Alcohol Involvement Research Articles

Changes in characteristics of drug overdose death trends during the COVID-19 pandemic.

Reports analyzing drug overdose (OD) mortality data during the COVID-19 pandemic are limited. Outcomes across states are heterogenous, necessitating assessments of associations between COVID-19 and OD deaths on a state-by-state level. This report aims to analyze trends in OD deaths in Massachusetts during COVID-19. Analyzing 3,924 death records, we characterize opioid-, cocaine-, and amphetamine-involved OD mortality and substance co-presence trends from March 24-November 8 in 2020 as compared to 2018 and 2019. OD deaths involving amphetamines increased by 85% from 2019 to 2020 (61 vs. 113; P<0.001) but were steady from 2018 to 2019. Heroin's presence continued to decrease (341 in 2018, 247 in 2019, 157 in 2020; P<0.001); however, fentanyl was present in more than 85% of all OD deaths across all periods. Among OD deaths, alcohol involvement consistently increased, present in 250 deaths in 2018, 299 in 2019 (P=0.02), and 350 in 2020 (P=0.04). In 2019, 78% of OD decedents were White and 7% were Black, versus 73% and 10% in 2020 (P=0.02). Increased deaths involving stimulants, alcohol, and fentanyl reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary.

Executive functions mediate the association between alcohol use and declarative memory symptoms in daily life

ABSTRACT Alcohol use is associated with memory problems in young adults with HIV, but the cognitive mechanisms of that association are not known. Sixty adults (aged 19–24 years) living with HIV were administered the Alcohol, Smoking, and Substance Involvement Screening Test to assess alcohol use, Behavior Rating Inventory of Executive Function for self-reported executive functions, and the Prospective and Retrospective Memory Questionnaire (PRMQ) for dailiy memory functioning. Controlling for mood, self-reported executive functions fully mediated the relationship between alcohol use and memory (indirect effect b=.568, 95%CI [.209,.888]). Findings suggest that self-reported executive dysregulation of memory processes (e.g., Strategic encoding and retrieval) may drive the effects of alcohol use on daily memory symptoms.

Prevalence and Correlates of Positive Follow-up Screens in Primary Care for Unhealthy Alcohol and Other Drug Use After a Negative Screen.

To determine the proportion and characteristics of adults in primary care (PC) who screen positive for unhealthy substance use (SU) (alcohol and/or other drug) 1 year or more after screening negative. Screening consisted of single-item questions for unhealthy use of alcohol and other drugs (illicit drugs and prescription medications). Health educators conducted in-person screening of patients presenting for a PC appointment. SU severity (low, moderate, high) was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Multivariate logistic regression models estimated predictors of a positive follow-up screen. Among 9215 patients who previously screened negative, 237 (2.6%) screened positive for unhealthy SU (42% alcohol only, 43% other drug only, 15% alcohol and other drug). The mean interval between screens was 19 months. Most alcohol use was low risk (ASSIST score ≤10) (81%), whereas most drug use was moderate risk (ASSIST score 4-26) (77%). Patients between ages of 18 to 25 had a higher proportion of positive follow-up screens (7.4% [33/ 443]) as well as those with a self-identified history of SU problems (9.4% [40/421]). Patients with a higher odds of a positive follow-up screen were male (adjusted odds ratio [AOR] 2.64; 95% CI: 2.02-3.45), used tobacco (AOR 2.38; 95% CI: 1.75-3.23), had a longer interval between screenings (AOR 3.26; 95% CI: 1.84-5.75). Screening for unhealthy SU 1 year or more after screening negative identified additional patients at-risk. These findings highlight the need to empirically determine the incremental benefits of screening all PC patients annually.

