Pub Date : 2025-12-29DOI: 10.1016/j.drugalcdep.2025.113019
Allison M. Glasser , Jessica K. Jensen , Kymberle L. Sterling , Andrea C. Villanti
Introduction
Blunts (cigars with tobacco replaced or mixed with cannabis) incur health risks from exposure to tobacco and cannabis and are disproportionately used by young adults, people identifying as Black/African American (B/AA), people with lower socioeconomic status (SES), and people with mental health issues. This study described patterns of blunt use among US adults with multiple identities or circumstances increasing risk for blunt use.
Methods
We used Wave 6 (2021) (US adults; N = 30,516) of the Population Assessment of Tobacco and Health Study to examine the association between current blunt use and race (B/AA vs. non-B/AA) + mental health (symptoms of internalizing/externalizing conditions) and socioeconomic status (SES; receipt of government assistance) using weighted multivariable logistic regression models, stratified by age (young adults [YAs] 18–34 vs. adults 35 + years).
Results
In 2021, 8.4 % of YAs and 1.4 % of adults 35 + currently used blunts. Compared to people with joint advantage (e.g., non-B/AA + high SES), those identifying as B/AA with low SES (aOR=5.10, 95 % CI=4.16–6.26), high internalizing (aOR=4.83, 95 % CI=3.70–6.32), or externalizing conditions (aOR=4.74, 95 % CI=3.47–6.48) had greater odds of using blunts. The magnitude of the association between identifying as B/AA and having low SES (alone and jointly) and blunt use was greater among adults 35 + years (vs. YAs).
Conclusions
Blunt use was most prevalent among B/AA adults with low SES or those who experienced mental health conditions. The magnitude of some inequities was greater among adults 35 + . Social and structural interventions to reduce blunt use among US adults could improve health equity.
{"title":"Inequities in blunt use across multiple socio-demographic intersections among US adults","authors":"Allison M. Glasser , Jessica K. Jensen , Kymberle L. Sterling , Andrea C. Villanti","doi":"10.1016/j.drugalcdep.2025.113019","DOIUrl":"10.1016/j.drugalcdep.2025.113019","url":null,"abstract":"<div><h3>Introduction</h3><div>Blunts (cigars with tobacco replaced or mixed with cannabis) incur health risks from exposure to tobacco and cannabis and are disproportionately used by young adults, people identifying as Black/African American (B/AA), people with lower socioeconomic status (SES), and people with mental health issues. This study described patterns of blunt use among US adults with multiple identities or circumstances increasing risk for blunt use.</div></div><div><h3>Methods</h3><div>We used Wave 6 (2021) (US adults; N = 30,516) of the Population Assessment of Tobacco and Health Study to examine the association between current blunt use and race (B/AA vs. non-B/AA) + mental health (symptoms of internalizing/externalizing conditions) and socioeconomic status (SES; receipt of government assistance) using weighted multivariable logistic regression models, stratified by age (young adults [YAs] 18–34 vs. adults 35 + years).</div></div><div><h3>Results</h3><div>In 2021, 8.4 % of YAs and 1.4 % of adults 35 + currently used blunts. Compared to people with joint advantage (e.g., non-B/AA + high SES), those identifying as B/AA with low SES (aOR=5.10, 95 % CI=4.16–6.26), high internalizing (aOR=4.83, 95 % CI=3.70–6.32), or externalizing conditions (aOR=4.74, 95 % CI=3.47–6.48) had greater odds of using blunts. The magnitude of the association between identifying as B/AA and having low SES (alone and jointly) and blunt use was greater among adults 35 + years (vs. YAs).</div></div><div><h3>Conclusions</h3><div>Blunt use was most prevalent among B/AA adults with low SES or those who experienced mental health conditions. The magnitude of some inequities was greater among adults 35 + . Social and structural interventions to reduce blunt use among US adults could improve health equity.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113019"},"PeriodicalIF":3.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-25DOI: 10.1016/j.drugalcdep.2025.113015
R. Vilardaga , F.J. McClernon , O. Akingbule , P. Mannelli , S.M. Thomas , J.M. Davis , M.F. Gray , C. Arnold , I. Chow Kai Reyes , R. Ashare , M. Paukner , L.R. Pacek
Introduction
Tobacco use is disproportionately prevalent among people living with HIV (PWH) and is a significant contributor to morbidity and mortality in this population. Reaching communities of PWH to facilitate smoking cessation is challenging. Digital Therapeutics (DTx) can facilitate widespread implementation and adoption of smoking cessation treatments for PWH.
Methods
We compared the feasibility and acceptability (primary outcomes) and preliminary efficacy (secondary outcome) of a DTx tailored to PWH -- Learn to Quit-HIV (LTQ-H) -- versus a gold standard smoking cessation DTx (QuitGuide) in a remote pilot randomized controlled trial. All participants received nicotine replacement therapy and were assessed at weeks 4, 8, and 12.
Results
During a 13-month period, we remotely recruited a sample of PWH (n = 41) across the United States, with randomization leading to a higher proportion of LTQ-H users with high levels of cannabis use. Digital markers of DTx use indicated that compared to QuitGuide, assignment to LTQ-H led to significantly greater number of device interactions (3610 vs 2086; RR=93.14; 95 % CI: 14.70–590; p < 0.001), and a four-fold increase in mean interactions with active smoking cessation content (8.5 vs. 2.15; Cohen’s d=0.91; p < 0.001). At week 12, in an adjusted model, LTQ-H resulted in numerically greater, but not statistically significant, biochemically verified 7-day point prevalence abstinence versus QuitGuide (18.2 % vs 15.8 %; aOR=6.97, 95 % CI: 0.65–74.33).
