Deep cuts have been proposed to federally funded nutrition assistance programs, including the Sup... more Deep cuts have been proposed to federally funded nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast and lunch programs. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Participation in these programs is linked with reductions in perinatal morbidity and mortality, improved childhood growth trajectories, enhanced school performance, and reductions in food insecurity and poverty. Given these compelling health and economic benefits, the Society of Behavioral Medicine urges Congress to protect and increase funding for federally funded nutrition assistance programs, specifically SNAP, WIC, and school breakfast and lunch programs. Per the recent (2017) recommendations of the School Nutrition Association, Congress should also resist any attempts to "block-grant" subsidized school breakfast and lunch programs, which could reduce access to these programs. It is further recommended that Congress improve the scope of implementation- and outcomes-based assessments of these programs. Finally, we recommend efforts to increase awareness of and participation in SNAP, WIC, and federally funded school meal programs for eligible individuals, children, and families.
BACKGROUND AND OBJECTIVE To promote increased access to and retention in buprenorphine treatment ... more BACKGROUND AND OBJECTIVE To promote increased access to and retention in buprenorphine treatment for opioid use disorder, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented the Buprenorphine Nurse Care Manager Initiative (BNCMI) in 2016, in which nurse care managers (NCMs) coordinate buprenorphine treatment in safety-net primary care clinics. To explore how patients experienced the care they received from NCMs, DOHMH staff conducted in-person, in-depth interviews with patients who had, or were currently receiving, buprenorphine treatment at BNCMI clinics. Participants were patients who were receiving, or had received, buprenorphine treatment through BNCMI at one of the participating safety-net primary care practices. METHODS The study team used a thematic analytic and framework analysis approach to capture concepts related to patient experiences of care received from NCMs, and to explore differences between those who were in treatment for at least six consecutive months and those who left treatment within the first six months. RESULTS Themes common to both groups were that NCMs showed care and concern for patients' overall well-being in a nonjudgmental manner. In addition, NCMs provided critical clinical and logistical support. Among out-of-treatment participants, interactions with the NCM were rarely the catalyst for disengaging with treatment. Moreover, in-treatment participants perceived the NCM as part of a larger clinical team that collectively offered support, and the care provided by NCMs was often a motivating factor for them to remain engaged in treatment. CONCLUSION Findings suggest that by providing emotional, clinical, and logistical support, as well as intensive engagement (e.g., frequent phone calls), the care that NCMs provide could encourage retention of patients in buprenorphine treatment.
Abstract Background Childhood abuse and homelessness are independently associated with substance ... more Abstract Background Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited. Objective: To estimate independent and joint effects of childhood abuse and homelessness on substance use risk during emerging adulthood and adulthood. Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we measured associations between exposure to physical or sexual abuse in childhood, homelessness in childhood or emerging adulthood, or exposure to both traumas and outcomes of binge drinking, marijuana use, cocaine use, methamphetamine use, and prescription opioid misuse during emerging adulthood (Wave III, ages 18–26 years) and adulthood (Wave IV, ages 24–32 years). Results: In adjusted analyses, exposure to childhood abuse alone, homelessness alone, and both childhood abuse and homelessness were significant correlates of most substance use indicators in emerging adulthood. Those jointly exposed to childhood abuse and homelessness had disproportionate risk of substance use, particularly use of cocaine (adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.70, 6.71) and methamphetamine (AOR = 6.59, 95% CI: 3.87, 11.21). The independent and combined effects of abuse and homelessness generally persisted into adulthood though associations tended to weaken. Conclusions/Importance: Those with exposure to abuse, homelessness, and both adverse outcomes constitute a high-risk population for substance use. Addressing abuse and homelessness should be a component of preventing drug risk for screening, treatment, and prevention efforts.
