Substance Abuse Treatment, Prevention, and Policy最新文献

{"title":"A qualitative study of experiences with physical activity among people receiving opioid agonist therapy.","authors":"Einar Furulund, Siv-Elin Leirvåg Carlsen, Karl Trygve Druckrey-Fiskaaen, Tesfaye Madebo, Lars T Fadnes, Torgeir Gilje Lid","doi":"10.1186/s13011-024-00607-9","DOIUrl":"10.1186/s13011-024-00607-9","url":null,"abstract":"<p><strong>Background: </strong>Physical or mental health comorbidities are common among people with substance use disorders undergoing opioid agonist therapy. As both a preventive and treatment strategy, exercise offers various health benefits for several conditions. Exercise interventions to people with substance use disorders receiving opioid agonist therapy are limited. This study aims to explore experiences with physical activity, perceived barriers, and facilitators among people receiving opioid agonist therapy.</p><p><strong>Method: </strong>Fourteen qualitative interviews were conducted with individuals receiving opioid agonist therapy in outpatient clinics in Western Norway.</p><p><strong>Results: </strong>Most were males in the age range 30 to 60 years. Participants had diverse and long-term substance use histories, and most received buprenorphine-based opioid agonist therapy. The identified themes were (1) Physical limitations: Participants experienced health-related problems like breathing difficulties, pain, and reduced physical function. (2) Social dynamics: Social support was essential for participating in physical activities and many argued for group exercises, but some were concerned about the possibility of meeting persons influenced by substances in a group setting, fearing temptations to use substances. (3) Shift in focus: As participants felt the weight of the health burden, their preference for activities shifted from sports aiming for \"adrenaline\" to a health promoting focus. (4) COVID-19's impact on exercise: because of the pandemic, group activities were suspended, and participants described it as challenging to resume. (5) Implementation preferences in clinics: Not interfering with opioid medication routines was reported to be essential.</p><p><strong>Conclusion: </strong>This study offers valuable insights for the development of customized exercise interventions aimed at enhancing the health and well-being of patients undergoing opioid agonist therapy. These findings underscore the significance of addressing social dynamics, overcoming physical limitations, and implementing a practical and effective exercise regimen.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11075283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858057","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}

{"title":"Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain.","authors":"Monique N Rodríguez, Dana D Colgan, Sarah Leyde, Kenneth Pike, Joseph O Merrill, Cynthia J Price","doi":"10.1186/s13011-024-00608-8","DOIUrl":"10.1186/s13011-024-00608-8","url":null,"abstract":"<p><strong>Background: </strong>There is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain.</p><p><strong>Methods: </strong>A cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind-body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression.</p><p><strong>Results: </strong>Participants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%).</p><p><strong>Conclusion: </strong>The study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment.</p><p><strong>Trial registration: </strong>NCT04082637.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"25"},"PeriodicalIF":3.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11067259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870060","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}

{"title":"People who use drugs engagement in substance use disorder services and harm reduction: evaluation, challenges and future direction of a community-based intervention.","authors":"Julie Gleason-Comstock, Cindy Bolden Calhoun, Barbara J Locke, Naga Vijaya Lakshmi Divya Boorle, Kevin Cobty, Tiffany McKenney, Kaji O Uddin, Samantha J Bauer, Jinping Xu","doi":"10.1186/s13011-024-00601-1","DOIUrl":"https://doi.org/10.1186/s13011-024-00601-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since 1996, an urban community-based organization whose primary mission is to serve diverse94 and emerging community health needs has provided screening, testing, overdose prevention and training, referrals, and access to treatment for substance use disorders (SUD) and communicable diseases such as HIV through its Life Points harm reduction program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As a partner in a State survey in 2021, the community organization recruited a convenience sample of people who use drugs to participate in a survey focused on their substance use, healthcare, and barriers to SUD services. Community health workers conducted outreach and used an encrypted identifier to collect data from a convenience sample of harm reduction participants regarding demographics, legal justice, engagement in harm reduction and access to healthcare. Evaluators entered paper surveys into Qualtrics for reporting and summative analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A convenience sample of fifty-five people who use drugs were recruited and surveyed. The majority (86%, n = 47) were active participants in the agency Life Points (LP) harm reduction service. Participants' average age was 42.9 years (SD = 11.5). About half (51%, n = 28) were male, 48% (n = 26) were female, and 2% (n = 1) was transgender. About two-thirds (67%, n = 37) of participants were White/Caucasian, 13% (n = 7) were Black/African-American, 11% (n = 6) were Hispanic and 7% (n = 4) were Multi-Racial. Regarding current substance use, 98% (n = 54) reported use of heroin, 51% (n = 28) reported crack, 47% (n = 26) cocaine, 25% (n = 14) alcohol, 24% (n = 13) opioids, and 15% (n = 8) marijuana. The majority, 87% (n = 48) said they had health care insurance and over two-thirds (69%, n = 37) said they had been arrested for a felony. Almost three quarters (71%, n = 39) reported receiving services from the Department of Health & Human Services. A higher percentage of females compared to males (65% and 29% respectively) reported engagement in community mental health services and 69% of females (n = 18) compared to 15% (n = 4) of males reported needing to participate in sex to meet basic social needs. Participants described social determinants of health as barriers to services, including access to food, legal justice and transportation. About 44% (n = 24) said they would consider enrolling in a drug treatment program in the next 30 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This sample was reflective of increased participation by White participants that began to appear about a decade ago. The majority of participants reported having healthcare insurance, which may be reflective of engagement with community health workers to access appropriate services. Community organizations and healthcare professionals should continue to explore social determinants of health that can impact the health of people who use drugs, including overcoming barriers to health care access such as inve","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11061983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858058","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}

