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To assess the relationship between stress throughout the day and aggressive discipline practices by parents during COVID-19 stay at home orders. For this study, participants took baseline survey online, then provided data three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 consecutive days using Ecological Momentary Assessment procedures. Data were collected from 323 participants, covering 9,357 observations from April 13 to May 27, 2020 in Central Ohio during stay-at-home orders due to COVID-19. Use of aggressive discipline, including corporal punishment and psychological aggression, was measured using the Dimensions of Discipline Inventory. For each higher level of stress, parents had 1.3 greater odds of using aggressive discipline. Having used aggressive discipline at baseline was related to three times greater odds of using it during the study period. Higher situational stress was associated with use of aggressive parenting. When combined with less contact with mandatory reporters, this places children at risk for abuse and neglect that may go without detection and intervention for longer time-periods. First responders and medical professionals become more important in identifying and reporting suspected child maltreatment, as this may be a child’s only contact with a mandated professional for six months to a year. Well child visits, routine vaccinations, and problem-focused care are important opportunities to assess parents’ stress and discipline practices that may be suggestive of abuse or neglect.

Parental alcohol use and alcohol outlet densities in residential areas are related to risk for child maltreatment. However, some parents spend significant time outside of their residential neighborhood. Thus, we may not be accurately assessing how alcohol environments are related to risks for problematic parenting. Here, we examine how residential environments and activity spaces are related to outlet density and whether drinking events in our sample of parents differ by location (e.g., routine vs. rare locations) and whether their children are present. We conducted semi-structured interviews with 60 parents living in four cities in the San Francisco Bay area who provided information on where they spent time, where they drank, and whether children were present. We constructed measures of activity spaces (e.g., convex hull polygons) and activity patterns (e.g., shortest network distance) and calculated outlet density in each. Density of alcohol outlets for residential Census tract was not related to density of the activity space and activity pattern measures. Alcohol use occurred more frequently (regardless of whether their children were present) inside activity spaces operationalized as convex hull polygons or two standard deviational ellipses. Measures that capture larger activity space areas (e.g., convex hull polygons, two standard deviational ellipses) may better model where people spend time, regardless of whether the location is routine or rare. By continuing to use activity spaces to explore relationships between outlet densities, drinking behaviors, and problems, we can start to ascertain those mechanisms by which outlets may affect local problems.

Background Across Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse. Methods EPIC is a quasi-experimental study. Under the program , child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults ( N  = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system. Discussion This intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG). Trial registration NCT04700696 . Registered January 7, 2021-retrospectively registered.

Background Opioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs. Methods The research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups. Discussion Findings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions. Trial registration ClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341

OBJECTIVES/GOALS: This study examines the impact of COVID restrictions on the process of engagement in the Ohio-HCS site. The goals are to: examine the impact of COVID restrictions on the process of engagement; 2) determine differences in process measures by geographic region (rural, urban). METHODS/STUDY POPULATION: Engagement activities collected as part of the Ohio HCS include an engagement log, coalition meeting type and attendance, tracker of implementation strategies. Study period: January 2020 to October 31, 2021. Measures are defined below. Meeting occurrence, type by month: Data report on whether a meeting occurred, was scheduled and cancelled, or a scheduled off-month. The meeting platform was also recorded (in-person, hybrid, virtual). Coalition meeting attendance by month: Number of community members in attendance. Engagement communications by type, by month: Counts and percent (types: email, calls, zoom, or in person). Evidence-Based Practices(EBP) delivery option: in person, virtual, or hybrid. Counties: 9 Ohio counties, 5 rural, 4 urban. RESULTS/ANTICIPATED RESULTS: Coalition meetings were cancelled in 40% of rural counties; none in the urban counties. Two rural counties switched back to in person or hybrid meetings by late 2020; urban counties remain 100% virtual. Rural counties had a drop-off in attendance in June 2021 with no decrease seen in urban counties. During first two months of 2020 engagement in rural and urban communities occurred in person; by March that shifted to 80% by email, which continued within rural counties. In urban counties that dropped to 50% by August of 2020, with zoom calls accounting for 30%. In-person strategies for naloxone distribution remained high in both county types (90%); urban counties use of in-person only strategies for medication for OUD (rural: 83%, urban 52%) and safer prescribing (rural:74%, urban:10%) were much lower than rural counties. DISCUSSION/SIGNIFICANCE: Results show that rural counties continue to rely on in person engagement strategies, making COVID restrictions more disruptive for rural counties. These results suggest that new supports and strategies may be needed to assure that rural regions are equally equipped to engage in research in a virtual environment.

