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Enhancing the drug addiction treatment service by introducing a new residential treatment model in the Philippines: A qualitative study. 在菲律宾引入新的住院治疗模式,加强戒毒服务:定性研究。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-11-14 DOI: 10.1186/s13011-024-00626-6
Shogo Kanamori, Tomohiro Shirasaka, Ma Teresa Iñigo, Alfonso Villaroman, Rosalina Noguera-Caoile, Aya Mizusawa, Jasmin Peralta, Takayuki Harada

Background: There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government's Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model.

Methods: Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process.

Results: The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient's recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks.

Conclusions: The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET's alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

背景:菲律宾吸毒者(PWUDs)对高质量治疗和康复服务的需求日益增加。为此,菲律宾政府卫生部(DOH)建立了一种新的住院治疗模式--住院治疗与康复中心强化治疗与康复项目(INTREPRET),并将其整合到卫生部所属的 21 家治疗与康复中心(TRCs)的现有治疗服务平台中。我们开展了一项定性研究,以确定这一治疗模式的实施所带来的变化:方法:通过面对面的个别访谈收集数据。我们有目的地采访了 7 家治疗中心的 29 名患者和 35 名 INTREPRET 小组活动的主持人。我们转录了访谈记录,并在编码过程中使用主题分析法将叙述信息整理成关键主题:研究参与者感受到的变化包括患者的态度和行为、辅导员的态度和能力、辅导员和患者之间的关系、治疗计划和审查过程、高效和标准化的治疗服务以及患者康复过程的监督机制。参与者还指出了在实施 INTREPRET 过程中遇到的挑战,包括家人参与治疗过程、缺乏辅导员、寻找适合开展治疗的场所以及复制工作手册等:研究结果表明,INTREPRET 的引入可以提高治疗服务质量和治疗效果,这主要与患者的行为改变、患者与促进者之间关系的改善以及 INTREPRET 与主要国际治疗标准的一致性有关。然而,尽管参与者感受到了积极的变化,但也发现了一些与家人参与治疗过程和缺乏资源有关的挑战。卫生部必须解决这些批评意见,同时将 INTREPRET 纳入其政策和战略框架,以确保新治疗模式的有效性和可持续性。
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引用次数: 0
COVID-19 public health restrictions and opioid overdoes: a summative content analysis of emergency medical services records in three Texas counties. COVID-19 公共卫生限制与阿片类药物过量:对德克萨斯州三个县的紧急医疗服务记录进行总结性内容分析。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-11-08 DOI: 10.1186/s13011-024-00627-5
S Scott Graham, Nandini Sharma, Tristin B Hooker, Kimberlyn Harrison, Kasey Claborn

Background: With the broad recognition of increased U.S. opioid overdose (OOD) rates between 2020 and 2021, media, public health, and healthcare organizations have raised significant concerns over the emergence of a simultaneous COVID-19-opioid "twindemic." Research in this area has explored the possible relationships between negative externalities associated with the pandemic and/or COVID-19 public health interventions and increased risks for opioid use and overdose alongside diminished outcomes following OOD events.

Methods: The study offers a summative content analysis of Emergency Medical Service (EMS) responses to opioid overdose (OOD) events before and after the institution of COVID-19 restrictions. Specifically, the study investigates three Texas counties to evaluate changing OOD rates, patient demographics, and OOD event features. The analysis uses a previously validated machine learning tool to identify OOD events and conducted a summative content analysis of identified events.

Results: A total of 1170 OOD responses events were identified in the three-county dataset. This includes 874 in Travis County, 242 in El Paso County, and 54 in Williamson County. Each county experienced modest changes in EMS calls for OOD events between the pre-restriction and public health restriction time periods. Travis County's OOD event rate declined from 454 to 420. El Paso's increased from 103 to 139, and Williamson County's increased from 23 to 31. These changes were not significant as percentage of possible OOD events or based on by-month comparison. The notable differences between pre-restriction and public health restriction periods were significant decreases in documentation of patient race/ethnicity in Travis and Williamson Counties, significant decreases in housing insecurity and use alone in Travis County, and an increase in transport refusal after treatment in the field in Travis County.

Conclusions: Ultimately the results presented here problematize prevailing analyses about the so-called opioid-COVID-19 "twindemic." The data further support emerging trends about substantial geographic variation and show some ways that COVID-19 mitigation measures may have improved conditions for some populations, particularly in terms of housing security. Additionally, the results presented here indicate that further attention should be paid to the effects of first responder stress on documentation quality.

