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1. Assessment of Anti-SARS-CoV-2 antibody levels among university students vaccinated with different COVID-19 primary and booster doses — fall 2021, Wisconsin

Author

Peter M. DeJonge, Anastasia S. Lambrou, Hannah E. Segaloff, Allen Bateman, Alana Sterkel, Carol Griggs, Jake Baggott, Patrick Kelly, Natalie Thornburg, Monica Epperson, Rodel Desamu-Thorpe, Glen Abedi, Christopher H. Hsu, Jasmine Y. Nakayama, Jasmine Ruffin, Darlene Turner-Harper, Almea Matanock, Olivia Almendares, Melissa Whaley, Ayan Chakrabarti, Kyle DeGruy, Michele Daly, Ryan Westergaard, Jacqueline E. Tate, and Hannah L. Kirking

Subjects
COVID-19 vaccines, Heterologous boosters, SARS-CoV-2 serology, Meso scale discovery, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background University students commonly received COVID-19 vaccinations before returning to U.S. campuses in the Fall of 2021. Given likely immunologic variation among students based on differences in type of primary series and/or booster dose vaccine received, we conducted serologic investigations in September and December 2021 on a large university campus in Wisconsin to assess anti-SARS-CoV-2 antibody levels. Methods We collected blood samples, demographic information, and COVID-19 illness and vaccination history from a convenience sample of students. Sera were analyzed for both anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibody levels using World Health Organization standardized binding antibody units per milliliter (BAU/mL). Levels were compared across categorical primary COVID-19 vaccine series received and binary COVID-19 mRNA booster status. The association between anti-S levels and time since most recent vaccination dose was estimated by mixed-effects linear regression. Results In total, 356 students participated, of whom 219 (61.5%) had received a primary vaccine series of Pfizer-BioNTech or Moderna mRNA vaccines and 85 (23.9%) had received vaccines from Sinovac or Sinopharm. Median anti-S levels were significantly higher for mRNA primary vaccine series recipients (2.90 and 2.86 log [BAU/mL], respectively), compared with those who received Sinopharm or Sinovac vaccines (1.63 and 1.95 log [BAU/mL], respectively). Sinopharm and Sinovac vaccine recipients were associated with a significantly faster anti-S decline over time, compared with mRNA vaccine recipients (P

Published
2023
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2. Travel history among persons infected with SARS-CoV-2 variants of concern in the United States, December 2020—February 2021

Author

Alicia Dunajcik, Kambria Haire, Jennifer D. Thomas, Leah F. Moriarty, Yuri Springer, Julie M. Villanueva, Adam MacNeil, Benjamin Silk, Jeffrey B. Nemhauser, Ramona Byrkit, Melanie Taylor, Krista Queen, Suxiang Tong, Justin Lee, Dhwani Batra, Clinton Paden, Tiffany Henderson, Audrey Kunkes, Mojisola Ojo, Melanie Firestone, Lindsey Martin Webb, Melissa Freeland, Catherine M. Brown, Thelonious Williams, Krisandra Allen, Judy Kauerauf, Erica Wilson, Seema Jain, Eric McDonald, Elana Silver, Sarah Stous, Debra Wadford, Rachel Radcliffe, Chandra Marriott, Jennifer P. Owes, Stephen M. Bart, Lynn E. Sosa, Kelly Oakeson, Natalie Wodniak, Julia Shaffner, Quanta Brown, Ryan Westergaard, Andrea Salinas, Sara Hallyburton, Yasmin Ogale, Tabatha Offutt-Powell, Kimberly Bonner, Sheri Tubach, Clay Van Houten, Victoria Hughes, Valerie Reeb, Chris Galeazzi, Shreya Khuntia, Sasha McGee, Joseph T. Hicks, Dimple Dinesh Patel, Anna Krueger, Scott Hughes, Fabiana Jeanty, Jade C. Wang, Ellen H. Lee, Tracey Assanah-Deane, Megan Tompkins, Kendra Dougherty, Ozair Naqvi, Matthew Donahue, Justin Frederick, Baha Abdalhamid, Ann M. Powers, and Mark Anderson

Subjects
Public aspects of medicine, RA1-1270
Abstract

The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs.

