Where are They Now? Featuring: Paul Archie

WHERE ARE THEY NOW?

Dr. Paul T. Archie

EdD in Global Sports Leadership

Department of Global Sport Leadership

Year of Graduation: 2021

Why did you choose ETSU for your education?

After applying to five colleges for grad school, I was super excited to read my acceptance email from Dr. Brian Johnston and his assistant at ETSU. ETSU was my number one choice, and it was also the first grad school to send me a decision! I loved the Global Sports and Leadership curriculum, and the two planned overseas trips were the icing on top. I was all in, and I could not wait to commence my studies with ETSU in the fall of 2018.

What is your current position and/or research?

I am a training and platform instructor for the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE) located in Irving, Texas. This is a dream job for me where I can apply my decades of leadership, training, and education to instruct agents and essential personnel in leadership. After a four-month interview process, I started this career on August 14, 2022!

What does this position/research entail?

I teach leadership instruction to DHS/ICE supervisors at the intermediate level, career level, and even the senior executive service level. I am also currently attending four months of “train the trainer” courses.

How did your time at ETSU prepare you for this career?

My time at ETSU refined my leadership, research, and overall communications skills! I am a proud ETSU Buccaneer for life! The Professors and assistants were great leaders that truly cared for the betterment of their students. Dr. Brian Johnston, Dr. Adam Sayers, and Dr. Richard Sanders expertly lead us, and my 17 classmates and I became friends for life!

What advice would you offer to current or future graduate students?

You are member of a great institution that will set you up for success if you do the work. Remember your “Why,” and keep moving forward every day! Through the highs and lows, keep pushing yourself, and you will achieve your goals at ETSU!!!

Anything else you would like to add:

Remember to have fun during your college studies! Life is short, so enjoy every minute of your time at ETSU! Time will quickly fly by!

According to the results from the 2019 Substance Abuse and Mental Health Services Administration (SAMHSA) national survey on drug use and health, 20.4 million people aged 12 or older in the United States (U.S) had a past-year substance use disorder (SUD). SUD is defined as meeting two or more of the DSM-5 criteria, which can include harmful use, difficulties with withdrawal, and neglecting aspects of life. Notably, the use and misuse of substances such as alcohol and tobacco has been linked to several diseases including pancreatitis and cancer. Recent research also indicates that the COVID-19 pandemic may have contributed to an increase in substance use and misuse (e.g., overdose), which demonstrates the need to identify ways to make treatment more accessible, usable, and effective. Esther Adeniran, a doctoral graduate from ETSU’s public health program, has completed her dissertation on the state of substance use treatment (SUT) among youth and adults in the U.S. This research feature explores Esther’s dissertation findings and how they help address substance use, misuse, and SUDs in the U.S.

Esther is from Kwara State, Ilorin, Nigeria. She received her bachelor’s degree in microbiology from the University of Ilorin. After graduating with her bachelor’s, she served as a clinical microbiologist in a lab, and she volunteered for a medical and dental health community development group. Esther participated in public health outreaches in the rural community, and this exposure inspired her to pursue graduate studies in public health in the U.S. After completing her master’s in public health at Missouri State University, Esther came to ETSU to pursue her doctorate in public health. Esther wanted to come to ETSU because of the knowledgeable faculty members conducting substance use research and the opportunity to intern at the Addiction Science Center. In addition, Esther appreciated the large international student population at ETSU.

Esther wanted to address the increasing gap between those who need SUT and those who are receiving treatment. Her dissertation is composed of four different manuscripts—each with a different aim. Her quantitative investigations were conducted under the conceptual framework of Andersen’s behavioral model for health services. This framework aims to understand the predisposing, enabling, need, and environmental factors influencing the use of SUT services to ensure that interventions can be targeted appropriately. Esther used the nationally representative datasets collected by SAMHSA, the lead federal government agency for behavioral health data and research. SAMHSA collects data from facilities in every state that receive government funding. Esther utilized SAMHSA’s 2019 admission (1.8 million observations) and discharge (1.7 million observations) datasets for her dissertation, which she cleaned and analyzed according to each dissertation aim.

Esther’s first dissertation aim was to create a literature review of the barriers and facilitators to integrating SUT into mainstream health care after the Affordable Care Act (ACA) was implemented in 2014. Her justification for pursuing this aim is that the implementation of the ACA laid the groundwork for integrated care by expanding access to behavioral health care through insurance coverage expansion. Even after the national implementation of the ACA, Esther identified several patient, provider, and program/systemlevel barriers that make it difficult to adopt SUT in U.S health care settings. Some barriers include patient concerns about confidentiality, providers’ fearing legal sanctions, and a lack of referral networks at the program/system level. Esther also identified several facilitators to integration, including patients trust in providers, provider education, and leadership support at the program/system level. The review highlighted the need for a comprehensive approach to improve SUT in mainstream health care. “Several providers say they need evidence to adopt SUT services in healthcare settings. This review gives them the evidence they need for this to happen,” said Esther.

