James K Cunningham

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• Cunningham, J. K., & Saleh, A. A. (2024). Structural Stigma, Racism, and Sexism Studies on Substance Use and Mental Health: A Review of Measures and Designs. Alcohol Research: Current Reviews, 44(Issue 1). doi:10.35946/arcr.v44.1.08
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  PURPOSE: Most research on the structural determinants of substance use and mental health has centered around widely studied factors such as alcohol taxes, tobacco control policies, essential/precursor chemical regulations, neighborhood/city characteristics, and immigration policies. Other structural determinants exist, however, many of which are being identified in the emerging fields of structural stigma, structural racism, and structural sexism. This narrative review surveys the measures and designs used in substance use and mental health studies from these three fields. SEARCH METHODS: The PubMed, PsycINFO, and Scopus databases were searched on May 11, 2023. A focused search approach used terminology for structural racism, stigma, or sexism combined with terminology for substance use or mental health. Peer-reviewed studies were included if they were written in English and assessed associations between objective structural measures and substance use and mental health outcomes. SEARCH RESULTS: Of 2,536 studies identified, 2,487 were excluded. Forty-nine studies (30 related to stigma, 16 related to racism, and three related to sexism) met the inclusion criteria. Information was abstracted about the structural measures, outcome measures, research design, sample, and findings of each study. DISCUSSION AND CONCLUSIONS: The structural determinant measures used in the studies reviewed were diverse. They addressed, for example, community opinions, the gender of legislators, economic vulnerability, financial loan discrimination, college policies, law enforcement, historical trauma, and legislative protections for sexual and gender minorities and for reproductive rights. Most of the structural determinant measures were constructed by combining multiple indicators into indexes or by merging indexes into composite indexes, although some studies relied on single indicators alone. The substance use and mental health outcome measures most frequently examined were related to alcohol and depression, respectively. The studies were conducted in numerous nations and drew samples from an array of groups, including, for example, patients who experienced overdoses from substance use, sexual and gender minorities, racial and ethnic minority groups, women, youth, migrants, and patients subject to involuntary psychiatric hospitalization. Most of the studies used passive-observational (correlational) research designs and, as a result, did not assess whether their structural determinant variables were causally related to substance use and mental health. Nevertheless, the studies reviewed can be used by public health proponents to foster awareness that a wide range of structural determinants correlate with the substance use and mental health of many groups within and across nations.
• Cunningham, J. K., Solomon, T. G., Ritchey, J., & Weiss, B. D. (2023). Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments. American Journal of Preventive Medicine, 65(6), 1113-1123.
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  Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well.
• Cunningham, J. K., Solomon, T. G., Ritchey, J., & Weiss, B. D. (2023). Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments. American Journal of Preventive Medicine, 65(Issue 6). doi:10.1016/j.amepre.2023.06.011
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  Introduction: Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. Methods: National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022–2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. Results: Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p
• Andrade, R., Govindarajan, L., Cunningham, J. K., Healy, E., Muramoto, M., & Taren, D. (2016). The Development and Evolution of Public Health Essentials In Action: A Training Course on the 3 Core Functions and 10 Essential Public Health Services. Pedagogy in Health Promotion.
• Cordova-Marks, F. M., Cunningham, J. K., Harris, R. B., Gerald, L. B., Norton, B., Mastergeorge,, A. M., & Teufel-Shone, N. I. (2020). Resilience and Stress Among Hopi Female Caregivers. American Indian and Alaska Native Mental Health Research, 27(Issue 2). doi:10.5820/aian.2702.2020.76
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  Abstract: Resilience and stress are important factors in the caregiving experience, but research has yet to examine their association among American Indian (AI) caregivers. This study examines resilience and stress in a group of Hopi female caregivers. Data came from the Hopi Adult Caregiver Survey (2017), which conducted interviews with 44 Hopi women who were providing care without remuneration to an adult family member. Measures included the abbreviated Connor-Davidson Resilience Scale (CD- RISC-10), the Perceived Stress Scale (PSS-10), and questions about caregiver characteristics, care recipient characteristics, social support/ community support, and cultural factors. Stress and resilience were looked at above the median (higher stress or higher resilience) and below the median (lower stress or lower resilience). Caregivers who reported relatively lower resilience were more likely to report that they lived separately from their care recipients and that all Hopis are expected to be caregivers. Caregivers who reported relatively higher stress reported a higher total number of caregiver difficulties, a poorer self-perception of their own health, use of a traditional healer in the past 5 years, and that females are expected to be caregivers. A regression analysis adjusting for age, education, and employment status indicated that higher resilience among the caregivers was significantly associated with lower stress. In light of these findings, programs working with AI caregivers may wish to explore whether supporting the resilience of these caregivers is a means towards limiting their stress.
• Cunningham, J. K., Ritchey, J., & Arambula Solomon, T. G. (2020). With socioeconomic status controlled, cigarette use is lower among American Indians/Alaska Natives than whites. Drug and Alcohol Dependence, 211(Issue). doi:10.1016/j.drugalcdep.2020.107836
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  Background: Higher crude prevalence of cigarette use among American Indians/Alaska Natives (AI/AN) than non-Hispanic whites (NHW) has helped engender an assumption that race/ethnicity explains the difference. This study examines whether being AI/AN versus NHW predicts greater use when socioeconomic status and demographics are controlled. Methods: Data came from the National Survey on Drug Use and Health (2013–2017). Using logistic regressions with socioeconomic (income, education) and demographic (gender, age, marital status) controls, differences between AI/AN (n = 4,305) and NHW (n = 166,348) regarding heavier cigarette use (past month daily use, past month use of 300+ cigarettes, and nicotine dependence) and current cigarette use (past month use plus 100+ cigarettes in lifetime) were assessed. Adjusted predicted probabilities were also constructed. Results: NHW, compared to AI/AN, had greater odds of daily use: adjusted odds ratio (AOR) = 1.23 (95% CI: 1.03–1.49); predicted probabilities—15.3% and 13.0%, respectively. NHW had greater odds of using 300+ cigarettes: AOR = 1.47 (CI: 1.19–1.83); predicted probabilities—13.6% and 9.9%. NHW had greater odds of being nicotine dependent: AOR = 1.57 (CI: 1.31–1.89); predicted probabilities—10.3% and 7.1%. A difference in current use was not found. As controls, income and education were especially impactful. Conclusions: With controls, particularly for socioeconomic status, heavier cigarette use was lower among AI/AN than NHW, and a current cigarette use difference was not indicated. This contradicts the idea that being AI/AN versus NHW independently predicts greater cigarette use, and it underscores the importance of socioeconomic status for understanding cigarette use among AI/AN.
• Cunningham, J. K., Ritchey, J., Solomon, T. A., & Cordova, F. M. (2019). Cigarette Use among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands. Journal of Public Health Management and Practice, 25(Issue). doi:10.1097/phh.0000000000001026
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  Context: Cigarette use among the US general population is significantly lower in metropolitan areas than in rural areas. Objective: To assess whether cigarette use among American Indians and Alaska Natives (AI/AN) is lower in metropolitan areas than in rural areas and tribal lands (which are predominantly rural). Design: Data came from the National Survey on Drug Use and Health (2012-2016). Regressions with adjustments for demographics were performed to assess whether cigarette use differed in association with type of place. Settings: The AI/AN in tribal lands (n = 1569), nontribal large metropolitan (1+ million people) areas (n = 582), nontribal small metropolitan (
• Giacobbi, P., Giacobbi, P., Giacobbi, P., Howe, C. L., Howe, C. L., Howe, C. L., Roe, D., Roe, D., Roe, D., Hingle, M. D., Hingle, M. D., Hingle, M. D., Armin, J. S., Armin, J. S., Armin, J. S., Johnson, T., Johnson, T., Johnson, T., Cunningham, J. K., , Cunningham, J. K., et al. (2017). Development and Evaluation of the See Me Smoke-Free Multi-Behavioral mHealth App for Women Smokers. Translational Behavioral Medicine, 7(2), 172-184.
• Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S. M., & Jacobs, T. A. (2017). Lessons learned in the development and evaluation of RxCoach™, an mHealth app to increase tobacco cessation medication adherence. Patient Education and Counseling, 100(Issue 4). doi:10.1016/j.pec.2016.11.003
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  Objective In this project we developed and evaluated a mobile health app to improve adherence to tobacco cessation medication. Methods The study was conducted in three phases: (1) Create app with input from our consultant, focus groups and user testing; (2) Test feasibility of the app; and (3) Develop and user-test the barcode scanner. Results Focus group feedback was instrumental in developing content and creating the user interface. User testing helped to identify problems and refine the app. The feasibility trial provided “real world” testing. We experienced challenges in recruitment due to the inclusion criteria. We had high attrition due to technical issues, medication side effects, enrollment procedures, and lack of personal contact. Among the five retained participants, use of the app was associated with good medication adherence and high consumer satisfaction. Conclusion The small sample size limits the generalizability of the findings and the conclusions that can be drawn from the study. However, the feasibility trial enabled the team to identify ways to improve the conduct of this and other mHealth studies. Practical implications We should expand RxCoach to include all prescription and over-the-counter tobacco cessation medications, and re-test for feasibility using lessons learned to improve recruitment and retention.
• Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S. M., & Jacobs, T. A. (2017). Lessons learned in the development and evaluation of RxCoach™, an mHealth app to increase tobacco cessation medication adherence.omen smokers.. Patient Education & Counseling, 100(4), 720-727. doi:10.1016/j.pec.2016.11.003
• Gordon, J. S., Armin, J., D. Hingle, M., Giacobbi, P., Cunningham, J. K., Johnson, T., Abbate, K., Howe, C. L., & Roe, D. J. (2017). Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers. Translational Behavioral Medicine, 7(Issue 2). doi:10.1007/s13142-017-0463-7
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  Women face particular challenges when quitting smoking, especially those with weight concerns. A multi-behavioral smoking cessation intervention addressing these concerns and incorporating guided imagery may assist women to engage in healthy lifestyle behaviors. An mHealth app can easily disseminate such an intervention. The goals of this pilot study were to develop and test the feasibility and potential of the See Me Smoke-Free™ mHealth app to address smoking, diet, and physical activity among women smokers. We used pragmatic, direct-to-consumer methods to develop and test program content, functionality, and the user interface and conduct a pre-/post-test, 90-day pilot study. We enrolled 151 participants. Attrition was 52%, leaving 73 participants. At 90 days, 47% of participants reported 7-day abstinence and significant increases in physical activity and fruit consumption. Recruitment methods worked well, but similar to other mHealth studies, we experienced high attrition. This study suggests that a guided imagery mHealth app has the potential to address multiple behaviors. Future research should consider different methods to improve retention and assess efficacy.
• Cunningham, J. K., Callaghan, R. C., & Liu, L. (2016). Essential/Precursor Chemicals and Drug Consumption: Impacts of US Sodium Permanganate and Mexico Pseudoephedrine Controls on the Numbers of US Cocaine and Methamphetamine Users. Addiction.
• Cunningham, J. K., Liu, L. M., & Callaghan, R. C. (2016). Essential/precursor chemicals and drug consumption: impacts of US sodium permanganate and Mexico pseudoephedrine controls on the numbers of US cocaine and methamphetamine users. Addiction (Abingdon, England), 111(Issue 11). doi:10.1111/add.13480
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  BACKGROUND AND AIMS: In December 2006 the United States regulated sodium permanganate, a cocaine essential chemical. In March 2007 Mexico, the United States' primary source for methamphetamine, closed a chemical company accused of illicitly importing 60+ tons of pseudoephedrine, a methamphetamine precursor chemical. US cocaine availability and methamphetamine availability, respectively, decreased in association. This study tested whether the controls had impacts upon the numbers of US cocaine users and methamphetamine users. DESIGN: Auto-regressive integrated moving average (ARIMA) intervention time-series analysis. Comparison series-heroin and marijuana users-were used. SETTING: United States, 2002-14. PARTICIPANTS: The National Survey on Drug Use and Health (n = 723 283), a complex sample survey of the US civilian, non-institutionalized population. MEASUREMENTS: Estimates of the numbers of (1) past-year users and (2) past-month users were constructed for each calendar quarter from 2002 to 2014, providing each series with 52 time-periods. FINDINGS: Downward shifts in cocaine users started at the time of the cocaine regulation. Past-year and past-month cocaine users series levels decreased by approximately 1 946 271 (-32%) (P < 0.05) and 694 770 (-29%) (P < 0.01), respectively-no apparent recovery occurred through 2014. Downward shifts in methamphetamine users started at the time of the chemical company closure. Past-year and past-month methamphetamine series levels decreased by 494 440 (-35%) [P < 0.01; 95% confidence interval (CI) = -771 897, -216 982] and 277 380 (-45%) (P < 0.05; CI = -554 073, -686), respectively-partial recovery possibly occurred in 2013. The comparison series changed little at the intervention times. CONCLUSIONS: Essential/precursor chemical controls in the United States (2006) and Mexico (2007) were associated with large, extended (7+ years) reductions in cocaine users and methamphetamine users in the United States.
• Cunningham, J. K., Solomon, T. A., & Muramoto, M. L. (2016). Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief. Drug and Alcohol Dependence, 160(Issue). doi:10.1016/j.drugalcdep.2015.12.015
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  Background: This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption. Methods: The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013: whites (n = 171,858) and NA (n = 4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1-4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2013: whites (n = 1,130,658) and NA (n = 21,589). Results: In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7-63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6-43.6), abstained-adjusted odds ratio (AOR): 0.64 (CI: 0.56-0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2-33.2) of whites (AOR: 1.90; CI: 1.51-2.39). NA and white binge drinking estimates were similar-17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4-17.0), respectively (AOR: 1.00; CI: 0.83-1.20). The two populations' heavy drinking estimates were also similar-8.3% (CI: 6.7-10.2) and 7.5% (CI: 7.3-7.7), respectively (AOR: 1.06; CI: 0.85-1.32). Results from the BRFSS analyses generally corroborated those from NSDUH. Conclusions: In contrast to the 'Native American elevated alcohol consumption' belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined.
• Cunningham, J. K., Solomon, T. A., & Muramoto, M. L. (2016). Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief. Drug and Alcohol Dependence, 160, 65-75.
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  This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption.
• Giacobbi, P., Hingle, M., Johnson, T., Cunningham, J. K., Armin, J., & Gordon, J. S. (2016). See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity. JMIR Research Protocols, 5(1), e12.
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  This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors-exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions.
• Giacobbi, P., Hingle, M., Johnson, T., Cunningham, J. K., Armin, J., & Gordon, J. S. (2016). See me smoke-free: Protocol for a research study to develop and test the feasibility of an mhealth app for women to address smoking, diet, and physical activity. JMIR Research Protocols, 5(Issue 1). doi:10.2196/resprot.5126
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  Background: This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions. Objective: The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers. Methods: We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application s usability with 6 participants in preparation for an open, pre-and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones. Results: The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app "most days" for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking). Conclusions: We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics.
• Gordon, J. S., Armin, J. S., Cunningham, J. K., Muramoto, M. L., Christiansen, S., & Jacobs, T. (2016). Development of RxCoach™: A theory-based mobile app to improve adherence to smoking cessation medication. Patient Education & Counseling. doi:10.1016/j.pec.2016.11.003
• Cunningham, J. K., Callaghan, R. C., & Liu, L. (2015). US federal cocaine essential ('precursor') chemical regulation impacts on US cocaine availability: an intervention time-series analysis with temporal replication. Addiction, 110(5), 805-20.
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  Research shows that essential/precursor chemical controls have had substantial impacts on US methamphetamine and heroin availability. This study examines whether US federal essential chemical regulations have impacted US cocaine seizure amount, price and purity-indicators of cocaine availability.
• Cunningham, J. K., Callaghan, R. C., & Liu, L. M. (2015). US federal cocaine essential ('precursor') chemical regulation impacts on US cocaine availability: An intervention time-series analysis with temporal replication. Addiction, 110(Issue 5). doi:10.1111/add.12839
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  Background and Aims: Research shows that essential/precursor chemical controls have had substantial impacts on US methamphetamine and heroin availability. This study examines whether US federal essential chemical regulations have impacted US cocaine seizure amount, price and purity-indicators of cocaine availability. Design: Autoregressive integrated moving average (ARIMA)-intervention time-series analysis was used to assess the impacts of four US regulations targeting cocaine manufacturing chemicals: potassium permanganate/selected solvents, implemented October 1989 sulfuric acid/hydrochloric acid, implemented October 1992; methyl isobutyl ketone, implemented May 1995; and sodium permanganate, implemented December 2006. Of these chemicals, potassium permanganate and sodium permanganate are the most critical to cocaine production. Setting: Conterminous United States (January 1987-April 2011). Measurements: Monthly time-series: purity-adjusted cocaine seizure amount (in gross weight seizures < 6000 grams), purity-adjusted price (all available seizures), and purity (all available seizures). Data source: System to Retrieve Information from Drug Evidence. Findings: The 1989 potassium permanganate/solvents regulation was associated with a seizure amount decrease (change in series level) of 28% (P < 0.05), a 36% increase in price (P < 0.05) and a 4% decrease in purity (P < 0.05). Availability recovered in 1-2 years. The 2006 potassium permanganate regulation was associated with a 22% seizure amount decrease (P < 0.05), 100% price increase (P < 0.05) and 35% purity decrease (P < 0.05). Following the 2006 regulation, essentially no recovery occurred to April 2011. The other two chemical regulations were associated with statistically significant but lesser declines in indicated availability. Conclusions: In the United States, essential chemical controls from 1989 to 2006 were associated with pronounced downturns in cocaine availability.
