Clinical Assistant Professor of Epidemiology
Dr. David Barnes’ training is in psychiatric epidemiology. His research focuses on substance use, HCV and HIV infection, and on how social position influences mental and behavioral health outcomes in both expected and paradoxical ways.
BA, History, Whitman College, Walla Walla, WAMPA, Columbia University, New York, NYPhD, Columbia University, New York, NY
Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” SettingDes Jarlais, D., Uuskula, A., Talu, A., Barnes, D., Raag, M., Arasteh, K., Org, G., Demarest, D., Feelemyer, J., Berg, H., & Tross, S.
Journal titleAIDS and BehaviorWe tested the hypothesis that an updated “Break the Cycle” (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.
A qualitative study of persons who inject drugs but who have never helped others with first injections: How their views on helping contrast with the views of persons who have helped with first injections, and implications for interventionsBarnes, D., Des Jarlais, D., Wolff, M., Feelemyer, J., & Tross, S.
Journal titleHarm Reduction Journal
Issue1Background: Transitioning from non-injection to injection drug use dramatically escalates health risks. Evidence suggests that people who inject drugs (PWID) help in a majority of others' first injections, yet these helpers represent only a minority of experienced PWID. Recent research has provided insight into this helping process, as reported by helpers. PWID who have never helped, although the majority of PWID, have not previously been the focus of study. To address this gap, we give primary voice to non-helpers' perspectives on the helping process, while also comparing their views with persons in our sample who have helped with first injections. Finally, we consider how non-helpers' perspectives can inform harm reduction interventions to reduce, or make safer, initiation into injecting drug use. Methods: We conducted audio-recorded, qualitative interviews with 23 current opioid injectors on Staten Island, NY, where the opioid epidemic is pronounced. Seventeen had never helped with first injections and 6 had. Interviews were transcribed verbatim, and three coders used a consensus-developed codebook to code all interviews. Framework analysis was used to identify overarching themes. Results: We identified three key themes in non-helpers' discourse around not helping: altruistic motivations to prevent immediate and delayed harms to individuals injecting for the first time; inhibition due to negative assessments of their own injecting skills; and absolutist ethical convictions against helping. Non-helpers differed from helpers on each theme. Conclusions: Because most PWID have never helped with first injections, their perspectives on helping warrant consideration and can inform harm reduction interventions to reduce, or make safer, transitions to injection drug use. Their perspectives can be used to broaden the factors PWID consider around questions of promoting injection and helping with others' first injections, including considerations of the moral issues involved in choosing to help or not to help.
Frequency and factors associated with providing injection initiation assistance in Tallinn, EstoniaUusküla, A., Barnes, D., Raag, M., Talu, A., Tross, S., & Des Jarlais, D.
Journal titleDrug and Alcohol Dependence
Page(s)64-70Injection drug use is expanding in numerous regions in the world. Persons who inject drugs (PWID) play an important role encouraging new persons into injecting, by providing injection initiation assistance (“assisting” behaviors) and stimulating interest in injection (“promoting” behaviors). Objectives: To describe the prevalence of assisting and promoting behaviors, and to identify factors associated with assisting, among PWID in Tallinn, Estonia. Methods: In 2016, PWID were recruited through respondent-driven sampling (RDS), interviewed, and HIV tested. RDS weights were used to estimate the prevalence of assisting and promoting behaviors and, in multivariable regression modeling, to identify factors associated with assisting. Results: Among 299 PWID recruited, 13.7% had ever assisted a non-PWID with their first injection. Regarding past-six-month promoting behaviors: 9.4% talked positively about injecting to non-PWID, 16.2% injected in front of non-PWID, and 0.6% offered to help with a first injection. Significant predictors of ever assisting with a first injection included: gender (men: aOR 6.31, 95% CI 2.02—19.74); age (30 years or younger: aOR 3.89, 95% CI 1.40—10.16); receptive sharing of syringes or needles (aOR 4.73, 95% CI 1.32—16.98); ever testing for HIV (aOR 8.44, 95% CI 1.15—62.07); and having peers who helped someone with their first injection (aOR 3.44, 95% CI 1.31—9.03). Conclusion: Demographic and drug-use related factors are associated with having initiated someone into injecting. Interventions targeting PWID and non-PWID are needed to prevent injection initiation.
Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000–2017: Protective effects of non-injecting drug useDes Jarlais, D., Arasteh, K., Feelemyer, J., Mcknight, C., Barnes, D., Perlman, D. C., Uuskula, A., Cooper, H. L., & Tross, S.
Journal titleDrug and Alcohol Dependence
Page(s)74-79Objective: Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs. Methods: 846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who “reversed transitioned” to non-injecting drug use and persons who used non-injected heroin in addition to injecting. Results: Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) “reverse transitioned” back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV. Conclusions: Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.
CAM use in recently-returned OEF/OIF/OND US veterans: Demographic and psychosocial predictorsPark, C. L., Finkelstein-Fox, L., Barnes, D., Mazure, C. M., & Hoff, R.
Journal titleComplementary Therapies in Medicine
Page(s)50-56Objectives Because the use of complementary and alternative medicine (CAM) is increasing among veterans, understanding more about the characteristics of veterans who use CAM is increasingly important. Studies reporting on predictors of use almost always discuss CAM in the aggregate, yet each CAM modality represents a unique approach to healthcare, and each may have different correlates as well as different effectiveness. Very little information is available about veterans’ use of each distinct modality, and about psychosocial correlates of various forms of CAM use. Design We analyzed data from wave 1 of the Survey of the Experiences of Returning Veterans (SERV) Study, which included 729 veterans returning from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND). Setting Data were collected by telephone interviews. Main measures We examined a range of potentially important correlates of CAM use, including demographics, military experiences, and current mental and physical health. Results Each predictor related to a unique constellation of CAM modalities; not one of the predictors examined was associated with more than half of the 12 modalities. For example, women were more likely to use acupuncture, massage, yoga, meditation and spiritual healing, and age related only to greater use of homeopathy, while deployment injuries related positively to use of chiropractic, nutrition and meditation. Conclusions Results suggest that in order to understand CAM use, CAM modalities should be considered unique and separate practices. This greater understanding should be useful for future health service provision for veterans.
From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug HabitsDes Jarlais, D., Arasteh, K., Feelemyer, J., Mcknight, C., Barnes, D., Tross, S., Perlman, D. C., Campbell, A. N. C., Cooper, H. L. F., & Hagan, H.
Journal titleJournal of Substance Abuse Treatment
Page(s)48-53Objectives Transitioning from injecting to non-injecting routes of drug administration can provide important individual and community health benefits. We assessed characteristics of persons who had ceased injecting while continuing to use heroin and/or cocaine in New York City. Methods We recruited subjects entering Mount Sinai Beth Israel detoxification and methadone maintenance programs between 2011 and 2015. Demographic information, drug use histories, sexual behaviors, and “reverse transitions” from injecting to non-injecting drug use were assessed in structured face-to-face interviews. There were 303 “former injectors,” operationally defined as persons who had injected at some time in their lives, but had not injected in at least the previous 6 months. Serum samples were collected for HIV and HCV testing. Results Former injectors were 81% male, 19% female, 17% White, 43% African-American, and 38% Latino/a, with a mean age of 50 (SD = 9.2), and were currently using heroin and/or cocaine. They had injected drugs for a mean of 14 (SD = 12.2) years before ceasing injection, and a mean of 13 (SD = 12) years had elapsed since their last injection. HIV prevalence among the sample was 13% and HCV prevalence was 66%. The former injectors reported a wide variety of reasons for ceasing injecting. Half of the group appeared to have reached a point where relapse back to injecting was no longer problematic: they had not injected for three or more years, were not deliberately using specific techniques to avoid relapse to injecting, and were not worried about relapsing to injecting. Conclusions Former injectors report very-long term behavior change toward reduced individual and societal harm while continuing to use heroin and cocaine. The behavior change appears to be self-sustaining, with full replacement of an injecting route of drug administration by a non-injecting route of administration. Additional research on the process of long-term cessation of injecting should be conducted within a “combined prevention and care” approach to HIV and HCV infection among persons who use drugs.
