Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-19 (of 19 Records) |
Query Trace: Noonan RK[original query] |
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Public health interventions and overdose-related outcomes among persons with opioid use disorder
Nataraj N , Rikard SM , Zhang K , Jiang X , Guy GP Jr , Rice K , Mattson CL , Gladden RM , Mustaquim DM , Illg ZN , Seth P , Noonan RK , Losby JL . JAMA Netw Open 2024 7 (4) e244617 IMPORTANCE: Given the high number of opioid overdose deaths in the US and the complex epidemiology of opioid use disorder (OUD), systems models can serve as a tool to identify opportunities for public health interventions. OBJECTIVE: To estimate the projected 3-year association between public health interventions and opioid overdose-related outcomes among persons with OUD. DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used a simulation model of the estimated US population aged 12 years and older with OUD that was developed and analyzed between January 2019 and December 2023. The model was parameterized and calibrated using 2019 to 2020 data and used to estimate the relative change in outcomes associated with simulated public health interventions implemented between 2021 and 2023. MAIN OUTCOMES AND MEASURES: Projected OUD and medications for OUD (MOUD) prevalence in 2023 and number of nonfatal and fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. RESULTS: In a baseline scenario assuming parameters calibrated using 2019 to 2020 data remained constant, the model projected more than 16 million persons with OUD not receiving MOUD treatment and nearly 1.7 million persons receiving MOUD treatment in 2023. Additionally, the model projected over 5 million nonfatal and over 145 000 fatal opioid-involved overdoses among persons with OUD between 2021 and 2023. When simulating combinations of interventions that involved reducing overdose rates by 50%, the model projected decreases of up to 35.2% in nonfatal and 36.6% in fatal opioid-involved overdoses among persons with OUD. Interventions specific to persons with OUD not currently receiving MOUD treatment demonstrated the greatest reduction in numbers of nonfatal and fatal overdoses. Combinations of interventions that increased MOUD initiation and decreased OUD recurrence were projected to reduce OUD prevalence by up to 23.4%, increase MOUD prevalence by up to 137.1%, and reduce nonfatal and fatal opioid-involved overdoses among persons with OUD by 6.7% and 3.5%, respectively. CONCLUSIONS AND RELEVANCE: In this decision analytical model study of persons with OUD, findings suggested that expansion of evidence-based interventions that directly reduce the risk of overdose fatality among persons with OUD, such as through harm reduction efforts, could engender the highest reductions in fatal overdoses in the short-term. Interventions aimed at increasing MOUD initiation and retention of persons in treatment projected considerable improvement in MOUD and OUD prevalence but could require a longer time horizon for substantial reductions in opioid-involved overdoses. |
The Martinsburg Initiative: A collaboration between public safety, public health, and schools to address trauma and substance use
Wisdom AC , Villamil V , Govindu M , Kursey M , Peppard L , Bates RA , Myrick A , Snyder C , Noonan RK . J Public Health Manag Pract 2022 28 S355-s358 The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span. |
The Overdose Response Strategy: Reducing drug overdose deaths through strategic partnership between public health and public safety
Wolff J , Gitukui S , O'Brien M , Mital S , Noonan RK . J Public Health Manag Pract 2022 28 S359-s366 CONTEXT: Public health and public safety collaborations can strengthen and improve efforts to address the worsening drug overdose crisis. PROGRAM: The Overdose Response Strategy is addressing this need through a national public health and public safety program designed to foster the cross-sector sharing of timely data, pertinent intelligence, and evidence-based and innovative strategies to prevent and respond to drug overdose. IMPLEMENTATION: Since 2015, the Overdose Response Strategy has been implemented by state-based public health and public safety teams who work together to prevent and respond to drug overdoses within and across sectors, states, and territories. The public health and public safety teams share data systems to inform rapid and effective community overdose prevention efforts; support immediate, evidence-based response efforts that can directly reduce overdose deaths; design and use promising strategies at the intersection of public health and public safety; and use effective and efficient primary prevention strategies that can reduce substance use and overdose long term. Implementation of the Overdose Response Strategy aligns with the US Centers for Disease Control and Prevention's Strategic Partnering Framework. EVALUATION: The evaluation of the Overdose Response Strategy, which is currently underway, is based on 2 evaluation approaches: Collective Impact and Organizational Network Analysis. These approaches provide a way to look at the strength of the relationship between public health and public safety and the way the relationship is leveraged to advance program goals and objectives. DISCUSSION: The Overdose Response Strategy serves as a strategic partnership model that can potentially be applied to other issues, such as gun violence, that may benefit from public health and public safety collaboration. |
