Background:

Pod-device use among adolescents has grown at an exponential rate since 2015. Understanding why and how pod-devices appeal to youth is critical to informing youth prevention. We examined adolescents’ reasons for liking/disliking pod-devices and the associations with frequency of pod-device use.

Methods:

Anonymous cross-sectional surveys were conducted in four high schools in southeastern Connecticut in 2018 (N=3170). The survey assessed pod-device use and reasons for liking/disliking pod-devices, including pharmacological effects, product characteristics, peer influence, comparisons to other e-cigarettes, and concealability.

Results:

30.2% of students used a pod-device in the past month (i.e., current users). Current users reported pod-device use on an average of 13.6 days (SD=11.7) in the past month (including 25% who reported daily use). The primary reasons for liking a pod-device included pharmacological effects (i.e., “It gives me a buzz”), positive product characteristics (i.e., “I like the flavors”), and peer influence (i.e., “My friends use it”). The top reasons for disliking a pod-device were negative product characteristics (i.e., “The pods are expensive”) and adverse pharmacological effect (i.e., “Nicotine is too high” and “It gives me a headache”). General regression analyses indicated that positive pharmacological effects (i.e., “buzz,” ability to manage appetite) and product characteristics (i.e., nicotine levels) were positively associated with pod-device use in the past month, but peer influence was negatively associated with frequency.

Conclusions:

The primary reasons that pod-device is appealing to youth are related to nicotine’s effects. Comprehensive tobacco control policies that target appealing factors are needed to prevent pod-device use among youth.

background

Women with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD.

objectives

This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT).

methods

A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies.

results

Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies.

conclusion

While most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.

Background

One in every ten bags of cocaine has enough fentanyl to kill a human. Opioid overdose deaths reportedly caused by fentanyl have increased by 426% over the last 6 years in the United States, due to its fatal toxicity in miniscule amounts in relation to other illicit substances and its use to adulterate substances without the consumer’s awareness. The aim of this study is to determine sociodemographic and geographical factors of cocaine and fentanyl combination caused deaths in Allegheny County, where and for whom prevention and harm reduction interventions would have the most impact.

Methods

A combination of individual and zip code level accidental overdose death data from Allegheny County Medical Examiner and demographic data estimates from the American Community Survey were used in this study. A geo-statistical analysis was conducted using Proc Genmod to conduct multivariate Poisson linear regression models and GIS to display geographical correlations.

Results

Spatially dependent models demonstrate that zip codes of Allegheny County that have high counts of African Americans (P <.0001) and individuals who live alone (P <.0001) are at highest risk of combined fentanyl and cocaine intoxication deaths. It follows a trend closer to cocaine alone deaths than fentanyl alone deaths (P <.0001).

Conclusion

Areas with high counts of African Americans and/or individuals living alone should be the main targets for research-based death and exposure prevention interventions; such as, K-12 socio-emotional learning, fentanyl test strip and Naloxone distribution and promotion programs, etc.

background: On October 1, 2015, the United States implemented the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) introducing major structural changes to opioid overdose coding. In ICD-9-CM, opioid overdoses were identified with diagnosis codes and/or external cause codes, whereas in ICD-10-CM only diagnosis codes are used. Because diagnosis codes are required for reimbursement but external cause codes are not, jurisdictions like Montana, without external cause coding mandates, may have variation in the completeness of external cause coding which could affect epidemiological analyses of opioid overdose trends.

objectives: To determine whether Montana observed an increase in opioid overdoses identified upon implementation of ICD-10-CM.

methods: Counting records with any opioid overdose ICD-9/10-CM code, we calculated monthly rates per 10,000 visits using 2010-2017 Montana emergency department (ED) and hospitalization data. We evaluated the effect of the ICD-10-CM transition on rates of opioid overdose using interrupted time series models including terms for immediate (level shift) and gradual (slope change) effects and adjusting for autocorrelation where necessary. α=.10.

results: Upon implementation of ICD-10-CM, there were significant positive level shifts of 1.82 per 10,000 ED visits (p=0.0472) and 3.89 per 10,000 hospitalizations (p=0.0798). For ED visits and hospitalizations, there were no significant changes in the slope of opioid overdose trends following the transition.

conclusion: The significant level increase observed in the rates of opioid overdose, without significant slope change, is consistent with changes to the coding structure and practice. External cause coding status may bias overdose trends spanning the ICD-10-CM transition.