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Sexuality education in public schools in the United States excludes a large population of students. These exclusions are due to a long history of legal and economic battles, as well as the politicized nature of adolescent sexuality. This critical interpretive inquiry explored the long history of sexuality education through the lens of economics, law, and psychological paradigms and examined the way in which each of these lenses furthered the exclusion of nonheterosexual males in curricula. Using a framework comprised of critical feminist theory, critical pedagogy, and queer theory, this manuscript provides an understanding of the social structures of sexuality education and how they continue to marginalize students labeled as “other.” Using critical discourse analysis, this study reviewed legal and political documents, state and private curricula, and works in the sociology and psychology fields. The outcomes of interpretive research do not lend themselves to specific answers, but to a greater understanding of the experience of marginalized individuals and the structures in place that keep this experience intact. Through a critical review of current programming initiatives, recommendations are made to continue moving toward a more gender- and identity-inclusive sexuality education curriculum. These recommendations, which are grounded in current legal and economic requirements, include teacher certification requirements, implementation of the Advocates for Youth 3Rs curriculum, utilization of a rights-based approach to program design, and adoption of national sexuality education by the Department of Health and Human Services, rather than by the Department of Education.

Background: Treatment providers have applied contingency management (CM) treatment, an intervention that often rewards individuals for drug abstinence (i.e., ABS CM), to treatment engagement as well. However, we know little about the magnitude of treatment effects when providers target attendance behaviors (i.e., ATT CM). Methods: This study conducted a systematic search to identify studies that included ATT CM, either in isolation or in combination with ABS CM. The study used meta-analysis to estimate the effect size of ATT CM and ABS CM + ATT CM on treatment attendance and drug abstinence. We identified a total of 10 studies including 12 CM treatments (6 ATT CM and 6 ABS CM + ATT CM) with 1841 participants. Results: Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.25, 0.69]) of ATT CM on attendance relative to non–reward active comparison conditions. Frequency of rewards was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.12, 0.33]) of ATT CM on abstinence outcomes relative to nonreward comparisons, p < 0.001. The study found no significant differences in attendance or abstinence between ATT CM and ABS CM + ATT CM (p's > 0.05). Conclusion: Overall, the results supported ATT CM for increasing treatment engagement, with smaller effects on abstinence. Effects on abstinence were smaller than those observed in prior meta-analyses focused on ABS CM. No significant differences existed in attendance or abstinence outcomes between ATT CM and ABS + ATT CM. However, future studies are needed to experimentally compare ABS CM + ATT CM to ABS CM, and ATT CM to determine additive effects. Clinics implementing CM should consider the differential effects between ATT CM and ABS CM when selecting target behavior(s).

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Introduction Neonatal abstinence syndrome (NAS) is a health condition in infants that results from the sudden discontinuation of substances that infants were exposed to in utero (Kocherlakota, 2014). Typical symptoms include: hyperirritability, sweating, hypertension, tremors, sleep deprivation, and seizures (Kocherlakota, 2014). The role of a SLP in treating infants with NAS in the NICU includes evaluation, assessment, and treatment of the feeding cycle. Our research is an early exploratory and descriptive study of the pre-natal, peri-natal, and post-natal characteristics of infants with NAS who required SLP assessment and intervention as opposed to those who did not. Our aim was to examine possible predictors of infants with feeding and swallowing difficulties. Methods Data was collected from a local hospital system that conducted a five-year retrospective chart review study. From charts of 140 infants in the NICU, infants were placed into two groups: infants who received SLP services (SLP group) and infants who did not receive SLP services (NSLP group). From those charts, 26 infants with NAS who received SLP services were placed in SLP group based on the availability of a match in NSLP group. Infants in both groups were matched based on gestational age, year of birth, and gender. Results/Conclusion There were no significant differences found between SLP group and NSLP groups in: number of prenatal visits, week/timing of initial prenatal visit, and dosage of buprenorphine taken by the mother. The two groups did not differ (all ps>.18) in their types of drug use, average dosage of buprenorphine taken, average number of prenatal visits, or average week of first visit. There was a statistically significant difference in maternal age in the SLP group (p<.05; M=29.7 years, SD=5.4) and in NSLP group (M=26.7 years, SD=4.3.). There was no statistically significant difference in initial measurements of weight, head circumference, length, Apgar scores at birth, and number of complications between groups. There were no significant differences found in NAS scores between groups regarding the highest NAS score or average NAS score, number of NAS scores and first day of collection or number of days collected. There was a statistically significant difference in the number of prescription drugs administered. Infants in SLP group had more prescription drugs on average (M=1.50, SD=.89) than NSLP group (M=1.04, SD=.20). There was a statistically significant difference in the amount of weight gained (SLP group gained 229 more grams) and in infant length of stay and overall cost (SLP group on average stayed in the NICU one week longer and cost $22,896 more). Little research has been conducted regarding NAS and the impact it has on feeding and swallowing. We found that there are statistically significant differences among infants who were in SLP and NSLP groups. It cannot be determined how many full-term infants have dysphagia; however, from a clinical opinion it is thought that most full-term babies with dysphagia also have a neurological impairment.

