Pub Date : 2024-08-19DOI: 10.1101/2024.08.16.24312118
Martin Osayande Agwogie, Landon Kuester, Polly Radcliffe, Andrea Gordon, Mary Loos, Anna Williams
Background: Suboptimal adherence to antiretroviral therapy (ART) is a major challenge in Human Immunodeficiency Virus (HIV) treatment interventions among persons who use alcohol and other substances (AOS) in fisherfolk communities. While studies have identified barriers to ART adherence and interventions to address these barriers in this population, no systematic review has been conducted to establish the significance of these interventions. Methods: Searches were conducted in three electronic databases: PubMed, Web of Science and PsycINFO for studies conducted in English between 1996 and April 2024 to identify relevant primary studies that included adult males or females, engages in fishing activities, use alcohol or other substances and are HIV positive. Outcomes include any measure of adherence to ART, a reduction or abstinence from alcohol and other substance use and associated consequences that could hinder ART adherence. Results: 54 studies were identified and screened against the inclusion/exclusion criteria. Five papers met the inclusion criteria (three quantitative designs, one qualitative design and one mixed methods design). Seven interventions were identified, these include counselling, peer support, screening and brief intervention, economic straightening, social network, gender transformative programmes and prescription monitoring. Conclusion: Findings highlight the significance of alcohol use reduction interventions and gender transformative programmes particularly among men to encourage ART adherence in fisherfolk communities. To achieve the universal target of an end to the HIV scourge by 2030, specific hard to reach populations like fisherfolk communities with high HIV prevalence, alcohol and other substance use needs particular attention.
背景：对抗逆转录病毒疗法（ART）的依从性不理想是渔民社区中酗酒和使用其他物质（AOS）的人在人类免疫缺陷病毒（HIV）治疗干预中面临的主要挑战。虽然已有研究确定了在这一人群中坚持抗逆转录病毒疗法的障碍以及解决这些障碍的干预措施，但还没有系统性的综述来确定这些干预措施的重要性：在三个电子数据库中进行了搜索：方法：在 PubMed、Web of Science 和 PsycINFO 三个电子数据库中搜索 1996 年至 2024 年 4 月间用英语进行的研究，以确定包含成年男性或女性、从事捕鱼活动、使用酒精或其他物质且 HIV 阳性的相关主要研究。结果包括对坚持抗逆转录病毒疗法、减少或戒除酗酒和使用其他药物以及可能妨碍坚持抗逆转录病毒疗法的相关后果的任何测量：共确定了 54 项研究，并根据纳入/排除标准进行了筛选。五篇论文符合纳入标准（三篇定量设计、一篇定性设计和一篇混合方法设计）。确定了七项干预措施，包括咨询、同伴支持、筛查和简单干预、经济矫正、社会网络、性别转变计划和处方监测：研究结果强调了减少酗酒干预措施和性别转变计划的重要性，尤其是在男性中，以鼓励渔民社区坚持抗逆转录病毒疗法。为了实现到 2030 年消除艾滋病毒祸害的普遍目标，需要特别关注像渔民社区这样的艾滋病毒高发、酗酒和使用其他物质的特定人群。
{"title":"Antiretroviral therapy adherence interventions among persons who use alcohol and other substances in fisherfolk communities: A systematic review","authors":"Martin Osayande Agwogie, Landon Kuester, Polly Radcliffe, Andrea Gordon, Mary Loos, Anna Williams","doi":"10.1101/2024.08.16.24312118","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312118","url":null,"abstract":"Background: Suboptimal adherence to antiretroviral therapy (ART) is a major challenge in Human Immunodeficiency Virus (HIV) treatment interventions among persons who use alcohol and other substances (AOS) in fisherfolk communities. While studies have identified barriers to ART adherence and interventions to address these barriers in this population, no systematic review has been conducted to establish the significance of these interventions.\u0000Methods: Searches were conducted in three electronic databases: PubMed, Web of Science and PsycINFO for studies conducted in English between 1996 and April 2024 to identify relevant primary studies that included adult males or females, engages in fishing activities, use alcohol or other substances and are HIV positive. Outcomes include any measure of adherence to ART, a reduction or abstinence from alcohol and other substance use and associated consequences that could hinder ART adherence.\u0000Results: 54 studies were identified and screened against the inclusion/exclusion criteria. Five papers met the inclusion criteria (three quantitative designs, one qualitative design and one mixed methods design). Seven interventions were identified, these include counselling, peer support, screening and brief intervention, economic straightening, social network, gender transformative programmes and prescription monitoring.\u0000Conclusion: Findings highlight the significance of alcohol use reduction interventions and gender transformative programmes particularly among men to encourage ART adherence in fisherfolk communities. To achieve the universal target of an end to the HIV scourge by 2030, specific hard to reach populations like fisherfolk communities with high HIV prevalence, alcohol and other substance use needs particular attention.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.31.24311291
Alexander Tran, Huan Jiang, Shannon Lange, Mindaugas Štelemėkas, Daumantas Stumbrys, Ilona Tamutienė, Jürgen Rehm
Background The Coronavirus Disease 2019 (COVID-19) pandemic and associated public health measures had an impact on alcohol use. Based on the literature of past crises (health, economic, etc.), it was hypothesized that the COVID-19 pandemic led to a polarization of drinking–that is, heavy drinkers increased their drinking, while light to moderate drinkers decreased their drinking and/or temporarily abstained. The aim of the current study was to test the respective hypothesis.
