And Substance Involvement Screening Test Scores Research Articles

Validation of the Amharic version of Internet Addiction Test-20: a cross-sectional study.

Internet Addiction is defined as excessive internet use or poorly controlled preoccupations, impulses, or behaviors related to computer use and internet access that cause impairment or suffering. It had devastating effect on people lives, families, productivity, academic performance and rarely engaging in criminal acts like alcohol use, drug addiction, or compulsive gambling. This study aimed to investigate the psychometric properties of the Amharic version of Internet Addiction Test-20 among Addis Ababa University, College of Health Sciences medical students, Addis Ababa, Ethiopia. A cross sectional study was carried out among 410 medical students using a convenience sampling method after stratifying them based on their year level. SPSS Version 23 was used to do Pearson's correlation coefficient to determine the convergent validity of Amharic version of IAT. We computed correlation coefficient between the aggregate scores of IAT-20 and the scores for depressive symptoms, problematic substance use, and other characteristics of participants which was assessed using Patient health questionnaire-9 (PHQ-9), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and questionnaire developed to assess demographic and internet use related characteristics, respectively. AMOS 23 software was used to conduct confirmatory factor analysis (CFA) to evaluate the construct validity of Amharic version of IAT. Test-retest reliability was also determined with 2 weeks interval (n = 51). The data confirmed a two-factor structure. Normed Fit Index (NFI) = 0.89, Tucker Lewis Index (TLI) = 0.91 and Comparative Fit Index (CFI) = 0.92, Root Mean Square Error Approximation (RMSEA) = 0.07, and Standardized Root Mean Residual (SRMR) =0.05 indicated a good fit model structure. There was moderate positive correlation between the aggregate scores of IAT-20 and PHQ-9 scores (r = 0.55, p < 0.00), but weak positive correlation between IAT-20 and ASSIST scores (r = 0.14, p < 0.00). IAT-20 was also found to have good internal consistency (Cronbach's alpha = 0.89 for each factor). The test-retest reliability was also good for all items (Intra Class Correlation Coefficient (ICC) > 0.30) except item 16. We found that the IAT-20 is psychometrically sound and a simple screening test for Internet Addiction. However, it is important to acknowledge that further studies are necessary to replicate these findings on diverse population.

Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA

Background: While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied. Objective: To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA. Methods: This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4. Results: Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2–6.8). Conclusion: Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.

The Relationship between Vaping Cannabis and Frequency of Cannabis Use and Cannabis-Related Problems among Urban High School Students

Background: Vaping, including vaping cannabis, is increasing among adolescents. In this longitudinal study, we examined the relationship between vaping cannabis and frequency of cannabis use and related problems over 6 months among adolescents. Material and Methods: Data were from 233 participants (46.8% male, 93.1% African American, mean age = 16.4 years) reporting cannabis use. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) assessed frequency of past 30-day cannabis use and cannabis-related problems at baseline, 3- and 6-months post-baseline. We used latent growth curve modeling to compare vaping to non-vaping adolescents on trends in cannabis use frequency and ASSIST cannabis scores. Results: Adolescents who vaped cannabis (11.7%) had higher past 30-day frequency (mean = 17.89 days, SD = 10.49) of cannabis use at baseline compared to adolescents who had not vaped (mean = 12.1 days, SD = 10.93), but reported a significantly sharper decline in frequency of cannabis use (b = −0.34, p = 0.017). A significantly steeper decrease existed in the mean cannabis ASSIST scores for the vaping group than for the non-vaping group (b = −0.34, p = 0.014). Mean ASSIST scores on the cannabis subscale between the two groups were significantly different at 6-month follow-up (Vape mean = 6.00, SD = 8.12 vs. Non-vape mean = 9.6, SD = 9.39; p < 0.021). Conclusions: In a sample of cannabis-using adolescents, adolescents with experience vaping cannabis, compared to adolescents without vaping experience, on average reported sharper decreases in frequency of cannabis use and cannabis-related problems such as health or social problems.

Cannabis use and psychotic disorders in diverse settings in the Global South: findings from INTREPID II.

