Renae D. Schmidt

Background and aims: Sleep disruptions increase the risk of substance misuse. Substance use—especially stimulants—can increase acute and chronic sleep dysfunction. This study aimed to estimate the associations between sleep disturbance and stimulant use over time among participants with stimulant use disorder (StUD). Design: In this secondary analysis, a Random Intercept Cross‐Lagged Panel Model (RI‐CLPM) was used to assess sleep disturbance and stimulant use over 8 weeks among participants with StUD. Setting: United States of America. Participants: The analysis included 793 participants with StUD enrolled across 3 randomized controlled trials in the National Institute on Drug Abuse's Clinical Trials Network (CTN): CTN‐0037, CTN‐0048 and CTN‐0068. Measurements: Self‐reported sleep disturbance was harmonized as a binary indicator across trial measures at each week. Stimulant use days per week were captured by Timeline Follow Back. Baseline covariates included age, sex, race/ethnicity, employment status, presence of depressive symptoms, any psychiatric history, treatment arm and trial. Findings: Sleep disturbance was associated with a higher average number of stimulant use days the following week [β = 0.15, 95% confidence interval (CI) = 0.09, 0.22, P < 0.001], and greater stimulant use was linked to increased odds of subsequent sleep disturbance (odds ratio = 1.20, 95% CI = 1.14, 1.26, P < 0.001). Conclusions: Higher‐than‐usual stimulant use appears to be associated with increased likelihood of sleep disturbance the following week, and vice versa.

Purpose The aim of this study was to assess body mass index (BMI) category as a predictor of substance craving in people with substance use disorder (SUD) participating in 5 clinical trials. Methods BMI was categorized into 4 groups: underweight, healthy weight, overweight, and obesity. Craving assessments were harmonized to calculate comparable craving scores for each participant across trials. General linear mixed effects regression models were fit to final craving score where BMI was considered a main effect and clinical trials as a random effect while also controlling for demographic and clinical characteristics of the participants. Results 1,418 participants were included in the final sample. Participants were primarily male (68.97%), and mean age was 39.73 years (SD: 11.38). Obesity (β = 0.59; p = 0.73) and overweight (β = 1.65; p = 0.29) were not significantly associated with final craving score while controlling for covariates. Baseline depression, age, and concomitant SUD medications were significantly associated with final craving score. Conclusions Although results indicate participants with obesity and SUD do not experience significantly higher craving for substances, more research is needed to uncover how this varies across different patient populations. Future studies should seek to include more comprehensive measures of obesity and eating behaviors to assess how these may impact substance craving and other SUD treatment outcomes. Level of Evidence Level III (Evidence obtained from well-designed cohort or case–control analytic studies).

As society becomes increasingly digital, qualitative research methods must continue to adapt and evolve to remain relevant and effective. This study aimed to evaluate the feasibility and utility of asynchronous online focus groups (AOFGs) as a platform to engage young women in discussions about mental health. The Learning Insights from Girls for Health (LIGHT) study utilized an AOFG to assess mental health problems and potential solutions among 52 young women, 18–25 years old, across the United States. This study analyzed survey data and transcripts from the LIGHT study to assess participants’ perceptions and satisfaction with the AOFG approach, and to characterize participant engagement and interaction within the AOFGs. Over half (59.6%) of participants were “Extremely satisfied” with the approach, and 34.6% were “Somewhat satisfied.” Participants highlighted Confidentiality , Flexibility , Connection and perspective sharing , and Equitable participation as strengths of the approach, and Lack of nonverbal and paraverbal cues , Disjointedness , and Prone to user and technical error as limitations. Two themes generated to characterize participant engagement and interactions in the AOFGs included (1) Engagement through storytelling elevates insights around mental health experiences and (2) Participant interactions included offering support in the form of advice, validation, and empathy . Results of this study indicate that AOFGs are a valuable platform for facilitating discussions about mental health in young women and are a practical and flexible approach to conducting qualitative research.

To determine whether endorsement patterns of psychosocial symptoms revealed distinct subgroups, or latent classes, of people living with HIV who use substances (PLWH-SU), and to assess whether these classes demonstrated differential health outcomes over time. This study uses data from 801 PLWH-SU initially enrolled across 11 US hospitals during 2012–2014 and followed up in 2017. Latent class analysis included 28 psychosocial items. Regression analysis examined class membership as a predictor of viral suppression. Survival analysis examined class as a predictor of all-cause mortality. The selected model identified five unique classes. Individuals in classes characterized by more severe and more numerous psychosocial symptoms at baseline had lower likelihoods of viral suppression and survival. The study demonstrated the importance of considering patterns of overlapping psychosocial symptoms to identify subgroups of PLWH-SU and reveal their risks for adverse outcomes. Integration of primary, mental health, and substance use care is essential to address the needs of this population.

