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Background: The present study aimed to identify sociodemographic characteristics, risky behaviors, type of drug use, and service use variables associated with emergency department (ED) use and hospitalization among people who inject drugs (PWID). Methods: Studies in English published from January 1, 1995, to December 15, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on ED use and hospitalization among PWID. Results: After a detailed assessment of 17,348 outputs, a total of 19 studies met the eligibility criteria for inclusion in the analysis. Greater risks of ED use and hospitalization among PWID were associated with (i) a history of homelessness, (ii) HIV-positive status, and (iii) injecting drugs more than four times per day. Individuals were more likely to use the ED if they (i) had a history of physical abuse, (ii) were using cocaine and methamphetamine, and (iii) had used primary care services. Women and individuals with chronic physical illnesses were more likely to be hospitalized. Conclusions: The present study is the first to integrate determinants related to ED use and hospitalization based on sociodemographic characteristics, risky behaviors, type of drug, and service use determinants among PWID. To reduce ED use and hospitalization among PWID, the paper also recommends various strategies could be implemented. [ABSTRACT FROM AUTHOR]

A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12–17 years) compared to young adults (aged 18–24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI. [ABSTRACT FROM AUTHOR]

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

Suicidal behaviors including ideations and attempts may ultimately lead to suicide especially among intravenous drug users (IVDUs). The present study assessed the prevalence, sociodemographic characteristics, risky behaviors, mental health conditions, and type of drug use associated with suicidal behaviors among IVDUs. Studies in English published from January 1, 1995 to February 1, 2022 were searched on PubMed, Scopus, Cochrane, and Web of Science to identify papers on variables associated with suicidal behaviors (ideation and attempts) among IVDUs. Out of 10,795 papers, 21 studies met the eligibility criteria. Among IVDUs, the findings indicated a past-year pooled prevalence rate of 35% for suicide ideations (95% CI, 22%–48%) and 25% for suicide attempts (95% CI, 13%–36%). Generally, suicide ideations were associated with being homeless, having a previous history of physical and sexual abuse, and depression. Suicide attempts were associated with being female, having a previous history of physical and sexual abuse, having depression or other mental health disorders (e.g., anxiety, stress, and serious mental health disorders), and having cocaine, methamphetamine, sedative-hypnotic, and polysubstance use disorders. Integrated treatment and assertive community treatment approaches may be promoted to prevent suicidal behaviors. Such programs can be implemented for referring individuals to receive suicide attempt-concerned interventions and motivational therapy. [ABSTRACT FROM AUTHOR]

This study aimed to identify socio-demographic determinants, risky behaviors and type of drug use, and the association with visiting by general practitioners (GP) in the last 12 months or outpatient service use among people who inject drugs (PWID). Studies in English published before November 1 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with visiting by GP or outpatient service use among PWID. After a detailed assessment of over 17,348 papers, a total of 13 studies met the eligibility criteria. Greater odds of visits to the GP in the last 12 months or outpatient service use was associated with (i) being younger, (ii) being female, (iii) employment status, (iv) having public health insurance, (v) individuals who shared needles, (vi) individuals who were prescribed benzodiazepines, (vii) history of taking prescribed mental health medications, (viii) individuals who got methadone maintenance treatment (MMT) and (X) individuals who had used primary care services. The present research findings highlighted that a significant proportion of the study participants used GP or outpatient service use/outpatient psychiatrist, suggesting that the focus should not be restricted to PWID. [ABSTRACT FROM AUTHOR]

Introduction: Identifying determinants of emergency department (ED) use and hospitalization among patients with substance‐related disorders (SRDs) can improve health services to address unmet health needs. Aim: The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients with SRDs. Methods: Studies in English published from January 1, 1995, to December 1, 2022, were searched on PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies. Results: The pooled prevalence rates of ED use and hospitalization among patients with SRDs were 36% and 41%, respectively. Patients with SRDs who were the most at risk of being both ED users and hospitalized were those (i) having medical insurance, (ii) having other drug and alcohol use disorders, (iii) having mental health disorders, and (iv) having chronic physical illnesses. A lower level of education increased the risk of ED use only. Discussion: To decrease ED use and hospitalization, more comprehensive services may be offered to these vulnerable patients with diversified needs. Implications for Practice: Chronic care integrating outreach interventions could be more provided for patients with SRDs after discharge from acute care units or hospitals. [ABSTRACT FROM AUTHOR]

