Substance use & addiction journal最新文献

{"title":"Shared Medical Appointments for Substance Use Disorders: A Systematic Review.","authors":"Kush Sehgal, Ana Carolina Leal, Leticia Mara Dos Santos Barbetta, Neil Nero, Akhil Anand","doi":"10.1177/29767342261457248","DOIUrl":"10.1177/29767342261457248","url":null,"abstract":"<p><strong>Background: </strong>Shared medical appointments (SMAs) integrate group-based clinical care with individual medical management and are increasingly used in the treatment of substance use disorders (SUDs) to improve access, engagement, and care coordination. However, their use, outcomes, and implementation in SUD care have not been systematically synthesized.</p><p><strong>Methods: </strong>We conducted a systematic review registered with PROSPERO (CRD42025639504). MEDLINE, Embase, PsycINFO, Scopus, and Cochrane Central were searched from database inception through September 2025. Randomized controlled trials, observational studies, and qualitative studies examining SMAs among adults with SUDs were included. Outcomes of interest included treatment engagement and retention, substance use outcomes, mental health and patient-reported outcomes, and implementation characteristics. Study quality was assessed across quantitative and qualitative designs, and findings were synthesized descriptively.</p><p><strong>Results: </strong>Fourteen studies, representing approximately 578 participants, met inclusion criteria. Twelve studies focused exclusively on opioid use disorder, 1 included both alcohol and opioid use disorders, and 1 did not specify substance type. Treatment retention was reported in 6 studies, with a median 6-month retention of 72.9%. Three studies reported reductions in substance use outcomes, and 2 reported improvements in depression or anxiety. Qualitative studies consistently described high patient satisfaction, peer support, and shared accountability. Implementation studies demonstrated feasibility across diverse outpatient settings, with substantial heterogeneity across study designs and outcomes.</p><p><strong>Conclusions: </strong>SMAs appear feasible and acceptable for addiction care and may support treatment retention and patient experience. Evidence remains heterogeneous and largely observational, highlighting the need for rigorous comparative studies to better define effectiveness and implementation.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1288-1296"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440649","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}

{"title":"Acceptability, Appropriateness, and Feasibility of Implementing the Locus-of-Hope Enhancement Program: Perspectives of Substance Use Disorder Treatment Providers.","authors":"Sixtus Dane A Ramos, Angela Lorraine P Cunanan, Paul Angelo S Arcega, Allan B I Bernardo","doi":"10.1177/29767342261490083","DOIUrl":"https://doi.org/10.1177/29767342261490083","url":null,"abstract":"<p><strong>Background: </strong>Positive psychological interventions have been introduced in substance use disorder (SUD) treatment, yet the possibility of multisite implementation of programs that cater to hope as a positive cognitive disposition based on the perspectives of SUD treatment providers are yet to be evaluated. Using the implementation outcomes framework, the current study investigated the acceptability, appropriateness, and feasibility of a positive psychological intervention grounded on hope.</p><p><strong>Methods: </strong>In the current study, 5 professional and 4 peer SUD treatment providers underwent focus group discussions and provided their perspectives on future multisite implementation of the Locus-of-Hope Enhancement Program (LEAP), a positive intervention that fosters hope, well-being, and recovery for people with SUD.</p><p><strong>Results: </strong>Participants reported that LEAP is an acceptable, appropriate, and feasible positive intervention for SUD that can be embedded in a therapeutic community program. Participants also identified some of LEAP's limitations and recommended improvements for the intervention.</p><p><strong>Conclusions: </strong>The results offer valuable knowledge on LEAP's implementation outcomes that can guide future multisite implementation studies on positive psychological interventions that promote well-being and recovery for individuals with SUD.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342261490083"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121924","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}