Street-drug lethality index: A novel methodology for predicting unintentional drug overdose fatalities in population research
Hall OE , Trent Hall O , Eadie JL , Teater J , Gay J , Kim M , Cauchon D , Noonan RK . Drug Alcohol Depend 2021 221 108637 BACKGROUND: Emerging evidence suggests the composition of local illicit drug markets varies over time and the availability and relative lethality of illicit drugs may contribute to temporal trends in overdose mortality. Law enforcement drug seizures represent a unique opportunity to sample the makeup of local drug markets. Prior research has associated shifts in the types of drugs seized and trends in unintentional drug overdose mortality. The present report builds on this work by demonstrating a novel methodology, the Street-Drug Lethality Index, which may serve as a low-lag predictor of unintentional overdose deaths. METHODS: Data included administrative records of law enforcement drug seizures and unintentional drug overdose deaths in Ohio from 2009 -to- 2018. Death records and lab results from drug seizures occurring during the calendar year 2017 were transformed via the described procedure to create lethality indices for individual drugs. These indices were then summed annually to create the independent variable for a linear regression model predicting unintentional overdose deaths for all years during the study period. RESULTS: The regression model explained 93 % of the year-to-year variance in unintentional overdose fatalities (slope = 0.009480; CI = 0.007369 to 0.011590; t(10) = 10.355942; P = 0.000007; Y = 11.808982 + 0.009480X, r(2) = 0.931). CONCLUSION: These findings contribute to a growing body of evidence that changes in the composition of the drug supply may predict trends in unintentional overdose mortality. The proposed methodology might inform future overdose prevention and response efforts as well as research. |
Continued Increases in Overdose Deaths Related to Synthetic Opioids: Implications for Clinical Practice.
Baldwin GT , Seth P , Noonan RK . JAMA 2021 325 (12) 1151-1152 The current overdose epidemic in the US that began in the late 1990s continues unabated. Since 2013, deaths involving synthetic opioids surged substantially, largely due to the rapid proliferation of illicitly manufactured fentanyl and fentanyl analogs (eg, acetylfentanyl, carfentanil).1,2 More recently, overdose deaths involving stimulants, such as methamphetamine and cocaine, have increased with and without opioid co-involvement.3,4 As illicitly manufactured fentanyl became more ubiquitous, drug overdose death rates increased in all age groups, among both sexes, across most races and ethnicities, within all urbanization levels, and in the majority of US states.1 |
Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose
Carroll JJ , Mital S , Wolff J , Noonan RK , Martinez P , Podolsky MC , Killorin JC , Green TC . Drug Alcohol Depend 2020 217 108257 BACKGROUND: Rates of fatal overdose (OD) from synthetic opioids rose nearly 60 % from 2016 to 2018. 911 Good Samaritan Laws (GSLs) are an evidenced-based strategy for preventing OD fatality. This study describes patrol officers' knowledge of their state's GSL, experience with OD response, and their perspectives on strategies to prevent and respond to opioid OD. METHODS: An electronic survey assessed officers' knowledge of state GSLs and experiences responding to OD. Descriptive statistics and hierarchical linear modeling were generated to examine differences in knowledge, preparedness, and endorsement of OD response efforts by experience with OD response. RESULTS: 2,829 officers responded to the survey. Among those who had responded to an OD call in the past six months (n = 1,946), 37 % reported administering naloxone on scene and 36 % reported making an arrest. Most (91 %) correctly reported whether their state had a GSL in effect. Only 26 % correctly reported whether that law provides limited immunity from arrest. Fifteen percent of officers who had responded to an OD work in departments that do not carry naloxone. Compared with officers who had not responded to any OD calls, those who reported responding OD calls at least monthly and at least weekly, were significantly less likely to endorse OD response efforts. CONCLUSION: Officers who respond to OD calls are generally receiving training and naloxone supplies to respond, but knowledge gaps and additional training needs persist. Additional training and strategies to relieve compassion fatigue among those who have more experience with OD response efforts may be indicated. |
Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018