背景:随着人们广泛认识到 2020 年至 2021 年期间美国阿片类药物过量(OOD)率的增加,媒体、公共卫生和医疗保健组织对 COVID-19 和阿片类药物 "双流行 "的同时出现表示了极大的担忧。该领域的研究探讨了与该流行病和/或 COVID-19 公共卫生干预措施相关的负外部性与阿片类药物使用和过量风险增加以及 OOD 事件后治疗效果降低之间可能存在的关系:本研究对 COVID-19 限制措施实施前后紧急医疗服务 (EMS) 对阿片类药物过量 (OOD) 事件的反应进行了总结性内容分析。具体而言,该研究调查了德克萨斯州的三个县,以评估不断变化的 OOD 发生率、患者人口统计学特征和 OOD 事件特征。分析使用了之前经过验证的机器学习工具来识别 OOD 事件,并对识别出的事件进行了总结性内容分析:结果:三县数据集中共识别出 1170 起 OOD 反应事件。其中特拉维斯县 874 起,埃尔帕索县 242 起,威廉姆森县 54 起。在限制前和公共卫生限制期间,每个县的 OOD 事件紧急医疗服务呼叫量都略有变化。特拉维斯县的 OOD 事件率从 454 下降到 420。埃尔帕索县的 OOD 事件从 103 起增加到 139 起,威廉姆森县从 23 起增加到 31 起。这些变化在可能发生的 OOD 事件中所占的百分比或逐月比较中并不明显。限制前和公共卫生限制期之间的显著差异是:特拉维斯县和威廉姆森县的患者种族/族裔记录显著减少,特拉维斯县的住房不安全和单独使用显著减少,以及特拉维斯县在现场治疗后拒绝转运的情况增加:最终,本文介绍的结果对所谓阿片类药物-COVID-19 "双流行 "的普遍分析提出了质疑。这些数据进一步支持了新出现的关于巨大地域差异的趋势,并显示出 COVID-19 缓解措施可能改善了某些人群的状况,尤其是在住房安全方面。此外,本文介绍的结果表明,应进一步关注第一响应者压力对文件质量的影响。
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引用次数: 0
The relationship between insecure attachment and nicotine dependence among users of classic cigarettes, e-cigarettes, and heated tobacco products: a moderated mediation model. 传统香烟、电子烟和加热烟草制品使用者的不安全依恋与尼古丁依赖之间的关系:调节中介模型。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-09-16 DOI: 10.1186/s13011-024-00623-9
Maria Nicoleta Turliuc,Octav-Sorin Candel,Mihaela Jitaru
BACKGROUNDPrevious research has investigated the association between attachment styles and smoking behaviors, indicating a positive association of insecure attachment styles with nicotine dependence. However, these links were mostly explored in adolescent and student samples. Moreover, the explanatory mechanisms and the variables influencing the strength of this relationship remained understudied. In this context, the present study aims to: (1) examine the associations between attachment anxiety, avoidance, and nicotine dependence; (2) investigate the mediating role of emotion dysregulation and metacognitions about smoking; and (3) test the moderating roles of psychological capital and type of tobacco product used by the participants.METHODThis cross-sectional study was conducted on a convenience sample of 447 participants who reported smoking. The age range of participants was 18 to 64 (M = 26.76; 59.7% women). All participants have completed five questionnaires measuring nicotine dependence, adult attachment, emotion dysregulation, metacognitions about smoking, and psychological capital. They also reported the type of tobacco product commonly used: classic cigarettes, e-cigarettes, or heated tobacco products.RESULTSOur findings show that the direct link between insecure attachment and nicotine dependence is rather inconsistent. However, it was mediated by the metacognitions about smoking. Psychological capital can act as a protective factor against the effects of attachment on nicotine dependence, especially for those using alternative tobacco products alongside classic cigarettes.CONCLUSIONSThe findings highlight the possibility of developing better-tailored interventions and treatments to discourage smoking and increase smoking cessation. These should focus on eliminating the dysfunctional beliefs related to the metacognitions about smoking and on improving the levels of psychological capital. In addition, targeting attachment insecurities in early adolescence can also function as a mean to prevent smoking.