Conclusions
While participants assigned to LTQ-H had proportionally more features known to predict low quit rates (e.g. cannabis use), LTQ-H showed promising population reach, device engagement, and smoking outcomes. A hybrid effectiveness-implementation trial will evaluate this novel DTx in a larger sample of PWH.
Implications
The study highlights the potential of DTx to address the high prevalence of tobacco use among people with HIV. Compared to QuitGuide (gold standard DTx developed by NCI), LTQ-H showed promising participant engagement and smoking cessation outcomes. These findings suggest that LTQ-H could be a valuable tool for smoking cessation in people with HIV, warranting further investigation in larger trials to evaluate its effectiveness and implementation feasibility.
烟草使用在艾滋病毒感染者（PWH）中不成比例地普遍，并且是该人群发病率和死亡率的重要因素。向PWH社区宣传戒烟是一项挑战。数字疗法（DTx）可以促进PWH戒烟治疗的广泛实施和采用。方法：在一项远程随机对照试验中，我们比较了针对PWH - Learn to Quit-HIV （LTQ-H）量身定制的DTx与金标准戒烟DTx （QuitGuide）的可行性、可接受性（主要结局）和初步疗效（次要结局）。所有参与者都接受尼古丁替代疗法，并在第4、8和12周进行评估。结果在13个月的时间里，我们远程招募了美国各地的PWH样本（n = 41），随机化导致LTQ-H使用者中高水平大麻使用的比例更高。DTx使用的数字标记表明，与QuitGuide相比，LTQ-H的分配显著增加了设备相互作用的数量（3610 vs 2086； RR=93.14; 95% CI: 14.70-590; p < 0.001），并且与主动戒烟内容的平均相互作用增加了四倍（8.5 vs 2.15; Cohen 's d=0.91; p < 0.001）。在第12周，在调整后的模型中，LTQ-H与QuitGuide相比，在生物化学上验证的7天点患病率禁欲在数值上更大，但在统计学上不显著（18.2% vs 15.8%; aOR=6.97, 95% CI: 0.65-74.33）。虽然分配到LTQ-H的参与者在预测低戒烟率（例如大麻使用）方面具有比例更多的已知特征，但LTQ-H显示出有希望的人口覆盖率、设备参与度和吸烟结果。一项混合有效性实施试验将在更大的PWH样本中评估这种新型DTx。该研究强调了DTx在解决艾滋病毒感染者中烟草使用高流行率方面的潜力。与QuitGuide （NCI开发的黄金标准DTx）相比，LTQ-H显示出良好的参与者参与度和戒烟效果。这些发现表明，LTQ-H可能是艾滋病毒感染者戒烟的一种有价值的工具，值得在更大规模的试验中进一步研究，以评估其有效性和实施可行性。
{"title":"Population reach, feasibility and acceptability of digital therapeutics for smoking cessation among people living with HIV: Results of the Quitting Matters pilot trial","authors":"R. Vilardaga , F.J. McClernon , O. Akingbule , P. Mannelli , S.M. Thomas , J.M. Davis , M.F. Gray , C. Arnold , I. Chow Kai Reyes , R. Ashare , M. Paukner , L.R. Pacek","doi":"10.1016/j.drugalcdep.2025.113015","DOIUrl":"10.1016/j.drugalcdep.2025.113015","url":null,"abstract":"<div><h3>Introduction</h3><div>Tobacco use is disproportionately prevalent among people living with HIV (PWH) and is a significant contributor to morbidity and mortality in this population. Reaching communities of PWH to facilitate smoking cessation is challenging. Digital Therapeutics (DTx) can facilitate widespread implementation and adoption of smoking cessation treatments for PWH.</div></div><div><h3>Methods</h3><div>We compared the feasibility and acceptability (primary outcomes) and preliminary efficacy (secondary outcome) of a DTx tailored to PWH -- Learn to Quit-HIV (LTQ-<em>H</em>) -- versus a gold standard smoking cessation DTx (QuitGuide) in a remote pilot randomized controlled trial. All participants received nicotine replacement therapy and were assessed at weeks 4, 8, and 12.</div></div><div><h3>Results</h3><div>During a 13-month period, we remotely recruited a sample of PWH (n = 41) across the United States, with randomization leading to a higher proportion of LTQ-<em>H</em> users with high levels of cannabis use. Digital markers of DTx use indicated that compared to QuitGuide, assignment to LTQ-<em>H</em> led to significantly greater number of device interactions (3610 vs 2086; RR=93.14; 95 % CI: 14.70–590; p < 0.001), and a four-fold increase in mean interactions with active smoking cessation content (8.5 vs. 2.15; Cohen’s d=0.91; p < 0.001). At week 12, in an adjusted model, LTQ-<em>H</em> resulted in numerically greater, but not statistically significant, biochemically verified 7-day point prevalence abstinence versus QuitGuide (18.2 % vs 15.8 %; aOR=6.97, 95 % CI: 0.65–74.33).</div></div><div><h3>Conclusions</h3><div>While participants assigned to LTQ-<em>H</em> had proportionally more features known to predict low quit rates (e.g. cannabis use), LTQ-<em>H</em> showed promising population reach, device engagement, and smoking outcomes. A hybrid effectiveness-implementation trial will evaluate this novel DTx in a larger sample of PWH.</div></div><div><h3>Implications</h3><div>The study highlights the potential of DTx to address the high prevalence of tobacco use among people with HIV. Compared to QuitGuide (gold standard DTx developed by NCI), LTQ-<em>H</em> showed promising participant engagement and smoking cessation outcomes. These findings suggest that LTQ-<em>H</em> could be a valuable tool for smoking cessation in people with HIV, warranting further investigation in larger trials to evaluate its effectiveness and implementation feasibility.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113015"},"PeriodicalIF":3.6,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.drugalcdep.2025.113017
Sharon Cox , Lion Shahab , Claire Garnett , Nicola Lindson , Sarah Jackson
Background and aims
Smoking rates remain higher among individuals from less advantaged social grades, who tend to be less successful when they try to quit. Abrupt quitting may be more successful than cutting down first, though evidence is mixed. It is not clear whether the quit methods chosen, and their effects, differ by social grade. This study aimed to: (1) compare the prevalence of gradual versus abrupt quit attempts across social grades; (2) examine the association between quit method and quit success; and (3) assess whether social grade moderates this association.