Validation of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool with the WHO alcohol, smoking, and substance Involvement screening test (ASSIST)

IntroductionCommunity pharmacies are emerging as a valuable setting to identify patients with substance use. Few tools have been specially validated to screen patients in these settings, particularly among those prescribed opioid medications. The goal of this study was to validate the performance of the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool in community pharmacy settings compared to a reference-standard substance use assessment. MethodsParticipants were recruited while receiving opioid medications (not solely buprenorphine) from 19 pharmacies from a large national chain in Ohio and Indiana. Adults who were not involved in the criminal justice system or receiving cancer treatment were invited to participate in a one-time, cross-sectional, self-administered, health survey which included the TAPS tool. Substance use risks calculated from the TAPS tool were compared with the reference standard, World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) using confusion matrices. We calculated Areas Under the Curve (AUC) of Receiver Operating Characteristics Curves (ROC) to evaluate the TAPS tool’s validity. ResultsThe TAPS tool showed fair or better discrimination between moderate-risk use and high-risk use for tobacco, alcohol, and prescription opioids (AUCs: 0.75–0.97 and fair or better discrimination between low-risk and moderate-risk use in five of eight subscales, including tobacco, alcohol, marijuana, stimulants, and heroin (AUCs: 0.70–0.92). ConclusionThe TAPS tool detected clinically relevant problem substance use in several drug classes and likely would be a valuable assessment for screening illicit drug use among community pharmacy patients prescribed opioid medications.

Rideshare Trips and Alcohol-Involved Motor Vehicle Crashes in Chicago

Rideshare companies such as Uber and Lyft have substantially changed transportation markets in the United States and globally. The aim of this study was to examine whether ridesharing is associated with reductions in alcohol-involved crashes. This case-series study used highly spatially and temporally resolved trip-level rideshare data and motor vehicle crash data from the Chicago Data Portal from November 2018 to December 2019. The units of analysis were motor vehicle crashes in Chicago. Events of interest were 962 crashes that police indicated were alcohol involved. The comparison group was 962 non-alcohol-involved crashes that occurred in the same census tract, matched 1:1. The exposure of interest was the density per square mile of rideshare trips that were in progress at the time of the crash, calculated using a kernel density function around the estimated route paths of active trips. A conditional logistic regression compared alcohol involvement to rideshare trip density while adjusting for matching and relevant time-varying covariates (taxi trips, precipitation, temperature, holidays). Mean rideshare trip density was 69.0 per square mile (SD = 129.7) at the time and location of alcohol-involved crashes and 105.7 per square mile (SD = 192.6) at the time and location of non-alcohol-involved crashes. After controlling for covariates, the conditional logistic regression model identified that a standard deviation increase in rideshare trips per square mile at the crash location was associated with 23% decreased odds that the crash location was alcohol involved (odds ratio = 0.771; 95% confidence interval [0.594, 0.878]). Ridesharing may replace motor vehicle trips by alcohol-impaired drivers.

Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000‒2018.

Objectives. To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States. Methods. In this repeated cross-sectional analysis, we used data from the Fatality Analysis Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level. Results. While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval [CI] = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively. Conclusions. The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (Am J Public Health. 2021;111(11):1976-1985. https://doi.org/10.2105/AJPH.2021.306466).

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort

BackgroundAdverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.MethodsData from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure.Results1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5–11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4–31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1–3.5).ConclusionACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and ‘trauma-informed’ approaches to tackling longer-term impact of ACEs in India.FundingNewton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Drug and alcohol use in Tanzanian road traffic collision drivers.

IntroductionRoad traffic collisions (RTCs) are an important public health problem in low and middle-income countries (LMIC), where 90% of RTC deaths occur. The World Health Organization has suggested strategies to address excess mortality from RTCs including efforts to combat driving after using alcohol or drugs. Data on the impact of drug and alcohol use on RTCs is limited in many low-resource settings including Tanzania. We sought to examine the prevalence of drug and alcohol use in Tanzanian RTC drivers.MethodsThis prospective, observational study was conducted in the emergency centre (EC) of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. We enrolled adult drivers presenting within 24 h of an RTC. We collected a saliva test of blood alcohol content (BAC) and a urine drug screen (UDS) and administered a validated substance use disorder screening tool, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Patients were excluded from individual analyses if they could not produce saliva or urine or answer questions. Primary outcomes were rates of positive BAC, UDS and self-reported risky alcohol and drug use patterns.ResultsWe screened 5264 trauma patients and enrolled 418, in whom 190 had a BAC, 364 had a UDS, and 410 had a complete ASSIST. 15 of 190 patients (7.9%) had a positive BAC, and 67/361 (18.7%) had a positive UDS for at least one drug. ASSIST scores showed 75/410 (18.3%) patients were at moderate or high risk for alcohol use disorder. Few were at risk for disordered use of other non-tobacco substances.DiscussionIn our population of RTC drivers, positive BAC and UDS tests were rare but many patients were at risk for an alcohol use disorder. Ideal screening for substance use in Tanzanian trauma populations may involve a combination of objective testing and a verbal screening tool.