背景以前的研究调查了依恋方式与吸烟行为之间的联系,结果表明不安全的依恋方式与尼古丁依赖之间存在正相关。然而,这些联系大多是在青少年和学生样本中进行的。此外,影响这种关系强度的解释机制和变量仍未得到充分研究。在此背景下,本研究旨在:(1)探讨依恋焦虑、回避和尼古丁依赖之间的关联;(2)研究情绪失调和对吸烟的元认知的中介作用;以及(3)检验心理资本和参与者使用的烟草制品类型的调节作用。 方法:本横断面研究对 447 名报告吸烟的参与者进行了抽样调查。参与者的年龄范围为 18 至 64 岁(男性 = 26.76;女性占 59.7%)。所有参与者都填写了五份问卷,分别测量尼古丁依赖、成人依恋、情绪失调、对吸烟的元认知和心理资本。我们的研究结果表明,不安全依恋与尼古丁依赖之间的直接联系并不一致。然而,这种联系受到吸烟元认知的调节。心理资本可以作为一种保护因素,防止依恋对尼古丁依赖的影响,尤其是对那些在使用传统香烟的同时还使用替代烟草制品的人而言。这些干预和治疗应侧重于消除与吸烟元认知相关的功能失调信念,并提高心理资本水平。此外,针对青春期早期的依恋不安全感也可以起到预防吸烟的作用。
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引用次数: 0
Access and barriers to safer supply prescribing during a toxic drug emergency: a mixed methods study of implementation in British Columbia, Canada. 在有毒药物紧急事件中开具更安全供应处方的途径和障碍:对加拿大不列颠哥伦比亚省实施情况的混合方法研究。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-09-16 DOI: 10.1186/s13011-024-00625-7
Karen A Urbanoski,Thea van Roode,Marion Selfridge,Katherine C Hogan,James Fraser,Kurt Lock,Phoenix Beck McGreevy,Charlene Burmeister,Brittany Barker,Amanda Slaunwhite,Bohdan Nosyk,Bernadette Pauly
BACKGROUNDIn March 2020, British Columbia, Canada, introduced prescribed safer supply involving the distribution of pharmaceutical grade alternatives to the unregulated toxic drug supply. Prior research has demonstrated positive impacts on overdose mortality, but with limited reach to people who use substances. Objectives of this study were to (1) identify barriers to accessing safer supply prescribing among people who use substances; and (2) determine whether and how barriers differed between people with and without prescriptions, and between urban and rural settings.METHODSWe conducted a participatory mixed-methods study guided by the Consolidated Framework for Implementation Research. Participants (≥ 19 years old) had received a safer supply prescription or were seeking one (survey n = 353; interviews n = 54).RESULTSParticipants who had a prescription were more likely to be living in a large urban centre, compared to medium/smaller centres and rural areas (78.5% vs. 65.8%, standardized mean difference = 0.286). Participants who did not have a prescription were more likely to report an array of structural, interpersonal, and health-related barriers (compared to those who had a prescription). In interviews, participants linked experiences of barriers to stigma and criminalization, low availability of services, lack of information and prescribers, not being able to get what they need, and anxieties, worries and doubts stemming from personal circumstances. There were no notable differences between large urban centres and medium/smaller centres and rural areas in the presence of specific types of barriers.CONCLUSIONSFindings demonstrate restricted access to safer supply prescribing outside of large urban centres and provide future targets for enhancing implementation. Attention is needed to promote equity and counter systemic barriers in the implementation of responses to the ongoing toxic drug emergency.
背景 2020 年 3 月,加拿大不列颠哥伦比亚省推出了更安全的处方药供应,其中包括分发医药级替代品,以取代不受管制的有毒药物供应。先前的研究表明,这种方法对用药过量死亡率有积极影响,但对药物使用者的影响有限。本研究的目标是:(1)确定药物使用者在获得更安全的供应处方时遇到的障碍;(2)确定有处方者和无处方者之间以及城市和农村环境之间遇到的障碍是否不同以及如何不同。结果有处方的参与者更有可能居住在大城市中心,而不是中小城市中心和农村地区(78.5% 对 65.8%,标准化平均差异 = 0.286)。没有处方的参与者更有可能报告一系列结构性、人际关系和健康相关障碍(与有处方的参与者相比)。在访谈中,参与者将障碍的经历与污名化和刑事犯罪、服务供应不足、缺乏信息和处方医生、无法获得所需的东西,以及源于个人情况的焦虑、担忧和疑虑联系起来。在存在特定类型的障碍方面,大型城市中心与中型/小型中心和农村地区之间没有明显差异。在实施应对当前有毒药物紧急状况的措施时,需要注意促进公平和消除系统性障碍。