Background The Stay Safe Study is the first observational prospective cohort study investigating fentanyl test strip (FTS) use by people who use drugs (PWUD) and distribution by community organizations that provide harm reduction services (e.g., naloxone distribution) in three states (Kentucky, New York, and Ohio). The purpose of this paper is to describe the study design, along with implementation successes and challenges. A related goal is to provide recommendations and encourage researchers to undertake multi-state and multilevel studies of FTS use and distribution. Methods The Stay Safe Study has one primary, five secondary, and three exploratory objectives. From May-December 2023, we collected survey, interview, and oral fluid drug test data with the primary population of PWUD attending service locations of partner organizations that distribute FTS. We collected survey and interview data with a population of community organizations providing harm reduction services that have a distribution relationship to FTS. There was no intervention, and the study did not distribute FTS. Results A total of 1,156 PWUD participants were enrolled in the study and were invited to complete four weekly survey assessments. Of these, 732 PWUD participants (97.6% of the target) completed at least two of the four weekly surveys and reported drug use at least once during the 28-day observation period. A subset of enrolled participants completed a one-time oral fluid data collection visit (48-hour self-report survey and oral fluid specimen collection) ( n  = 267) and one-on-one semi-structured interviews ( n  = 120). From the population of 36 organizations providing harm reduction services, employees of 28 (78%) in 22 counties across 3 states completed a web-based survey and employees of 24 (66.7%) completed an interview. Study findings will be presented in subsequent publications [ 1 , 2 ]. Conclusion The research team successfully enrolled a large sample of PWUD participants and organizations that provide harm reduction services in three states, followed a cohort of PWUD participants, and generated rich data using three types of instruments. Factors contributing to implementation success include drawing on the community expertise of the parent HEALing Communities Study, selecting incentive amounts that acknowledged the time and expertise of PWUD participants, centralizing survey data collection, and tracking implementation challenges and solutions. Areas of implementation complexity included conducting research on site at the service locations of 14 partner organizations, facilitating timely incentive payments, overseeing research staff, and returning oral fluid results to PWUD participants.

Background Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. Methods Communities were randomized to intervention ( n  = 34) or wait-list control ( n  = 33) arms stratified by state. Jail-based surveys ( n  = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. Results The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative risk Adj = 1.51 [95% CI: 1.09, 2.08], p  = 0.013) and the number of jails providing naloxone upon release (H2, relative risk Adj = 1.49 [95% CI: 1.05, 2.13)], p  = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. Conclusions The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.

Alcohol outlets have been associated with different social problems, such as crime, violence, intimate partner violence, and child maltreatment. The spatial analysis of neighborhood availability of alcohol outlets is key for better understanding of these influences. Most studies on the spatial distribution of alcohol outlets in the community have been conducted in U.S. cities, but few studies have assessed this spatial distribution in other countries where the drinking culture may differ. The aim of this study was to analyze the spatiotemporal distribution of alcohol outlets in the city of Valencia, Spain, and its relationship with neighborhood-level characteristics, as well as to examine the influence of alcohol outlet density on alcohol-related police calls-for-service. Spain is characterized by having a “wet” drinking culture and greater social acceptance of drinking compared to the U.S. Data on alcohol outlets between 2010–2015 in three categories (off-premise, restaurants and cafes, and bars) were used for the analysis. We used the 552 census block groups allocated within the city as neighborhood unit. Data were analyzed using Bayesian spatiotemporal regression models. Results showed different associations between alcohol outlets categories and neighborhood variables: off-premise density was higher in areas with lower economic status, higher immigrant concentration, and lower residential instability; restaurant and cafe density was higher in areas with higher spatially-lagged economic status, and bar density was higher in areas with higher economic status and higher spatially-lagged economic status. Furthermore, restaurant and cafe density was negatively associated with alcohol-related police calls-for-service, while bar density was positively associated with alcohol-related calls-for-service. These results can be used to inform preventive strategies for alcohol-related problems at the neighborhood-level in Spain or other countries with a wet drinking culture. Future research would benefit from exploring the relationship between alcohol availability and different social problems in cities outside the U.S.

The purpose of this paper is to examine how geographical availability of social services is related to foster care entry rates and referrals for child maltreatment investigations. The primary concerns are to (1) determine locations across Los Angeles County where the availability of social services is low but display a high need for those services and (2) begin to examine how the geographic distribution of social services is related to rates of referrals and foster care entries in child maltreatment. Archival data for all 288 zip codes within Los Angeles County were collected on rates of referrals, foster care entries, location and types of social service agencies, and zip code demographics. Data were analyzed using point process models and spatial regressions. Higher densities of child welfare services in local areas (for referrals) and lagged areas (for referrals and foster care entries) were related to lower rates of child maltreatment. The density of housing and housingrelated services was negatively related to referrals in local areas and foster care entry rates in lagged areas. Areas with higher densities of substance abuse and domestic violence service agencies had significantly higher rates of both Child Protective Services referrals and entries into foster care in local areas. While the total density of child welfare services within and surrounding zip code areas is related to lower rates of referrals and foster care entries, the findings are less clear about what those specific services are. Living in and around \"resource rich\" zip codes may reduce rates of child maltreatment.

A positive relationship between parents’ drinking and child physical abuse has been established by previous research. This paper examines how a parent’s use of drinking locations is related to physical abuse. A convenience sample of 103 parents answered questions on physical abuse with the Conflict Tactics Scale-Parent Child version (CTS-PC), current drinking behavior, and the frequency with which they drank at different venues, including bars and parties. Ordered probit models were used to assess relationships between parent demographics, drinking patterns, places of drinking, and CTS-PC scores. Frequent drinking, frequently going to bars, frequently going to parties in a parent’s own home, and frequently going to parties in friends’ homes were positively related to child physical abuse. The number of drinking locations was positively related to child physical abuse such that parents who report attending and drinking at more of these venues were more likely to be perpetrators of physical abuse. This suggests that time spent in these venues provides opportunities to mix with individuals that may share the same attitudes and norms towards acting violently.