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Public libraries support community health needs, including responding to the opioid epidemic with events, services, and information. However, we lack insight into why libraries respond to problematic opioid use in their communities, what tensions are associated with responding to community opioid use, and how their responses fit within the scope of public libraries. We conducted a multimethod study to solicit the perspectives of Ohio public library directors. They characterized responding to the opioid epidemic in their communities as aligning with both the mission and attributes of public libraries, while also facing tensions that emerged from balancing the demand for expansive social services with pressure to protect the sanctity of libraries. [ABSTRACT FROM AUTHOR]

ObjectiveThe COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain.MethodsWe evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)-Department of Veterans Affairs (VA)-Department of Defense (DOD) Pain Management Collaboratory. COVID-19-related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed.ResultsPandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time.ConclusionsNegative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.

BACKGROUND: Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement. OBJECTIVE: This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users. METHODS: We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD. RESULTS: In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P

PurposeTraumatic brain injury (TBI) and potentially traumatic events (PTEs) contribute to increased substance use, mental health issues, and cognitive impairments. However, there's not enough research on how TBI and PTEs combined impact mental heath, substance use, and neurocognition.MethodsThis study leverages a subset of The National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) multi-site dataset with 551 adolescents to assess the combined and distinctive impacts of TBI, PTEs, and TBI+PTEs (prior to age 18) on substance use, mental health, and neurocognitive outcomes at age 18.ResultsTBI, PTEs, and TBI+PTEs predicted greater lifetime substance use and past-year alcohol and cannabis use. PTEs predicted greater internalizing symptoms, while TBI+PTEs predicted greater externalizing symptoms. Varying effects on neurocognitive outcomes included PTEs influencing attention accuracy and TBI+PTEs predicting faster speed in emotion tasks. PTEs predicted greater accuracy in abstraction-related tasks. Associations with working memory were not detected.ConclusionThis exploratory study contributes to the growing literature on the complex interplay between TBI, PTEs, and adolescent mental health, substance use, and neurocognition. The developmental implications of trauma via TBIs and/or PTEs during adolescence are considerable and worthy of further investigation.

The COVID-19 pandemic has uniquely impacted people living with HIV (PLWH) worldwide. The negative impacts on PLWH's mental health from fear of COVID-19 are labeled as "a double stress." The association between fear of COVID-19 and HIV (internalized) stigma has been found among PLWH. Studies that explore the relationships between fear of COVID-19 and physical health outcomes are few, especially among PLWH. In this study, we explored the relationship between fear of COVID-19 and physical health among PLWH and the mediated effects of HIV stigma, social support, and substance use. A cross-sectional online survey of PLWH (n = 201) from November 2021 to May 2022 was carried out in Shanghai, China. The data on socio-demographics, fear of COVID-19, physical health, HIV-related perceived stigma, social support, and substance use were gathered and analyzed by structure equation modeling (SEM). In SEM analysis, fear of COVID-19 showed a significant and indirect effect on physical health (β=-0.085) which was primarily mediated by HIV stigma. In SEM analysis, the final model had a good fit. Fear of COVID-19 showed a significant effect on HIV stigma (β = 0.223) with the majority being direct effects (β = 0.262) and a small indirect effect via substance use (β=-0.039). Furthermore, HIV stigma showed a significant effect on physical health (β=-0.382), the majority of which was direct (β=-0.340), and a small indirect effect via social support (β=-0.042). This is one of the first studies to explore how fear of contracting COVID-19 can affect PLWH's coping behaviors (e.g., using substances and obtaining social support) used to combat HIV stigma as well as to achieve better physical health in China.

INTRODUCTION: To better understand the development of the growing opioid crisis in the early 21st century, the authors studied trends in substance use disorder among 46,132,211 emergency department (ED) visit discharges in California between 2006 and 2011. METHODS: Utilizing the California State Emergency Department Database, the authors identified substance use based on International Classification of Diseases, Ninth Revision codes. Tabular and multivariable analysis methods were applied. ED visits were considered clustered at the level of patient. RESULTS: The authors observed a notable increase in substance use prevalence from 7.32 ± 6.07 to 12.21 ± 9.35 per 1000 ED visits. Nonopioid substance use was more prevalent among individuals aged ≤ 50 years old. Opioid use disorder (OUD) was associated with a higher mortality rate in the ED. In 2011, OUD was significantly higher among American Indians visiting the ED. A multivariable analysis revealed that OUD was an independent predictor for increased ED visits after controlling for demographic factors. DISCUSSION: Despite an overall decrease in mortality rate, opioid-related ED visits showed a higher mortality rate, underscoring the grave consequences of OUD. Nonopioid substance use was prevalent among younger age groups, suggesting a need for age-specific interventions. A major finding was the elevated OUD among American Indians, indicating persistent health disparities impacting this demographic. OUD was an independent risk factor for excess ED visits, which could strain health care systems. The authors suggest strategies like nonopioid pain management, community-level programs, and bridging ED with outpatient treatment facilities to mitigate the opioid crisis and ED overutilization. CONCLUSION: These findings advocate for tailored public health strategies, addressing the underlying disparities to combat the opioid epidemic effectively.

BackgroundIdentifying factors associated with post-disaster youth substance use is a crucial element of developing evidence-based prevention and intervention efforts. Hurricane María struck Puerto Rico in September of 2017 and the wide-spread impact from this disaster, including exposure to trauma, displacement, and disrupted social supports had the potential to negatively impact levels of substance use among youth across the archipelago. However, post-disaster substance use remains under-investigated in this context. The current study sought to identify risk and protective factors associated with substance use among Puerto Rican youth in the aftermath of Hurricane Maria.MethodsCross-sectional, secondary data analyses were conducted using school-based survey data collected at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane María). Social supports, substance use, and trauma symptoms were assessed. An ordinal regression analysis was conducted to identify student factors associated with greater likelihood of post-disaster substance use.ResultsA total of 36,485 participants (50.7% female, grades 7-12), were included in an ordinal regression analysis that compared the likelihood of respondents endorsing high, low, or no substance use after Hurricane María based on reported adult social support, counselor/teacher social support, peer social support, ptsd symptomatology, and gender. Findings showed that, when compared to students that endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds (OR = 0.42, 95% CI: 0.34-0.53) of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds (OR = 0.79, 95% CI: 0.69-0.89) of reporting high substance use. Additionally, those that reported having peer social support demonstrated a 31% increase in odds (OR = 1.31, 95% CI: 1.10 to 1.58) of reporting higher substance use, compared to those that reported low or no substance use.ConclusionsWhile social support was generally protective, prevention efforts to build positive family and community connections may be indicated. Evidence-based school screenings of substance use and trauma may help direct intervention to those most at risk for co-occurring issues.