• Cunningham, J. K., Floden, L. L., Howerter, A. L., Matthews, E., Gordon, J. S., & Muramoto, M. (2015). Complementary and Alternative Medicine (CAM) practitioners’ readiness for tobacco intervention training: Development and psychometric properties of a new measure. Advances in Integrative Medicine.
• Cunningham, J. K., Floden, L. L., Howerter, A. L., Matthews, E., Gordon, J. S., & Muramoto, M. L. (2015). Complementary and Alternative Medicine (CAM) practitioners’ readiness for tobacco intervention training: Development and psychometric properties of a new measure. Advances in Integrative Medicine, 2(Issue 2). doi:10.1016/j.aimed.2014.10.012
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  Objective Complementary and Alternative Medicine (CAM) practitioners are an important potential resource for expanding the use of tobacco cessation brief interventions. Training these practitioners to conduct such interventions has been hampered, however, by a lack of tools for assessing the practitioners’ tobacco intervention behaviors and interest, and openness to non-CAM tobacco cessation aids (e.g., medications, quitlines). Recognizing this, we developed a new measure: the CAM Readiness for Training in Tobacco Intervention (CAM RTTI) questionnaire. Methods Together with a key informant group of CAM experts, we constructed 18 questionnaire items. For structured review and face validity assessment, the items were submitted to a national panel of CAM practitioners and tobacco cessation experts, and revised according to their comments. The items were then administered to a sample of 97 CAM practitioners (30 chiropractors, 26 licensed acupuncturists, 41 licensed massage therapists). Exploratory factor analysis and internal reliability tests were used to examine the items’ psychometric properties. Results Three underlying factors were indicated: current tobacco cessation activity, motivation/confidence regarding the conduct of tobacco cessation activity, and comfort providing patients/clients with information about non-CAM tobacco interventions. Acceptable internal validity was indicated for the factor-based subscales (Cronbach's alphas ranged .71–.81). Responses differed substantially across the factors/subscales. The practitioners indicated little current engagement in tobacco-cessation activities (factor 1), but were well-motivated to begin doing so (factor 2). Level of comfort with non-CAM tobacco interventions (factor 3) had pronounced dispersion from negative to positive. Conclusions CAM RTTI assessed three factors that can be critical to implementing effective tobacco intervention trainings for a CAM practitioner: (1) current tobacco intervention activity, (2) motivation/confidence and (3) comfort with non-CAM interventions. Moreover, it assessed these factors using language appropriate to CAM practitioners, providing the first measure, to our knowledge, specific to the development of tobacco intervention training for this group.
• Floden, L., Howerter, A., Matthews, E., Nichter, M., Cunningham, J. K., Ritenbaugh, C., Gordon, J. S., & Muramoto, M. L. (2015). Considerations for practice-based research: A cross-sectional survey of chiropractic, acupuncture and massage practices. BMC Complementary and Alternative Medicine, 15(Issue 1). doi:10.1186/s12906-015-0659-7
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  Background: Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States. Methods: Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice. Results: The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor. Conclusions: CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study designs, and implementation plans.
• Floden, L., Howerter, A., Matthews, E., Nichter, M., Cunningham, J. K., Ritenbaugh, C., Gordon, J. S., & Muramoto, M. L. (2015). Considerations for practice-based research: a cross-sectional survey of chiropractic, acupuncture and massage practices. BMC Complementary and Alternative Medicine, 15, 140.
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  Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States.
• Callaghan, R. C., Sanches, M., Gatley, J. M., Liu, L. M., & Cunningham, J. K. (2014). Hazardous birthday drinking among young people: population-based impacts on emergency department and in-patient hospital admissions. Addiction (Abingdon, England), 109(Issue 10). doi:10.1111/add.12626
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  BACKGROUND AND AIMS: There is growing concern about the possible adverse health impacts of binge drinking during birthday celebrations among adolescents and young adults. We estimate the impacts of birthday alcohol use on adolescent and young adult in-patient/emergency department (ED) hospital admissions. DESIGN: We employed Autoregressive Integrated Moving Average (ARIMA) intervention analysis to assess whether the rate of ICD-10 alcohol-use-disorder (AUD) events per 1000 in-patient/ED admissions increased significantly during birthday weeks. SETTING: All in-patient/ED admissions in Ontario, Canada from 1 April 2002 to 31 March 2007. PARTICIPANTS: Individuals aged 12-30 years. MEASUREMENTS: AUD events per 1000 in-patient/ED admissions by age in weeks. FINDINGS: Multiple increases were found. The largest occurred during the birthday week of 19 years of age, the beginning of the minimum legal drinking age (MLDA) in Ontario: AUD admission rates increased (spiked) by 38.30 per 1000 total admissions [95% confidence interval (CI) = 34.66-41.94] among males (a 114.3% increase over baseline), and by 28.13 (95% CI = 25.56-30.70) among females (a 164.0% increase). Among both genders, the second largest birthday-week spikes occurred during ages 20-22 years, followed by somewhat lower but still pronounced birthday-week spikes during ages 23-26 years and 30 years (all these spikes: P < 0.05). Birthday-week spikes occurred as early as age 16 years for males and 14 years for females (both spikes: P < 0.05). CONCLUSIONS: There appears to be an increase in alcohol-related adverse events from drinking around the time of one's birthday among young adults in Canada.
• Callaghan, R. C., Sanches, M., Gatley, J. M., Liu, L., & Cunningham, J. K. (2014). Hazardous birthday drinking among young people: population-based impacts on emergency department and in-patient hospital admissions. Addiction, 109(10), 1667-75.
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  There is growing concern about the possible adverse health impacts of binge drinking during birthday celebrations among adolescents and young adults. We estimate the impacts of birthday alcohol use on adolescent and young adult in-patient/emergency department (ED) hospital admissions.
• Muramoto, M. L., Howerter, A., Matthews, E., Floden, L., Gordon, J., Nichter, M., Cunningham, J., & Ritenbaugh, C. (2014). Tobacco brief intervention training for chiropractic, acupuncture, and massage practitioners: Protocol for the CAM reach study. BMC Complementary and Alternative Medicine, 14(Issue 1). doi:10.1186/1472-6882-14-510
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  Background: Tobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners' background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners. Methods/Design: The CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention's impact on CAM practitioners' tobacco-related practice behaviors. Primary outcomes included CAM practitioners' self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients' readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients' actions to help someone else quit. Discussion: CAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners' tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.
• Muramoto, M. L., Howerter, A., Matthews, E., Ford-Floden, L., Gordon, J., Nichter, M., Cunningham, J. K., & Ritenbaugh, C. (2014). Tobacco Brief Intervention Training for Chiropractic, Acupuncture, and Massage Practitioners: Protocol for the CAM Reach Study. BMC Complementary and Alternative Medicine, 14, 510.
• Callaghan, R. C., Sanches, M., Gatley, J. M., & Cunningham, J. K. (2013). Effects of the minimum legal drinking age on alcohol-related health service use in hospital settings in Ontario: A regression-discontinuity approach. American Journal of Public Health, 103(Issue 12). doi:10.2105/ajph.2013.301320
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  Objectives. We assessed the impact of the minimum legal drinking age (MLDA) on hospital-based treatment for alcohol-related conditions or events in Ontario, Canada. Methods. We conducted regression-discontinuity analyses to examine MLDA effects with respect to diagnosed alcohol-related conditions. Data were derived from administrative records detailing inpatient and emergency department events in Ontario from April 2002 to March 2007. Results. Relative to youths slightly younger than the MLDA, youths just older than the MLDA exhibited increases in inpatient and emergency department events associated with alcohol-use disorders (10.8%; P = .048), assaults (7.9%; P < .001), and suicides related to alcohol (51.8%; P = .01). Among young men who had recently crossed the MLDA threshold, there was a 2.0% increase (P = .01) in hospitalizations for injuries. Conclusions. Young adults gaining legal access to alcohol incur increases in hospital-based care for a range of serious alcohol-related conditions. Our regression-discontinuity approach can be used in future studies to assess the effects of the MLDA across different settings, and our estimates can be used to inform cost-benefit analyses across MLDA scenarios.
