The Networks and Causal Inference for Public Health Research (NCIPHER) Lab at the University of Rhode Island (URI) was established in 2018, with an initial pilot project supported by Advance Rhode Island Clinical Translational Research (RI-CTR), to develop methodological and computational approaches for evaluating interventions in real-world settings where individuals are connected in ways that impact their health. Leveraging bioinformatics and high-performance computing resources through Advance RI-CTR, we integrate empirical and simulation methods to estimate causal intervention effects (i.e., change in an outcome caused by a specific intervention) beyond treated individuals, including spillover through social and healthcare networks and clusters. Our work demonstrates that accounting for spillover improves understanding of the effectiveness of HIV and opioid use disorder (OUD) interventions. In the Transmission Reduction Intervention Project Athens, Greece, participants not exposed themselves to community alerts about HIV risk, with 50% of their immediate contacts exposed, reported three fewer unsafe injection behaviors (per 100 participants), compared to those who had 20% of their contacts exposed (95% CI: -7, 0). We also found 26 fewer reports (per 100 persons) at six months under individual treatment with medication for opioid use disorder with 60% of other individuals in the network treated, compared to no treatment with 20% of others treated (95% CI: -38, -13). Understanding effects in networks can improve translation from intervention delivery to population-level impact, supporting evidence-based policy.

People who inject drugs (PWID) are often members of HIV/AIDS risk networks, where individuals engage in sexual and injection risk behavior. Engagement in HIV care is important for this population. Low socioeconomic status, stigmatization, and lack of access to medical care often complicate successful engagement in the HIV cascade of care for PWID. This study investigates how individual's attitudes about how much control they have over HIV/AIDS risk in their life (i.e., locus of control and self-blame) affect health-seeking behavior in PWID participants and their community members. We applied causal inference methodology to PWID HIV risk networks ascertained from the Social Factors and HIV Risk Study (SFHR) conducted between 1991 and 1993 in Bushwick, Brooklyn, New York. We estimated protective disseminated effects of attitudes toward HIV/AIDS on the health-seeking behaviors of others in the PWID community. In other words, a positive attitude toward controlling HIV/AIDS can improve the health-seeking behavior of other members of the community who report a pessimistic attitude toward HIV/AIDS control. Given this finding, we also discuss potential network interventions to improve health-seeking behavior among both PWID individuals who receive the intervention and others in the PWID network informed by our analysis of disseminated effects.

BACKGROUND: There is limited evidence on the effect of adherence to oral anticancer medications on health care resource utilization (HRU) among patients with cancer. OBJECTIVE: To determine the association between adherence to oral anticancer medication and subsequent HRU. METHODS: A retrospective cohort study was conducted using Optum Clinformatics (R) Data Mart commercial claims database. Patients who initiated an oral anticancer medication between 2010 and 2017 were included. Proportion of days covered was used to calculate medication adherence in the first 6 months after oral anticancer medication initiation. All-cause HRU in the following 6 months was assessed. Multivariable negative binomial regressions were used to determine the association between oral anticancer medication adherence and HRU, after controlling for confounders. RESULTS: Of 37,938 patients, 51.9% were adherent to oral anticancer medications. Adherence with oral anticancer medication was significantly associated with more frequent physician office and outpatient visits for several cancer types with the strongest association among those with liver cancer (adjusted incidence rate ratio [aIRR] = 1.34; 95% CI = 1.18-1.52 and aIRR = 1.32; 95% CI = 1.13-1.55, respectively). Oral anticancer medication adherence was associated with more emergency department visits only among patients with lung cancer (aIRR = 1.22; 95% CI = 1.01-1.48). Oral anticancer medication adherence was significantly associated with a higher rate of inpatient hospitalizations and longer stays among patients with liver cancer (aIRRs were 1.45 [95% CI = 1.02-2.05] and 2.15 [95% CI = 1.21-3.81], respectively), whereas hospitalizations were fewer and length of stay was shorter among patients with colorectal cancer who were adherent with oral anticancer medication (aIRRs were 0.77 [95% CI = 0.68-0.86] and 0.77 [95% CI = -0.66 to 0.90], respectively). Other measures did not reveal statistically significant differences in HRU among adherent and nonadherent patients for the cancer types included in the study. CONCLUSIONS: HRU following the initial phase of oral anticancer medication therapy was generally similar among adherent and nonadherent patients. We observed a slightly higher rate of office and outpatient visits among adherent patients, which may reflect ongoing monitoring among patients continuing oral anticancer medication. Further studies are needed to determine how oral anticancer medication adherence may affect HRU over a longer time period.

