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Association between toxic drug events and encephalopathy in British Columbia, Canada: a cross-sectional analysis. 加拿大不列颠哥伦比亚省有毒药物事件与脑病之间的关系:横断面分析。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-07-07 DOI: 10.1186/s13011-023-00544-z
Chloé G Xavier, Margot Kuo, Roshni Desai, Heather Palis, Gemma Regan, Bin Zhao, Jessica Moe, Frank X Scheuermeyer, Wen Qi Gan, Soha Sabeti, Louise Meilleur, Jane A Buxton, Amanda K Slaunwhite

Background: Encephalopathy can occur from a non-fatal toxic drug event (overdose) which results in a partial or complete loss of oxygen to the brain, or due to long-term substance use issues. It can be categorized as a non-traumatic acquired brain injury or toxic encephalopathy. In the context of the drug toxicity crisis in British Columbia (BC), Canada, measuring the co-occurrence of encephalopathy and drug toxicity is challenging due to lack of standardized screening. We aimed to estimate the prevalence of encephalopathy among people who experienced a toxic drug event and examine the association between toxic drug events and encephalopathy.

Methods: Using a 20% random sample of BC residents from administrative health data, we conducted a cross-sectional analysis. Toxic drug events were identified using the BC Provincial Overdose Cohort definition and encephalopathy was identified using ICD codes from hospitalization, emergency department, and primary care records between January 1st 2015 and December 31st 2019. Unadjusted and adjusted log-binomial regression models were employed to estimate the risk of encephalopathy among people who had a toxic drug event compared to people who did not experience a toxic drug event.

Results: Among people with encephalopathy, 14.6% (n = 54) had one or more drug toxicity events between 2015 and 2019. After adjusting for sex, age, and mental illness, people who experienced drug toxicity were 15.3 times (95% CI = 11.3, 20.7) more likely to have encephalopathy compared to people who did not experience a drug toxicity event. People who were 40 years and older, male, and had a mental illness were at increased risk of encephalopathy.

Conclusions: There is a need for collaboration between community members, health care providers, and key stakeholders to develop a standardized approach to define, screen, and detect neurocognitive injury related to drug toxicity.

背景:脑病可因非致命的毒性药物事件(用药过量)导致大脑部分或完全缺氧,或因长期使用药物所致。脑病可分为非创伤性获得性脑损伤或中毒性脑病。在加拿大不列颠哥伦比亚省(BC省)药物中毒危机的背景下,由于缺乏标准化的筛查方法,衡量脑病和药物中毒的并发率具有挑战性。我们的目的是估算发生过药物中毒事件的人群中脑病的发病率,并研究药物中毒事件与脑病之间的关联:我们从行政健康数据中随机抽取了 20% 的不列颠哥伦比亚省居民,进行了横断面分析。根据不列颠哥伦比亚省药物过量队列定义确定有毒药物事件,根据2015年1月1日至2019年12月31日期间住院、急诊科和初级保健记录中的ICD代码确定脑病。采用未经调整和调整的对数二叉回归模型来估算发生过有毒药物事件的人与未发生过有毒药物事件的人相比发生脑病的风险:在脑病患者中,14.6%(n = 54)的人在2015年至2019年期间发生过一次或多次药物毒性事件。在对性别、年龄和精神疾病进行调整后,与未经历药物毒性事件的人相比,经历过药物毒性事件的人患脑病的可能性是未经历药物毒性事件的人的15.3倍(95% CI = 11.3, 20.7)。40岁及以上、男性和患有精神疾病的人患脑病的风险更高:结论:社区成员、医疗服务提供者和主要利益相关者之间需要开展合作,以制定标准化的方法来定义、筛查和检测与药物中毒相关的神经认知损伤。
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引用次数: 0
Technical violations and infractions are drivers of disengagement from methadone treatment among people with opioid use disorder discharged from Connecticut jails 2014-2018. 2014-2018年康涅狄格州监狱释放的阿片类药物使用障碍患者中,技术违规和违纪行为是脱离美沙酮治疗的驱动因素。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-07-07 DOI: 10.1186/s13011-023-00541-2
Phillip Marotta, Alissa Hass, Adam Viera, Molly Doernberg, Russell Barbour, Lauretta E Grau, Robert Heimer

Background: We investigated the interaction between arrests for technical violations vs. receiving new charges with receiving community-based methadone treatment on time-to reincarceration (TTR) in a cohort of men with opioid use disorder (OUD) released from custody from two Connecticut jails from 2014 to 2018.