BackgroundLittle is known about trauma and its mental health impact on Native Hawaiians/Pacific Islanders (NH/PI), an understudied Indigenous-colonized population that endures severe mental health disparities.AimsThis novel investigation assessed trauma prevalence and its mental health and substance use correlates in NH/PIs in the U.S.MethodUsing community-based participatory research methods, survey data on NH/PI trauma, depression, anxiety, substance use, and treatment need were collected from 306 NH/PI adults using online, telephone, and in-person methods. Descriptive statistics and adjusted regression models were employed.ResultsSixty-nine percent of participants experienced lifetime trauma, reporting mean exposure to 2.5 different trauma types. Childhood physical and sexual abuse, and lifetime forced sexual assault rates were 34%, 25%, and 27%, respectively, exceeding general population rates. Women and men reported equivalent total mean exposure to different trauma types, as well as equal prevalence for every trauma type examined (e.g. sexual abuse/assault). Confirming hypotheses, after controlling for key demographic and mental health risk factors, increased exposure to multiple trauma types uniquely associated with greater depression, anxiety, alcohol symptomology, and greater likelihood for needing treatment and using illicit substances.ConclusionsTrauma is prevalent in NH/PI populations and significantly impacts NH/PI mental health; serving as an important but overlooked contributor to NH/PI mental health disparities. Current findings fill critical gaps in our knowledge of NH/PI trauma and mental health while revealing the importance of screening and treating NH/PIs for trauma exposure to alleviate existing mental health disparities.

It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.

Adolescents, especially female youth, who have more family meals tend to be at lower risk for substance use. The present study tested whether family meals relate to substance use count and frequency during high school, whether associations differ by gender, and whether other family-related variables explain these associations. A community sample of 316 adolescents (Mage = 16.40, SD = 0.74; 56.96% female; 41.77% Latine, 23.10% Asian American, 29.11% European American, 6.01% from other ethnic backgrounds including Middle Eastern and African American) reported the number of substances they have ever used and how often they used alcohol, marijuana, and cigarettes, and completed measures of parental support and family cohesion. Across 15 days, they reported whether they had a family meal, got along with parents, and spent leisure time with their family each day. Regression models tested associations between frequency of family meals and substance use, whether associations differed by gender, and whether associations were explained by other family-related variables. Results indicated that more frequent family meals were associated with lower substance use count and less frequent alcohol, marijuana, and cigarette use among female adolescents but not male adolescents. Other daily family experiences were unrelated to substance use, and family meal frequency was independently related to lower substance use after accounting for parental support and family cohesion. Taken together, more frequent family meals in high school may reduce substance use risk for female adolescents, and interventions could consider promoting family meals in addition to other positive family values.

The current study examined associations between risk contexts (i.e., immigration discrimination,classism, colorism), acculturation (i.e., assimilation, separation, integration, marginalization),and adjustment (i.e., school belonging, substance use, GPA) among U.S. Latinx adolescents.Additionally, we considered how gender may moderate study associations. Participants for thisstudy include a subsample of Latinx adolescents from a larger study with two public highschools in the western United States (N=703, Mage=15.93 (SD =1.22); 51.3% male). Preliminaryresults revealed that experiencing more colorism, classism, and immigrant discrimination wasassociated with a higher inclination for separation and substance use (e.g., tobacco, cannabis,alcohol). Specifically, Latinx adolescents were more likely to reject U.S. culture and formstronger ties with the culture and values of their country of origin, as well as engage in substanceuse, when they experienced higher levels of risk contexts. Regarding differences by gender,bi-variate associations revealed that higher levels of separation were linked with higher GPA forLatinx female adolescents only. Male adolescents, on the other hand, were more likely to reporthigher levels of assimilation to U.S. culture, in conjunction with higher levels of colorism,classism, and immigration discrimination. Follow-up analyses will include testing howcomponents of the acculturation process mediate associations between each risk context andadjustment, as well as differences by gender. Findings have implications for how Latinxadolescents navigate risky contexts and the critical role of acculturation processes in relation tohealthy adjustment.

BACKGROUND: Exposure to climate change events like wildfires can lead to health and mental health problems. While conceptual frameworks have been hypothesized describing the potential relationship between disaster exposure and substance use, the association remains under-researched and unquantified. METHODS: We constructed a quantitative portrayal of one proposed conceptual framework that focuses on the intermediary role of anxiety. We used the Monte Carlo simulation to estimate the impact of wildfire exposure on opioid misuse outcomes through increased anxiety. We searched for and extracted prior empirical evidence on the associations between wildfire anxiety and anxiety-opioid misuse. Three scenarios were devised: in S1 the impact of wildfire on opioid misuse was limited to increasing anxiety incidence; in S2 we also considered the additive role of altered anxiety phenotype; and in S3 we further considered the role of increased opioid-related consequences of pre-existing anxiety due to wildfire exposure. RESULTS: Models show that the prevalence of opioid misuse post-wildfire may rise to 6.0%-7.2% from a baseline of 5.3%. In S1, the opioid misuse prevalence ratio was 1.12 (95% uncertainty interval [UI]: 1.00 - 1.27). The two exploratory scenarios, with less stringent assumptions, yielded prevalence ratios of 1.23 (95% UI: 1.00 - 1.51) and 1.34 (95% UI: 1.11 - 1.63). CONCLUSIONS: Our modeling study suggests that exposure to wildfires may elevate opioid misuse through increasing anxiety incidence and severity. This can lead to substantial health burdens, possibly beyond the duration of the wildfire event, which may offset recent gains in opioid misuse prevention.