Jones CM , Noonan RK , Compton WM . Drug Alcohol Depend 2020 214 108169 BACKGROUND: Expanding access to treatment and recovery services is key to reducing substance use-related harms. Fundamental to expanding such services is better understanding the populations identifying themselves as in recovery. This study uses nationally representative data to estimate prevalence and correlates of recovery in the U.S. METHODS: Data are from the 43,026 adults (aged 18 or older) participating in the 2018 National Survey on Drug Use and Health. Based on self-reported data, we estimate prevalence of ever having a substance use problem, the percentage in recovery among those with a substance use problem, and a multivariable logistic regression model to explore associations of recovery status with demographic characteristics and lifetime mental health problems. Among adults reporting a substance use problem, we compare prevalence of substance use by recovery status, followed by a multivariable model examining associations between each substance used and being in recovery. RESULTS: More than 1 in 10 adults (27.5 million) in the U.S. reported ever having a substance use problem, and, among those with a problem, nearly 75 % (20.5 million) reported being in recovery. Reporting lower prevalence of using substances in the past year and having received treatment for their substance use problem were associated with being in recovery. Ever having a mental health problem was highly prevalent among those reporting a substance use problem. CONCLUSIONS: The provision and expansion of substance use treatment services continues to be important to reduce harms related to substance use, especially for those with both substance use and mental health disorders. |
Quantifying the epidemic of prescription opioid overdose deaths
Seth P , Rudd RA , Noonan RK , Haegerich TM . Am J Public Health 2018 108 (4) 500-502 In 2016, 63 632 persons died of a drug overdose in the United States; 66.4% (42 249) involved an opioid.1 Opioid-involved deaths include prescription opioid analgesics (e.g., morphine, oxycodone), illicit opioids (e.g., heroin, illicitly manufactured fentanyl [IMF]), or both. Although prescription and illicit opioid overdoses are closely entwined,2 it is important to differentiate the deaths to craft appropriate prevention and response efforts. Unfortunately, disentangling these deaths is challenging because multiple drugs are often involved. Additionally, death certificate data do not specify whether the drugs were pharmaceutically manufactured and prescribed by a health care provider, pharmaceutically manufactured but not prescribed to the person (i.e., diverted prescriptions), or illicitly manufactured. |
Underlying factors in drug overdose deaths
Dowell D , Noonan RK , Houry D . JAMA 2017 318 (23) 2295-2296 Drug overdose accounted for 52 404 deaths in the United States in 2015,1 which are more deaths than for AIDS at its peak in 1995. Provisional data from the US Centers for Disease Control and Prevention (CDC) indicate drug overdose deaths increased again from 2015 to 2016 by more than 20% (from 52 898 deaths in the year ending in January 2016 to 64 070 deaths in the year ending in January 2017).2 Increases are greatest forover-doses related to the category including illicitly manufactured fentanyl (ie, synthetic opioids excluding methadone), which more than doubled, accounting for more than 20 000 overdose deaths in 2016 vs less than 10 000 deaths in 2015. This difference is enough to account for nearly all the increase in drug overdose deaths from 2015 to 2016.2 | Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure). Why have overdose deaths related to illicit opioids increased so substantially? Data from the National Survey on Drug Use and Health reveal moderate increases in people reporting past-year heroin use from 2010 to 2015 (Figure). Increasing numbers of individuals who use heroin are younger, might be less experienced, and might use heroin in riskier ways that are difficult to measure (eg, using it alone, using more heroin, using it more often, or combining drugs). |
Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates
Dowell D , Zhang K , Noonan RK , Hockenberry JM . Health Aff (Millwood) 2016 35 (10) 1876-1883 To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed. |
Technical packages in injury and violence prevention to move evidence into practice: Systematic reviews and beyond
Haegerich TM , David-Ferdon C , Noonan RK , Manns BJ , Billie HC . Eval Rev 2016 41 (1) 78-108 Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence. |
Effect of religiosity and dysfunctional dating attitudes on youth substance use