The present study aims to determine mental health conditions, service use determinants, and drug use behaviors associated with non-fatal overdose among people who use illicit drugs (PWUIDs). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIDs. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, and Outcomes (PICO) criteria. The present study applied OR to measure the effect size with 95% CI. For data analysis, R 3.5.1 with the "meta" package was used to conduct the meta-analysis. After a detailed assessment of more than 13,845 articles, a total of 60 studies met the eligibility criteria. We found that non-fatal overdose was independently and positively associated with various factors considered and was, as expected, most strongly associated with being male, needs help injecting, needle sharing, overdose experience in past 12 months, alcohol abuse, had mental health diagnosis, depression, and anxiety disorders, suicide (ideation or attempt), inpatient detoxification, benzodiazepine use, and emergency department visit or hospitalization. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management. Abbreviations: PWUIDs: People who use illicit drugs; WHO: World Health Organization; CI: Confidence intervals; NOS: Newcastle-Ottawa Scale; OR: Odds ratio; PICO: Population, Intervention, Comparator, Outcomes; PRISMA: Protocols of Systematic Reviews and Meta-Analyses; PWIDs: people who inject drugs; WHO: World Health Organization; SIF: Safer Injection Facility [ABSTRACT FROM AUTHOR]

We assessed sociodemographic variables, risky determinants, and type of drug use associated with fatal overdose among people who use drugs (PWUD). Studies in English published from January 1, 1985 to May 1, 2021, were searched on PubMed, Scopus, Cochrane, and Web of Science to identify studies on variables associated with fatal overdoses among PWUDs. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: PWUD; (ii) intervention: fatal overdose in the past year; (iii) comparator: PWUD who had not fatal overdose; (iv) outcome: fatal overdose in the last year and (v) study type: cross-sectional, cohort, and case–control studies. Out of 13,821 articles, 25 studies met eligibility criteria. Our findings showed socio-demographic determinants (younger age, marital status, being homeless, being male,) risky determinants (poor mental health, experience non-fatal overdose and needle sharing), and type of drug use (cocaine disorder, benzodiazepines disorder, alcohol disorder, psychostimulant disorder, polysubstance disorders, and heroin dependence), were significantly associated with fatal overdose among PWUD. The present study data indicated that numerous characteristics were correlated with overdose-induced mortality. Such characteristics are certainly interrelated; however, each factor could potentially be targeted for intervention. The most particular reason for death was practicing illicit drug use, including opioids (e.g., heroin). PWUD: People who use drug; CI: Confidence intervals; NOS: Newcastle-Ottawa Scale; OR: Odds ratio; PICO: Population, Intervention, Comparator, Outcomes; PRISMA: Protocols of Systematic Reviews and Meta-Analyses; PWIDs: People who inject drugs; WHO: World Health Organization [ABSTRACT FROM AUTHOR]

Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32–2.83; hospitalization: OR = 1.53, 95%CI = 1.36–1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13–1.59; hospitalization: OR = 1.42, 95%CI = 1.20–1.69). Being female (OR = 1.24, 95%CI = 1.14–1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24–3.21) and tobacco (OR = 1.25, 95%CI = 1.11–1.42), having HIV (OR = 1.70, 95%CI = 1.47–1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27–2.85) and injury (OR = 2.62, 95%CI = 1.08–6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08–1.81) and using cocaine (OR = 1.60, 95%CI = 1.32–1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the prevalence of non-fatal overdose among people who use illicit opioids (PWUIOs) and determine the demographic and behavioral characteristics associated with non-fatal overdose among this population. Studies in English published before February 1, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIOs. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PICOs criteria. After a detailed assessment of over 13,845 papers, a total of 67 studies met the eligibility criteria. The findings showed a past-year pooled prevalence rate of non-fatal overdose among PWUIOs of 26% (95% CI, 23% −29%). Greater odds of non-fatal overdose among PWUIOs was associated with (i) being younger, (ii) being female, (iii) being homeless, (iv) individuals who received money, goods, or drugs in exchange for sex, (v) individuals who had witnessed somebody else have an overdose, (vi) individuals who had used public spaces as primary injection locations, (vii) individuals who reported polydrug use, (vii) use of non-injection methamphetamine, and (viii) high injecting frequency (more than two daily drug injections). Harm-reduction programs should consider the provision of education concerning overdose-related risk factors to the vulnerable and hard-to-reach PWUIOs. [ABSTRACT FROM AUTHOR]