BackgroundSocial media can influence alcohol initiation behaviors such as sipping, which can lead to future adverse alcohol-related outcomes. Few studies have examined the role of problematic social media use, characterized by addiction, mood modification, tolerance, withdrawal, conflict, and relapse, especially in early adolescence.ObjectiveTo examine the prospective association between social media use and sipping alcohol in a nationwide sample of early adolescents, and the extent to which problematic social media use mediates the association.MethodsWe analyzed prospective data from the Adolescent Brain Cognitive Development Study (N = 7514; ages 9-10 years at baseline; 2016-2018) to estimate associations between social media time (Year 1) and alcohol sipping (Year 3) using modified Poisson regression, adjusting for confounders and testing problematic social media use (Year 2) as a mediator.ResultsSocial media time (Year 1) was prospectively associated with 1.31 (95% confidence interval 1.20-1.43) times higher risk of new-onset sipping (Year 3). The association between social media time and new-onset alcohol sipping was partially mediated by problematic social media use at Year 2 (25.0% reduction in the association between the former two factors after adding problematic social media use, p = 0.002).ConclusionsTime spent on social media was associated with a higher risk of alcohol sipping in a diverse national sample of early adolescents, and the association was partially mediated by problematic social media use. Media literacy education and family media use plans could advise early adolescents about exposure to alcohol content on social media and warning signs for problematic use.

Early life stress (ELS) is defined as an acute or chronic stressor that negatively impacts a child's development. ELS is associated with substance use and mental health problems. This narrative literature review focuses on sex and gender differences in the effects of ELS on 1) adolescent neuroendocrine development; 2) pubertal brain maturation; and 3) development of internalizing symptoms and subsequent substance use. We posit that ELS may generate larger hormonal dysregulation in females than males during puberty, increasing internalizing symptoms and substance use. Future research should consider sex and gender differences in neuroendocrine developmental processes when studying the link between ELS and negative health outcomes.

This study demonstrates that changes in mindfulness predict subsequent changes in well-being in a data set including individuals who recently engaged in psychedelic use.

High rates of cannabis use among people with posttraumatic stress disorder (PTSD) have raised questions about the efficacy of evidence-based PTSD treatments for individuals reporting cannabis use, particularly those with co-occurring alcohol or other substance use disorders (SUDs). Using a subset of four randomized clinical trials (RCTs) included in Project Harmony, an individual patient meta-analysis of 36 RCTs (total N = 4046) of treatments for co-occurring PTSD+SUD, we examined differences in trauma-focused (TF) and non-trauma-focused (non-TF) treatment outcomes for individuals who did and did not endorse baseline cannabis use (N = 410; 70% male; 33.2% endorsed cannabis use). Propensity score-weighted mixed effects modeling evaluated main and interactive effects of treatment assignment (TF versus non-TF) and baseline cannabis use (yes/no) on attendance rates and within-treatment changes in PTSD, alcohol, and non-cannabis drug use severity. Results revealed significant improvements across outcomes among participants in all conditions, with larger PTSD symptom reductions but lower attendance among individuals receiving TF versus non-TF treatment in both cannabis groups. Participants achieved similar reductions in alcohol and drug use across all conditions. TF outperformed non-TF treatments regardless of recent cannabis use, underscoring the importance of reducing barriers to accessing TF treatments for individuals reporting cannabis use.

BackgroundPrevious investigations that have examined associations between family history (FH) of alcohol/substance use and adolescent brain development have been primarily cross-sectional. Here, leveraging a large population-based sample of youths, we characterized frontal cortical trajectories among 9- to 13-year-olds with (FH+) versus without (FH-) an FH and examined sex as a potential moderator.MethodsWe used data from 9710 participants in the Adolescent Brain Cognitive Development (ABCD) Study (release 4.0). FH+ was defined as having ≥1 biological parents and/or ≥2 biological grandparents with a history of alcohol/substance use problems (n = 2433). Our primary outcome was frontal cortical structural measures obtained at baseline (ages 9-11) and year 2 follow-up (ages 11-13). We used linear mixed-effects models to examine the extent to which FH status qualified frontal cortical development over the age span studied. Finally, we ran additional interactions with sex to test whether observed associations between FH and cortical development differed significantly between sexes.ResultsFor FH+ (vs. FH-) youths, we observed increased cortical thinning from 9 to 13 years across the frontal cortex as a whole. When we probed for sex differences, we observed significant declines in frontal cortical thickness among boys but not girls from ages 9 to 13 years. No associations were observed between FH and frontal cortical surface area or volume.ConclusionsHaving a FH+ is associated with more rapid thinning of the frontal cortex across ages 9 to 13, with this effect driven primarily by male participants. Future studies will need to test whether the observed pattern of accelerated thinning predicts future substance use outcomes.

BACKGROUND: The prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran. METHOD: From March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use. RESULT: We analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P

BACKGROUND: Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. AIM: The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. METHODS: Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. RESULTS: A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. CONCLUSION: Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young peoples developmental opportunities and health outcomes.

BACKGROUND: The overdose crisis driven by synthetic opioids continues to escalate in the USA. We evaluated the efficacy of multiple manufacturing lots of a fentanyl test strip (FTS) to detect fentanyl and fentanyl analogs and assessed cross-reactivity with possible interferences. METHODS: Drug standards were dissolved in water in a laboratory setting and serially diluted. Drug dilutions were tested using five different manufacturing lots of BTNX Rapid Response (20 ng/mL cutoff) lateral flow chromatographic immunoassay strips to assess lot-to-lot variability for FTS sensitivity and cross-reactivity for the analytes of interest. RESULTS: All five manufacturing lots cross-reacted with fentanyl and eleven fentanyl analogs. Diphenhydramine, lidocaine, MDMA, and methamphetamine were found to cause false positives with the strips. There was notable lot-to-lot variability in the sensitivity of the strips for fentanyl, fentanyl analogs, and known interferences. DISCUSSION: FTS remains an important overdose prevention tool, but lot-to-lot variability in performance complicates robust instructions that balance the prevention of false positives and false negatives. Continued lot-to-lot performance assessment is recommended to ensure health education for FTS remains accurate. More sophisticated drug checking technologies and services are needed in the community landscape to augment personal FTS use to facilitate informed consumption and overdose risk mitigation.