Methods: Hazard ratios (HR) were estimated for time to reincarceration for technical violations/infractions, misdemeanors only, felonies only, and both misdemeanors and felonies after adjusting for age, race/ethnicity, and receiving methadone treatment during incarceration or in the community following release. Moderation analyses tested the hypotheses that the benefits of receiving methadone in jail or the community on TTR were significantly different for people with only technical violations and infractions compared to misdemeanor and felony charges.

Results: In the sample of 788 men who were reincarcerated, 29.4% received technical violations with no new charges (n = 232) with the remainder of the sample receiving new charges consisting of 26.9% new misdemeanor charges, 6.5% felony charges, and 37.2% both felony and misdemeanor charges. Compared to men who received new misdemeanor charges, TTR was significantly shorter among those who received technical violations and infractions with no new charges amounting to a 50% increase in TTR (334.5 days, SD = 321.3 vs. 228.1 days, SD = 308.0, p < 0.001; aHR = 1.5, 95% CI = 1.3, 1.8, p < 0.001). TTR of men who resumed methadone and were charged with a new crime was 50% longer than those who resumed methadone and received technical violations/infractions with no new charges. (230.2 days, SD = 340.2 vs. 402.3 days, SD = 231.3; aHR = 1.5, 95%CI = 1.0, 2.2, p = 0.038).

Conclusions: Reducing technical violations may enhance the benefits of providing community-based methadone following release from incarceration on extending the time between incarcerations during the vulnerable time post-incarceration and reduce the burden on correctional systems.

背景:我们调查了2014年至2018年从康涅狄格州两所监狱获释的阿片类药物使用障碍(OUD)男性队列中,因技术违规被捕与接受新指控和接受社区美沙酮治疗对重新监禁时间(TTR)的交互作用。方法:在对年龄、种族/族裔以及监禁期间或出狱后在社区接受美沙酮治疗等因素进行调整后,估算了技术违规/违规、仅轻罪、仅重罪以及轻罪和重罪的再监禁时间的危险比(HR)。调节分析检验了以下假设:仅有技术违规和违纪行为的人与轻罪和重罪指控的人相比,在监狱或社区接受美沙酮治疗对TTR的益处有显著不同:在 788 名被重新监禁的男性样本中,29.4% 的人受到了技术性违规指控,但没有受到新的指控(n = 232),其余受到新指控的样本中,26.9% 的人受到新的轻罪指控,6.5% 的人受到重罪指控,37.2% 的人同时受到重罪和轻罪指控。与受到新的轻罪指控的男性相比,受到技术性违规和违纪指控的男性的服刑时间明显缩短,而没有受到新指控的男性的服刑时间增加了 50%(334.5 天,SD = 321.3 vs. 228.1 天,SD = 308.0,P 结论:减少技术性违规可能会提高服刑时间,但也可能会降低服刑时间:减少技术性违规可能会提高刑满释放后在社区提供美沙酮的益处,延长刑满释放后脆弱时期的监禁间隔时间,减轻管教系统的负担。
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引用次数: 0
Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa. 在南非西开普省,麻醉品匿名参与者对替代行为的看法和经验。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-07-05 DOI: 10.1186/s13011-023-00552-z
Deborah Louise Sinclair, Steve Sussman, Shazly Savahl, Maria Florence, Wouter Vanderplasschen

Background: Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services.

Methods: Twenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35).

Results: Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized.

Conclusions: Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.