Weighing the evidence for harm from long-term treatment with antipsychotic medications: A systematic reviewSohler, N., Adams, B. G., Barnes, D., Cohen, G. H., Prins, S. J., & Schwartz, S.
Journal titleAmerican Journal of Orthopsychiatry
Page(s)477-485Research findings supporting the use of antipsychotic medication for acute treatment of schizophrenia are relatively consistent and undisputed. However, the rationale for recommending long-term antipsychotic medication treatment-the current standard of care treatment strategy-is unclear. A controversial hypothesis proposed recently suggests people with schizophrenia who are exposed to long-term treatment with antipsychotic medications have worse outcomes than people with schizophrenia who are not exposed to these medications. We tested whether a systematic appraisal of published literature would produce data consistent with this hypothesis. We reviewed the published literature to identify studies of patients with psychotic disorders who were followed for at least 2 years that compared outcomes in patients who received antipsychotic medication during the follow-up with patients who did not receive antipsychotic medication during the follow-up. We included all English language articles published through 2013 in this review. Our process for selecting studies and documenting study findings included a consensus decision of 2 members of the research team. We found the published data to be inadequate to test this hypothesis. By extension, these data were also inadequate to conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average. We conclude that careful reappraisal of existing data is useful to ensure standard of care treatment strategies are indeed evidence-based. In the case of long-term use of antipsychotic medications, new data may be needed to establish a sufficient evidence base to understand its benefit/risk balance for patients with schizophrenia.
Sexual orientation disparities in mental health: the moderating role of educational attainmentBarnes, D., Hatzenbuehler, M. L., Hamilton, A. D., & Keyes, K. M.
Journal titleSocial Psychiatry and Psychiatric Epidemiology
Page(s)1447-1454PURPOSE: Mental health disparities between sexual minorities and heterosexuals remain inadequately understood, especially across levels of educational attainment. The purpose of the present study was to test whether education modifies the association between sexual orientation and mental disorder.METHODS: We compared the odds of past 12-month and lifetime psychiatric disorder prevalence (any Axis-I, any mood, any anxiety, any substance use, and comorbidity) between lesbian, gay, and bisexual (LGB) and heterosexual individuals by educational attainment (those with and without a bachelor's degree), adjusting for covariates, and tested for interaction between sexual orientation and educational attainment. Data are drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of non-institutionalized US adults (N = 34,653; 577 LGB).RESULTS: Sexual orientation disparities in mental health are smaller among those with a college education. Specifically, the disparity in those with versus those without a bachelor's degree was attenuated by 100 % for any current mood disorder, 82 % for any current Axis-I disorder, 76 % for any current anxiety disorder, and 67 % for both any current substance use disorder and any current comorbidity. Further, the interaction between sexual orientation and education was statistically significant for any current Axis-I disorder, any current mood disorder, and any current anxiety disorder. Our findings for lifetime outcomes were similar.CONCLUSIONS: The attenuated mental health disparity at higher education levels underscores the particular risk for disorder among LGBs with less education. Future studies should consider selection versus causal factors to explain the attenuated disparity we found at higher education levels.
Racial differences in depression in the United States: How do subgroup analyses inform a paradox?Barnes, D., Keyes, K. M., & Bates, L. M.
