Substance Abuse Treatment, Prevention, and Policy最新文献

The WHO recently published a Tobacco Knowledge Summary (TKS) which is prepared with the objective to summarize the current evidence on the association between tobacco use and asthma. This is also intended as an advocacy tool to widely include health care professionals in the fight for tobacco control and prevention of tobacco related adverse health effects. This article expands on the evidence outlined in the TKS, providing a more comprehensive and clinically focused analysis, aimed at lung-specialist audience. It emphasizes six key messages aimed at guiding healthcare providers and governments in advocating for the health of people living with asthma and the broader population: (1) Babies born to mothers who smoke have smaller lungs and an increased risk of developing asthma during childhood. Pregnant women should receive targeted support to quit tobacco use. (2) Children exposed to second-hand tobacco smoke have an increased risk of developing asthma. (3) Smoking during adolescence and adulthood increases the risk of developing asthma and exacerbates the condition, as well as causing other lung diseases such as chronic obstructive pulmonary disease (COPD) and lung cancer. (4) For people living with asthma, smoking worsens symptoms and can make treatment with medications less effective. All smokers with asthma should be supported to quit smoking. (5) E-cigarettes, heated tobacco products and other nicotine-delivery devices likely also carry risks. Governments should implement effective tobacco control measures to protect all individuals, including those who are vulnerable. (6) The tobacco and nicotine industries' aggressive tactics in the marketing of their products specifically target children, adolescents and young adults. Protecting youth from these harmful tactics is a top priority.

Background: An increasing number of studies are exploring the profiles of men who have sex with men (MSM) in the context of the sexualized use of drugs (chemsex). However, less attention has been paid to MSM who use drugs but do not engage in chemsex. We do not know to what extent the latter are different from the former, or whether they require similar harm reduction services. This study aimed to compare both populations in terms of their sexual risk practices, health, and pre-exposure prophylaxis (PrEP) use.

Methods: We used longitudinal data from the ongoing French cohort study ANRS-PREVENIR, which comprises 3076 MSM receiving PrEP. Analyses were conducted on MSM who engaged in chemsex, MSM who used drugs but did not engage in chemsex, and MSM who did not use drugs. Only persons with available data from at least one follow-up visit between M0 and M36 were included, representing 19,375 visits. We built a three-category outcome: (i) MSM who did not use drugs (non-DU), (ii) MSM who used drugs but did not engage in chemsex (DU), and (iii) MSM who engaged in chemsex (CX). A multinomial logistic functional form was used to estimate odds-ratios and 95% confidence intervals, using the DU category as a reference.

Results: Among the 2493 cohort participants, at baseline, 62.8%, 22.5%, and 14.6% of the participants were classified in the non-DU, DU, and CX categories, respectively. Compared to DU, non-DU were less likely to (i) declare fisting/BDSM practices, (ii) have a moderately risky sex life, ii) report lifetime PrEP use. Compared to DU, CX also had lower alcohol consumption, and were less likely to have (i) a tertiary education qualification, and (ii) a main partner; in contrast, CX were more likely to be depressed. CX were more likely to report fisting/BDSM practices, but less likely not to use PrEP and to report suboptimal PrEP adherence compared to DU participants.

Conclusions: Differences between the DU and CX populations were observed; the latter were more likely to (i) have at-risk sexual practices, (ii) suffer from depression, and (iii) have optimal PrEP adherence. It is essential to provide suitable mental health services to people who engage in chemsex, and to implement tailored sexual health and harm reduction services to MSM who use drugs but who do not engage in chemsex.

Background: This qualitative study investigates how college students construct their alcohol-related content (ARC) identities on social media platforms. Through the lens of social norms theory, symbolic interactionism, and public commitment paradigms, we examined how students portray themselves through ARC posts.

Methods: In-depth semi-structured interviews were conducted with 20 college students (M_age= 21.2, SD = 1.67) who reported engaging in drinking and ARC posting to elucidate what types of ARC-related identities students employed on social media by going through participants' social media posts. Thematic analysis was used to categorize ARC identity themes and subthemes.

Results: Results revealed two central themes where alcohol was either featured as focal point or as an accessory within students' ARC identities. Under the central theme of alcohol as a focal point, subthemes of partier, humorist, and master drinker ARC identities were uncovered. Under the central theme of alcohol as an accessory, the subthemes of social/outgoing, sophisticated, and material status ARC identities were identified. Some students within the partier, humorist, social/outgoing, and sophisticated subthemes engaged in secrecy/implicit signaling to shield their drinking from others outside their in-groups.