背景:在参加康复支持小组的人员中,成瘾康复期间替代行为的动态仍然未知。深入了解替代行为的性质、动机和过程,有助于形成康复支持和减少伤害的服务。方法:23个半结构化深度访谈(n = 14名男性和n = 9名女性)与来自南非西开普省多个团体的麻醉品匿名参与者进行了方便样本。参与者年龄在22-55岁之间(M = 39.3, SD = 9.35)。结果:专题分析产生了四个主题:(i)物质对物质替代;(ii)物质-行为替代;(iii)替代行为和危害(减少);(iv)管理和解决替代行为的支持需求。研究表明,参与者的替代行为在各个恢复阶段都有发展;是物质使用障碍的临时或长期替代品,用于分散注意力,与他人隔离,镇静,缓解无聊,保持忙碌,填补感知到的经验空白,调节情绪和自我治疗。虽然替代品被用于减少危害或预防复发,但表面上健康的行为也有可能威胁到康复并导致复发。结论:自我监控,持续警惕,意识到替代品何时成为真正的成瘾是及时,合适的干预措施的关键。
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引用次数: 0
Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base. 咀嚼阿拉伯茶与精神疾病有关吗?对当前证据库的内容和质量进行范围审查。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-27 DOI: 10.1186/s13011-023-00545-y
Amanti Baru Olani, Mulusew Gerbaba, Masrie Getnet, Matiwos Soboka, Tom Decorte

Background: Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.

Methods: We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.

Results: 7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.

Conclusion: Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.

背景:阿拉伯茶(Catha edulis)是一种常见于非洲之角的植物,其叶子被咀嚼以具有精神刺激作用。几项研究表明,阿拉伯茶的使用与心理健康问题之间存在关联。然而,证据是混合和不一致的,有必要进一步审查现有的研究。这项范围审查的目的是调查阿拉伯茶使用与精神健康障碍之间关联的证据的内容和质量,并提出进一步研究的途径。方法:我们使用范围评价方法,利用PubMed、SCOPUS、Embase和CINAHL数据库绘制现有证据图谱。包括着重于任何阿拉伯茶使用模式与任何形式的精神健康障碍之间关系的初步研究。该综述集中于所有年龄组、任何研究设计、所有地理位置和任何出版年份。用于搜索符合条件的研究的术语包括阿拉伯茶,精神障碍和各种替代术语。叙述性回顾是用来呈现研究结果的。结果:在12个不同的国家发现了7121篇文章,其中108篇符合条件。大多数研究是在过去十年完成的,研究大多采用横断面设计。已确定约有10种不同类型的精神健康障碍与使用阿拉伯茶有关。尽管这些研究之间有许多相互矛盾的发现,但大多数证据表明,阿拉伯茶的使用与精神健康障碍有关。非特异性心理困扰是最常被提及的心理健康问题(在26.9%的研究中报告)。阿拉伯茶的使用作为一个预测变量,主要使用“是/否”类别进行评估,因此,阿拉伯茶使用对心理健康的剂量依赖性影响没有得到太多考虑。结论:尽管大多数研究将阿拉伯茶的使用与精神健康障碍联系起来,但考虑到研究的横断面设计,以及潜在的混杂因素和几种形式的偏差,因果关系尚无定论。现有的研究也报告了相互矛盾的结果。建议采用前瞻性设计、标准化和有效的阿拉伯茶使用措施进行进一步研究,并侧重于特定类型的精神健康障碍。
{"title":"Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base.","authors":"Amanti Baru Olani, Mulusew Gerbaba, Masrie Getnet, Matiwos Soboka, Tom Decorte","doi":"10.1186/s13011-023-00545-y","DOIUrl":"10.1186/s13011-023-00545-y","url":null,"abstract":"<p><strong>Background: </strong>Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.</p><p><strong>Methods: </strong>We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.</p><p><strong>Results: </strong>7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.</p><p><strong>Conclusion: </strong>Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"18 1","pages":"39"},"PeriodicalIF":3.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10079309","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
Patients' goals when initiating long-acting injectable buprenorphine treatment for opioid use disorder: findings from a longitudinal qualitative study. 阿片类药物使用障碍患者开始接受长效注射丁丙诺啡治疗时的目标:一项纵向定性研究的结果。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-22 DOI: 10.1186/s13011-023-00551-0
Joanne Neale, Stephen Parkin, John Strang

Background: Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that has been introduced against an international policy backdrop of recovery and person-centred care. This paper explores the goals that people want to achieve from LAIB to identify potential implications for policy and practice.