Methods
We used data from 27,390 adults in England who reported a past-year quit attempt in the Smoking Toolkit Study (2006–2025). Quit method used (gradual vs. abrupt) and quitting success were self-reported. Logistic regression analyses examined the two-way interaction between quit method and social grade (ABC1 =more advantaged vs. C2DE=less advantaged) and success, adjusting for sociodemographic and smoking-related covariates.
Results
People from less advantaged social grades were less likely to attempt to quit abruptly (53.2 % [95 % CI: 52.3–54.0 %] vs. 57.4 % [56.4–58.4 %]). Abrupt quitting was associated with higher odds of success compared with gradual quitting (OR = 1.70; 95 % CI: 1.58–1.84) providing no clear evidence this was moderated by social grade (interaction OR = 1.13; 95 % CI: 0.97–1.33, p = 0.14).
Conclusion
People who choose to quit abruptly are more likely to quit successfully than people who choose to quit gradually, irrespective of their social grade. However, people from less advantaged social grades are less likely to choose to quit abruptly.
{"title":"Are there differences in gradual versus abrupt smoking cessation quit attempts and success by social grade? A population study in England","authors":"Sharon Cox , Lion Shahab , Claire Garnett , Nicola Lindson , Sarah Jackson","doi":"10.1016/j.drugalcdep.2025.113017","DOIUrl":"10.1016/j.drugalcdep.2025.113017","url":null,"abstract":"<div><h3>Background and aims</h3><div>Smoking rates remain higher among individuals from less advantaged social grades, who tend to be less successful when they try to quit. Abrupt quitting may be more successful than cutting down first, though evidence is mixed. It is not clear whether the quit methods chosen, and their effects, differ by social grade. This study aimed to: (1) compare the prevalence of gradual versus abrupt quit attempts across social grades; (2) examine the association between quit method and quit success; and (3) assess whether social grade moderates this association.</div></div><div><h3>Methods</h3><div>We used data from 27,390 adults in England who reported a past-year quit attempt in the Smoking Toolkit Study (2006–2025). Quit method used (gradual vs. abrupt) and quitting success were self-reported. Logistic regression analyses examined the two-way interaction between quit method and social grade (ABC1 =more advantaged vs. C2DE=less advantaged) and success, adjusting for sociodemographic and smoking-related covariates.</div></div><div><h3>Results</h3><div>People from less advantaged social grades were less likely to attempt to quit abruptly (53.2 % [95 % CI: 52.3–54.0 %] vs. 57.4 % [56.4–58.4 %]). Abrupt quitting was associated with higher odds of success compared with gradual quitting (OR = 1.70; 95 % CI: 1.58–1.84) providing no clear evidence this was moderated by social grade (interaction OR = 1.13; 95 % CI: 0.97–1.33, <em>p</em> = 0.14).</div></div><div><h3>Conclusion</h3><div>People who choose to quit abruptly are more likely to quit successfully than people who choose to quit gradually, irrespective of their social grade. However, people from less advantaged social grades are less likely to choose to quit abruptly.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113017"},"PeriodicalIF":3.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.drugalcdep.2025.113016
Dae-Hee Han , Tahsin Rahman , Richard A. Miech , Alyssa F. Harlow , Hongying D. Dai , Junhan Cho , Steve Y. Sussman , Louisiana M. Sanchez , Leah R. Meza , Adam M. Leventhal
Introduction
Evidence on the association between tobacco/nicotine and other substance use (TOSU) and adolescent nicotine pouch (NP) awareness and use is lacking but vital for policy and prevention planning.
Methods
The sample was drawn from the 2023 Monitoring the Future study, a nationally representative survey of U.S. adolescents (8th, 10th, 12th graders). One-third of participants were randomly selected to complete questions on NP awareness and use (lifetime, past 12-month, past 12-month frequency) and past 30-day TOSU measures (yes/no). We estimated risk ratios (RRs) and incident rate ratios (IRRs) to examine the associations between TOSU and NP awareness and use.
Results
Overall (n = 6958; 53.4 % female), 35.4 % reported NP awareness, 2.5 % reported lifetime use, and 1.8 % reported past 12-month use. Past 30-day use of tobacco/nicotine products was each positively associated with NP awareness (RRs:1.42–1.70), lifetime (RRs:7.14–20.40), and past 12-month (RRs:5.84–22.44) use, with the strong associations for youth with vs. without smokeless tobacco use. Cannabis, alcohol, and other drug past 30-day use were each associated with NP awareness (RRs:1.49–1.68), lifetime (RRs:3.47–10.49), and past 12-month (RRs:4.70–15.70) use.
