Substance use among deaf and hard of hearing individuals: a scoping review of prevalence and patterns

Background: Colorectal cancer (CRC) screening rates among Deaf and Hard of Hearing (DHH) individuals are often lower than those of the hearing population. This disparity is driven by factors including communication barriers, limited access to healthcare services, and insufficient support systems. As a result, DHH individuals face unique challenges in accessing timely screening, leading to delayed diagnoses and poorer cancer outcomes. Methods: We analyzed data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) to examine colorectal cancer (CRC) screening rates among Deaf and Hard of Hearing (DHH) individuals. The sample included 3,496 individuals aged 40 years and older, residing in Puerto Rico. Prevalence ratios (PR) for non-endoscopic colorectal cancer screening methods were calculated. Subgroup analyses were performed to assess the impact of transportation access, social and emotional support, and the ability to manage daily errands on CRC screening rates. Results: Compared to hearing individuals, DHH individuals had an 11% lower prevalence of colorectal cancer (CRC) screening (PR = 0.89, 95% CI: 0.89, 0.90). After adjusting the model for age, sex, education, income, access to personal healthcare providers, and health insurance status, the prevalence ratio (PR) decreased further to 0.84 (95% CI: 0.83, 0.84).In subgroup analyses, the PR remained stable for individuals with reliable transportation. However, it decreased by 13% for those facing transportation challenges (PR = 0.78, 95% CI: 0.77, 0.79). The PR dropped by 15% for individuals without social and emotional support (PR = 0.76, 95% CI: 0.74, 0.77) and by 11% for those struggling with daily errands on their own (PR = 0.80, 95% CI: 0.79, 0.80). Discussion: This study reveals a disparity in CRC screening rates between DHH individuals and the hearing population, driven by factors such as limited transportation, lack of social support, and difficulties managing errands. The lack of culturally and linguistically appropriate materials, including PRSL, worsens these barriers. Training healthcare providers to improve communication with DHH individuals is essential for increasing screening. Conclusion: Addressing these barriers requires targeted research and interventions, focusing on accessible educational resources (including PRSL translations), improving healthcare provider training, and enhancing screening access. Future research should examine how social factors, such as socioeconomic status and geography, affect CRC screening access in DHH populations. These strategies are key to reducing disparities and improving health outcomes for DHH individuals in Puerto Rico and beyond. Citation Format: Francisco Muñoz-Torres, Roxana Soto-Abreu, Vivian Colon-López. Colorectal cancer screening among deaf and hard of hearing individuals in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4899.

Music plays an important role in the personal fulfillment and cognitive performance of deaf and hard of hearing (DHH) individuals. Since deafness is a spectrum -- as are DHH individuals' preferences and perceptions of music -- a more situated understanding of their interaction with music is needed. To understand the music experience of this population, we conducted social media analyses, both qualitatively and quantitatively, in the deaf and hard of hearing Reddit communities and followed this up with interviews with DHH individuals. Our analysis revealed accessibility challenges, i.e., hearing aids were not customized for music, visual/haptic techniques developed were not widely available and affordable, and accessibility accommodations by music streaming apps and offline events were imperfect -- leading to suboptimal music experiences. In response, DHH individuals leveraged audio, visual, and physical senses to listen to the music -- treating it as a full-body experience; as accessibility heuristics, they may also prefer familiar, non lyrical, instrument-heavy, or loud music, which was perceived as more accessible. The DHH community embodied mutual support among music lovers, evidenced by active information sharing around music. Misconceptions by hearing individuals regarding how DHH individuals listen to music were reported, which is a major hurdle for creating a more accessible music experience. We reflect on design justice for DHH individuals' music experience based on a situated understanding and propose practical design implications to create a more accessible music experience for them.

Deaf and hard of hearing (DHH) individuals face several barriers to communication in the workplace, particularly in small-group meetings with their hearing peers. The impromptu nature of these meetings makes scheduling sign-language interpreting or professional captioning services difficult. Recent advances in Automatic Speech Recognition (ASR) technology could help remove some of these barriers that prevent DHH people from becoming involved in group meetings. However, ASR is still imperfect, and it contains errors in its output text in many real-world conversation settings. My research proposes to investigate whether there are benefits in using ASR technology to aid understanding and communication among DHH and hearing individuals. My dissertation research will evaluate the effectiveness of using ASR in small group meetings (through empirical studies with DHH and hearing participants), as well as develop guidelines for system design to encourage hearing participants to communicate and speak more clearly.