Background: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women.Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women's Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV.Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April-September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August-September 2020) phone survey.Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33-0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41-0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02-2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24-2.43).Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.

BackgroundThe syndemic of HIV, substance use (SU), and mental illness has serious implications for HIV disease progression among women. We described co-utilization of HIV care, SU treatment, and mental health treatment among women with or at risk for HIV.MethodsWe included data from women with or at risk for HIV (n = 2559) enrolled in all 10 sites of the Women's Interagency HIV Study (WIHS) from 2013 to 2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. Tobacco and alcohol were assessed separately. We described co-utilization of SU treatment, tobacco and alcohol use treatment, HIV care, and mental health care in the past year among women who were eligible for each service. We compared service utilization by those who did/did not utilize SU treatment using Wald Chi-square tests.ResultsAmong women with current SU (n = 358), 42% reported utilizing SU treatment. Among those with current SU+HIV (n = 224), 84% saw their HIV provider, and 34% saw a mental health provider. Among women with current SU+heavy alcohol use (n = 95), 18% utilized alcohol use treatment; among current SU+tobacco use (n = 276), 8% utilized tobacco use treatment. Women who utilized SU treatment had higher utilization of alcohol use treatment (59% vs. 5%; P

BackgroundTravel restrictions implemented to mitigate the spread of SARS-CoV-2 decreased mobility and reduced physical contact during 2020-2021 for many in the general population. This analysis explored changes to network contacts among people who inject drugs (PWID) in the San Diego Border Region (SDBR) by cross-border mobility before and during the COVID-19 era.MethodsBaseline data collected between October 2020-2021, from a cohort study of PWID in the SDBR were used to retrospectively describe differences in baseline characteristics across cross-border PWID groups (cross-border PWID [CB-PWID]: n = 206; San Diego PWID [SD-PWID]: n = 203; Tijuana PWID [TJ-PWID]: n = 202). Chi-square and Fisher's exact tests evaluated sociodemographic, injecting risk behaviors, harm reduction service history, incarceration history, non-fatal overdose, HCV, HIV. Median differences in sex, drug/alcohol, and close partners before and during the pandemic among all PWID and by cross-border PWID status were evaluated using Kruskal-Wallis tests. Pairwise associations across cross-border PWID groups were assessed using the Dwass, Steel, Critchlow-Fligner multiple comparison test.ResultsAmong 611 PWID, the number of sex, drug/alcohol-related partners and close contacts before and during the pandemic remained relatively stable (psex=0.71;pdrug/alcohol=0.15;pclose=0.09). PWID in San Diego experienced the greatest difference in drug/alcohol-related partners (median[IQR]:-1[-6,0]), while cross-border PWID reported the smallest change in close contacts versus pre-pandemic (median[IQR]:0[0,1]). PWID in Tijuana had the greatest proportion (87%) of close contacts who injected drugs of all three groups.ConclusionsCompared to pre-pandemic, the median number of sex partners, drug/alcohol-related partners, and close contacts remained stable among PWID in the SDBR. Future research should explore how these network contacts evolve over time.

Worldwide, health professionals from all specialties are encouraging patients to reduce alcohol use if not abstain, and abstinence is clearly encouraged for tobacco. However, for users of substances that meet diagnostic criteria for substance use disorder (addiction), reducing use or abstaining will be difficult without appropriate addiction treatment. Moreover, this group is the most at risk and the most likely to benefit from reducing use. We propose research-based arguments to better combine encouragement to reduce or abstain from alcohol and tobacco to systematic screening for addiction and facilitated access to addiction treatment to make alcohol and tobacco preventable deaths truly preventable.

BACKGROUND: Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. METHODS: The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. RESULTS: At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. CONCLUSION: PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

BackgroundMortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.MethodsWe conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: "clients" (individuals who use drugs and receive harm reduction services) and "providers" (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.ResultsWe found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.ConclusionThis study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

BackgroundThe rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.MethodsData from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.ResultsThirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.ConclusionsThe risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.