Esther’s second dissertation aim was to examine the rate of treatment completion and dropout among youth who received medication-assisted opioid therapy and the factors influencing treatment completion and dropout among these youth. Medication-assisted therapy involves the use of prescription drugs as part of a comprehensive treatment plan for SUDs. Medications can help treat opioid dependence, which is very important as it can reduce the chance of overdose and death. Despite this, the literature has shown that medicationassisted opioid therapy is underutilized in youth populations. For this study, Esther’s sample size was 4,917. She analyzed her data using log-binomial regression to explore the relationship between various covariates and the outcome, i.e., treatment completion/dropout. According to Esther’s findings among youths who received medication-assisted opioid therapy, treatment drop out was higher (56.1%) than treatment completion (43.9%). Remarkably, Esther found that the use of medication-assisted opioid therapy helps to facilitate treatment completion among youth with opioid use disorder.

Esther’s third dissertation aim examined the predictors of length of stay (LOS) among adults in residential rehabilitation facilities (RRF) in the U.S. Previous research focused on individuals in

“Several providers say they need evidence to adopt SUT services in healthcare settings. This review gives them the evidence they need for this to happen.”

Dr. Esther A. Adeniran Dr. Hadii M. Mamudu

psychiatric inpatient settings, which are not representative of all individuals receiving treatment in the U.S. Residential treatment settings refer to live-in facilities where patients with substance use problems can stay and receive the support they need. Psychiatric settings refer to facilities providing treatment for behavioral health problems such as mental disorders and SUDs. Esther’s sample size was 28,813, and she examined how prior substance use treatment episodes (primary independent variable) affected short-term LOS (≤ 30 days) in RRF. Esther ran a Poisson regression with LOS as the outcome variable while controlling for covariates. She found that people who have experienced one or more prior substance use treatment episodes were more likely to stay in treatment longer than those with no prior treatment episode. The average LOS among adults in short-term RRF was 16.4 days. Other predictors for lower LOS included being age 18-34, being employed, having private insurance, and living in the Northeast.

Esther’s final dissertation aim was to determine if experiencing multiple treatment episodes and being in certain age groups were associated with longer wait period (>1 month) to enter SUT. Esther’s sample size was 554,350, and she used logistic regression to determine the association between the number of prior substance use treatment episodes, age groups, and the wait period to enter an SUT facility. Esther examined the age categories 12-17, 18-24, 25-34, 35-49, and 50 and older. She found that those with five or more prior substance treatment episodes had a higher likelihood of experiencing longer wait period. She also found that people aged 25-49 years were more likely to experience wait periods of greater than one month. This is important to know because as wait period to enter treatment lengthens, so do the chances of other events occurring that may impact treatment entry and re-entry. Esther speculated that people who have experienced five or more prior substance use treatment episodes may be given less priority than those experiencing their first episode. People experiencing their first episode may be viewed as an emergency, whereas those with five or more prior episodes might not be viewed this way. Esther’s advisor, Dr. Megan Quinn, gave Esther the confidence to pursue the daunting task of completing four manuscripts for her dissertation, as the minimum requirement was three. Her committee members, Drs. Pack, Brooks, and Liu, provided timely feedback and supported her throughout her dissertation. Dr. Mamudu was also highly involved in Esther’s development as a student and researcher. Dr. Mamudu provided Esther with hands-on experience through writing manuscripts, data analysis, and fostering close collaboration with experts at the Center for Cardiovascular Risks Research. Esther has already co-authored two published manuscripts with Dr. Mamudu and is the first author of one study (currently in review) examining e-cigarette use in U.S. adolescents. Esther has presented at various conferences including the Appalachian Student Research Forum, the Tennessee Public Health Association, the American Heart Association, and the American Public Health Association (APHA). She was also an abstract reviewer at the 2021 APHA Conference. During her dissertation defense, Esther presented to two SAMHSA regional representatives. “It was exciting for them to see my work!” remarked Esther.

Esther’s dissertation fills in several gaps in substance use disorder research and gives researchers, practitioners, and policy makers the evidence they need to improve the access and use of SUT. She now works as a postdoctoral scientist at Cedars-Sinai Samuel Oschin Cancer Center in Los Angeles, California examining how health behaviors such as alcohol use contribute to the development of acute pancreatitis. Esther’s commitment and contributions to her field will aid in the creation of intervention strategies for substance use, misuse, and SUDs as well as prevent chronic disease progression. While the implementation of newly released research takes time, Esther has taken big steps toward improving the state of SUT in the U.S.