Methods: Data derive from longitudinal qualitative interviews conducted with 26 people (18 male; 8 female) initiating LAIB in England and Wales, UK (June 2021-March 2022). Participants were interviewed up to five times by telephone over six months (107 interviews in total). Transcribed interview data relating to each participant's treatment goals were coded, summarised in Excel, and then analysed via a process of Iterative Categorization.

Results: Participants often articulated a desire to be abstinent without defining exactly what they meant by this. Most intended to reduce their dosage of LAIB but did not want to rush. Although participants seldom used the term 'recovery', almost all identified objectives consistent with current definitions of this concept. Participants articulated broadly consistent goals over time, although some extended the timeframes for achieving treatment-related goals at later interviews. At their last interview, most participants remained on LAIB, and there were reports that the medication was enabling positive outcomes. Despite this, participants were aware of the complex personal, service-level, and situational factors that hindered their treatment progress, understood the additional support they needed to achieve their goals, and voiced frustrations when services failed them.

Conclusions: There is a need for wider debate regarding the goals people initiating LAIB are seeking and the diverse range of positive treatment outcomes LAIB could potentially generate. Those providing LAIB should offer regular on-going contact and other forms of non-medical support so that patients have the best opportunity to succeed. Policies relating to recovery and person-centred care have previously been criticised for responsibilising patients and service users to take better care of themselves and to change their own lives. In contrast, our findings suggest that these policies may, in fact, be empowering people to expect a greater range of support as part of the package of care they receive from service providers.

背景:长效注射用丁丙诺啡(LAIB)是一种治疗阿片类药物使用障碍的新疗法,它是在康复和以人为本的国际政策背景下引入的。本文探讨了人们希望从 LAIB 中实现的目标,以确定对政策和实践的潜在影响:数据来源于对英国英格兰和威尔士(2021 年 6 月至 2022 年 3 月)的 26 名 LAIB 患者(18 名男性;8 名女性)进行的纵向定性访谈。参与者在六个月内接受了最多五次电话访谈(共 107 次访谈)。与每位参与者的治疗目标相关的访谈记录数据均已编码,并在Excel中汇总,然后通过迭代分类法进行分析:结果:受试者通常都表达了禁欲的愿望,但并没有明确说明禁欲的具体含义。大多数人打算减少 LAIB 的用量,但又不想操之过急。虽然参与者很少使用 "康复 "一词,但几乎所有人都确定了与这一概念的当前定义相一致的目标。尽管有些参与者在后来的访谈中延长了实现治疗相关目标的时间框架,但他们所阐述的目标在一段时间内大体一致。在最后一次访谈中,大多数参与者仍在服用 LAIB,有报告称药物治疗带来了积极的结果。尽管如此,参与者还是意识到阻碍其治疗进展的复杂的个人、服务层面和情境因素,了解实现目标所需的额外支持,并在服务失败时表达了挫败感:有必要就开始 LAIB 的人所追求的目标以及 LAIB 有可能产生的各种积极治疗结果进行更广泛的讨论。提供 LAIB 的机构应提供定期的持续联系和其他形式的非医疗支持,以便患者获得成功的最佳机会。与康复和以人为本的护理相关的政策曾被批评为要求病人和服务使用者更好地照顾自己并改变自己的生活。与此相反,我们的研究结果表明,这些政策实际上可能赋予了人们更多的权力,使他们能够期望获得更多的支持,作为他们从服务提供者那里获得的一揽子护理服务的一部分。
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引用次数: 0
Symptoms of posttraumatic stress partially mediate the relationship between gender-based violence and alcohol misuse among South African women. 创伤后应激症状在一定程度上调节了性别暴力与南非妇女酗酒之间的关系。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-22 DOI: 10.1186/s13011-023-00549-8
Kim A Nguyen, Bronwyn Myers, Naeemah Abrahams, Rachel Jewkes, Shibe Mhlongo, Soraya Seedat, Carl Lombard, Claudia Garcia-Moreno, Esnat Chirwa, Andre P Kengne, Nasheeta Peer

Background: The association of traumatic experiences with problematic alcohol use has been described, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol use.