{"title":"Changes in self-reported alcohol consumption at high and low consumption in the wake of the COVID-19 pandemic: A test of the polarization hypothesis","authors":"Alexander Tran, Huan Jiang, Shannon Lange, Mindaugas Štelemėkas, Daumantas Stumbrys, Ilona Tamutienė, Jürgen Rehm","doi":"10.1101/2024.07.31.24311291","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311291","url":null,"abstract":"<strong>Background</strong> The Coronavirus Disease 2019 (COVID-19) pandemic and associated public health measures had an impact on alcohol use. Based on the literature of past crises (health, economic, etc.), it was hypothesized that the COVID-19 pandemic led to a polarization of drinking–that is, heavy drinkers increased their drinking, while light to moderate drinkers decreased their drinking and/or temporarily abstained. The aim of the current study was to test the respective hypothesis.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141880789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.30.24311204
Vera Helen Buss, Loren Kock, Harry Oisin Tattan-Birch, Sarah E Jackson, Lion Shahab, Jamie Brown
Background and Aims: Due to the COVID-19 pandemic, the survey mode of the Smoking and Alcohol Toolkit Study, a long-running repeat cross-sectional survey, had to change from face-to-face to telephone interviews. This study aimed to assess similarities and differences in sociodemographic, smoking, alternative nicotine and alcohol use estimates between the two survey modes, to understand the potential impacts of this change in methodology on prevalence estimates and trends over time. Design: After COVID-19 restrictions were lifted, we conducted parallel telephone and face-to-face household surveys in March 2022 and in January to March 2024, using a hybrid of random and quota sampling. Data from both years were aggregated. Setting and Participants: People aged 16+ years living in private households in Great Britain. Measurements: Sociodemographic characteristics, nicotine and alcohol use related estimates and their 95% CIs - unweighted and weighted - collected via telephone versus face-to-face in a household. Findings: In the unweighted analyses, the telephone sample included slightly younger and less socioeconomically advantaged groups than the face-to-face sample. After the samples were weighted, estimates of sociodemographic characteristics and nicotine and alcohol use were generally consistent across methodologies, including daily cigarette smoking (face-to-face: 11.1% [10.1-12.1] vs. telephone: 10.6% [9.5-11.7]), non-daily cigarette smoking (face-to-face: 2.7% [2.2-3.3] vs. telephone: 3.4% [2.8-4.1]), and e-cigarette use among people who smoke (face-to-face: 27.0% [23.5-30.5] vs. telephone: 29.3% [25.4-33.3]). However, compared with telephone participants, a lower proportion of face-to-face participants reported currently using e-cigarettes (face-to-face: 6.4% [5.6-7.1] vs. telephone: 10.4% [9.3-11.5]), and a higher proportion reported never drinking alcohol (face-to-face: 31.1% [29.7-32.5] vs. telephone: 25.0% [23.5-26.5]) and never having 6 or more standard drinks on one occasion (face-to-face: 46.6% [44.7-48.5] vs. telephone: 40.2% [38.4-42.1]). More participants provided "don't know" or "refused" responses in the telephone compared with the face-to-face interview, including in response to questions about tobacco use, e-cigarette device type, and the number of standard drinks on a typical day. Conclusions: Face-to-face and telephone surveys generally yield similar estimates of nicotine and alcohol use. However, there may be some underreporting of vaping and drinking in a face-to-face survey conducted in the home compared with telephone.
背景和目的：由于COVID-19大流行，吸烟与饮酒工具包研究这一长期重复性横断面调查的调查方式不得不从面对面调查改为电话访问。本研究旨在评估两种调查模式在社会人口学、吸烟、尼古丁替代品和酒精使用估计值方面的异同，以了解方法的改变对流行估计值和长期趋势的潜在影响。设计：COVID-19 限制解除后，我们在 2022 年 3 月和 2024 年 1 月至 3 月采用随机抽样和配额抽样的混合方法同时进行了电话和面对面住户调查。我们对这两年的数据进行了汇总。调查地点和参与者：居住在英国私人家庭中的 16 岁以上人群。测量：社会人口学特征、尼古丁和酒精使用相关估计值及其 95% CIs（非加权和加权）--通过电话收集，而不是在家庭中面对面收集。研究结果：在未加权分析中，电话样本中的年轻群体和社会经济地位较低的群体略多于面对面样本。在对样本进行加权分析后，各种方法对社会人口特征以及尼古丁和酒精使用情况的估计值基本一致，包括每天吸烟（面对面：11.1% [10.1-12.1] vs. 电话：10.6% [9.1] vs. 其他方法：11.1% [10.1-12.1] vs. 其他方法：11.1% [10.1-12.1] vs. 其他方法：10.6% [9.1电话：10.6% [9.5-11.7]）、非每日吸烟（面对面：2.7% [2.2-3.3] vs. 电话：3.4% [2.8-4.1]）和吸烟者使用电子烟（面对面：27.0% [23.5-30.5] vs. 电话：29.3% [25.4-33.3]）。然而，与电话参与者相比，较低比例的面对面参与者表示目前正在使用电子烟（面对面：6.4% [5.6-7.1] vs. 电话：10.4% [9.3-11.5]），有更高比例的参与者表示从未饮酒（面对面：31.1% [29.7-32.5] vs. 电话：25.0% [23.5-26.5]），也从未一次性喝过 6 杯或更多标准饮料（面对面：46.6% [44.7-48.5] vs. 电话：40.2% [38.4-42.1]）。与面对面访谈相比，更多参与者在电话访谈中回答 "不知道 "或 "拒绝"，包括回答有关烟草使用、电子烟设备类型和通常一天中标准饮料的数量等问题。结论：面对面调查和电话调查对尼古丁和酒精使用情况的估计值基本相似。然而，与电话调查相比，在家中进行的面对面调查可能会少报一些吸食电子烟和饮酒的情况。