Journal titleSocial Psychiatry and Psychiatric Epidemiology
Page(s)1941-1949Purpose: Non-Hispanic Blacks in the US have lower rates of major depression than non-Hispanic Whites, in national household samples. This has been termed a "paradox," as Blacks suffer greater exposure to social stressors, a risk factor for depression. Subgroup analyses can inform hypotheses to explain this paradox. For example, it has been suggested that selection bias in household samples undercounts depression in Blacks; if selection is driving the paradox, Black-White differences should be most pronounced among young men with low education. Methods: We examined Black-White differences in lifetime major depression in subgroups defined simultaneously by sex, age, and education using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Collaborative Psychiatric Epidemiology Surveys (CPES). Results: In NESARC and CPES, Blacks had lower odds than Whites of lifetime major depression in 21 and 23 subgroups, respectively, of 24. All statistically significant differences were in subgroups favoring Blacks, and lower odds in Blacks were more pronounced among those with more education. Conclusions: These results suggest that hypotheses to explain the paradox must posit global mechanisms that pertain to all subgroups defined by sex, age, and education. Results do not lend support for the selection bias hypothesis.
Religious Affiliation, Internalized Homophobia, and Mental Health in Lesbians, Gay Men, and BisexualsBarnes, D., & Meyer, I. H.
Journal titleAmerican Journal of Orthopsychiatry
Page(s)505-515Most religious environments in the United States do not affirm homosexuality. The authors investigated the relationship between exposure to nonaffirming religious environments and internalized homophobia and mental health in a sample of lesbians, gay men, and bisexuals (LGBs) in New York City. Guided by minority stress theory, the authors hypothesized that exposure to nonaffirming religious settings would lead to higher internalized homophobia, more depressive symptoms, and less psychological well-being. The authors hypothesized that Black and Latino LGBs would be more likely than White LGBs to participate in nonaffirming religious settings and would therefore have higher internalized homophobia than White LGBs. Participants were 355 LGBs recruited through community-based venue sampling and evenly divided among Black, Latino, and White race or ethnic groups and among age groups within each race or ethnic group, as well as between women and men. Results supported the general hypothesis that nonaffirming religion was associated with higher internalized homophobia. There was no main effect of nonaffirming religion on mental health, an unexpected finding discussed in this article. Latinos, but not Blacks, had higher internalized homophobia than Whites, and as predicted, this was mediated by their greater exposure to nonaffirming religion.
Re: Reconsidering the role of social disadvantage in physical and mental health: Stressful life events, health behaviors, race, and depressionBates, L. M., Barnes, D., & Keyes, K. M.
Journal titleAmerican Journal of Epidemiology
Stress, coping, and depression: Testing a new hypothesis in a prospectively studied general population sample of U.S.-born Whites and BlacksKeyes, K. M., Barnes, D., & Bates, L. M.
Journal titleSocial Science and Medicine
Page(s)650-659The scarcity of empirically supported explanations for the Black/White prevalence difference in depression in the U.S. is a conspicuous gap in the literature. Recent evidence suggests that the paradoxical observation of decreased risk of depression but elevated rates of physical illness among Blacks in the U.S. compared with Whites may be accounted for by the use of coping behaviors (e.g., alcohol and nicotine consumption, overeating) among Blacks exposed to high stress levels. Such coping behaviors may mitigate deleterious effects of stressful exposures on mental health while increasing the risk of physical ailments. The racial patterning in mental and physical health outcomes could therefore be explained by this mechanism if a) these behaviors were more prevalent among Blacks than Whites and/or b) the effect of these behavioral responses to stress was differential by race. The present study challenges this hypothesis using longitudinal, nationally-representative data with comprehensive DSM-IV diagnoses. Data are drawn from 34,653 individuals sampled in Waves 1 (2001-2002) and 2 (2004-2005) as part of the US National Epidemiologic Survey on Alcohol and Related Conditions. Results showed that a) Blacks were less likely to engage in alcohol or nicotine consumption at low, moderate, and high levels of stress compared to Whites, and b) there was a significant three-way interaction between race, stress, and coping behavior for BMI only (F = 2.11, df = 12, p = 0.03), but, contrary to the hypothesis, elevated BMI was protective against depression in Blacks at low, not high, levels of stress. Further, engagement in unhealthy behaviors, especially at pathological levels, did not protect against depression in Blacks or in Whites. In sum, the impact of stress and coping processes on depression does not appear to operate differently in Blacks versus Whites. Further research testing innovative hypotheses that would explain the difference in Black/White depression prevalence is warranted.