{"title":"Access and barriers to safer supply prescribing during a toxic drug emergency: a mixed methods study of implementation in British Columbia, Canada.","authors":"Karen A Urbanoski,Thea van Roode,Marion Selfridge,Katherine C Hogan,James Fraser,Kurt Lock,Phoenix Beck McGreevy,Charlene Burmeister,Brittany Barker,Amanda Slaunwhite,Bohdan Nosyk,Bernadette Pauly","doi":"10.1186/s13011-024-00625-7","DOIUrl":"https://doi.org/10.1186/s13011-024-00625-7","url":null,"abstract":"BACKGROUNDIn March 2020, British Columbia, Canada, introduced prescribed safer supply involving the distribution of pharmaceutical grade alternatives to the unregulated toxic drug supply. Prior research has demonstrated positive impacts on overdose mortality, but with limited reach to people who use substances. Objectives of this study were to (1) identify barriers to accessing safer supply prescribing among people who use substances; and (2) determine whether and how barriers differed between people with and without prescriptions, and between urban and rural settings.METHODSWe conducted a participatory mixed-methods study guided by the Consolidated Framework for Implementation Research. Participants (≥ 19 years old) had received a safer supply prescription or were seeking one (survey n = 353; interviews n = 54).RESULTSParticipants who had a prescription were more likely to be living in a large urban centre, compared to medium/smaller centres and rural areas (78.5% vs. 65.8%, standardized mean difference = 0.286). Participants who did not have a prescription were more likely to report an array of structural, interpersonal, and health-related barriers (compared to those who had a prescription). In interviews, participants linked experiences of barriers to stigma and criminalization, low availability of services, lack of information and prescribers, not being able to get what they need, and anxieties, worries and doubts stemming from personal circumstances. There were no notable differences between large urban centres and medium/smaller centres and rural areas in the presence of specific types of barriers.CONCLUSIONSFindings demonstrate restricted access to safer supply prescribing outside of large urban centres and provide future targets for enhancing implementation. Attention is needed to promote equity and counter systemic barriers in the implementation of responses to the ongoing toxic drug emergency.","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"79 1","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Initiation and/or re-initiation of drug use among people who use drugs in Vancouver, Canada from 2021 to 2022: a prospective cohort study. 2021年至2022年加拿大温哥华吸毒者开始和/或重新开始吸毒:一项前瞻性队列研究。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-09-10 DOI: 10.1186/s13011-024-00624-8
Anjali Sergeant,Paxton Bach,Jingxin Lei,Kora DeBeck,M-J Milloy,Kanna Hayashi
OBJECTIVESWidespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU).METHODSData were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months.RESULTSAmong 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded 'yes' to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75).CONCLUSIONSIn an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population.
