Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020.

BACKGROUND: We use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. METHODS: We used data (1992-2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (1999-2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. RESULTS: We found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DISCUSSION: Steep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.

Impact of laparoscopic adjustable gastric banding on type 2 diabetes.

Bariatric surgery is becoming an accepted option for obese people with type 2 diabetes. Our aim was to assess the impact of laparoscopic adjustable gastric banding (LAGB) through a systematic review of the literature. Data was sourced from Scopus, MEDLINE and EMBASE published from 2000 through May 2011, and five unpublished studies that were performed by industry for regulatory approval were also included. Studies were selected on the basis that they provide some detail of diabetes status before and after LAGB. There were 35 studies meeting the inclusion criteria. There was considerable heterogeneity in study design, sample size, length of follow-up, attrition rates and classification of diabetes status. Weight loss was progressive over the first 2 years with a weighted average of 47% excess weight loss at 2 years. Remission or improvement in diabetes varied from 53% to 70% over different time periods. Results were broadly consistent, demonstrating clinically relevant improvements in diabetes outcomes with sustained weight loss in obese people with type 2 diabetes following LAGB surgery. However, there were significant shortcomings in the reviewed literature with few high-quality studies, inconsistent reporting of diabetes outcomes and high attrition rates. Long-term studies that address these limitations are needed.

Adolescent pregnancy and subsequent obesity in African-American girls.

PURPOSE: Obesity is a significant contemporary health problem among African-American women. This study investigates whether excessive gestational weight gain during adolescent pregnancy is associated with subsequent obesity. METHODS: Thirty previously pregnant African-American adolescents on whom there were extensive extant anthropometric and psychosocial data were evaluated approximately 3.3 years following delivery. RESULTS: Rapid gestational weight gain (> .40 kg/wk) was associated with a 19.9% increase in body mass index (BMI); average gestational weight gain (.23 to .40 kg/wk) was associated with a 13.2% increase, and slow gestational weight gain (< .23 kg/wk) was associated with a 3.4% increase (difference between rapid and slow, p < 0.05). Adolescents who had high prepregnant BMIs were massively obese subsequently. CONCLUSIONS: 1. Rapid gestational weight gain is associated with a significantly greater percent change in the BMI compared with the slow gestational weight gain in adolescent pregnancy. 2. Adolescents who are obese prior to their first pregnancy often become even more obese on average 3.3 years following pregnancy. Such adolescents may be at particular risk of retaining gestational weight gain, and the consequences of their morbid obesity may be ultimately life-threatening.

PIP: The goal is to determine whether there is a relationship between high gestational weight gain and subsequent obesity in women who are pregnant as adolescents. 30 young women who were approximately 3.3 years postpartum from their first pregnancies were asked to return to the hospital for an interview and anthropometric measurements. They had participated in an anthropometric study of gestational weight gain and neonatal outcome when they were less than 20 years of age. 83% were primiparous, and all had singleton live-born infants. The subjects were primarily young, poor, single black women with approximately 11 years of education. The study group was divided into three sub-groups according to gestational weight gain categories: rapid (0.40 kg/week), average (0.23-0.40 kg/week), and slow (0.23 kg/week). The three groups had similar background variables, including maternal age, medical insurance, marital status, years of education, subjects' mothers' mean body mass index (BMI), and cigarette and alcohol use. Adolescents with rapid gestational weight gain had an increase in their BMI (weight in kg/height in m) of 19.9% between prepregnant and subsequent BMI. In contrast, a slow gestational weight gain was associated with a subsequent 3.4% increase, and average gestational weight gain was associated with a 13.2% increase. The difference between the BMI change of the rapid and slow gestational weight gain groups was statistically significant. Adolescents who had high BMIs (BMI or= 26) when they became pregnant had the highest mean subsequent BMI (34.8 +or- 3.8). Adolescents who had a low BMI (BMI 19.8) when they became pregnant had the lowest subsequent BMI. Those women who started pregnancy with high BMIs were morbidly obese on follow-up (mean = 91.1 kg) and gained an average of 13 kilograms. The percent increase was 17% each for the high and average gestational weight groups and 12.5% for the low group.

Characteristics of community-based individuals with mental retardation and aggressive behavioral disorders.

A cohort of 199 individuals with mental retardation referred for behavioral and psychiatric crisis intervention services was studied to determine attributes differentiating physically aggressive behavior from other behavioral problems. Individuals with aggressive and nonaggressive behavior had similar neurological histories and current medical status and similar levels of seizure disorders and CNS abnormalities. Aggressive individuals more often had psychiatric diagnoses of organic brain syndrome, but frequencies of this diagnosis in each group were small. Current aggression was predicted by gender, level of mental retardation, and history of previous institutional placement; the strongest predictor was history of aggression. These data suggest a complex equation to describe social inadequacy involving interactions between CNS functioning and developmental cognitive and social variables that are only partially defined at this time. Further work to characterize this interaction almost certainly must include a prospective longitudinal analysis of social and developmental functions early in life.