Conclusions
NP awareness and use prevalence were disproportionately high among adolescents with various forms of TOSU in 2023, especially smokeless tobacco. These findings suggest the importance of monitoring NP use among youth with TOSU while recognizing that awareness may also reflect broader marketing, product availability, or incidental exposure. Policy and prevention efforts should address NP use alongside TOSU with established health risks.
{"title":"Association of tobacco and other substance use with nicotine pouch awareness and use in US adolescents","authors":"Dae-Hee Han , Tahsin Rahman , Richard A. Miech , Alyssa F. Harlow , Hongying D. Dai , Junhan Cho , Steve Y. Sussman , Louisiana M. Sanchez , Leah R. Meza , Adam M. Leventhal","doi":"10.1016/j.drugalcdep.2025.113016","DOIUrl":"10.1016/j.drugalcdep.2025.113016","url":null,"abstract":"<div><h3>Introduction</h3><div>Evidence on the association between tobacco/nicotine and other substance use (TOSU) and adolescent nicotine pouch (NP) awareness and use is lacking but vital for policy and prevention planning.</div></div><div><h3>Methods</h3><div>The sample was drawn from the 2023 Monitoring the Future study, a nationally representative survey of U.S. adolescents (8th, 10th, 12th graders). One-third of participants were randomly selected to complete questions on NP awareness and use (lifetime, past 12-month, past 12-month frequency) and past 30-day TOSU measures (yes/no). We estimated risk ratios (RRs) and incident rate ratios (IRRs) to examine the associations between TOSU and NP awareness and use.</div></div><div><h3>Results</h3><div>Overall (n = 6958; 53.4 % female), 35.4 % reported NP awareness, 2.5 % reported lifetime use, and 1.8 % reported past 12-month use. Past 30-day use of tobacco/nicotine products was each positively associated with NP awareness (RRs:1.42–1.70), lifetime (RRs:7.14–20.40), and past 12-month (RRs:5.84–22.44) use, with the strong associations for youth with vs. without smokeless tobacco use. Cannabis, alcohol, and other drug past 30-day use were each associated with NP awareness (RRs:1.49–1.68), lifetime (RRs:3.47–10.49), and past 12-month (RRs:4.70–15.70) use.</div></div><div><h3>Conclusions</h3><div>NP awareness and use prevalence were disproportionately high among adolescents with various forms of TOSU in 2023, especially smokeless tobacco. These findings suggest the importance of monitoring NP use among youth with TOSU while recognizing that awareness may also reflect broader marketing, product availability, or incidental exposure. Policy and prevention efforts should address NP use alongside TOSU with established health risks.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113016"},"PeriodicalIF":3.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.drugalcdep.2025.113008
Mallet R. Reid , Blake Reynolds , Jacqueline Cape , Zara Ahmed , Hashim Ali , Edgar Jaimes-Bautista , Connor Gott , Arturo Barajas , Frank Müller , Omayma Alshaarawy
Background
Several groups of people of color have a higher prevalence and more severe cases of cannabis use disorder (CUD) compared to White people. They also endure unique issues like racial discrimination, which are linked with an increased likelihood of CUD. We conducted a systematic review to identify the number of people of color in CUD behavioral health RCTs and whether researchers designed interventions to address people of color’s unique challenges.
Methods
We systematically searched PubMed, PsycINFO, and ClinicalTrials.gov for CUD behavioral health RCTs implemented in the United States for adults. We identified 14 out of 966 from 1994 to 2025 for review (12 published, two in ClinicalTrials.gov, completed but not published).
Results
White people comprise ~64 % of all participants, and were included at rates 49 times greater than their share of CUD cases. Black people comprise ~19 %, Latiné people 5 %, multiracial/other 0.8 %, Asians 0.6 %, and Indigenous people 0.4 %. No studies were culturally adapted or were designed to address people of color’s unique challenges (e.g., racial discrimination). Racial sample diversity has not improved over time.
Discussion
People of color are significantly underincluded in CUD RCTs despite their heightened prevalence and CUD severity. This limits research’s generalizability and applicability to people of color. Further, the lack of research into people of color’s unique challenges may hinder therapists from meeting the full range of people of color’s needs. Finally, despite decades of calls to increase racial sample diversity in RCTs, people of color’s inclusion has remained low in CUD RCTs.