Tharp AT , DeWall CN , Richman SB , Noonan RK . J Addict 2014 2014 143709 The current investigation examined the interactive effect of dysfunctional dating attitudes and religiosity on substance use in a large sample of youth (N = 1,357) from the YouthStyles survey. Based on past research, we explored the possibility that religiosity buffered the association between dysfunctional dating attitudes and substance use. Because age was significantly associated with all study variables, we included age in our analyses. In support of our hypothesis we found an attitude by religiosity by age interaction among youth with moderate levels of dysfunctional dating attitudes. Among these youth, the buffering effect of religiosity increased with age. For youth with low and high dysfunctional dating attitudes, religiosity did not buffer the association. The results of this study are in line with past work that suggests that the association between relationship characteristics and substance use is complex. It also identifies religiosity as a protective factor for the effect of dating attitudes on substance use but suggests that these effects may be the most important for youth with moderate levels of dysfunctional dating attitudes. |
Twenty years of scientific progress in injury and violence research and the next public health frontier
Greenspan AI , Noonan RK . J Safety Res 2012 43 (4) 249-55 The establishment of the National Center for Injury Prevention and Control (NCIPC or Injury Center) in 1992 as part of the Centers for Disease Control and Prevention (CDC) firmly established the Injury Center as the lead federal agency for non-occupational injury prevention and control (Sleet et al., 2012). Since then, it has provided leadership and a strong scientific base for intramural and extramural-investigator funded injury research. The Injury Center's scientific mission encompasses efforts from primary prevention to treatment and rehabilitation. Early CDC efforts were primarily focused on describing the extent of the problem, identifying risk and protective factors that affect the extent of violence and injury in our society, and gaining visibility for violence and injury as a major public health problem. Efforts such as the development of injury-based surveillance systems provided population-based surveillance data regarding the extent and distribution of fatal and non-fatal injuries, helped to identify demographic characteristics for those who were most at risk, and identified risk and protective factors that influence that risk. Celebrating the Injury Center's 20th anniversary presents an opportunity not only to reflect on past accomplishments but also to look ahead at what still needs to be done. |
Associations between three characteristics of parent-youth relationships, youth substance use, and dating attitudes
Tharp AT , Noonan RK . Health Promot Pract 2012 13 (4) 515-23 Various dimensions of parenting have been associated with youth risk behaviors, such as substance use and dating violence. These associations have spawned many prevention strategies that focus on parenting. However, it is unclear which characteristics of parent-youth relationships, and thus, which parent-focused prevention strategies, may be most influential in youth risk behaviors and, thus, which should be targeted in prevention. Using responses from the YouthStyles 2007 survey (N = 1,357), this study identified three youth-reported parent-youth relationship characteristics: communication about risk behaviors, closeness/respect, and rules/monitoring. The authors examined the associations among these characteristics and youths' demographics, attitudes supporting controlling dating relationships, and use of alcohol, marijuana, and tobacco. Results suggested risk behavior communication was more frequently reported by girls and was more frequent among older youth. Closeness/respect and rules/monitoring were more frequent among younger youth. Regressions suggested communication about risk behaviors was not a predictor of attitudes supporting controlling dating relationships but was a significant predictor of substance use, closeness/respect and rules/monitoring predicted substance nonuse and attitudes unsupportive of controlling dating relationships. The findings suggest that parental communication alone may not be sufficient to influence youth risk taking, but that parental monitoring and the establishment of respectful, close relationships with children may be important elements of parent-focused health promotion efforts. |
Navigating the road ahead: public health challenges and the Interactive Systems Framework for Dissemination and Implementation
Noonan RK , Wilson KM , Mercer SL . Am J Community Psychol 2012 50 572-80 Public health is currently faced with an array of critical challenges and disconnects. Research and evaluation have identified a number of evidence-based strategies for effecting behavior change at individual, group, organizational, and environmental levels, all of which hold promise for leading to substantial reductions in morbidity and mortality, and increased quality of life. Unfortunately, there is huge variability across the public health system in awareness of the value of using evidence to inform decision making, let alone in capacity to locate, assess, compare, select, justify, adapt, implement, and evaluate evidence-based strategies, or to participate in building the evidence base for practice-based innovations. As a result, many communities may not be benefitting from research-tested and practice-based strategies that could help them to meet their public health goals more efficiently and effectively. CDC's Interactive Systems Framework for Dissemination and Implementation (ISF), released in 2008, was designed to help close this gap between research and practice. This commentary identifies the ways in which the ISF framework is useful in addressing the research practice gap; revisits the elements of the framework that have continued to guide research and practice in fruitful ways; and highlights areas that need further development to meet current public health challenges. |