Introduction: Suicide is the tenth leading cause of death in the United States and continues to be a major public health concern. Suicide risk is highly prevalent among individuals with co-occurring substance use disorders (SUD) and mental health disorders, making them more prone to adverse substance use related outcomes including overdose. Identifying individuals with SUD who are suicidal, and therefore potentially most at risk of overdose, is an important step to address the synergistic epidemics of suicides and overdose fatalities in the United States. The current study assesses whether patterns of suicidality endorsement can indicate risk for substance use and overdose.Methods: Latent class analysis (LCA) was used to assess patterns of item level responses to the Concise Health Risk Tracking Self-Report (CHRT-SR), which measures thoughts and feelings associated with suicidal propensity. We used data from 2,541 participants with SUD who were enrolled across 8 randomized clinical trials in the National Drug Abuse Treatment Clinical Trials Network from 2012 to 2021. Characteristics of individuals in each class were assessed, and multivariable logistic regression was performed to examine class membership as a predictor of overdose. LCA was also used to analyze predictors of substance use days.Results: Three classes were identified and discussed: Class (1) Minimal Suicidality, with low probabilities of endorsing each CHRT-SR construct; Class (2) Moderate Suicidality, with high probabilities of endorsing pessimism, helplessness, and lack of social support, but minimal endorsement of despair or suicidal thoughts; and Class (3) High Suicidality with high probabilities of endorsing all constructs. Individuals in the High Suicidality class comprise the highest proportions of males, Black/African American individuals, and those with a psychiatric history and baseline depression, as compared with the other two classes. Regression analysis revealed that those in the High Suicidality class are more likely to overdose as compared to those in the Minimal Suicidality class (p = 0.04).Conclusion: Suicidality is an essential factor to consider when building strategies to screen, identify, and address individuals at risk for overdose. The integration of detailed suicide assessment and suicide risk reduction is a potential solution to help prevent suicide and overdose among people with SUD.

Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network’s CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals’ experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.

Increasing rates of overdose and overdose deaths are a significant public health problem. Research has examined co-occurring mental health conditions, including suicidality, as a risk factor for intentional and unintentional overdose among individuals with substance use disorder (SUD). However, this research has been limited to single site studies of self-reported outcomes. The current research evaluated suicidality as a predictor of overdose events in 2541 participants who use substances enrolled across eight multi-site clinical trials completed within the National Drug Abuse Treatment Clinical Trials Network between 2012 to 2021. The trials assessed baseline suicidality with the Concise Health Risk Tracking Self-Report (CHRT-SR). Overdose events were determined by reports of adverse events, cause of death, or hospitalization due to substance overdose, and verified through a rigorous adjudication process. Multivariate logistic regression was performed to assess continuous CHRT-SR score as a predictor of overdose, controlling for covariates. CHRT-SR score was associated with overdose events (p = 0.03) during the trial; the likelihood of overdose increased as continuous CHRT score increased (OR 1.02). Participants with lifetime heroin use were more likely to overdose (OR 3.08). Response to the marked rise in overdose deaths should integrate suicide risk reduction as part of prevention strategies.

Objective: The coronavirus disease 2019 (COVID‐19) pandemic in the United States has exacerbated a number of mental health conditions and problems related to prolonged social isolation. While COVID‐19 has led to greater loneliness and a lack of social connectedness, little is known about who are the most affected and how they are impacted. Therefore, we performed a Latent Class Analysis using items from two scales – the UCLA Loneliness Scale and the Social Connectedness Scale – to characterize different experiences of loneliness and connectedness, examine their relationship with mental health and substance use symptoms, including depression, anxiety, drinking, and drug use.Methods: Data were drawn from an anonymous one‐time online survey examining the mental health of 1008 young adults (18–35 years old) during COVID‐19. A latent class analysis (LCA) was conducted to observe and identify classes based on responses to loneliness and connectedness scale items, and to examine the existence of subgroups among this young adult population.Results: We identified a 4‐class model of loneliness and connectedness: (1) Lonely and Disconnected – highest probabilities in items of loneliness and disconnectedness, (2) Moderately Lonely and Disconnected – adaptive levels of some isolation and disconnection during COVID‐19, (3) Ambivalent Feelings – displaying negative responses in particular to negatively‐worded items while simultaneously affirming positively worded items, and (4) Connected and Not Lonely – lowest probabilities in items of loneliness and disconnectedness.Conclusion: Key findings include (1) the delineation of classes by levels of loneliness and connectedness showcasing differential mental health and substance use symptoms, (2) the utility of item‐level evaluation with LCA in determining specific classes of people in need of outreach and intervention, and (3) the promise of social connection to bolster resilience in young adults.

Although epidemiology core competencies are established by the Association of Schools and Programs of Public Health for masters-level trainees, no equivalent currently exists for the doctoral level. Thus, the objective of the Doctoral Education in Epidemiology Survey (2019) was to collect information on doctoral-level competencies in general epidemiology (doctoral) degree programs and other pertinent information from accredited programs in the United States and Canada. Participants (doctoral program directors or knowledgeable representatives of the program) from 57 institutions were invited to respond to a 39-item survey (18 core competencies; 9 noncore or emerging topic–related competencies; and 12 program-related items). Participants from 55 institutions (96.5%) responded to the survey, of whom over 85% rated 11 out of 18 core competencies as “very important” or “extremely important.” More than 80% of the programs currently emphasize 2 of 9 noncore competencies (i.e., competency to ( 1) develop and write grant proposals, and ( 2) assess evidence for causality on the basis of different causal inference concepts). “Big data” is the most frequently cited topic currently lacking in doctoral curricula. Information gleaned from previous efforts and this survey should prompt a dialog among relevant stakeholders to establish a cohesive set of core competencies for doctoral training in epidemiology.