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Objectives: This study analyses changes in drug use in Mexican junior high and high-school students and identifies differences over two decades in the social factors (availability of drugs, perceptions of risk and social tolerance) associated with such use. Method: Data from two national surveys, conducted in 1991 and 2014, were analysed. Results: Data show that the proportion of students who had tried drugs doubled in 2014. In both surveys, substance use was significantly associated with a high perception of availability and use by friends and older siblings; in 2014, there was a decrease in the perception of risk for marijuana use and an increase in social tolerance toward illegal drugs. Conclusions: It can be inferred from this analysis that public policy to prevent drug use has not had the expected impact, at least not on the social factors considered here.

Background: Web-based interventions are at an early stage in non-English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective: The aim of this study is to explore participants' satisfaction and acceptability for the second version of HDep. Methods: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative-quantitative study from a low- to middle-income, non-English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify priority variables to evaluate alcohol brief interventions from the perspective of experts in the field in Latin America.Method: A two-round Delphi procedure was carried out through online surveys of 465 individuals from 18 Latin American countries, including core outcome set developers, researchers, health professionals, users of healthcare services, journal editors, members of nongovernmental organizations, and policymakers. The questionnaire, in Spanish and Portuguese, rated 101 variables according to their relevance to the efficacy and effectiveness of brief interventions.Results: Round 1 yielded 47 variables that met the consensus criterion of at least 70% of participants; Round 2 yielded 63 variables. To reduce the possible effect of varying levels of expertise, data were analyzed by subgroup, with consensus defined as 70% of each subgroup rating a variable as critical. Seventeen outcome variables met this criterion, 14 from the initial set and 3 suggested by the participants in Round 1.Conclusions: Only four outcomes coincide with the findings of a similar international Delphi study that underrepresented Latin American countries. The findings point to the importance of including a wider variety of professionals and cultural backgrounds in international consensus panels to minimize the risk of predominance of a single perspective. [ABSTRACT FROM AUTHOR]

Background: Web-based cognitive-behavioral interventions to reduce substance use can be a useful low-cost treatment for a large number of people, and an attractive option in countries where a greater availability of treatment is needed. Objective: To evaluate the feasibility and initial effectiveness of a web-based cognitive-behavioral intervention for the reduction of substance use and depression compared with treatment as usual, with and without a printed self-help manual. Method: Individuals seeking outpatient treatment for substance use were randomly assigned to one of the following: (1) the web-based Help Program for Drug Abuse and Depression (n = 23); (2) an in-person session with an addiction therapist and use of the Alcohol, Smoking, and Substance Involvement Screening Test Self-Help Strategies guide, followed by treatment as usual (n = 25), or (3) treatment ordinarily offered in the participating treatment centers (n = 26). The study took place in 2013-2014 (trial registration: ISRCTN25429892), and participants completed baseline, posttreatment, and 1-month follow-up evaluation interviews. Results: Treatment retention and data availability were comparable in all three conditions. A reduction was observed from baseline to follow-up in average days of use [F(1,28) = 29.70, p < 0.001], severity of use [F(2,28) = 143.66, p < 0.001], and depressive symptomatology [F = (4)16.40, p < 0.001], independent of the type of treatment provided. Conclusions: The findings suggest that the web-based intervention to reduce substance abuse is feasible, although it is not more effective than other intervention modalities; its effectiveness must be evaluated in a larger sample. Attrition was a main limitation; future studies must improve retention and assess cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study analyses changes in drug use in Mexican junior high and high-school students and identifies differences over two decades in the social factors (availability of drugs, perceptions of risk and social tolerance) associated with such use. Method: Data from two national surveys, conducted in 1991 and 2014, were analysed. Results: Data show that the proportion of students who had tried drugs doubled in 2014. In both surveys, substance use was significantly associated with a high perception of availability and use by friends and older siblings; in 2014, there was a decrease in the perception of risk for marijuana use and an increase in social tolerance toward illegal drugs. Conclusions: It can be inferred from this analysis that public policy to prevent drug use has not had the expected impact, at least not on the social factors considered here. [ABSTRACT FROM AUTHOR]

Background: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program "Alcohol e-Health."Objective: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial.Methods: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8).Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=-4.18, 95% CI -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results.Conclusions: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results.Trial Registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475.International Registered Report Identifier (irrid): RR2-10.1111/add.14034. [ABSTRACT FROM AUTHOR]

Background: Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities., Objective: This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030., Methods: A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference., Results: The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis., Conclusions: The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones., (©Florian Scheibein, Elsa Caballeria, Md Abu Taher, Sidharth Arya, Angus Bancroft, Lisa Dannatt, Charlotte De Kock, Nazish Idrees Chaudhary, Roberto Perez Gayo, Abhishek Ghosh, Lillian Gelberg, Cees Goos, Rebecca Gordon, Antoni Gual, Penelope Hill, Iga Jeziorska, Eliza Kurcevič, Aleksey Lakhov, Ishwor Maharjan, Silvia Matrai, Nirvana Morgan, Ilias Paraskevopoulos, Zrinka Puharić, Goodman Sibeko, Jan Stola, Marcela Tiburcio, Joseph Tay Wee Teck, Zaza Tsereteli, Hugo López-Pelayo. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 12.12.2023.)

