Trends in buprenorphine-waivered providers in Medicaid expansion and non-expansion states by their public listing status.

Background: The federal government has made several efforts to increase access to buprenorphine for the treatment of opioid use disorder (OUD). However, patients continue to face challenges in access to treatment for OUD. Objectives: This study seeks to examine the trends in the prevalence of buprenorphine-waivered practitioners who opt to be publicly listed on the Buprenorphine Treatment Practitioner Locator tool maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and how this varies between Medicaid expansion and non-expansion states. Methods: Administrative records of all the DATA-waivered providers collected by SAMHSA were utilized to identify the trends in the number of waivered practitioners by their public listing status from 2002-2017. We further examine how that trend varied between Medicaid expansion and non-expansion states. Results: The total number of waivered providers increased steadily from 300 in 2002 to 41,960 in 2017. In 2015, the number of waivered providers began to increase rapidly, with the number in Medicaid expansion states increasing faster than in non-expansion states from 2014-2017 (136% vs. 59%). Even though a greater proportion of waivered providers listed their names publicly in non-expansion states than in expansion states from 2014-2017, the rate of public listing of names increased more rapidly in Medicaid expansion states than in non-expansion states (170% vs. 85%) during the same period. Conclusions: This finding suggests that even though there has been an increase in waivered providers to prescribe buprenorphine in Medicaid expansion and non-expansion states, barriers to access treatment still persist. Policy initiatives that seek to expand access to substance-use treatment are warranted.

Technology Use: Too Much of a Good Thing?

There is growing evidence of risks associated with excessive technology use, especially among teens and young adults. However, little is known about the characteristics of those who are at elevated risk of being problematic users. Using data from the 2012 Current Population Survey Internet Use Supplement and Educational Supplement for teens and young adults, this study developed a conceptual framework for modeling technology use. A three-part categorization of use was posited for utilitarian, social and entertainment purposes, which fit observed data well in confirmatory factor analysis. Seemingly unrelated regression was used to examine the demographic characteristics associated with each of the three categories of use. Exploratory factor analysis uncovered five distinct types of users, including one user type that was hypothesized to likely be at elevated risk of problematic use. Regression results indicated that females in their twenties who are in school and have greater access to technology were most likely to fall into this higher-risk category. Young people who live with both parents were less likely to belong to this category. This study highlighted the importance of constructing models that facilitate identification of patterns of use that may characterize a subset of users at high risk of problematic use. The findings can be applied to other contexts to inform policies related to technology and society as well. Supplementary Information: The online version of this article (10.1007/s11293-020-09683-1) contains supplementary material, which is available to authorized users.

Prescription opioid misuse, sources of opioids and reasons for opioid misuse among reproductive aged parenting women with major depressive episode.

The impact of the opioid epidemic has been particularly hard on reproductive-aged parenting women. Yet, very little is known about opioid use, opioid misuse and opioid use disorder among parenting women with major depressive episode (MDE). Information on sources of opioids intended for misuse and reasons for opioid misuse among this population is also lacking. Using the 2015-2016 National Survey on Drug Use and Health, the study estimates a multinomial logistic regression model to investigate the association between MDE and opioid misuse as well as use disorder among reproductive-aged parenting women (n = 7750). Among reproductive-aged parenting women with prescription opioid use in the past 12 months, having had a MDE was associated with a higher relative risk of misusing prescription pain relievers without use disorder (RRR = 1.38, p < .001) and having a use disorder (RRR = 1.99, p < .001), relative to using prescription opioid without misuse or use disorder. However, utilization of mental health treatment mitigated the risk for opioid misuse and use disorder. A significant proportion of parenting women regardless of their MDE status identified family or friends and physicians as their main source of opioids. Relief from physical pain and help with feelings or emotions were the two primary motivations for opioid misuse among this population. These findings underscore the importance of maternal depression and mental health treatment in undertaking policy initiatives directed at the opioid crisis and highlights the role of medical providers, family and friends in targeted interventions aimed at this population.

Mental Health Treatment and Unmet Mental Health Care Need Among Pregnant Women With Major Depressive Episode in the United States.

OBJECTIVE: Perinatal mental health is a major public health issue in the United States. Yet, much is unknown about unmet mental health care need among pregnant women with a major depressive episode and the reasons for unmet need. METHODS: Using a nationally representative data set, the study examined mental health treatment utilization, unmet mental health care need, and the reasons for unmet mental health care needs among pregnant women with a major depressive episode compared with nonpregnant women with a major depressive episode (weighted N=128,000). RESULTS: Of pregnant women who had experienced a major depressive episode, 49% reported receiving any mental health treatment, compared with 57% of nonpregnant women with a major depressive episode. The study also found financial barriers to be the primary reason for unmet mental health care need. CONCLUSIONS: Despite current treatment guidelines and policy initiatives, most women with major depressive episodes go without any treatment utilization and perceive an unmet need for their mental health care.

Social network effects in contraceptive behavior among adolescents.

OBJECTIVE: To quantify empirically the role of peer social networks in contraceptive behavior among adolescents. METHOD: Using longitudinal data from a nationally representative sample of adolescents, the authors use a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects, and peer selection to reduce the potential impact of biases from the estimates of peer influence. The peer group measures are drawn not only from the nominations of close friends but also from classmates. Contraception use among the peer groups was constructed using the peers' own reports of their contraceptive behavior. RESULTS: Controlling for parental characteristics and other demographic variables, the authors find that a 10% increase in the proportion of classmates who use contraception increases the likelihood of individual contraception use by approximately 5%. They also find evidence that the influence of close friends diminishes after accounting for unobserved environmental confounders. CONCLUSION: The findings of this study support the findings in the literature that peer effects are important determinants of contraception use even after controlling for potential biases in the data. Effective policy aimed at increasing contraception use among adolescents should consider these peer effects.