• Callaghan, R. C., Sanches, M., Gatley, J. M., & Cunningham, J. K. (2013). Effects of the minimum legal drinking age on alcohol-related health service use in hospital settings in Ontario: a regression-discontinuity approach. American Journal of Public Health, 103(12), 2284-91.
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  We assessed the impact of the minimum legal drinking age (MLDA) on hospital-based treatment for alcohol-related conditions or events in Ontario, Canada.
• Cunningham, J. K., Liu, L. M., & Callaghan, R. C. (2013). Essential ("Precursor") chemical control for heroin: Impact of acetic anhydride regulation on US heroin availability. Drug and Alcohol Dependence, 133(Issue 2). doi:10.1016/j.drugalcdep.2013.07.014
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  Background: To reduce heroin availability, the United Nations (UN) has encouraged nations to control acetic anhydride, an essential ("precursor") chemical typically necessary to the drug's production. This effort, a major environmental prevention policy, has received little evaluation. The United States, per the UN's lead, implemented acetic anhydride regulation in 11/1989. The present study examines whether the US regulation impacted US heroin availability. Methods: Monthly series of three heroin availability indicators-heroin purity, heroin price, and amount of heroin seized-were constructed for the conterminous United States, the US Southwest (supplied predominantly with Mexican-produced heroin), and the US Northeast (supplied predominantly, at the time, with Southeast Asian-produced heroin). Data came from the System to Retrieve Information from Drug Evidence (01/1987-04/2011). Impacts were assessed using ARIMA-intervention time series analysis. Results: In each US area, heroin purity and amount seized rose and price decreased throughout the pre-intervention period. All of the indicators then reversed course at the time of the regulation. In the conterminous United States, the US Northeast, and the US Southwest, purity decreased (-40%, -25% and -50%, respectively); amount seized decreased (-27%, -37% and -39%, respectively); and price rose (+93%, +102% and +296%, respectively). Impacts lasted 2-5 years. Conclusion: US heroin availability decreased in association with the US acetic anhydride regulation. The impacts in the US Southwest and US Northeast suggest that heroin production in Mexico and Southeast Asia, respectively, was constrained. This study lends support to the contention that essential ("precursor") chemical control can be used to help address heroin. © 2013 Elsevier Ireland Ltd.
• Cunningham, J. K., Liu, L., & Callaghan, R. C. (2013). Essential ("precursor") chemical control for heroin: impact of acetic anhydride regulation on US heroin availability. Drug and Alcohol Dependence, 133(2), 520-8.
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  To reduce heroin availability, the United Nations (UN) has encouraged nations to control acetic anhydride, an essential ("precursor") chemical typically necessary to the drug's production. This effort, a major environmental prevention policy, has received little evaluation. The United States, per the UN's lead, implemented acetic anhydride regulation in 11/1989. The present study examines whether the US regulation impacted US heroin availability.
• Cunningham, J. K., Maxwell, J. C., Campollo, O., Liu, L. M., Lattyak, W. J., & Callaghan, R. C. (2013). Mexico's precursor chemical controls: Emergence of less potent types of methamphetamine in the United States. Drug and Alcohol Dependence, 129(Issue 1-2). doi:10.1016/j.drugalcdep.2012.10.001
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  Background: This study examines whether Mexico's controls on ephedrine and pseudoephedrine, the two precursor chemicals that yield the most potent form of methamphetamine, d-methamphetamine, impacted the prevalence/availability of less potent types of methamphetamine in the United States-types associated with the alternative precursor chemical P2P. Method: Using ARIMA-intervention time series analysis of monthly drug exhibits (a prevalence/availability indicator) from the System to Retrieve Information from Drug Evidence (STRIDE), we tested whether Mexico's controls, which began in 2005, were associated with growth/decline in d-methamphetamine and growth/decline in P2P-associated, less potent l-methamphetamine, racemic methamphetamine (a 50:50 ratio of d- and l-isomers), and mixed isomer methamphetamine (an unequal ratio of d- and l-isomers). Heroin, cocaine and marijuana exhibits were used for quasi-control (01/2000-04/2011). Results: Mixed-isomer exhibits constituted about 4% of the methamphetamine exhibits before Mexico's controls, then rose sharply in association with them and remained elevated, constituting about 37% of methamphetamine exhibits in 2010. d-Methamphetamine exhibits dropped sharply; l-methamphetamine and racemic methamphetamine exhibits had small rises. d-Methamphetamine exhibits partially recovered in the US West, but little recovery occurred in the US Central/South. Quasi-control series were generally unaffected. Conclusion: The US methamphetamine market changed. Widespread emergence of less potent methamphetamine occurred in conjunction with Mexico's controls. And prevalence/availability of the most potent type of the drug, d-methamphetamine, declined, a partial recovery in the West notwithstanding. Granting that lower potency drugs typically engender less dependence and attendant problems, these findings suggest that, following Mexico's controls, the potential harm of a sizeable amount of the US methamphetamine supply decreased. © 2012 Elsevier Ireland Ltd.
• Cunningham, J. K., Maxwell, J. C., Campollo, O., Liu, L., Lattyak, W. J., & Callaghan, R. C. (2013). Mexico's precursor chemical controls: emergence of less potent types of methamphetamine in the United States. Drug and Alcohol Dependence, 129(1-2), 125-36.
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  This study examines whether Mexico's controls on ephedrine and pseudoephedrine, the two precursor chemicals that yield the most potent form of methamphetamine, d-methamphetamine, impacted the prevalence/availability of less potent types of methamphetamine in the United States-types associated with the alternative precursor chemical P2P.
• Callaghan, R. C., Callaghan, R. C., Cunningham, J. K., Cunningham, J. K., Allebeck, P., Allebeck, P., Arenovich, T., Arenovich, T., Sajeev, G., Sajeev, G., Remington, G., Remington, G., Boileau, I., Boileau, I., Kish, S. J., & Kish, S. J. (2012). Methamphetamine use and schizophrenia: A population-based cohort study in California. American Journal of Psychiatry, 169(Issue 4). doi:10.1176/appi.ajp.2011.10070937
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  Objective: Clinical investigators in Japan have long suggested that exposure to methamphetamine might cause a persistent schizophrenia-like psychosis. This possibility is discounted in the Western literature. To investigate the relationship between drug use and later schizophrenia, the authors conducted a large-scale cohort study of drug users initially free of persistent psychosis. Method: A population-based cohort study was conducted using data from California inpatient hospital discharge records from 1990 through 2000. Patients with methamphetamine-related conditions (N=42,412) and those with other drug use disorders (cannabis, cocaine, alcohol, and opioids) were propensity score-matched to individuals with primary appendicitis who served as a population proxy comparison group; the methamphetamine cohort was also matched to the other drug cohorts. Cox modeling was used to estimate differences between matched groups in the rates of subsequent admission with schizophrenia diagnoses. Results: The methamphetamine cohort had a significantly higher risk of schizophrenia than the appendicitis group (hazard ratio=9.37) and the cocaine, opioid, and alcohol groups (hazard ratios ranging from 1.46 to 2.81), but not significantly different from that of the cannabis group. The risk of schizophrenia was higher in all drug cohorts than in the appendicitis group. Conclusions: Study limitations include difficulty in confirming schizophrenia diagnoses independent of drug intoxication and the possibility of undetected schizophrenia predating drug exposure. The study 's findings suggest that individuals with methamphetamine-related disorders have a higher risk of schizophrenia than those with other drug use disorders, with the exception of cannabis use disorders. The elevated risk in methamphetamine users may be explained by shared etiological mechanisms involved in the development of schizophrenia.
• Callaghan, R. C., Cunningham, J. K., Allebeck, P., Arenovich, T., Sajeev, G., Remington, G., Boileau, I., & Kish, S. J. (2012). Methamphetamine use and schizophrenia: a population-based cohort study in California. The American Journal of Psychiatry, 169(4), 389-96.
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  Clinical investigators in Japan have long suggested that exposure to methamphetamine might cause a persistent schizophrenia-like psychosis. This possibility is discounted in the Western literature. To investigate the relationship between drug use and later schizophrenia, the authors conducted a large-scale cohort study of drug users initially free of persistent psychosis.