{"title":"Liver stiffness and associated risk factors among people with a history of injecting drugs: a prospective cohort study.","authors":"Karl Trygve Druckrey-Fiskaaen, Jørn Henrik Vold, Tesfaye Madebo, Håvard Midgard, Olav Dalgard, Rafael Alexander Leiva, Lars T Fadnes","doi":"10.1186/s13011-024-00603-z","DOIUrl":"10.1186/s13011-024-00603-z","url":null,"abstract":"<p><strong>Background: </strong>Persons with opioid use disorders (OUD) and persons with substance use disorders (SUD) who inject substances have a reduced life expectancy of up to 25 years compared with the general population. Chronic liver diseases are a substantial cause of this. Screening strategies based on liver stiffness measurements (LSM) may facilitate early detection, timely intervention, and treatment of liver disease. This study aims to investigate the extent of chronic liver disease measured with transient elastography and the association between LSM and various risk factors, including substance use patterns, hepatitis C virus (HCV) infection, alcohol use, body mass index, age, type 2 diabetes mellitus, and high-density lipoprotein (HDL) cholesterol among people with OUD or with SUD who inject substances.</p><p><strong>Methods: </strong>Data was collected from May 2017 to March 2022 in a cohort of 676 persons from Western Norway. The cohort was recruited from two populations: Persons receiving opioid agonist therapy (OAT) (81% of the sample) or persons with SUD injecting substances but not receiving OAT. All participants were assessed at least once with transient elastography. A linear mixed model was performed to assess the impact of risk factors such as HCV infection, alcohol use, lifestyle-associated factors, and substance use on liver stiffness at baseline and over time. Baseline was defined as the time of the first liver stiffness measurement. The results are presented as coefficients (in kilopascal (kPa)) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>At baseline, 12% (n = 83) of the study sample had LSM suggestive of advanced chronic liver disease (LSM ≥ 10 kPa). Advanced age (1.0 kPa per 10 years increments, 95% CI: 0.68;1.3), at least weekly alcohol use (1.3, 0.47;2.1), HCV infection (1.2, 0.55;1.9), low HDL cholesterol level (1.4, 0.64;2.2), and higher body mass index (0.25 per increasing unit, 0.17;0.32) were all significantly associated with higher LSM at baseline. Compared with persistent chronic HCV infection, a resolved HCV infection predicted a yearly reduction of LSM (-0.73, -1.3;-0.21) from baseline to the following liver stiffness measurement.</p><p><strong>Conclusions: </strong>More than one-tenth of the participants in this study had LSM suggestive of advanced chronic liver disease. It underscores the need for addressing HCV infection and reducing lifestyle-related liver risk factors, such as metabolic health factors and alcohol consumption, to prevent the advancement of liver fibrosis or cirrhosis in this particular population.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294630","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}

{"title":"What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada.","authors":"Holly Mathias, Lois A Jackson, Jane A Buxton, Anik Dubé, Niki Kiepek, Fiona Martin, Paula Martin","doi":"10.1186/s13011-024-00602-0","DOIUrl":"10.1186/s13011-024-00602-0","url":null,"abstract":"<p><strong>Background: </strong>Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment.</p><p><strong>Methods: </strong>One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques.</p><p><strong>Results: </strong>Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems.</p><p><strong>Conclusions: </strong>Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10960477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194586","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}

