Drug and alcohol review最新文献

Introduction: In Canada, the COVID-19 pandemic collided with an ongoing overdose crisis driven by a toxic unregulated drug supply. Public health guidance intended to limit transmission of COVID-19 (e.g., social distancing) directly contradicted guidance responding to the ongoing overdose crisis (e.g., never use drugs alone), exacerbating harms among people reliant on the toxic unregulated drug supply. While existing literature characterises many harms associated with consuming unregulated drugs during COVID-19, less is known about the specific impacts on women. We explored the perspectives of women who use unregulated drugs and experienced socio-economic marginalisation on how the COVID-19 environment shaped their overdose risk in British Columbia, Canada.

Methods: We conducted semi-structured interviews remotely with 45 participants between May 2020 and September 2021, and analysed the data thematically using a social violence framework.

Results: Participants identified contamination of the unregulated drug supply, particularly with benzodiazepines, as a significant driver of overdose and gendered violence among women who use drugs. 'Social distancing' guidelines (e.g., guest restrictions in supportive housing, reduced capacity in harm reduction services) compounded these risks and resulted in more women using drugs alone, reducing opportunities for timely overdose intervention. In response, participants practiced individualised acts of caregiving (e.g., establishing informal networks that regularly check on each other) to mitigate the risks of overdose and gendered violence for themselves and their community.

Discussion and conclusions: These intersecting health crises perpetuated individualised approaches to addressing the risks of overdose and gendered violence, rather than addressing underlying social and structural drivers of these risks.

Issues: Creating and implementing a plan to successfully quit smoking likely requires executive function (EF) skills such as inhibition, cognitive flexibility, attention and working memory. This scoping review consolidates the research evidence evaluating the role of EF in smoking cessation.

Approach: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), researchers and a medical librarian searched PubMed, EMBASE, ERIC, CINAHL and PSYCINFO in June 2022, hand-search in September 2022 using relevant MeSH terms, and an updated search was completed in August 2024.

Key findings: Fifteen articles were included. Self-regulation was the most frequently evaluated EF across all studies. Performance on measures of impulsivity was most frequently related to successful smoking cessation. Across studies, performance on measures in areas of attention, working memory, cognitive flexibility and higher-level EF was variable as it relates to smoking cessation success. There was considerable variability in the measures used to evaluate EF and definitions of cessation success. Across studies, very little research evaluates higher-level EF.

Implications and conclusion: Differences in EF and cessation measures make comparisons across studies difficult. Future work is needed utilising common assessment and outcome measures that will improve our understanding of the complex cognitive skills needed for successful cessation. Particular consideration should be given to higher-level EFs including reasoning, planning, problem-solving and decision-making.

Introduction: It is well established that a gradient exists among cigarette smokers, such that smoking is more prevalent among individuals who are of lower socio-economic status (SES). In this study, we examined whether a similar SES gradient exists among electronic cigarette (e-cigarette) using youth and adults in three Canadian jurisdictions.

Methods: A secondary analysis of data from Ontario, Quebec and Yukon respondents (n = 58,592) to the 2017-2018 Canadian Community Health Survey was conducted. Unadjusted and adjusted logistic regression models explored SES measures: total and relative household income, and education level, separately on use of e-cigarettes or cigarettes in the past 30 days. Models adjusted for additional socio-demographic and psychosocial covariates.

Results: A significant inverse SES gradient existed for cigarette smoking based on education and income variables, with higher education and income associated with decreasing consumption in a stepwise manner. No SES gradient was observed for e-cigarettes.

Discussion and conclusions: While a robust SES gradient was observed among cigarette smokers, no gradient for e-cigarette use was observed. Explanations for these findings may be linked to perceptions that e-cigarettes are healthier, have convenient designs and appealing flavours, and less stigmatised. As more becomes known about potential harms from e-cigarettes, effective interventions may be needed to prevent the emergence of a gradient that disproportionately affects those at lowest income and education levels. Continued monitoring of e-cigarette use patterns across SES groups is necessary for public health.

Introduction: Alcohol's harms to others (AHTO) refers to the negative effects experienced by individuals other than the drinker. This study investigates the prevalence and risk factors of AHTOs among US college students (sophomores/juniors), based on the first national probability-based survey conducted in 20 years.

Methods: We assessed AHTOs in the fall of 2021 from 1918 participants across 46 US schools, weighting the data to reflect the US undergraduate sophomore/junior population. We combined survey weights and prevalence estimates to approximate the number of sophomores/juniors in the US college population who experienced each AHTO. Once weighted, the sampling method was designed to be representative of sophomores/juniors. We used multivariate logistic regression with clustered standard errors to estimate the likelihood of each AHTO domain and any AHTO for demographic and behavioural risk and protective factors.