Despite being bio-epidemiological phenomena, the causes and effects of pandemics are culturally influenced in ways that go beyond national boundaries. However, they are often studied in isolated pockets, and this fact makes it difficult to parse the unique influence of specific cultural psychologies. To help fill in this gap, the present study applies existing cultural theories via linear mixed modeling to test the influence of unique cultural factors in a multi-national sample (that moves beyond Western nations) on the effects of age, biological sex, and political beliefs on pandemic outcomes that include adverse financial impacts, adverse resource impacts, adverse psychological impacts, and the health impacts of COVID. Our study spanned 19 nations (participant N = 14,133) and involved translations into 9 languages. Linear mixed models revealed similarities across cultures, with both young persons and women reporting worse outcomes from COVID across the multi-national sample. However, these effects were generally qualified by culture-specific variance, and overall more evidence emerged for effects unique to each culture than effects similar across cultures. Follow-up analyses suggested this cultural variability was consistent with models of pre-existing inequalities and socioecological stressors exacerbating the effects of the pandemic. Collectively, this evidence highlights the importance of developing culturally flexible models for understanding the cross-cultural nature of pandemic psychology beyond typical WEIRD approaches., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Conway, Woodard, Zubrod, Tiburcio, Martínez-Vélez, Sorgente, Lanz, Serido, Vosylis, Fonseca, Lep, Li, Zupančič, Crespo, Relvas, Papageorgiou, Gianniou, Truhan, Mojtahedi, Hull, Lilley, Canning, Ulukök, Akın, Massaccesi, Chiappini, Paracampo, Korb, Szaflarski, Touré, Camara, Magassouba, Doumbouya, Mutlu, Bozkurt, Grotkowski, Przepiórka, Corral-Frías, Watson, Corona Espinosa, Lucas, Paleari, Tchalova, Gregory, Azrieli, Bartz, Farmer, Goldberg, Rosenkranz, Pickett, Mackelprang, Graves, Orr and Balmores-Paulino.)

People can increase their use of psychoactive substances in response to stressful situations as a maladaptive mechanism for reducing negative affective states. It is therefore necessary to examine changes in the use of such substances and their relationship to mental health in light of the COVID-19 pandemic. Objective: Evaluate the relationship between psychoactive substances and stress, emotional state, and symptomatology during the COVID-19 lockdown in Mexico. Method: A national survey was conducted, using the free Google Forms platform, of residents of Mexico aged 18 and older. The survey was disseminated through social media. Results: The sample comprised 4,122 individuals, mostly women (71.8%), with an age range of 18-81 years ( M = 37.08, SD = 12.689), of which 46.8% were single, and 42.9% married. In general, there was a reduction in substance use during the first 2 months of the quarantine; the most commonly used substances were alcohol, tobacco, and tranquilizers. Respondents who described having greater use than before the pandemic presented greater stress, depressive symptomatology, and perceived threat than those who did not use substances. Conclusions: Respondents who did not use substances reported lower levels of stress, depressive symptomatology, impact of the coronavirus pandemic, and perception of its threat. Women reported greater stress, depressive symptomatology, and emotional intensity than men., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Martínez-Vélez, Tiburcio, Natera Rey, Villatoro Velázquez, Arroyo-Belmonte, Sánchez-Hernández and Fernández-Torres.)

Background: The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries., Objective: This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresión, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs., Methods: The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users' experience., Results: The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding "read more" links, and providing feedback about every activity. On the other hand, the users said the information presented within the modules was easy to follow and suggested more dynamic features with concrete instructions and feedback., Conclusions: The resulting Web-based program may have advantages over traditional face-to-face therapies owing to its low cost, wide accessibility, anonymity, and independence of time and distance factors. The detailed description of the process of designing a Web-based program is an important contribution to others interested in this field. The potential benefits must be verified in specific studies., Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 25429892; http://www.controlled-trials.com/ISRCTN25429892 (Archived by WebCite at http://www.webcitation.org/6ko1Fsvym)., Competing Interests: Conflicts of Interest: None declared.