{"title":"Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation.","authors":"J McCall, H Hobbs, C Ranger, F Cameron, H Stuart, J Nelken, J Majalahti, K Urbanoski, G Kolla, J LeMaistre, K Toombs, R Herriot, Bernie Pauly","doi":"10.1186/s13011-024-00598-7","DOIUrl":"10.1186/s13011-024-00598-7","url":null,"abstract":"<p><strong>Background: </strong>Within North America and worldwide, drug related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply to replace unregulated substances and to reduce toxicity and overdoses. Service providers play an integral role in the delivery of safer supply but there is little empirical evidence that conceptualizes effective safer supply from their perspectives. This study explored early implementation and impacts of a safer supply program, capturing the perspectives of an interdisciplinary team of service providers on tensions and issues encountered in the development of the SAFER program.</p><p><strong>Methods: </strong>Using a community-based participatory approach, we conducted individual interviews with program providers (n = 9). The research team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide. Data was analyzed using thematic analysis.</p><p><strong>Results: </strong>There are six themes describing early implementation: (1) risk mitigation prescribing as context for early implementation; (2) developing SAFER specific clinical protocols; (3) accessibility challenges and program innovations; (4) interdisciplinary team and wraparound care; (5) program tensions between addiction medicine and harm reduction; (6) the successes of safer supply and future visions.</p><p><strong>Conclusion: </strong>Early implementation issues and tensions included prescriber concerns about safer supply prescribing in a highly politicized environment, accessibility challenges for service users such as stigma, encampment displacement, OAT requirements, program capacity and costs, and tensions between addiction medicine and harm reduction. Navigating these tensions included development of clinical protocols, innovations to reduce accessibility challenges such as outreach, wraparound care, program coverage of medication costs and prescribing safer supply with/without OAT. These findings contribute important insights for the development of prescribed safer supply programs.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040382","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}

{"title":"Prevalence, correlates, and reasons for substance use among adolescents aged 10-17 in Ghana: a cross-sectional convergent parallel mixed-method study.","authors":"Sylvester Kyei-Gyamfi, Frank Kyei-Arthur, Nurudeen Alhassan, Martin Wiredu Agyekum, Prince Boamah Abrah, Nuworza Kugbey","doi":"10.1186/s13011-024-00600-2","DOIUrl":"10.1186/s13011-024-00600-2","url":null,"abstract":"<p><strong>Background: </strong>Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10-17 in Ghana.</p><p><strong>Methods: </strong>Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8-17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children's rights and wellbeing. Overall, 4144 adolescents aged 10-17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson's chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.</p><p><strong>Results: </strong>The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10-13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.</p><p><strong>Conclusions: </strong>There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10905778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997446","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}

{"title":"Quadruple pharmacotherapy for alcohol use disorder tolerable yet insufficient: a case report.","authors":"Dale Terasaki, Aimee Ellinwood, Dan White","doi":"10.1186/s13011-024-00599-6","DOIUrl":"10.1186/s13011-024-00599-6","url":null,"abstract":"<p><strong>Background: </strong>Combinations of alcohol use disorder (AUD) medications have been investigated, but few if any reports describe patients maintained on more than two options at the same time.</p><p><strong>Case presentation: </strong>We report a case of a middle-aged man hospitalized with gastrointestinal bleeding and acute kidney injury who had been maintained on four AUD medications (naltrexone, acamprosate, disulfiram, and gabapentin) and multiple psychiatric medications simultaneously as an outpatient. Direct quotations of his experiences with each AUD medication are included, revealing some deviations from what was prescribed as well as nuanced perceptions of effects. Overall, he tolerated the regimen well, but its AUD effects were insufficient to prevent several episodes of returning to alcohol use. He had very high hospital utilization. This prompted the initiation of an involuntary commitment, which began a period of at least six months of sobriety.</p><p><strong>Conclusions: </strong>Quadruple pharmacotherapy for AUD may be well tolerated and supportive of recovery for an extended period of time. However, for our patient the regimen ultimately failed to prevent multiple episodes of returning to alcohol use and serious medical complications. In refractory cases like this, more intensive interventions such as involuntary commitment can be considered.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10905892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997447","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}