Cannabis use has been linked to psychotic disorders but this association has been primarily observed in the Global North. This study investigates patterns of cannabis use and associations with psychoses in three Global South (regions within Latin America, Asia, Africa and Oceania) settings. Case-control study within the International Programme of Research on Psychotic Disorders (INTREPID) II conducted between May 2018 and September 2020. In each setting, we recruited over 200 individuals with an untreated psychosis and individually-matched controls (Kancheepuram India; Ibadan, Nigeria; northern Trinidad). Controls, with no past or current psychotic disorder, were individually-matched to cases by 5-year age group, sex and neighbourhood. Presence of psychotic disorder assessed using the Schedules for Clinical Assessment in Neuropsychiatry and cannabis exposure measured by the World Health Organisation Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Cases reported higher lifetime and frequent cannabis use than controls in each setting. In Trinidad, cannabis use was associated with increased odds of psychotic disorder: lifetime cannabis use (adj. OR 1.58, 95% CI 0.99-2.53); frequent cannabis use (adj. OR 1.99, 95% CI 1.10-3.60); cannabis dependency (as measured by high ASSIST score) (adj. OR 4.70, 95% CI 1.77-12.47), early age of first use (adj. OR 1.83, 95% CI 1.03-3.27). Cannabis use in the other two settings was too rare to examine associations. In line with previous studies, we found associations between cannabis use and the occurrence and age of onset of psychoses in Trinidad. These findings have implications for strategies for prevention of psychosis.

Digital screening and brief intervention for illicit drug misuse in college students: A mixed methods, pilot, cluster, randomized trial from India

Adolescence and early adulthood are vulnerable periods for substance use-related disorders later in life. The use of internet-enabled interventions can be useful, especially in low-resource settings. To examine the feasibility, acceptability, and preliminary effectiveness of single-session digital screening and brief intervention (d-SBI) for illicit drug misuse in college students and explore barriers and facilitators of d-SBI. Design: Mixed-methods, pilot cluster randomized trial. Four conveniently selected colleges were randomized into intervention and control groups. 219 students were screened, and 37 fulfilled eligibility. Twenty-four completed follow-ups. In-depth interviews were done with ten students. Intervention and Comparator: Following a digital screening, Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) based brief intervention was provided in the d-SBI group. The control group received brief education. Acceptability was assessed by direct questions and usage statistics. ASSIST scores of groups were assessed at baseline and 3 months. Inductive coding of the interview transcript was done. More than 50% of participants found d-SBI user-friendly, appropriate, and useful. Eighty percent of users, who logged in, completed screening. Per-protocol analysis showed a reduction in cannabis-ASSIST score over 3 months. The mean ASSIST score for other drugs combined did not differ significantly between groups. The difference in risk transition (moderate to low) was not significant. Qualitative analysis revealed three overarching themes- recruitment, engagement, and behavior change. Digital SBI for drug misuse is feasible among college students. d-SBI might be effective in reducing cannabis use.

Assist-linked brief intervention to reduce risky pattern of substance use in male workers employed at a tertiary care hospital in India: A randomized controlled trial.

Substance use in workplace leads to adverse effects both on the employees and on the workplace. Existing research focuses on alcohol-related harm, while workplace use of other substances has been neglected. There are no randomized controlled studies of brief interventions in Indian hospital settings. To evaluate the efficacy of World Health Organization (WHO) alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention (ALBI) for reducing risky patterns of substance use in male workers at a tertiary-care hospital in North India. The study was conducted in two phases. In Phase-I, a random list of 400 employees was generated from the entire pool of male hospital workers, of which 360 participated. Data on the ASSIST risk categories (mild, moderate, and high) were generated from Phase I. In Phase-II, moderate- or high-risk subjects ('ASSIST screen-positive') were randomized into intervention and control groups, with 35 screen-positive subjects in each group. The intervention group was provided a 15-30-min structured session per ALBI protocol, while the control group was given a 15-30-min general talk on health-related consequences associated with substance use. The subjects were compared on ASSIST score, WHO quality-of-life brief version (WHOQOL-BREF) and readiness to change questionnaire (RCQ) at baseline and at 3-month follow up. The prevalence of moderate-to-high-risk use of tobacco, alcohol, and cannabis in the total sample was 28.6%, 27.5%, and 6.9%, respectively. At 3-months postintervention follow-up of the randomized sample, recipients of ALBI had significant reduction of ASSIST scores for all substances compared to the control group (p < 0.001). More participants receiving ALBI were ready to change to RCQ action stage (p values for tobacco, alcohol, and cannabis <0.001, <0.001 and 0.007, respectively). WHOQOL-BREF scores significantly improved in ALBI group across all domains. ALBI was effective in reducing risky substance use, increasing readiness to change and improving the QOL of the subjects at workplace setting.