Published
2023

3. Shedding of infectious SARS-CoV-2 despite vaccination.

Author

Kasen K Riemersma, Luis A Haddock, Nancy A Wilson, Nicholas Minor, Jens Eickhoff, Brittany E Grogan, Amanda Kita-Yarbro, Peter J Halfmann, Hannah E Segaloff, Anna Kocharian, Kelsey R Florek, Ryan Westergaard, Allen Bateman, Gunnar E Jeppson, Yoshihiro Kawaoka, David H O'Connor, Thomas C Friedrich, and Katarina M Grande

Subjects
Immunologic diseases. Allergy, RC581-607, Biology (General), QH301-705.5
Abstract

The SARS-CoV-2 Delta Variant of Concern is highly transmissible and contains mutations that confer partial immune escape. The emergence of Delta in North America caused the first surge in COVID-19 cases after SARS-CoV-2 vaccines became widely available. To determine whether individuals infected despite vaccination might be capable of transmitting SARS-CoV-2, we compared RT-PCR cycle threshold (Ct) data from 20,431 test-positive anterior nasal swab specimens from fully vaccinated (n = 9,347) or unvaccinated (n = 11,084) individuals tested at a single commercial laboratory during the interval 28 June- 1 December 2021 when Delta variants were predominant. We observed no significant effect of vaccine status alone on Ct value, nor when controlling for vaccine product or sex. Testing a subset of low-Ct (

Published
2022
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4. Predictors of skin and soft tissue infections among sample of rural residents who inject drugs

Author

Amelia Baltes, Wajiha Akhtar, Jen Birstler, Heidi Olson-Streed, Kellene Eagen, David Seal, Ryan Westergaard, and Randall Brown

Subjects
Skin and soft tissue infections, People who inject drugs, Heroin, Opioid, Methamphetamine, Injection drug use, Public aspects of medicine, RA1-1270
Abstract

Abstract Introduction Skin and soft tissue infections (SSTIs) are among the leading causes of morbidity and mortality for people who inject drugs (PWID). Studies demonstrate that certain injection practices correlate with SSTI incidence among PWID. The opioid epidemic in the USA has particularly affected rural communities, where access to prevention and treatment presents unique challenges. This study aims to estimate unsafe injection practices among rural-dwelling PWID; assess treatments utilized for injection related SSTIs; and gather data to help reduce the overall risk of injection-related SSTIs. Methods Thirteen questions specific to SSTIs and injection practices were added to a larger study assessing unmet health care needs among PWID and were administered at six syringe exchange programs in rural Wisconsin between May and July 2019. SSTI history prevalence was estimated based on infections reported within one-year prior of response and was compared to self-reported demographics and injection practices. Results Eighty responses were collected and analyzed. Respondents were white (77.5%), males (60%), between the ages 30 and 39 (42.5%), and have a high school diploma or GED (38.75%). The majority of respondents (77.5%) reported no history of SSTI within the year prior to survey response. Females were over three times more likely to report SSTI history (OR = 3.07, p = 0.038) compared to males. Water sources for drug dilution (p = 0.093) and frequency of injecting on first attempt (p = 0.037), but not proper skin cleaning method (p = 0.378), were significantly associated with a history of SSTI. Injecting into skin (p = 0.038) or muscle (p = 0.001) was significantly associated with a history of SSTI. Injection into veins was not significantly associated with SSTI (p = 0.333). Conclusion Higher-risk injection practices were common among participants reporting a history of SSTIs in this rural sample. Studies exploring socio-demographic factors influencing risky injection practices and general barriers to safer injection practices to prevent SSTIs are warranted. Dissemination of education materials targeting SSTI prevention and intervention among PWID not in treatment is warranted.