Results: Half (53.5%) of our sample reported experiencing at least one AHTO, which corresponds to nearly 6 million US sophomores/juniors. Students who were White; attended 4-year schools; identified as cisfemale or transgender, gender nonconforming, or 2+ identities; of higher socioeconomic status (as indicated by parent's highest level of education); lived with roommates; and/or participated in Greek organisations or intercollegiate athletics had a higher likelihood of AHTOs.

Discussion and conclusions: Our findings demonstrate that AHTOs, including academic, physical and sexual harms, are prevalent on college campuses. These results suggest that colleges likely underestimate the impact of alcohol on their students. Therefore, broadening and strengthening campus and state-level policies and strategies to prevent and reduce these harms effectively are needed.

Introduction: Alcohol consumption is a global health issue linked to over 200 diseases and accounts for 5.3% of all deaths annually. We aimed to determine the sociodemographic factors associated with alcohol consumption among Cambodian women and men aged 15-49 years.

Methods: We used data from the 2022 Cambodia Demographic and Health Survey, including 19,496 women and 8825 men aged 15-49. Multiple logistic regressions were performed using STATA V18 to examine factors associated with alcohol consumption.

Results: Nearly 70% of men (95% CI 67.6-70.9) and 16.3% of women (95% CI 15.3-17.3) reported consuming alcohol in the past months. Among men, predictors of alcohol consumption, including those aged 19-24 years, had higher odds of consuming alcohol than the younger ages ≤18 years (AOR 2.14; 95% CI 1.65-2.77). Married men consumed alcohol more than unmarried men and smokers had higher odds of alcohol use than non-smokers with AOR 1.80 (95% CI 1.52-2.14). Similar patterns were found among women, including increased ages, marriage and smoking were predictors of alcohol consumption.

Discussion and conclusions: The study highlights the high prevalence of alcohol consumption among the Cambodian adult population, particularly among men. For both sexes, increased ages greater than 18 years, those who were married, had jobs, and smoking were the main predictors of alcohol consumption. Health promotion efforts should be focused on younger adults aged 19-24, who are increasingly engaging in risky behaviours, including alcohol intake and smoking, by raising awareness about the health consequences of harmful alcohol consumption.

Introduction: As part of several measures to inform consumers about the health risks of alcohol, the Irish Government signed into law the Public Health (Alcohol) Act 2018, with Section 13 requiring the implementation of multiple health warnings in all alcohol ads. Although health warnings on product labels have been subject to intensive political discussion and academic research, health warnings in alcohol ads have received little attention.

Methods: A between-subject factorial survey experiment was conducted with a convenience sample of adults in Ireland (n = 932) to compare single-text, multiple-text and shocking image-and-text health warnings displayed on two types of static alcohol ads-an ad with social imagery featuring people drinking alcohol and an ad featuring only the alcohol product. Believability of health warnings, negative emotions, perceived risks of alcohol use and self-efficacy to drink less were measured after viewing each alcohol ad with or without health warnings.

Results: Single-text health warnings, with and without shocking imagery, were more effective in increasing negative emotions than multiple-text health warnings (p ≤ 0.001), whereas multiple-text warnings were found to be more believable than single-text warnings (p ≤ 0.001). No significant effects were found on perceived risks of alcohol use and self-efficacy to drink less (p > 0.05). The warnings did not differ across demographic groups and the type of alcohol ads on all outcomes (p > 0.05).

Discussions and conclusions: A single health warning emphasising cancer risk could be a useful starting point for policymakers when implementing health warnings in alcohol ads.

Issue: There is growing awareness of the benefits of treating patients in their own home, yet home-based detoxification of individuals with substance use disorder has received limited attention. While home-based alcohol detoxification seems to be safe and effective for patients without severe withdrawal, little is known about detoxification for illicit or polysubstance dependence. This review synthesises recent findings on home-based detoxification for alcohol and other substances.

Approach: A systematic search of published and unpublished studies from 2010 onwards was conducted. Studies describing home detoxification interventions and programs, along with qualitative, quantitative and mixed-methods research, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Findings were narratively synthesised.

Key findings: Eleven publications were included. Many studies are descriptive, explorative or use a small sample, but four studies are of high quality. Five publications focused exclusively on alcohol detoxification. The outcomes in reducing or abstaining from substance use seem acceptable, except for opioids. Patients and families reported high satisfaction, viewing it as less stressful than inpatient care. However, no conclusions can be drawn regarding the effectiveness compared to other detoxification settings.

Implications: The limited evidence base illustrates a great need for further investigation and controlled trials of home-based detoxification and comparison between detoxification settings. Investigating the broader applicability across substances is crucial.