{"title":"Racial diversity in cannabis use disorder research: A systematic review","authors":"Mallet R. Reid , Blake Reynolds , Jacqueline Cape , Zara Ahmed , Hashim Ali , Edgar Jaimes-Bautista , Connor Gott , Arturo Barajas , Frank Müller , Omayma Alshaarawy","doi":"10.1016/j.drugalcdep.2025.113008","DOIUrl":"10.1016/j.drugalcdep.2025.113008","url":null,"abstract":"<div><h3>Background</h3><div>Several groups of people of color have a higher prevalence and more severe cases of cannabis use disorder (CUD) compared to White people. They also endure unique issues like racial discrimination, which are linked with an increased likelihood of CUD. We conducted a systematic review to identify the number of people of color in CUD behavioral health RCTs and whether researchers designed interventions to address people of color’s unique challenges.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, PsycINFO, and ClinicalTrials.gov for CUD behavioral health RCTs implemented in the United States for adults. We identified 14 out of 966 from 1994 to 2025 for review (12 published, two in ClinicalTrials.gov, completed but not published).</div></div><div><h3>Results</h3><div>White people comprise ~64 % of all participants, and were included at rates 49 times greater than their share of CUD cases. Black people comprise ~19 %, Latiné people 5 %, multiracial/other 0.8 %, Asians 0.6 %, and Indigenous people 0.4 %. No studies were culturally adapted or were designed to address people of color’s unique challenges (e.g., racial discrimination). Racial sample diversity has not improved over time.</div></div><div><h3>Discussion</h3><div>People of color are significantly underincluded in CUD RCTs despite their heightened prevalence and CUD severity. This limits research’s generalizability and applicability to people of color. Further, the lack of research into people of color’s unique challenges may hinder therapists from meeting the full range of people of color’s needs. Finally, despite decades of calls to increase racial sample diversity in RCTs, people of color’s inclusion has remained low in CUD RCTs.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113008"},"PeriodicalIF":3.6,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.drugalcdep.2025.113013
Kimberly Morren , Marieke Rombouts , Karin Monshouwer
Background
Substance use is bidirectionally related to perceived harmfulness of its use. While adolescent tobacco, alcohol, and cannabis use have declined over time, little is known about perceived harmfulness trends across substances and frequencies of use. This study examines 20-year harmfulness perception trends of these substances.
Methods
Data from six survey rounds (n = 40,690) of a national cross-sectional school survey on substance use in the Netherlands were used to examine trends in harmfulness perception and substance use among 12- to 16-year-old secondary school students from 2003 to 2023. Logistic regression models were performed to examine these trends.
Results
Students increasingly viewed tobacco and alcohol consumption as harmful (tobacco: occasional use: prevalence difference (PD) + 54.1 %, p < .001; daily use: PD + 2.5 %, p < .05; alcohol: ≥ 5 drinks every weekend: PD + 11.9 %, p < .001; daily use: PD + 40.3 %, p < .001). However, the perceived harmfulness perception of daily cannabis use declined (PD −5.6, p < .001). During that same time, lifetime, monthly, and daily use of tobacco, alcohol, and cannabis significantly declined (e.g., prevalence difference in monthly use; tobacco −55.0 %; alcohol −61.5 %; cannabis −44.3 %). Differences in harmfulness perception trends were observed between adolescents who used the substance in the previous month and those who did not, with a generally more pronounced change in perceived harm among those with recent use.
Conclusions
Over two decades, harmfulness perception of tobacco and alcohol increased, while cannabis perceptions remained stable or decreased. Changing perceptions, particularly the decline in perceived harmfulness of daily cannabis use, should be monitored to prevent potential future increases in use.
{"title":"Trends in perceived harmfulness of tobacco, alcohol, and cannabis and its’ use in 12–16-year-olds, from 2003 to 2023","authors":"Kimberly Morren , Marieke Rombouts , Karin Monshouwer","doi":"10.1016/j.drugalcdep.2025.113013","DOIUrl":"10.1016/j.drugalcdep.2025.113013","url":null,"abstract":"<div><h3>Background</h3><div>Substance use is bidirectionally related to perceived harmfulness of its use. While adolescent tobacco, alcohol, and cannabis use have declined over time, little is known about perceived harmfulness trends across substances and frequencies of use. This study examines 20-year harmfulness perception trends of these substances.</div></div><div><h3>Methods</h3><div>Data from six survey rounds (n = 40,690) of a national cross-sectional school survey on substance use in the Netherlands were used to examine trends in harmfulness perception and substance use among 12- to 16-year-old secondary school students from 2003 to 2023. Logistic regression models were performed to examine these trends.</div></div><div><h3>Results</h3><div>Students increasingly viewed tobacco and alcohol consumption as harmful (tobacco: occasional use: prevalence difference (PD) + 54.1 %, p < .001; daily use: PD + 2.5 %, p < .05; alcohol: ≥ 5 drinks every weekend: PD + 11.9 %, p < .001; daily use: PD + 40.3 %, p < .001). However, the perceived harmfulness perception of daily cannabis use declined (PD −5.6, p < .001). During that same time, lifetime, monthly, and daily use of tobacco, alcohol, and cannabis significantly declined (e.g., prevalence difference in monthly use; tobacco −55.0 %; alcohol −61.5 %; cannabis −44.3 %). Differences in harmfulness perception trends were observed between adolescents who used the substance in the previous month and those who did not, with a generally more pronounced change in perceived harm among those with recent use.</div></div><div><h3>Conclusions</h3><div>Over two decades, harmfulness perception of tobacco and alcohol increased, while cannabis perceptions remained stable or decreased. Changing perceptions, particularly the decline in perceived harmfulness of daily cannabis use, should be monitored to prevent potential future increases in use.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113013"},"PeriodicalIF":3.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.drugalcdep.2025.113011
Sarah Rosenwohl-Mack , Megan Heeney , Lysa Samuel , Erik Anderson , Andrew A. Herring , Lauren Roller Sirey , Damian Peterson , Alexander R. Bazazi , Hannah Snyder , Leslie W. Suen
Background
Fentanyl-involved overdose deaths have surged, yet buprenorphine remains underutilized for opioid use disorder (OUD) treatment, partly due to the risk of precipitated withdrawal during buprenorphine initiation. Direct-to-inject (DTI) buprenorphine using weekly long-acting injectable formulations may reduce this risk with a gradual and sustained rise in serum buprenorphine levels.
Objective
To evaluate 90-day treatment retention, withdrawal tolerability, and associated factors following DTI buprenorphine initiation across multiple outpatient safety-net settings.
