Objectives Cocaine use is increasing and many cocaine users engage in polysubstance use. Within polysubstance use, relationships among use of individual substances are necessarily complex. To address this complexity, we used latent class analysis (LCA) to identify patterns of polysubstance use among lifetime cocaine users and examine associations among these patterns, demographics, and risk profiles. Methods Members of HealthStreet, an ongoing community engagement program, were asked about lifetime and past 30-day use of cocaine, alcohol, tobacco, marijuana, and prescription medications, mental health conditions, recent Emergency Department (ED) visits and demographics. LCA was used to identify classes of past 30-day polysubstance use among individuals who endorsed lifetime cocaine use. Multinomial logistic regression identified factors associated with these classes. Results Among 1797 lifetime cocaine users, a five-class LCA model was identified: 1) past 30-day tobacco use only (45%), 2) past 30-day alcohol, marijuana and tobacco use (31%), 3) past 30-day tobacco, prescription opioid and sedative use (13%), 4) past 30-day cocaine, alcohol, marijuana and tobacco use (9%), 5) past 30-day cocaine and multiple polysubstance use (2%). Demographics, ED visits and mental health conditions were associated with class membership. Conclusions Approximately 11% of lifetime cocaine users used cocaine in the past 30 days with two different concurrent substance use patterns. Prescription medication (opioids and sedatives) and complex polysubstance use patterns were stronger indicators of negative outcomes than current cocaine use. Cocaine was not used frequently with other stimulants. In addition to polysubstance use, prescription medication use should be targeted for intervention among lifetime cocaine users.

Concurrent use of prescription medications and alcohol is prevalent among older adults and impacts women more than men, however little is known about characteristics of older women who use both. The current analysis aims to evaluate those characteristics. Participants were recruited through HealthStreet, an outreach program. Community health workers (CHWs) assess health needs and concerns among community members. CHWs collect demographic, substance use, and other health data from participants. Female participants (≥ 50 years) interviewed November 2011–November 2017 were included and stratified into four groups: neither prescription opioid nor hazardous alcohol use (three or more drinks in a single day), hazardous alcohol use only, prescription opioid use only, and both prescription opioid and hazardous alcohol use. Chi square and ANOVA tests were used to compare these groups. Among the 2370 women (53% black; mean age 61 years), 70% reported neither prescription opioid nor hazardous alcohol use, 12% reported hazardous alcohol use only, 15% reported prescription opioid use only, and 3% reported use of both in the past 30 days. Concurrent prescription opioid and hazardous alcohol use were significantly associated with comorbid depression and anxiety (p < 0.0001); women who endorsed prescription opioid use only were significantly more likely to report a history of back pain, cancer, or diabetes compared to their counterparts (p < 0.0001). Nearly a third of women reported prescription opioid and/or hazardous alcohol use in the past 30 days. Because the risk and consequences of concomitant alcohol and opioid use increase with age, interventions tailored to women are needed.

Despite its severe consequences, gambling disorder is under-researched and under-funded especially among African Americans (AA). We had the opportunity to evaluate gambling among a community sample of AA gamblers and to assess whether gambling impacts their interest in, willingness to participate in, navigation to, and enrollment in health studies. AA recruited into the HealthStreet community engagement program between 2014 and 2017 (n=2,661) were asked by Community Health Workers about their gambling behaviors and for which types of research studies they would volunteer. Chi-square tests and t-tests were calculated by gambling status for demographics, perceptions of research, navigation to and enrollment in health research. About 34% of the sample (n=911) endorsed lifetime gambling. Compared to AA non-gamblers, AA gamblers were more “definitely interested” in participating in research, more willing to volunteer for three types of studies, and did not require additional remuneration to be enrolled in a study. Though AA gamblers are more willing to participate, they are less likely to be enrolled into health research than AA non-gamblers. This suggests that AA gamblers face increased barriers to enrollment and that researchers may not be using the right avenues to approach and enroll AA gamblers in health research. African American gamblers: are they willing to participate in health research? Amy L Elliott*, Nathan D L Smith, Catherine W Striley, Mirsada Serdarevic and Linda B Cottler Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, USA *Correspondence to: Amy L. Elliott, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, Tel: (352) 273-5468; E-mail: amy.elliott@ufl.edu