Published
2020
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5. 'Service with open arms': enhancing community healthcare experiences for individuals with a history of incarceration

Author

Devin Walsh-Felz, Ryan Westergaard, Gabrielle Waclawik, and Nancy Pandhi

Subjects
Qualitative, Incarceration, Reentry, Healthcare, Public aspects of medicine, RA1-1270, Social pathology. Social and public welfare. Criminology, HV1-9960
Abstract

Abstract Background The criminal justice-involved population has a higher disease burden than the general population and a high risk of death post-incarceration. However, this group underutilizes healthcare, especially preventive and primary care services. Sixteen in-person, semi-structured interviews were conducted with formerly incarcerated individuals in Milwaukee to explore health impacts of incarceration, barriers and facilitators to healthcare access, and what ideal health service provision would look like following incarceration. Interviews were transcribed, coded, and analyzed using an immersion/crystallization approach. Results Overall, people perceived incarceration to have a negative impact on their physical and mental health and expressed dissatisfaction with care in correctional settings. Many faced lapses in care following incarceration, frequently due to insurance challenges. Conclusions Participants offered advice for designing an ideal clinic including formal coordination with corrections and provision of additional social services. Staff demeanor that created a welcoming and caring environment was highlighted as an important component and facilitator of care.

Published
2019
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6. Provider-Level and Other Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study of a Vulnerable Population.

Author

Yukyan Lam, Ryan Westergaard, Gregory Kirk, Azal Ahmadi, Andrew Genz, Jeanne Keruly, Heidi Hutton, and Pamela J Surkan

Subjects
Medicine, Science
Abstract

Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients' engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care "team." Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage.

Published
2016
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8. mHealth and social mediation: Mobile support among stigmatized people living with HIV and substance use disorder

Author

Fan ('Ellie') Yang, Dhavan V Shah, Alexander Tahk, Olivia Vjorn, Sarah Dietz, Klaren Pe-Romashko, Erika Bailey, Rachel E Gicquelais, Juwon Hwang, David H Gustafson, and Ryan Westergaard

Subjects
Sociology and Political Science, Communication
Abstract

The social mediation role of mobile technology is typified by mHealth apps designed to connect individuals to others and support substance use disorder (SUD) recovery. In this study, we examined the use and utility of one such app designed to support people living with HIV (PLWH) and SUD. Drawing on Ling’s emphasis on reciprocity and micro-coordination in mobile telephony as a social mediation technology, we gathered digital trace data from app logs to construct two metrics, initiation (i.e. whether a particular feature is engaged on a given day) and intensity (i.e. degree of involvement in the activity when engaged on that day), at three levels of communication—networked (one-to-many), dyadic (one-to-one), and intraindividual (self-to-self). We consider these system features alongside use of information resources, games and relaxation links, a meeting and events calendar, and support tools to address use urges. We found few differences in patterns of use by race, sex, and age, though African Americans were less likely to engage in intraindividual expression, whereas women and older users were more likely to make use of this feature. The initiation and intensity of network and dyadic reception, as well as the intensity of network expression, predicts recovery outcomes as measured on a weekly “check-in” survey, suggesting the utility of mobile log data for digital phenotyping in mHealth. By implementing this app during the COVID-19 pandemic, the study also found the disruption caused by national lockdown was negatively related to the app use.

Published
2023

9. Tracing the origin of SARS-CoV-2 Omicron-like Spike sequences detected in wastewater

Author

Martin M Shafer, Max J Bobholz, William C Vuyk, Devon A Gregory, Adelaide Roguet, Luis A Haddock Soto, Clayton Rushford, Kayley H Janssen, Hunter J Ries, Hannah E Pilch, Paige A Mullen, Rebecca B Fahney, Wanting Wei, Matthew Lambert, Jeff Wenzel, Peter Halfmann, Yoshihiro Kawaoka, Nancy A Wilson, Thomas C Friedrich, Ian W Pray, Ryan Westergaard, David H O'Connor, and Marc Johnson

