Substance Abuse Treatment, Prevention, and Policy最新文献

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.

Background: Tobacco use, particularly smoking, remains the leading cause of preventable death in the United States. While Medicaid in all states provides some coverage of tobacco cessation treatments, rates of tobacco use remain much higher among Medicaid beneficiaries (30.0%) compared to those with private insurance (18.0%). The extent to which Medicaid beneficiaries receive cessation counseling services remains unclear. The current study assessed tobacco counseling occurrence among individuals who use tobacco among South Carolina Medicaid fee-for-service beneficiaries from 2019 to 2022.

Methods: Individuals with a tobacco use disorder diagnosis were identified (N = 49,401) and the differences in the number of patients counseled between demographic groups and the types of providers delivering counseling were assessed. Between-group differences in receiving counseling were assessed using Chi-squared tests.

Results: Fewer Black (χ2 = 34.54, 23.51, 8.54, 12.02, p < 0.5) and younger (χ2 = 81.43, 117.45, 83.25, 78.98, p < 0.0001) beneficiaries received counseling across all four years compared to their White and older counterparts, respectively. Additionally, fewer individuals in rural areas (χ2 = 12.44, 4.05, 5.07, p < 0.05) received counseling compared to those in urban areas in years 2019-2021. There were additional sex and regional differences in some years.

Conclusions: To improve cessation rates, focusing on increasing availability of cessation counseling services to Medicaid beneficiaries is critical.

Introduction: Smoking cessation interventions tend to be less effective for people of lower socioeconomic position (SEP) compared to those of higher SEP. Mobile phone-based interventions have been shown to increase abstinence from smoking. Stopcoach is an mHealth smoking cessation intervention that specifically targets people with a lower SEP. A pilot study showed the potential and feasibility of Stopcoach but as yet no research exists that assesses the effectiveness of Stopcoach.

Objective: This study aims to evaluate whether using Stopcoach in combination with group-based smoking cessation counselling (SCC; intervention group) increases short- and long-term abstinence compared to SCC alone (control groups). Secondarily, this study aims to assess acceptability of Stopcoach as perceived by people who smoke and SCC group coaches.

Methods: This multi-methods study was originally designed comparing an intervention group (n = 242; 2020-2022) to a historical control group (n = 3362; 2018-2020) that did not use Stopcoach. However, the COVID-19 pandemic hampered realistic comparison due to declining abstinence rates. Therefore, a COVID-era control group was added (n = 312; 2020-2021). All participants enrolled in professionally led SCC groups. The primary outcome was abstinence at four weeks and one year after quit date. In the intervention group, usability, acceptability and usefulness were also measured. In a qualitative assessment, eight SCC trainers were interviewed to explore acceptance by trainers and integration of Stopcoach into SCC.

Results: Due to the COVID-19 related overall decline in abstinence rates, the intervention group had lower abstinence rates compared to the pre-COVID control group (73.6% vs. 78.2% p < 0.001). However, the COVID-era control group revealed that Stopcoach, as addition to accredited SCC, was associated with higher abstinence rates after four weeks than SCC alone (73.6% vs. 57.1%, p < 0.001). This difference was sustained in the lower SEP subgroup (65.6% vs. 49.6%, p = 0.043). No overall significant differences in 1-year abstinence rates were found between the intervention group and both control groups. Participants rated usability, acceptability and usefulness highly positive, irrespective of SEP. Qualitative measures showed most trainers welcomed adding Stopcoach to their SCC.

Conclusion: Addition of the Stopcoach app to SCC appears effective and feasible. Importantly, this also holds for the lower SEP subgroup. This makes Stopcoach one of the few smoking cessation mHealth interventions that also meets the needs of people with lower SEP who smoke.

Background: People in the United States who use opioids frequently use emergency department (ED) services. Some hospitals have begun placing peer recovery support specialists (PRSS) in EDs to support and advocate for patients and provide linkages to services, in an effort to reduce future presentations for opioid-related and other health problems related to substance use. However, evidence supporting the impact of PRSS services on reducing future ED presentations is limited, and even less is known about ED-based PRSS services delivered via telehealth.

Methods: Using records from a large Indiana-based hospital system, we conducted an interrupted time series (ITS) analysis of ED patients presenting for unintentional opioid overdose or other opioid-related issues. Over a five-year period, 2,542 unique ED visits were included across 12 hospitals. The primary outcome assessed was the impact of PRSS telehealth service implementation (comparing pre- and post-periods) on 30-day all-cause ED revisits. Analyses were also stratified by appropriate demographics.

Results: There was no significant change in 30-day ED revisits between pre- and post-implementation of the PRSS telehealth program. Results of sex-stratified ITS indicated a significant change for females only, with decreasing log-odds of ED revisits post-program implementation (post-implementation slope OR = 0.911, p = 0.031; slope change OR = 0.874, p = 0.017).

Conclusions: Although there was no detectable difference in overall ED revisits following program implementation, outcomes of stratified analyses suggested that the program may have been more impactful for females vs. males. Future research should examine the underlying mechanism of the observed sex differences to target behavioral change more effectively for all participants of telehealth PRSS services in ED settings.