Methods
We conducted a retrospective cohort study of 131 DTI initiations among 114 patients with OUD across San Francisco and Oakland safety-net clinics from March 2024 to May 2025. Patients were initiated on weekly long-acting buprenorphine. We assessed withdrawal severity in the first 24 h and calculated continuous treatment retention at 7, 30, and 90 days using pharmacy and chart data.
Results
Mean age was 42 years; 79 % reported fentanyl use, and 67 % were unstably housed or unhoused. In the 24 h after injection, 37 % experienced no withdrawal, 31 % experienced mild-moderate withdrawal, and 11 % experienced severe withdrawal, with 21 % missing data. Overall, 72 % continued buprenorphine beyond initial injection, with most transitioning to monthly formulations. Retention rates were 69 % at 7 days, 68 % at 30 days, and 43 % at 90 days. No demographic or clinical factors predicted 90-day retention.
Conclusions
In this retrospective study, DTI buprenorphine initiation demonstrated favorable tolerability and retention in a high-risk population across diverse outpatient settings. This approach may offer a viable pathway to long-acting buprenorphine treatment for individuals using fentanyl who may not tolerate traditional initiation methods.
{"title":"Outpatient initiation of direct-to-inject buprenorphine","authors":"Sarah Rosenwohl-Mack , Megan Heeney , Lysa Samuel , Erik Anderson , Andrew A. Herring , Lauren Roller Sirey , Damian Peterson , Alexander R. Bazazi , Hannah Snyder , Leslie W. Suen","doi":"10.1016/j.drugalcdep.2025.113011","DOIUrl":"10.1016/j.drugalcdep.2025.113011","url":null,"abstract":"<div><h3>Background</h3><div>Fentanyl-involved overdose deaths have surged, yet buprenorphine remains underutilized for opioid use disorder (OUD) treatment, partly due to the risk of precipitated withdrawal during buprenorphine initiation. Direct-to-inject (DTI) buprenorphine using weekly long-acting injectable formulations may reduce this risk with a gradual and sustained rise in serum buprenorphine levels.</div></div><div><h3>Objective</h3><div>To evaluate 90-day treatment retention, withdrawal tolerability, and associated factors following DTI buprenorphine initiation across multiple outpatient safety-net settings.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 131 DTI initiations among 114 patients with OUD across San Francisco and Oakland safety-net clinics from March 2024 to May 2025. Patients were initiated on weekly long-acting buprenorphine. We assessed withdrawal severity in the first 24<!--> <!-->h and calculated continuous treatment retention at 7, 30, and 90 days using pharmacy and chart data.</div></div><div><h3>Results</h3><div>Mean age was 42 years; 79 % reported fentanyl use, and 67 % were unstably housed or unhoused. In the 24<!--> <!-->h after injection, 37 % experienced no withdrawal, 31 % experienced mild-moderate withdrawal, and 11 % experienced severe withdrawal, with 21 % missing data. Overall, 72 % continued buprenorphine beyond initial injection, with most transitioning to monthly formulations. Retention rates were 69 % at 7 days, 68 % at 30 days, and 43 % at 90 days. No demographic or clinical factors predicted 90-day retention.</div></div><div><h3>Conclusions</h3><div>In this retrospective study, DTI buprenorphine initiation demonstrated favorable tolerability and retention in a high-risk population across diverse outpatient settings. This approach may offer a viable pathway to long-acting buprenorphine treatment for individuals using fentanyl who may not tolerate traditional initiation methods.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113011"},"PeriodicalIF":3.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.drugalcdep.2025.113012
Gabriel Zamora , Tommy Gunawan , Qingyu Zhao , Alejandro D. Meruelo
Background
Predicting progression from substance use to substance use disorder (SUD) is challenging, particularly for participants with cannabis and stimulant use who follow distinct risk trajectories. Machine learning enables integration of demographic, behavioral, wearable-derived, and social determinants of health (SDoH) data, yet few studies have compared linear and non-linear approaches in large, diverse populations.
Methods
Data came from the All of Us Research Program, a nationwide cohort integrating electronic health records, surveys, wearable metrics, and SDoH. Individuals with baseline cannabis or stimulant use were followed for incident SUD diagnoses. Predictors included demographics, wearable-derived activity and sleep, and SDoH domains (income, food insecurity, housing instability, transportation barriers). Elastic net (EN) logistic regression and random forest (RF) models were trained separately within cannabis and stimulant cohorts. Discrimination was evaluated on independent test sets using the area under the receiver operating characteristic curve (AUC) and compared with the DeLong test.
Results
For participants with cannabis use, EN and RF showed similar performance (AUC = 0.740 vs. 0.741; DeLong p = 0.764). For participants with stimulant use, RF achieved AUC = 0.732 vs. EN = 0.698; DeLong p = 0.219. Demographic variables were the strongest predictors across models. SDoH indicators—particularly income—contributed substantially to prediction, while wearable-derived metrics provided incremental explanatory value primarily in EN models, with limited independent contribution in RF.
Conclusions
EN and RF models achieved moderate prediction of SUD transitions. Incorporating SDoH and wearable-derived data enhanced interpretability and risk stratification, particularly in linear models, underscoring substance-specific pathways and the utility of multimodal frameworks for developing precision prevention strategies.
