Kathleen Louise Egan

Substance use is a critical public health concern disproportionately affecting sexual and gender minority (SGM) youth and young adults. Greater understanding is needed of substance use patterns among these populations, as well as relationships between demographic and psychosocial factors and use, particularly in the U.S. South. Data on substance use behaviors and risk and protective factors were collected via a statewide, cross-sectional telephone survey of North Carolina (NC) residents ages 12–25 (N = 15,000). Survey weights were applied to adjust prevalence estimates for selected NC population demographics and, among participants self-reporting a sexual and/or gender minority identity, we explored substance use by age group and used multivariable weighted logistic regression models to identify potential correlates. Among the SGM sample (n = 212), weighted prevalence of past 30-day alcohol use was 56.4% (n_u = 108), cigarette use was 55.7% (n_u = 99), nicotine vape use was 36.5% (n_u = 63), marijuana use was 30.3% (n_u = 56), and polysubstance use (i.e., simultaneous use of multiple substances with overlapping effects) was 42.7% (n_u = 74). Several factors were associated with substance use, including race/ethnicity, gender identity, perceived harms, future orientation, perceived parental and peer use, and perceived discrimination. This analysis identified high substance use prevalence among SGM youth and young adults in NC. Findings can potentially inform culturally responsive, contextually relevant interventions to reduce substance use among SGM youth and young adults in the U.S. South.

Substance use during adolescence and young adulthood is a persistent public health problem. Social connectedness is associated with health, but research is needed to clarify the potential protective role of different aspects of social connectedness in primary prevention of substance use behaviors. This study explores associations between perceived social connectedness to two developmentally important social groups (friends and family) and various substances (alcohol, e-cigarettes, cigarettes, cannabis, and prescription medication) among adolescents and young adults. In addition, it examines how descriptive and injunctive norms within social groups affect associations between perceived social connectedness and substance use behaviors among adolescents and young adults. A statewide survey was conducted among 15,000 adolescents and young adults (12–25 years old, 52.6% female, 69.6% White) in North Carolina. Perceived social connectedness and substance use were assessed cross-sectionally, along with potential moderators (perceived friend and parent substance use and disapproval). Logistic regression was used to model associations with substance use. Moderation was examined with a regions-of-significance approach. Overall, perceived social connectedness was associated with lower odds of using most substances among adolescents and young adults. However, associations were moderated by perceptions of parental and friend substance disapproval and to a lesser extent by perceptions of parental and friend substance use behaviors. Findings suggest perceived connectedness to friends could potentially protect against substance use in the context of high perceived friend disapproval, whereas perceived connectedness to family is complex and may protect against substance use in the context of moderate/lower perceived parental disapproval of substance use. Longitudinal research is needed to understand the direction of associations with additional measures of social connectedness to help elucidate which aspects are protective and which are risky for adolescent and young adult substance use.

Young women who inject drugs (YWID) face heightened risks for HIV, hepatitis C, and overdose that are shaped by the relational contexts in which they injec

The opioid epidemic continues to disproportionately impact rural communities across the United States, where structural barriers, including geographic isol

Background: Pharmacies can implement multiple strategies, including medication disposal programs (eg, disposal boxes, deactivation products, and mail-back envelopes) and offering over-the-counter naloxone, to prevent nonmedical opioid use and overdose. The quantity of opioid prescriptions dispensed in the United States is so high that every other adult could receive one opioid prescription per year. Many of these opioids go unused and are kept in homes rather than disposed of after ceasing use. The primary source of prescription opioids for nonmedical use is relatives or friends, which suggests that the diversion of excess and retained prescription opioids contributes significantly to nonmedical use. Naloxone is a life-saving medication that works as an opioid antagonist to reverse the effects of opioids and restore normal breathing to a person experiencing an overdose. All 50 US states have passed laws (eg, statewide standing orders) that allow pharmacists to distribute naloxone without an individual patient prescription, and the US Food and Drug Administration approved the first over-the-counter naloxone medication in March 2023. Individual and neighborhood characteristics are associated with nonmedical opioid use and overdose. It is essential to ensure that pharmacy-based overdose prevention practices are widely available to all individuals. Objective: : This study aims to assess the extent to which disposal programs and same-day naloxone have been implemented in pharmacies across the United States and examine neighborhood characteristics in implementation. We hypothesize that as neighborhood disadvantage and the proportion of Black or African American residents in a neighborhood increase, the likelihood of a pharmacy having a disposal program or same-day naloxone decreases. We also hypothesize differences in medication disposal programs and same-day naloxone availability by retailer chain and type of pharmacy. Methods: A secret shopper caller protocol will be used to identify pharmacies that have implemented a medication disposal program and have naloxone available on the same day without a prescription. We will conduct disproportionate stratified random sampling with the strata being pharmacy chains to maximize the likelihood of sampling corporations and independent pharmacies. The goal is to obtain a final sample of 1000 pharmacies. Neighborhood characteristics will be appended to the secret shopper data. To explore neighborhood and pharmacy characteristics associated with the availability of medication disposal programs and same-day naloxone, we will use logistic regression. This protocol represents the entire structure of the secret shopper caller approach. Results: Data collection was completed in the spring of 2024. The expected results will be published in 2025. Conclusions: This will be the first study to examine national estimates of medication disposal programs, same-day naloxone availability at pharmacies, and the geographic characteristics associated with their implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/64344