OBJECTIVES/GOALS: Using the NIH’s expanded definition of underrepresented populations in the biomedical, clinical, behavioral and social science research enterprise, we examined the impediments for conducting translational research experienced by those from underrepresented groups. [https://acts.slayte.com/calls/detail/740a13de-316c-11ee-90f4-0e0ce905385c/draft/389221c1-434e-11ee-90f4-0e0ce905385c#_ftn1] #_ftn1 METHODS/STUDY POPULATION: One hundred and ninety-nine people completed a survey distributed to 750 persons who had interacted with our Center’s service cores as users, awardees, mentors, committee members, seminar attendees, and/or participated Center sponsored programming (response rate = 26.5%). The survey addressed barriers to conducting clinical and translational research at the respondent’s institution, awareness of and interest in using specific Advance RI-CTR services, and satisfaction with their institution’s efforts to support clinical and translational research. RESULTS/ANTICIPATED RESULTS: Women reported access to collaboration across institutions as a barrier to clinical and translational research that existed to a great extent (28%) significantly more than men (10%). More than half (53%) of the other underrepresented researchers surveyed identified insufficient grant administration supportas a barrier that occurs to a great extent, compared with 35% of researchers who were not from an underrepresented group. Other barriers reported more frequently among underrepresented researchers included lack of pilot project funding, inadequate space for conducting research, lower access to collaborators across institutions, and difficulty obtaining advice on regulatory issues and commercial development. DISCUSSION/SIGNIFICANCE: Efforts to address the barriers identified by underrepresented groups will include, but not be limited to, improving collaborations across institutions, support for grant administration, and a discussion of plans for the Center to augment and advocate at the partner institutions on behalf of these underrepresented individuals.

Pharmacy benefit plans in the United States are evaluated on quality measures and other requirements of the government and accrediting organizations. This primer describes the roles of key organizations involved in measuring and reporting quality in pharmacy benefit plans and explains the methods that pharmacy benefit plans use to promote quality of medication use.

People who inject drugs (PWID) are part of HIV/AIDS risk networks, where individuals can engage in sexual and injection risk behavior. Low socioeconomic status and lack of access to medical care often complicate successful engagement in HIV care for PWID. This study investigates how locus of control and self-blame regarding HIV/AIDS risk affects health-seeking behavior in PWID participants and their community members. We apply causal inference methodology to PWID HIV risk networks ascertained from the Social Factors and HIV Risk Study (SFHR) conducted between 1991 and 1993 in Bushwick, Brooklyn, New York. We found estimated protective disseminated effects of attitudes toward HIV/AIDS on health-seeking behaviors of others in the PWID community. A positive attitude toward controlling HIV/AIDS can improve the health-seeking behavior of other members in the community with a pessimistic attitude toward HIV/AIDS control. Interventions to improve attitudes toward HIV/AIDS risk can boost health-seeking behavior among both PWID receiving the intervention themselves and other unexposed PWID in the community.

According to 2019 data from the Centers for Disease Control and Prevention, approximately 7% of women in the United States were prescribed opioids during pregnancy. 1Prescription opioid use among pregnant women with private insurance or Medicaid coverage in the US is prevalent. 2 3In particular, the incidence of neonatal abstinence syndrome, as a result of drug withdrawal, increased by 83% from 2010 to 2017, albeit while declining by 18% between 2016 and 2020. 4 5However, the risk of neurodevelopmental disorders in children with prenatal opioid exposure remains unclear because previous studies had small sample sizes and limited follow-up periods. 6 7The linked study by Kang and colleagues (doi:10.1136/bmj-2023-077664)addressed this research gap using data from the National Health Insurance Service of South Korea. 8Their study cohort included 3 128 571 children and 2 299 664 mothers, further categorized into subgroups according to prescription opioid dose, duration, and exposure periods as well as the frequency of prescriptions.The authors adjusted for many confounding factors, conducted stratification analyses, examined dose responses, and performed interaction analyses between opioid use and corresponding medical indications.