Background Since the emergence of fentanyl in the drug market, syringe services programs (SSPs) h... more Background Since the emergence of fentanyl in the drug market, syringe services programs (SSPs) have been at the forefront of providing life-saving tools such as naloxone and fentanyl test strips to people who use drugs (PWUD). It is still unclear, however, how the adoption of risk-reduction practices has differed among PWUD in the context of increasing presence of non-pharmaceutical fentanyl in the drug supply. This study aims to assess the adoption of risk-reduction tools (e.g., naloxone) among those engaged with SSP services and those not engaged with SSP services. Methods We conducted a mixed-methods study following a convergent parallel design integrating both quantitative and qualitative data. Interviews were conducted with 80 people who used street opioids (i.e., heroin or opioid pills not prescribed), 32 of whom were not engaged in SSP services. Quantitative differences between those engaged and those not engaged in SSPs were assessed using independent samples t tests and Fi...
The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused ... more The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the ho...
Background: Little is known about what individuals of different social position perceive as ideal... more Background: Little is known about what individuals of different social position perceive as ideal' childbearing circumstances. This can inform our conceptualization of pregnancy intentions. Objectives: To assess and compare perceptions of childbearing among those who became pregnant before or during their desired ideal' situation. Methods: The Social Position and Family Formation (SPAFF) study comprised cross-sectional, qualitative interviews from a communitybased sample of 200 men and women (18-35 years), with and without children, of various racial/ethnic, financial and educational backgrounds. We categorized individuals by those who became pregnant either before or during their perceived ideal' childbearing circumstances and analyzed transcripts from both groups to identify themes pertaining to childbearing. Results: Preliminary analyses suggest that both groups maintain similar ideals prior to childbearing, specifically completing their education and achieving financ...
ABSTRACT Breast milk is the optimum form of nutrition for most infants and is recommended as the ... more ABSTRACT Breast milk is the optimum form of nutrition for most infants and is recommended as the sole food source for the first six months of life. Breastfeeding has been shown to reduce the risk of many infectious and chronic diseases in babies and mothers, thereby decreasing healthcare costs and contributing to a more productive workforce. Efforts to promote and support breastfeeding are therefore necessary for improving public health. Laws in New York State and the US require most workplaces to provide reasonable unpaid break time and to provide a space near the work area (which is not a restroom) where an employee can express milk in private. However, much of the statutory language is vague and open to interpretation, leading to suboptimal implementation. In response, students at the Graduate Center of the City University of New York, in collaboration with Worksites for Wellness, led an initiative to establish a dedicated space for lactating mothers for the purpose of expressing breast milk. A case study representing a successful strategy for implementation of such a space will be presented along with other lessons learned. These efforts highlight the requirement for specific enforcement language, as well as provisions addressing the needs of students at academic institutions.
Families in Society: The Journal of Contemporary Social Services
Despite growing numbers of homeless youth living in shelters with caregivers, little research has... more Despite growing numbers of homeless youth living in shelters with caregivers, little research has explored the impact of the shelter environment on emotional well-being. As such, this study assesses the relationship between shelter rules and two psychosocial outcomes among youth in New York City family shelters. Additionally, the direct effect of trauma and the moderating effect of difficulty following shelter rules on psychosocial outcomes was assessed. Youth with difficulty following shelter rules reported significantly more depressive symptoms, but less substance use. Trauma was found to be associated with increased depression and substance use. Difficulty following shelter rules was found to moderate the association between trauma and substance use. Recommendations for future interventions and the creation of shelter policies are discussed.
Examination of longitudinal relationships between childhood traumatic experiences and drug use ac... more Examination of longitudinal relationships between childhood traumatic experiences and drug use across the life-course at the national level, with control of confounding by other forms of trauma, is needed. We aimed to estimate the prevalence of nine typologies of childhood traumas and the cumulative number experienced, correlation between traumas, and associations between individual and cumulative number of traumas with drug use during adolescence, emerging adulthood, and adulthood. Secondary data analysis using the National Longitudinal Study of Adolescent to Adult Health SETTING: United States of America. A nationally-representative sample of individuals in grades 7-12 (ages 11-21) during 1994-95, who were re-interviewed during emerging adulthood (2001-02; ages 18-26) and adulthood (2007-08; ages 24-32). The analytic sample is 12,288 participants with data at all three waves. Nine typologies of childhood traumas: neglect; emotional, physical, and sexual abuse; parental incarcerati...