{"title":"Problematic alcohol use among gay, bisexual, and other men who have sex with men in Canada: the role of proximal stressors and anxiety.","authors":"Adhm Zahran, Sarah S Dermody, Graham W Berlin, Paolo A Palma, Shayna Skakoon-Sparling, Syed W Noor, Nathan J Lachowsky, Daniel Grace, Joseph Cox, David M Moore, Gilles Lambert, Terri H Zhang, Milada Dvorakova, Jody Jollimore, Allan Lal, Trevor A Hart","doi":"10.1186/s13011-024-00597-8","DOIUrl":"10.1186/s13011-024-00597-8","url":null,"abstract":"<p><strong>Background: </strong>Gay, bisexual, and other men who have sex with men (GBM) report high rates of problematic alcohol use, anxiety, and depression. This may, in part, be due to stressors related to their sexual identity (i.e., minority stressors). However, few studies have examined both distal and proximal stressors, as well as the specific psychological mechanisms by which these stressors may be related to alcohol use outcomes, in a representative sample of GBM. We explored the relationship between distal and proximal stressors and alcohol use outcomes, as well as the role of anxiety and depression as potential mediators of these relationships.</p><p><strong>Methods: </strong>We analyzed the baseline data of 2,449 GBM from Engage, a cohort study of sexually active GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver from February 2017 to August 2019. Using structural equation modeling, we examined the associations between distal minority stressors (i.e., experiences of heterosexist harassment, rejection, and discrimination), proximal minority stressors (i.e., internalized homonegativity, concerns about acceptance, concealment, and lack of affirmation), anxiety and depression, and alcohol consumption and alcohol use problems. RDS-adjusted analyses controlled for age, income, sexual orientation, ethnicity, recruitment city, and HIV serostatus.</p><p><strong>Results: </strong>There were positive direct associations between distal stress and proximal stress, anxiety, and depression, but not alcohol use outcomes. Proximal stress had a positive direct association with anxiety, depression, and alcohol use problems, but not alcohol consumption. Anxiety was positively associated with alcohol consumption and alcohol use problems. Depression was negatively associated with alcohol consumption but not alcohol use problems. Regarding indirect effects, distal stress was associated with alcohol use outcomes via proximal stress and anxiety, but not via depression.</p><p><strong>Conclusions: </strong>We found support for a minority stress model as it relates to alcohol use outcomes among GBM. Findings suggest that proximal minority stress and anxiety differentially impact the problematic alcohol use among GBM who experience heterosexist discrimination. Clinical providers should consider incorporating the treatment of proximal minority stressors and anxiety into existing alcohol interventions for GBM.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983777","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}

{"title":"Predictors of COVID-19 vaccine uptake among people who use substances: a case study in Tehran.","authors":"Salah Eddin Karimi, Sina Amadi, Zahra Rampisheh, Batool Tayefi, Neda Soleimanvandiazar, Peter Higgs, Arash Tehrani-Banihashemi, Ahmad Hajebi, Marzieh Nojomi, Gelavizh Karimijavan","doi":"10.1186/s13011-024-00596-9","DOIUrl":"10.1186/s13011-024-00596-9","url":null,"abstract":"<p><strong>Background: </strong>Vaccination is one of the most effective ways to manage infectious disease epidemics such as Covid-19. However, the low rates of vaccination in populations at risk including people using illicit substances, hinders the effectiveness of preventive vaccines in reducing transmission. The aim of this study was to investigate the rate of Covid-19 vaccination and its related factors among people who use substances in Tehran, Iran.</p><p><strong>Methods: </strong>Between July and December 2022, 386 people who use substances aged ≥ 18 years old were recruited by convenience street-based sampling in Tehran. The outcome variable in this study was self-reported completion of at least two doses of the Covid-19 vaccine. Logistic regression was used to investigate the factors related to Covid-19 vaccination. Data were analyzed using SPSS software version 20 at the 0.05 level of significance. As a measure of risk, 95% Confidence interval (CI) was used. The level of significance was considered at 0.05.</p><p><strong>Results: </strong>Almost three-quarters (n = 286) of the participants reported receiving at least two doses of the Covid-19 vaccine (95% CI, 70.2-79.3). Those participants with high school diplomas were 1.17 times more likely than less educated participants to report having had 2 vaccinations (OR of 1.17, CI 95%: 1.03-1.81). Participants with a higher mean score of having a positive attitude towards Covid-19 vaccination were more likely to have received a vaccination (OR of 1.12, CI 95%: 1.08-1.17). Ethnicity was also an influential variable, people with non-Fars ethnicity were less likely to be vaccinated than those of Fars ethnicity (OR of 0.33, CI 95%: 0.13-0.81). People with higher-than-average monthly income were more likely to report vaccination than those with low monthly incomes (OR of 1.27, CI 95%: 1.09-1.8). Also, participants reporting less access to vaccination centers had a lower chance of reporting having been vaccinated than those who reported high access to vaccination centers (OR of .17, CI 95%: .08-.36).</p><p><strong>Conclusions: </strong>Covid-19 vaccine uptake was found to be relatively high among people using illicit substances in this study. Higher levels of education, Fars ethnicity, higher income levels, having a positive attitude towards vaccination and access to vaccination centers were the most important predictors of Covid-19 vaccination in this study.</p>","PeriodicalId":22041,"journal":{"name":"Substance Abuse Treatment, Prevention, and Policy","volume":"19 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10895917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973529","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}