Conclusion: Home-based detoxification shows potential as a safe and patient-preferred intervention, though more research is required to assess its broader effectiveness and feasibility across various substances. It could play a valuable role within established care models.

Introduction: Alcohol contributes significantly global disease burden. Over 50 countries, including Canada, have established low-risk drinking guidelines to reduce alcohol-related harm. Canada's Guidance on Alcohol and Health (CGAH) was released in 2023. This study examines the relationship between weekly alcohol consumption, CGAH risk zones and mortality patterns among Canadian drinkers aged 15 and older.

Methods: A retrospective cohort study was conducted using data from three cycles of the national, population-based Canadian Community Health Survey (2000-2006) linked to mortality data up to 2017. The sample included 145,760 respondents aged 15 and older who reported alcohol consumption in the past week. Average weekly alcohol consumption was assessed using the Timeline Followback method (i.e., 7-day recall). Outcomes included all-cause mortality, alcohol-related mortality and mortality from conditions with an alcohol-attributable fraction ≥15%.

Results: Alcohol consumption was significantly positively associated with increased risks of all-cause (hazard ratio = 1.01, p < 0.001), alcohol-related (hazard ratio = 1.01, p = 0.001) and alcohol-attributable fraction-related mortality (hazard ratio = 1.02, p < 0.001). Each additional standard drink per week raised mortality risk, with women experiencing a greater increase in risk compared to men.

Discussion and conclusion: The findings support the CGAH recommendations, highlighting the importance of lower alcohol consumption limits to reduce health risks. Public health efforts should focus on increasing awareness and adherence to these guidelines, particularly among women who face greater mortality risks at higher consumption levels. Ongoing monitoring of alcohol consumption is critical for tracking and evaluating low-risk drinking guideline effectiveness in reducing alcohol-related harm.

Introduction: Reducing alcohol affordability reduces alcohol-related harm but its impact on socio-economic inequalities requires further study. We examine changes in alcohol-attributable mortality inequalities in Finland during periods of sharply rising (2000-2007) and falling (2008-2017) alcohol affordability.

Methods: Linking individual-level register data on causes of death and socio-demographics for the Finnish population aged ≥25 in 2000-2017 (68 million person-years), we analysed age-standardised monthly alcohol-attributable mortality rates by sex and income quintile (n = 32,699 alcohol-attributable deaths). Regression models were used to analyse mortality trends in the two periods, contrasting high- and low-income groups.

Results: Inequalities in alcohol-attributable mortality between low- and high-income groups were large throughout the study period. During the period of rising alcohol affordability, mortality increased among high-income men with an average monthly increase of 0.17% (p = 0.046). This rate was even higher among low-income men, increasing by 0.55% per month, that is, +0.38 percentage points more than the rate for high-income men (p = 0.002). Among women, mortality increased at similar rates in both income groups. During the period of falling alcohol affordability, mortality decreased among high-income men with an average monthly decrease of -0.21% (p < 0.001), and it decreased even more among low-income men (-0.40%, i.e., -0.19 percentage points more, p = 0.030). Among women, the decreases were not statistically significant.

Discussion and conclusions: The results indicate that increased alcohol affordability was associated with widening socio-economic inequalities while reduced affordability was linked with narrowing inequalities among men. Reducing alcohol affordability is thus a recommendable policy for reducing socio-economic inequality in alcohol-related harm.

Introduction: A growing body of evidence has established alcohol consumption as a causative factor in an increasing array of cancer types, thereby positioning it as a leading global risk factor for cancer. Surprisingly, there is a scarcity of studies examining the extent to which shifts in population drinking affect cancer mortality, despite the substantial public health implications. This paper aims to: (i) estimate the impact of changes in per capita alcohol consumption on both overall cancer mortality rates and specific types of alcohol-related cancer; and (ii) assess whether the association between cancer and population alcohol consumption is influenced by a country's drinking patterns.

Methods: We used time-series data for 19 high-income countries spanning the period 1960-2018. Cigarette sales and GDP per capita were included as control variables. The data were analysed using first-difference modelling. The World Health Organization drinking patterns score was used to evaluate a country's drinking pattern.

Results: Our findings revealed that a 1 L per capita increase in alcohol consumption was associated with a 0.9% rise in total cancer mortality among women and a 1.1% increase among men. Notably, among men, the association was more pronounced for cancers with strong evidence of alcohol's effect and for prostate cancer. For women, the alcohol effect was statistically significant for breast cancer. Generally, the estimated alcohol effects were elevated in the country group with more harmful drinking patterns.

Discussion and conclusions: Our results indicate that lowering per capita alcohol consumption is likely to reduce cancer mortality.