Objective: The current analysis examines whether opioid use is associated with insomnia in a community sample, as the consequences of the growing epidemic of prescription opioid use continue to cause public health concern. Study design: A cross‐sectional study including 8433 members in a community outreach program, HealthStreet, in Northeast Florida. Methods: Community Health Workers (CHWs) assessed health information, including use of opioids (i.e., Vicodin®, Oxycodone, Codeine, Demerol®, Morphine, Percocet®, Darvon®, Hydrocodone) from community members during field outreach. Insomnia was determined based on self‐report: “Have you ever been told you had, or have you ever had a problem with insomnia?” Summary descriptive statistics were calculated and logistic regression modeling was used to calculate adjusted odds ratios (ORs) with 95% confidence intervals for insomnia, by opioid use status, after adjustment for demographics and other covariates. Results: Among 8433 community members recruited (41% male; 61% Black), 2115 (25%) reported insomnia, and 4200 (50.3%) reported use of opioids. After adjusting for covariates, opioid users were significantly more likely to report insomnia than non‐users (adjusted OR, 1.42; 95% CI, 1.25–1.61). Conclusion: Insomnia was 42% more likely among those who reported using prescription opioids compared to those who did not. With one half of the sample reporting prescription opioid use, and a fourth reporting insomnia, it is important to further investigate the relationship between the two. Findings provide useful preliminary information from which to conduct further analyses.

Purpose of review Recent literature focused on prescription opioids has neglected sex differences in use. Here, we evaluated the recent literature (since 2015) examining sex differences in prescription opioid use. Recent findings Between 2015 and 2016, our review found only eight articles addressing sex differences in prescription opioid use mostly opioid misuse in North America among individuals with chronic pain. Risk factors included depression, pain, and polydrug use. In addition to that review, we had the opportunity to further address sex differences in, and risk factors for, prescription opioid use through a community engagement program, HealthStreet. Among the sample (n = 8525, M age = 43.7 years, 58.6% women), approximately half reported use of prescription opioids. Women were significantly more likely to report lifetime use (54.9 vs. 42.2%; P < 0.0001) and report cancer compared with men, yet, women with cancer had a significantly reduced risk of using opioids compared with men with cancer (odds ratio: 0.46; 95% confidence interval, 0.36–0.59). Summary Only a few recently published studies analyzed sex differences related to prescription opioid use. Findings from the literature and our data suggest women are more likely to use prescription opioids compared with men. There is limited information on sex differences in opioid use risk factors and outcomes and more research in this area is warranted.

Background Non-medical use (NMU) of prescription opioids in youth is of concern since they may continue this pattern into adulthood and become addicted or divert medications to others. Research into risk factors for NMU can help target interventions to prevent non-medical use of opioids in youth. Method The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) was conducted from 2008 to 2011. Participants 10-18 years of age were recruited from entertainment venues in urban, rural and suburban areas of 10 US cities. Participants completed a survey including questions on their use of prescription opioids. NMU was defined as a non-labeled route of administration or using someone else’s prescription. Information on age, gender, alcohol, marijuana and tobacco use was also collected. Summary descriptive and chi-square statistics were calculated using SAS 9.4. Results Of the 10,965 youth who provided information about past 30 day prescription opioid use, prevalence of reported opioid use was 4.8% with 3.2% reported as NMU (n=345) and 1.6% as medical use (MU) only (n=180). More males than females (55.7% vs 44.4%) reported opioid NMU (p<0.0001). Logistic regression revealed that among males (comparing NMU to MU only), current smokers were 4.4 times more likely to report opioid NMU than non-smokers (95% CI: 1.8, 10.7). Among females (comparing NMU to MU only), current smokers and alcohol users were more likely to report opioid NMU than those who had never smoked or used alcohol (OR=3.2, 95% CI:1.4, 7.0 and OR=4.1, 95% CI: 1.7, 10.4, respectively). Conclusions These results suggest that further research on gender differences in opioid NMU is needed; interventions for opioid NMU may need to be gender specific to obtain the best results.

This article provides a review of extant literature on Motivational Interviewing (MI) and its effect on medical/biopsychosocial treatment regimen adherence and general health outcomes in the geriatric population (>65 years). This is the first comprehensive literature review study exploring the effects of MI on older adults representative of typical age group seen in geriatrics clinics (i.e., >65 years, with many patients well into their 70s and 80s).The goal of the review is to provide readers with a focused, up-to-date outcome research review and to discuss the feasibility of clinical applications of MI within an interdisciplinary geriatric clinical settings and its adaptation for use with older individuals dealing with both mental health and general medical conditions. To be included in this review, studies had to be randomized controlled design, examine the effects of Motivational Interviewing, and include participants with an average age of 65 years or more. Though limited in number, 7 out of 9 studies reviewed showed a significant improvement in health outcomes as a result of Motivational Interviewing treatment. The two studies that showed no significant improvements included telephone-based MI counseling rather than face-to-face MI treatment. MI shows promise as an effective treatment in affecting health behavioral change for older adults, but further studies are needed to identify key necessary therapeutic features of the MI with this population.