{"title":"A comparison of prevalence estimates of smoking, alternative nicotine and alcohol use in Great Britain collected via telephone versus face-to-face: Smoking and Alcohol Toolkit surveys","authors":"Vera Helen Buss, Loren Kock, Harry Oisin Tattan-Birch, Sarah E Jackson, Lion Shahab, Jamie Brown","doi":"10.1101/2024.07.30.24311204","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311204","url":null,"abstract":"Background and Aims: Due to the COVID-19 pandemic, the survey mode of the Smoking and Alcohol Toolkit Study, a long-running repeat cross-sectional survey, had to change from face-to-face to telephone interviews. This study aimed to assess similarities and differences in sociodemographic, smoking, alternative nicotine and alcohol use estimates between the two survey modes, to understand the potential impacts of this change in methodology on prevalence estimates and trends over time. Design: After COVID-19 restrictions were lifted, we conducted parallel telephone and face-to-face household surveys in March 2022 and in January to March 2024, using a hybrid of random and quota sampling. Data from both years were aggregated. Setting and Participants: People aged 16+ years living in private households in Great Britain. Measurements: Sociodemographic characteristics, nicotine and alcohol use related estimates and their 95% CIs - unweighted and weighted - collected via telephone versus face-to-face in a household. Findings: In the unweighted analyses, the telephone sample included slightly younger and less socioeconomically advantaged groups than the face-to-face sample. After the samples were weighted, estimates of sociodemographic characteristics and nicotine and alcohol use were generally consistent across methodologies, including daily cigarette smoking (face-to-face: 11.1% [10.1-12.1] vs. telephone: 10.6% [9.5-11.7]), non-daily cigarette smoking (face-to-face: 2.7% [2.2-3.3] vs. telephone: 3.4% [2.8-4.1]), and e-cigarette use among people who smoke (face-to-face: 27.0% [23.5-30.5] vs. telephone: 29.3% [25.4-33.3]). However, compared with telephone participants, a lower proportion of face-to-face participants reported currently using e-cigarettes (face-to-face: 6.4% [5.6-7.1] vs. telephone: 10.4% [9.3-11.5]), and a higher proportion reported never drinking alcohol (face-to-face: 31.1% [29.7-32.5] vs. telephone: 25.0% [23.5-26.5]) and never having 6 or more standard drinks on one occasion (face-to-face: 46.6% [44.7-48.5] vs. telephone: 40.2% [38.4-42.1]). More participants provided \"don't know\" or \"refused\" responses in the telephone compared with the face-to-face interview, including in response to questions about tobacco use, e-cigarette device type, and the number of standard drinks on a typical day. Conclusions: Face-to-face and telephone surveys generally yield similar estimates of nicotine and alcohol use. However, there may be some underreporting of vaping and drinking in a face-to-face survey conducted in the home compared with telephone.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141872382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1101/2024.07.26.24311053
Hannah Family, Gabriele Vojt, Hannah Poulter, Chris Bailey, Ana Paula Abdala Sheikh, Damiana Cavallo, Sara Karimi, Nick Booth, Peter Da Silva, Louise Aitken, Samantha Stewart, Matthew Hickman, Graeme Henderson, Jenny Scott, Joanna Kesten
Background Co-use of benzodiazepines and/or 'z-drugs' along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought. Methods Forty-eight semi-structured interviews across Glasgow in Scotland (n=28), Bristol (n=10) and Teesside (n=10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method. Results Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria ("warm glow", "gouching out") or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use. Conclusions The patterns identified provide opportunities for future harm reduction strategies, tailoring advice, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.
