Community and Global Health Works

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    The Changing Landscape of the Opioid Epidemic in Marion County and Evidence for Action
    (Richard M. Fairbanks School of Public Health, 2018-10-18) Watson, Dennis; Duwve, Joan; Greene, Marion; Weathers, Tess; Huynh, Philip; Nannery, Rebecca
    The impact of the opioid crisis is vast, with its effects impacting individuals, families, and communities as a whole. The epidemic has evolved – what began largely as a prescription opioid problem surged into the street, where heroin and “fake” pills resembling prescription drugs are now often laced with deadly amounts of illegally produced fentanyl. The evolving epidemic has compelled an evolving response, including new and more diverse strategies, and the engagement of multiple sectors of the community beyond health care, including employers, schools, nonprofit agencies, government agencies, law enforcement and policymakers. This report updates a 2016 report by the IU Richard M. Fairbanks School of Public Health to describe the current landscape of the evolving opioid epidemic in Marion County, Indiana, and across the state.
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    Report on the Tobacco Epidemic in Indiana and Marion County and Effective Solutions: 2018 Update
    (Richard M. Fairbanks School of Public Health, 2018-10) Tauras, John; Chaloupka, Frank; Halverson, Paul
    A number of effective solutions exist for lowering tobacco rates, improving health, and lowering costs in Indiana and Marion County. Policy makers, health care systems, employers, schools, and nonprofit and community-based organizations all play a critical role.
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    Worlds Further Apart
    (Richard M. Fairbanks School of Public Health, 2021-08) Weathers, Tess; Comer, Karen; Staten, Lisa
    In our updated analysis of 104 ZIP codes in the Indianapolis metro area (2014-2018), we identified the northern suburb of Fishers as our longest living community and just 17 miles away, within the Indianapolis city limits, is the shortest living community within the metro area. Though only 17 miles of distance separate them, their life expectancy is worlds apart.
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    Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services
    (BMC, 2023-02-11) Watson, Dennis P.; Phalen, Peter; Medcalf, Spencer; Messmer, Sarah; McGuire, Alan; Social and Behavioral Sciences, School of Public Health
    Background: In recent years, emergency departments (EDs) across the nation have implemented peer recovery coach (PRC) services to support patients who use opioids. The majority of such interventions discussed in the literature follow an in-person modality where PRCs engage patients directly at the ED bedside. However, the use of telehealth services in EDs is becoming more popular. These services connect PRCs with ED patients in real-time via secure communications technology, and very little is known about the service- and clinical-based outcomes with which they are associated. The current study sought to assess factors associated with successful post-discharge follow-up of patients with a history of opioid use who received PRC telehealth services while in the ED. Method: Data come from records for 917 patients who engaged with a telehealth PRC one or more times (1208 total engagements) at 1 of 13 EDs within the same health system. A multilevel Poisson regression model was used to assess the degree to which variables predicted successful post-discharge follow-up, defined as the number of times a PRC successfully spoke with the patient each month after ED discharge. Results: At least one follow-up was successfully completed by a PRC for 23% of enrolled patients. Significant predictors of successful follow-up included patient employment at baseline (Incidence Rate Ratio [IRR]: 2.8, CI: 2.05-3.9), living in a rural area (IRR: 1.8, CI: 1.04-3.2), PRC provision of referrals (IRR: 1.7, CI: 1.2-2.2), number of ED encounters in the previous 365 days (IRR: 0.99, CI: 0.98-0.99), and duration of the initial PRC telehealth interaction (IRR: 0.87, CI: 0.85-0.88). Conclusion: Given that relationship development is a key tool in the PRC profession, understanding successful follow-up associated with telehealth engagement has unique importance. The results have potential utility for planning and implementing peer telehealth services in EDs and other locations, which is needed for the development of the PRC profession and the likely expansion of peer telehealth services.