AbstractObjectiveMethodResultsConclusionsGuided by Minority Stress and Interpersonal and Ideation-to-Action Theories of Suicide, we sought to identify latent classes of painful and provocative events (PPEs), determine associations with class membership, and assess class-specific suicide attempt prevalence among cisgender sexually minoritized men (SMM) with suicidal ideation in the United States.Using data collected from October 2020 to January 2021 from 1617 SMM reporting past-year suicidal ideation, we performed latent class analysis on 22 PPE items spanning sexual behavior stigma, substance use, high-risk sex, and food and housing insecurity. We used multinomial logistic regression to assess associations with class membership and the Bolck-Croon-Hagenaars method to estimate class-specific past-year suicide attempt prevalence.Participant mean age was 29 years, 63% (n = 1010) were non-Hispanic white, and 14% (n = 221) reported a past-year suicide attempt. Five classes emerged: Extreme (7%, n = 113), featuring pervasive stigma, polysubstance use, high-risk sex, and food and housing insecurity; Severe/marijuana (15%, n = 236), featuring pervasive stigma, alcohol use, marijuana use, high-risk sex, and food insecurity; Severe (18%, n = 296), featuring the same PPEs minus marijuana use; Moderate (17%, n = 267), featuring family stigma, verbal harassment, some polysubstance use, and high-risk sex; and Mild (44%, n = 705), featuring family and friends stigma, verbal harassment, and alcohol use. Significantly higher suicide attempt prevalence emerged in the Extreme/Severe classes (12–16%) relative to the Mild/Moderate classes (2%).Stigma and substance use were common across classes, implicating both as key factors shaping suicide risk among SMM. Holistic, multipronged, tailored interventions targeting stigma, substance use, and other PPEs are needed. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance This study was undertaken to explore the experiences and concerns of people living with epilepsy by analyzing discussions in an online epilepsy community, using large language models (LLMs) to identify themes, demographic patterns, and associations with emotional distress, substance use, and suicidal ideation.We analyzed 56 970 posts and responses to them from 21 906 users on the epilepsy forum (subreddit) of Reddit and 768 504 posts from the same users in other subreddits, between 2010 and 2023. LLMs, validated against human labeling, were used to identify 23 recurring themes, assess demographic differences, and examine cross‐posting to depression‐ and suicide‐related subreddits. Hazard ratios (HRs) were calculated to assess the association between specific themes and activity in mental health forums.Prominent topics included seizure descriptions, medication management, stigma, drug and alcohol use, and emotional well‐being. The posts on topics less likely to be discussed in clinical settings had the highest engagement. Younger users focused on stigma and emotional issues, whereas older users discussed medical treatments. Posts about emotional distress (HR = 1.3), postictal state (HR = 1.4), surgical treatment (HR = .7), and work challenges (HR = 1.6) predicted activity in a subreddit associated with suicidal ideation, whereas emotional distress (HR = 1.5), surgical treatment (HR = .6), and stigma (HR = 1.3) predicted activity in the depression subreddit. Substance use discussions showed a temporal pattern of association with seizure descriptions, implying possible opportunities for intervention.LLM analysis of online epilepsy communities provides novel insights into patient concerns often overlooked in clinical settings. These findings may improve patient–provider communication, inform personalized interventions, and support the development of patient‐reported outcome measures. Additionally, hazard models can help identify at‐risk individuals, offering opportunities for early mental health interventions. [ABSTRACT FROM AUTHOR]

Female sex workers (FSW) living with HIV experience greater depression and worse HIV outcomes than people living with HIV (PLHIV) overall. Mindfulness is related to lower depression and higher ART adherence in PLHIV. Few studies have assessed these relationships among FSW, especially longitudinally. This study assessed the temporal relationship between mindfulness, mental health and HIV outcomes among FSW from the Dominican Republic (DR). We analyzed data collected between 2018 and 2021 among 240 FSW using mixed modeling to assess contemporaneous relationships and time-lagged relationships between mindfulness and mental health (i.e., depression,HIV stigma, drug and alcohol use ), and HIV outcomes (i.e., ART adherence, viral suppression) , accounting for clustering of repeated measures. Greater mindfulness showed contemporaneous and time-lagged associations with lower depression (contemporaneous: b = −0.57, SE = 0.03, p < 0.001; time-lagged: b = −0.16, SE = 0.05, p < 0.001), lower HIV stigma (contemporaneous: b = −0.11, SE = 0.02, p < 0.001; time-lagged: b = −0.08, SE = 0.03, p = 0.003) and higher ART adherence (contemporaneous: b = 0.03, SE = 0.01, p = 0.003; time-lagged: b = 0.04, SE = 0.01, p = 0.004), and contemporaneous associations with reduced at-risk alcohol use and higher viral suppression (aOR = 0.99, 95% CI = 0.99–1.00, p = 0.003; aOR = 1.01, 95% CI: 1.00–1.01, p = 0.036, separately). Mindfulness instruction is a promising intervention for reducing depression and HIV stigma, and promoting better HIV outcomes among FSW living with HIV, meriting future intervention research in this area. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) dramatically reduces HIV transmission risk. PrEP is underutilized among men who have sex with men who use substances (SU-MSM) in the Southern U.S., for whom there is limited research and high PrEP need. Using cross-sectional data from the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0082 study, we explored factors associated with PrEP awareness and use among 225 SU-MSM in the Southern U.S. Participants were recruited from community-based sexually transmitted infection clinics, syringe services programs and outpatient substance use treatment programs in eight cities across five Southern states with high HIV incidence. Multinomial logistic regressions examined PrEP awareness and use relative to sociodemographic factors, sexual behaviors and substance use. Results demonstrated overall high awareness, yet limited uptake of PrEP. Younger age, higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP awareness. Higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP use. Results highlight the need for innovative PrEP outreach to Southern SU-MSM that accounts for age, education and substances used. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To determine how the rise of telehealth during the COVID‐19 pandemic impacted Medicaid enrollees' access to opioid use disorder (OUD) treatment.Electronic health records from Northwestern Medicine, a large midwestern academic health system, from January 1, 2019 to December 31, 2021.The exposure was the expansion of telehealth services during the COVID‐19 pandemic. A difference‐in‐differences design was used to determine the impact of telehealth on the probability of receiving any OUD care, any in‐person OUD care, and any telehealth OUD care in a month.The study included Medicaid and privately insured patients older than 18 years of age, diagnosed with OUD, who had any encounter with the Northwestern Medicine system. All outpatient visits with OUD as the primary diagnosis were included in the analysis. There were 486 individuals in the sample and 17,496 person‐month observations.After the onset of the COVID‐19 pandemic, Medicaid enrollees are 4.5 percentage points (percentage change, 43.7%; 95% confidence interval [CI] 8.7 to 0.3 percentage points; p = 0.035) less likely to receive any OUD care in a month, relative to privately insured patients. While no statistically significant differences in the likehood of receiving in‐person OUD care were detected between the groups after exposure, we did observe that Medicaid enrollees are 3.6 percentage points (percentage change 64.2%; 95% CI 6.0 to 1.1 percentage points; p = 0.004) less likely to receive any telehealth OUD care in a month relative to privately insured patients.While those with private insurance were able to maintain OUD treatment during the pandemic by supplementing in‐person care with telehealth, Medicaid enrollees experienced a drop in overall OUD treatment rates due to lower telehealth use. The rise of telehealth for OUD treatment might contribute to widening care gaps for Medicaid enrollees. [ABSTRACT FROM AUTHOR]