Chemsex in HIV pre-exposure prophylaxis users: Assessment of mood disorders and addictive behavior.

The assessment of mood disorders and addiction linked to the practice of chemsex is of interest given the psychoactive substances used. The aim of this study was to assess risky sexual and addictive behavior to chemsex and related anxiety/depression symptoms in individuals receiving HIV pre-exposure prophylaxis (PrEP). In this cross-sectional study, all adults presenting for PrEP renewal at French sexual health centers were enrolled from January 2018 to March 2019. Participants completed a questionnaire on chemsex (i.e., the use of psychoactive substances before/during sex), including adapted Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to chemsex addiction (questions of ASSIST were modified to focus on chemsex). Anxiety/depression was assessed with the Hospital Anxiety and Depression Scale. In the last 3 months before enrollment, 39.8% (94/236) of participants reported chemsex. The main psychoactive substances consumed during chemsex were cathinones (74.6%), gamma-hydroxybutyrate (66.3%), and other psychostimulants (60%). The median score of the chemsex-focused ASSIST was 8 [IQR25-75 : 3-15]; 72.2% of participants had a score justifying at least a brief intervention (>4). In multivariate analyses, anxiety and cathinones consumption were associated with an ASSIST score >4: OR 13.65 (95% CI 1.68-662.7), P = 0.0062, and OR 8.468 (95% CI 2.066-43.059), P = 0.0014, respectively. The level of addiction to the practice of chemsex can be difficult to estimate for the user, and the ASSIST makes it possible to evaluate this addiction and to direct the subjects toward specialized consultations of addictology, sexual health, or PrEP renewals. The implementation of the modified ASSIST in these consultations can allow early systematic screening and counseling.

Screening and Brief Intervention for Cannabis Misuse in Individuals on Buprenorphine Treatment for Opioid Use Disorder: Double-Blind Randomized Clinical Trial

ABSTRACT Cannabis misuse and opioid use disorder (OUD) are highly comorbid but under-treated and associated with poorer outcomes. This paper reports a double-blind, parallel-group randomized controlled trial to determine the efficacy of single-session, clinician-delivered screening and brief intervention (SBI) for reducing cannabis risk. The primary outcome was the cannabis-specific Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) scores, measured at three-month post-intervention. The secondary objectives were to determine the efficacy of SBI in reducing the frequency of cannabis use, in risk transition from moderate to low risk, and in prescription and non-prescription opioid use. One hundred forty-three participants were randomly allocated to receive either SBI (n = 72) or control (n = 71) interventions. We performed Per-protocol (PP) (n = 125) and Intention-to-treat (ITT) analysis (n = 143). We adjusted our analysis for age, sex, and baseline ASSIST score. The ITT showed that the SBI group had a significant reduction (F = 39.46, p < .001, Effect size 0.22) in the mean ASSIST at follow-up. PP analyses too revealed a similar positive effect of SBI (F = 53.1; p < .001, Effect size 0.31). At follow-up, the SBI group had a higher number of days of cannabis abstinence. Care providers and policymakers may consider SBI for cannabis use in individuals on medications for OUD.

The Effect of SBIRT on Harmful Alcohol Consumption in the Community Health Centers of Shanghai, China: A Randomized Controlled Study

The present study was a randomized controlled trial with a longitudinal design aimed at examining the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) on harmful alcohol use in the community health centres in Shanghai, China, and further compared the effects of a multi-session brief intervention (MBI) and a single-session brief intervention (SBI). A total of 362 participants were recruited from four districts of Shanghai and randomly assigned to MBI, SBI and routine care (RC) groups. The MBI group received the brief intervention twice. Follow-up assessments were conducted at 1 and 3months after the intervention. Compared with the SBI and the RC groups, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores (F = 6.422, P = 0.002), SDS scores (F = 5.779, P = 0.003) and SAS scores (F = 4.004, P = 0.019) were significant improved in the MBI group at 1and 3-month follow-up assessment. In the SBI group, the SDS scores decreased significantly compared with the RC group, and there were no significant differences in ASSIST scores, drinking knowledge scores and SAS scores 1-month follow-up assessment. The findings suggested that SBIRT with two sessions of BI had considerable effects on individuals with harmful alcohol use. It provided clinical evidence for future use in China and other Asian countries with similar situations.