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    Challenges Experienced by Black Women with Breast Cancer During Active Treatment: Relationship to Treatment Adherence
    (Springer Nature, 2023) Bigatti, Silvia M.; Weathers, Tess; Hayes, Lisa; Daggy, Joanne; Social and Behavioral Sciences, School of Public Health
    Background: Although rates of death from breast cancer have declined in the USA for both Black and White women since 1990, mortality rates for Black women remain strikingly higher - 40% higher compared to White women (American Cancer Society 1). The barriers and challenges that may be triggering unfavorable treatment-related outcomes and diminished treatment adherence among Black women are not well understood. Methods: We recruited 25 Black women with breast cancer who were to receive surgery and chemotherapy and/or radiation therapy. Through weekly electronic surveys, we assessed types and severity of challenges across various life domains. Because the participants rarely missed treatments or appointments, we examined the impact of severity of weekly challenges on thoughts of skipping treatment or appointment with their cancer care team using a mixed-effects location scale model. Results: Both a higher average severity of challenges and a higher deviation of severity reported across weeks were associated with increased thoughts on skipping treatment or appointment. The correlation between the random location and scale effects was positive; thus, those women that reported more thoughts on skipping a dose of medicine or appointment were also more unpredictable with respect to the severity of challenges reported. Conclusions: Black women with breast cancer are impacted by familial, social, work-related, and medical care factors, and these may in turn affect adherence to treatment. Providers are encouraged to actively screen and communicate with patients regarding life challenges and to build networks of support within the medical care team and social community that can help patients successfully complete treatment as planned.
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    Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process
    (Elsevier, 2021) Smart, Rosanna; Grant, Sean; Social and Behavioral Sciences, School of Public Health
    Background: Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. Methods: We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. Results: Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. Conclusion: Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.
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    Association between indoor tanning frequency during early life and other potentially addictive behaviors among US women
    (Elsevier, 2021) Tsibris, Hillary C.; Nan, Hongmei; Li, Xin; Global Health, School of Public Health
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    Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19
    (Elsevier, 2020) Aroniadis, Olga C.; DiMaio, Christopher J.; Dixon, Rebekah E.; Elmunzer, B. Joseph; Kolb, Jennifer M.; Mendelsohn, Robin; Ordiah, Collins O.; Rockey, Don C.; Singal, Amit G.; Spitzer, Rebecca L.; Tierney, William M.; Wani, Sachin; Yadav, Dhiraj; Global Health, School of Public Health
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    Socioeconomic Inequalities and Toothbrushing Frequency among Schoolchildren Aged 6 to 12 Years in a Multi-Site Study of Mexican Cities: A Cross-Sectional Study
    (MDPI, 2022-07-18) Acuña-González, Gladys Remigia; Casanova-Sarmiento, Juan Alejandro; Islas-Granillo, Horacio; Márquez-Rodríguez, Sonia; Benítez-Valladare, David; Mendoza-Rodríguez, Martha; de la Rosa-Santillana, Rubén; Navarrete-Hernández, José de Jesús; Medina-Solís, Carlo Eduardo; Maupomé, Gerardo; Global Health, School of Public Health
    Periodic toothbrushing is the most common, effective, and reliable way to mechanically remove biofilm from oral tissues. The objective of the present study was to determine the association between toothbrushing frequency and socioeconomic position for schoolchildren between 6 and 12 years of age in four cities in Mexico. A cross-sectional study was conducted on 500 Mexican schoolchildren between 6 and 12 years of age from public schools in four Mexican cities. Questionnaires were administered to the parents/guardians of the schoolchildren to obtain the variables included in the study. The dependent variable was toothbrushing frequency, dichotomized as: 0 = less than twice a day and 1 = at least twice a day. The analysis was performed in Stata. The average age of the schoolchildren was 8.9 ± 1.9 years; 50.4% were female. The prevalence of toothbrushing was 52.8% (at least twice a day) (95% CI = 48.4−57.1). In the multivariate model, the variables associated (p < 0.05) with toothbrushing frequency were older age of the schoolchild (OR = 1.14); younger age of the mother (OR = 0.93); being a girl (OR = 1.70); being enrolled in Seguro Popular (OR = 0.69); being in a household that was owned (OR = 2.43); and being a schoolchild who lived in a home that owned a car (OR = 1.31). The prevalence of toothbrushing at least twice a day was just over 50% in these Mexican children. We found demographic and socioeconomic variables to be associated with toothbrushing. Based on socioeconomic variables that were associated with toothbrushing frequency—such as health insurance, home ownership and the household owning a car—the results of the present study confirm the existence of health inequalities in toothbrushing frequency.
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    Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process
    (BMC, 2022-06-08) Grant, Sean; Smart, Rosanna; Social and Behavioral Sciences, School of Public Health
    Background: Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws. Methods: We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL. Results: Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system. Conclusions: Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.