Method: We analysed cross-sectional data from a sample of rape-exposed and non-rape-exposed women, living in KwaZulu-Natal, with self-reported data on alcohol misuse (AUDIT-C cut-off ≥ 3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health. Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse.

Results: Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (aOR): 1.59, 95% confidence interval (CI): 1.27-1.99), as well as to sexual, physical and emotional CM, were independently associated with alcohol misuse. Lifetime exposure to any IPV (aOR:2.01, 95%CI:1.59-2.54), as well as to physical, emotional and economic IPV, NPSV (aOR: 1.75, 95%CI: 1.32-2.33), and other trauma (aOR:2.08, 95%CI:1.62-2.66), was associated with alcohol misuse. Exposure to an increasing number of abuse types, and other traumatic events, was independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (ps ≤ 0.04 for indirect effects), but depression symptoms did not.

Conclusions: These findings highlight the need for trauma-informed interventions to address alcohol misuse that are tailored to the needs of women who have experienced violence.

背景:创伤经历与问题性酗酒之间的关联已有描述,但有关精神痛苦可能产生的中介效应的数据却很少。我们研究了心理不健康是否对整个生命周期中的创伤暴露与酗酒之间的关联有中介作用:我们分析了居住在夸祖鲁-纳塔尔省的遭受过强奸和未遭受过强奸的女性样本的横截面数据,这些样本自我报告了酒精滥用数据(AUDIT-C 临界值≥ 3)以及遭受儿童虐待 (CM)、亲密伴侣暴力 (IPV)、非伴侣性暴力 (NPSV)、其他创伤事件和精神疾病的情况。我们使用逻辑回归和多重中介模型来检验抑郁症状和创伤后应激障碍对虐待/创伤与酗酒之间关系的中介效应:结果:在 1615 名女性中,31%(n = 498)报告有酗酒行为。遭受任何精神创伤(调整后的几率比(aOR):1.59,95% 置信区间(CI):1.27-1.99)以及性、身体和情感方面的精神创伤均与酗酒独立相关。终生遭受任何 IPV(aOR:2.01,95%CI:1.59-2.54),以及身体、情感和经济 IPV、NPSV(aOR:1.75,95%CI:1.32-2.33)和其他创伤(aOR:2.08,95%CI:1.62-2.66)均与酗酒有关。暴露于越来越多的虐待类型和其他创伤事件与酗酒独立相关。PTSS在一定程度上介导了CM、IPV、NPSV和其他创伤暴露与酒精滥用之间的关系(间接效应的ps≤0.04),但抑郁症状与之无关:这些研究结果突出表明,有必要针对遭受暴力侵害的女性的需求,采取创伤知情干预措施来解决酒精滥用问题。
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引用次数: 0
Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations. 加拿大大麻合法化后的青少年大麻使用情况:服务提供者的看法、做法和建议。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-22 DOI: 10.1186/s13011-023-00550-1
Toula Kourgiantakis, Eunjung Lee, A Kumsal Tekirdag Kosar, Christine Tait, Carrie K Y Lau, Sandra McNeil, Shelley Craig, Rachelle Ashcroft, Charmaine C Williams, Abby L Goldstein, Uppala Chandrasekera, Deepy Sur, J L Henderson

Background: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use.

Methods: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.

Results: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.