Objective: To assess prescribing of tramadol among patients with contraindications and higher risks of adverse events in a large population of commercially insured and Medicare Advantage members. Design: We performed a cross-sectional analysis evaluating tramadol utilization in patients with higher risk of adverse outcomes. Setting: This study utilized 2016-2017 data from the Optum Clinformatics Data Mart. Patients and participants: Patients with at least one tramadol prescription without a cancer or sickle cell diagnosis during the study period. Main outcome measures: We first determined if tramadol was prescribed among patients with contraindications or risk factors for adverse outcomes. We then determined if patient demographic or clinical factors were associated with the use of tramadol in these higher-risk scenarios using multivariable logistic regression models. Results: Among patients with at least one prescription for tramadol, 19.66 percent (99 percent CI: 19.57-19.75) concurrently received an interacting cytochrome P450 isoenzyme medication, 19.24 percent (99 percent CI: 19.15-19.33) concurrently received a serotonergic medication, and 7.93 percent (99 percent CI: 7.88-8.00) concurrently received a benzodiazepine. Additionally, 1.59 percent (99 percent CI: 1.56-1.61) of patients who received tramadol also had a seizure disorder, while 0.55 percent (99 percent CI: 0.53-0.56) of patients were under the age of 18. Overall, nearly one in three patients (31.17 percent) received tramadol in the presence of at least one of these risks (99 percent CI: 31.06-31.27). Conclusion: Almost one in three patients prescribed tramadol had a clinically significant drug interaction or contraindication for use, suggesting that prescribers often disregard these concerns. Real-world studies are needed to better understand the likelihood of harms associated with the use of tramadol in these contexts.

The American Society of Clinical Oncology's Choosing Wisely (CW) initiative recommends against the use of staging imaging procedures in patients with early-stage breast cancer who are at the low risk of metastasis. The impact of CW on staging imaging in older patients with early-stage breast cancer by their cancer stage was examined.

DISCLOSURES: This letter pertains to our recent publication in JMCP, which describes a study that was jointly funded by the Pharmacy Quality Alliance and the National Pharmaceutical Council.

BACKGROUND:Benzodiazepine use among older adults is discouraged.METHODS:We analyzed the Medicare Part D Prescribers by Provider and Drug dataset to determine the number of benzodiazepine claims per 100 Medicare enrollees for each NE state between 2016-2020, and to determine the percentage of benzodiazepine claims by provider type.RESULTS:Rhode Island led all NE states the with highest annual rates of Part D benzodiazepine claims for all years from 2016 to 2020. Benzodiazepine claims decreased in all NE states over the 5-year period. Internal medicine and family practice providers were associated with the highest percentage of benzodiazepine claims.CONCLUSION:While Part D benzodiazepine claims declined between 2016-2020, the overall volume of dispensings suggests that these medications remain overprescribed among older adults. Our findings underscore the need for intensified efforts to reduce benzo- diazepine use among Medicare beneficiaries in RI.

The American Society of Clinical Oncology's (ASCO) Choosing Wisely (CW) initiative recommends against the use of surveillance testing (ST) of asymptomatic women with breast cancer (BC) using advanced imaging or serum tumor biomarkers testing. We evaluated if CW impacted the use of ST in women with BC. Also, its predictors were identified.

BACKGROUND:Health care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States. METHODS:A cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population. RESULTS:A total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured. CONCLUSIONS:A difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.

The Tracking and Evaluation Core of Rhode Island Advance-CTR conducted an online needs assessment survey at the program's inception in 2016 and again in 2021. Now dealing with well-established support systems provided by the grant, we were particularly interested in how the perceived needs of the research community in Rhode Island might have changed over five years. Specifically, what barriers have been reduced or eliminated and which have persisted or increased? How do those barriers vary by demographic status and what implications do those differences have for the CTR? An online survey was completed by 199 researchers, who reported the extent to which they perceived the lack of access to a range of research supports as a barrier to conducting research at their institution. Overall, researchers indicated statistically significant changes from 2016 to 2021 such that a lack of pilot project funding and proposal development support had decreased as barriers, while space for research, and advice on commercial development, had increased. Statistically significant differences in the salience of particular barriers by some demographic variables were also noted and the results of this study suggest Centers for Clinical and Translational Research can have salutary effects on the research paradigm within their partnering institutions in a relatively short time.