目的在 COVID-19 大流行导致医疗服务大面积中断的同时,加拿大温哥华的吸毒者(PWUD)因吸毒过量而死亡的人数急剧增加。众所周知,有注射吸毒史的人受到药物相关伤害的风险更高。自大流行开始以来,对这一人群的毒品使用模式以及相关的社会人口和医疗保健使用趋势的研究一直不足。我们试图了解有注射吸毒史(IVDU)的人群开始和/或重新开始吸毒的模式。研究对象包括在 2021 年 6 月至 2022 年 5 月期间接受过调查的终生有 IVDU 史的参与者。主要结果变量是研究期间开始使用和再次开始使用药物的复合变量,称为药物(再次)开始使用。结果在 1061 名参与者中,基线年龄的中位数为 47 岁,589 人(55.5%)为男性。共有 183 名参与者(17.2%)报告开始和/或重新开始吸食毒品,其中 44 名(4.1%)报告开始吸食新毒品,148 名(14.0%)报告重新开始吸食毒品(9 名参与者对两者均回答 "是")。总体而言,未受管制的兴奋剂(如冰毒和可卡因)是最常见的(再次)开始吸食的毒品类别(n = 101;55.2%),其次是类阿片(n = 74;40.4%)和迷幻剂(n = 36;19.7%)。在多变量分析中,(重新)开始吸毒与最近的 IVDU(调整赔率 [AOR] 2.62,95% 置信区间 [CI] 1.02,6.76)、监禁(AOR 3.36,CI 1.12,10.14)和无法获得戒毒治疗(AOR 4.结论 在 COVID-19 大流行和吸毒过量危机交织影响的时代,近五分之一有 IVDU 史的吸毒者开始使用新毒品和/或重新开始使用以前的毒品。那些报告开始(重新)使用毒品的人表现出更高风险的药物使用行为,并报告难以获得治疗服务。我们的研究结果表明,有必要为这一高风险人群提供更多的资源支持。
{"title":"Initiation and/or re-initiation of drug use among people who use drugs in Vancouver, Canada from 2021 to 2022: a prospective cohort study.","authors":"Anjali Sergeant,Paxton Bach,Jingxin Lei,Kora DeBeck,M-J Milloy,Kanna Hayashi","doi":"10.1186/s13011-024-00624-8","DOIUrl":"https://doi.org/10.1186/s13011-024-00624-8","url":null,"abstract":"OBJECTIVESWidespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU).METHODSData were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months.RESULTSAmong 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded 'yes' to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75).CONCLUSIONSIn an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population.","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"10 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sex-related inequalities in current cigarette smoking among adolescents in Africa. 非洲青少年当前吸烟情况中与性别有关的不平等。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-09-05 DOI: 10.1186/s13011-024-00619-5
Richard Gyan Aboagye, Aliu Mohammed, Precious Adade Duodu, Qorinah Estiningtyas Sakilah Adnani, Abdul-Aziz Seidu, Bright Opoku Ahinkorah
<p><strong>Introduction: </strong>Risky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13-15 years in Africa.</p><p><strong>Methods: </strong>The present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results.</p><p><strong>Results: </strong>The prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed.</p><p><strong>Conclusion: </strong>This study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smo
导言:包括吸烟在内的危险行为在全球青少年中非常普遍。尽管这些行为在很大程度上受到包括性别在内的各种社会人口因素的影响,但有关非洲青少年吸烟中与性别相关的不平等现象的具有地区代表性的文献却很少。本研究探讨了非洲 13-15 岁青少年当前吸烟情况的性别差异:本研究对通过世界卫生组织(WHO)全球健康观察站获得的全球青少年烟草调查中 45 个非洲国家的国家代表性数据进行了二次分析。我们使用在线版世界卫生组织健康公平评估工具包(HEAT)生成结果:在接受调查的青少年中,目前吸烟率在低收入国家中从厄立特里亚的1.6%到马里的10.4%不等;在中低收入国家中从坦桑尼亚的1.3%到毛里塔尼亚的13.1%不等;在中高收入国家中从加蓬的5.2%到毛里求斯的15.3%不等;在塞舌尔(研究中唯一的高收入国家)则为14.7%。绝对汇总指标(D)显示,各次区域青少年当前吸烟负担的性别差异各不相同。在所有接受调查的国家中,男性青少年的吸烟率均高于女性,但利比里亚和莫桑比克除外,这两个国家的女性青少年比男性青少年的吸烟负担更重。此外,在马里、马达加斯加、几内亚、布基纳法索和冈比亚等低收入国家,男性青少年吸烟率高的负担比女性更重,这种差异在这些国家最为明显。与此同时,我们发现在大多数被调查的中低收入和中高收入国家中,男女青少年吸烟负担的差异较小:本研究揭示了非洲青少年当前吸烟率中基于性别的不平等。与女性青少年相比,男性青少年目前的吸烟负担更重。在马里、马达加斯加、几内亚、布基纳法索和冈比亚等低收入国家,吸烟负担最为沉重。相反,在大多数接受调查的中低收入和中高收入国家,男性和女性青少年当前吸烟负担的差异较小。因此,必须在所有非洲国家实施预防吸烟计划和战略。此外,还需要加强旨在改变男性青少年吸烟行为的干预措施。政策制定者可以制定并实施循证干预措施,以解决青少年吸烟问题。最后,应重新评估和加强针对青少年吸烟问题的现有政策和计划,以实现其目标。
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引用次数: 0
Assessing support for substance use policies among the general public and policy influencers in two Canadian provinces. 评估加拿大两个省份的公众和政策影响者对药物使用政策的支持情况。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-09-04 DOI: 10.1186/s13011-024-00622-w
Kimberley D Curtin, Mathew Thomson, Elaine Hyshka, Ian Colman, T Cameron Wild, Ana Paula Belon, Candace I J Nykiforuk