背景：预测从物质使用到物质使用障碍（SUD）的进展是具有挑战性的，特别是对于大麻和兴奋剂使用的参与者，他们遵循不同的风险轨迹。机器学习可以整合人口统计、行为、可穿戴衍生和健康社会决定因素（SDoH）数据，但很少有研究在大量不同人群中比较线性和非线性方法。方法：数据来自我们所有人研究计划，这是一个全国性的队列，整合了电子健康记录、调查、可穿戴指标和SDoH。对基线使用大麻或兴奋剂的个体进行了SUD诊断。预测因素包括人口统计、可穿戴设备衍生的活动和睡眠，以及SDoH域（收入、粮食不安全、住房不稳定、交通障碍）。在大麻和兴奋剂队列中分别训练弹性网（EN）逻辑回归和随机森林（RF）模型。使用受试者工作特征曲线下面积（AUC）对独立测试集进行判别，并与DeLong测试进行比较。结果：对于使用大麻的参与者，EN和RF表现相似（AUC = 0.740 vs. 0.741; DeLong p = 0.764）。对于使用兴奋剂的参与者，RF达到的AUC = 0.732 vs. EN = 0.698；DeLong p = 0.219。人口变量是所有模型中最强的预测因子。SDoH指标——尤其是收入指标——对预测有很大贡献，而可穿戴衍生指标主要在EN模型中提供了增量解释价值，对RF的独立贡献有限。结论：EN和RF模型可适度预测SUD的转变。结合SDoH和可穿戴数据增强了可解释性和风险分层，特别是在线性模型中，强调了特定物质的途径和制定精确预防战略的多模式框架的效用。
{"title":"Comparing random forest and elastic net models to predict substance use disorder transitions in participants with cannabis and stimulant use: Evidence from the All of Us cohort","authors":"Gabriel Zamora , Tommy Gunawan , Qingyu Zhao , Alejandro D. Meruelo","doi":"10.1016/j.drugalcdep.2025.113012","DOIUrl":"10.1016/j.drugalcdep.2025.113012","url":null,"abstract":"<div><h3>Background</h3><div>Predicting progression from substance use to substance use disorder (SUD) is challenging, particularly for participants with cannabis and stimulant use who follow distinct risk trajectories. Machine learning enables integration of demographic, behavioral, wearable-derived, and social determinants of health (SDoH) data, yet few studies have compared linear and non-linear approaches in large, diverse populations.</div></div><div><h3>Methods</h3><div>Data came from the All of Us Research Program, a nationwide cohort integrating electronic health records, surveys, wearable metrics, and SDoH. Individuals with baseline cannabis or stimulant use were followed for incident SUD diagnoses. Predictors included demographics, wearable-derived activity and sleep, and SDoH domains (income, food insecurity, housing instability, transportation barriers). Elastic net (EN) logistic regression and random forest (RF) models were trained separately within cannabis and stimulant cohorts. Discrimination was evaluated on independent test sets using the area under the receiver operating characteristic curve (AUC) and compared with the DeLong test.</div></div><div><h3>Results</h3><div>For participants with cannabis use, EN and RF showed similar performance (AUC = 0.740 vs. 0.741; DeLong p = 0.764). For participants with stimulant use, RF achieved AUC = 0.732 vs. EN = 0.698; DeLong p = 0.219. Demographic variables were the strongest predictors across models. SDoH indicators—particularly income—contributed substantially to prediction, while wearable-derived metrics provided incremental explanatory value primarily in EN models, with limited independent contribution in RF.</div></div><div><h3>Conclusions</h3><div>EN and RF models achieved moderate prediction of SUD transitions. Incorporating SDoH and wearable-derived data enhanced interpretability and risk stratification, particularly in linear models, underscoring substance-specific pathways and the utility of multimodal frameworks for developing precision prevention strategies.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113012"},"PeriodicalIF":3.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.drugalcdep.2025.113010
Laura Sirbu , Julia S. Sisti , James E. Cone
Background
Individuals with post-traumatic stress disorder (PTSD) are more likely to smoke and less likely to quit smoking than people without the condition. Building upon previous research, we examined associations between probable PTSD and smoking cessation among World Trade Center Health Registry (WTCHR) enrollees, who have a relatively high prevalence of PTSD.
Methods
We used five waves of survey data (2003–2021) from the WTCHR, a closed cohort of 9/11-exposed individuals, to examine longitudinal associations between probable PTSD and subsequent smoking cessation among enrollees who reported current smoking. Probable PTSD was assessed with the PTSD Checklist for DSM-IV (PCL-S). The outcome of smoking cessation was also assessed via survey responses at the subsequent wave. Multivariable-adjusted risk ratios (RRs) and 95 % confidence intervals (95 % CI) were estimated with generalized estimating equations.
Results
Overall, 31.3 % of enrollees quit smoking by the subsequent survey wave. Differences by probable PTSD status were observed, and in multivariable adjusted models, enrollees with probable PTSD were 8 % less likely to quit smoking compared to enrollees without probable PTSD (RR=0.92, 95 % CI: 0.87, 0.97).
Conclusion
Although various smoking cessation programs have been implemented among the WTC-exposed population, differences in cessation by PTSD status persist. Additional efforts to promote cessation among this group should consider mental health conditions.
