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Article
Peer Reviewed

Parental Psychosocial Factors Moderate Opioid Administration Following Children's Surgery.

UC Irvine Previously Published Works (2021)

Background

This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain.

Methods

Participants in this longitudinal analysis were children ages 2-12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset.

Results

Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child's pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant.

Conclusions

These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.

Cover page: Parental Psychosocial Factors Moderate Opioid Administration Following Children's Surgery.

Creative Commons 'BY' version 4.0 license

Article
Peer Reviewed

Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption.

UC Irvine Previously Published Works (2020)

Objective

Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain.

Methods

Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy surgery and their parents. Longitudinal multilevel modeling examined changes in both parent-reported pain and hydrocodone/APAP consumption (mg/kg) on days 1 to 7 after surgery.

Results

Parent reports of postoperative pain were higher in Hispanic/Latinx patients compared to their Non-Hispanic White counterparts (β = -0.15; 95% CI: -0.28, -0.01). There was also a significant interaction of ethnicity and pain on opioid consumption (β = 0.07; 95% CI: 0.01, 0.13). The relationship between parent perceived pain and opioid use was stronger for Non-Hispanic White children, suggesting that this group was more likely to consume opioids to help manage clinically significant postsurgical pain.

Conclusions

Hispanic/Latinx children might be at risk for undertreatment of surgical pain. Findings highlight the importance of assessing parent background and cultural beliefs as predictors of at home pain management and the potential effectiveness of tailored interventions that educate parents about monitoring and treating child postoperative pain.

Cover page: Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption.

Article
Peer Reviewed

A Multivariable Model of Parent Satisfaction, Pain, and Opioid Administration in a Pediatric Emergency Department

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 22, Issue 5 (2021)

Introduction: Children and adolescents are not impervious to the unprecedented epidemic of opioid misuse in the United States. In 2016 more than 88,000 adolescents between the ages of 12–17 reported misusing opioid medication, and evidence suggests that there has been a rise in opioid-related mortality for pediatric patients. A major source of prescribed opioids for the treatment of pain is the emergency department (ED). The current study sought to assess the complex relationship between opioid administration, pain severity, and parent satisfaction with children’s care in a pediatric ED.

Methods: We examined data from a tertiary pediatric care facility. A health survey questionnaire was administered after ED discharge to capture the outcome of parental likelihood of providing a positive facility rating. We abstracted patient demographic, clinical, and top diagnostic information using electronic health records. Data were merged and multivariable models were constructed.

Results: We collected data from 15,895 pediatric patients between the ages of 0–17 years (mean = 6.69; standard deviation = 5.19) and their parents. Approximately 786 (4.94%) patients were administered an opioid; 8212 (51.70%) were administered a non-opioid analgesic; and 3966 (24.95%) expressed clinically significant pain (pain score >/= 4). Results of a multivariable regression analysis from these pediatric patients revealed a three-way interaction of age, pain severity, and opioid administration (odds ratio 1.022, 95% confidence interval, 1.006, 1.038, P = 0.007). Our findings suggest that opioid administration negatively impacted parent satisfaction of older adolescent patients in milder pain who were administered an opioid analgesic, but positively influenced the satisfaction scores of parents of younger children who were administered opioids. When pain levels were severe, the relationship between age and patient experience was not statistically significant.

Conclusion: This investigation highlights the complexity of the relationship between opioid administration, pain severity, and satisfaction, and suggests that the impact of opioid administration on parent satisfaction is a function of the age of the child.

Cover page: A Multivariable Model of Parent Satisfaction, Pain, and Opioid Administration in a Pediatric Emergency Department

Article
Peer Reviewed

State and Sociodemographic Trends in US Cigarette Smoking With Future Projections

UC San Diego Previously Published Works (2025)

Importance

There are still significant population-level health consequences of cigarette smoking in US states.

Objective

To estimate whether differential sociodemographic trends in smoking prevalence since 1992 will close the prevalence gap between states by 2035.

Design, setting, and participants

This cross-sectional study included data from 18 repeated, state-representative US Tobacco Use Supplement to the Current Population Surveys (TUS-CPS) from 1992 to 2022. Data were analyzed between June and October 2024.

Main outcomes and measures

Nonlinear time series trends in smoking prevalence in US states from 1992 to 2022 were projected through 2035 and compared with recommended targets. States were grouped into tertiles using their 1990s prevalence. Differential change in sociodemographic groups were compared across tertiles.