Background: Neonatal Abstinence Syndrome (NAS), a manifestation of the widespread opioid epidemic, has plagued our country, and particularly the region of Northeast Tennessee, for quite some time now. One question among many that seems to baffle almost everyone involved in research on the topic at hand is that why do only 35-40% of opioid exposed pregnancies result in NAS requiring medication while sparing the rest. Is there some discriminatory factor other than in utero opioid exposure involved? Thus, in light of this knowledge, we wanted to investigate whether birth weight at the time of delivery can influence the development of NAS; that is, are neonates of a low birth weight or high birth weight (with respect to gestational age thresholds) more likely to develop NAS. Methods: Therefore, we conducted a retrospective chart analysis of all deliveries within the Mountain States Health Alliance System over a 5 years period between July 1, 2011- June 30, 2016 at all 5 delivery sites in Northeast Tennessee and Southwest Virginia (N=18,728). Out of this sample size, we identified 2,392 at-term newborns as positive for prenatal opioid exposure, and then we stratified them into 2 categories: birth weight ≤3.5kg (proxy for low or average birth weight with respect to gestational age thresholds) and birth weight ≥3.5kg (proxy for high birth weight with respect to gestational age thresholds). Thereafter, we ran SPSS statistical analyses involving chi square, t tests, and logistic regression to assess whether one birth weight group was more likely to have a higher incidence rate of NAS compared to the other birth weight group. Results: We found that even after controlling for significant confounders such as marital status, race, and pregnancy smoking, benzodiazepine, and marijuana use, infants who were in the low to average birth weight group (≤3.5kg in this study) were almost twice as likely (statistically significant adjusted odds ratio of 1.95) to develop NAS compared to infants who were in the high birth weight group (≥3.5kg in this study). Our study helps shed some important light on the discriminatory factors for NAS development, with birth weight being a significantly associated clinical factor as we now know. Discussion & Implications: Unfortunately, the mechanism for the transport of opioids across the placenta is complicated, and poorly understood. There may be more ‘unbound or free opioids’ available in infants of low to average birth weight (with respect to gestational age thresholds) compared to infants of high birth weight (with respect to gestational age thresholds) resulting in a higher incidence of NAS in the former population. It is more of a speculation rather than a conclusion to explain the results of our study. However, being equipped with this knowledge that opioid exposed neonates of low to average birth weight (with respect to gestational age thresholds) have a higher risk of developing NAS will allow physicians to identify infants with a higher risk for NAS early, and this will subsequently lead to better outcomes and reduced severity in cases of NAS.