{"title":"The Behavioral Health Treatment Engagement and Retention Learning Collaborative to Improve Receipt and Continuity of Medication Treatment for Opioid Use Disorder.","authors":"Dushka Crane, Lareina La Flair, Shadia Jallaq, Adam Bartley, Marguerite Burns, Christine McClure, Andrew J Barnes, Julie M Donohue, Adam J Gordon","doi":"10.1177/29767342261464063","DOIUrl":"10.1177/29767342261464063","url":null,"abstract":"<p><p>Medicaid is the largest insurer for patients with opioid use disorder (OUD) and finances a disproportionate share of medication treatment for OUD (MOUD). Within Medicaid, initiation and continuity of MOUD are associated with improved outcomes, but substantial inequities across populations and care settings remain. The Medicaid Outcomes Distributed Research Network (MODRN) has supported Medicaid agency efforts to improve MOUD receipt and continuity of care. In the context of MODRN-Examining Quality Improvement for Medicaid Programs, the Behavioral Health Treatment Engagement and Retention Learning Collaborative (BHTER) will implement and evaluate interventions focused on improving quality and reducing variation in process and clinical outcomes in Medicaid patients with OUD. BHTER's aims are to (1) estimate the effects of a quality improvement intervention on receipt and continuity of MOUD in intervention practices relative to comparison practices, (2) examine whether a quality improvement intervention narrows racial gaps in rates and continuity of MOUD in intervention relative to comparison practices, (3) examine provider perspectives on the quality improvement intervention, with a focus on practice and process changes that resulted in improvement, and factors that impede or facilitate delivery of high-quality MOUD care. In this protocol paper, we describe the rationale, methods, and impact of BHTER.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1214-1223"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overdose Prevention Education and Medication for Opioid Use Disorder in School-Based Health Centers: A Qualitative Exploration.","authors":"Cala M Renehan, Abdul Mureed Alim, Ally Cogan, Moriah Wiggins, Emma Weinberger, Brittany L Carney, Justin Alves, Alicia S Ventura, Máireád Day Lopes, Sarah M Bagley","doi":"10.1177/29767342261442454","DOIUrl":"10.1177/29767342261442454","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to explore attitudes and beliefs of school-based health center (SBHC) staff about overdose prevention education and medication for opioid use disorder (MOUD) in SBHCs.</p><p><strong>Methods: </strong>We interviewed 13 SBHC staff using a semi-structured interview guide covering the following: youth substance use training, beliefs in and attitudes about overdose prevention, providing MOUD, and interactions with students' families. A hybrid deductive and inductive approach was used to conduct thematic analysis.</p><p><strong>Results: </strong>Four themes emerged: (1) limited experience in providing care or education on opioids and overdose, (2) barriers to implementation of education and MOUD including school administration and operational concerns, (3) overdose prevention and treatment is consistent with existing practices, and (4) confidentiality as a facilitator and barrier of overdose prevention education and MOUD provision.</p><p><strong>Conclusion: </strong>SBHCs are uniquely positioned to provide overdose prevention education and MOUD. Developing, testing, and implementing both interventions should be made in collaboration with youth and SBHC staff.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1072-1079"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794164","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}

{"title":"Elevating Early-Career Voices in Addiction Science.","authors":"Terry David Church, Jessica Barrington-Trimis, Victoria Williams, Jillian Boelke, Adam Matthew Leventhal","doi":"10.1177/29767342261448436","DOIUrl":"10.1177/29767342261448436","url":null,"abstract":"","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"959-962"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019895","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}