• Callaghan, R. C., Cunningham, J. K., Sykes, J., & Kish, S. J. (2012). Increased risk of Parkinson's disease in individuals hospitalized with conditions related to the use of methamphetamine or other amphetamine-type drugs. Drug and Alcohol Dependence, 120(Issue 1-3). doi:10.1016/j.drugalcdep.2011.06.013
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  Background: Since methamphetamine and other amphetamine-type stimulants (meth/amphetamine) can damage dopaminergic neurons, researchers have long speculated that these drugs may predispose users to develop Parkinson's disease (PD), a dopamine deficiency neurological disorder. Methods: We employed a retrospective population-based cohort study using all linked statewide California inpatient hospital episodes and death records from January 1, 1990 through December 31, 2005. Patients at least 30 years of age were followed for up to 16 years. Competing risks analysis was used to determine whether the meth/amphetamine cohort had elevated risk of developing PD (ICD-9 332.0; ICD-10 G20) in comparison to a matched population-proxy appendicitis group and a matched cocaine drug control group. Individuals admitted to hospital with meth/amphetamine-related conditions (n = 40,472; ICD-9 codes 304.4, 305.7, 969.7, E854.2) were matched on age, race, sex, date of index admission, and patterns of hospital admission with patients with appendicitis conditions (n = 207,831; ICD-9 codes 540-542) and also individuals with cocaine-use disorders (n = 35,335; ICD-9 codes 304.2, 305.6, 968.5). Results: The meth/amphetamine cohort showed increased risk of PD compared to both that of the matched appendicitis group [hazard ratio (HR) = 1.76, 95% CI: 1.12-2.75, p = 0.017] and the matched cocaine group [HR = 2.44, 95% CI: 1.32-4.41, p = 0.004]. The cocaine group did not show elevated hazard of PD compared to the matched appendicitis group [HR = 1.04, 95% CI: 0.56-1.93, p = 0.80]. Conclusion: These data provide evidence that meth/amphetamine users have above-normal risk for developing PD. © 2011 Elsevier Ireland Ltd.
• Callaghan, R. C., Cunningham, J. K., Sykes, J., & Kish, S. J. (2012). Increased risk of Parkinson's disease in individuals hospitalized with conditions related to the use of methamphetamine or other amphetamine-type drugs. Drug and Alcohol Dependence, 120(1-3), 35-40.
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  Since methamphetamine and other amphetamine-type stimulants (meth/amphetamine) can damage dopaminergic neurons, researchers have long speculated that these drugs may predispose users to develop Parkinson's disease (PD), a dopamine deficiency neurological disorder.
• Callaghan, R. C., Cunningham, J. K., Verdichevski, M., Sykes, J., Jaffer, S. R., & Kish, S. J. (2012). All-cause mortality among individuals with disorders related to the use of methamphetamine: A comparative cohort study. Drug and Alcohol Dependence, 125(Issue 3). doi:10.1016/j.drugalcdep.2012.03.004
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  Background: Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking. Methods: The current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n=74,139), alcohol- (n=582,771), opioid- (n=67,104), cannabis- (n=46,548), or cocaine-related disorders (n=48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated. Results: The methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81). Conclusions: Our study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use. © 2012 Elsevier Ireland Ltd.
• Callaghan, R. C., Cunningham, J. K., Verdichevski, M., Sykes, J., Jaffer, S. R., & Kish, S. J. (2012). All-cause mortality among individuals with disorders related to the use of methamphetamine: a comparative cohort study. Drug and Alcohol Dependence, 125(3), 290-4.
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  Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (U.S.) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking.
• Campollo, O., Roman, S., Panduro, A., Hernandez, G., Diaz-Barriga, L., Balanzario, M. C., & Cunningham, J. K. (2012). Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico. Drug and Alcohol Dependence, 123(1-3), 269-72.
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  Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico.
• Campollo, O., Roman, S., Panduro, A., Hernandez, G., Diaz-Barriga, L., Balanzario, M. C., & Cunningham, J. K. (2012). Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico. Drug and Alcohol Dependence, 123(Issue 1-3). doi:10.1016/j.drugalcdep.2011.11.009
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  Background: Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. Methods: We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N= 122) and NIDUs in a prison-based drug treatment program (N= 30), both located in west central Mexico. Results: Among the community clients, prevalence was 4.1% (95% confidence interval [CI]: 1.8-9.2) for HCV, 5.7% for HBV (95% CI: 2.8-11.4), and 1.6% for HIV (95% CI: 0.4-5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6-57.7) for HCV, 20.0% for HBV (95% CI: 9.5-37.3), and 6.7% for HIV (95% CI: 1.9-21.3). None of the clients were aware of being infected. Conclusion: The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison-one compounded by the finding that none of this study's clients knew they were HCV positive. © 2011 Elsevier Ireland Ltd.
• Cunningham, J. K., Callaghan, R. C., Tong, D., Liu, L. M., Li, H. Y., & Lattyak, W. J. (2012). Changing over-the-counter ephedrine and pseudoephedrine products to prescription only: Impacts on methamphetamine clandestine laboratory seizures. Drug and Alcohol Dependence, 126(Issue 1-2). doi:10.1016/j.drugalcdep.2012.04.011
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  Background: Clandestine laboratory operators commonly extract ephedrine and pseudoephedrine-precursor chemicals used to synthesize methamphetamine-from over-the-counter cold/allergy/sinus products. To prevent this activity, two states, Oregon in 07/2006 and Mississippi in 07/2010, implemented regulations classifying ephedrine and pseudoephedrine as Schedule III substances, making products containing them available by prescription only. Using simple pre-regulation versus post-regulation comparisons, reports claim that the regulations have substantially reduced clandestine laboratory seizures (an indicator of laboratory prevalence) in both states, motivating efforts to implement similar regulation nationally. This study uses ARIMA-intervention time-series analysis to more rigorously evaluate the regulations' impacts on laboratory seizures. Methods: Monthly counts of methamphetamine clandestine laboratory seizures were extracted from the Clandestine Laboratory Seizure System (2000-early 2011) for Oregon, Mississippi and selected nearby states (for quasi-control). Findings: Seizures in Oregon and nearby western states largely bottomed out months before Oregon's regulation, and changed little thereafter. No significant impact for Oregon's regulation was found. Mississippi and nearby states generally had elevated seizures before Mississippi's regulation. Mississippi experienced a regulation-associated drop of 28.9 seizures (50.2%) in the series level (p
• Cunningham, J. K., Callaghan, R. C., Tong, D., Liu, L., Li, H., & Lattyak, W. J. (2012). Changing over-the-counter ephedrine and pseudoephedrine products to prescription only: impacts on methamphetamine clandestine laboratory seizures. Drug and Alcohol Dependence, 126(1-2), 55-64.
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  Clandestine laboratory operators commonly extract ephedrine and pseudoephedrine-precursor chemicals used to synthesize methamphetamine-from over-the-counter cold/allergy/sinus products. To prevent this activity, two states, Oregon in 07/2006 and Mississippi in 07/2010, implemented regulations classifying ephedrine and pseudoephedrine as Schedule III substances, making products containing them available by prescription only. Using simple pre-regulation versus post-regulation comparisons, reports claim that the regulations have substantially reduced clandestine laboratory seizures (an indicator of laboratory prevalence) in both states, motivating efforts to implement similar regulation nationally. This study uses ARIMA-intervention time-series analysis to more rigorously evaluate the regulations' impacts on laboratory seizures.
• Campollo, O., Diaz, F., Prado, C. M., & Cunningham, J. K. (2011). Residential Treatment Services in West Central Mexico: Resources and Needs. Anuario de Investigacion en Adicciones, 12, 96-97.
• Campollo, O., Diaz, F., Prado, C. M., Cunningham, J. K., & Avila, D. S. (2011). Evaluacion de clinicas de tratamiento residencial para adicciones en el estado de Jalisco [Evaluation of Residential Drug Treatment Clinics in Jalisco]. Anuario de Investigacion en Adicciones, 12, 97-98.
• Campollo, O., Roman, S., Panduro, A., Hernandez, G., & Cunningham, J. K. (2011). Hepatitis B, Hepatitis C y VIH en adictos a drogas y sustancias en Mexico. Anuario de Investigacion en Adicciones, 12, 98-99.
• Cunningham, J. K., Bojorquez, I., Campollo, O., Liu, L., & Maxwell, J. C. (2011). Intervenciones Dirigidas a Precursores Quimicos de Metanfetamina en Mexico: Impacto en los Ingresos a Tratamiento por Drogas en Mexico y Tejas [Interventions Directed at Methamphetamine Precursor Chemicals in Mexico: Impact on Drug Treatment Admissions in Mexico and Texas]. Anuario de Investigacion en Adicciones, 12, 5-19.
• Verdichevski, M., Burns, R., Cunningham, J. K., Tavares, J., & Callaghan, R. C. (2011). Trends in primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005-2006 and 2009-2010. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 56(11), 696-700.