This study aimed to identify risk and protective factors associated with substance use among Iranian university students. We searched for studies in English published from January 1, 1995 to February 20, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with substance use among university students. Out of 8,481 articles, 39 studies met eligibility criteria. Our findings showed a pooled prevalence rate of alcohol use 23% (95% CI, 8% 39%), smoking 21% (95% CI, 6% 37%) and other drug use 14% (95% CI, 10% 18%) in the last year among student. Hookah use, living alone, being a current cigarette smoker, and other drug use were significantly associated with alcohol use. The findings of the present study showed that being male, older age, alcohol use, had depression, had parents or friends who smoke, and religious beliefs were significantly associated with smoking among students. This meta-analysis also showed that living alone, alcohol use, history of drug use, and hookah use were significantly associated with drug use among students. Substance use prevention programs provided by universities could be improved by signifying high-risk populations addressed by the related literature. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the association between drug type, risk behaviors and non-fatal overdose among people who use drugs (PWUD). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. After a detailed assessment of over 13,845 articles, a total of 49 studies met the eligibility criteria. We found that non-injection opioid use, heroin injection, cocaine use, concurrent use of buprenorphine and benzodiazepines, benzodiazepine use, incarceration, injecting drugs, and duration of injecting were associated with greater odds of non-fatal overdose among PWUD. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management, and further focusing on the need to balance the current emphasis on enforcement-based responses to illegal drug use with health-related interventions. [ABSTRACT FROM AUTHOR]

We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case–control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to assess the impacts of oral health determinants (eg frequency of brushing < 2 day, poor life style and non‐white ethnicity) and clinical oral caries indices (eg Decayed, Missing, and Filled Teeth (DMFT)) and periodontal disease) on Poor Quality of Life (PQoL) among PW. Methods: The search strategy was restricted to publications in English before 1 December 2019 in the PsycINFO, PubMed, SciELO, Scopus and Web of Science databases. We only included oral diseases considered as public health issues with a global burden. As a result, investigations reporting the frequency of brushing, poor lifestyle behaviours, non‐white ethnicity, DMFT scores and periodontal disease as an outcome were included. The two reviewers resolved any disagreements. Reviewers analysed the full texts, considering the inclusion and exclusion criteria. Also, a manual search of the reference lists was performed on all the selected studies. Results: In total, 11 publications were included in the meta‐analysis. Findings indicate a positive association between non‐white ethnicity and PQoL among PW. Among PW, those who had non‐white ethnicity were 1.43 times more likely to have PQoL (OR = 1.43, 95% CI = 1.17, 1.70). A positive association between DMFT and poor QoL among PW was also observed. Those who has suffered DMFT were 1.4 times more likely to have poor QoL (OR = 1.4, 95% CI = 1.24, 1.55). Conclusions: Results from this meta‐analysis support the need for behavioural interventions for improving oral hygiene in expectant mothers. This could help to decrease periodontal conditions and improve their oral and general life quality. [ABSTRACT FROM AUTHOR]

We conducted this systematic review and meta-analysis study to better understand the factors (being drug use, drug type (methamphetamine vs others), sex partner, frequency of injection, homelessness and being HIV positive) associated with injecting-related risk behaviors (lending and/or borrowing already used syringes) among people who inject drugs (PWID). We searched the English language citations in PubMed, Science Direct, Web of Science, and Cochrane electronic databases for previous studies on risk behaviors among PWID. Two independent researchers reviewed all search results, screened for eligibility and extracted data independently. A meta-analysis was conducted with pooled odds ratio and the 95% confidence intervals for factors associated with injecting risk behaviors among PWID. After detailed assessment of the citations, we included 14 studies in our meta-analysis. Binge drug use (OR, 1.39; 95% CI, 1.06–1.71) and drug type (methamphetamine vs. others) (OR, 1.50; 95% CI, 1.22–1.77) were positively associated with the borrowing of already used syringes among PWID. We also found that drug type (OR, 1.39; 95% CI, 1.16–1.64) and homelessness (OR, 1.89; 95% CI, 1.27–2.51) had a positive association with the lending of already used syringes among PWID. Additionally, being HIV positive was negatively associated with the lending of used syringes among PWID (OR, 0.58; 95% CI, 0.37–0.63). This systematic review and meta-analysis supports harm-reduction initiatives especially the establishment and maintenance of sterile needle syringe programs. [ABSTRACT FROM AUTHOR]