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya

BackgroundAdverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya.MethodsMaisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June–December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach.ResultsOf 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support.ConclusionsThe high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.

Incidence report of traumatic brain injury in Mimika Public Hospital Papua

Introduction: Traumatic brain injury is a functional brain disorder caused by an external force, which giving persistent consequences, progressive, long-term care, and rehabilitation might be needed. It is also called a “silent epidemic” due to the increased global incidence rate, socio-economic burden, and quality of life. The major cause of TBI was road traffic injury, fall, and blunt trauma.Methods: This research was conducted with a descriptive research design using a prospective cross-sectional design. The research sampling was using medical records in accordance with inclusion and exclusion criteria from 2018 to 2019.Result: The collected sample was 393 cases. There were 66.16% and 67.18% cases occurred to man and productive age with incidence rate 178.89 in 100.000 people. The major cause of TBI was road traffic injury and intentional injury with 58.52% and 24.17% consecutively. The involvement of alcohol in TBI cases was found in 24.42% of cases. The usage of the helmet was not found in 96.6% of cases of RTI.Conclusion: The majority of TBI patients at Mimika Public Hospital in 2018-2019 occurred in men and in the productive age, which was majorly caused by road traffic injury and intentional injury.

The influence of work environment relationships on mental health of Brazilian seamstresses.

The work environment is a place in which different kinds of interpersonal relationships are developed and can contribute positively or negatively to productivity and to workers' well-being. Discussion on this topic may contribute to building more coping strategies to fight against gender inequality and the emotional repercussions of these conditions. This is a cross-sectional study that investigated the possible influence of work environment relationships on the mental health of Brazilian seamstresses. The participants were seamstresses from four clothing factories in a city in the southwest of Brazil. For data collection, we used the Social Support Perception at Work Scale; Self-Report Questionnaire; Alcohol, Smoking and Substance Involvement Screening Test; and a focus group. The quantitative data were statistically analyzed, and data from the focus groups were analyzed using content analysis. Interpersonal relationships at work were mentioned as sources of conflict and stress but also as emotional and material social support providers. In the sample studied, these relationships did not influence directly the development of mental health disorders. Study results suggest that a low level of education is an important factor that increases the vulnerability of these women to the precariousness of work, and, consequently to developing mental health symptoms or aggravating previous mental health distress. However, emotional and material support from peers likely protects these workers' mental health.

Psychoactive substance consumption: A Portuguese cross-sectional study.

Increasing consumption of psychoactive substances is a major social concern worldwide. To investigate the prevalence of psychoactive substances consumption in the Portuguese, throughout their life as well as recently, and the main reasons for the consumption and associated factors. This cross-sectional study was based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) applied to a sample of 385 Portuguese obtained for convenience. It was used descriptive statistics, the Cui-square, Mann-Whitney U and Kruskal-Wallis tests, with a significance level of 5%. Alcohol was the most consumed throughout life (86%), followed by xanthines (79%) and tobacco (60%). In the last 3 months, xanthines (49%) were the most consumed daily, followed by tobacco (22%) and alcohol (9%). Socializing was the main reason for consumption of alcohol (67%), tobacco (36%) and cannabis (34%) while anxiolytics have been used to sleep (50%) and xanthines to increase cognitive capacity (35%). Tobacco (p = 0.016), alcohol (p = 0.03) and illicit substances (p < 0.001) were more consumed by men and anxiolytics by women (p = 0.027). Alcohol (p = 0.008), cannabis (p = 0.027), and xanthines (p = 0.009) were mostly consumed by young adults. The results reveal sporadic and recreational use of illicit substances, and regular use of alcohol, tobacco and xanthines, mostly by young adults and men, and anxiolytics by women. Socializing was the main reason for psychoactive substances consumption.