Background: There is robust preclinical literature and preliminary clinical findings supporting the use of N-Acetylcysteine (NAC) to treat substance use disorders, including tobacco use disorder (TUD). However, randomized controlled trials have yielded mixed results and NAC's efficacy for TUD has not been established. The goals of this study were to assess the efficacy of NAC in promoting early and end-of-treatment abstinence and preventing relapse among adult smokers. Methods: This randomized, double-blinded clinical trial enrolled adult, daily smokers (N = 114; ages 23–64; 51 % female; 65 % White; 29 % Black/African American; 7% Hispanic/Latinx), who were randomized 1:1 to receive NAC (n = 59) or placebo (n = 55) (1200 mg b.i.d.) for eight weeks. Participants received brief cessation counseling and incentives for abstinence during the first three days of the quit attempt. Primary outcomes: (i) carbon monoxide (CO)-confirmed abstinence during the first three days of the quit attempt. Secondary outcomes: (ii) time to relapse; (iii) biologically confirmed abstinence at Week 8. Results: No differences were found between NAC and placebo groups on measures of early abstinence (3-day quit attempt; 11 % for NAC vs. 15 % for placebo; all p > 0.11), time to relapse (p = 0.19), and end-of-treatment abstinence (7% for NAC vs. 11 % for placebo; all p > 0.40]. Conclusions: Results indicate that NAC is a well-tolerated pharmacotherapy but is unlikely to be efficacious as a monotherapy for TUD in adults. Considered in the collective context of other research, NAC may potentially be more useful in a younger population, as a combination pharmacotherapy, or in the presence of more intensive psychosocial treatment.

Neonatal Abstinence Syndrome (NAS) is the condition which occurs when newborn babies experience withdrawal symptoms from medications taken by their mothers during pregnancy. Prior research suggest NAS is associated with long-term educational difficulties and alterations in neonatal brain structure. Between 2008 and 2017, NAS rates more than tripled in the United States. An epicenter of the NAS epidemic is Southern Appalachia. West Virginia, the only state with all counties located in Southern Appalachia, has an NAS rate roughly seven times the national average, and in 2017, four of the 10 states with the highest NAS rates were part of Southern Appalachia. Upon reviewing Tennessee data, it was noted that increasing NAS rates had a similar curve to buprenorphine prescribing patterns. Buprenorphine is an opioid partial-agonist prescribed in medication assisted therapy (MAT) intended to help individuals, including those pregnant, avoid withdrawal symptoms. Previous research at an East Tennessee clinic identified buprenorphine in urine drug screens of 16% of all pregnant patients; patients admit to both prescribed and illicit use, including snorting, smoking, and injecting. These findings align with a 2017 study suggesting that mothers of NAS infants in eastern Tennessee, compared to mothers across the state, were more likely to use substances prescribed to another person. Despite the drug’s increasing prescribing patterns and popularity for illicit use, its effects on the mother and fetus remain controversial. We therefore felt it appropriate to investigate possible linkages between buprenorphine prescriptions and NAS rates. For the purposes of this study, we define Southern Appalachia as 250 counties from 7 states, including Tennessee, West Virginia, Virginia, North Carolina, Kentucky, Ohio, and Maryland. Annual NAS rates, buprenorphine prescription rates, drug-induced death rates, and opioid prescribing rates from each county in the region were assessed for the years 2008-2018 using data provided by governmental agencies. It was found that buprenorphine prescriptions in the region more than quintupled between 2008 and 2018. NAS rates and drug-induced death rates did not decrease as well; unfortunately, they dramatically increased. We identified a significant linear association between the rate of NAS diagnoses and buprenorphine prescriptions (r = 0.9774, R2 = 0.9553, p-value less than 0.001) and between the rate of buprenorphine prescriptions and drug-induced deaths (r = 0.7129, R2 = 0.5082, p-value .0311). This is the first report which documents a relationship between NAS rates and increasing buprenorphine prescribing. Discussions regarding current policies for buprenorphine management during pregnancy are warranted. We encourage further research on establishing the lowest effective buprenorphine dose for each patient, and we support the CDC’s resumption of tracking the morphine milligram equivalents (MME) of buprenorphine prescribed during pregnancy so that researchers can further study the effect of congenital MME exposure on fetal outcomes.