Deep cuts have been proposed to federally funded nutrition assistance programs, including the Sup... more Deep cuts have been proposed to federally funded nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast and lunch programs. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Participation in these programs is linked with reductions in perinatal morbidity and mortality, improved childhood growth trajectories, enhanced school performance, and reductions in food insecurity and poverty. Given these compelling health and economic benefits, the Society of Behavioral Medicine urges Congress to protect and increase funding for federally funded nutrition assistance programs, specifically SNAP, WIC, and school breakfast and lunch programs. Per the recent (2017) recommendations of the School Nutrition Association, Congress should also resist any attempts to "block-grant" subsidized school breakfast and lunch programs, which could reduce access to these programs. It is further recommended that Congress improve the scope of implementation- and outcomes-based assessments of these programs. Finally, we recommend efforts to increase awareness of and participation in SNAP, WIC, and federally funded school meal programs for eligible individuals, children, and families.
BACKGROUND AND OBJECTIVE To promote increased access to and retention in buprenorphine treatment ... more BACKGROUND AND OBJECTIVE To promote increased access to and retention in buprenorphine treatment for opioid use disorder, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented the Buprenorphine Nurse Care Manager Initiative (BNCMI) in 2016, in which nurse care managers (NCMs) coordinate buprenorphine treatment in safety-net primary care clinics. To explore how patients experienced the care they received from NCMs, DOHMH staff conducted in-person, in-depth interviews with patients who had, or were currently receiving, buprenorphine treatment at BNCMI clinics. Participants were patients who were receiving, or had received, buprenorphine treatment through BNCMI at one of the participating safety-net primary care practices. METHODS The study team used a thematic analytic and framework analysis approach to capture concepts related to patient experiences of care received from NCMs, and to explore differences between those who were in treatment for at least six consecutive months and those who left treatment within the first six months. RESULTS Themes common to both groups were that NCMs showed care and concern for patients' overall well-being in a nonjudgmental manner. In addition, NCMs provided critical clinical and logistical support. Among out-of-treatment participants, interactions with the NCM were rarely the catalyst for disengaging with treatment. Moreover, in-treatment participants perceived the NCM as part of a larger clinical team that collectively offered support, and the care provided by NCMs was often a motivating factor for them to remain engaged in treatment. CONCLUSION Findings suggest that by providing emotional, clinical, and logistical support, as well as intensive engagement (e.g., frequent phone calls), the care that NCMs provide could encourage retention of patients in buprenorphine treatment.
Abstract Background Childhood abuse and homelessness are independently associated with substance ... more Abstract Background Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited. Objective: To estimate independent and joint effects of childhood abuse and homelessness on substance use risk during emerging adulthood and adulthood. Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we measured associations between exposure to physical or sexual abuse in childhood, homelessness in childhood or emerging adulthood, or exposure to both traumas and outcomes of binge drinking, marijuana use, cocaine use, methamphetamine use, and prescription opioid misuse during emerging adulthood (Wave III, ages 18–26 years) and adulthood (Wave IV, ages 24–32 years). Results: In adjusted analyses, exposure to childhood abuse alone, homelessness alone, and both childhood abuse and homelessness were significant correlates of most substance use indicators in emerging adulthood. Those jointly exposed to childhood abuse and homelessness had disproportionate risk of substance use, particularly use of cocaine (adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.70, 6.71) and methamphetamine (AOR = 6.59, 95% CI: 3.87, 11.21). The independent and combined effects of abuse and homelessness generally persisted into adulthood though associations tended to weaken. Conclusions/Importance: Those with exposure to abuse, homelessness, and both adverse outcomes constitute a high-risk population for substance use. Addressing abuse and homelessness should be a component of preventing drug risk for screening, treatment, and prevention efforts.
