin and nonoverdose unintentional fatalities. Whereas analgesic fatalities typically occur in lower-income, more fragmented neighborhoods than nonoverdose fatalities, they tend to occur in higher-income, less unequal, and less fragmented neighborhoods than heroin fatalities. [ABSTRACT FROM AUTHOR]

An estimated 80% of sexually active young women in the United States use hormonal contraceptives during their reproductive years. Associations between hormonal contraceptive use and mood disturbances remain understudied, despite the hypothesis that estrogen and progesterone play a role in mood problems. In this study, we used data from 6,654 sexually active nonpregnant women across 4 waves of the National Longitudinal Study of Adolescent Health (1994–2008), focusing on women aged 25–34 years. Women were asked about hormonal contraceptive use in the context of a current sexual partnership; thus, contraceptive users were compared with other sexually active women who were using either nonhormonal contraception or no contraception. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. At ages 25–34 years, hormonal contraceptive users had lower mean levels of concurrent depressive symptoms (β = −1.04, 95% confidence interval: −1.73, −0.35) and were less likely to report a past-year suicide attempt (odds ratio = 0.37, 95% confidence interval: 0.14, 0.95) than women using low-efficacy contraception or no contraception, in models adjusted for propensity scores for hormonal contraceptive use. Longitudinal analyses indicated that associations between hormonal contraception and depressive symptoms were stable. Hormonal contraception may reduce levels of depressive symptoms among young women. Systematic investigation of exogenous hormones as a potential preventive factor in psychiatric epidemiology is warranted. [ABSTRACT FROM PUBLISHER]

We examined associations between stressful life events and relapse among adults in the United States with at least 1 year of remission from DSM-IV alcohol dependence. The sample consisted of individuals in remission from alcohol dependence at the Wave 1 interview (2001–2002) for the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who also participated in a Wave 2 interview (2004–2005; N = 1,707). Associations between stressful life events, demographic variables, and the binary outcome of alcohol dependence relapse were examined with multiple logistic regression models. After adjustment for potential confounders, respondents who were divorced or separated in the year preceding the baseline assessment (Wave 1) were over two times more likely (OR = 2.32; CI = 1.01–5.34) to have relapsed 3 years later (Wave 2), compared to those not experiencing a divorce/separation in the 12 months prior to Wave 1. No other stressful life event was associated with relapse. Findings suggest that formerly alcohol dependent adults are at increased risk for relapse following divorce/separation. These results highlight the need for social work practitioners to consider the possibility of relapse following a divorce when one or both partners have a history of alcohol dependence. [ABSTRACT FROM PUBLISHER]

Abstract: Understanding current patterns of population smoking by socioeconomic position (SEP) can be substantially enhanced by research that follows birth cohorts over long periods of time, yet such data in the US are rare. Information from birth cohorts followed during critical time periods when the health consequences of smoking became widely known can inform the ways in which current smoking prevalence has been shaped by the historical processes that preceded it. The present study utilizes data from a substudy of the Child Health and Development Study pregnancy cohort (N =1612). Women were queried about smoking status in 1959–1962, 1971–1972 and 1977–1980. Women were divided into three cohorts based on date of birth. Offspring represented another birth cohort assessed for smoking in 1977–1980. Results indicated that the overall prevalence of smoking exhibited cohort-specific patterns that persisted across time. Notably, the youngest maternal cohort (born 1937–1946) had high smoking prevalence throughout and showed no appreciable decrease (44.7%, 41.4%, 40.1% for 1959–1962, 1971–1972, and 1977–1980). Results also indicated that the relation of smoking to SEP exhibited cohort-specific patterns over time. Among the oldest birth cohort (born 1914–1930), no inverse relation of SEP to smoking was observed at any time; in contrast, an inverse relation emerged by 1959–1962 among the youngest cohort of mothers. Among the adolescent offspring, there was a strong SEP gradient (OR=2.0, 95% CI=1.4–3.0) that was stronger than in any maternal birth cohort at any assessment (β =0.40, SE=0.1, p <0.01). We conclude that SEP gradients in smoking emerge across birth cohorts rather than time alone, with increasingly strong gradients across time especially among younger cohorts. [Copyright &y& Elsevier]

ABSTRACT Aims Studies of the relationship between social norms and marijuana use have generally focused on individual attitudes, leaving the influence of larger societal-level attitudes unknown. The present study investigated societal-level disapproval of marijuana use defined by birth cohort or by time-period. Design Combined analysis of nationally representative annual surveys of secondary school students in the United States conducted from 1976 to 2007 as part of the Monitoring the Future study. Setting In-school surveys completed by adolescents in the United States. Participants A total of 986 003 adolescents in grades 8, 10 and 12. Measurements Main predictors included the percentage of students who disapproved of marijuana in each birth cohort and time-period. Multi-level models with individuals clustered in time-periods of observation and birth cohorts were modeled, with past-year marijuana use as the outcome. Findings Results indicated a significant and strong effect of birth cohort disapproval of marijuana use in predicting individual risk of marijuana use, after controlling for individual-level disapproval, perceived norms towards marijuana and other characteristics. Compared to birth cohorts in which most (87-90.9%) adolescents disapproved of marijuana use, odds of marijuana use were 3.53 times higher in cohorts where fewer than half (42-46.9%) disapproved (99% confidence interval: 2.75, 4.53). Conclusions Individuals in birth cohorts that are more disapproving of marijuana use are less likely to use, independent of their personal attitudes towards marijuana use. Social norms and attitudes regarding marijuana use cluster in birth cohorts, and this clustering has a direct effect on marijuana use even after controlling for individual attitudes and perceptions of norms. [ABSTRACT FROM AUTHOR]