YOUR ILLNESS ON DRUGS: THE GENETICS OF SUBSTANCE USE INFORMS OUR RESPONSE TO SOMATIC DISEASES

Overall Abstract: SUDs are among the top contributors to all cause mortality. This session highlights cross-cutting genetic and genomic analyses that illuminate the relationships between substance use disorders (SUDs) and aspects of health and disease beyond the known relationships with other psychiatric disorders. This is a topic that has gotten very little attention in the past. It is timely, given multiple global health crises, as it addresses the role of SUDs in respiratory and cardiometabolic illness, COVID-19 and HIV/AIDS – each among the leading contributors to mortality. The first talk will showcase findings from a phenome-wide analysis (PheWAS) of alcohol and cannabis involvement, using medical center data. It demonstrates that genetic liability for substance use has a profound effect on multiple bodily systems. For example, genetic liability for cannabis use predicted respiratory illness while that for alcohol use predicted heart disease. Individuals with SUDs are at higher risk to develop severe cases of COVID-19. The second talk examines genetic correlations between COVID-19 severity phenotypes and 1014 heritable traits, and reveals that the largest genetic causality proportions were for alcohol use frequency, smoking and cannabis use. Third, we pivot from the current pandemic to the ongoing HIV epidemic to discuss the impact of cocaine abuse among HIV+ individuals. The findings showed cocaine use increased viral load, worsened progression, accelerated mortality, and increase the latent viral reservoir. Specific DNA methylation and gene expression differences that appear to be biological mediators of these relationships were uncovered. The last talk addresses the mediating role of behavioral disinhibition, which is genetically correlated with SUD, using a multivariate GWAS approach to creating a broad genetic measure of externalizing behavior (EXT). Pooling data from ∼1.5 million people, more than 500 genetic loci were discovered. A PheWAS showed that EXT-PRS was associated with 255 of the 1335 disease phenotypes tested (FDR < 0.05). Individuals with higher EXT-PRS showed poorer health in nearly every bodily system. To conclude, the panel will discuss the importance of considering the genetics of SUDs more broadly, to better understand both psychiatric and somatic disorders and the enormous health burden arising from them. Disclosure: Nothing to disclose.

Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO alcohol, smoking, and substance involvement screening test

BackgroundPrescription drug monitoring programs (PDMPs) are critical for pharmacists to identify risky opioid medication use. We performed an independent evaluation of the PDMP-based Narcotic Score (NS) metric. MethodsThis study was a one-time, cross-sectional health assessment within 19 pharmacies from a national chain among adults picking-up opioid medications. The NS metric is a 3-digit composite indicator. The WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was the gold-standard to which the NS metric was compared. Machine learning determined optimal risk thresholds; Receiver Operating Characteristic curves and Spearman (P) and Kappa (K) coefficients analyzed concurrent validity. Regression analyses evaluated participant characteristics associated with misclassification. ResultsThe NS metric showed fair concurrent validity (area under the curve≥0.70; K=0.35; P = 0.37, p < 0.001). The ASSIST and NS metric categorized 37% of participants as low-risk (i.e., not needing screening/intervention) and 32.3% as moderate/high-risk (i.e., needing screening/intervention). Further, 17.2% were categorized as low ASSIST risk but moderate/high NS metric risk, termed false positives. These reported disability (OR=3.12), poor general health (OR=0.66), and/or greater pain severity/interference (OR=1.12/1.09; all p < 0.05; i.e., needing unmanaged-pain screening/intervention). A total of 13.4% were categorized as moderate/high ASSIST risk but low NS metric risk, termed false negatives. These reported greater overdose history (OR=1.24) and/or substance use (OR=1.81–12.66; all p < 0.05). ConclusionsThe NS metric could serve as a useful initial universal prescription opioid-risk screener given its: 1) low-burden (i.e., no direct assessment); 2) high accuracy (86.5%) of actionable data identifying low-risk patients and those needing opioid use/unmanaged pain screening/intervention; and 3) broad availability.

Effectiveness of E-SBIRT intervention in community healthcare institution in China: study proposal for a randomised controlled trial

BackgroundMany studies have demonstrated the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) in addressing substance use problem. However, owing to the shortage of counsellors, it has not...