Background: Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables.

Methods: Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables.

Results: Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education.

Conclusions: The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.

背景:审查公众和政策影响者对药物使用政策(包括减少伤害政策)的支持情况,是绘制当前政策图景和利用政策机会的基本步骤。然而,这在加拿大还是一个知识空白。我们的论文确定了加拿大两个省份对药物使用政策的支持程度,并描述了支持程度如何与侵扰性和社会人口变量相关联:数据来自 2019 年慢性病预防调查。代表性样本包括普通公众(艾伯塔省 n = 1648,马尼托巴省 n = 1770)以及政策影响者(艾伯塔省 n = 204,马尼托巴省 n = 98)。我们通过 4 点李克特量表测量了 22 项有关药物使用的公共政策的支持程度。纳菲尔德生物伦理学委员会干预阶梯框架用于评估侵扰性。我们使用累积联系模型进行序数回归,以确定解释性社会人口变量:总体而言,所评估的政策普遍得到了强有力的支持。马尼托巴省公众对政策的支持程度明显高于艾伯塔省。不同省份和样本之间存在一些差异。对于某些药物使用政策,女性的支持率高于男性,教育程度较高者的支持率高于教育程度较低者:结论:研究结果强调了需要在哪些方面做出努力,以增加政策影响者和公众对物质使用政策的采纳、实施和推广的支持。与支持药物使用政策相关的社会人口变量可能有助于为知识动员等战略提供信息,从而推动加拿大西部的政策环境。
{"title":"Assessing support for substance use policies among the general public and policy influencers in two Canadian provinces.","authors":"Kimberley D Curtin, Mathew Thomson, Elaine Hyshka, Ian Colman, T Cameron Wild, Ana Paula Belon, Candace I J Nykiforuk","doi":"10.1186/s13011-024-00622-w","DOIUrl":"10.1186/s13011-024-00622-w","url":null,"abstract":"<p><strong>Background: </strong>Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables.</p><p><strong>Methods: </strong>Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables.</p><p><strong>Results: </strong>Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education.</p><p><strong>Conclusions: </strong>The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"40"},"PeriodicalIF":3.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurocognitive function and medical care utilization in Veterans treated for substance use disorder. 因药物使用障碍而接受治疗的退伍军人的神经认知功能和医疗护理使用情况。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-08-30 DOI: 10.1186/s13011-024-00621-x
James M Bjork, Jarrod Reisweber, Paul B Perrin, Paul E Plonski, Clara E Dismuke-Greer

Background: Veterans with substance use disorder (SUD) are at high risk for cognitive problems due to neurotoxic effects of chronic drug and alcohol use coupled in many cases with histories of traumatic brain injury (TBI). These problems may in turn result in proneness to SUD relapse and reduced adherence to medical self-care regimens and therefore reliance on health care systems. However, the direct relationship between cognitive function and utilization of Veterans Health Administration (VHA) SUD and other VHA health care services has not been evaluated. We sought initial evidence as to whether neurocognitive performance relates to repeated health care engagement in Veterans as indexed by estimated VHA care costs.

Methods: Neurocognitive performance in 76 Veterans being treated for SUD was assessed using CNS-Vital Signs, a commercial computerized cognitive testing battery, and related to histories of outpatient and inpatient/residential care costs as estimated by the VHA Health Economics Resource Center.

Results: After controlling for age, an aggregate metric of overall neurocognitive performance (Neurocognition Index) correlated negatively with total VHA health care costs, particularly with SUD-related outpatient care costs but also with non-mental health-related care costs. Barratt Impulsiveness Scale scores also correlated positively with total VHA care costs.

Conclusions: In Veterans receiving SUD care, higher impulsivity and lower cognitive performance were associated with greater health care utilization within the VHA system. This suggests that veterans with SUD who show lower neurocognitive performance are at greater risk for continued health problems that require healthcare engagement. Cognitive rehabilitation programs developed for brain injury and other neurological conditions could be tried in Veterans with SUD to improve their health outcomes.