Background: Opioid misuse and addiction are at epidemic levels in the United States. Postoperative opioid prescription is inconsistent and often excessive, including for cesarean section patients. Technology, such as mobile applications and clinical decision support tools, can be used to decrease opioid use and misuse among patients, and to determine more appropriate prescribing practices for specific procedures. The objective of this study was to examine the preliminary impact of the Continuing Precision Medicine (CPM) mobile application to reduce the use of opioid pain medication among women who underwent cesarean section. The primary outcome is morphine milligram equivalents (MME), while the secondary outcomes will be delay to dosages, decrease of usage, and pain scores. Methods: Patients undergoing cesarean section were randomized to either a control group or an experimental group, which used the CPMRx mobile app to help manage postoperative pain. Logistic regression analyses were run to predict opioid misuse by group (control [electronic monitoring blister pack only] versus CPMRx [electronic monitoring blister pack plus mobile application]) and odds ratios (ORs) were calculated. Relative risk (RR) was also estimated by log-binomial regression. Results: In phase I, 105 patients were assessed for eligibility, however, 66 were excluded (not meeting criteria or declined to participate). In phase 2, 98 patients were assessed for eligibility, however, 48 were excluded for the aforementioned. Results of the logistic regression showed that opioid misuse differed significantly by group (χ2 = 7.27, p = 0.007) with participants in the CPMRx group experiencing a 92% reduction in odds of opioid misuse compared to blister packs only (OR = 0.08, p = 0.03). Relative risk estimation by log-binomial regression also revealed that patients in the control group were at 7 times higher risk of opioid misuse than those using the CPMRx app (Wald χ2 = 3.82, RR = 7.00, p = 0.05). Among the 21 participants in Phase I who did not misuse their prescription opioids, the average number of pills used was 2.7 (SD = 3.5); 95% of patients used 8 or fewer pills, 90% used 6 or fewer, 75% used 4 or fewer, and half of participants used 1 or fewer opioids. Conclusions: Women using the CPMRx mobile application were less likely to misuse their prescription opioids during the postoperative period following cesarean section. A prescription of 7 tablets of 5 mg oxycodone may be a more appropriate prescription size among this group. Systematically right-sizing prescriptions, including for subgroups, may decrease both patient- and community-level risk of opioid misuse and reduce public health burden. Trial registration: The study was registered at ClinicalTrials.gov (NCT05461196, 18/07/2022). [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Method Results Discussion Youth substance use has been associated with recurrent episodes of substance misuse. A large body of research has shown that relapsing into substance use is still a significant obstacle that prevents people who use substances and want to stop from recovering and abstaining. The objective of this evaluation was to locate, compile and summarise the results of all pertinent research on youth substance use relapse prevention programmes.An integrative literature review (ILR) was conducted, guided by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546), following a step‐by‐step guide for conducting an ILR. The PRISMA guidelines were used in the selection process.Twenty‐three papers met the eligibility criteria, and three were added from grey literature. Three themes identified in the studies included in the review: Continuing care, technology‐mediated recovery management interventions and relapse prevention through developmentally engaging activities.The review identified that a successful substance use relapse prevention programme for the youth requires continued care following discharge from hospital treatment. The care encompasses posttreatment check‐ups, assessments and linkages to treatment in which a suspected/potential relapse is referred back to treatment to prevent its severity or occurrence. [ABSTRACT FROM AUTHOR]

This study compared a purposive sample of secular and religious female social work students during four years of the pandemic. The objective of this study was to assess the association between COVID-19 fear, religiosity, well-being, and substance use in Israel. The Fear of COVID-19 Scale (FCV-19S) was used for study purposes. A total of 1790 students completed an online survey from May 2020 to April 2023. Findings evidence deterioration of student well-being, as well as increased substance use and alcohol binge drinking over 4 years of the pandemic. Regression analysis shows that the predictors associated with substance use are most evident during the first 2 years of COVID-19. The last 2 years of COVID-19 evidence less fear and substance use due to possible student adjustment to health conditions. Present findings do not evidence religiosity as a protective factor. Additional research is needed over time, academic study profession and location to further understand the possible impact of fear on healthcare students during and after disaster conditions including those related to war and violence. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Alcohol health literacy is critical for informed consumer decision making but has yet received limited attention in public health research. We therefore seek to measure alcohol health literacy and its educational distribution in Germany.In this cross‐sectional study, we developed and applied a brief nine‐item questionnaire on alcohol health literacy in an adult convenience sample (n = 391; February to April 2023). The association of educational attainment with ‘insufficient’ alcohol health literacy was tested in adjusted logistic regression models.Insufficient alcohol health literacy was recorded in 47.8% of men and 41.1% of women in our sample. While most respondents correctly identified common misconceptions and wrong beliefs about alcohol and were able to specify low‐risk drinking limits for women and women during pregnancy, only few correctly identified all alcohol‐related health conditions, especially respiratory and infectious diseases. Respondents with low education were 1.35 (risk ratio [RR], 95% confidence interval 1.09–1.50, p = 0.014) times more likely to have been classified as having insufficient alcohol health literacy than high‐educated respondents. There was no statistically significant difference between respondents with medium versus high education (RR = 1.22, 95% confidence interval 0.99–1.43, p = 0.060).Educational gaps in alcohol health literacy question a policy rationale that is fundamentally based on the premise of informed consumer choice. Strategies to raise alcohol health literacy must ensure that they reach all population groups, for instance, by providing health warning labels on alcohol containers. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsFamily plays an important role in helping or hindering a loved one’s alcohol recovery and this is particularly true in South Asian communities. In South Asian cultures women are seen as the keepers of the izzat (family honour), and to behave in ways that can jeopardise the izzat, such as drinking alcohol, can have a grave impact on women’s health and wellbeing. This paper explores the lived experiences of alcohol use and help-seeking among South Asian women in England with a particular focus on the role of the family.18 South Asian women with personal lived experience of alcohol dependency were interviewed using an in-depth, semi-structured interview approach.The findings focus on feelings of stigma and shame linked to izzat and family dishonour. The women shared personal accounts of controlling and restrictive upbringings that influenced their alcohol use. They talked about how their families reacted to their alcohol dependency with shame and a lack of understanding, and they explained how many of their families offered support when they realised that the women’s physical and mental health was at a point of crisis.Recommendations focus on educational outreach to families regarding alcohol use within South Asian communities. [ABSTRACT FROM AUTHOR]

