Justine Wittenauer Welsh

Background: Transitional age youth aged 18–25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood may impact emotional health and well-being, contributing to anxiety, depression, and feelings of hopelessness, all of which are linked to increased risk of substance use and disorders. Objective: This study characterizes the design and status of the MAPme Project, a prospective project centered on substance use and emotional wellness during and beyond college. Herein, we describe the 2018–2024 pilot cohort that was followed during the first two years of college, remotely during the COVID-19 pandemic, and upon the return to campus. We also describe our latest 2025+ cohort with ongoing data collection. Participants: The 2018–2024 cohort comprised 301 college freshmen who completed online assessments at baseline (Wave 1). The 2025+ cohort has currently enrolled 618 students and counting. Methods: We provide descriptive information on both cohorts, along with preliminary associations of pre- and early collegiate substance use outcomes, psychopathology, sleep patterns, and personality traits. Results: Approximately 64% of first-year students reported use of a substance in the 90 days leading up to college in 2018. Alcohol and cannabis were the most prevalent substances used in both cohorts with males consuming more alcohol than females. Females reported greater levels of daily stressors and mood symptoms. Other health and personality characteristics and observed associations between psychosocial risk and protective factors are described. Prior studies demonstrate the ability to test research hypotheses in the social, health, and clinical areas of psychology with robust statistical power. Conclusions: Substance use and emotional well-being vary considerably upon entry into college/university and at any particular moment in time. The MAPme Project encourages the engagement of students to address challenges associated with lack of awareness, inclusivity, and acceptance of scientific research. Overcoming barriers of inclusivity and empowering the community is key to the successful adoption and implementation of campus health and community-oriented research programs and systematically enhancing research training.

To enable timely intervention and reduce risk of returning to use in individuals with opioid use disorder (OUD), there is a need to monitor opioid withdrawal severity using physiological biomarkers. However, in the context of opioid withdrawal, prior studies have relied on data recorded in controlled lab settings over short periods of time and have only focused on a limited set of biomarkers. To address these limitations, using multimodal wearable signals, we extracted and characterized 32 cardiorespiratory features from 16 individuals with OUD experiencing varying levels of withdrawal severity over a 7-day period. Across all participants, we found statistically significant ( p < 0.05) differences in 6 features between high and low withdrawal. For machine learning-based classification of high vs. low withdrawal, we found that performance improved when leveraging respiratory-focused and sex-/BMI-stratified models (highest macro F1 of 0.812). Finally, in 14 out of 16 participants, at least 1 feature statistically significantly ( p < 0.1) tracked changes in withdrawal scores over the 7-day period. Therefore, our analyses of these features uncovered substantial phenotype sensitivity and physiological heterogeneity across the study cohort. These findings underscore the need for phenotype-aware and personalized modeling approaches for continuous, sensor-based monitoring of withdrawal severity in the future.

Background: Disproportionately high mortality rates from opioid overdose among adolescents have emerged as a major public health concern in the United States (U.S.). Among available interventions, naloxone, an opioid receptor antagonist, continues to be recognized for its effectiveness in reversing opioid overdose. However, access to naloxone among adolescents remains scarce, underscoring potential gaps in overdose prevention for this population. Methods: This narrative review examines current literature to identify barriers and facilitators that influence naloxone availability and uptake among adolescents. The review includes young adult (up to age 30) data when it overlaps with adolescent literature. The review followed the SANRA checklist criteria and utilized the Cochrane, MEDLINE-PubMed, and Google Scholar databases for relevant studies from 2012-2026. Key Findings: Barriers to naloxone access are multifactorial, including cost-related constraints, inconsistent implementation of over-the-counter dispensing practices, limited awareness of dispensing policies, and stigma towards people who use drugs. Structural and individual factors found to assist in the facilitation of naloxone access include policy changes enabling non-prescription dispensing, pharmacy standing orders, and laws that permit independent minor consent for substance use treatment. However, disparities in naloxone availability and use persist, and implementation of such policies is inconsistent across settings. Recommendations: Accordingly, legislation that promotes naloxone availability and educational initiatives designed to increase knowledge and acceptance of its use in diverse settings may be important, as evidence supports its association with reduced overdose mortality. Additional efforts are warranted to improve naloxone availability and use among adolescents, including expansion of clinician prescribing practices, reduction of costs at the point-of-dispense, and greater distribution of the medication for patients leaving treatment facilities.

