Accidental substance-related acute toxicity deaths among youth in Canada: a descriptive analysis of a national chart review study of coroner and medical examiner data.

Dealing with gender-related and general stress: Substance use among Brazilian transgender youth

Background: Maternal substance use and common mental disorders (CMDs) during or after pregnancy can lead to negative health outcomes among mothers and infants. We examined whether nativity (US-born versus foreign-born) and stress levels during pregnancy were associated with antenatal substance use and postnatal CMDs. Methods: We analyzed the Boston Birth Cohort, a racially diverse cohort recruited at birth with rolling enrollment since 1998. Information on antenatal substance use (tobacco and/or alcohol use) was obtained using an in-person postpartum questionnaire (n = 6,514). Information on postnatal CMDs (depression and/or anxiety) was obtained from medical records (n = 2,052). Nativity and stress during pregnancy were self-reported. We performed multivariate logistic regression to examine how nativity and stress levels were jointly associated with antenatal substance use and postnatal CMDs. We further investigated if blacks, Hispanics, and whites were differentially at risk. Results: We found that US-born mothers were at higher risk of substance use and CMDs than their foreign-born counterparts. In analyses combining nativity and stress, being US-born with high stress was associated with increased odds of antenatal substance use (adjusted odds ratio [aOR] = 14.91, 95% confidence interval [CI]: 12.09-18.39) and postnatal CMDs (aOR = 4.09, 95% CI: 2.72-6.15) compared with foreign-born mothers with low stress. The results of the subanalyses limited to black and Hispanic women separately were similar; high stress alone was associated with fourfold increased odds of CMDs among foreign-born Hispanic mothers (aOR = 4.27, 95% CI: 1.96-9.33). Conclusions: Findings suggest that identifying and alleviating high stress among pregnant women may reduce their risk of antenatal substance use and postnatal CMDs.

This study aims to explore family dynamics and the economic hardships experienced by families during the COVID-19 pandemic and their associations with adolescents' health risk behaviours (HRBs). Based on a representative study of adolescents aged 11-16 conducted in Bulgaria during the COVID-19 pandemic and HBSC data from the pre-pandemic period, logistic regression models were applied, assessing cigarette smoking, vaping, alcohol use, drunkenness, and cannabis use. The independent variables included demographics, Family Affluence Scale (FAS III), family structure, ease of communication with parents, and the authors' developed questions on parents' income and economic status change, family conflicts, and missing contact with extended family due to the pandemic. Material status of the family showed increasing differentials in adolescents' HRBs during the pandemic. Parental unemployment, income reduction, and temporary lay-offs were associated with a higher risk of substance use. Family conflicts, missing contact with extended family, and difficulties in communication with the mother were related to a higher risk of substance use. Communication with the father was significantly associated with alcohol use and drunkenness. Boys had lower odds of vaping and higher odds of alcohol use, drunkenness, and cannabis use. Higher age and minority status were associated with an increase in adolescents' HRBs. This study highlights the need for special family-focused interventions in times of health and economic crises.

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children (LSAC; N = 2,285), in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model (MEPSUM), we identified three trajectories of substance use initiation in adolescence: one (65.7% of the sample) characterized by near-complete abstinence until late adolescence, another (27.2%) by earlier initiation of alcohol, nicotine, and cannabis, and another (7.2%) by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context.

The "crossover" effect, a phenomenon by which some minority groups switch from low to high risk for substance use as a function of age, was first documented 25 years ago. However, rigorous methodological research examining the crossover effect has only recently emerged. The current paper reviews the past 25 years of research on the crossover effect, which has primarily examined the shift from low to high substance use risk among Blacks relative to Whites. Although findings regarding the crossover effect vary based on gender, socioeconomic status, and substance, Blacks and Hispanics appear to be at lower risk for some substance use- particularly binge drinking and cigarette smoking-than Whites during adolescence and early adulthood, but at higher risk for use in later life. Research regarding the crossover effect of substance use disorder and related problems is limited but more consistent with a similar pattern of effects observed. Due to significant limitations of the extant literature examining the crossover effect, it requires additional research clarifying sociodemographic differences in the, identifying its mechanisms, and determining its clinical implications. Such research may have important implications for preventing racial/ethnic disparities in the consequences associated with disordered substance use.