Results

The 18 surveys comprised 1 770 442 respondents (997 569 female [56.3%]; 146 865 Hispanic [8.3%], 160 751 non-Hispanic Black [9.1%], and 1 373 454 non-Hispanic White [78.0%]). From 1992 to 2022, all state tertiles experienced significant declines in smoking prevalence, each decreasing by approximately 13 percentage points from 2001 to 2022. In 2022, prevalence was 7.4% (95% CI, 6.9% to 7.9%) in tertile 1 (lowest 1990s prevalence), 10.0% (95% CI, 9.2% to 10.8%) in tertile 2, and 12.7% (95% CI, 11.9% to 13.4%) in tertile 3. Projections to 2035 indicated the prevalence gap closing between tertiles, to 3.8% (95% CI, 2.6% to 5.1%) in tertile 1, to 5.1% (95% CI, 3.2% to 7.2%) in tertile 2, and to 6.6% (95% CI, 4.8% to 9.1%) in tertile 3. The only sociodemographic trend that reduced the gap occurred among individuals aged 18 to 24 year (tertile 3 change, -21.3% [95% CI, -24.5% to -18.2%] vs tertile 1 change, -16.4% [95% CI, -18.5% to -14.4%]; P = .005). Yet age was not a significant factor in projected changes, as the decline in the group aged 50 years and older was greater in tertile 1 than 3 (-4.7% [95% CI, -5.7% to -3.8%] vs -2.3% [95% CI, -3.5% to -1.2%]; P < .001). By 2035, only 4 states (California, Utah, Hawaii, and Colorado) were projected to be significantly under the recommended target of 5% prevalence.

Conclusions and relevance

The findings of these repeated cross-sectional surveys suggest that the difference in cigarette smoking prevalence between historically high vs low prevalence states will shrink by 2035, primarily from much faster declines among young adults in the traditionally highest prevalence states. Slower prevalence declines among older adults are likely to slow the decline in health consequences in these states.

Cover page: State and Sociodemographic Trends in US Cigarette Smoking With Future Projections

Article
Peer Reviewed

Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting.

UC Irvine Previously Published Works (2021)

This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain-the pain-opioid relation was stronger for patients without an anxiety disorder than for patients with an anxiety diagnosis. Instead, physicians were more likely to place non-opioid analgesic orders to manage the pain of patients with anxiety disorders. Findings imply that pain management decisions might be influenced by patient's mental health.

Cover page: Anxiety and Mood Disorders Impacting Physician Opioid Prescribing in the Pediatric Hospital Setting.

Article
Peer Reviewed

Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting

UC Irvine Previously Published Works (2021)

Background

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.

Methods

Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.

Results

There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage.

Conclusion

Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.

Cover page: Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting

Article
Peer Reviewed

Flavors increase adolescents’ willingness to try nicotine and cannabis vape products

UC San Francisco Previously Published Works (2023)

Background

Certain product characteristics, such as flavor, may increase adolescents' willingness to try vaped nicotine and cannabis (marijuana) products.

Methods

A discrete choice experiment embedded within the 2021-2022 California Teens Nicotine and Tobacco Project Online Survey was administered to a non-probability sample of N = 2342 adolescents ages 12-17. Participants were sequentially presented four randomly-generated pairs of hypothetical vape products that varied in device type (disposable, refillable), content (nicotine, marijuana, "just vapor"), and flavor (seven options) and asked which of these (or neither) they would be more willing to try if a best friend offered. Conditional logistic regression quantified associations between product characteristics and participants' selections, including interactions by past 30-day use of e-cigarettes, marijuana, or both.

Results

Candy/dessert, fruit, and fruit-ice combination flavors were all associated with greater willingness to try a vape product (versus tobacco flavor) among participants not using e-cigarettes or marijuana, those using only e-cigarettes, and those co-using e-cigarettes and marijuana. Among participants only using marijuana, the most preferred flavors were no flavor, candy/dessert, and icy/frost/menthol. Among participants not using e-cigarettes or marijuana, model-predicted willingness to try a displayed vape product was greater when products were sweet or fruit flavored than tobacco or unflavored, regardless of whether displayed options contained nicotine (fruit/sweet: 21 %, tobacco/unflavored: 4 %), marijuana (fruit/sweet: 18 %, tobacco/unflavored: 6 %), or "just vapor" (fruit/sweet: 29 %, tobacco/unflavored: 16 %).

Conclusions

In this online non-probability sample, flavors in nicotine and cannabis vape products increased adolescents' willingness to try them. Comprehensive bans on flavored vapes would likely reduce adolescent use.

