• Behavioral Health among Foreign-Born and U.S.-Born Emerging Adults: Barriers to Seeking Services, College Enrollment Status, and Service Utilization

      Bessaha, Melissa; Cornelius, Llewellyn Joseph, 1959-; Unick, George Jay (2016)
      Behavioral health problems are a leading cause of disability and a major public health issue in the United States. Compared to other adult age groups, emerging adults aged 18 to 29 experience more behavioral health problems. Although transitioning to adulthood may provide growth opportunities, it can also be a time of increased vulnerability and risk as emerging adults often face challenges in emotional, educational, and professional transitions. The United States has also seen rapid growth in the foreign-born emerging adult population as well as growing health disparities among immigrant and minority groups; however, prior research investigating behavioral health service use of emerging adults has largely been limited to homogeneous samples of college students. Using the Behavioral Model for Vulnerable Populations, this study explored factors associated with patterns of behavioral health service use across a diverse national sample of emerging adults by nativity status (foreign-born, U.S.-born) and college enrollment status (college student, non- student). A subsample of 6,696 emerging adults from the 2012 Agency for Healthcare Research and Quality Medical Expansion Panel Study was used for this study. Multiple hierarchical binomial logistic regression analyses were performed to determine which factors predicted patterns of behavioral health service use among emerging adult groups. Employed (foreign-born) and Black (all groups except foreign-born) emerging adults were less likely to use services compared to unemployed and White emerging adults, respectively. Preference for English language (non-college students), shorter duration in the United States (college students), and having insurance (all groups except foreign-born) was associated with service use. Those with middle and high income backgrounds (college students) were less likely to use services compared to poor students. Having higher perceived mental health status (all groups except college students) and higher general mental health status (all groups) predicted less service use. Although certain factors were consistently predictive of service use among emerging adult groups, there were differences that necessitate further research. Findings clearly portray the need for greater awareness and consideration of factors related to service use on healthcare policy and higher education program initiatives especially as they relate to promoting health equity and successful transition to adulthood.
    • An Evaluation of the Effectiveness of Extended-Release Naltrexone

      Hochheimer, Martin; Sacco, Paul; Unick, George Jay; 0000-0001-6644-4841 (2022)
      Medications for the treatment of opioid use disorder (MOUDs) are considered the gold standard form of treatment for this condition. There are two forms of MOUD treatment, agonist, and antagonist. Agonist treatment has the medical system provide people with opioid use disorder methadone or buprenorphine which are long lasting opioids that do not produce a euphoric reaction with the goal of alleviating cravings and mitigating illicit use of opioids. Conversely, antagonist treatment blocks opioid absorption in the brain. Extended-release naltrexone (XR-NTX) is the most common antagonist treatment it is administered as a once-monthly injection. During the month after injection, patients who use opioids will not experience their effect and by negating the reward of opioid use the treatment discourages continued use. This study evaluated the effectiveness of buprenorphine and XR-NTX treatment on three characteristics: treatment retention, risk of opioid related acute care incidents, and changes in healthcare costs during treatment. Data from the Truven Health MarketScan® databases which records the date, type of interaction, and cost of every interaction that a person insured privately with one of over 250 insurance providers has with the healthcare system was used to identify a sample of approximately 30,000 people who were treated with buprenorphine or and 617 who were treated with XR-NTX for opioid use disorder. Treatment episodes were constructed based on filled prescription information and a frailty model survival analysis was fit both to a matched sample and the whole sample to length of treatment for each medication. The risk of acute care incidents was evaluated using a generalized estimating equation, and healthcare costs were evaluated using fixed-effects regression models. The study found that there are no significant differences in treatment retention between the MOUDS. Treatment with either medication was associated with an approximately 10% reduction, per day in treatment, of the odds of experiencing an acute care incident during one month. Healthcare costs increased while people were in treatment, with either MOUD, between approximately 0.85% and 1.5% for both opioid related and non-opioid related services.