背景:患有药物使用障碍(SUD)的退伍军人由于长期使用药物和酒精造成的神经毒性影响,再加上很多情况下都有脑外伤(TBI)病史,因此出现认知问题的风险很高。这些问题反过来又可能导致吸毒成瘾复发,降低对医疗自我护理方案的依从性,从而减少对医疗保健系统的依赖。然而,认知功能与退伍军人健康管理局 (VHA) SUD 及其他退伍军人健康管理局医疗保健服务利用率之间的直接关系尚未得到评估。我们正在寻找初步证据,以证明神经认知能力是否与退伍军人重复参与医疗保健服务有关,并以估计的退伍军人医疗保健费用为指标:我们使用 CNS-Vital Signs(一种商用计算机化认知测试电池)对 76 名接受 SUD 治疗的退伍军人的神经认知能力进行了评估,并将其与退伍军人管理局健康经济资源中心估算的门诊和住院/住宿护理费用历史记录联系起来:在对年龄进行控制后,整体神经认知性能的综合指标(神经认知指数)与退伍军人事务部的医疗费用总额呈负相关,尤其是与精神分裂症相关的门诊医疗费用,但也与非精神健康相关的医疗费用呈负相关。巴拉特冲动量表(Barratt Impulsiveness Scale)得分也与退伍军人医疗管理局的总医疗费用呈正相关:结论:在接受 SUD 治疗的退伍军人中,较高的冲动性和较低的认知能力与退伍军人医疗保健系统内较高的医疗保健使用率相关。这表明,神经认知能力较低的患有药物滥用症的退伍军人更有可能持续出现健康问题,需要接受医疗保健服务。针对脑损伤和其他神经系统疾病开发的认知康复计划可试用于有药物依赖性的退伍军人,以改善他们的健康状况。
{"title":"Neurocognitive function and medical care utilization in Veterans treated for substance use disorder.","authors":"James M Bjork, Jarrod Reisweber, Paul B Perrin, Paul E Plonski, Clara E Dismuke-Greer","doi":"10.1186/s13011-024-00621-x","DOIUrl":"10.1186/s13011-024-00621-x","url":null,"abstract":"<p><strong>Background: </strong>Veterans with substance use disorder (SUD) are at high risk for cognitive problems due to neurotoxic effects of chronic drug and alcohol use coupled in many cases with histories of traumatic brain injury (TBI). These problems may in turn result in proneness to SUD relapse and reduced adherence to medical self-care regimens and therefore reliance on health care systems. However, the direct relationship between cognitive function and utilization of Veterans Health Administration (VHA) SUD and other VHA health care services has not been evaluated. We sought initial evidence as to whether neurocognitive performance relates to repeated health care engagement in Veterans as indexed by estimated VHA care costs.</p><p><strong>Methods: </strong>Neurocognitive performance in 76 Veterans being treated for SUD was assessed using CNS-Vital Signs, a commercial computerized cognitive testing battery, and related to histories of outpatient and inpatient/residential care costs as estimated by the VHA Health Economics Resource Center.</p><p><strong>Results: </strong>After controlling for age, an aggregate metric of overall neurocognitive performance (Neurocognition Index) correlated negatively with total VHA health care costs, particularly with SUD-related outpatient care costs but also with non-mental health-related care costs. Barratt Impulsiveness Scale scores also correlated positively with total VHA care costs.</p><p><strong>Conclusions: </strong>In Veterans receiving SUD care, higher impulsivity and lower cognitive performance were associated with greater health care utilization within the VHA system. This suggests that veterans with SUD who show lower neurocognitive performance are at greater risk for continued health problems that require healthcare engagement. Cognitive rehabilitation programs developed for brain injury and other neurological conditions could be tried in Veterans with SUD to improve their health outcomes.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"39"},"PeriodicalIF":3.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associations between childbirth, gang exposure and substance use among young women in Cape Town, South Africa. 南非开普敦年轻女性的生育、帮派接触和药物使用之间的关系。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-08-10 DOI: 10.1186/s13011-024-00610-0
Felicia A Browne, Tara Carney, Bronwyn Myers, Courtney Peasant Bonner, Wendee M Wechsberg

The prevalence and influence of gangs on adolescents and young adults remain a concern in Western Cape, South Africa-particularly as they have one of the largest gang presence. While less attention has been focused on young women, there is a need to elucidate the relationship between gang exposure and health behaviors, such substance use, in addition to understanding whether becoming a caregiver impacts this relationship. This study uses baseline data from 496 participants enrolled in a NIDA-funded R01 trial that recruited young women aged 16 to 19 who were out of school and reported recent alcohol or other drug use and sexual risk behavior. At enrollment, a risk behavior survey was administered, and urine drug screening was conducted. Multivariable logistic regression analyses were conducted to examine baseline associations between childbirth, a gang exposure index based on eight items, and positive drug screens of the most prevalent drugs in the Western Cape (marijuana, methaqualone, and methamphetamine). At enrollment, approximately 39% of the sample had a positive urine screen for marijuana, 17% for methaqualone, and 11% for methamphetamine. Additionally, 28% had ever given birth. While only 6% reported ever being a member of a gang, most reported exposure to gangs through their physical and social environments. For all three drugs, gang exposure was associated with statistically significantly higher odds of a positive screen. Every one-point increase in the gang exposure index was associated with a 31% increase in the odds of a positive marijuana screen (p < .001), a 26% increase for methaqualone (p = 0.005) and a 37% increase in the odds of a positive methamphetamine screen (p < .001). Ever given birth was associated with lower odds of marijuana use (adjusted odds ratio [AOR]: 0.63; 95% CI: 0.42-0.96), but it was not associated with methaqualone or methamphetamine use. The findings suggest that exposure to gangs through young women's social and physical environment is positively associated with drug use. Childbirth was also protective for marijuana use, indicating there may be something unique about this type of drug, such as one's ability to more easily stop use. Although very few young women reported gang membership, a majority reported some exposure, indicating the need to address how pervasive this exposure is and the potential risk.