Background: The therapeutic alliance is an important predictor of treatment outcomes but people who use alcohol and other drugs report mixed views of treatment providers. We analysed patients' accounts of inpatient detoxification staff to ascertain whether, and if so how, relationships with them, and thus the therapeutic alliance, might be improved. Methods: Semi-structured qualitative interviews were conducted (in 2022/2023) with 20 people (14 males; 6 females) who had just completed inpatient detoxification in sixteen different facilities. Interviews were part of a larger longitudinal qualitative evaluation of an initiative to increase inpatient detoxification capacity across England. Results: Patients described how treatment was delivered by professionals with diverse roles. They rated staff highly and appreciated their personal qualities; the standard of medical care and non-medical services they provided; their willingness to provide privacy, freedom and choice; the support given at key points in the treatment journey; and the positive impact staff relationships had on their substance use and lives more generally. Criticisms of staff were infrequent, mostly related to specific individuals or events, and potentially more common when detoxification occurred within general hospitals rather than within specialist services. Conclusions: Patients' accounts of staff in this study were more positive than documented in previous literature. However, the characteristics that patients appreciated (and disliked) were consistent with earlier research. There was scope to improve in some services and patient groups not interviewed may have held more negative views of staff. Overall, the holistic and patient-centred approach that staff adopted, and patients valued, appears to contribute to a good therapeutic alliance. [ABSTRACT FROM AUTHOR]

In the United States, women account for one-fourth of people living with HIV. Most women living with HIV are Black or Hispanic and acquired HIV from heterosexual contact. Many face significant barriers to appropriate medical care, with lower retention in care and viral suppression than men who acquire HIV from male-to-male sexual contact. Many factors contribute to these disparities, including high rates of alcohol abuse, substance use, intimate partner violence, depression, and socioeconomic marginalisation. HIV, substance use, and violence each contribute independently to the collective health burden on women. The co-occurrence of these factors, termed the SAVA (substance abuse, violence, and HIV/AIDS) syndemic, is particularly hard to address, as the conditions act synergistically to negatively influence health outcomes. In addition, mental health conditions frequently coexist and further contribute to adverse outcomes. Unfortunately, clinician knowledge of this syndemic is low, and patients living with HIV and other elements of SAVA, including depression, are not recognised and referred for appropriate services. In this paper we describe our pilot educational and quality improvement program and the subsequent educational program we developed to increase knowledge of SAVA with the goal of improving health outcomes for women living with HIV. [ABSTRACT FROM AUTHOR]

Background: Substance use treatment programs are ideal places for suicide prevention interventions. People who misuse substances are at elevated risk for suicide compared to the general population. However, most treatment programs do not incorporate suicide prevention, and none have been adapted for American Indian and Alaska Native (AI/AN) people. Preventing Addiction Related Suicide (PARS) is a suicide prevention module developed for use with people in treatment for substance misuse. A previous study demonstrated increased suicide help‐seeking among this population. Objective: Culturally adapt PARS for use with AI/AN communities. Methods: We conducted focus groups and interviews with stakeholders in three Tribal health systems. We elicited feedback on PARS content, structure, and implementation. Data were analyzed using constant comparison. Results were used to adapt PARS and member checking was used to refine it. Results: Participants unanimously endorsed using PARS in their health systems. Suggested adaptations included shortening the module, using community‐specific information, removing jargon and stigmatizing language, and emphasizing cultural connectedness. Discussion: This community‐based, qualitative study adapted the PARS module for use with AI/AN communities. Research is needed to evaluate the clinical effectiveness of the adapted module. If found effective, this would represent the first evidence‐based suicide prevention intervention among AI/AN individuals in treatment for substance misuse. [ABSTRACT FROM AUTHOR]

We explore how a group of service-providing organizations have strategically engaged in actions to cultivate legitimacy among varied external stakeholders. Using the case of syringe service programs, programs that use harm reduction services to engage the population of drug users, the authors use qualitative methods to examine how these stigmatized yet increasingly accepted organizations have sought to cultivate legitimacy among the audiences that dictate the means of their survival. Findings show that SSPs use different strategies to maintain and foster legitimacy depending on how long they have existed, organizational sector, relationships with stakeholders, and the drug use stigma in their immediate community. This article can inform how human services organizations can use different stigma-lessening strategies to cultivate organizational legitimacy among the external audiences on which they are dependent. [ABSTRACT FROM AUTHOR]

Sex under the influence of substances is a common sexual practice. Although they could explain engagement in sex under the influence of substances, few studies have explored sexual motivations driving substance use. To bridge this knowledge gap, this study aims to investigate differences in sexual motivations across genders and substance categories, and the link between substance use severity and sexual motivations. In all, 188 adults (aged 18–74) took part in a comprehensive assessment interview addressing substance use (Évaluation intégrée spécialisée en dépendance), including three sexual motivation items for three substance categories (alcohol, cannabis, other substances), and substance use severity (WMH-CIDI). Wilcoxon rank-sum tests and generalized estimating equations were used to compare sexual motivations among substance categories between men and women. A logistic regression assessed whether substance use severity could influence the presence of sexual motivations when considering gender and age. Results revealed an interaction between gender and substance categories on sexual motivations. Men were more likely to present sexual motivations and exhibited greater sex-related substance use motivations than women for substances other than alcohol and cannabis. Moreover, higher substance use severity scores were associated with the presence of sexual motivations for substance use. This study underscores the need to develop gender-sensitive interventions that consider sexual motivations underlying substance use. Consideration of sexual motivations could help identify the needs fulfilled by substance use and prevent triggers arising from sexual situations. Being among the first studies on the subject, continuing research in this area to further investigate sexual motivations underlying substance use remains essential. [ABSTRACT FROM AUTHOR]