{"title":"Retention and Other Efficacy Outcomes With Long-Acting Injectable Buprenorphine (Buvidal^®) in France: A National Retrospective Cross-Sectional Study (OPALE 2).","authors":"Alice Deschenau, Pascal Melin, Julien Azuar, Benjamin Touchon, Isabelle Vinel-Jacquet, Benoit Trojak, Lisa Blecha, Julien Cabé, Margaux Kosim, Geoffroy Dupeyron, Jean-Pierre Daulouède, Georges Brousse, Mathieu Chappuy, Benjamin Rolland","doi":"10.1177/29767342261433342","DOIUrl":"10.1177/29767342261433342","url":null,"abstract":"<p><strong>Background: </strong>Opioid agonist treatment (OAT) is the mainstay for opioid use disorder (OUD). Long-acting injectable buprenorphine may address limitations of daily medications by reducing treatment burden and improving engagement. This study assessed retention and patient-reported outcomes with Buvidal^® in France.</p><p><strong>Methods: </strong>This multicenter, observational, retrospective study analyzed medical records of adults diagnosed with OUD who received ≥1 Buvidal^® injection between July 2021 and August 2023. The primary endpoint was retention at 6 months. Key secondary endpoints included changes in opioid consumption, perceived improvement in OUD using the Patient Global Impression of Change (PGIC) scale, distancing from OUD, reduction in craving, and satisfaction with Buvidal^® treatment.</p><p><strong>Results: </strong>Among 101 participants (mean age 43.9 years; 72.3% male; 98.0% switched to Buvidal^® from previous OAT), 74 (73.3%) were retained on Buvidal^® at 6 months. Of those using non-prescribed or misused opioids at baseline, decreased consumption of non-prescribed or misused opioids during treatment with Buvidal^® was reported by 80.0% (16/20) of retained participants and 66.7% (8/12) of non-retained participants. A significantly higher proportion of retained than non-retained participants reported improvement in OUD on PGIC (85.1% [63/74] vs 40.7% [11/27]; <i>P</i> < .001), increased distancing from OUD (90.5% [67/74] vs 70.4% [19/27]; <i>P</i> = .02), and reduced craving (91.9% [68/74] vs 66.7% [18/27]; <i>P</i> < .001). Satisfaction with Buvidal^® was high overall (89.1% [90/101]), with 98.6% (73/74) of retained participants satisfied compared with 63.0% (17/27) of non-retained participants (<i>P</i> < .001). Among retained participants, 91.9% (68/74) expressed willingness to continue Buvidal^® treatment beyond 6 months.</p><p><strong>Conclusions: </strong>Nearly three-quarters of participants initiating Buvidal^® were retained in treatment at 6 months. Patient-reported outcomes indicated high satisfaction, perceived improvement in OUD, and reductions in opioid consumption and craving, even among individuals largely stabilized on OAT at baseline. These findings suggest that Buvidal^® may support sustained engagement and meaningful improvements in patient experience under real-world conditions.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1012-1026"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944158","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}

{"title":"What We Do Matters: A Documentary Style Video to Address Healthcare Stigma Toward People Who Use Substances.","authors":"Andrea Truncali, Wendy Y Craig, Kristen Silvia","doi":"10.1177/29767342261436911","DOIUrl":"10.1177/29767342261436911","url":null,"abstract":"<p><strong>Background: </strong>Stigma toward people with substance use disorders (SUDs) has been documented across health professions and is associated with negative impacts.</p><p><strong>Methods: </strong>We created a freely available, documentary-style video intervention aimed at reducing SUD stigma among healthcare workers. The video features narrative from people with SUD and commentary by healthcare workers experienced in addiction treatment. Participants working in clinical and non-clinical roles viewed and briefly discussed the video documentary, and were asked to complete a pre- and post-survey that included the Medical Condition Regard Scale (MCRS). We evaluated differences in attitudes among participants completing both surveys using paired <i>t</i>-tests.</p><p><strong>Results: </strong>Four hundred seventy-one people completed a pre-survey, 366 completed a post-survey, and of these, 276 provided paired responses. Among paired responses, 63% were from medical students, 19% medical providers, 3% residents/fellows, 9% clinical staff, and 6% non-clinical staff and pharmacists. Attitudes endorsed were highly positive prior to the intervention with a mean MCRS score of 52.3 ± 7.8 (range 6-66). Scores increased to 55.2 ± 7.6, <i>P</i> < .001, pre to post. Change was positive across items, indicating stronger agreement with non-stigmatizing attitudes and treatment optimism, and greater disagreement with negative attitudes and treatment pessimism. Improvements were seen across roles, and these changes were significant (<i>P</i> < .05) in all but 2 small subgroups: non-clinical staff (n = 14) and residents/fellows (n = 8).