在南非西开普省,帮派的盛行及其对青少年和年轻成年人的影响仍然是一个令人担忧的问题,尤其是因为该地区是帮派势力最大的地区之一。虽然对年轻女性的关注较少,但有必要阐明黑帮接触与健康行为(如药物使用)之间的关系,并了解成为照顾者是否会影响这种关系。本研究使用了 496 名参与者的基线数据,这些参与者参加了一项由国家药品管理局资助的 R01 试验,该试验招募了 16 至 19 岁的失学年轻女性,她们报告了最近的酒精或其他药物使用情况以及性危险行为。在注册时,他们接受了一项危险行为调查,并进行了尿液药物筛查。研究人员进行了多变量逻辑回归分析,以检验分娩、基于八个项目的帮派接触指数和西开普省最流行的毒品(大麻、甲喹酮和甲基苯丙胺)筛查结果呈阳性之间的基线关联。入学时,约 39% 的样本尿检结果呈大麻阳性,17% 呈甲喹酮阳性,11% 呈甲基苯丙胺阳性。此外,28%的人曾经生育过。虽然只有 6% 的人称自己曾是帮派成员,但大多数人都称自己曾在物质和社会环境中接触过帮派。在所有三种毒品中,接触帮派与筛查结果呈阳性的几率有显著的统计学关联。帮派接触指数每增加一个点,大麻筛查呈阳性的几率就会增加 31%(P<0.05)。
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引用次数: 0
Effectively engaging faith-based leaders on syringe services programs: U.S. pastors' knowledge, perceptions, and questions. 让宗教领袖有效参与注射器服务计划:美国牧师的知识、看法和问题。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2024-08-05 DOI: 10.1186/s13011-024-00620-y
Betsy Smither, Philip M Reeves, Jennifer Reynolds

Objective: To identify faith-based leaders' (FBLs') knowledge, perceptions, and questions about syringe services programs (SSPs).

Methods: We conducted a one-time, national online survey of 461 Christian FBLs August-September 2022.

Results: 56% of FBLs agreed they support having SSPs in their communities; only 7% strongly disagreed. We identified 15 main questions FBLs have about SSPs. We found statistically significant differences based on FBL Protestant affiliations. Mainline FBLs are more knowledgeable about SSPs, likely to believe a larger number of SSP services would benefit their community, supportive of SSPs, interested in data related to SSPs, and likely to look to local public health officials to shape their opinions on SSPs compared with non-mainline FBLs.

Conclusions: SSP advocates can address questions that FBLs have about SSPs before beginning outreach. By understanding common Protestant denominational affiliations, advocates can focus initial engagement efforts on FBLs in their communities who are more likely to support SSPs. Our findings suggest that local public health officials can influence FBLs' opinions about SSPs.

目的确定宗教领袖(FBLs)对注射器服务计划(SSPs)的了解、看法和问题:我们于 2022 年 8 月至 9 月对 461 名基督教信仰领袖进行了一次性全国在线调查:56%的无国界医生同意他们支持在社区开展注射器服务计划;只有7%的人强烈反对。我们确定了自由职业者对 SSP 的 15 个主要问题。我们发现,在统计意义上,不同信仰的新教徒之间存在明显差异。与非主流自由肢体运动者相比,主流自由肢体运动者对 SSP 有更多的了解,可能认为更多的 SSP 服务将使他们的社区受益,支持 SSP,对与 SSP 相关的数据感兴趣,并可能希望当地的公共卫生官员来影响他们对 SSP 的看法:SSP 倡导者可以在开展外联活动之前解决非主流自由职业者对 SSP 的疑问。通过了解常见的新教教派归属,倡导者可以将初步接触工作的重点放在社区中更有可能支持撒哈拉以南非洲撒哈拉以南非洲的无信仰者身上。我们的研究结果表明,地方公共卫生官员可以影响无国界医生组织对 SSP 的看法。
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引用次数: 0
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Substance Abuse Treatment, Prevention, and Policy
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