The public health approach to older adult fall prevention: comments from the U.S. Centers for Disease Control and Prevention
Noonan RK , Stevens JA , Baldwin G . Open Longev Sci 2011 5 26-31 Unintentional falls among persons aged 65 years and older are an important public health issue, associated with significant mortality and morbidity. About one third of older adults fall annually and, although many fall outcomes are minor, between 10% and 20% cause serious injuries such as traumatic brain injury, contusions, and fractures. Therefore the U.S. Centers for Disease Control and Prevention (CDC) is working to prevent injuries and fatalities due to older adult falls. The public health approach to older adult falls focuses on prevention and is based on scientific rigor. Its steps include defining the problem, identifying causes, developing and testing interventions, and then implementing effective approaches on a large scale. We highlight current CDC activities that map onto each step of the public health model and close by providing future directions for older adult fall prevention, including improved surveillance, support for program implementation, and enhanced partnership building. Noonan et al. |
An older adult falls research agenda from a public health perspective
Stevens JA , Baldwin GT , Ballesteros MF , Noonan RK , Sleet DA . Clin Geriatr Med 2010 26 (4) 767-79 This article reviews fall prevention research using the Centers for Disease Control public health model and suggests several critical research questions at each step. Research topics include surveillance and data systems, fall risk factors, development, evaluation and implementation of fall interventions, translation of interventions into programs, and promotion, dissemination, and widespread adoption of fall prevention programs. These broad topics provide a framework for research that can guide future advances in older adult fall prevention. |
Older adult fall prevention: perceptions, beliefs, and behaviors
Stevens JA , Noonan RK , Rubenstein LZ . Am J Lifestyle Med 2010 4 (1) 16-20 Falls in adults aged 65 years and older are an important health issue associated with excess mortality, functional limitations, loss of independence, and reduced quality of life. Physicians can reduce the likelihood of falls in their older patients by incorporating prevention strategies into their clinical practice. Research has identified effective interventions, notably clinical assessment and risk factor reduction and exercise programs with balance training, that require older adults to adopt new behaviors. However, some older adults believe falls are an inevitable consequence of aging, while others do not see themselves as personally vulnerable. Factors that facilitate adopting fall interventions include social support, low intensity exercise, and the perception that the programs are relevant. Barriers include fatalism, denial of risk, poor self-efficacy, and no previous history of exercise. To encourage their patients’ participation, physicians need to present fall interventions as lifestyle enhancing and as a way to remain independent. Messages should focus on positive health and social benefits such as improving balance and maintaining independence, rather than emphasizing negative information about falls and fall injuries. Along with the support of family and friends, a personal invitation from a health care provider will encourage older adults to take part in fall prevention programs. |
Developing teen dating violence prevention strategies: formative research with middle school youth
Noonan RK , Charles D . Violence Against Women 2009 15 (9) 1087-105 Intimate partner violence (IPV) peaks in youth and young adulthood and is associated with multiple adolescent risk behaviors and negative health outcomes. Targeting youth with prevention messages before they start dating may avert teen dating violence and subsequent adult IPV. This article discusses findings from focus groups with middle school youth to determine behaviors and beliefs regarding dating violence. To develop effective prevention messages, participants were asked questions about characteristics of middle school dating relationships, healthy relationships, relationship norms, unhealthy relationships, emotional abuse, physical abuse, sexual abuse, intervening in violent situations, and trusted sources for information about dating violence. The recommendations for prevention efforts include an emphasis on skill building, tailoring efforts for particular subgroups, and identifying innovative ways of reaching youth. |
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