HIV testing is the first step to early identification, treatment and management of HIV infection among people involved in high-risk behaviors specifically drug injection. Achieving declines in morbidity and mortality associated with HIV and reducing onward HIV transmission are key to testing and treatment. Evaluating the frequency of HIV testing among people who inject drugs (PWID) provides information that helps to identify missed opportunities to improve the efficacy of testing. This meta-analysis aimed to determine the association between HIV testing and risk taking behaviors among PWID. Two independent researchers reviewed the databases of PubMed, Scopus, Web of Science, and Cochrane electronic databases, for manuscripts published between 2000 and 2017, to identify primary studies on the factors associated with HIV testing among PWID. After reviewing for duplication, the full texts of 16 articles were assessed for eligibility. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CIs) from the data collected. From the four databases 15,965 studies were identified. After evaluations of the citations, article title and abstracts 16 studies were included in the analysis. Findings indicate a significant association between HIV testing and having ≥6 years education (OR = 1.19, 95% CI = 1.01–1.38), a history of imprisonment (OR = 1.92, 95% CI = 1.30–2.53), access to needle syringe programs (OR = 1.6, 95% CI = 1.00–2.21), and PWID attending a health professional or physician (OR = 1.46, 95% CI = 1.17–1.74). Appropriate strategies to increase awareness of primary care physicians on the importance of regular HIV testing will help with global targets for HIV elimination among PWID. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to perform a systematic review of the literature and meta-analysis in order to investigate relationship between drug use and oral health. Methods: We searched for studies in English published before July 1, 2019 on PsycINFO, PubMed, SciELO, Scopus, and Web of Science. We assessed the relationship between drug use (methamphetamines, heroin; opiates; crack, cocaine and cannabis as dependent variables) and reported tooth loss, periodontal disease, or decayed, missing, and filled teeth index as an independent variable. The data were analyzed using Stata 12.0 software. Results: We initially identified 1836 potential articles (with 1100 duplicates) and screened the remaining 736 titles and abstracts, comprising 54 studies. In the next step, we evaluated the full-texts; 44 studies were excluded, accordingly. In total, we included 10 publications in the meta-analysis. Drug type was associated with periodontal disease (OR 1.44; 95% CI 0.8–2.6) and pooled estimates showed that type of drug used increased the odds of the number of decayed, missed and filled teeth (DMFT) (OR 4.11; 95% CI 2.07–8.15) respectively. Conclusions: The analytical challenges of segregating the impact of individual drug types on oral health diseases mean that investigations on the direct relationship between oral health status and drug use are limited. Developing programs to improve potential confounding with various substances and addressing the dental health needs of people who use drugs is vital if we are to improve their overall quality of life. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of skin and soft tissue infections (SSTIs) is a significant health concern among people who inject drugs (PWIDs). This meta-analysis estimates the prevalence of SSTIs and its related risk behaviors among PWIDs. Methods: We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in February 2018. After reviewing for duplication, full-text of selected articles were assessed for eligibility using certain Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CI). Results: After a detailed assessment, a total of 20 studies containing 9,502 patients met the eligibility criteria. A pooled prevalence of 44% (95% CI, 31–56%) was estimated for SSTIs among PWIDs. Among the potential risk factors, only injecting frequency has a significant positive relationship with SSTIs among PWIDs (OR = 1.20, 95%CI = 1.03–1.37). Conclusion: The results of the present study indicate that PWIDs have a very high burden of SSTs infection, and also emphasized the potential role of higher injecting frequency on the prevalence of SSTs among PWIDs. These results suggest that more interventions to reduce of injection frequency might be useful in decreasing of SSTs burden among PWIDs. [ABSTRACT FROM AUTHOR]

Objective: In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions. Methods: PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT. Results: From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: −0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (−4.6 [95% CI: −6.49, −2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health. Conclusion: The current meta‐analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths. [ABSTRACT FROM AUTHOR]