Conclusion: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

背景:2018 年,加拿大将娱乐性大麻使用合法化,目的是保护青少年并限制其使用。然而,由于 16-24 岁青少年使用大麻的比例并未下降,人们担心这一目标并未实现。青少年吸食大麻与各种不良影响有关,包括精神病、焦虑、抑郁、自杀、呼吸窘迫、大麻素分泌过多综合症和中毒。服务提供者在解决青少年吸食大麻问题方面发挥着至关重要的作用。本研究旨在了解安大略省服务提供者对青少年使用大麻的看法、做法和建议:这项混合方法研究包括一项调查和两个焦点小组。调查对象是安大略省为 16-24 岁青少年提供服务的心理健康服务提供者,他们可以选择参加焦点小组。调查包括有关看法、做法和建议的封闭式和开放式问题,而焦点小组则更深入地探讨了这些类别。描述性统计用于分析封闭式问题,解释性内容分析用于分析开放式问题。焦点小组数据采用主题分析法进行分析:160 名服务提供者完成了调查,12 人参加了两个焦点小组。在看法方面,60% 的调查参与者同意大麻合法化,26% 的调查参与者对医用大麻和娱乐用大麻有很深的了解,84% 的调查参与者认为大麻有身心健康风险,49% 的调查参与者认为大麻会带来污名。不到一半的调查参与者报告说他们筛查或评估了大麻使用情况,16% 的人表示他们非常熟悉大麻使用的治疗,67% 的人报告说他们很少与家庭合作。焦点小组在观念项下确定的次主题包括正常化和污名化、对青少年的危害以及污名化、种族主义和歧视。实践项下的次主题包括大麻不是主要关注点,筛查、评估和干预方面的挑战,以及转介到专门服务。调查和焦点小组参与者都建议加强公众教育、加强服务提供者培训、改进监管和政策、减少耻辱感和最小化、改善服务获取途径,以及提供更多文化上相适应的服务:加拿大青少年使用大麻仍然是一个重大的公共卫生问题,需要制定更全面的计划来保护安大略省青少年并减少相关危害。
{"title":"Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations.","authors":"Toula Kourgiantakis, Eunjung Lee, A Kumsal Tekirdag Kosar, Christine Tait, Carrie K Y Lau, Sandra McNeil, Shelley Craig, Rachelle Ashcroft, Charmaine C Williams, Abby L Goldstein, Uppala Chandrasekera, Deepy Sur, J L Henderson","doi":"10.1186/s13011-023-00550-1","DOIUrl":"10.1186/s13011-023-00550-1","url":null,"abstract":"<p><strong>Background: </strong>In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use.</p><p><strong>Methods: </strong>This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.</p><p><strong>Results: </strong>The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.</p><p><strong>Conclusion: </strong>Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"18 1","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10089079","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
A review of social media platform policies that address cannabis promotion, marketing and sales. 审查涉及大麻推广、营销和销售的社交媒体平台政策。
IF 3 3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-19 DOI: 10.1186/s13011-023-00546-x
Carla J Berg, Cassidy R LoParco, Yuxian Cui, Alexandria Pannell, Grace Kong, Lynniah Griffith, Katelyn F Romm, Y Tony Yang, Yan Wang, Patricia A Cavazos-Rehg

Background: Cannabis marketing exposure via social media may impact use in youth and young adults. Most states with recreational cannabis lack policies regarding social media-based marketing. Thus, we examined such policies among prominent platforms, particularly those popular among youth and young adults.

Methods: In September-October 2022, 3 research team members extracted policies applying to the general community, advertising, and any specific content regarding drug-related content for 11 social media sites: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter, and YouTube. Using inductive thematic analysis, they then dual-coded restrictions on cannabis-related content (e.g., paid advertising, unpaid promotion, sales). Descriptive analyses were conducted.

Results: Ten (all except TikTok) referenced cannabis/marijuana, 7 (all except Discord, Instagram, TikTok, and YouTube) distinguished different cannabis-derived products, and 5 (Reddit, Snapchat, TikTok, Tumblr, Twitter) noted jurisdictional differences in cannabis regulations/legality. All prohibited sales, 9 (all except Snapchat and Tumblr) prohibited paid advertising, and 4 (Discord, Reddit, Snapchat, TikTok) prohibited unpaid promotion (e.g., user-generated content). All restricted underage access to cannabis-related content. However, policies varied and were ambiguous regarding how "promotion" was defined, whether/how jurisdictional differences in legality were addressed, how businesses may interact on social media, barriers implemented to inhibit the facilitation of sales, and enforcement protocols.

Conclusions: Social media policies regarding cannabis marketing are ambiguous and may facilitate cannabis marketing, promotion, sales, and underage exposure, thus compounding concerns regarding insufficient governmental regulations. Greater specificity in social media cannabis-related policies and enforcement is needed.