</p><p><strong>Conclusion: </strong>Viewing a freely available documentary-style video featuring personal narrative from patients with SUD and commentary from SUD-focused professionals was effective in reducing healthcare worker stigma toward people with SUDs and in anticipating the positive impact of treatment encounters.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1175-1182"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Intervention Landscape for Methamphetamine Use Disorder: A Scoping Review of Integrated Pharmacological, Behavioral, and Neuromodulation Approaches.","authors":"Sirralkhatim Alamin Abdulgadir Mohammed, Mohamad Hussain Habil, Babiker Mohamed Ali Rahamtalla","doi":"10.1177/29767342261456262","DOIUrl":"10.1177/29767342261456262","url":null,"abstract":"<p><strong>Background: </strong>The global resurgence of methamphetamine use disorder (MUD) represents a critical public health challenge, characterized by high morbidity and a lack of approved pharmacotherapies. Treatment research spans diverse domains, but a comprehensive synthesis of the scope, efficacy, and interrelationships of these approaches is lacking.</p><p><strong>Objective: </strong>To systematically map and synthesize the available evidence on interventions for MUD, including their efficacy, mechanisms, and the overall structure of the research landscape.</p><p><strong>Methods: </strong>Following the Arksey and O'Malley framework and PRISMA-ScR guidelines, we conducted a systematic search of 5 electronic databases (MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL) from inception to October 2025. We included studies of any design evaluating interventions for MUD in human populations.</p><p><strong>Results: </strong>From 6852 screened records, 62 studies were included. Our synthesis reveals a tripartite intervention landscape: (1) Behavioral interventions, particularly contingency management (CM), demonstrate the most robust efficacy, increasing abstinence rates by 40% to 60%. (2) Pharmacological approaches show promise with combination therapy (naltrexone-bupropion and Wellbutrin), significantly increasing methamphetamine-negative urine samples versus placebo (11.4% vs 5.7%), though effect sizes are generally modest. (3) Neuromodulation, specifically repetitive transcranial magnetic stimulation targeting the dorsolateral prefrontal cortex, consistently reduces cue-induced craving by 25% to 35%. Critical moderators of treatment response were identified, including the OPRM1 A118G polymorphism and high rates of polydrug use (up to 42% in opioid use disorder cohorts), which predicts poorer outcomes. Implementation feasibility and intervention fidelity are critical considerations, particularly for CM and pharmacotherapy adherence.</p><p><strong>Conclusion: </strong>Effective MUD management requires a multimodal, personalized framework. While CM remains a foundational behavioral strategy, advances in combination pharmacotherapy and neuromodulation offer new avenues for targeting core neurobiological deficits. Future research must prioritize integrated treatment platforms, implementation science to scale effective interventions like CM, and personalized strategies informed by genetics and neuroimaging.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1257-1272"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400343","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}