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  During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005-2006 that 21% of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005-2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009-2010, as well as important trend information for these periods.
• Verdichevski, M., Burns, R., Cunningham, J. K., Tavares, J., & Callaghan, R. C. (2011). Trends in primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005-2006 and 2009-2010. Canadian Journal of Psychiatry, 56(Issue 11). doi:10.1177/070674371105601108
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  Objective: During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005-2006 that 21% of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005-2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009-2010, as well as important trend information for these periods. Method: We developed a comprehensive list of all Canadian residential youth substance abuse treatment facilities. The executive director of each facility was asked about the site's annual caseload, and the proportion of cases primarily due to methamphetamine abuse within the past 12 months. Results: Our survey data for the periods of 2005-2006 and 2009-2010 show marked reductions in admissions. In 2009-2010, we found that about 6% of all admissions were due primarily to methamphetamine abuse, a substantial drop from the 21% reported in our 2005-2006 study. Conclusions: Our data show a significant national reduction in methamphetamine-related admissions. Other reports show that methamphetamine-related treatment admissions in the United States and Mexico declined sharply during 2005-2008, reportedly in association with Mexico's methamphetamine precursor chemical controls, raising the possibility that the controls may also be associated with the declines reported here.
• Callaghan, R. C., Cunningham, J. K., Sajeev, G., & Kish, S. J. (2010). Incidence of Parkinson's disease among hospital patients with methamphetamine-use disorders. Movement Disorders, 25(Issue 14). doi:10.1002/mds.23263
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  Because methamphetamine exposure to experimental animals can damage brain dopamine neurones, we examined whether hospital patients diagnosed with methamphetamine-related disorders might have greater risk of subsequent admission with a Parkinson's disease diagnosis. This was a population-based cohort study using all statewide inpatient hospital discharge records from July 1, 1990, through June 30, 2000, in California, USA, in which subjects aged at least 50 years were followed for up to 10 years. Individuals with reported methamphetamine-related conditions (n = 1,863; ICD-9 codes 304.4, 305.7, 969.7, and E854.2) were matched on demographic variables and follow-up time with those with primary appendicitis conditions (n = 9,315). The appendicitis group had a Parkinson's disease incidence rate no different than the rate found among members of a large health maintenance organization in California. Cox regression procedures were used to estimate group differences in the rates of receiving a subsequent inpatient diagnosis of Parkinson's disease (ICD-9 332.0). The methamphetamine group showed increased risk of a subsequent admission with Parkinson's disease compared with that of the matched appendicitis group (adjusted hazard ratio = 2.65, 95% CI, 1.17-5.98, P= 0.019). Study limitations include a population limited to hospital admissions, an uncertainty regarding diagnostic validity of the ICD-9 code 332.0 (Parkinson's disease), and a small number of incident cases with suspected Parkinson's disease. We strongly emphasize the preliminary nature of the findings. Nevertheless, these data, requiring replication, provide some evidence that methamphetamine users might be at greater than normal risk for developing Parkinson's disease. © 2010 Movement Disorder Society.
• Callaghan, R. C., Cunningham, J. K., Sajeev, G., & Kish, S. J. (2010). Incidence of Parkinson's disease among hospital patients with methamphetamine-use disorders. Movement Disorders : Official Journal of the Movement Disorder Society, 25(14), 2333-9.
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  Because methamphetamine exposure to experimental animals can damage brain dopamine neurones, we examined whether hospital patients diagnosed with methamphetamine-related disorders might have greater risk of subsequent admission with a Parkinson's disease diagnosis. This was a population-based cohort study using all statewide inpatient hospital discharge records from July 1, 1990, through June 30, 2000, in California, USA, in which subjects aged at least 50 years were followed for up to 10 years. Individuals with reported methamphetamine-related conditions (n = 1,863; ICD-9 codes 304.4, 305.7, 969.7, and E854.2) were matched on demographic variables and follow-up time with those with primary appendicitis conditions (n = 9,315). The appendicitis group had a Parkinson's disease incidence rate no different than the rate found among members of a large health maintenance organization in California. Cox regression procedures were used to estimate group differences in the rates of receiving a subsequent inpatient diagnosis of Parkinson's disease (ICD-9 332.0). The methamphetamine group showed increased risk of a subsequent admission with Parkinson's disease compared with that of the matched appendicitis group (adjusted hazard ratio = 2.65, 95% CI, 1.17-5.98, P= 0.019). Study limitations include a population limited to hospital admissions, an uncertainty regarding diagnostic validity of the ICD-9 code 332.0 (Parkinson's disease), and a small number of incident cases with suspected Parkinson's disease. We strongly emphasize the preliminary nature of the findings. Nevertheless, these data, requiring replication, provide some evidence that methamphetamine users might be at greater than normal risk for developing Parkinson's disease.
• Cunningham, J. K., Bojorquez, I., Campollo, O., Liu, L. M., & Maxwell, J. C. (2010). Mexico's methamphetamine precursor chemical interventions: Impacts on drug treatment admissions. Addiction, 105(Issue 11). doi:10.1111/j.1360-0443.2010.03068.x
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  Aims: To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences. Design: Quasi-experiment: autoregressive integrated moving average (ARIMA)-based intervention time-series analysis. Interventions: precursor chemical restrictions implemented beginning November 2005; major rogue precursor chemical company closed (including possibly the largest single drug-cash seizure in history) March 2007; precursor chemicals banned from Mexico (North America's first precursor ban) August 2008. Settings: Mexico and Texas (1996-2008). Measurements: Monthly treatment admissions for methamphetamine (intervention series) and cocaine, heroin and alcohol (quasi-control series). Findings: The precursor restriction was associated with temporary methamphetamine admissions decreases of 12% in Mexico and 11% in Texas. The company closure was associated with decreases of 56% in Mexico and 48% in Texas; these decreases generally remained to the end of the study period. Neither intervention was associated with significant changes in the Mexico or Texas quasi-control series. The analysis of Mexico's ban was indeterminate due largely to a short post-ban series. Conclusions: This study, one of the first quasi-experimental analyses of an illicit-drug policy in Mexico, indicates that the country's precursor interventions were associated with positive impacts domestically and in one of the Unites States' most populous states-Texas. These interventions, coupled with previous US and Canadian interventions, amount to a new, relatively cohesive level of methamphetamine precursor control across North America's largest nations, raising the possibility that the impacts found here could continue for an extended period. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
• Cunningham, J. K., Bojorquez, I., Campollo, O., Liu, L., & Maxwell, J. C. (2010). Mexico's methamphetamine precursor chemical interventions: impacts on drug treatment admissions. Addiction, 105(11), 1973-83.
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  To help counter problems related to methamphetamine, Mexico has implemented interventions targeting pseudoephedrine and ephedrine, the precursor chemicals commonly used in the drug's synthesis. This study examines whether the interventions impacted methamphetamine treatment admissions-an indicator of methamphetamine consequences.
• Cunningham, J. K., Maxwell, J. C., Campollo, O., Cunningham, K. I., Liu, L. M., & Lin, H. L. (2010). Proximity to the US-Mexico border: A key to explaining geographic variation in US methamphetamine, cocaine and heroin purity. Addiction, 105(Issue 10). doi:10.1111/j.1360-0443.2010.03032.x
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  Aims: Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. Design: Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239 070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). Setting: Coterminous United States. Findings: Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards - a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (
• Cunningham, J. K., Maxwell, J. C., Campollo, O., Cunningham, K. I., Liu, L., & Lin, H. (2010). Proximity to the US-Mexico border: a key to explaining geographic variation in US methamphetamine, cocaine and heroin purity. Addiction, 105(10), 1785-98.
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  Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity.
• Callaghan, R. C., Cunningham, J. K., Victor, J. C., & Liu, L. (2009). Impact of Canadian federal methamphetamine precursor and essential chemical regulations on methamphetamine-related acute-care hospital admissions. Drug and Alcohol Dependence, 105(3), 185-93.
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  In response to its domestic methamphetamine problems and an emerging international consensus that methamphetamine precursor and essential chemicals should be controlled, Canada regulated its import/export of ephedrine and pseudoephedrine (precursor chemicals) in January 2003, its domestic distribution of those chemicals in July 2003, and its import/export and manufacturing of essential chemicals (e.g., toluene) in January 2004. This study examines the regulations' impact on the problem of methamphetamine-related hospital admissions in Canada.