Background: Transitional age youth aged 18-25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood may impact emotional health and well-being, contributing to anxiety, depression, and feelings of hopelessness, all of which are linked to increased risk of substance use and disorders. In 2018, we launched the MAPme Project to pilot a multi-site, longitudinal, college-based study intending to increase the foundational understanding of substance use and behavior development in diverse groups of young adults. Objective: To characterize the design and status of the MAPme Project, a prospective longitudinal study centered on substance use and emotional wellness during and beyond college. Participants: The pilot cohort comprised 301 college freshmen who completed online assessments at baseline (Wave 1). Methods: We provide descriptive information on the pilot cohort, along with preliminary associations of pre- and early collegiate substance use outcomes, psychopathology, sleep patterns, and personality traits. Results: Approximately 64% of participants reported use of a substance in the 90 days leading up to college. Alcohol and cannabis were the most prevalent substances used with males consuming more alcohol than females (t-value=-2.66, p=0.01). Females reported greater levels of daily stressors and mood symptoms. Other health and personality characteristics and observed associations between psychosocial risk and protective factors are described. Prior studies demonstrate the ability to test research hypotheses in the social, health, and clinical areas of psychology with robust statistical power. Conclusions: Substance use and emotional well-being vary considerably upon entry into college/university. The MAPme Project encourages the engagement of students to address challenges associated with lack of awareness, inclusivity, and acceptance of scientific research. Overcoming barriers of inclusivity and empowering the community is key to the successful adoption and implementation of campus health and community-oriented research programs and systematically enhancing research training. Students and faculty interested in bringing MAPme to their campus community should or outreach page at https://scholarblogs.emory.edu/mapme/participant-requirements/ and sign-up page at https://forms.gle/puC7T2zS91td3rA98.

Background: To describe the contextual factors that affect patients’ acceptability and feasibility of alcohol and substance use-related service implementation in family planning (FP) clinics in Massachusetts. Materials and Methods: We conducted a qualitative study of patients at an FP clinic in Massachusetts. Through semistructured interviews ( N = 11), we asked participants about their perspectives regarding receiving substance use screening, patient preferences for care and referral, barriers and facilitators to receiving care, and their acceptability of receiving screening, brief intervention, and referral to treatment (SBIRT) implementation within the FP clinic context. Interview data was analyzed through content thematic analysis utilizing Dedoose software. Results: Patients shared insightful knowledge about the barriers and facilitators to their acceptance of SBIRT implementation within FP clinics in Massachusetts. Patients emphasized the need for SBIRT implementation efforts to be contextually rooted within FP care while also considering how best to alleviate barriers to accessing care. Facilitators to SBIRT implementation included provider trust, psychological safety, provider congruence, varied care modalities, and selectivity by appointment type. Barriers to SBIRT implementation included stigma, transportation, funding, scheduling, and staffing scarcity. Conclusions: Despite persistent structural and systemic barriers, participants expressed broad support for integrating SBIRT into FP settings when delivered in ways that felt affirming, trauma-informed, and individualized to patient needs. Findings revealed critical opportunities for integrating alcohol and/or substance use-related care into FP settings.

Purpose Despite more recent declines in opioid overdose deaths, opioid use among adolescents and young adults (AYA) continues to be a significant public health crisis in the U.S., contributing to various adverse health outcomes. We summarized peer-reviewed literature on the prevalence, risk factors, treatment options, and barriers to evidence-based care for AYA with opioid misuse and opioid use disorder (OUD). Recent Findings Despite the significant need, treatment access for OUD among AYA is low, with limited utilization of evidence-based practices including medications for OUD (MOUD). Primary barriers to effective treatment include inadequate healthcare provider training, a shortage of specialized facilities, prevalent stigma towards treatment, and prohibitive costs. Furthermore, greater naloxone distribution is necessary to reduce overdose deaths in this population. Summary Comprehensive efforts to enhance MOUD accessibility, integrate behavioral interventions, reduce stigma, and support ongoing research into effective AYA-specific strategies are needed to address this national crisis.

Numerous states, including Georgia in April 2019, have advanced policies designed to increase availability of sterile syringes in pharmacies for people who inject drugs (PWID); however, the extent to which pharmacies are willing to sell syringes to PWID is unclear. We examine sterile syringes sales practices in Georgia pharmacies to PWID following a recent policy change and pharmacists' cited reasons for these practices. We conducted a telephone survey from October 2020 through May 2021 of one pharmacist (staff or manager) per pharmacy in a sample of Georgia retail pharmacies stratified by urbanicity. The 15-question survey queried respondents about the pharmacy's current practices regarding nonprescription sterile syringe sales and the respondents' perceptions of syringe sales and counseling practices to those purchasing syringes. Pharmacy and pharmacist demographics were collected and correlations between these characteristics were estimated using unadjusted logistic regression models. We obtained responses from 119 pharmacies (response rate = 34%). Most surveyed pharmacies (81%) reported that they did not sell syringes to patients without a prescription for nonmedical uses, including intravenous drug use. There were no differences in whether pharmacies were more or less likely to sell syringes by level of urbanicity, local poverty rate, local racial/ethnic composition, or pharmacy type (i.e., chain vs. independently owned). The most common reasons cited for not selling syringes were security concerns, that syringe sales encourage drug use, and corporate policy. Among pharmacists in pharmacies not currently selling syringes, only 54% of were aware of the state law change allowing sales of syringes without a medical reason. Despite an important policy change advancing harm reduction through sterile syringe access, availability of sterile syringes to PWID in Georgia pharmacies was likely still hampered by lack of dispensing by pharmacies. Implementation efforts following important policy changes-including building awareness of the new policy, encouraging support of harm reduction efforts, and continuing education around substance use disorders-are essential for achieving the intended outcomes of the policy.