Abstract

Background: The origin of divergent SARS-CoV-2 spike sequences found in wastewater, but not in clinical surveillance, remains unclear. These cryptic wastewater sequences have harbored many of the same mutations that later emerged in Omicron lineages. We first detected a cryptic lineage in municipal wastewater in Wisconsin in January 2022. Named the Wisconsin Lineage, we sought to determine the geographic origin of this virus and characterize its persistence and evolution over time. Methods: We systematically sampled maintenance holes to trace the origin of the Wisconsin Lineage. We sequenced spike RBD domains, and where possible, whole viral genomes, to characterize the evolution of this lineage over the 13 consecutive months that it was detectable. Findings: The persistence of the Wisconsin Lineage signal allowed us to trace it from a central wastewater plant to a single facility, with a high concentration of viral RNA. The viral sequences contained a combination of fixed nucleotide substitutions characteristic of Pango lineage B.1.234, which circulated in Wisconsin at low levels from October 2020 to February 2021, while mutations in the spike gene resembled those subsequently found in Omicron variants. Interpretation: We propose that prolonged detection of the Wisconsin Lineage in wastewater represents persistent shedding of SARS-CoV-2 from an infected individual, with ongoing within-host viral evolution leading to an ancestral B.1.234 virus accumulating Omicron-like mutations. Funding: The Rockefeller Foundation, Wisconsin Department of Health Services, Centers for Disease Control and Prevention (CDC), National Institute on Drug Abuse (NIDA), and the Center for Research on Influenza Pathogenesis and Transmission.

Published
2022

10. Evolution of a globally unique SARS-CoV-2 Spike E484T monoclonal antibody escape mutation in a persistently infected, immunocompromised individual

Author

Peter J Halfmann, Nicholas R Minor, Luis A Haddock III, Robert Maddox, Gage K Moreno, Katarina M Braun, David A Baker, Kasen K Riemersa, Ankur Prasad, Kirsten J Alman, Matthew C Lambert, Kelsey Florek, Allen Bateman, Ryan Westergaard, Nasia Safdar, David R Andes, Yoshihiro Kawaoka, Madiha Fida, Joseph D Yao, Thomas C Friedrich, and David H O’Connor

Subjects
Virology, Microbiology
Abstract

Prolonged infections in immunocompromised individuals may be a source for novel SARS-CoV-2 variants, particularly when both the immune system and antiviral therapy fail to clear the infection and enable within-host evolution. Here we describe a 486-day case of SARS-CoV-2 infection in an immunocompromised individual. Following monotherapy with the monoclonal antibody Bamlanivimab, the individual’s virus acquired resistance, likely via the earliest known occurrence of Spike amino acid variant E484T. Recently, E484T has arisen again as a derivative of E484A in the Omicron Variant of Concern, supporting the hypothesis that prolonged infections can give rise to novel variants long before they become prevalent in the human population.

Published
2022

11. Shedding of infectious SARS-CoV-2 despite vaccination

Author

Kasen K. Riemersma, Luis A. Haddock, Nancy A. Wilson, Nicholas Minor, Jens Eickhoff, Brittany E. Grogan, Amanda Kita-Yarbro, Peter J. Halfmann, Hannah E. Segaloff, Anna Kocharian, Kelsey R. Florek, Ryan Westergaard, Allen Bateman, Gunnar E. Jeppson, Yoshihiro Kawaoka, David H. O’Connor, Thomas C. Friedrich, and Katarina M. Grande

Subjects
Delta, Cycle threshold, COVID-19 Vaccines, business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Immunology, Vaccination, Immune escape, Outbreak, COVID-19, Viral Vaccines, Microbiology, Virology, Immunization, Genetics, Medicine, Humans, Parasitology, business, Molecular Biology, Viral load
Abstract

The SARS-CoV-2 Delta Variant of Concern is highly transmissible and contains mutations that confer partial immune escape. The emergence of Delta in North America caused the first surge in COVID-19 cases after SARS-CoV-2 vaccines became widely available. To determine whether individuals infected despite vaccination might be capable of transmitting SARS-CoV-2, we compared RT-PCR cycle threshold (Ct) data from 20,431 test-positive anterior nasal swab specimens from fully vaccinated (n = 9,347) or unvaccinated (n=11,084) individuals tested at a single commercial laboratory during the interval 28 June – 1 December 2021 when Delta variants were predominant. We observed no significant effect of vaccine status alone on Ct value, nor when controlling for vaccine product or sex. Testing a subset of low-Ct (