Background: Recent research suggests that adding a quantity/frequency alcohol consumption measure to diagnoses of alcohol use disorders may improve construct validity of the diagnoses for Diagnostic and Statistical Manual of Mental and Behavior Disorders (DSM-V). This study explores the epidemiological impact of including weekly at-risk drinking (WAD) in the DMS-IV diagnostic definition of alcohol dependence via 3 hypothetical reformulations of the current criteria. Methods: The sample was the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample with 43,093 adults aged >18 in the U.S interviewed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule IV. The current (DSM-IV) definition of alcohol dependence was compared with 4 hypothetical alcohol dependence reformulations that included WAD: (1) WAD added as an eighth criteria; (2) WAD required for a diagnosis; (3) adding abuse and dependence criteria together, and including WAD with a 3 of 12 symptom threshold; (4) adding abuse and dependence criteria together, and including WAD with a 5 of 12 symptom threshold. Results: The inclusion of at-risk drinking as an eighth criterion of alcohol dependence has a minimal impact on the sociodemographic correlates of alcohol dependence but substantially increases the prevalence of dependence (from 3.8% to 5.0%). At-risk drinking as a required criterion or as part of a diagnosis that combines abuse with dependence criteria with a higher threshold (5+ criteria) decreases prevalence and has a larger impact on sociodemographic correlates. Blacks, Hispanics, and women are less likely to be included in diagnostic reformulations that include WAD, whereas individuals with low-income and education are more likely to remain diagnosed. Conclusions: Including WAD as either a requirement of diagnosis or as an additional criterion would have a large impact on the prevalence of alcohol dependence in the general population. The inclusion of a quantity/frequency requirement may eliminate false positives from studies of alcohol disorder etiology and improve phenotype definition for genetic association studies by reducing heterogeneity in the diagnosis, but may also reduce eligibility for treatment services among women and racial/ethnic minorities compared. [ABSTRACT FROM AUTHOR]

Abstract: Background: Ecstasy use is prevalent among young people and often co-occurs with other drug use, but little is known about the past 12-month and lifetime psychiatric comorbidity and specific additional drug abuse among young adult ecstasy users in the general population. To provide this information, we compared current ecstasy users to former users, other illicit drug users, and non-illicit drug users. Method: Data were gathered in a face-to-face survey of the United States conducted in the 2001–2002 (NESARC). Participants were household and group quarters residents aged 18–29 years (n =8666). We measured current ecstasy use defined as any use in the past year; former ecstasy use as use prior to the past year only; other lifetime drug use included any drug other than ecstasy; lifetime non-illicit drug use as no illicit drug use. Associations were determined for nine other classes of illicit drugs, eight personality disorders, and seven mood and anxiety disorders. Results: Of current ecstasy users, 44% used >3 other classes of illicit drugs in the past year, compared to 1.6% of non-ecstasy drug users. Current ecstasy use was associated with current anxiety (OR=3.7), specifically panic disorder (OR=7.7) and specific phobia (OR=4.1), also alcohol abuse (OR=21.6) and dependence (OR=4.1) and any personality disorder (OR=5.1) compared to non-illicit drug users. Conclusions: Results indicate important differences in comorbidities of current and former ecstasy users compared to other drug users and lifetime non-illicit drug users that may affect phenotype definitions and etiologic studies. Ecstasy use may represent a distinct population of drug users for which unique treatments may be necessary. [Copyright &y& Elsevier]

Background National trends in adolescent’s marijuana risk perceptions are traditionally used as a predictor of concurrent and future trends in adolescent marijuana use. We test the validity of this practice during a time of rapid marijuana policy change. Methods Two repeated cross-sectional U.S. nationally-representative surveys of 8th, 10th, and 12th-graders: Monitoring the Future (MTF) (1991–2015; N = 1,181,692) and National Survey on Drug Use and Health (NSDUH) (2002–2014; N = 113,317). We examined trends in the year-to-year prevalence of perceiving no risk of harm in using marijuana regularly, and prevalence of regular marijuana use within the previous month. A piecewise linear regression model tested for a change in the relationship between trends. Similar analyses examined any past-month use and controlled for demographic characteristics. Results Among MTF 12th-graders, the prevalence of regular marijuana use and risk perceptions changed similarly between 1991 and 2006 but diverged sharply afterward. The prevalence of regular marijuana use increased by ∼1 percentage point to 6.03% by 2015. In contrast, the proportion of 12th-graders that perceived marijuana as posing no risk increased over 11 percentage points to 21.39%. A similar divergence was found among NSDUH 12th-graders and other grades, for any past month marijuana use, and when controlling demographic characteristics. Conclusions An increase in adolescent marijuana use has not accompanied recent rapid decreases in marijuana risk perceptions. Policy makers may consider broader prevention strategies in addition to targeting marijuana risk perceptions. Further monitoring of predictors of marijuana use trends is needed as states legalize recreational marijuana use. [ABSTRACT FROM AUTHOR]