Background Prevalence rates of adolescent substance use have shifted over time, although potential changes in nuanced patterns of substance use remain unexplored. We examined patterns of adolescent substance use in Sweden and changes in these patterns between 1988 and 2011. Furthermore, we investigated whether gender and internalizing problems were associated with substance use and whether these associations changed over time. Methods The sample included all 15-16-year-old students in Värmland County, Sweden (N = 20,057). Survey data were collected eight times between 1988 and 2011 and analyzed as four cohorts (1988/1991, 1995/1998, 2002/2005, 2008/2011). We measured alcohol, tobacco and inhalant use and internalizing problems. Results A latent class analysis showed that a three-class model fit the data best (i.e. non/low use, experimental use, and polysubstance use classes). Class- and item-response probabilities changed over time: fewer adolescents exhibited riskier substance use patterns in the later cohorts. Boys were more likely than girls to be in the polysubstance use class compared to the non/low use class across all cohorts (all ps < .001). Gender differences in experimental use differed across the cohorts. Adolescents who reported more internalizing problems were more likely to be included in the experimental and polysubstance use classes compared to the non/low use class (all ps < .001) and this effect did not change over the study period. Conclusions We extended the research on trends in rates of substance use by mapping how patterns of substance use changed over time as well as how the effects of gender and internalizing problems shifted. While fewer adolescents exhibited riskier patterns of substance use in the later cohorts, these patterns were associated with experiencing more internalizing problems across the study period. Prevention efforts could be more effective by targeting patterns of substance use rather than prevalence rates. Key messages We tested whether patterns of adolescent substance use changed from 1988 to 2011 in Sweden. Fewer adolescents showed riskier substance use patterns in the late 2000s than in the earlier study years. Gender differences shifted over time for experimental use but not polysubstance use. Internalizing problems were consistently associated with riskier substance use patterns across the study period.

Patterns of substance use and associations with mental health and interpersonal violence among adolescents.

The Deaf and hard of hearing (DHH) population suffers disproportionately from barriers to health care access. Progress has been made toward improving access to medical care in the human health field; however, the veterinary field has not yet implemented similar standards. More research is needed to improve access to veterinary care for disabled individuals. This systematic review aimed to evaluate all primary research articles pertaining to medical and veterinary health care access for DHH adults in the United States. Its purpose was to assess gaps in knowledge regarding DHH persons' access to veterinary care. The review includes 39 articles related to DHH access to medical care and 6 articles related to general access to veterinary care. The authors found no articles related specifically to DHH access to veterinary care nor any articles on disability accessibility to veterinary care that met the inclusion criteria. Results outline significant barriers to DHH persons' access to health care, unique needs specific for this population of patients, and recommendations to improve access to medical care for individuals who identify as DHH. The results also suggest that further research is needed to investigate barriers to veterinary care experienced by DHH pet owners, the unique needs of this population of pet owners, and how the field of veterinary medicine can better accommodate those needs.

BackgroundAdolescence is a critical period of vulnerability to substance use. Recent research has shown that gender differences in adolescence substance use are complex and in constant flux. The present study aims to investigate gender differences in substance use and initiation patterns in male and female adolescents, and to assess individual, family, peer, and school associated factors of these patterns.MethodsWe applied latent class regression analysis to a Portuguese representative population sample of 1551 15-year-old adolescents, drawn from the 2010 ‘Health Behavior in School-Aged Children’ survey, to characterise different profiles of substance use and initiation for boys and girls, and to identify factors associated with latent class membership, stratifying the associations analysis by gender.ResultsThree common classes were found for both genders, specifically, Non-Users (boys [B] 34.42%, girls [G] 26.79%), Alcohol Experimenters (B 38.79%, G 43.98%) and Alcohol and Tobacco Frequent Users (B 21.31%, G 10.36%), with two additional unique classes: Alcohol Experimenters and Tobacco Users in girls (18.87%), and Early Initiation and Poly-Substance Users in boys (5.48%). Poor school satisfaction, bullying, fighting and higher family affluence scale score formed a common core of associated factors of substance use, although we found gender differences in these associations. In girls, but not in boys, family factors were associated with more problematic substance use. Not living with both parents was associated with girl’s Alcohol and Tobacco Frequent Users (gATFU) class (OR 3.78 CI 1.18–12.11) and Alcohol Experimenters and Tobacco Users (AETU) class (OR 3.22 CI 1.4–7.44). Poor communication with mother was also associated with gATFU class membership (OR 3.82 CI 1.26–11.53) and AETU class (OR 3.66 CI 1.99–6.75). Additionally, a higher psychological symptoms score was associated with gATFU class membership (OR 1.16 CI 1.02–1.31).ConclusionAlthough we found common patterns and associated factors between boys and girls, we report two unique patterns of substance use in boys and girls and specific associations between family, school and peers, and individual factors with these patterns. These findings underscore the need for substance use prevention and health promotion programmes that address potential differences in substance use patterns and associated factors.

