AJPH March 2018 highlights

Date: Mar 22 2018

AJPH publishes new research on NYC smoking age, opioids up 500% in Brazil, Defense Dept. policies and traumatic brain injury, Medicaid expansion and opioids

CONTACT: To request copies of articles or for information on scheduling interviews with an expert, please contact Megan Lowry.

American Journal of Public Health May Issue research highlights:

Raising smoking age to 21 in NYC didn’t accelerate smoking reduction

Raising the smoking age to 21 in New York City didn’t accelerate the decline of tobacco use when compared with the rest of New York state, where the minimum legal purchase age stayed at 18. Adolescent tobacco use declined slightly in New York City after officials raised the minimum legal purchase age for tobacco and e-cigarettes from 18 to 21. However, the rate of change for smoking decline was actually greater in the rest of the state during that time period. 

Researchers found that e-cigarette use increased and reported purchases of loose cigarettes remained unchanged, suggesting uneven policy implementation, enforcement or compliance. Study authors note that other cities and states currently raising their minimum legal purchase age for tobacco may need to pay close attention to policy enforcement and conduct enhanced monitoring of retailer compliance to achieve the full benefits of the policy.

[Author Contact: James Macinko, Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA. “Impact of New York City’s 2014 Increased Minimum Legal Purchase Age on Youth Tobacco Use.”]. 

Opioid sales have increased by nearly 500 percent in Brazil: An epidemic in the making?

Opioid sales have increased across Brazil from 1,601,043 prescriptions in 2009 to 9,045,945 prescriptions in 2015, corresponding to a 465 percent increase in six years. The largest absolute increase was for codeine products, accounting for more than 98 percent of prescriptions in both years. Oxycodone had the largest relative increase, and fentanyl products had the smallest absolute and relative increase.

Study authors cautioned that given rapid increases in opioid sales across Brazil, it is critical to introduce effective prescribing and monitoring methods that allow patients to access necessary medications without escalating risk of opioid misuse and related consequences. Careful surveillance of supply and subsequent outcomes are needed to prevent the development of another devastating opioid epidemic like the one seen in the United States.

[Author Contact: Noa Krawczyk, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. “Rising trends of prescription opioid sales in contemporary Brazil, 2009–2015.”].

New Department of Defense policies increased traumatic brain injury reporting

Department of Defense and service-specific policies introduced between 2006 and 2013 significantly increased the number of battlefield traumatic brain injuries identified, successfully improving the longstanding problem of underreporting of TBIs in the military. The findings also suggest significant under-identification of battlefield TBIs before 2006.

The study found that two Army policies encouraging TBI reporting were associated with an increase of 251 percent and 97 percent in TBIs identified following their implementation, respectively. The introduction of TBI-specific screening questions to the Post-Deployment Health Assessment was associated with a 78 percent increase in reported TBIs. The 2010 Department of Defense Directive Type Memorandum 09-033 was associated with another increase of 80 percent in the likelihood of being identified with a TBI among soldiers, a 51 percent increase among sailors and a 124 percent increase among Marines.

[Author Contact: Yll Agimi, Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. "Traumatic brain injuries among deployed us service members identified by Department of Defense policies, 2001–2016."].

Medicaid expansion didn’t increase access to opioids

Research found no difference in the rate of opioid prescriptions between Medicaid expansion states and non-expansion states from 2011-2016. These findings follow a letter sent from U.S. Senator Ron Johnson to the Inspector General of the U.S. Department of Health and Human Services in July 2017 that claims the Medicaid program contributed to the opioid crisis.

The study found the rate of buprenorphine and naltrexone (used in medication-assisted addiction treatment) prescribing increased more than 200 percent after states expanded eligibility, while increasing by less than 50 percent in states that did not expand. Methadone prescribing decreased in all states in this period, with larger decreases in expansion states.

Authors concluded that Medicaid expansion enrolled a population no more likely to be prescribed opioids than the base Medicaid population while significantly increasing uptake of two drugs used in medication-assisted treatment.

[Author Contact: Alana Sharp, amfAR, The Foundation for AIDS Research, Washington, DC. "Impact of Medicaid expansion on access to opioid analgesic medications and medication-assisted treatment."].

Youth development program lowers risk of anti-social behavior, drug use, violence through 21 years of age

This study found students who participated in a youth development program from 5th through 12th grade reduced their risk of anti-social behavior, drug use and violence through age 21, three years after leaving the program.

The Communities that Care system, a program to promote positive youth development and reduce health-risking behavior, increased the likelihood of sustained abstinence from gateway drug use by 49 percent and antisocial behavior by 18 percent, and reduced lifetime incidence of violence by 11 percent through age 21 years. In male participants, the CTC system also increased the likelihood of sustained abstinence from tobacco use by 30 percent and marijuana use by 24 percent, and reduced lifetime incidence of inhalant use by 18 percent. 

[Author Contact: Margaret R. Kuklinski, Social Development Research Group, School of Social Work, University of Washington, Seattle, WA "Long-term effects of the communities that care trial on substance use, antisocial behavior, and violence through age 21 years."].

Find a full list of AJPH research papers published online below:

  • Oral  Health 4 Life: A Randomized Semi-Pragmatic Trial Evaluating A Novel Oral Health Promotion And Smoking Cessation Program Delivered Via Tobacco Quitlines
  • U.S. Mayors' And Health Commissioners' Opinions About Health Disparities In Their Cities
  • Long-Term Effects Of The Communities That Care Trial  On Substance Use, Antisocial Behavior, And Violence Through Age 21
  • Undiagnosed HIV And HCV Infection In A New York City Emergency Department, 2015
  • The Rise of Prescription Opioid Sales In Contemporary Brazil: An Epidemic In The Making?
  • The C-Word: Scientific Euphemisms Do Not Improve Causal Inference From Observational Data
  • The Impact Of New York City's Increased Minimum Legal Purchase Age For Tobacco
  • Impact Of Medicaid Expansion On Access To Opioid Analgesic Medications And Medication-Assisted Treatment
  • Local Health Department-Hospital Collaborations Around Community Health Needs Assessment And Investment In Community Health
  • Contagion And Public Health In Switzerland
  • Fostering Local Health Department and Health System Collaboration through Case Conferences for At-Risk and Vulnerable Populations.
  • Role Of Department Of Defense Policies On Traumatic Brain Injury Identification And Reporting Among Deployed US Service Members (2001-2016)
  • Disproportionate Sterilization Of Latinos Under California's Eugenic Sterilization Program, 1920-1945
  • Implications Of The Tax Cuts And Jobs Act For Public Health

The articles above were published online March 22, 2018, at 4 p.m. ET by AJPH under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association, and is available at www.ajph.org.

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