• Callaghan, R. C., Cunningham, J. K., Victor, J. C., & Liu, L. M. (2009). Impact of Canadian federal methamphetamine precursor and essential chemical regulations on methamphetamine-related acute-care hospital admissions. Drug and Alcohol Dependence, 105(Issue 3). doi:10.1016/j.drugalcdep.2009.06.024
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  Background: In response to its domestic methamphetamine problems and an emerging international consensus that methamphetamine precursor and essential chemicals should be controlled, Canada regulated its import/export of ephedrine and pseudoephedrine (precursor chemicals) in January 2003, its domestic distribution of those chemicals in July 2003, and its import/export and manufacturing of essential chemicals (e.g., toluene) in January 2004. This study examines the regulations' impact on the problem of methamphetamine-related hospital admissions in Canada. Methods: ARIMA-based intervention time-series analysis was used to assess impacts on monthly counts of Canada's methamphetamine-related acute-care hospital admissions (04/1996 to 03/2005). Cocaine-, heroin/opioid-, and alcohol-related hospital admissions were examined as quasi-control time-series. Results: No impact was found for the January 2003 regulation. The July 2003 and January 2004 regulations were associated with 20% and 21% increases, respectively, in methamphetamine-related admissions. No impacts on the quasi-control time-series were found. Conclusions: This study indicates that Canada's regulations were not associated with reductions in methamphetamine-related hospital admissions. The January 2003 regulation's focus on imports/exports rather than domestic distribution may help explain its lack of impact. In contrast, the two other regulations had salient domestic foci - domestic precursor sales (July 2003) and domestic essential chemical manufacturing (January 2004). Both regulations, however, were associated with increases in admissions, rather than declines. Government reports indicate that a shift in methamphetamine production, from smaller-scale operators to more sophisticated crime organizations (groups better able to circumvent the regulations), occurred around the times of the regulations. Such a shift could increase supply and possibly admissions. © 2009 Elsevier Ireland Ltd. All rights reserved.
• Cunningham, J. K., Liu, L., & Callaghan, R. (2009). Impact of US and Canadian precursor regulation on methamphetamine purity in the United States. Addiction, 104(3), 441-53.
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  Reducing drug purity is a major, but largely unstudied, goal of drug suppression. This study examines whether US methamphetamine purity was impacted by the suppression policy of US and Canadian precursor chemical regulation.
• Cunningham, J. K., & Liu, L. (2008). Impact of methamphetamine precursor chemical legislation, a suppression policy, on the demand for drug treatment. Social Science & Medicine, 66(7), 1463-73.
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  Research is needed to help treatment programs plan for the impacts of drug suppression efforts. Studies to date indicate that heroin suppression may increase treatment demand. This study examines whether treatment demand was impacted by a major US methamphetamine suppression policy -- legislation regulating precursor chemicals. The precursors ephedrine and pseudoephedrine, in forms used by large-scale methamphetamine producers, were regulated in August 1995 and October 1997, respectively. ARIMA-intervention time-series analysis was used to examine the impact of each precursor's regulation on monthly voluntary methamphetamine treatment admissions (a measure of treatment demand), including first-time admissions and re-admissions, in California (1992-2004). Cocaine, heroin, and alcohol treatment admissions were used as quasi-control series. The 1995 regulation of ephedrine was found to be associated with a significant reduction in methamphetamine treatment admissions that lasted approximately 2 years. The 1997 regulation of pseudoephedrine was associated with a significant reduction that lasted approximately 4 years. First-time admissions declined more than re-admissions. Cocaine, heroin, and alcohol admissions were generally unaffected. While heroin suppression may be associated with increased treatment demand as suggested by research to date, this study indicates that methamphetamine precursor regulation was associated with decreases in treatment demand. A possible explanation is that, during times of suppression, heroin users may seek treatment to obtain substitute drugs (e.g., methadone), while methamphetamine users have no comparable incentive. Methamphetamine suppression may particularly impact treatment demand among newer users, as indicated by larger declines in first-time admissions.
• Cunningham, J. K., & Liu, L. M. (2008). Impact of methamphetamine precursor chemical legislation, a suppression policy, on the demand for drug treatment. Social Science and Medicine, 66(Issue 7). doi:10.1016/j.socscimed.2007.12.006
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  Research is needed to help treatment programs plan for the impacts of drug suppression efforts. Studies to date indicate that heroin suppression may increase treatment demand. This study examines whether treatment demand was impacted by a major US methamphetamine suppression policy-legislation regulating precursor chemicals. The precursors ephedrine and pseudoephedrine, in forms used by large-scale methamphetamine producers, were regulated in August 1995 and October 1997, respectively. ARIMA-intervention time-series analysis was used to examine the impact of each precursor's regulation on monthly voluntary methamphetamine treatment admissions (a measure of treatment demand), including first-time admissions and re-admissions, in California (1992-2004). Cocaine, heroin, and alcohol treatment admissions were used as quasi-control series. The 1995 regulation of ephedrine was found to be associated with a significant reduction in methamphetamine treatment admissions that lasted approximately 2 years. The 1997 regulation of pseudoephedrine was associated with a significant reduction that lasted approximately 4 years. First-time admissions declined more than re-admissions. Cocaine, heroin, and alcohol admissions were generally unaffected. While heroin suppression may be associated with increased treatment demand as suggested by research to date, this study indicates that methamphetamine precursor regulation was associated with decreases in treatment demand. A possible explanation is that, during times of suppression, heroin users may seek treatment to obtain substitute drugs (e.g., methadone), while methamphetamine users have no comparable incentive. Methamphetamine suppression may particularly impact treatment demand among newer users, as indicated by larger declines in first-time admissions. © 2008 Elsevier Ltd. All rights reserved.
• Cunningham, J. K., Liu, L. M., & Muramoto, M. (2008). Methamphetamine suppression and route of administration: Precursor regulation impacts on snorting, smoking, swallowing and injecting. Addiction, 103(Issue 7). doi:10.1111/j.1360-0443.2008.02208.x
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  Aims: The route of drug administration affects risk for dependence and medical harm. This study examines whether routes used by methamphetamine treatment participants were impacted by a major drug suppression policy - federal regulation of the methamphetamine precursor chemicals ephedrine and pseudoephedrine. Design: Autoregressive-integrated moving average (ARIMA) intervention time-series analysis. Setting: California (1992-2004). Interventions: Ephedrine single-ingredient products regulation, implemented August 1995; ephedrine with other active medicinal ingredients regulation, implemented October 1996; pseudoephedrine products regulation, implemented October 1997. Measurements: Monthly counts of non-coerced methamphetamine treatment admissions reporting snorting, smoking, swallowing or injecting. Findings: After rising sharply, snorting, smoking, swallowing and injecting admissions dropped 50%, 43%, 26% and 26%, respectively, when the 1995 regulation was implemented. Snorting also dropped 38% at the time of the 1997 regulation. Snorting, swallowing and injecting remained at lower levels to the end of the study period. Smoking resurged (40%) at the time of the 1996 regulation and continued rising. Conclusions: Precursor regulation was associated with changes in the administration of methamphetamine. Injecting, the route with the greatest health risk, entered a long-term reduction. So, too, did snorting and swallowing, two routes with lower risk for dependence. In contrast, smoking, which has a relatively high risk for dependence, dropped, then rebounded and entered a long-term rise. A possible explanation is that injecting, snorting and swallowing were largely linked with US domestic methamphetamine production, which has yet to recover from the regulations. While Mexican production, which was impacted only temporarily by the regulations and has supplanted domestic production, may have helped to diffuse smoking, a route with which it is historically correlated. © 2008 The Authors.
• Cunningham, J. K., Liu, L., & Muramoto, M. (2008). Methamphetamine suppression and route of administration: precursor regulation impacts on snorting, smoking, swallowing and injecting. Addiction, 103(7), 1174-86.
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  The route of drug administration affects risk for dependence and medical harm. This study examines whether routes used by methamphetamine treatment participants were impacted by a major drug suppression policy-federal regulation of the methamphetamine precursor chemicals ephedrine and pseudoephedrine.
• Cunningham, J. K., & Liu, L. (2005). Impacts of federal precursor chemical regulations on methamphetamine arrests. Addiction, 100(4), 479-88.
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  The US government regulated precursor chemicals, ephedrine and pseudoephedrine, multiple times to limit methamphetamine production/availability and thus methamphetamine problems. Research has found that the regulations reduced methamphetamine hospital admissions, but authors have argued that other problems were unaffected. This study examines whether the regulations impacted methamphetamine arrests.