When considering deaf and hard of hearing (DHH) population, research recognizes that fatigue due to communication challenges and multi-focal attention allocation is a significant concern. Given the putative heightened demands of distance learning on deaf and hard of hearing students, we investigate how an online environment might differently affect deaf and hard of hearing participants, compared to hearing participants, Portuguese Sign Language (PSL) users and non-users. Our findings show that the deaf and hard of hearing group present higher values in the post-task fatigue rates with significant differences from the hearing group (non-PSL users). Furthermore, our results revealed an association between post-task fatigue rates and lower performance scores for the deaf and hard of hearing group, and the gap is significantly bigger when compared with the hearing group (non-PSL users). We also found evidence for high levels of post-task fatigue and lower performance scores in the hearing group PSL users. These novel data contribute to the discussion concerning of the pros and cons of digital migration and help redesign more accessible and equitable methodologies and approaches, especially in the DHH educational field, ultimately supporting policymakers in redefining optimal learning strategies.

To compile the literature available about the oral health and dental care of the deaf and hard of hearing (DHH) population. The study question of this scoping review was 'What are the main findings reported in the literature about oral health and dental care of the DHH population?' The following databases were included: Web of Science, LILACS, SciELO, MEDLINE, Scopus, EMBASE, GoogleScholar and Redalyc. Full-text articles published in peer-reviewed journals, in Spanish, Portuguese, and English, from the January 2000 to January 2018 were selected with qualitative and quantitative methods. All study designs were included in the review with the exception of letters to the editor and case reports. A total of fifty articles were selected for analysis. DHH population has poorer oral hygiene and a higher prevalence of caries than their non DHH peers. DHH also report significant struggles with oral health and dental access. Most dentists experienced difficulties communicating with their DHH patients. This scoping review is the first known that centers on DHH oral health and their dental care. Efforts to develop accessible dental health programmes are needed to address apparent oral health inequities in the DHH population.

Deaf and hard of hearing (DHH) individuals face barriers to communication in small-group meetings with hearing peers; we examine generation of captions on mobile devices by automatic speech recognition (ASR). While ASR output displays errors, we study whether such tools benefit users and influence conversational behaviors. An experiment was conducted where DHH and hearing individuals collaborated in discussions in three conditions (without an ASR-based application, with the application, and with a version indicating words for which the ASR has low confidence). An analysis of audio recordings, from each participant across conditions, revealed significant differences in speech features. When using the ASR-based automatic captioning application, hearing individuals spoke more loudly, with improved voice quality (harmonics-to-noise ratio), with a non-standard articulation (changes in F1 and F2 formants), and at a faster rate. Identifying non-standard speech in this setting has implications on the composition of data used for ASR training/testing, which should be representative of its usage context. Understanding these behavioral influences may also enable designers of ASR captioning systems to leverage these effects, to promote communication success.

Theory of Mind (ToM) is a construct that includes a range of connected abilities linked to the understanding of others’ mental states. During the last three decades, ToM development has been studied extensively in deaf and hard of hearing (DHH) individuals and performances compared to the typically hearing (TH) population. Given the advances in the early diagnosis of deafness, interventions, and hearing devices over this period, variations in task performance among DHH participants might have been reduced. The current systematic review aims to synthesize all studies of ToM in DHH individuals and answer the following question: Do DHH individuals (Population), compared to a control sample of TH and/or among themselves (Comparator), in an assessment of ToM (Intervention), have differentiated results (Outcome)? After a search of the literature, 97 papers were included. We found that, in general, TH participants outperformed their DHH peers in ToM measures; however, there was a wide range of results. Explanations for this variability included the quality of early interactions and early exposure to both signed and spoken language. The review also indicates that the understanding of false belief was the most studied component within ToM, while other components, such as understanding intention and irony, require further research. Implications of these findings for clinical practice are discussed.