Background: Global estimates suggest there are 15.6 million people who inject drugs (PWID) of whom 17.8% are living with HIV.Few studies have characterized newly-onset injectors with long-term injectors and its association with injecting risk behaviors. Objectives: We examined the relationship between length of injection and risk behaviors among people who inject drugs (PWID) in Tehran, Iran. Methods: A cross-sectional study was conducted among PWID, from March to August 2016 in Tehran, Iran. PWID were recruited by convenience and snowball sampling from five Drop-in Centers (DIC) located in the south of Tehran. Our primary independent variable was length of injecting career, defined as the number of months since injecting initiation. Those defined as new injectors (were injecting for less than 18 months), and long-term injectors (as injecting drugs for more than 18 months). We reported the adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI95%) as the effect measure. The level of significance used in multiple logistic regression model was 0.05. We used STATA v. 11 for all analyzes. Results: The analytical sample comprised of 500 participants (100% male). Mean (±SD) age of PWID with a length of injection history was 31.2 ± 7.2 years. Overall, 270 (54%) (CI95%: 49.6%, 58.4%) of participants were long-term injectors. The average age of drug use initiation among long-term injectors group was lower as compared to new injectors group (31.2 vs. 29.4, p < 0.001). The odds of distributive syringe sharing among new injectors were two times higher than long-term injectors (AOR = 2.1, 95% CI 1.4-4.7). The odds of receptive syringe sharing were lower among new injectors group (AOR = 0.7, CI95% 0.2-0.87), compared to long-term injectors. New injectors had higher odds of reusing their own syringes (OR = 2.8, 95% CI: 1.4-5.7; p = 0.01). Conclusions: Improvements in harm reduction service provision can occur through taregted risk reduction education for new injectors focusing on reducing distributive syringe sharing among them. [ABSTRACT FROM AUTHOR]

Background: Little published research have assessed factors predicting the uptake of HIV-testing services for people who inject drugs (PWID) in Iranian settings. The objectives of the present study were to determine factors associated with HIV testing uptake among PWID in Tehran. Methods: We surveyed 500 PWID in Tehran concerning demographic characteristics, drug-related and sexual risk behaviors, and HIV testing. HIV-related stigma variables were assessed using a scale consisted of 22 agree/disagree statements in three subscales including shame/blame/isolation, perceived discrimination, and equity. We used multivariate logistic regression to identify factors associated with HIV testing. Results: Participant ages ranged from 19 to 67 years. Multivariable model shows that factors independently associated with recent HIV testing included level of education (adjusted odds ratios [aOR] 1.12, 95% CI 1.44-4.42), living status (aOR 1.91, 95% confidence interval [CI] 1.35-2.71), income (aOR 1.64, 95% CI 1.18-2.29), length of injecting career (aOR 1.3, 95% CI 1.2-2.23), and perceived risk of HIV infection (aOR 0.51, 95% CI 1.18-0.88). There was a statistically significant relationship between lower level of HIV-related stigma and HIV testing among PWID (OR 2.78, 95% CI 1.15-5.2). Conclusions: These findings suggested a need to strengthen current HIV testing programs by social support and reducing HIV-related stigma. It is also important to modify the attitude of the public toward people living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran. Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception. Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7,p < 0.05), or use of multiple drugs at the same time (AOR = 1.7,p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) . Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran. [ABSTRACT FROM PUBLISHER]

Introduction: It has been estimated that 2–4 million people in developing countries possess HCV infection driven by unsafe injection drug use each year that is extending to other population. High-risk injection behaviors are the leading cause of HCV infections among PWIDs. The purpose of this study was to survey prevalence of HCV and risk factors associated with HCV among injecting drug users. Methods: This cross-sectional study was carried out on 410 injection drug users in Kermanshah that were recruited through peer-referral and convenience sampling from two Drop-In Centers (DICs). Data were collected using structured information form, and data analysis was done with descriptive and logistic regression. Results: A total of 410 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19–58) years, Overall, the prevalence of HCV infections was 42% (95%CI: 23.7–52.5). Trend test showed clear trends for living place, income, age of first injecting drug, age at first drug use across the two groups (P-value < 0.05), but there was no significant trend for marital status, education level, or age (P-value > 0.05). Conclusion: Developing the needle and syringe programs could reduce unsafe injection rate among PWIDs. Therefore, the more accurate and better coverage of NSP programs in PWID, the more reduce in needle sharing rate and HCV infection. [ABSTRACT FROM PUBLISHER]

Purpose: Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception's effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. Method: We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Results: Study participants were categorized as follows: 'low' ( n = 100, 22%), 'moderate' ( n = 150, 32%), and 'high' ( n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as 'high' risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of 'high' risk perception when compared to PWID with 'low' risk perception. Conclusion: Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use. [ABSTRACT FROM AUTHOR]