{"title":"Longitudinal study of smoking cessation among World Trade Center Health Registry enrollees, 2003–2021","authors":"Laura Sirbu , Julia S. Sisti , James E. Cone","doi":"10.1016/j.drugalcdep.2025.113010","DOIUrl":"10.1016/j.drugalcdep.2025.113010","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with post-traumatic stress disorder (PTSD) are more likely to smoke and less likely to quit smoking than people without the condition. Building upon previous research, we examined associations between probable PTSD and smoking cessation among World Trade Center Health Registry (WTCHR) enrollees, who have a relatively high prevalence of PTSD.</div></div><div><h3>Methods</h3><div>We used five waves of survey data (2003–2021) from the WTCHR, a closed cohort of 9/11-exposed individuals, to examine longitudinal associations between probable PTSD and subsequent smoking cessation among enrollees who reported current smoking. Probable PTSD was assessed with the PTSD Checklist for DSM-IV (PCL-S). The outcome of smoking cessation was also assessed via survey responses at the subsequent wave. Multivariable-adjusted risk ratios (RRs) and 95 % confidence intervals (95 % CI) were estimated with generalized estimating equations.</div></div><div><h3>Results</h3><div>Overall, 31.3 % of enrollees quit smoking by the subsequent survey wave. Differences by probable PTSD status were observed, and in multivariable adjusted models, enrollees with probable PTSD were 8 % less likely to quit smoking compared to enrollees without probable PTSD (RR=0.92, 95 % CI: 0.87, 0.97).</div></div><div><h3>Conclusion</h3><div>Although various smoking cessation programs have been implemented among the WTC-exposed population, differences in cessation by PTSD status persist. Additional efforts to promote cessation among this group should consider mental health conditions.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113010"},"PeriodicalIF":3.6,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.drugalcdep.2025.113007
Zachary J. Pierce-Messick , Catherine F. Moore , Justin C. Strickland , Elise M. Weerts
Aims
The orexin receptor system is gaining interest as a potential therapeutic target to reduce heavy alcohol drinking. Studies of orexin-1 and orexin-2 receptor antagonists have shown decreased alcohol seeking and self-administration in rodents. This study examined if acute treatment with the dual orexin receptor antagonist suvorexant would decrease alcohol seeking and self-administration in a nonhuman primate chronic drinking model.
Methods
Subjects were six baboons with extensive histories of chronic alcohol self-administration under an operant chained schedule of reinforcement. Sessions consisted of three components (modeling alcohol anticipation, seeking, consumption), each with distinct stimuli and behavioral contingencies to gain access to and self-administer alcohol. Suvorexant (0, 0.032, 0.1, 0.32, 0.6, 1.0 mg/kg, p.o.) was acutely administered 60 min before the session. Linear mixed-effect models were used to evaluate suvorexant effects on alcohol seeking (fixed interval [FI] latency and responses) and self-administration (Fixed ratio [FR] responses, alcohol volume and g/kg intake).
Results
No significant effects of acute suvorexant were observed on alcohol seeking (p > .62). A significant effect of suvorexant was observed for self-administration responses (p = .04), but not for alcohol g/kg intake (p = .08). Both outcomes demonstrated a dose-related biphasic curve with a modest decrease in self-administration after 0.1 mg/kg suvorexant and modest increase in self-administration after 1.0 mg/kg suvorexant.
Conclusions
Low dose suvorexant may acutely reduce drinking, but the magnitude of change may not be clinically meaningful. Higher doses of suvorexant may worsen heavy drinking. These data do not support suvorexant use to reduce alcohol intake during ongoing use.
{"title":"Evaluation of suvorexant effects on alcohol seeking and self-administration in baboons","authors":"Zachary J. Pierce-Messick , Catherine F. Moore , Justin C. Strickland , Elise M. Weerts","doi":"10.1016/j.drugalcdep.2025.113007","DOIUrl":"10.1016/j.drugalcdep.2025.113007","url":null,"abstract":"<div><h3>Aims</h3><div>The orexin receptor system is gaining interest as a potential therapeutic target to reduce heavy alcohol drinking. Studies of orexin-1 and orexin-2 receptor antagonists have shown decreased alcohol seeking and self-administration in rodents. This study examined if acute treatment with the dual orexin receptor antagonist suvorexant would decrease alcohol seeking and self-administration in a nonhuman primate chronic drinking model.</div></div><div><h3>Methods</h3><div>Subjects were six baboons with extensive histories of chronic alcohol self-administration under an operant chained schedule of reinforcement. Sessions consisted of three components (modeling alcohol anticipation, seeking, consumption), each with distinct stimuli and behavioral contingencies to gain access to and self-administer alcohol. Suvorexant (0, 0.032, 0.1, 0.32, 0.6, 1.0<!--> <!-->mg/kg, p.o.) was acutely administered 60<!--> <!-->min before the session. Linear mixed-effect models were used to evaluate suvorexant effects on alcohol seeking (fixed interval [FI] latency and responses) and self-administration (Fixed ratio [FR] responses, alcohol volume and g/kg intake).</div></div><div><h3>Results</h3><div>No significant effects of acute suvorexant were observed on alcohol seeking (<em>p</em> > .62). A significant effect of suvorexant was observed for self-administration responses (<em>p</em> = .04), but not for alcohol g/kg intake (<em>p</em> = .08). Both outcomes demonstrated a dose-related biphasic curve with a modest decrease in self-administration after 0.1<!--> <!-->mg/kg suvorexant and modest increase in self-administration after 1.0<!--> <!-->mg/kg suvorexant.</div></div><div><h3>Conclusions</h3><div>Low dose suvorexant may acutely reduce drinking, but the magnitude of change may not be clinically meaningful. Higher doses of suvorexant may worsen heavy drinking. These data do not support suvorexant use to reduce alcohol intake during ongoing use.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"278 ","pages":"Article 113007"},"PeriodicalIF":3.6,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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