0685 Sleep, mental health and socioeconomic factors concomitantly influence the risk in tobacco consumption

Abstract Introduction Extensive evidence points that sleep, psychiatric symptoms and sociodemographic factors separately affect the risk involved in substance use. Due to the well-known relationship between these 3 pillars, an investigation of the combined effect of this factors on substance use is necessary. The objective of this study was to build a model including the 3 factors simultaneously and their effect on risk in substance use. Methods Volunteers of the EPISONO (2007) study underwent assessment through validated questionnaires concerning their general health and a night of polysomnographic examination. For this study, scores in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were evaluated considering responses to questionnaires concerning sleep, psychiatric symptoms, and socioeconomic parameters, as well as polysomnographic findings. A structured equation modelling (SEM) protocol was conducted to build a theoretical model in which variables pertaining to the 3 factors of interest (sleep, mental health and socioeconomic influence) could have their simultaneous effect on substance use measured. Results 793 participants of the EPISONO were included (mean age=43.4 years; 452 women). Significant effects were found for the tobacco consumption model. Subjective sleep quality (SSQ), psychiatric symptoms (PS) and socioeconomic status (SES) influenced the ASSIST score for tobacco consumption. Influence of PS on tobacco consumption was also mediated by SSQ. Models for other substances assessed in the ASSIST questionnaire, such as alcohol, did not find any statistically significant effect. Conclusion The lack of significance of models for alcohol and other substances may be related to the nature of our sample, in which not many individuals presented a substantial risk of substance involvement that could be detected by the ASSIST questionnaire. However, in the model for tobacco consumption, subjective sleep quality, socioeconomic status and psychiatric symptoms exerted an effect on tobacco consumption risk, with psychiatric symptoms having their influence mediated by self-perceived sleep quality. Support (If Any) Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.

PII: S0035-3787(22)00259-4

There is a strong link between conflict exposure and ill health, including substance use. However, this widely acknowledged problem has not been studied yet in refugee camps in Lebanon.To investigate substance use among civilians following war or displacement, and to assess its association with socio-demographic characteristics.Cross-sectional observational study carried out in three Palestinian camps in Lebanon using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were Palestinian adults born in Lebanon and Palestinian and Syrian adults recently displaced from Syria due to war. The percentage of people reporting substance use and the associations between lifetime and last three months substance use and demographic features were assessed using a multivariate logistic regression.In general, lifetime substance use was higher among Palestinians born in Lebanon compared to Syrians and Palestinians displaced from Syria (OR 7.241, 95% CI [3.781–13.869], P <0.0001). Results from ASSIST score during last three months showed that moderate and high-risk use of cannabis and cocaine were higher among Palestinians born in Lebanon than Palestinians and Syrians displaced from Syria. The multivariate analysis showed that women had lower lifetime (OR 0.188, 95%CI [0.080–0.442], P <0.0001) and lower last three months substance use than men, whereas single people were more likely to use substances than married people (OR: 2.78, 95%CI [1.588–4.866], P <0.0001). Tobacco was significantly associated with higher risk of substance use.These findings suggest a higher rate of lifetime substance use among Palestinians born in Lebanon than in Palestinians and Syrians recently displaced from Syria. Substance use is influenced by different socio-demographic factors in the two groups of refugees. However, many factors other than socio-demographic characteristics and refugee status may influence substance use, particularly quality of life and health status that should be assessed in future studies.

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.

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.

Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients.