Cover page: Flavors increase adolescents’ willingness to try nicotine and cannabis vape products

Creative Commons 'BY-NC-ND' version 4.0 license

Article
Peer Reviewed

Vaping identity in adolescent e-cigarette users: A comparison of norms, attitudes, and behaviors

UC Davis Previously Published Works (2021)

Introduction

Using the tenets underlying social identity theory and the theory of planned behavior, the current study compared the perceptions, attitudes, and behaviors of e-cigarette users that reported vaping as self-defining ("vapers") compared to users that denied vaping was central to their identity ("non-vapers").

Method

Secondary analyses of data from the 2017-2018 California Student Tobacco Survey were utilized. A weighted, multivariable regression model (N = 82,217) compared the demographic characteristics, beliefs, and behaviors of vapers and non-vapers. A path analytic model examined whether norms and attitudes mediated the relationship between vaper identity and use behavior.

Results

Self-identified sexual and/or gender minority youth were more likely to identify as vapers compared to heterosexual and cisgender respondents. Youth that identified as vapers viewed e-cigarette use as more normative, held more favorable attitudes (i.e., lower harm beliefs), used e-cigarettes more frequently and in greater quantities, were more likely to use fruit and mint flavored e-cigarettes, and were more likely to acquire e-cigarettes from commercial sellers (i.e., vape/tobacco shops; all p < 0.05). Additionally, descriptive norms and attitudes mediated the relationship between vaper identity and use frequency/quantity.

Conclusions

Differences in e-cigarette beliefs and behaviors were found for youth e-cigarette users that perceived vaping as self-defining versus those that did not view vaping as part of their self-concept. Future studies are needed to examine causal directionality between identity, norms, attitudes, and behavior. Tobacco control efforts might use these findings to further denormalize vaping using evidence-based media campaigns and policy implementation.

Cover page: Vaping identity in adolescent e-cigarette users: A comparison of norms, attitudes, and behaviors

Article
Peer Reviewed

The subcomponents of affect scale (SAS): validating a widely used affect scale

UC Irvine Previously Published Works (2023)

Objective

There is a need for a brief affect scale that also encompasses different components of affect relevant for researchers interested in physiological and health outcomes. The Subcomponents of Affect Scale (SAS) meets this need. This 18-item scale has nine positive and nine negative affect items encompassing six subscales (calm, well-being, vigour, depression, anxiety, anger). Previous research using the SAS has demonstrated its predictive validity, but no work has tested its subscale structure or longitudinal validity.

Design

Data from the Common Cold Project in which individuals (N = 610) completed the SAS over the course of seven days were used.

Results

Confirmatory factor analysis demonstrated the reliability of the subscale structure of the SAS across seven days (positive affect subscale structure: CFIs ≥ 0.98; negative affect subscale structure: CFIs ≥ 0.94 with day 6 CFI = 0.91) and tests of factorial invariance showed the scale is valid to use over time.

Conclusions

These results confirm the psychometric validity of the subscale structure of the SAS and imply that the subscales can be used longitudinally, allowing for its use in health research as well as non-health research that can benefit from its subscale structure and longitudinal capabilities.

Cover page: The subcomponents of affect scale (SAS): validating a widely used affect scale

Article
Peer Reviewed

Tobacco policy coverage in California jurisdictions before and after enactment of proposition 56

UC San Diego Previously Published Works (2025)

Objective

Proposition 56, a $2 tobacco tax enacted in California in 2016, led to increased funding to Local Lead Agencies which work to reduce tobacco use. We examined whether Proposition 56 was associated with increases in the population covered by local policies addressing four areas: 1) tobacco retail sales (TRS), 2) flavored tobacco products sales (FTP), 3) outdoor secondhand smoke (SHS) restrictions, and 4) smoking restrictions in multi-unit housing (MUH).

Methods

2007-2023 data from the Policy Evaluation Tracking System in California were analyzed. The unit of analysis was the California jurisdiction, with outcome the time (in months) to policy enactment in a jurisdiction. Kaplan-Meier estimates and population coverage percentages were calculated by weighing each jurisdiction by its population size. Discrete-time survival models were fitted to test the effect of Proposition 56 on the rate of population coverage for each policy of interest.

Results

By January 2023, 79 % of the California population was covered by a local SHS policy but only 55 %, 47 % and 18 % was covered by a local TRS, FTP and MUH policy, respectively. The rate of increase in TRS and FTP policy coverage was greater post-Proposition 56 than pre-Proposition 56 (p < 0.001), while the rate of increase did not change significantly for MUH and SHS policies.

Conclusions

Proposition 56 was associated with marked increases in the enactment of TRS and FTP, but not SHS or MUH policies. Despite increases post-Proposition 56, additional efforts are needed to increase local adoption of TRS, FTP and MUH policies because coverage remains low.

Cover page: Tobacco policy coverage in California jurisdictions before and after enactment of proposition 56