背景:通过社交媒体接触大麻营销可能会影响青少年的使用。大多数拥有娱乐性大麻的州都缺乏有关社交媒体营销的政策。因此,我们研究了主要平台的此类政策,尤其是在青少年和年轻人中流行的平台:2022 年 9 月至 10 月,3 名研究小组成员提取了 11 个社交媒体网站适用于普通社区、广告和任何与毒品相关的具体内容的政策:Discord、Facebook、Instagram、Pinterest、Reddit、Snapchat、TikTok、Tumblr、Twitch、Twitter 和 YouTube。通过归纳主题分析,他们对大麻相关内容的限制(如付费广告、无偿推广、销售)进行了双重编码。结果进行了描述性分析:有 10 个网站(除 TikTok 外均为)提到了大麻,7 个网站(除 Discord、Instagram、TikTok 和 YouTube 外均为)区分了不同的大麻衍生产品,5 个网站(Reddit、Snapchat、TikTok、Tumblr、Twitter)注意到了大麻法规/合法性方面的辖区差异。所有网站都禁止销售,9 个网站(除 Snapchat 和 Tumblr 外)禁止付费广告,4 个网站(Discord、Reddit、Snapchat、TikTok)禁止无偿推广(如用户生成的内容)。所有网站都限制未成年人访问与大麻有关的内容。然而,在如何定义 "促销"、是否/如何解决合法性方面的管辖差异、企业如何在社交媒体上互动、为抑制销售便利化而设置的障碍以及执行协议等方面,政策各不相同且模棱两可:有关大麻营销的社交媒体政策含糊不清,可能会为大麻营销、推广、销售和未成年人接触大麻提供便利,从而加剧了对政府监管不足的担忧。社交媒体上与大麻有关的政策和执法需要更加明确。
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引用次数: 0
A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment. 在药物使用治疗中采用简短的多成分干预措施改善烟草治疗效果的分组随机试验。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-16 DOI: 10.1186/s13011-023-00539-w
Joseph Guydish, Caravella McCuistian, Sindhushree Hosakote, Thao Le, Carmen L Masson, Barbara K Campbell, Kevin Delucchi

Background: Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients.

Methods: Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed.

Results: Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication.

Conclusion: The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients.

Trial registration: Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.

背景:在接受药物使用障碍(SUD)治疗的人群中,吸烟率很高,而针对吸烟问题的项目干预通常复杂而漫长。这项分组随机试验测试了简短的多成分干预是否会影响员工和客户的吸烟结果:方法: 七个 SUD 治疗项目被随机分配到多组分干预或等待名单对照组。为期 6 个月的干预包括领导力动机评估、项目激励、4 次员工培训课程和一次领导力学习社区课程。在干预前和干预后收集了员工和客户的调查数据。首先比较了不同条件下的结果(干预与候补对照),然后对干预前和干预后的结果进行了比较:结果:干预人员(48 人)和对照组人员(26 人)在干预后的吸烟率、帮助服务对象戒烟的自我效能以及帮助服务对象戒烟的方法上没有差异。干预对象(n = 113)与对照组(n = 61)在吸烟率或接受烟草服务方面没有差异。不同条件下的前后比较显示,服务对象和工作人员的吸烟率有所下降,但这不能归因于干预措施,服务对象接受戒烟药物治疗的人数也有所减少:结论:简短的多成分干预并不能帮助改变客户的吸烟率或接受的烟草相关服务。需要其他干预措施来减少 SUD 患者的吸烟率:随机化发生在项目层面,测量的结果也是项目层面的测量结果。因此,该试验未进行注册。
{"title":"A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment.","authors":"Joseph Guydish, Caravella McCuistian, Sindhushree Hosakote, Thao Le, Carmen L Masson, Barbara K Campbell, Kevin Delucchi","doi":"10.1186/s13011-023-00539-w","DOIUrl":"10.1186/s13011-023-00539-w","url":null,"abstract":"<p><strong>Background: </strong>Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients.</p><p><strong>Methods: </strong>Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed.</p><p><strong>Results: </strong>Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication.</p><p><strong>Conclusion: </strong>The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients.</p><p><strong>Trial registration: </strong>Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"18 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065718","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
Awareness and utilization of smoking cessation clinics in Saudi Arabia, findings from the 2019 Global Adult Tobacco Survey. 沙特阿拉伯戒烟门诊的认知和使用情况,2019 年全球成人烟草调查的结果。
3区 医学 Q2 SUBSTANCE ABUSE Pub Date : 2023-06-15 DOI: 10.1186/s13011-023-00543-0
Sarah S Monshi, Abdullah M M Alanazi, Ali M Alzahrani, Abdulrhman A Alzhrani, Turky J Arbaein, Khulud K Alharbi, Mansour Z Alqahtani, Ali H Alzahrani, Ahmed A Elkhobby, Aljoharah M Almazrou, Abdulmohsen H Al-Zalabani