Background Although childhood adversities (CAs) are known to be associated with later suicidal behavior, it is uncertain whether the timing of specific CAs may influence this association. Methods We analyzed nationally representative data for 9205 participants from the Korean Welfare Panel Study. Four different CAs (parental death, parental divorce, suspension of school education and being raised in a relative's house due to financial strain) were assessed and were categorized as early childhood and adolescent onset. Lifetime experiences of suicidal behaviors along with the age of the first time experience were recorded. Cox regression was used. Results After adjusting for age, sex, and childhood socioeconomic status, parental death before the age of 12 was associated with adulthood suicidal behavior (ideation HR 1.35, 95% CI 1.13, 1.61; attempt HR 1.60, 95% CI 1.02, 2.52), while suspension of school due to financial strain was associated with suicidal behavior when it occurred at adolescence (ideation HR 1.48, 95% CI 1.22, 1.79; plan HR 1.69, 95% CI 1.16, 2.48). When we also adjusted for adulthood SES, which is a potential mediator, there was no significant change except that the association between early parental death and suicidal attempt became non-significant (HR: 1.43, 95% CI: 0.92, 2.26). Limitations Experience of CA was assessed retrospectively, and the assessment of suicidal attempt was not specifically defined. There could be selection bias due to loss to the follow-up. Conclusions There may be a critical period for the effect of CA on later suicidal behavior depending on the characteristics of CA. [ABSTRACT FROM AUTHOR]

Background: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas.Methods: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and what factors were associated with death from prescription opioids vs. heroin, historically the most prevalent form of opioid overdose in urban areas.Results: Analgesic-induced overdose fatalities were the only types of overdose fatalities to increase in 1990-2006 in NYC; the fatality rate increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006. Whites and Latinos were the only racial/ethnic groups to exhibit an increase in overdose-related mortality. Relative to heroin overdose decedents, analgesic and methadone overdose decedents were more likely to be female and to concurrently use psychotherapeutic drugs, but less likely to concurrently use alcohol or cocaine. Analgesic overdose decedents were less likely to be Black or Hispanic, while methadone overdose decedents were more likely to be Black or Hispanic in contrast to heroin overdose decedents.Conclusions: The distinct epidemiologic profiles exhibited by analgesic and methadone overdose fatalities highlight the need to define drug-specific public health prevention efforts. [ABSTRACT FROM AUTHOR]

Abstract: Background: There has been a significant increase in opioid prescriptions and the prevalence of opioid nonmedical use. Nonmedical use may lead to opioid abuse/dependence, a serious public health concern. The aim of this paper was to determine the mental and physical health predictors of incident nonmedical prescription opioid use (NMPOU) and abuse/dependence, and the impact of comorbidity in a longitudinal, nationally representative sample. Methods: Data come from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N =34,653; ≥20 years old). Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV edition. Physical conditions were based on self-reports of physician-diagnoses. Multiple logistic regression models examined the associations between mental and physical health predictors at Wave 1 and their association to incident NMPOU and abuse/dependence disorders at Wave 2. Results: After adjusting for sociodemographics, Axis I and II mental disorders and physical conditions, the presence of mental disorders (i.e., mood, personality disorders and substance use disorders), physical conditions (i.e., increasing number of physical conditions, any physical condition, arteriosclerosis or hypertension, cardiovascular disease and arthritis) and sociodemographic factors (i.e., sex and marital status) at Wave 1 positively predicted incident abuse/dependence at Wave 2. Comorbid disorders increased the risk of NMPOU and abuse/dependence. Conclusion: These results suggest the importance of mental and physical comorbidity as a risk for NMPOU and abuse/dependence, emphasizing the need for careful screening practices when prescribing opioids. [Copyright &y& Elsevier]

Abstract: Objective: To compare the prevalence of suicidal ideation/attempts among Hispanic subgroups in the US in 1991–1992 and 2001–2002, and identify high-risk groups. Method: Data were drawn from the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES, n = 42,862) and the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 43,093), two nationally representative surveys of individuals aged 18 years and older. Results: 1) Puerto Ricans are the Hispanic ethnic subgroup with the highest rates of suicide attempts; 2) 45- to 64-year-old Puerto Rican women are a high-risk group for suicide attempts; 3) Over the 10 year period between the two surveys, the lifetime prevalence of suicide attempts significantly increased among 18- to 24-year-old Puerto Rican women and Cuban men, and among 45- to 64-year-old Puerto Rican men. Conclusion: Hispanics in the US are not a homogeneous group. We identify high-risk groups among Hispanics. Specific interventions for subgroups of Hispanics at high risk for suicidal behaviors may be required. [Copyright &y& Elsevier]