Background: College students identifying as Lesbian, Gay or Bisexual (LGB) are at increased risk for substance use. Few studies have assessed correlates of concurrent substance use, which increases the risk for substance use disorders. Objectives: The current study aimed to (1) examine differences in substance use among male and female sexual minorities and (2) explore the impact of psychosocial factors on the relationship between sexual identity and concurrent substance use. Methods: A web-based survey assessing health behavior, psychosocial characteristics, attitudes and demographics was administered to students from six colleges in the southeastern US. A total of 4840 students responded to the survey; 2.9% reported a homosexual identity (n = 111) and 3.5% reported a bisexual identity (n = 135). Multivariable modeling was used to assess the relationship between sexual identity and the number of substances used, adjusting for demographic and psychosocial factors. Results: Bisexual females were significantly more likely than their homosexual or heterosexual counterparts to report tobacco use (p < 0.0001), binge drinking (p < 0.05) and marijuana use (p < 0.0001) in the past 30 days. No differences in substances used existed among males. Adjusted for age and ethnicity, homosexually- and bisexually-identified females were more likely to have concurrent substance use than those who identified as heterosexual (p < 0.0001 and p < 0.0001, respectively). Adjusting for psychosocial factors decreased the magnitude and significance of the association (p < 0.01 and p < 0.001, respectively). Conclusion: Female sexual minorities are at high risk for substance use. Targeting specific psychosocial factors might be useful in efforts to address use of tobacco, alcohol and marijuana among LGB young adults.

Juvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.

INTRODUCTION: The role of partner substance use as a risk factor for prenatal substance use remains understudied. This study aimed to investigate the association between self-reported partner history of problematic substance use and pregnant person’s use of alcohol, cannabis, e-cigarettes, and tobacco during early pregnancy. METHODS: A total of 82,180 pregnant individuals screened for substance use in Kaiser Permanente Northern California at their first prenatal visit (approximately 8–10 weeks of gestation) during 2021–2022 were included. Partner substance use and prenatal substance use were determined via a self-administered questionnaire. Cannabis use was additionally determined by urine toxicology. Adjusted odds ratios (aORs) were calculated using binomial and multinomial logistic regression. RESULTS: Among 82,180 pregnant people, 1,010 (1.2%) reported having a partner with history of problematic substance use. Partner history of problematic substance use was associated with higher adjusted odds of any prenatal substance use (aOR 1.80; 95% CI, 1.56–2.08) and prenatal alcohol (aOR 1.58; 95% CI, 1.33–1.87), cannabis (aOR 1.89; 95% CI, 1.57–2.27), e-cigarette (aOR 3.38; 95% CI, 2.43–4.58), and tobacco use (aOR 3.66; 95% CI, 2.63–4.96). Additionally, frequency analyses showed that a partner history of problematic substance use was associated with higher odds of weekly or daily and monthly or less substance use compared to no use. CONCLUSIONS/IMPLICATIONS: Self-reported partner history of problematic substance use was associated with increased odds of use of alcohol, cannabis, e-cigarettes, and tobacco during early pregnancy. These findings suggest that individuals with a partner history of substance use may benefit from targeted intervention prior to pregnancy to reduce prenatal substance use.

Interpersonal conflict tactics and substance use among high-risk adolescents

Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Introduction: Both heart failure (HF) and substance use disorders are associated with substantial morbidity and mortality. Many illicit substances exert adverse cardiovascular effects and socioeconomic impact. Hypothesis: Substance use will be independently associated with worse clinical outcomes in patients with HF. Methods: Retrospective, cohort study of adult patients with a primary diagnosis of HF enrolled in the Optum Clinformatics Data Mart (2010 – 2020). Demographics and clinical outcomes were obtained via ICD-9/10 codes. Patients were stratified by history of substance use [anytime; prior or current use; type of substance (i.e., cannabis, opiates, stimulants – cocaine and methamphetamine, and hallucinogens – phencyclidine and sedative/hypnotic/anxiolytics)] and compared to patients with no history of substance use. A multivariable logistic regression analysis was conducted in a propensity-score 1:1 matched cohort. Outcomes were 30 and 180-day, and 1-year hospital readmission and mortality. Results: There were 184,508 patients included; 11,611 (6.3%) with documented substance use at any time. Prior to matching, patients with substance use were younger, more often male, and with fewer comorbidities compared to those with no history of substance use. Substance use was associated with greater 30 and 180-day, and 1-year hospital readmissions and mortality (table). The associated risk of substance use was confirmed in the propensity matched analysis. The risk was retained when substance use was restricted to use prior to or at time of index hospitalization and use after index hospitalization. Stimulant use was associated with a 2-fold increase in risk of hospital readmission. Conclusions: Despite younger age and fewer comorbidities, substance use in patients with HF was associated with an increased risk of all-cause and HF-related hospital readmissions and mortality.