{"title":"A qualitative study of Benzodiazepine/Z-drug and Opioid co-use patterns and overdose risk: insights for future policy and practice","authors":"Hannah Family, Gabriele Vojt, Hannah Poulter, Chris Bailey, Ana Paula Abdala Sheikh, Damiana Cavallo, Sara Karimi, Nick Booth, Peter Da Silva, Louise Aitken, Samantha Stewart, Matthew Hickman, Graeme Henderson, Jenny Scott, Joanna Kesten","doi":"10.1101/2024.07.26.24311053","DOIUrl":"https://doi.org/10.1101/2024.07.26.24311053","url":null,"abstract":"Background Co-use of benzodiazepines and/or 'z-drugs' along with opioids is linked to the rise in drug related deaths (DRD) in the UK. Understanding patterns of co-use could inform harm reduction strategies for reducing DRDs. This study explored how people co-use, including dosages, timings, methods of administration, use of other substances and desired effects sought. Methods Forty-eight semi-structured interviews across Glasgow in Scotland (n=28), Bristol (n=10) and Teesside (n=10) in England with individuals who co-use illicit and/or prescribed opioids and benzodiazepines/z-drugs were conducted. Eighteen interviews were co-facilitated with qualitatively trained local peer researchers. Interviews were analysed using the Framework method. Results Six co-use patterns were generated: (1) co-use to aid sleep or come down, (2) curated co-use, opioid agonist therapy (OAT) only (3) morning and evening benzodiazepine doses with opioids throughout the day (4) co-use binges (5) co-use throughout the day, (6) benzodiazepine use throughout the day plus OAT. Patterns one to three reflected more controlled co-use with a focus on self-medicating to give confidence, manage anxiety, promote sleep and come-down from cocaine/ketamine. Patterns four to six involved greater poly-drug use, and less controlled co-use with a focus on seeking euphoria (\"warm glow\", \"gouching out\") or oblivion (to escape untreated mental health conditions and trauma). Patterns two, three, five and six involved daily co-use. People switched between patterns depending on available resources (e.g. finances) or changes to prescriptions (opioids or benzodiazepines). Near-fatal overdoses were reported by participants across all co-use patterns. Patterns four to six were conceptualised as presenting greater overdose risk due to less controlled co-use and more extensive polydrug use. Conclusions The patterns identified provide opportunities for future harm reduction strategies, tailoring advice, updated prescribing guidance and policies, and the need for better access to mental health care, for people who co-use benzodiazepines and opioids to reduce DRDs.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141783191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Craving, a potent driving force behind drug-seeking and consumption behaviors, represents a dynamic emotional-motivational response primarily elicited by drug-related cues. In laboratory settings, the drug cue reactivity (DCR) paradigm is frequently employed to evoke craving and investigate the neural and behavioral responses to drug cues. This study adopts functional magnetic resonance imaging (fMRI) alongside behavioral assessments to establish a collection of validated pictorial cues encompassing both cannabis and neutral images. Methods: 110 cannabis-related images were selected across cannabis flowers and powder, cannabis use methods, and paraphernalia categories. Participants with a history of cannabis use were then asked to assess the selected images for craving, valence, and arousal using both the visual analog scale and the self-assessment Manikin. Using fMRI, the neural mechanisms underlying cannabis cue-reactivity were investigated at the whole-brain level and within Brainnetome atlas areas in a subgroup of 31 cannabis users. Results: The selected cannabis-related images (n = 110) received significantly higher craving (t = 6.56; p<0.001) and arousal (t = 17.46; p<0.001) ratings compared to the neutral ones (n = 30). Fifty regular cannabis users (mean=19.9, SD= 4.8 years; 10 females and 40 males) with at least a one-year history of use were included. Investigating blood oxygenation level-dependent (BOLD) responses to cannabis compared with neutral cues yielded significant activations in the inferior/medial frontal gyrus, fusiform gyrus, parahippocampal gyrus, orbital gyrus, postcentral gyrus, insula, precuneus, superior/middle temporal gyrus, and cerebellar tonsil. Conclusion: This study provides a resource of ecologically validated cannabis-related images useful for studies applying DCR as interventions or assessments for cannabis users.
{"title":"Development and Validation of a Pictorial Cue Database for Cannabis Cue Reactivity Studies: Insights from Behavioral and Neural Investigations","authors":"Zahra Hamidein, Neda Mohammad, Parnian Rafei, Mohsen Ebrahimi, Hamed Ekhtiari, Tara Rezapour, Peyman Ghobadi-Azbari","doi":"10.1101/2024.07.26.24310880","DOIUrl":"https://doi.org/10.1101/2024.07.26.24310880","url":null,"abstract":"Introduction: Craving, a potent driving force behind drug-seeking and consumption behaviors, represents a dynamic emotional-motivational response primarily elicited by drug-related cues. In laboratory settings, the drug cue reactivity (DCR) paradigm is frequently employed to evoke craving and investigate the neural and behavioral responses to drug cues. This study adopts functional magnetic resonance imaging (fMRI) alongside behavioral assessments to establish a collection of validated pictorial cues encompassing both cannabis and neutral images.\u0000Methods: 110 cannabis-related images were selected across cannabis flowers and powder, cannabis use methods, and paraphernalia categories. Participants with a history of cannabis use were then asked to assess the selected images for craving, valence, and arousal using both the visual analog scale and the self-assessment Manikin. Using fMRI, the neural mechanisms underlying cannabis cue-reactivity were investigated at the whole-brain level and within Brainnetome atlas areas in a subgroup of 31 cannabis users.\u0000Results: The selected cannabis-related images (n = 110) received significantly higher craving (t = 6.56; p<0.001) and arousal (t = 17.46; p<0.001) ratings compared to the neutral ones (n = 30). Fifty regular cannabis users (mean=19.9, SD= 4.8 years; 10 females and 40 males) with at least a one-year history of use were included. Investigating blood oxygenation level-dependent (BOLD) responses to cannabis compared with neutral cues yielded significant activations in the inferior/medial frontal gyrus, fusiform gyrus, parahippocampal gyrus, orbital gyrus, postcentral gyrus, insula, precuneus, superior/middle temporal gyrus, and cerebellar tonsil.\u0000Conclusion: This study provides a resource of ecologically validated cannabis-related images useful for studies applying DCR as interventions or assessments for cannabis users.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141783192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-07DOI: 10.1101/2024.07.06.24310035