Adolescents may be exposed to online content depicting substance use, raising the question of how exposure to others' online substance use content relates to one's own use. Additionally, it is of interest to explore how parental restrictive (i.e., media content restriction) and active mediation (i.e., media content discussion) may relate to links between online substance use exposure and substance use. In a sample of 1017 U.S. adolescents (55% female; T1 Mage = 15.04), this longitudinal study examined links between exposure to peers' online postings about substances and adolescents' own alcohol, marijuana, cigarette, and e-cigarette use two years later. Adolescents' Time 1 exposure to peers' online substance postings was generally associated with greater Time 2 marijuana use, alcohol use, and, to some extent, e-cigarette use. Greater Time 1 cigarette use was associated with lower Time 2 exposure to peers' online substance postings. Time 1 parent-reported restrictive mediation was associated with lower Time 2 exposure to online postings, but mediation did not buffer associations between exposure and use. Intervention and prevention efforts should be geared towards targeting risky content adolescents are exposed to online, and what parenting behaviors may be effective in attenuating associations between online substance exposure and use. Highlights: Social media platforms provide a new space for substance use portrayals to occur Perceived exposure to such portrayals was linked with greater marijuana use, alcohol use, and to some extent e-cigarette use, over time These associations were not moderated by parent active or restrictive mediation practices [ABSTRACT FROM AUTHOR]

Background: Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. Objective: To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. Methods: We surveyed VHE (n = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. Results: The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p < 0.001), but not for problematic substance use alone, compared to VHE with neither pain nor problematic substance use. In analyses limited to VHE with chronic pain, those on long-term opioids were less likely to report an unfavorable experience (OR = 0.49, 95%CI 0.34–0.69). Receipt of occupational therapy was associated with lower odds of reporting an unfavorable experience (OR = 0.83, 95%CI 0707–0.98). PCQ-H items related to trust, relationships, and provider communication had the greatest differences in dissatisfaction ratings (all p < 0.001). Conclusions: Chronic pain is associated with unfavorable primary care experiences among VHE, potentially contributing to poor care outcomes. Strategies are needed to enhance patient-provider trust and communication and increase VHE's access to effective pain treatments. [ABSTRACT FROM AUTHOR]

Background: Spirituality is an important component of recovery for many individuals with substance use disorder (SUD). However, few studies have compared patient and physician attitudes on spirituality in SUD recovery. Objective: This study investigates patient and physician beliefs about the role of spirituality in SUD recovery and about discussing spirituality in relationship to recovery in primary care settings. Design: Semi-structured interviews were conducted with primary care physicians recruited at two academic hospitals, and patients recruited from a faith-based residential therapeutic community. Interview transcripts were independently coded by two researchers and a grounded theory approach was used to generate themes that reflected participants' experiences. Key Results: Interviews were conducted with 15 patients and 10 physicians. Patients had diverse views about the impact of spirituality on their SUD recovery, including positive, negative, and neutral. Patient and physician opinions on discussing spirituality in a primary care setting differed: most physicians felt positively towards this, believing that understanding their patients' spirituality helped them care for their patients as whole people. Many patients felt neutral, stating that they did not feel like these conversations were necessary for their care, and that they believed physicians preferred not to discuss spirituality in medical settings. Tolerance from both the patient and physician, open-ended questioning, and an individualized approach were identified as facilitators to effective discussions about spirituality and recovery. Conclusions: Spirituality can have diverse effects on an individual's SUD recovery. Physicians endorsed the benefits of discussing spirituality in the context of their patients' recovery, while patients expressed reservations about engaging in these conversations with their physicians. This variation in perspectives highlights the need for additional research to understand the individual and structural factors that contribute to it, as well as best practices for engaging in effective, non-judgmental conversations about spirituality in recovery. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Chemsex means substance use in a sexual context and is associated with men who have sex with men. Typical substances are methamphetamines, GHB/GBL, ketamine and mephedrone. Chemsex is associated with psychological distress. Internalized homonegativity is considered an explanatory approach. The study tests the hypothesis whether chemsex behavior is associated with higher levels of psychological distress and internalized homonegativity and what role georeferenced dating apps play in chemsex users. Methodology: The data collection was conducted as an online survey. Data were collected on depression (PHQ-9), somatization (PHQ-15) and generalized anxiety (GAD 7) and internalized homonegativity (Reaction to Homosexuality Scale). Results: N=280 reported chemsex (CS), N=534 used other substances in a sexual context, N= 170 did not use in a sexual context (NSSK). There were significant differences between CS and NSSK in terms of somatization. CS showed a significantly lower degree of internalized homonegativity. CS used georeferenced dating apps significantly more often. Conclusion: Internalized homonegativity was lowest among chemsex users and does not appear to promote chemsex behavior. Psychological distress was increased. It is possible that social normalization processes, reinforced by the use of dating apps, contribute to the explanation of chemsex. [ABSTRACT FROM AUTHOR]

Substance use among youth is associated with adverse consequences and may increase vulnerability to addiction and psychiatric disorders later in life. Sociocultural factors such as discrimination have been associated with substance use, while positive cultural resources, such as enculturation and familism, have demonstrated protective outcomes. However, few studies have highlighted how family factors influence substance use among Latinx youth during their transition from adolescence to young adulthood. This study used longitudinal data to explore the associations between sociocultural factors, family factors, childhood adversity, and substance use among Latinx youth. The data were from a longitudinal study of acculturation and substance use among Latinx youth in Southern California (n = 1257, 52.1% female, mixed socioeconomic status). The average age was 14.5 (SD = 0.39). Data collection began in 2005 and ended in 2016. Hierarchical regression models showed that discrimination was associated with higher problematic alcohol susceptibility. Childhood adversity was associated with higher odds of tobacco, alcohol, and marijuana use. Parental communication was associated with lower odds of problematic alcohol and marijuana use. To promote youth well‐being, preventive efforts should prioritize reducing childhood adversity and discrimination, while fostering positive family relationships. Overall, our findings suggest the need for interventions targeting various systemic levels to effectively address substance use among Latinx youth. [ABSTRACT FROM AUTHOR]