Conclusions: Uncovering specific types of ARC identities could be helpful to identify harmful drinking patterns in college students. Future research could explore how the frequency in which students display their identities using alcohol as either a focal point or alcohol as an accessory might differentially predict varying levels of drinking and alcohol-related problems among college students. This type of research could help target which college students are more at-risk and inform intervention strategies for college students whose ARC identities are more intertwined with alcohol misuse and alcohol-related problems.

This study describes the delivery of opioid use disorder (OUD) services in a Pacific Northwest County jail focusing on screening, assessment, withdrawal management, and medications for opioid use disorder (MOUD). Guided by the 2023 Medicaid performance measures, self-assessment data were collected through stakeholder interviews, policy and electronic healthcare records (EHR) analyses, and a systematic survey focusing on conformity to practice, policy, and documentation. This jail provided OUD screening, assessment, withdrawal management, and MOUD supported by institutional policy and an EHR software system. Survey results confirmed strong conformity to the 2023 Medicaid performance measures, with 91.9% of required recommendations met for policy and practice domains and 87.9% for documentation. Optional (not required) recommendations achieved 80.0% conformity for policy, 93.3% for practice, and 60.0% for documentation. The findings from this self-assessment underscore the robust implementation of OUD services in one jail and can inform internal and external performance improvement goals and activities. (150 words).

People living in rural communities are more likely to receive opioid prescriptions, partly due to job-related injuries. State-level interventions have reduced opioid prescribing; however, rural/urban disparities persist due to differences in demographics and prescribing practices, particularly in states with large rural populations like Indiana. While spatiotemporal analyses have explored aspects of the opioid crisis, spatiotemporal patterns of opioid prescribing have not been sufficiently studied. This study utilizes a sample of Medicaid claims data from the Indiana Family and Social Services Administration from 2015 to 2019 to analyze spatiotemporal patterns of patients receiving at least one opioid prescription across Indiana. The goal was to analyze patient demographics and track prescription hotspot movement over time in rural and urban areas. We analyzed data for 107,574 Medicaid enrollees who received opioid prescriptions during the study period. We found that most patients in the cohort resided in urban areas, with the number of patients who were prescribed opioids and resided in rural areas decreasing at a faster rate. We conducted a negative binomial regression analysis to examine the relationship between various demographics (sex, age, race/ethnicity, and urban/rural classification) and the number of patients receiving at least one opioid prescription over time. Our findings indicate that older patients, patients identifying as females, patients who identify as White, and patients living in urban areas, are more likely to receive at least one opioid prescription. Additionally, the interaction effects revealed that patients from all demographic groups were more likely to receive at least one opioid prescription if they lived in urban areas, compared to those living in rural areas. Using Local Moran's I as a local spatial autocorrelation measure, we identified clusters highlighting transitions from rural to urban areas over time. In 2015-2016, three significant clusters emerged within rural-surrounded 3-digit ZIP codes (472, 474, 476), based on the Rural-Urban Commuting Area Codes. Over time, significant clusters shifted towards urban or mixed areas, possibly influenced by state guidelines and legislation. These findings enhance the understanding of opioid prescription dynamics and identify patterns in opioid prescribing rates in terms of the proportion of patients receiving opioid prescriptions among urban vs. rural communities in Indiana.

Background: To further develop effective smoking cessation interventions within mental healthcare for people with severe mental illness (SMI), it is essential to gain insights into patients' experiences with smoking (cessation), and professionals' experiences with guiding patients in overcoming tobacco addiction.

Methods: We conducted 26 semi-structured interviews with 16 patients and 10 mental healthcare professionals (MHPs), as part of a one-year smoking cessation intervention. A purposive sampling strategy was applied to select the interviewees. All interviews were transcribed verbatim and thematically analysed using MAXQDA software. This study was embedded in a randomised controlled trial conducted in ambulatory mental healthcare in the Netherlands.

Results: Patients reported to smoke to cope with psychological distress and psychiatric symptoms, and to alleviate potential side effects of antipsychotic medication. For some patients low self-esteem and a lack of confidence in one's own capacity to quit smoking were obstacles to a quit attempt. Therefore, for those patients these were crucial aspects to address. Patients and MHPs valued the exercises based on cognitive behavioural therapy (CBT). During group sessions, establishing personalised relapse prevention strategies was regarded as effective preparation for a quit attempt. The group setting was welcomed, however, adjustments to individual needs and preferences are required to personalise the intervention.

Conclusions: Findings highlight the need for personalised care in treating tobacco addiction among people with severe mental illness. The KISMET intervention may serve as a useful framework for tailored cessation support, informed by the diverse experiences presented in this study.

Background: Randomized controlled trials (RCTs) are a critical component of the development of pharmacological treatment options for substance use disorders. Pragmatic trials, in particular, aim to enhance generalizability by testing interventions in real-world settings. However, structural barriers, including socioeconomic marginalization and criminalization, continue to limit research participation among people who use drugs (PWUD). While prior research has explored perspectives of PWUD in research, less is known about how RCT staff navigate obstacles to engaging PWUD who experience structural disadvantage.