Published
2021

13. Performance of an Antigen-Based Test for Asymptomatic and Symptomatic SARS-CoV-2 Testing at Two University Campuses - Wisconsin, September-October 2020

Author

Ian W, Pray, Laura, Ford, Devlin, Cole, Christine, Lee, John Paul, Bigouette, Glen R, Abedi, Dena, Bushman, Miranda J, Delahoy, Dustin, Currie, Blake, Cherney, Marie, Kirby, Geroncio, Fajardo, Motria, Caudill, Kimberly, Langolf, Juliana, Kahrs, Patrick, Kelly, Collin, Pitts, Ailam, Lim, Nicole, Aulik, Azaibi, Tamin, Jennifer L, Harcourt, Krista, Queen, Jing, Zhang, Brett, Whitaker, Hannah, Browne, Magdalena, Medrzycki, Patricia, Shewmaker, Jennifer, Folster, Bettina, Bankamp, Michael D, Bowen, Natalie J, Thornburg, Kimberly, Goffard, Brandi, Limbago, Allen, Bateman, Jacqueline E, Tate, Douglas, Gieryn, Hannah L, Kirking, Ryan, Westergaard, Marie, Killerby, and Phili, Wong

Subjects
Adult, Male, Emergency Use Authorization, medicine.medical_specialty, Health (social science), Adolescent, Universities, Epidemiology, Student Health Services, Health, Toxicology and Mutagenesis, Population, 01 natural sciences, Asymptomatic, Sensitivity and Specificity, 03 medical and health sciences, Young Adult, 0302 clinical medicine, COVID-19 Testing, Wisconsin, Health Information Management, Antigen, Internal medicine, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, education, Antigens, Viral, Asymptomatic Diseases, education.field_of_study, Viral culture, business.industry, SARS-CoV-2, 010102 general mathematics, COVID-19, General Medicine, Middle Aged, Specimen collection, Nasal Swab, Female, medicine.symptom, business
Abstract

Antigen-based tests for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), are inexpensive and can return results within 15 minutes (1). Antigen tests have received Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for use in asymptomatic and symptomatic persons within the first 5-12 days after symptom onset (2). These tests have been used at U.S. colleges and universities and other congregate settings (e.g., nursing homes and correctional and detention facilities), where serial testing of asymptomatic persons might facilitate early case identification (3-5). However, test performance data from symptomatic and asymptomatic persons are limited. This investigation evaluated performance of the Sofia SARS Antigen Fluorescent Immunoassay (FIA) (Quidel Corporation) compared with real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection among asymptomatic and symptomatic persons at two universities in Wisconsin. During September 28-October 9, a total of 1,098 paired nasal swabs were tested using the Sofia SARS Antigen FIA and real-time RT-PCR. Virus culture was attempted on all antigen-positive or real-time RT-PCR-positive specimens. Among 871 (79%) paired swabs from asymptomatic participants, the antigen test sensitivity was 41.2%, specificity was 98.4%, and in this population the estimated positive predictive value (PPV) was 33.3%, and negative predictive value (NPV) was 98.8%. Antigen test performance was improved among 227 (21%) paired swabs from participants who reported one or more symptoms at specimen collection (sensitivity = 80.0%; specificity = 98.9%; PPV = 94.1%; NPV = 95.9%). Virus was isolated from 34 (46.6%) of 73 antigen-positive or real-time RT-PCR-positive nasal swab specimens, including two of 18 that were antigen-negative and real-time RT-PCR-positive (false-negatives). The advantages of antigen tests such as low cost and rapid turnaround might allow for rapid identification of infectious persons. However, these advantages need to be balanced against lower sensitivity and lower PPV, especially among asymptomatic persons. Confirmatory testing with an FDA-authorized nucleic acid amplification test (NAAT), such as RT-PCR, should be considered after negative antigen test results in symptomatic persons, and after positive antigen test results in asymptomatic persons (1).