The aims of this study were to examine the psychometric properties of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in psychiatric inpatients, due to the scarcity of screening instruments validated in this population. Patients from Hospital Clínic's psychiatric ward (n=202) completed: ASSIST, Addiction Severity Index (ASI), MINI-International Neuropsychiatric Interview (MINI), Alcohol Use Disorders Identification Test (AUDIT), Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and Drug Abuse Screening Test (DAST). Reliability and validity evidences based on internal structure (Exploratory and Confirmatory Factor Analyses) and on the relation to other variables were obtained. Excellent internal consistency was found for Total Substance Involvement (TSI) (α = .92 and ω = .93) and for Specific Substance Involvement (SSI) scores (α = .88 - .96 and ω = .89 - .95). Analysis of internal structure for tobacco, alcohol and cannabis subscales resulted in unidimensional models with adequate goodness-of-fit indices. ASSIST scores were significantly correlated with those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r = .808), DAST (r = .831), SDS (r = .519) and with "number of diagnoses of abuse/dependence" in MINI-Plus (TSI: r = .857 to r = .862; SSI: r = .646 to r = .834). Receiver operating characteristic analysis (ROC) and Mann-Whitney's U test found good discriminative validity evidences. ASSIST scores showed good reliability and there were validity evidences that support its use for identifying risk levels of tobacco, alcohol and other substance use in psychiatric patients.

Substance use among refugees in three Lebanese camps: A cross-sectional study.

There is a strong link between conflict exposure and ill health, including substance use. However, this widely acknowledged problem has not been studied yet in refugee camps in Lebanon. To investigate substance use among civilians following war or displacement, and to assess its association with socio-demographic characteristics. Cross-sectional observational study carried out in three Palestinian camps in Lebanon using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were Palestinian adults born in Lebanon and Palestinian and Syrian adults recently displaced from Syria due to war. The percentage of people reporting substance use and the associations between lifetime and last three months substance use and demographic features were assessed using a multivariate logistic regression. In general, lifetime substance use was higher among Palestinians born in Lebanon compared to Syrians and Palestinians displaced from Syria (OR 7.241, 95% CI [3.781-13.869], P <0.0001). Results from ASSIST score during last three months showed that moderate and high-risk use of cannabis and cocaine were higher among Palestinians born in Lebanon than Palestinians and Syrians displaced from Syria. The multivariate analysis showed that women had lower lifetime (OR 0.188, 95%CI [0.080-0.442], P <0.0001) and lower last three months substance use than men, whereas single people were more likely to use substances than married people (OR: 2.78, 95%CI [1.588-4.866], P <0.0001). Tobacco was significantly associated with higher risk of substance use. These findings suggest a higher rate of lifetime substance use among Palestinians born in Lebanon than in Palestinians and Syrians recently displaced from Syria. Substance use is influenced by different socio-demographic factors in the two groups of refugees. However, many factors other than socio-demographic characteristics and refugee status may influence substance use, particularly quality of life and health status that should be assessed in future studies.

A Digital Health Tool to Understand and Prevent Cannabis-Impaired Driving Among Youth: A Cross-sectional Study of Responses to a Brief Intervention for Cannabis Use.

BackgroundCannabis legalization has raised concern about an increased risk of cannabis-impaired driving, particularly among youth. Youth advocates and policy makers require cost-effective tools to target educational resources to promote responsible cannabis use.ObjectiveThe objective of this paper is threefold. First, it describes how a youth advocacy organization disseminated a low-cost digital brief intervention to educate and inform young people about responsible cannabis use. Second, it illustrates how digital tools can help promote understanding about attitudes and behaviors toward cannabis while simultaneously offering tailored education. Finally, this paper contributes to examining behavioral factors associated with youth cannabis-impaired driving by quantifying relationships between cannabis users' willingness to drive impaired and self-reported demographic and behavioral factors.MethodsThis paper analyzed data from 1110 completed Check Your Cannabis (CYC) brief interventions between March 2019 and October 2020. The CYC asks respondents a brief set of questions about their cannabis use and their personal beliefs and behaviors. Respondents receive comprehensive feedback about their cannabis use and how it compares with others. They also receive a summary of reported behaviors with brief advice. An ordered probit model was used to test relationships between cannabis use, demographics, and driving behaviors to gain further insights.ResultsThe vast majority (817/1110, 73.6%) of respondents reported using cannabis. However, a much smaller share of respondents reported problems associated with their cannabis use (257/1110, 23.2%) or driving after cannabis use (342/1110, 30.8%). We found statistically significant relationships between driving after cannabis use and age; Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk score; and polysubstance use. However, we did not find gender to be a significant determinant of driving after cannabis use. We estimated that every 10-point increase in the ASSIST score increased the probability of sometimes driving after cannabis use by 7.3% (P<.001). Relative to respondents who reported never drinking alcohol or using other substances with cannabis, those who sometimes drink or use other substances with cannabis were 13% (P<.001) more likely to sometimes or always drive after using cannabis.ConclusionsThe digital health tool cost the youth advocacy organization approximately Can $0.90 (US $0.71) per use. Due to the tool's unlimited use structure, the per-use cost would further decrease with increased use by the organization’s target population. Based on our results, public health campaigns and other interventions may consider tailoring resources to frequent cannabis users, youth with high ASSIST scores, and those with polysubstance abuse. The cost-effectiveness of delivering digital brief interventions with unlimited use is attractive, as increased use decreases the per-user cost. Further research examining the efficacy of digital health interventions targeting problematic cannabis use is required.