Background Since the emergence of fentanyl in the drug market, syringe services programs (SSPs) h... more Background Since the emergence of fentanyl in the drug market, syringe services programs (SSPs) have been at the forefront of providing life-saving tools such as naloxone and fentanyl test strips to people who use drugs (PWUD). It is still unclear, however, how the adoption of risk-reduction practices has differed among PWUD in the context of increasing presence of non-pharmaceutical fentanyl in the drug supply. This study aims to assess the adoption of risk-reduction tools (e.g., naloxone) among those engaged with SSP services and those not engaged with SSP services. Methods We conducted a mixed-methods study following a convergent parallel design integrating both quantitative and qualitative data. Interviews were conducted with 80 people who used street opioids (i.e., heroin or opioid pills not prescribed), 32 of whom were not engaged in SSP services. Quantitative differences between those engaged and those not engaged in SSPs were assessed using independent samples t tests and Fi...
The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused ... more The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the ho...
Background: Little is known about what individuals of different social position perceive as ideal... more Background: Little is known about what individuals of different social position perceive as ideal' childbearing circumstances. This can inform our conceptualization of pregnancy intentions. Objectives: To assess and compare perceptions of childbearing among those who became pregnant before or during their desired ideal' situation. Methods: The Social Position and Family Formation (SPAFF) study comprised cross-sectional, qualitative interviews from a communitybased sample of 200 men and women (18-35 years), with and without children, of various racial/ethnic, financial and educational backgrounds. We categorized individuals by those who became pregnant either before or during their perceived ideal' childbearing circumstances and analyzed transcripts from both groups to identify themes pertaining to childbearing. Results: Preliminary analyses suggest that both groups maintain similar ideals prior to childbearing, specifically completing their education and achieving financ...
ABSTRACT Breast milk is the optimum form of nutrition for most infants and is recommended as the ... more ABSTRACT Breast milk is the optimum form of nutrition for most infants and is recommended as the sole food source for the first six months of life. Breastfeeding has been shown to reduce the risk of many infectious and chronic diseases in babies and mothers, thereby decreasing healthcare costs and contributing to a more productive workforce. Efforts to promote and support breastfeeding are therefore necessary for improving public health. Laws in New York State and the US require most workplaces to provide reasonable unpaid break time and to provide a space near the work area (which is not a restroom) where an employee can express milk in private. However, much of the statutory language is vague and open to interpretation, leading to suboptimal implementation. In response, students at the Graduate Center of the City University of New York, in collaboration with Worksites for Wellness, led an initiative to establish a dedicated space for lactating mothers for the purpose of expressing breast milk. A case study representing a successful strategy for implementation of such a space will be presented along with other lessons learned. These efforts highlight the requirement for specific enforcement language, as well as provisions addressing the needs of students at academic institutions.
Families in Society: The Journal of Contemporary Social Services
Despite growing numbers of homeless youth living in shelters with caregivers, little research has... more Despite growing numbers of homeless youth living in shelters with caregivers, little research has explored the impact of the shelter environment on emotional well-being. As such, this study assesses the relationship between shelter rules and two psychosocial outcomes among youth in New York City family shelters. Additionally, the direct effect of trauma and the moderating effect of difficulty following shelter rules on psychosocial outcomes was assessed. Youth with difficulty following shelter rules reported significantly more depressive symptoms, but less substance use. Trauma was found to be associated with increased depression and substance use. Difficulty following shelter rules was found to moderate the association between trauma and substance use. Recommendations for future interventions and the creation of shelter policies are discussed.
Examination of longitudinal relationships between childhood traumatic experiences and drug use ac... more Examination of longitudinal relationships between childhood traumatic experiences and drug use across the life-course at the national level, with control of confounding by other forms of trauma, is needed. We aimed to estimate the prevalence of nine typologies of childhood traumas and the cumulative number experienced, correlation between traumas, and associations between individual and cumulative number of traumas with drug use during adolescence, emerging adulthood, and adulthood. Secondary data analysis using the National Longitudinal Study of Adolescent to Adult Health SETTING: United States of America. A nationally-representative sample of individuals in grades 7-12 (ages 11-21) during 1994-95, who were re-interviewed during emerging adulthood (2001-02; ages 18-26) and adulthood (2007-08; ages 24-32). The analytic sample is 12,288 participants with data at all three waves. Nine typologies of childhood traumas: neglect; emotional, physical, and sexual abuse; parental incarcerati...
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Papers by Nisha N Beharie