Kristy A Carpenter, Anna T Nguyen, Delaney A Smith, Issah A Samori, Keith Humphreys, Anna Lembke, Mathew V Kiang, Johannes C Eichstaedt, Russ B Altman
Background and Aims Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have leveraged data from platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened their usability in opioid overdose surveillance systems. Here, we evaluate the potential of a broad set of platforms to detect emerging trends in the opioid crisis. Design We identified 72 online platforms with a substantial global user base or prior citations in opioid-related research. We evaluated each platform's fit with our definition of social media, size of North American user base, and volume of opioid-related discourse. We created a shortlist of 11 platforms that met our criteria. We documented basic characteristics, volume and nature of opioid discussion, official policies regulating drug-related discussion, and data accessibility of shortlisted platforms. Setting USA and Canada. Measurements We quantified the volume of opioid discussion by number of platform-specific Google search hits for opioid terms. We captured informal language by including slang generated using a large language model. We report the number of opioid-related hits and proportion of opioid-related hits to hits for common nouns. Findings We found that TikTok, YouTube, and Facebook have the most potential for use in opioid-related surveillance. TikTok and Facebook have the highest relative amount of drug-related discussions. Language on TikTok was predominantly informal. Many platforms offer data access tools for research, but changing company policies and user norms create instability. The demographics of users varies substantially across platforms. Conclusions Social media data sources hold promise for detecting trends in opioid use, but researchers must consider the utility, accessibility, and stability of data on each platform. A strategy mixing several platforms may be required to cover all demographics suffering in the epidemic.
{"title":"Which Social Media Platforms Provide the Most Informative Data for Monitoring the Opioid Crisis?","authors":"Kristy A Carpenter, Anna T Nguyen, Delaney A Smith, Issah A Samori, Keith Humphreys, Anna Lembke, Mathew V Kiang, Johannes C Eichstaedt, Russ B Altman","doi":"10.1101/2024.07.06.24310035","DOIUrl":"https://doi.org/10.1101/2024.07.06.24310035","url":null,"abstract":"Background and Aims\u0000Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have leveraged data from platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened their usability in opioid overdose surveillance systems. Here, we evaluate the potential of a broad set of platforms to detect emerging trends in the opioid crisis. Design\u0000We identified 72 online platforms with a substantial global user base or prior citations in opioid-related research. We evaluated each platform's fit with our definition of social media, size of North American user base, and volume of opioid-related discourse. We created a shortlist of 11 platforms that met our criteria. We documented basic characteristics, volume and nature of opioid discussion, official policies regulating drug-related discussion, and data accessibility of shortlisted platforms. Setting\u0000USA and Canada. Measurements\u0000We quantified the volume of opioid discussion by number of platform-specific Google search hits for opioid terms. We captured informal language by including slang generated using a large language model. We report the number of opioid-related hits and proportion of opioid-related hits to hits for common nouns. Findings\u0000We found that TikTok, YouTube, and Facebook have the most potential for use in opioid-related surveillance. TikTok and Facebook have the highest relative amount of drug-related discussions. Language on TikTok was predominantly informal. Many platforms offer data access tools for research, but changing company policies and user norms create instability. The demographics of users varies substantially across platforms. Conclusions\u0000Social media data sources hold promise for detecting trends in opioid use, but researchers must consider the utility, accessibility, and stability of data on each platform. A strategy mixing several platforms may be required to cover all demographics suffering in the epidemic.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141567199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1101/2024.06.21.24309014
Billie Bonevski, Melissa A Jackson, Emma Austin, Nicholas Lintzeris, Nadine Ezard, Coral Gartner, Christopher Oldmeadow, Paul Haber, Richard Hallinan, Craig Rodgers, Tim Ho, Mary Harrod, Adrian J Dunlop
Introduction Tobacco smoking is a major cause of preventable disease in Australia. Individuals receiving opiate agonist treatment (OAT) are a group who experience high tobacco-related morbidity and mortality rates. Despite reporting a desire to stop, relapse rates in OAT clients are high and cessation attempts supported by pharmacotherapy are less effective than in general populations. New and innovative ways of addressing smoking amongst this group are needed. Vaporised nicotine products (VNPs), or e-cigarettes, may reduce a person's exposure to toxicants and carcinogens when compared to tobacco cigarettes. High quality evidence indicates that VNPs can increase rates of smoking cessation compared to nicotine replacement therapy. Pilot results of VNPs as a smoking cessation aid in OAT clients suggests their use is feasible and acceptable but effectiveness in this group has not been explored. This protocol details the rationale and methodology for a randomised controlled trial to examine the effectiveness of VNPs for tobacco smoking cessation amongst OAT clients in New South Wales, Australia. Methods and Analysis This will be a randomised single-blinded parallel group trial comparing 12-weeks of 12mg/mL vaporised nicotine to best-practice NRT. Participants must be 18 years or older, accessing opiate treatment at a participating health site, and a current daily tobacco smoker seeking to quit or reduce their smoking. The primary outcome will be self-reported 7-day point prevalence abstinence from tobacco after 12-weeks of treatment. Secondary outcomes include biochemically verified abstinence, self-reported 30-day abstinence, number of cigarettes smoked each day, craving and withdrawal symptoms, and VNP safety. Between-group comparisons will be conducted at end of treatment, and at 12-weeks post-treatment. Discussion This study examines new ways of reducing tobacco related harm in individuals receiving OAT. Outcomes may be enhanced by leveraging participants interactions with health care provides who can facilitate the required support. Study findings have the potential to significantly impact tobacco smoking prevalence in priority populations. Ethics and Dissemination Protocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 2020/ETH01866). Findings will be disseminated via academic conferences, peer-reviewed publications and social media. Registration The study was registered in the Australian New Zealand Clinical Trials Registry (Reference ACTRN12621000148875).