Prevalence and health risk score of tobacco and alcohol use by using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test among construction workers in Puducherry, India.

Background:Construction workers are one of the important neglected occupation groups. The study aimed to assess the prevalence and health risk score of tobacco and alcohol use and its association with sociodemographic factors and self-reported morbidities among construction workers.Materials and Methods:A cross-sectional study was conducted among 400 male construction workers in a tertiary care medical institution in Puducherry, India. A semi-structured questionnaire based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) guidelines for assessment and health risk score of alcohol and tobacco use was used. The association of current tobacco and alcohol use with associated factors was analyzed by univariate analysis.Results:About 371 male construction workers participated. The mean (standard deviation) age of construction workers was 28.28 (9.04) years. The prevalence of current tobacco and alcohol use was 60.1% (223/371) and 47.7% (177/371), respectively. Out of 133 smokers, 60.9% (81) were used only bidi, 27.1% (36) only cigarette, and 12% (16) both bidi and cigarette. Most of the workers (126/151 [83.4%]) used khaini among smokeless tobacco users. The majority (204/241 [84.6%]) of ever smokers and nearly half of alcohol users (103 [49.8%]) had moderate risk based on ASSIST score. Higher current tobacco consumption is associated with higher age group, married, lower education status, unskilled occupation, contractual workers, migrants from other states, more duration of work in construction field, and the presence of self-reported health problems (P < 0.05). Current alcohol consumption is associated with more duration of work in construction field and the presence of self-reported health problems (P < 0.05).Conclusions:Tobacco and alcohol use is high, and health risk due to substance use is also more in construction workers.

Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV

Youth living with HIV make up one-quarter of new infections and have high rates of risk behaviors but are significantly understudied. Effectiveness trials in real-world settings are needed to inform program delivery. To compare the effectiveness of the Healthy Choices intervention delivered in a home or community setting vs a medical clinic. This randomized clinical trial was conducted from November 1, 2014, to January 31, 2018, with 52 weeks of follow-up. Participants, recruited from 5 adolescent HIV clinics in the United States, were youths and young adults living with HIV aged 16 to 24 years who were fluent in English, were currently prescribed HIV medication, had a detectable viral load, and had used alcohol in the past 12 weeks. Individuals with an active psychosis that resulted in an inability to complete questionnaires were excluded. Data were analyzed from May to December, 2019. Participants were randomized to receive the Healthy Choices intervention in either a home or clinic setting. Four 30-minute individual sessions based on motivational interviewing to improve (1) medication adherence and (2) drinking behavior were delivered during 10 weeks by trained community health workers. In session 1, participants chose which behavior to discuss first. Using motivational interviewing strategies, the community health worker elicited motivational language, guided the development of an individualized change plan while supporting autonomy, delivered feedback, and addressed knowledge gaps. Session 2 focused on the second target behavior. In subsequent sessions, community health workers reviewed the individualized change plan, monitored progress, guided problem solving, and helped maintain changes made. Primary outcomes were viral load and alcohol use change trajectories during 52 weeks of follow-up. Alcohol use severity and frequency were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (scores range from 0 to 33, with higher scores indicating greater severity of alcohol-related problems) and number of drinks consumed each day over a 30-day period, with timeline followback. A total of 183 young people living with HIV (145 male [79.2%]; mean [SD] age, 21.4 [1.9] y) were randomized to the home setting (n = 90) or clinical setting (n = 93). Using growth-curve analysis, both groups showed declines in viral load after the intervention: among participants with available viral load information, in the home group, 12 participants (21%) had an undetectable viral load at 16 weeks, 12 (22%) at 28 weeks, and 10 (20%) at 52 weeks; in the clinic group, 16 participants (24%) had an undetectable viral load at 16 weeks, 20 (39%) at 28 weeks, and 18 (35%) at 52 weeks. However, the clinic group maintained gains, whereas those counseled at home had a significantly different and increasing trajectory during follow-up (unstandardized β = -0.07; 95% CI,-0.14 to -0.01; P = .02). A similar pattern was observed in ASSIST scores during follow-up, with reduced ASSIST scores in the clinic group (unstandardized β = -0.44; 95% CI,-0.81 to -0.07; P = .02). In this trial, the Healthy Choices intervention resulted in improvements in viral load and alcohol use over 12 months. Unexpectedly, the clinic setting outperformed home-based delivery for viral suppression. Although cross-sectional differences in ASSIST scores were nonsignificant, clinic delivery did improve the trajectory of ASSIST scores during follow-up. Thus, clinics may be the more effective site for interventions aimed at viral load reduction for young people living with HIV. ClinicalTrials.gov Identifier: NCT01969461.