Cross-sectional study the consumption of drugs by pregnant women in four public hospitals in the city of Recife from the application of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Cross-sectional study the consumption of drugs by pregnant women in four public hospitals in the city of Recife from the application of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Literal text analysis of poly-class and polydrug overdose deaths in North Carolina, 2015–2019

BackgroundThe literal text on death certificates was leveraged to enhance the examination of trends in the specific drugs and drug combinations involved in North Carolina (NC) overdose deaths from 2015 to 2019. MethodsUsing NC death certificate data, overdose deaths included those with a drug poisoning as the underlying ICD-10 cause-of-death code (n = 10,117). The literal text from three death certificate fields were searched for drug mentions by integrating a tool developed by the Council of State and Territorial Epidemiologists Overdose Subcommittee with search terms originating from a National Center for Health Statistics/Food and Drug Administration collaboration. Descriptive statistics were calculated to evaluate substance classes, specific drugs, and drug combinations most frequently involved in these deaths over time. ResultsFrom 2015–2019, polydrug involvement in NC overdose deaths increased (71% in 2015 to 75% in 2019). During the study period, opioid involvement shifted from heroin and/or oxycodone in 2015 to predominantly fentanyl in 2019, with fentanyl involvement increasing from 15% to 58%. Psychostimulant involvement increased for both cocaine (2015: 21%, 2019: 35%) and methamphetamine (2015: 3%, 2019: 13%). Benzodiazepine involvement, including alprazolam and clonazepam, declined during the study period, while the involvement of alcohol and antiepileptics/sedative-hypnotics, specifically gabapentin, remained stable. The top polydrug combinations in 2019 were fentanyl + cocaine (15% of all overdose deaths), fentanyl + heroin (10%), fentanyl + cocaine + heroin (6%), and fentanyl + methamphetamine (4%). ConclusionsIncorporation of literal text methodology into ongoing overdose surveillance can facilitate the identification of specific, emerging drugs and combinations and inform targeted overdose prevention approaches.

Sleep, psychiatric and socioeconomic factors associated with substance use in a large population sample: A cross-sectional study

Multiple elements modulate drug use, including sleep, which is increasingly being considered as an important contributor to substance use and abuse. The present study aimed to evaluate the association between sleep, psychiatric and socioeconomic/demographic factors and substance use in a large-scale representative sample from the city of São Paulo, Brazil. Data from the 2007 São Paulo Epidemiological Sleep Study (EPISONO) database were used. In the EPISONO study, volunteers underwent a polysomnographic exam and completed a series of questionnaires to assess objective and subjective sleep quality and associated comorbidities. Drug use was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Linear (univariate and multivariate) and logistic regressions were performed to identify factors associated with the use of the 4 most commonly used substances in the sample (tobacco, alcohol, cannabis and cocaine/crack). Structural equation models were used to establish theoretical networks to explain the relationship between sleep, psychiatric and socioeconomic factors and use of these substances. The logistic regression results showed that psychiatric symptoms, lower income, and poorer subjective sleep were the main factors associated with tobacco consumption; gender and occupational status with alcohol intake; age and occupation with cannabis use; and education with cocaine/crack use. The structural equation models partially supported these findings and identified significant effects of psychiatric symptoms on tobacco consumption, both directly and mediated by sleep. Our results reinforce previous findings concerning factors associated with generally misused substances and suggest that sleep should be considered as an important element in future substance use disorder studies.

Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya

BackgroundLittle data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya’s largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment.MethodsWe sampled 338 residents belonging to 8 different specialties using self administered questionnaires in this cross-sectional survey between October 2019 and February 2020. Questionnaires included: sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure. Bivariate and multivariate linear regression were used to assess for risk factors for depression.ResultsMean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported no to mild depressive symptoms, 12.7% had moderate, and 16.9% had severe depressive symptoms. Most residents had high social support (71.8%) and moderate stress (61.6%). The educational environment was rated as more positive than negative by 46.3% of residents. Bivariate analyses revealed significant correlations between depressive symptoms, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis showed that depression was strongly associated with: fewer hours of sleep (β = − 0.683, p = 0.002), high perceived stress (β = 0.709, p < 0.001) and low perceived social support (β = − 2.19, p < 0.001).ConclusionsOnly 30% of medical residents in our study had moderate and severe depressive symptoms. Most residents in our study reported high levels of social support, and moderate levels of stress. Though their overall appraisal of medical residency experience was positive, mental health support and self-care skills in the training of medical professionals needs prioritization.

Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients.

Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% (n = 2286) had BAC data available. While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair (κ = 0.33, 95% confidence interval: 0.27-0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.