{"title":"HARMONY (HARM reduction for Opiates, Nicotine and You) Trial: Protocol of a Randomised Controlled Trial of the Effectiveness of Vaporised Nicotine Products for Tobacco Smoking Cessation amongst NSW Opiate Agonist Treatment Clients","authors":"Billie Bonevski, Melissa A Jackson, Emma Austin, Nicholas Lintzeris, Nadine Ezard, Coral Gartner, Christopher Oldmeadow, Paul Haber, Richard Hallinan, Craig Rodgers, Tim Ho, Mary Harrod, Adrian J Dunlop","doi":"10.1101/2024.06.21.24309014","DOIUrl":"https://doi.org/10.1101/2024.06.21.24309014","url":null,"abstract":"Introduction Tobacco smoking is a major cause of preventable disease in Australia. Individuals receiving opiate agonist treatment (OAT) are a group who experience high tobacco-related morbidity and mortality rates. Despite reporting a desire to stop, relapse rates in OAT clients are high and cessation attempts supported by pharmacotherapy are less effective than in general populations. New and innovative ways of addressing smoking amongst this group are needed. Vaporised nicotine products (VNPs), or e-cigarettes, may reduce a person's exposure to toxicants and carcinogens when compared to tobacco cigarettes. High quality evidence indicates that VNPs can increase rates of smoking cessation compared to nicotine replacement therapy. Pilot results of VNPs as a smoking cessation aid in OAT clients suggests their use is feasible and acceptable but effectiveness in this group has not been explored. This protocol details the rationale and methodology for a randomised controlled trial to examine the effectiveness of VNPs for tobacco smoking cessation amongst OAT clients in New South Wales, Australia. Methods and Analysis This will be a randomised single-blinded parallel group trial comparing 12-weeks of 12mg/mL vaporised nicotine to best-practice NRT. Participants must be 18 years or older, accessing opiate treatment at a participating health site, and a current daily tobacco smoker seeking to quit or reduce their smoking. The primary outcome will be self-reported 7-day point prevalence abstinence from tobacco after 12-weeks of treatment. Secondary outcomes include biochemically verified abstinence, self-reported 30-day abstinence, number of cigarettes smoked each day, craving and withdrawal symptoms, and VNP safety. Between-group comparisons will be conducted at end of treatment, and at 12-weeks post-treatment. Discussion This study examines new ways of reducing tobacco related harm in individuals receiving OAT. Outcomes may be enhanced by leveraging participants interactions with health care provides who can facilitate the required support. Study findings have the potential to significantly impact tobacco smoking prevalence in priority populations. Ethics and Dissemination Protocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 2020/ETH01866). Findings will be disseminated via academic conferences, peer-reviewed publications and social media. Registration The study was registered in the Australian New Zealand Clinical Trials Registry (Reference ACTRN12621000148875).","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141503950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1101/2024.06.21.24309282
Christopher Oldmeadow, Erin Nolan, Billie Bonevski, Melissa A Jackson, Nicholas Lintzeris, Nadine Ezard, Coral Gartner, Paul Haber, Richard Hallinan, Craig Rodgers, Tim Ho, Adrian J Dunlop
Background The HARMONY study is a multicentre, randomised, single-blinded parallel group trial. It will compare the effectiveness of a 12-week course of liquid nicotine delivered via vapourised nicotine products (VNPs) to best practice nicotine replacement therapy (NRT) for smoking cessation in individuals receiving opiate agonist treatment (OAT). The aim of publishing this statistical analysis plan is to make the pre-specified statistical principles and procedures to be performed in the analysis of data generated by the HARMONY study, publicly accessible prior to the commencement of data analysis. Methods The plan outlines the analysis procedures for analysing the primary outcome of self-reported 7-day point prevalence abstinence from tobacco after 12-weeks of treatment. Secondary outcomes include biochemically verified abstinence, self-reported 30-day abstinence, number of cigarettes smoked each day, craving and withdrawal symptoms, and VNP safety. Between-group comparisons will be conducted at end of treatment, and at 12-weeks post-treatment. Researchers collecting outcome data are blind to the treatment group of each participant. Analysis Bayesian hierarchical models will be used to estimate the treatment effects for all outcomes with uninformative prior distributions for all effect parameters. Alongside the treatment effect estimate of each outcome, a 95% credible interval (highest posterior density), Bayes factor, and probability of direction will be presented. The analyses will be performed under an ITT framework assuming missing at random. All missing outcome and baseline data will be multiply imputed with predictive mean matching. Conclusion Making the statistical analysis plan for the HARMONY study publicly accessible prior to the commencement of data analysis minimises the risk of bias in the analysis of data, and the interpretation and reporting of results generated by the study. Registration The study was registered in the Australian New Zealand Clinical Trials Registry (Reference ACTRN12621000148875).