Men who have sex with men (MSM) remain disproportionately infected with HIV. MSM accounted for 53% of the 56,300 new HIV infections in the US in 2006, despite representing only 4% of the national male population [1, 2]. This high HIV disease burden coincides with high prevalence of non-injection substance use and alcohol consumption among US MSM. A national MSM sample found a 42% previous year prevalence for any non-injection substance use [3]. The recently released United States National HIV/AIDS strategy highlights the need to address substance use among MSM as a critical component of reducing HIV incidence in the United States [4]. To advance this goal, it is imperative to: (1) redress the knowledge gaps on patterns of non-injection substance use among substance using MSM (SUMSM); (2) improve upon existing interventions; (3) develop effective, scalable interventions for the spectrum of users; and (4) determine how to best identify and address the structural and cultural factors that may contribute to non-injection substance use in the MSM population. Non-injection substance use may increase susceptibility to HIV infection in multiple ways [5, 6]. Many epidemiological studies document the association between these substances and sexual risk behaviors [7–24]. These sexual risks are paralleled by high rates of incident and prevalent HIV cases and sexually transmitted infections among SUMSM. Most notably, methamphetamine, cocaine, poppers, and alcohol use have each been associated with an increased risk for HIV and other STD infections [9, 12, 24–30]. The contribution of polysubstance use may also be considerable [9, 28, 31]. Patterns of Substance Use among MSM Drug use among MSM is not an all or nothing phenomenon. There needs to be more emphasis on addressing the specific patterns of non-injection substance use among SUMSM, and what implications these patterns have for intervention approaches. Most SUMSM are not drug-dependent, but rather use episodically (i.e., using substances less than weekly). National HIV Behavioral Surveillance (NHBS) data show that 69–86% of SUMSM report less than weekly substance use [32–35]. Episodic binge drinking is also common among high-risk MSM [36, 37]. Importantly, episodic patterns are associated with high-risk sexual behaviors, suggesting that while perhaps less concerning from a drug-dependence perspective, they may nonetheless contribute substantially to HIV transmission rates among SUMSM [24, 38]. Polysubstance use patterns (i.e., taking more than one substance concurrently, or periodically over a period of time) are often the norm among SUMSM. For example, exclusive of alcohol use, 93% of non-injection methamphetamine using MSM in the San Francisco NHBS sample reported polysubstance use during the prior 12 months before interview; similarly, 94% of cocaine and 90% of poppers users reported using other substances [39]. In a sample of HIV-positive methamphetamine using MSM, 95% of respondents were polysubstance users [40]. Similar findings were reported among samples of MSM club drug users and African American MSM [41–43]. Among various MSM samples, 11–44% of participants reported recent use of three or more substances [44–48]. We need to better understand how to address the wide spectrum of non-injection substance use patterns among MSM. At one extreme are the substance-dependent MSM for whom risk behavior and substance use morbidity may be especially high. Yet, there is also the larger population of MSM whose substance use is infrequent, but for whom it is associated with harmful use and HIV risk. It is unclear where on the substance use spectrum interventions should be invested to have the maximum effectiveness. There is also little understanding as to why, with overall substance use being so prevalent among MSM, only a small proportion develops dependence. Similarly, there is a paucity of understanding as to why some MSM do not use substances, and what factors confer protective effects or relative resiliency with regard to substance use [49]. Finally, how substance use patterns vary across the life trajectories of MSM and how those variations coincide with major life milestones (e.g., sexual debut, coming out, dating, aging, etc.), remains largely unexplored.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

Deaf and hard of hearing (DHH) individuals who use signed language and those who use spoken language face different challenges and stressors. Accordingly, the profile of their mental problems may also differ. However, studies of mental disorders in this population have seldom differentiated between linguistic groups. Our study compares demographics, mental disorders, and levels of distress and functioning in 40 patients using Norwegian Sign Language (NSL) and 36 patients using spoken language. Assessment instruments were translated into NSL. More signers were deaf than hard of hearing, did not share a common language with their childhood caregivers, and had attended schools for DHH children. More Norwegian-speaking than signing patients reported medical comorbidity, whereas the distribution of mental disorders, symptoms of anxiety and depression, and daily functioning did not differ significantly. Somatic complaints and greater perceived social isolation indicate higher stress levels in DHH patients using spoken language than in those using sign language. Therefore, preventive interventions are necessary, as well as larger epidemiological and clinical studies concerning the mental health of all language groups within the DHH population.

Exploring deaf students’ disaster awareness and preparedness in U.S. higher education settings: Implications for university-level DRR policy and programming