Adolescents from single-parent families are at significantly higher risk of substance use compared to those from mother-father families. More than half of American Indian (AI) children live in single-parent families, the second highest percentage among all groups. Given the paucity of research pertaining to the role of family structure and substance use in the AI population, we sought to examine this relationship. Data from this study were obtained from the Substance Use Among American Indian Youth: Epidemiology and Etiology, [US], 2015-2020 study. Response variables of interest included age at first substance use, number of substances used, ever-use of substance, and substance use type (i.e., alcohol, cigarette, marijuana, etc.). Living in a father-only or mother-only setting showed a similar pattern of drug use. There was a significant increase in the risk of cigarette, alcohol and marijuana use. For cigarettes, the odds ratio was (OR = 2.60, 95% CI 1.80-3.75) in father-only setting compared to (OR = 1.42, 95% CI 1.13-1.78) for mother only setting. Alcohol use showed (OR = 1.72, 95% CI 1.19-2.50 and OR = 1.40, 95% CI 1.12-1.74) for father-only and mother-only respectively and marijuana use showed (OR = 1.59, 95% CI 1.10-2.30 and OR = 1.54, 95% CI -1.24-1.92) for father-only and mother-only respectively. Disturbed family structure is associated with increased risk of substance use among AI youth. This indicates the importance and need for policy and community level interventions to reduce youth substance exposure.

SummaryObjectiveThe objective of this article is to gain a deeper understanding of the attitudes and perceptions of adolescents in the United Arab Emirates regarding substance and to identify factors that, in their view, may influence the risk of substance use and suggest possible interventions.DesignThis was a qualitative study that used a focus group approach.SettingThe study was carried out in Abu Dhabi, United Arab Emirates.ParticipantsMale and female teenagers aged 13-18 years residing in the emirate of Abu Dhabi.Main outcome measuresAdolescents’ awareness of substance use, patterns of use and associated harm; Adolescents' perceptions about the factors associated with substance use.ResultsSix focus groups were carried out, and a total of 41 adolescents (20 males and 21 females) participated. Data analysis identified three main themes: (1) adolescents’ awareness of substance use and associated harm; (2) gender role and image and (3) perceived factors affecting substance use among adolescents. Knowledge of substances and related consequences of use varied between groups but was compatible with participants’ age and school years. Factors that participants believed influenced substance use were classified into: (1) parent–adolescent relationship, (2) peer pressure, (3) substance accessibility, (4) religiosity and (5) others. Many factors were believed to increase the risk of substance use among adolescents such as peer pressure, inadequate knowledge of the harmful consequences of drug use, family-related factors (e.g. low monitoring and poor parent–adolescents relationship), affordability and availability of substances, boredom and affluence. On the other hand, religiosity was as a shield against substance use, especially alcohol. Other identified protective factors included carrying out schools- and communities-based educational campaigns, enhancing social workers’ ability to raise awareness and detect early signs of addiction and implementing CCTV systems in schools.ConclusionsThe study was successful in exploring adolescents’ awareness of substances and associated harm to health from their use. Also, it identifies a number of risk and protective factors based on the perceptions of a group of adolescents residing in the United Arab Emirates. Such factors can guide the planning, designing and implementing of prevention programmes that focus on raising awareness about the harms of substance use. The study findings would suggest that multifactorial prevention programmes that address social norms, gender role and image, and incorporate drug policy, religion, family and school would be more effective and may have better protective outcomes.

Longitudinal associations between minority stressors and substance use among sexual and gender minority individuals

This study examined the association between community disadvantage and substance use among adolescents referred to child protective services (CPS) and the interaction role of race/ethnicity in the association between community disadvantage and adolescent substance use. Findings revealed that higher county-level alcohol/drug mortality rates were associated with a higher risk of substance use across non-Hispanic Black, non-Hispanic white, and Hispanic adolescents. An interaction test showed that the association between county-level alcohol/drug mortality rates and risk of substance use was particularly stronger for non-Hispanic Black adolescents compared to non-Hispanic white adolescents. However, county-level vacant housing rates and low median household income did not show a significant association with adolescent substance use across all racial/ethnic groups. Results suggest that practitioners should screen for community-level substance risk levels to prevent substance use among historically marginalized racial-ethnic adolescents involved in CPS.