Background: Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization.

Method: This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users' awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed.

Results: One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31-2.68; mobile SCCs: OR = 2.09; CI = 1.37-3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17-0.56; mobile SCCs: OR = 0.42; CI = 0.20-0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25-34 (OR = 5.61; CI = 1.73-18.21) and 35-44 (OR = 4.22; CI = 1.07-16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09-0.73).

Conclusion: The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

背景:吸烟仍然是导致过早死亡的主要原因。为了打击烟草使用,卫生部(MOH)通过发展固定戒烟门诊和流动戒烟门诊,改善了戒烟门诊的可及性。本研究旨在调查沙特阿拉伯烟草使用者对戒烟门诊的认知和使用情况,以及影响其认知和使用情况的因素:这项横断面研究使用了 2019 年全球成人烟草调查。采用了三个结果变量,包括烟草使用者对固定 SCC 的认知度、移动 SCC 和固定 SCC 的使用率。研究还考察了几个自变量,包括社会人口特征和烟草使用情况。进行了多变量逻辑回归分析:本研究共纳入了 1667 名烟草使用者。分别有 60%、26% 和 9% 的烟草使用者知道固定 SCC、知道移动 SCC 和去过固定 SCC。居住在城市地区的烟草使用者知道 SCC 的可能性增加(固定 SCC:OR=1.88;95% CI=1.31-2.68;移动 SCC:OR=2.09;CI=1.37-3.17),而自营职业者则有所下降(固定 SCCs:OR=0.31;CI=1.37-3.17):OR = 0.31; CI = 0.17-0.56; 流动 SCCs:OR = 0.42;CI = 0.20-0.89)。年龄在25-34岁(OR = 5.61; CI = 1.73-18.21)和35-44岁(OR = 4.22; CI = 1.07-16.64)的受过教育的烟草使用者去固定SCC的可能性增加,而在私营部门工作的烟草使用者去SCC的几率下降(OR = 0.26; CI = 0.09-0.73):戒烟的决定必须得到有效的医疗保健系统的支持,该系统应提供方便且价格合理的戒烟服务。了解影响人们对戒烟中心的认识和使用的因素将有助于政策制定者针对那些渴望戒烟但在使用戒烟中心方面受到限制的人群开展工作。
{"title":"Awareness and utilization of smoking cessation clinics in Saudi Arabia, findings from the 2019 Global Adult Tobacco Survey.","authors":"Sarah S Monshi, Abdullah M M Alanazi, Ali M Alzahrani, Abdulrhman A Alzhrani, Turky J Arbaein, Khulud K Alharbi, Mansour Z Alqahtani, Ali H Alzahrani, Ahmed A Elkhobby, Aljoharah M Almazrou, Abdulmohsen H Al-Zalabani","doi":"10.1186/s13011-023-00543-0","DOIUrl":"10.1186/s13011-023-00543-0","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization.</p><p><strong>Method: </strong>This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users' awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31-2.68; mobile SCCs: OR = 2.09; CI = 1.37-3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17-0.56; mobile SCCs: OR = 0.42; CI = 0.20-0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25-34 (OR = 5.61; CI = 1.73-18.21) and 35-44 (OR = 4.22; CI = 1.07-16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09-0.73).</p><p><strong>Conclusion: </strong>The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"18 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10268372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9658948","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}
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Substance Abuse Treatment, Prevention, and Policy
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