Methods: We conducted semi-structured interviews with 36 U.S. research staff (i.e., research coordinators; research assistants) working on pragmatic RCTs testing the effectiveness of medications for substance use disorders.

Results: Staff described challenges that complicated study enrollment and retention, including mistrust, negative perceptions of study components, restrictive eligibility criteria, and logistical challenges related to transportation, housing, and communication. Despite the more flexible design of pragmatic RCTs, staff still encountered constraints that conflicted with participant needs and necessitated going beyond their role to facilitate inclusion and retention. Research staff also identified important facilitators of recruitment and retention, including relationship building, leveraging referral systems, and adopting flexible, participant-centered approaches, where possible.

Conclusion: Even in pragmatic trials designed for real-world conditions, social and structural disadvantages and rigid research structures can limit study participation among PWUD. Our findings suggest that with support, research staff play a central role in navigating these challenges and devising potential strategies for engaging marginalized populations in research.

Substance use disorder remains a United States public health concern, particularly for minoritized populations. This systematic review explores the relationship between workforce diversity, cultural competency, and the quality of substance use disorder treatment for minoritized populations. Studies published between 2003 and 2023 were analyzed and nine studies met inclusion criteria. Findings reveal conflicting evidence about the impact of workforce diversity and cultural competency on quality outcomes. While some studies suggest positive associations, others report no relationship or adverse effects. Moreover, inconsistencies in research methodology limited comparative analyses. The literature predominantly focuses on Hispanic/Latinx populations, leaving gaps in understanding other minoritized populations' experiences. Despite national initiatives promoting health equity and diversity, federal research funding regarding substance use disorder treatment for minoritized populations remains limited. This review calls for further research to inform policy and practice, emphasizing multi-agency collaboration, standardized measures of cultural competency, and targeted funding to address disparities in treatment quality outcomes for minoritized populations.

Background: Dog ownership has been reported to positively influence the lives of individuals with substance use disorder (SUD) fostering social connection, a sense of belonging, and greater daily structure. However, the specific ways in which dog ownership impacts substance use and mental health remain underexplored. This study aimed to explore how people with SUD perceived that dog ownership affected their use of substances and mental health characteristics.

Method: Qualitative, semi-structured, in-depth interviews were conducted with eight individuals with experience of dog ownership and SUD. Data were gathered and analysed using a 4-step qualitative content analysis.

Results: Three key categories emerged from the analysis. The unique relationship with their dog encouraged the development of a new sense of self for participants that had not been previously possible. Participants reported an increased awareness and regulation of substance use, and they became more mindful of their use, often reducing or managing it to align with caring for their dog. The bond with their dog contributed to improved mental health, emotional stability and appeared to play a role in reducing suicidal ideation.

Discussion: Dog ownership provided participants with a positive sense of self and reinforced feelings of self-worth. This helped them move away from impulsive or habitual substance use patterns and adopt a more intentional, less harmful approach. The relationship with the dog also appeared to stabilise participants' mental health, enabling them to navigate depressive episodes more effectively and recover from negative moods more easily.

Background: Cigarette smoking is a major contributor to the global burden of bladder cancer. Its carcinogenic effects result from the harmful substances in tobacco smoke, which induce genetic mutations and disrupt cellular processes. Understanding how smoking contributes to bladder cancer is essential for developing effective prevention and treatment strategies.

Objective: This study systematically reviews global research on the relationship between smoking and bladder cancer through bibliometric analysis, identifying research hotspots, trends and future directions.

Methods: Relevant literature on the relationship between cigarette smoking and bladder cancer published between 1999 and 2023 was retrieved from the Web of Science database. Visual analyses were conducted using VOSviewer and CiteSpace software, focusing on contributions from countries, institutions, journals, authors and keywords.

Results: Our analysis of 2,802 publications revealed an upward trend in annual output on the relationship between smoking and bladder cancer, with the United States and China as leading contributors. Notable institutions included the NIH, National Cancer Institute, University of Texas System and the International Agency for Research on Cancer. Key journals were Cancer Epidemiology, Biomarkers & Prevention and International Journal of Cancer. Rothman, Nathaniel and Zeegers, M.P.A. were the most productive and co-cited authors. Keyword analysis highlighted DNA repair, genome-wide association studies, and smoking cessation.

Conclusion: This bibliometric analysis has significantly advanced the field by highlighting current research directions and the application of specific mechanisms. These findings also have implications for clinical practice and public health policy, potentially improving patient outcomes through a comprehensive understanding of disease pathogenesis.