{"title":"HARMONY (HARM reduction for Opiates, Nicotine and You): Statistical Analysis Plan for a Randomised Controlled Trial of the Effectiveness of Vaporised Nicotine Products for Tobacco Smoking Cessation amongst NSW Opiate Agonist Treatment Clients","authors":"Christopher Oldmeadow, Erin Nolan, Billie Bonevski, Melissa A Jackson, Nicholas Lintzeris, Nadine Ezard, Coral Gartner, Paul Haber, Richard Hallinan, Craig Rodgers, Tim Ho, Adrian J Dunlop","doi":"10.1101/2024.06.21.24309282","DOIUrl":"https://doi.org/10.1101/2024.06.21.24309282","url":null,"abstract":"Background The HARMONY study is a multicentre, randomised, single-blinded parallel group trial. It will compare the effectiveness of a 12-week course of liquid nicotine delivered via vapourised nicotine products (VNPs) to best practice nicotine replacement therapy (NRT) for smoking cessation in individuals receiving opiate agonist treatment (OAT). The aim of publishing this statistical analysis plan is to make the pre-specified statistical principles and procedures to be performed in the analysis of data generated by the HARMONY study, publicly accessible prior to the commencement of data analysis. Methods The plan outlines the analysis procedures for analysing the primary outcome of self-reported 7-day point prevalence abstinence from tobacco after 12-weeks of treatment. Secondary outcomes include biochemically verified abstinence, self-reported 30-day abstinence, number of cigarettes smoked each day, craving and withdrawal symptoms, and VNP safety. Between-group comparisons will be conducted at end of treatment, and at 12-weeks post-treatment. Researchers collecting outcome data are blind to the treatment group of each participant. Analysis Bayesian hierarchical models will be used to estimate the treatment effects for all outcomes with uninformative prior distributions for all effect parameters. Alongside the treatment effect estimate of each outcome, a 95% credible interval (highest posterior density), Bayes factor, and probability of direction will be presented. The analyses will be performed under an ITT framework assuming missing at random. All missing outcome and baseline data will be multiply imputed with predictive mean matching. Conclusion Making the statistical analysis plan for the HARMONY study publicly accessible prior to the commencement of data analysis minimises the risk of bias in the analysis of data, and the interpretation and reporting of results generated by the study. Registration The study was registered in the Australian New Zealand Clinical Trials Registry (Reference ACTRN12621000148875).","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141529062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1101/2024.06.18.24309063
Benjamin Klugah-Brown, Xing Yao, Hang Yang, Pan Wang, Bharat B Biswal
Background Cocaine Use Disorder (CUD) poses significant neurobiological and neuropsychiatric challenges, often resulting in severe cognitive and behavioral impairments. This study aims to explore the neural dynamics of CUD using a dynamic coactivation pattern (CAP) analysis approach to provide a deeper understanding of the transient neurobiological mechanisms of the disorder. Methods Resting-state functional MRI data (SUDMEX_CONN) from 56 CUD patients and 57 healthy controls (HC) were analyzed. CAP analysis was employed to capture transient brain states and their coactivation patterns. Temporal dynamic metrics such as Fraction of Time, Persistence (PST), and Counts were computed to assess differences between groups. Stationary functional connectivity (sFC) was also examined, and meta-analytic term mapping from the Neurosynth database was used to characterize functional associations. Results CAP analysis revealed six distinct coactivation patterns, with five showing high spatial similarity between CUD and HC groups. Notable differences were observed in State 6, which displayed inverse activation patterns between the groups. CUD individuals exhibited significantly reduced PST across all brain states and altered transition probabilities, particularly increased transitions from the default mode network (DMN) to the somatomotor network and decreased transitions from DMN to attentional/executive networks. Clinical correlations indicated that prolonged cocaine use was associated with altered PST in specific brain states. sFC analysis identified significant alterations in regions such as the right supramarginal gyrus, left superior frontal gyrus, right precentral gyrus, and right lingual gyrus, each linked to distinct cognitive and behavioral functions. Conclusions This study highlights the utility of CAP analysis in capturing the dynamic neural underpinnings of CUD. The findings provide insights into the neurobiological mechanisms of the disorder, suggesting potential biomarkers for CUD. These results have implications for developing an enhanced approach for substance use disorders, as well as improving our understanding and management of CUD.