Background: A new transitional housing program was established in Sudbury, Ontario, Canada, in response to the escalating prevalence of substance use and homelessness, and the specific challenges faced in Northern Ontario. There is a scarcity of research investigating the implementation of housing programs with clinical, social, and functional support for people with substance use in Northern settings in the era of Fentanyl and its analogs and a contaminated dangerous drug supply. To bridge this knowledge gap, we evaluated a unique harm reduction-focused transitional housing program. Our study objectives encompassed exploring patients' viewpoints on considerations when implementing a transitional housing program for people with substance use and mental disorders.

Methods: This is a qualitative interview study of 12 clients from a transitional housing program that offers comprehensive health and social assistance through addiction medicine, psychiatric consultation, primary care, and harm reduction services to clients in a transitional housing program in an Urban setting in Northern Canada. This study was a pilot project, to gather their perspectives on the care provided by the team. Maslow's Hierarchy of Needs was used to contextualize the data.

Results: Participants emphasized the importance of the program's housing first approach, its positive impact on accessing health and social services, and the increase in sense of belonging, self-esteem, and confidence because of being in the program. Participants also indicated that the program had a positive overall impact, leading to reduced substance use, improved mental and emotional well-being, and enhanced socio-economic conditions. However, several considerations were highlighted as important for ensuring the effectiveness of the program, such as better aligning client and program expectations, facilitating access to community supports with food, support with medication regimen, providing empathetic engagement, and individualizing approaches to care.

Conclusion: A new transitional housing program in a Northern Urban setting in the era of an increasingly contaminated drug supply led to perceived positive outcomes for clients. Important considerations include focusing (or enhancing supports) on physiological needs and empathetic, individualized approaches to care.

Background: Smoking is a major preventable cause of death, associated with cancers and chronic diseases. Nurse-initiated smoking cessation programs have proven effective, providing counseling, education, and mental health support. These interventions increase quit rates by tackling nicotine addiction, emphasizing the important role of nurses and the need for targeted training. Systematic reviews and meta-analyses are essential for gaining a deeper understanding of the effectiveness of various cessation strategies.

Methods: A literature search was conducted using eight electronic databases (CINAHL, EMbase, MEDLINE, Cochrane, RISS, KMbase, KISS, and NDSL). The literature search was conducted from March, 27, 2024, to August 1, 2024. All included studies were randomized controlled trials (RCTs). Quality assessment was conducted using the Risk of Bias (ROB) tool. RevMan 5.4 was used for qualitative analysis, with effect sizes measured as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Thirteen studies, all published after 2005, were included in the evidence assessment of nurse-initiated smoking cessation programs. The interventions examined comprised 11 intensive or personalized counseling programs and 3 telephone-based approaches. The OR for self-reported quit success 7-day smoking cessation rate at 6-month follow-up was 1.43 (95% CI [1.08, 1.90]), indicating a significant difference in quit effectiveness (Z = 2.27, p =.01), with moderate heterogeneity observed across studies (I² = 67.0%, p =.001). A meta-analysis of 7-day point abstinence rate at 12-month follow-up revealed a pooled OR of 1.18 (95% CI [0.96, 1.44]), showing no significant difference in quit effectiveness (Z = 1.58, p =.11) and moderate heterogeneity among the studies (I² = 55.0%, p =.02).

Conclusions: A comprehensive approach by trained nursing professionals is essential in addressing the complexities of smoking cessation. Further clinical trials are needed to assess intervention methods and follow-up strategies. Future research should emphasize long-term outcomes and ongoing support to sustain behavior change, contributing to more effective, tailored cessation programs and improved public health outcomes.

Background: Methamphetamine use is a pressing public health concern among people who inject drugs (PWID) worldwide. This study aimed to estimate the prevalence of methamphetamine use and its correlates in a nationwide survey among PWID in Iran in 2020.

Methods:  We recruited 2,684 PWID in 11 major cities from July 2019 to March 2020 using respondent-driven sampling (RDS). Participants were eligible if they were ≥ 18 years old, self-reported drug injection in the last 12 months, resided in the city of the study, and provided a valid RDS coupon. Behavioral data was collected using a standard questionnaire via face-to-face interviews. 2,259 PWID (84.2%) with valid responses to the primary outcome (i.e., methamphetamine use (either injecting or non-injection use) in the last three months) were included in the analysis. We used RDS-Gile's SS weighted analysis for descriptive statistics and a survey package (svy) using linearized variance estimations and stratification by cities for bivariable and multivariable logistic regression analyses.

Results: The last 3-month prevalence of methamphetamine use among PWID was 47.0% (95% CI: 44.9, 49.1). The following factors were significantly associated with methamphetamine use in the last three months: history of homelessness in the last 12 months (aOR = 1.57; 1.77, 2.10), drug use onset before the age 18 (aOR = 1.40; 1.05, 1.87), injecting drug for more than ten years (aOR = 1.47; 1.11, 1.95), using non-injection (aOR = 7.18; 4.93, 10.47) and injecting illicit opioids (aOR = 2.98; 2.03, 4.36) in the last three months, as well as having multiple sex partners in the last 12 months (aOR = 1.60; 1.50, 2.73) and region (north: aOR = 5.42; 2.92 10.03; south: aOR = 2.95; 2.04, 4.27; east: aOR = 24.43; 15.62, 38.22).

Conclusions: The frequency of methamphetamine use among PWID is considerable in Iran. Our findings underscore the importance of implementing tailored comprehensive harm reduction services for this sub-population of PWID. They also emphasize the urgent need for evidence-based interventions to address the harms associated with the increasing co-use of opioids and methamphetamine among PWID.