The social contagion effect of suicidal behavior in adolescents: does it really exist?

BACKGROUND: Suicide is the third leading cause of death among adolescents and a non-trivial percentage of adolescents report knowing someone who has attempted suicide. In light of this, a growing body of literature has explored whether suicidal behavior in one person may be imitated by others in their social networks. AIM: We seek to determine the extent to which suicidal behavior in individuals is influenced by suicidal behaviors of their peer and family members. METHODOLOGY: Using a nationally-representative sample of adolescents, we employ multivariate regression analysis with controls for known factors associated with suicidal behaviors to help isolate the effects of peer and family members on suicidal behaviors. Our methodology allows us to account for environmental confounders, simultaneity and to a limited extent, non-random peer selection. Our peer measures are drawn from the nomination of close friends by the individuals and suicidal behaviors among the peer group were constructed using the peers' own responses. RESULTS AND DISCUSSION: We find that a 10% increase in suicide attempts by family members were associated with a 2.13% and 1.23% increase in adolescent suicidal ideation and attempts, respectively. Our results also show that a 10% increase in peer suicidal ideation and attempts lead to a 0.7% and 0.3% increase in such behavior by the individuals. However, these positive associations between peer and individual suicide behavior become smaller and insignificant after adjustments were made for environmental confounders and peer selection. LIMITATIONS: Although we are able to establish the overall importance of environmental confounding factors, we are unable to identify the specific components or characteristics of the surroundings that can explain suicidality. The complex relationships between peer selection and suicidality also limit the determination of causality. CONCLUSIONS AND IMPLICATIONS: An increase in suicidal behavior by family members is positively associated with suicidal behavior among adolescents and effective policies aimed at reducing suicidal rates should consider these impacts. However, attributing correlations in suicidal behaviors among peers to social network effects should be undertaken with caution, especially when environmental confounders are not adequately controlled for in the analysis. FUTURE RESEARCH: Recent studies have found evidence that family connectedness and parent-child relationships have a significant impact in deterring risky behaviors among adolescents. This motivates future work aimed at designing policies that would utilize these findings in order to effectively reduce suicidal behavior among adolescents.

The social contagion effect of marijuana use among adolescents.

BACKGROUND: Research on adolescent substance use has consistently identified a strong relationship between adolescent behavior and the behavior of their peers. However, peer effects are difficult to estimate and causal interpretations must be undertaken with caution since individuals in most cases choose with whom to associate. In this paper we seek to empirically quantify the causal role of peer social networks in explaining marijuana usage among adolescents. METHODS AND FINDINGS: Using data from a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends (N = 6,377), but also from classmates (N = 19,335). Marijuana usage among the peer groups were constructed using the peers' own report of their marijuana consumption. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of close friends and classmates who use marijuana increases the probability that an individual chooses to use marijuana by 5%. CONCLUSION: Our findings indicate that peer effects are important determinants of marijuana use even after controlling for potential biases We also found evidence to show that the influence of close friends and the more exogenous classmates are quite similar in magnitude under our preferred specification, supporting theory predicting the importance of peer influence. Effective policy aimed at reducing marijuana usage among adolescents would consider these significant peer effects.

Estimating peer effects in sexual behavior among adolescents.

In this paper we seek to empirically quantify the role of peer social networks in influencing sexual behavior among adolescents. Using data of a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of close friends who initiates sex increases the probability that an individual chooses to initiate sex by 5% and a 10% increase in number of sexual partners among close friends increases an individual's sexual partner by 5%. The influence of classmates however, diminishes in magnitude after accounting for unobserved environmental confounders.

Adolescent propensity to engage in health risky behaviors: the role of individual resilience.

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less. The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating.

Social network effects in alcohol consumption among adolescents.

In this paper we seek to empirically quantify the role of peer social networks in explaining drinking behavior among adolescents. Using data from a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selection to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Drinking behavior among the peer groups was constructed using the peers' own report of their alcohol consumption. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of classmates who drink will increase the likelihood of drinking participation and frequency by approximately four percentage points. We also find evidence to show that the influence of close friends, while still significant, diminishes in magnitude after accounting for unobserved environmental confounders. Our findings support the literature that peer effects are important determinants of drinking behavior even after controlling for potential biases. Effective policy aimed at reducing alcohol consumption among adolescents would consider these significant peer effects.

Estimating peer effects in adolescent smoking behavior: a longitudinal analysis.

PURPOSE: To empirically quantify the role of peer social networks in explaining smoking behavior among adolescents. We follow adolescents over time to examine whether the role of adolescent peers persists in affecting individual behaviors as adolescents transition into adulthood. METHODS: Using longitudinal data of a nationally representative sample of adolescents we use a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects, and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends but also from classmates. Smoking prevalence among the peer groups were constructed using the peers' own reports of their cigarette consumption. RESULTS: Controlling for parent level characteristics and other demographic parameters, we find that a 10% increase in the proportion of classmates who smoke will increase the likelihood of smoking by more than 3%. Also, an increase in smoking rates among an individual's close friends by 10% will increase the likelihood of smoking by 5%. We find evidence to show that the influence of close friends from adolescence years continue to have an impact on smoking propensities even when a transition into adulthood is made. CONCLUSIONS: Our findings support the literature reporting that peer effects are important determinants of smoking even after controlling for potential biases in the data and that these effects persist into adulthood. Effective policy aimed at reducing smoking rates among adolescents would consider these long-lasting peer effects.