{"title":"Elevating Patient Voices to Improve Opioid Use Disorder Quality Measurement: A Survey Protocol.","authors":"Andrew J Barnes, Caroline Hale, Zoe D'Angelo, Susan Kennedy, J Tyrus Reidt, Christine McClure, Sarah J Marks, Tonya T Harris, Leah Reine, Leonor Gualchi, Marissa Kluk, Indida I Birto, Marguerite Burns, Rose S Bono, Adam J Gordon, Julie M Donohue, Sarah J Clark","doi":"10.1177/29767342261463426","DOIUrl":"10.1177/29767342261463426","url":null,"abstract":"<p><p>Public payers in the US cover more than half of individuals who receive treatment for opioid use disorder (OUD). Despite this, patient-reported measures that reflect treatment engagement and quality of life are largely missing from OUD quality improvement initiatives. This commentary describes the survey protocol for Project ELVIS (ELevating patient VoIceS to Improve OUD Treatment Quality), 1 of 3 projects of the Medicaid Outcomes Distributed Research Network's initiative Examining Quality Improvement in Medicaid Programs. Project ELVIS collects patient experiences with OUD treatment and tests the relationship between patient-reported and claims-based measures of treatment quality. As this commentary describes, Project ELVIS is innovative in its approach to grounding measure development in sustained, iterative engagement with individuals with lived experience and Medicaid policymakers and in employing a policy-driven regional survey sampling approach that prioritizes Medicaid decision-making relevance. Our project is also innovative in its planned linkages of self-reported patient experiences and outcomes with quality measures based on administrative data, positioning patient experience to explain-not just quantify-treatment quality in Medicaid programs. The goals of this project are to inform mechanisms underlying providers' high (and low) performance on claims-based measures, offering insight into why patients initiate, remain engaged in, or discontinue medication for OUD. In doing so, this work endeavors to support the development of patient-centered, process-based quality measures that complement existing and emerging utilization-based metrics.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1205-1213"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining External and Internal Factors That Could Influence Adolescent Smoking Behaviors in Adolescents of Crete, Greece: The Cross-Sectional FRESHAIR4Life Study.","authors":"Theodoros Krasanakis, Izolde Bouloukaki, Antonios Christodoulakis, Antonia Aravantinou-Karlatou, Charlotte M Hoffman, Rianne M J J van der Kleij, Ioanna Tsiligianni","doi":"10.1177/29767342261446843","DOIUrl":"10.1177/29767342261446843","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent smoking continues to pose significant public health challenge, persisting due to a multifaceted interplay of internal and external factors. The present study aimed to explore internal and external factors that may influence adolescents' smoking behaviors in Crete, Greece.</p><p><strong>Methods: </strong>Conducted as part of Phase A of the European-funded FRESHAIR4Life Program; this cross-sectional study included adolescents aged 14 to 21 years, recruited between January and February of 2024. Ten educational institutions in the Municipality of Heraklion, Crete, were selected, including high schools (n = 7), technical schools (n = 2), and universities (n = 1).</p><p><strong>Results: </strong>The sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). Smoking history was reported by 34% (n = 60). Older adolescents had higher odds of ever smoking (OR = 1.57, 95% CI: 1.32-1.88; <i>P</i> < .001). The most prevalent reasons for smoking initiation were reported to be addiction after the initial use of nicotine products (60%), stress (43%), and to look cool and attractive (27%). Ignoring smoking's negative consequences was positively associated with ever smoking (OR = 3.89, 95% CI: 1.85-7.99, <i>P</i> < .001). The perception of smoking as a risk factor for the development of illness (OR = 2.6, 95% CI: 1.2-5.3, <i>P</i> = .012), and concerns about the health impact (OR = 5.7, 95% CI: 2.3-14.1, <i>P</i> < .001) were positively associated with non-smoking behaviors. External factors positively associated with ever smoking were smoking exposure at school (OR = 2.81, 95% CI: 1.36-5.81; <i>P</i> = .005), use of nicotine products by parent(s) (OR = 7.64, 95% CI: 1.95-29.96, <i>P</i> = .004), close friend(s) (OR = 12.88, 95% CI: 3.24-51.15, <i>P</i> < .001), and sibling(s) (OR = 25.13, 95% CI: 3.23-195.63, <i>P</i> = .002).</p><p><strong>Conclusion: </strong>Our findings highlight the need for multifaceted, targeted interventions. Future research should evaluate tailored interventions and investigate emerging potential influences like social media and alternative nicotine products on youth smoking.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1151-1163"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019944","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}