• Cunningham, J. K., & Liu, L. M. (2005). Impacts of federal precursor chemical regulations on methamphetamine arrests. Addiction, 100(Issue 4). doi:10.1111/j.1360-0443.2005.01032.x
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  Aims: The US government regulated precursor chemicals, ephedrine and pseudoephedrine, multiple times to limit methamphetamine production/availability and thus methamphetamine problems. Research has found that the regulations reduced methamphetamine hospital admissions, but authors have argued that other problems were unaffected. This study examines whether the regulations impacted methamphetamine arrests. Design: ARIMA-intervention time-series analysis with control series. Setting: California (1982-2001). Measurements: Dependent variable series: monthly methamphetamine arrests. Control series: monthly marijuana arrests and cocaine/heroin arrests. Interventions: Bulk powder ephedrine and pseudoephedrine: regulated November 1989. Products containing ephedrine as the single active medicinal ingredient: regulated August 1995. Pseudoephedrine products: regulated October 1997. Large-scale producers used ephedrine and pseudoephedrine in these forms. Ephedrine combined with other active medicinal ingredients (e.g. various cold medicines)-used mainly by small-scale producers: regulated October 1996. Findings: The regulation targeting small-scale producers (1996) had no significant impact. In contrast, methamphetamine arrests stopped rising and dropped 31% to 45% each of the three times precursor chemicals used by large-scale producers were regulated. Within 3 years of the bulk powder regulation (1989) and again within 2 years of the ephedrine single ingredient regulation (1995), arrests fully rebounded. During the 4 years following the last regulation (pseudoephedrine products, 1997) arrests only partially rebounded. These effects parallel those reported on hospital admissions. The control series were generally unaffected. Conclusions: Precursor regulations targeting large-scale producers impacted methamphetamine arrests, a criminal justice problem, much as they impacted the public health problem of methamphetamine hospital admissions. Ongoing research is needed to determine whether these problems eventually fully rebound from the last regulation. © 2005 Society for the Study of Addiction.
• Cunningham, J. K., & Liu, L. (2003). Guidelines for measuring impacts of methamphetamine precursor chemical regulations: a reply to Reuter and Caulkins (2003). Addiction, 98(10), 1463-4.
• Cunningham, J. K., & Liu, L. (2003). Impacts of federal ephedrine and pseudoephedrine regulations on methamphetamine-related hospital admissions. Addiction, 98(9), 1229-37.
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  To determine whether the federal regulation of ephedrine and pseudoephedrine, precursors used in illicit methamphetamine production, reduced methamphetamine-related acute care hospital admissions.
• Cunningham, J. K., & Liu, L. M. (2003). Guidelines for measuring impacts of methamphetamine precursor chemical regulations: A reply to Reuter and Caulkins (2003). Addiction, 98(Issue 10). doi:10.1046/j.1360-0443.2003.00539.x
• Cunningham, J. K., & Liu, L. M. (2003). Impacts of federal ephedrine and pseudoephedrine regulations on methamphetamine-related hospital admissions. Addiction, 98(Issue 9). doi:10.1046/j.1360-0443.2003.00450.x
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  Aims: To determine whether the federal regulation of ephedrine and pseudoephedrine, precursors used in illicit methamphetamine production, reduced methamphetamine-related acute care hospital admissions. Design: ARIMA-intervention time-series analysis. Setting: California (1983-2000), Arizona and Nevada (1991-2000), USA. Measurements: Monthly counts of methamphetamine-related acute care hospital admissions. Interventions: Bulk powder ephedrine and pseudoephedrine: regulated November 1989. Products containing ephedrine as the single active medicinal ingredient: regulated August 1995. Products containing pseudoephedrine: regulated October 1997. Large-scale producers used ephedrine and pseudoephedrine in these forms. Ephedrine combined with other active medicinal ingredients (e.g. various cold medicines), used mainly by small-scale producers: regulated October 1996. Findings: In California, the bulk powder regulation stopped a 7-year rise in admissions (1983-89) and reduced them by 35% (P < 0.01). The single ingredient ephedrine regulation stopped a 4-year rise (1992-95) in California, Arizona and Nevada, with 48% (P
• Cunningham, J. K., & Stoeckert, J. A. (1992). Evaluations of 3M/House Single Channel and Nucleus Multichannel Cochlear Implants. The American Journal of Otology, 13, 449-453.
• Cunningham, J. K. (1990). Parents' Evaluations of the Effects of the 3M/House Cochlear Implant on Children. Ear and Hearing, 11, 375-381.
• Cunningham, J. K. (1990). Parents’ evaluations of the effects of the 3M/house cochlear implant on children. Ear and Hearing, 11(Issue 5). doi:10.1097/00003446-199010000-00009
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  A questionnaire was used to obtain parents’ opinions o their children’s 3M/House cochlear implant. Responses were received from parents of 132 children aged 3 through 17. Seventy-five percent of the parents were satisfied overall with the implant; 25% were not. The parents were more positive about the implant than they felt their children were. Fifty-seven percent, 34%, and 9% of the parents reported that the implant performed better, the same, or worse, respectively, than their implant counselors said it would. Almost all of the parents (98%) said they would recommend the implant to other parents. The parents thought that the effect of the implant on environmental sound perception and speech production was superior to its effect on speech perception. Environmental sound perception was a more substantial predictor of parental satisfaction than was speech perception or speech production. About half of the parents felt that the size and cords of the external processor were problematic. Adolescent children wore their implants less than preadolescent children. It was concluded that the majority of the parents thought the 3M/House cochlear implant provided realworld benefits for their children. © 1990 by The Williams and Wilkins Co.
• Fujikawa, S., & Cunningham, J. K. (1989). Practices and Attitudes Related to Hearing: A survey of Executives. Ear and Hearing, 10, 375-381.
• Fujikawa, S., & Cunningham, J. K. (1989). Practices and attitudes related to hearing: A survey of executives. Ear and Hearing, 10(Issue 6). doi:10.1097/00003446-198912000-00007
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  Executives were surveyed about their hearing health-care practices and attitudes toward hearing loss (N = 140, mean age = 49, number of males = 133). In regard to hearing health-care practices, about one-third of the executives had not had a hearing test during the past 5 years. Fifty-one percent of the executives reported that a hearing test was conducted or recommended during their annual physical examinations. Twenty (14%) of the executives rated their hearing as fair or poor, but only two of them wore hearing aids. Executives who reported poorer hearing were less likely to have had recent hearing tests. When seeking a hearing evaluation, the xecutives indicated a two-to-one preference for medical doctors over audiologistsnone preferred hearing aid dispensers. Regarding attitudes, approximately 90% of the executives felt that earing aids were effective, but only two-thirds disagreed with the stereotype that hearing aids connote old age. Executives who tended to equate hearing aids with old age were less likely to be aware of hearingimpaired employees in their companies. Implications of these findings are discussed. © 1989 by The Williams & Wilkins Co.
• Berliner, K. I., Cunningham, J. K., House, W. F., & House, J. W. (1987). Effect of the Cochlear Implant on Tinnitus in Profoundly Deaf Patients. Proceedings III International Tinnitus Seminar.
• Eisenberg, L. S., Thielemeir, M. A., Luxford, W. M., & Cunningham, J. K. (1986). Cochlear implants in children: speech production and auditory discrimination. The Otolaryngologic Clinics of North America, 19, 409-421.

Presentations

• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free. Technology Preview. 37th Annual Meeting of the Society of Behavioral Medicine. Washington DC.
• Govindarajan, L., Taren, D. L., & Cunningham, J. K. (2016, October). The Partnership between Local Health Departments and the Western Region Public Health Training Center in Addressing Workforce Development. Annual Meeting of the American Public Health Association Meeting. Denver: APHA.

Poster Presentations

• C, Q., De La Rosa, J., Mcguffin, B., & Cunningham, J. K. (2018, April). Database Development to Support and Help Evaluate the UA Behavioral Health Peer Credentialing Program. Mel and Enid Zuckerman College of Public Health Public Health Poster Forum. Tucson, AZ: University of Arizona Mel and Enid Zuckerman College of Public Health Public.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 30-April 2). See Me Smoke-Free: Results of a feasibility trial of an mHealth app for women to address smoking, diet and physical activity.. 37th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine. Washington DC.
• Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., Giacobbi, P., Gordon, J. S., Cunningham, J. K., Johnson, T., Armin, J. S., Hingle, M. D., & Giacobbi, P. (2016, March 2-4). See Me Smoke-Free: Development and feasibility of an mHealth app for women to address smoking, diet and physical activity. Annual Meeting of the Society for Research on Nicotine and Tobacco. Chicago, IL.
• Gordon, J. S., Muramoto, M., Cunningham, J. K., Armin, J., Christiansen, S., & Jacobs, T. (2015, April). Development and evaluation of the RxCoach mHealth app to increase tobacco cessation medication adherence. Annual Meeting of the Society for Behavioral Medicine. San Antonio, TX.