Psychiatry and Behavioral Sciences funds population health pilots

Finding the economic and social roots of the opioid epidemic in Washington State

Investigators
Mark Sullivan, Psychiatry and Behavioral Sciences
Jonathan Mayer, Geography and Epidemiology
Anirban Basu, Pharmacy, Health Services, and Economics
Joan Russo, Psychiatry and Behavioral Sciences
Jennifer Sabel, Washington State Department of Health

Project abstract
The opioid epidemic has become a top priority for population health due to high death rates and social devastation in affected communities. This multidisciplinary proposal builds on strengths of the UW in pain and opioid research, treatment and policy to address opioid-related population health.

Project aims:

• 1.a. Investigate relationships among opioid prescribing, opioid adverse events and social/economic characteristics within the 248 five-digit zipcode regions of Washington State. Opioid prescribing characteristics: daily dose, cumulative dose, long-acting opioid use, co-prescription with sedatives. Opioid adverse event characteristics: opioid-related deaths, opioid-related hospitalizations, opioid-related ED visits. Social/economic regional characteristics: years education, unemployment rate, Medicaid enrollment, etc.
• 1.b. Analyze relationships among these variables among groups defined by 5-digit zipcodes.

Opioid prescribing varies 6-fold between counties. Rates of opioid death and hospitalization also vary widely but are only partially explained by these differences in prescribing. Social and economic characteristics of affected communities play an important role in the variation in opioid prescribing and in the likelihood of opioid adverse events. We propose to examine opioid (and other controlled substance) prescribing, opioid adverse event rates (deaths, hospitalizations) and socio-economic characteristics of communities in Washington at the 5-digit zipcode level using data from WA, Federal and local sources. We will perform cross-sectional analysis of annual files 2012-2017 with linear, logistic and multilevel regression to determine patterns of relationship both within and among zipcode regions. These analyses will suggest targets for public health intervention and inform future longitudinal analysis supported by external funding that will clarify causal relationships among variables.

Caring Letters After the War: Veterans Writing Veterans to Prevent Suicide

Investigators
Mark Reger, Psychiatry and Behavioral Sciences
Natalie Mizik, Foster School of Business
Lori Zoellner, Psychology

Project abstract
Veteran suicides represent 26% of all suicides in Washington State, and the veteran suicide rate is significantly higher than the population rate. Despite the urgency for improved prevention, there is very little evidence to support most suicide prevention approaches. However, the Caring Letters intervention is one of the only suicide prevention interventions that have reduced suicide rates in a randomized controlled trial (RCT).

In this simple intervention, providers send high-risk patients brief messages that express caring concern to patients over the course of a year or more. Receiving repeated Caring Letters is presumed to exert a suicide preventative effect by promoting a feeling of caring connection and reminding patients about treatment options. Unfortunately, caring messages sent from Veterans Affairs (VA) providers will probably not have the same beneficial effects, since veterans have a long history of trust issues with the VA. Furthermore, providers simply cannot reach all of the individuals who need help due to the limited number of providers.

This pilot proposes to leverage the expertise of three UW Departments and a community partner to develop and evaluate a peer-approach to sending Caring Letters. Veteran volunteers from the American Legion will be matched to veterans discharged from a psychiatric inpatient unit (a very high risk period) to send monthly Caring Letters. The pilot study will develop and evaluate instructions for volunteer letter writers, procedures to match letter writers and recipients, privacy and safety procedures, as well as preliminary outcomes for both letter writers and recipients (e.g., depression, hopelessness, suicidal ideation).

Real-time Influences of Geospatial Context and Negative Affect on Young Adult Marijuana Use

Investigators
Isaac Rhew, Psychiatry and Behavioral Sciences
Philip Hurvitz, Urban Design and Planning
Ann Vander Stoep, Psychiatry and Behavioral Sciences, Epidemiology
Elizabeth McCauley, Psychiatry and Behavioral Sciences

Project abstract
As the socio-political landscape of marijuana use has shifted in many states, including Washington, and national studies suggest increasing prevalence of marijuana use and disorder, particularly among young adults, understanding factors that influence use and misuse of marijuana has become a population health priority. Using a socio-ecological perspective that spans multiple levels of influence (e.g., intra-individual, community) will contribute to this public health agenda by strengthening knowledge regarding the etiology of marijuana misuse and informing intervention strategies.

A multidisciplinary team proposes to conduct a pilot study integrating Global Positioning System (GPS) and Ecological Momentary Assessment (EMA) methodologies that will lead to a program of research investigating “real-time” exposures to neighborhood features (marijuana retail outlets, area-level disorganization) and fluctuations in negative mood and their joint impacts on marijuana craving and use. Twenty young adult regular marijuana users living in King County, recruited from an ongoing longitudinal study, will be tracked over geographic space and time with GPS and assessed for marijuana use and craving and mood multiple times per day for 14 consecutive days.

The study will demonstrate feasibility and acceptability of the study procedures, showcase development of innovative spatio-temporal measures, and provide preliminary findings for future larger-scale research on geospatial contexts of event-level marijuana use. This line of research could inform local planning decisions (e.g., zoning, licensing, and placement of retail outlets), other community-level strategies (e.g., interventions to improve social capital, reduce permissive substance use norms), and development of novel interventions that could target individuals at high-risk moments and places.