Do men who have sex with men who report alcohol and illicit drug use before/during sex (chemsex) present moderate/high risk for substance use disorders?

BackgroundWe evaluated the prevalence of sexualized drug use (Chemsex) and its association with moderate/high risk for substance use disorders and HIV sexual risk behavior among men who have sex with men (MSM). MethodsWe conducted a cross-sectional web-based survey among MSM from Rio de Janeiro (Brazil). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to screen people at moderate/high-risk for substance use disorders. Individuals found to be using substances in the prior three months were asked if they used before/during sex. Sexualized drug use was classified into: no sexualized drug use, sex using only alcohol (alcohol-sex), sex using only illicit drugs (drug-sex) and sex using alcohol and illicit drugs (alcohol-drug-sex). The questionnaire included questions about sociodemographic, HIV status/prevention and risk behavior. A multinomial regression model was performed to assess the factors associated with sexualized drug use. ResultsOverall, 1048 MSM completed the questionnaire; median age was 29 years. Prevalence of alcohol and illicit drug use in previous 3 months was 89 % and 49 %, respectively. Most MSM (64 %) reported sexualized drug use: 28 % alcohol-sex, 9 % drug-sex and 27 % alcohol-drug-sex. Median ASSIST scores were higher among those reporting sexualized drug use compared to no use. All HIV sexual risk behavior variables presented increasing prevalence across the outcome categories. In the adjusted multivariate model, having moderate/high-risk for substance use disorders were associated with sexualized drug use. ConclusionsMSM reporting sexualized drug use should receive brief intervention for substance use disorders and be evaluated for combination HIV prevention strategies including PrEP.

Brief Interventions for Cannabis Use in Healthcare Settings: Systematic Review and Meta-analyses of Randomized Trials.

The efficacy of brief interventions for cannabis use was assessed in a systematic review and meta-analyses. Systematic searches in academic databases were conducted, and reference lists of included studies were reviewed. Randomized trials were included that compared brief interventions with minimal control interventions for improving cannabis-specific outcomes among participants recruited from healthcare settings. Mean differences (MDs) based on change-from-baseline measurements were pooled using random-effects meta-analyses, with stratification by short term (≤3 months) and long term (>3 months). Ten reports from 9 studies were included. Most studies were conducted in the United States, including participants who were adults and were recruited from primary care or emergency departments. There were no significant effects of brief interventions on cannabis-specific Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores in the short term (MD -1.27 points; 95% confidence interval [CI] -3.75, 1.21; I 84.40%). The null pattern of findings was also observed for number of days of cannabis use in the past 30 days in the short term (MD -0.22 days; 95% CI -2.27, 1.82; I 60.30%) and long term (MD -0.28 days; 95% CI -2.42, 1.86; I 60.50%). The evidence base for other outcomes not subjected to meta-analyses was limited and mixed. Brief interventions did not result in reductions in cannabis-specific ASSIST scores or number of days of cannabis use, whereas the evidence base for other outcomes was limited and mixed. As such, brief interventions in healthcare settings may not be efficacious for cannabis use.