The aim of this study is to characterize patients with chronic pain in methadone maintenance treatment (MMT). Between September and December, 2003, 170 consecutive patients from an MMT clinic participated in a questionnaire survey on pain (duration and severity). Chronic pain was defined as current pain lasting for >or=6 months. The patients' maintenance methadone dosage and urine tests for drug abuse during the month before and of the survey were recorded. Of the 170 patients, 94 (55.3%) experienced chronic pain. They had a significantly higher proportion of chronic illness (74.5%) compared to non-pain patients (44.7%) (Fisher's Exact Test P<0.0005). Twelve (12.8%) of the chronic pain patients scored their pain as mild, 38 (40.4%) as moderate, 22 (23.4%) as severe and 22 (23.4%) as very severe. Pain duration significantly correlated with pain severity (Pearson R=0.3, P>0.0005) and was significantly associated with methadone daily dosage: patients with pain duration of >or=10 years (n=26) were receiving the highest methadone dosage (182.1+/-59.2 mg/day), those with pain duration from 1 to 10 years (n=59) 160.9+/-56.2 mg/day, and those with pain duration of <1 year (n=9) 134.2+/-73.2 mg/day. Patients in the non-pain group (n=76) were receiving 147.1+/-52.8 mg/day of methadone (ANOVA, F=3.1, P=0.03). We conclude that pain duration and severity significantly correlated. Although methadone was not prescribed for the treatment of pain but rather for opiate addiction, the patients in the MMT clinic with prolonged pain were prescribed a significantly higher methadone dosage compared to patients with short pain duration, and non-pain patients.

Smoking in the United States follows a clear socioeconomic gradient: low-income Americans smoke more and quit less than those with more education and income. Evidence-based interventions like tobacco quitlines are designed to make effective cessation services available on a population basis to all smokers. However, these interventions do not address many of the unique challenges faced by low-income smokers, including unmet basic needs like food, housing, personal safety and money for necessities that often supersede health needs. Research is needed to maximize the use and effectiveness of tobacco quitlines in low-income populations. This paper details the rationale, design and methods for a 2×2 randomized controlled trial currently underway comparing the effects of Standard and Specialized Tobacco Quitlines with and without Basic Needs Navigation on intervention engagement and smoking cessation among low-income smokers. Smokers are recruited from United Way 2-1-1 in Missouri and all participants receive tobacco quitline services from Optum. Quitline and navigation services are provided for 3 months. Participants complete telephone surveys at baseline, 3-and 6-month follow up. The primary study outcome is self-reported 7-day point prevalence abstinence at 6-month follow up. Embedding the study in practice agencies will accelerate dissemination and scalability should our findings demonstrate intervention effectiveness.

Background Sexual and gender minority (SGM) persons face a number of physical and mental health disparities closely linked to discrimination, social stigma, and victimization. Despite the acceptability and increasing number of digital health interventions focused on improving health outcomes among SGM people, there is a lack of reviews summarizing whether and how researchers assess engagement with social media–delivered health interventions for this group. Objective The objective of this systematic review was to synthesize and critique the evidence on evaluation of engagement with social media–delivered interventions for improving health outcomes among SGM persons. Methods We conducted a literature search for studies published between January 2003 and June 2020 using 4 electronic databases. Articles were included if they were peer-reviewed, in English language, assessed engagement with a social media–delivered health intervention for improving health outcomes among sexual and gender minorities. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed quality of data reporting using the CONSORT extension for pilot and feasibility studies and CONSORT statement parallel group randomized trials. Results We included 18 articles in the review; 15 were feasibility studies and 3 were efficacy or effectiveness randomized trials. The quality of data reporting varied considerably. The vast majority of articles focused on improving HIV-related outcomes among men who have sex with men. Only three studies recruited cisgender women and/or transgender persons. We found heterogeneity in how engagement was defined and assessed. Intervention usage from social media data was the most frequently used engagement measure. Conclusion In addition to the heterogeneity in defining and assessing engagement, we found that the focus of assessment was often on measures of intervention usage only. More purposeful recruitment is needed to learn about whether, how, and why different SGM groups engage with social media-interventions. This leaves significant room for future research to expand evaluation criteria for cognitive and emotional aspects of intervention engagement in order to develop effective and tailored social media-delivered interventions for SGM people. Our findings also support the need for developing and testing social media-delivered interventions that focus on improving mental health and outcomes related to chronic health conditions among SGM persons.

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We examined relations between objectively and subjectively assessed sleep and self-reported psychological distress from internalizing symptoms. Consistent with a health disparities perspective, ethnicity and subjective social status (SSS) were examined as moderators of these associations. Participants were 219 individuals (18-29 years old; 51% female) from diverse ethnic (55% non-Latino White, 27% Latino, and 18% other) and socioeconomic backgrounds. Individuals self-reported on their daytime sleepiness and actigraphs measured sleep duration, sleep efficiency, and variability in sleep onset time. Path models revealed that greater daytime sleepiness and variability in sleep onset time were more robustly related to distress from internalizing symptoms for Latinos and those with lower SSS. Other interactions emerged; longer sleep duration in conjunction with higher SSS related to less distress from internalizing symptoms. The results are novel and indicate that the consideration of ethnicity and socioeconomic position holds promise for better understanding sleep during emerging adulthood.