Published
2020

14. Contributors

Author

Charles S. Abrams, Mark J. Abzug, Horacio E. Adrogué, Tod C. Aeby, Lee Akst, Mahboob Alam, Brian K. Albertson, Madson Q. Almeida, Girish Anand, Deverick J. Anderson, Kelley P. Anderson, Emmanuel Andrès, Gregory M. Anstead, Aydin Arici, Ann M. Aring, Isao Arita, Cecilio Azar, Masoud Azodi, Adrianne Williams Bagley, Justin Bailey, Federico Balagué, Ashok Balasubramanyam, Arna Banerjee, Nurcan Baykam, Meg Begany, David I. Bernstein, John P. Bilezikian, Federico Bilotta, Natalie C. Blevins, Roberta C. Bogaev, Diana Bolotin, Mary Ann Bonilla, Zuleika L. Bonilla-Martinez, David Borenstein, Patrick Borgen, Krystene I. Boyle, Mark E. Brecher, Sylvia L. Brice, Patricia D. Brown, Patrick Brown, Richard B. Brown, Peter Buckley, Irina Burd, Diego Cadavid, Grant R. Caddy, Thomas R. Caraccio, Enrique V. Carbajal, Steve Carpenter, Petros E. Carvounis, Donald O. Castell, Alvaro Cervera, Lawrence Chan, Miriam M. Chan, Emery L. Chen, Venkata Sri Cherukumilli, Meera Chitlur, Saima Chohan, Peter E. Clark, Claus-Frenz Claussen, Keith K. Colburn, Gary C. Coleman, Patricia A. Cornett, Fiona Costello, John F. Coyle, Lester M. Crawford, Burke A. Cunha, F. William Danby, Ralph C. Daniel, Athena Daniolos, Stella Dantas, Andre Dascal, Susan Davids, Susan A. Davidson, Melinda V. Davis-Malesevich, Francisco J.A. de Paula, Prakash C. Deedwania, Phyllis A. Dennery, Stephen R. Deputy, Richard D. deShazo, Clio Dessinioti, Gretchen M. Dickson, Douglas DiOrio, Sunil Dogra, Basak Dokuzoguz, Joseph Domachowske, Geoffrey A. Donnan, Craig L. Donnelly, John Dorsch, Douglas A. Drevets, Jean Dudler, Peter R. Duggan, Kim Eagle, Genevieve L. Egnatios, Julian Elliott, Sean P. Elliott, Dirk M. Elston, John M. Embil, Tobias Engel, Scott K. Epstein, Andrew M. Evens, Walid A. Farhat, Dorianne Feldman, Gregory Feldman, Steven R. Feldman, Barri J. Fessler, Terry D. Fife, David Finley, Robert S. Fisher, William E. Fisher, Alan B. Fleischer, Raja Flores, Brian J. Flynn, Nathan B. Fountain, Jennifer Frank, Robert S. Freelove, Ellen W. Freeman, Theodore M. Freeman, Aaron Friedman, R. Michael Gallagher, John Garber, Khalil G. Ghanem, Donald L. Gilbert, Robert Giusti, Mark T. Gladwin, Andrew W. Goddard, Mark S. Gold, Robert Goldstein, Robert C. Goldstein, Marlís González-Fernández, E. Ann Gormley, Eduardo Gotuzzo, Luigi Gradoni, Jane M. Grant-Kels, William Greene, Joseph Greensher, David Gregory, Priya Grewal, Charles Grose, Robert Grossberg, Michael Groves, Eva C. Guinan, Tawanda Gumbo, Juliet Gunkel, Amita Gupta, David Hadley, Rebat M. Halder, Ronald Hall, Nicola A. Hanania, Rashidul Haque, David R. Harnisch, George D. Harris, Emily J. Herndon, David G. Hill, L. David Hillis, Christopher D. Hillyer, Stacey Hinderliter, Molly Hinshaw, Bryan Ho, Raymond J. Hohl, Sarah A. Holstein, Marisa Holubar, M. Ekramul Hoque, Ahmad Reza Hossani-Madani, Christine Hsieh, Judith M. Hübschen, Christine Hudak, William J. Hueston, Joseph M. Hughes, Scott A. Hundahl, Stephen P. Hunger, Khawaja O. Husain, Gerald A. Isenberg, Alan C. Jackson, Danny O. Jacobs, Kurt M. Jacobson, Robert M. Jacobson, James J. James, Katarzyna Jamieson, James N. Jarvis, Nathaniel Jellinek, Roy M. John, James F. Jones, Marc A. Judson, Tamilarasu Kadhiravan, Harmit Kalia, Walter Kao, Dilip R. Karnad, Andreas Katsambas, Philip O. Katz, Arthur Kavanaugh, Clive Kearon, B. Mark Keegan, Paul R. Kelley, Stephen F. Kemp, Haejin Kim, Paul S. Kingma, Robert S. Kirsner, Joseph E. Kiss, Joel D. Klein, Luciano Kolodny, Gerald B. Kolski, Frederick K. Korley, Kristin Kozakowski, Robert A. Kratzke, Jeffrey A. Kraut, Jacques