{"title":"Altered Dynamics and Characterization of Functional Networks in Cocaine Use Disorder: A Coactivation Pattern Analysis of Resting-State fMRI data.","authors":"Benjamin Klugah-Brown, Xing Yao, Hang Yang, Pan Wang, Bharat B Biswal","doi":"10.1101/2024.06.18.24309063","DOIUrl":"https://doi.org/10.1101/2024.06.18.24309063","url":null,"abstract":"Background Cocaine Use Disorder (CUD) poses significant neurobiological and neuropsychiatric challenges, often resulting in severe cognitive and behavioral impairments. This study aims to explore the neural dynamics of CUD using a dynamic coactivation pattern (CAP) analysis approach to provide a deeper understanding of the transient neurobiological mechanisms of the disorder.\u0000Methods Resting-state functional MRI data (SUDMEX_CONN) from 56 CUD patients and 57 healthy controls (HC) were analyzed. CAP analysis was employed to capture transient brain states and their coactivation patterns. Temporal dynamic metrics such as Fraction of Time, Persistence (PST), and Counts were computed to assess differences between groups. Stationary functional connectivity (sFC) was also examined, and meta-analytic term mapping from the Neurosynth database was used to characterize functional associations.\u0000Results CAP analysis revealed six distinct coactivation patterns, with five showing high spatial similarity between CUD and HC groups. Notable differences were observed in State 6, which displayed inverse activation patterns between the groups. CUD individuals exhibited significantly reduced PST across all brain states and altered transition probabilities, particularly increased transitions from the default mode network (DMN) to the somatomotor network and decreased transitions from DMN to attentional/executive networks. Clinical correlations indicated that prolonged cocaine use was associated with altered PST in specific brain states. sFC analysis identified significant alterations in regions such as the right supramarginal gyrus, left superior frontal gyrus, right precentral gyrus, and right lingual gyrus, each linked to distinct cognitive and behavioral functions.\u0000Conclusions This study highlights the utility of CAP analysis in capturing the dynamic neural underpinnings of CUD. The findings provide insights into the neurobiological mechanisms of the disorder, suggesting potential biomarkers for CUD. These results have implications for developing an enhanced approach for substance use disorders, as well as improving our understanding and management of CUD.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"141 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141503949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28DOI: 10.1101/2024.05.27.24307989
Giovanni Deiana, Jun He, Brenda Cabrera-Mendoza, Roberto Ciccocioppo, Valerio Napolioni, Renato Polimanti
To investigate the pleiotropic mechanisms linking brain structure and function to alcohol drinking and tobacco smoking, we integrated genome-wide data generated by the GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN; up to 805,431 participants) with information related to 3,935 brain imaging-derived phenotypes (IDPs) available from UK Biobank (N=33,224). We observed global genetic correlation of smoking behaviors with white matter hyperintensities, the morphology of the superior longitudinal fasciculus, and the mean thickness of pole-occipital. With respect to the latter brain IDP, we identified a local genetic correlation with age at which the individual began smoking regularly (hg38 chr2:35,895,678-36,640,246: rho=1, p=1.01×10−5). This region has been previously associated with smoking initiation, educational attainment, chronotype, and cortical thickness. Our genetically informed causal inference analysis using both latent causal variable approach and Mendelian randomization linked the activity of prefrontal and premotor cortex and that of superior and inferior precentral sulci, and cingulate sulci to the number of alcoholic drinks per week (genetic causality proportion, gcp=0.38, p=8.9×10−4, rho=-0.18±0.07; inverse variance weighting, IVW beta=-0.04, 95%CI=-0.07 – −0.01). This relationship could be related to the role of these brain regions in the modulation of reward-seeking motivation and the processing of social cues. Overall, our brain-wide investigation highlighted that different pleiotropic mechanisms likely contribute to the relationship of brain structure and function with alcohol drinking and tobacco smoking, suggesting decision-making activities and chemosensory processing as modulators of propensity towards alcohol and tobacco consumption.
{"title":"Brain-wide pleiotropy investigation of alcohol drinking and tobacco smoking behaviors","authors":"Giovanni Deiana, Jun He, Brenda Cabrera-Mendoza, Roberto Ciccocioppo, Valerio Napolioni, Renato Polimanti","doi":"10.1101/2024.05.27.24307989","DOIUrl":"https://doi.org/10.1101/2024.05.27.24307989","url":null,"abstract":"To investigate the pleiotropic mechanisms linking brain structure and function to alcohol drinking and tobacco smoking, we integrated genome-wide data generated by the GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN; up to 805,431 participants) with information related to 3,935 brain imaging-derived phenotypes (IDPs) available from UK Biobank (N=33,224). We observed global genetic correlation of smoking behaviors with white matter hyperintensities, the morphology of the superior longitudinal fasciculus, and the mean thickness of pole-occipital. With respect to the latter brain IDP, we identified a local genetic correlation with age at which the individual began smoking regularly (hg38 chr2:35,895,678-36,640,246: rho=1, p=1.01×10<sup>−5</sup>). This region has been previously associated with smoking initiation, educational attainment, chronotype, and cortical thickness. Our genetically informed causal inference analysis using both latent causal variable approach and Mendelian randomization linked the activity of prefrontal and premotor cortex and that of superior and inferior precentral sulci, and cingulate sulci to the number of alcoholic drinks per week (genetic causality proportion, gcp=0.38, p=8.9×10<sup>−4</sup>, rho=-0.18±0.07; inverse variance weighting, IVW beta=-0.04, 95%CI=-0.07 – −0.01). This relationship could be related to the role of these brain regions in the modulation of reward-seeking motivation and the processing of social cues. Overall, our brain-wide investigation highlighted that different pleiotropic mechanisms likely contribute to the relationship of brain structure and function with alcohol drinking and tobacco smoking, suggesting decision-making activities and chemosensory processing as modulators of propensity towards alcohol and tobacco consumption.","PeriodicalId":501282,"journal":{"name":"medRxiv - Addiction Medicine","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141195434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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