Background: Nonmedical use of prescription opioids remains a critical public health issue; 8.5 million people in the United States misused opioids in 2022. Most people obtain prescription opioids for misuse from family or friends. Thus, facilitating secure storage and disposal of opioid medications during and after treatment is needed to prevent medication diversion and subsequent misuse. Objective: The primary objective of this study is to test the feasibility and efficacy of a novel intervention that uses a persuasive, informational SMS text message reminder system to enhance the impact of secure storage and disposal of unused opioid medications. We hypothesize that the SMS text message intervention will increase secure storage during treatment and disposal of prescription opioids after treatment. Methods: We will use a 2-arm randomized controlled trial to test the intervention for feasibility and efficacy. Participants (aged 18+ years who have received an opioid prescription in the past 2 weeks) will be randomly assigned to either receive the SMS text message intervention or standard-of-care educational materials. Participants in the intervention will receive 4 SMS text messages related to secure storage and 3 messages related to disposal. All participants will complete baseline, midpoint (day 25), and postintervention (day 45) evaluation surveys. We will test whether receipt of the intervention is associated with two primary outcomes, which are (1) secure storage of prescription opioid medication (locked vs unlocked) and (2) disposal of unused prescription opioid medication (disposed vs not disposed). We will use multiple logistic regression to test the main hypotheses that the intervention will be positively associated with secure storage (locked vs unlocked) and disposal (yes vs no) behaviors, which will allow us to control for demographic variables known to influence the outcomes. This protocol represents the entire structure of the randomized controlled trial. Results: Recruitment for the randomized controlled trial was launched in April 2024, and data collection was completed in December 2024. The final sample size is 484. Data analyses for the main hypothesis will be completed by May 2025, and the main hypothesis manuscript will be submitted for publication by May 2025. Conclusions: Results from this study will indicate whether a text message reminder system can increase secure storage and disposal behaviors for individuals who receive opioid medication. This type of intervention has the potential to be integrated into currently used health care delivery systems, such as prescription pickup reminders at pharmacies. Thus, the intervention is scalable across systems of care, thus expanding the reach of secure storage and disposal programs to prevent prescription opioid misuse. Trial Registration: ClinicalTrials.gov NCT05503186; https://clinicaltrials.gov/study/NCT05503186 International Registered Report Identifier (IRRID): DERR1-10.2196/60332

Introduction: HPV vaccination prevents most HPV-related cancers, yet uptake remains low. HPV is linked to an estimated 70% of oropharyngeal cancers (OPCs) in the US and outnumber cases of HPV-related cervical cancers. Not all OPCs can be detected through routine screening, making HPV vaccination a more effective primary prevention strategy. However, bridging primary and oral healthcare faces challenges due to a lack of referral networks between practices. The purpose of this study is to identify key infrastructure elements and policies, as well as HPV prevention strategies, among an academic practice network of dental clinics and partnering community health clinics in a southeastern state. Methods: Researchers held interviews with directors and focus groups with staff at six dental clinics and eight associated community clinics in a southeastern state. Interviews and focus groups at dental and community clinics were analyzed by two study team members using thematic analysis with Nvivo software. Results: A total of 90 participants participated in all focus groups and interviews (N = 14 interviews, 10 focus groups (5–13 participants per focus group). Most participants identified as white (58.9%) and female (70%), with an average age of 38.5 years. Researchers identified nine key study themes: three specific to the dental clinics’ HPV conversations with patients, two related to community clinics’ vaccine provision, and four involving the relationship between the dental and co-located community clinics. Dental clinic staff do not currently discuss HPV with patients. They are open to discussing HPV with patients but anticipate barriers that require preparation to overcome them. Community clinics have demonstrated previous success with HPV vaccination, but patients over the age of 18 face financial barriers to vaccination. Community clinics and dental clinics report that they do not currently have existing referral networks but are open to a referral system between practices if infrastructure is put into place to support it. Conclusions: Our findings indicate that there is interest in, and potential for, increased discussion of HPV with dental patients and collaboration between dental and community clinics for HPV vaccination referral. The results of this investigation can be used to develop intervention strategies to increase HPV vaccination through referrals between dental clinics and nearby community clinics. Ultimately, this work can reduce health inequities in HPV-related cancers, serve as a model for US dental practices, and possibly influence public health policy.

Background: Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal.Objectives: To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids.Methods: In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total N = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration's recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach.Results: Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods.Conclusion: Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Drug-related overdoses impact communities all over the United States. In the past 2 decades, over 28,000 people have died of a drug overdose in North Carolina (NC). Research has shown that there has been an increase in overdose deaths throughout NC, particularly in rural areas. To reduce overdose rates, health care interventions should be expanded. Naloxone distribution is one intervention to combat overdose rates. Naloxone is a medication designed to reverse an opioid overdose rapidly. Public health vending machines (PHVMs) are a strategy recently implemented in some US communities to expand access to harm reduction supplies. Examples of locations where PHVMs have been installed include public health departments, libraries, county detention centers, and law enforcement offices. Objective: This protocol aims to develop a community-engaged approach to implementing PHVMs as a health care delivery option for harm reduction supplies in 5 rural counties in NC. Methods: This study will use a community-based participatory approach in which we partnered with the NC Harm Reduction Coalition and Community Impact NC to engage with substance use prevention providers and community members in 5 rural counties in NC to improve naloxone access. We will collect qualitative interview data from people with lived experience of substance use to identify the optimal placement of PHVMs and items to be stocked in PHVMs. To do this, we will hire 1 local community member with lived experience of substance use from each county to be an interviewer who will recruit, conduct interviews, and collect data from other community members with lived experience of substance use. Interviewers will be trained to recruit participants, conduct interviews, and collect and analyze data. Developing a protocol for training interviewers includes an interview training presentation with an adapted collaborative institutional training initiative portion. Results: Data will be collected from 2024 to 2025. The findings will inform the implementation of PHVMs to improve harm reduction access and assist in decreasing overdose deaths. Conclusions: This study will use in a community-based participatory approach to improve naloxone access in rural communities. Community partners will assist the academic team in developing a sustainability plan for each county and an implementation toolkit for other communities to use.