Kremer, John N. Krieger, Leonard R. Krilov, Lakshmanan Krishnamurti, Roshni Kulkarni, Bhushan Kumar, Seema Kumar, Louis Kuritzky, Robert A. Kyle, Lori M.B. Laffel, Richard A. Lange, Julius Larioza, Jerome Larkin, Andrew B. Lassman, Barbara A. Latenser, Christine L. Lau, Susan Lawrence-Hylland, Miguel A. Leal, Paul J. Lee, Jerrold B. Leikin, Jana Lewis, Albert P. Lin, Morten Lindbaek, Janet C. Lindemann, Jeffrey A. Linder, Gary H. Lipscomb, James A. Litch, James Lock, Robert C. Lowe, Benjamin J. Luft, Michael F. Lynch, Kelly E. Lyons, James M. Lyznicki, Kimberly E. Mace, Judith Mackall, Bahaa S. Malaeb, Christopher R. Mantyh, Woraphong Manuskiatti, Lynne Margesson, Paul Martin, Vickie Martin, Maria Mascarenhas, Pinckney J. Maxwell, Ali Mazloom, Anthony L. McCall, Jill D. McCarley, Laura J. McCloskey, Michael McGuigan, Donald McNeil, Genevieve B. Melton, Mario F. Mendez, Moises Mercado, Jeffrey Wm. Milks, Brian Miller, Peter A. Millward, Howard C. Mofenson, Enrique Morales, Jaime Morales-Arias, Timothy I. Morgenthaler, Warwick L. Morison, Scott Moses, Ladan Mostaghimi, Judd W. Moul, Claude P. Muller, Michael Murphy, Diya F. Mutasim, Nicole Nader, Alykhan S. Nagji, Tara J. Neil, David G. Neschis, David H. Neustadt, Douglas E. Ney, Lucybeth Nieves-Arriba, Enrico M. Novelli, Jeffrey P. Okeson, David L. Olive, Peck Y. Ong, Silvia Orengo-Nania, Bernhard Ortel, Matthew T. Oughton, Gary D. Overturf, Kerem Ozer, Karel Pacak, Richard L. Page, Rajesh Pahwa, Pratik Pandharipande, Sangtae Park, Jotam Pasipanodya, Manish R. Patel, Paul Paulman, Alexander Perez, Allen Perkins, William A. Petri, Vesna Petronic-Rosic, Michael E. Pichichero, Claus A. Pierach, Antonello Pietrangelo, Daniel K. Podolsky, Michael A. Posencheg, Manuel Praga, Abhiram Prasad, Daniel Pratt, Richard A. Prinz, David Puchalsky, David M. Quillen, Beth W. Rackow, Peter S. Rahko, S. Vincent Rajkumar, Kirk D. Ramin, Julio A. Ramirez, Didier Raoult, Lakshmi Ravindran, Elizabeth Reddy, Guy S. Reeder, Ian R. Reid, Robert L. Reid, John D. Reveille, Robert W. Rho, Jason R. Roberts, Malcolm K. Robinson, Nidra Rodriguez, Giovanni Rosa, Jonathan Rosand, Peter G. Rose, Clifford J. Rosen, Richard N. Rosenthal, Anne E. Rosin, Anne-Michelle Ruha, Susan L. Samson, J. Terry Saunders, Barry M. Schaitkin, Ralph M. Schapira, Michael Schatz, Stacey A. Scheib, Lawrence R. Schiller, Janet A. Schlechte, Kerrie Schoffer, Kevin Schroeder, Dan Schuller, Carlos Seas, Steven A. Seifert, Edward Septimus, Daniel J. Sexton, Beejal Shah, Jamile M. Shammo, Amir Sharafkhaneh, Ala I. Sharara, Chelsea A. Sheppard, Julie Shott, Dan-Arin Silasi, Michael J. Smith, Suman L. Sood, Erik K. St. Louis, Murray B. Stein, Todd Stephens, Dennis L. Stevens, Brenda Stokes, Constantine A. Stratakis, Harris Strokoff, Prabhakar P. Swaroop, Jessica P. Swartout, Masayoshi Takashima, Matthew D. Taylor, Edmond Teng, Joyce M.C. Teng, Nathan Thielman, David R. Thomas, Kenneth Tobin, David E. Trachtenbarg, Maria Trent, Debra Tristram, Elaine B. Trujillo, Arvid E. Underman, Utku Uysal, David van Duin, Mary Lee Vance, Erin Vanness, Vahan Vartanian, Brenda R. Velasco, Donald C. Vinh, Todd W. Vitaz, Thomas W. Wakefield, Ellen R. Wald, Anne Walling, Andrew Wang, Bryan K. Ward, Ruth Weber, Anthony P. Weetman, Arthur Weinstein, David N. Weissman, Robert C. Welliver, Ryan Westergaard, Meir Wetzler, Kimberly Williams, Steven R. Williams, Tracy L. Williams, Elaine Winkel, Jennifer Wipperman, Michael Wolfe, Gary S. Wood, Jamie R.S. Wood, Jon B. Woods, Steve W. Wu, Elizabeth Yeu, James A. Yiannias, Ronald F. Young, Jami Star Zeltzer, Wei Zhou, and Mary Zupanc

Published
2012

15. Early onset inhalant use and risk for opiate initiation by young adulthood

Author

Ryan Westergaard, James C. Anthony, and Carla L. Storr

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Substance-Related Disorders, media_common.quotation_subject, Toxicology, Heroin, Risk Factors, Epidemiology, Administration, Inhalation, medicine, Humans, Pharmacology (medical), Prospective Studies, Risk factor, Young adult, Age of Onset, Psychiatry, media_common, Pharmacology, Heroin Dependence, Addiction, Incidence, Psychiatry and Mental health, Relative risk, Female, Age of onset, Opiate, Psychology, medicine.drug, Follow-Up Studies
Abstract

In this study, we estimate a hypothesized link from early onset inhalant use to later use of opiates by young adulthood, with data from an epidemiological sample of 2311 first graders who entered an urban mid-Atlantic public school system in 1985 or 1986 (49.8% male; 67.1% ethnic minority), and who were studied longitudinally to young adulthood. An estimated 9% had initiated inhalant use before the age of 14 and at follow-up in young adulthood an estimated 3% (n = 66) of the sample had tried opiates at least once. Youth who used inhalants prior to age 14 were twice as likely to initiate opiate use, as compared to those who had never tried (relative risk 2.2; 95% CI = 1.4, 3.3). Statistical adjustment for other covariates attenuated but did not dissolve this relationship. These findings help confirm previously reported evidence that the use of inhalants might be an early marker of vulnerability for future involvement with illegal drugs such as heroin, but an exploratory analysis suggests that there may be no direct inhalants–opiate link once a general early onset susceptibility trait is taken into account. © 2004 Elsevier Ireland Ltd. All rights reserved.

Published
2004

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