Differences In Substance Use Research Articles

Substance use during pregnancy and postpartum among individuals with perinatally-acquired HIV in the United States

Use of cannabis and alcohol were common during pregnancy and the first year postpartum among people with HIV in the United States (2007–2019), but there were no major differences in substance use during pregnancy based on mode of HIV acquisition. The relatively high prevalence of substance use in this population, particularly postpartum alcohol and cannabis use, warrants further attention.

Substance use during the COVID-19 pandemic among persons with traumatic spinal cord injury: A cross-sectional perspective

Study design: Analysis of data from two cohorts of Spinal Cord Injury Model Systems Database (SCIMS) participants, pre-pandemic (2017–2019, n = 6368) and during pandemic (2020, n = 1889). Objectives: To examine differences in substance use during the pandemic compared to the years prior to the pandemic. Setting: 19 SCIMS Centers. Methods: Participant characteristics, wellness (depression, life satisfaction, resilience), participation, and substance use between the two cohorts were compared. Multiple logistic regression examined the association of the pandemic with substance use after accounting for other factors. Results: Characteristics of the two cohorts were similar. Cannabis and sedative uses were not greatly different (28.8% vs 25.1%, and 8.3% vs 6.6%) but did reach statistical significance. Non-prescribed opioid use was double for the pandemic group (6.6% vs 3.3%). Alcohol use patterns were similar across the two cohorts. Measures of wellness were similar, while the pandemic group reported lower participation. The odds of use of cannabis, sedatives, and opioids were 1.3, 1.3, and 2.2 times greater, respectively, for the pandemic cohort after accounting for demographics, wellness, and participation. Greater use of non-prescribed opioids was reported during the pandemic in the South compared to prior to the pandemic (13.8% vs 6.1%). Conclusions: The pandemic may have been associated with increased use of non-prescribed substances in the traumatic spinal cord injury population. Efforts to pursue longitudinal investigations would be warranted for definitive analysis of trends. The provision of demonstrably effective substance use treatment resources delivered via accessible methods will likely be needed in this population, particularly opioid treatment.

Population-level effects of Hurricane Sandy on adolescent health

BackgroundDisasters are increasing in frequency and intensity due to climate change. Youth are the largest and most vulnerable group exposed to disasters. More evidence is needed regarding how youth mental health and health behaviors vary based on disaster exposure, how mental health influences health behaviors, and how diverse groups of youth may be differentially affected. MethodsUsing data from the Youth Risk Behavior Survey and Federal Emergency Management Agency, we examined the impact of Hurricane Sandy (2012) on mental health (sadness, suicidality) and health behaviors (substance use, physical activity, screen time, sexual behaviors) of 240,365 youth. Difference-in-differences regression analyses evaluated pre-disaster (2005–2011) and post-disaster (2013–2019) changes. ResultsThere were 83,442 (34.7 %) adolescents (51.2 % female, 18.1 % non-Hispanic White) located in 6 districts exposed to Hurricane Sandy and 156,923 (65.3 %) adolescents located in 13 non-exposed districts. Exposure was associated with differences in substance use, physical (in)activity, and risky sexual behaviors, but not mental health outcomes. Mental health did not moderate the association between disaster exposure and health behaviors. Hispanic adolescents and those identifying as Other races/ethnicities were most vulnerable to post-disaster negative health outcomes. LimitationsStudy limitations include questionnaire design, cross-sectional data, sampling, and possible response biases. ConclusionsFindings provide critical information about youth mental health and health behaviors following disasters, as well as how youth may differ in their responses. Findings provide guidance for early identification and resource allocation for youth at higher risk for post-disaster health issues.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students.

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students. Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes. About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms. It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other. Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

Characterizing clinical heterogeneity in an inpatient service treating mental, substance use and concurrent disorders

Patients diagnosed with concurrent disorders (CD)—comorbid substance use disorder with other psychiatric conditions—experience poorer clinical outcomes, and significant gaps remain in defining the optimal care path for treating CD. Toward this goal, the primary aim of this study was to characterize individual differences in substance use and psychiatric symptomology in an inpatient clinical sample using a person-centred approach. Admission assessment data from a private inpatient service treating mental disorders, substance use, and concurrent disorders was used (n = 177). Latent profile analysis (LPA) was performed to classify individuals into statistically distinct latent profiles based on their psychiatric symptoms and polysubstance use as covariates. LPA revealed four profiles. Profile 1 (20%) was identified as having low SUD and low psychiatric disorders, profile 2 (65%) was identified as having low SUD and high psychiatric disorders, profile 3 (8%) was characterized as high substance use and moderate psychiatric disorders and profile 4 (7%) was identified as the high SUD and high psychiatric disorders. The participants in the two profiles endorsing high SUDs, Profiles 3 and 4, showed significantly higher impulsivity in terms of higher positive urgency sensation-seeking scores compared to the other profiles and the highest use of cocaine/stimulants than the other two. Identifying clinical heterogeneity by classifying individuals into distinct profiles is a first step toward designing more targeted and personalized interventions in clinically complex inpatient populations.

Dismantling stereotypes: Sexual orientation and risk for substance use in adolescence.

Substance use and abuse is a major public health problem. Research has generally shown that sexual minority groups such as lesbian, gay, bisexual, transgender and other (LGBT+) people are among the most at-risk vulnerable groups for substance use. However, research in the Spanish context is very scarce and has not analyzed these issues. This research, therefore, aimed to analyze substance use in young people according to their sexual orientation through two studies using representative samples of adolescents. The analyses revealed only some differences in substance use by sexual minority groups. Bisexual adolescents showed a higher frequency of use in some indicators of tobacco, cannabis and alcohol, and lesbians showed a higher frequency of heavy alcohol use but no other indicators of differential use. Questioning adolescents, on the other hand, had the lowest rates of use compared to the other groups on many indicators. Results derived from both studies could indicate, at least with these samples and indicators, that there is no generalized and more frequent use of substances by people of sexual minority groups, which could suggest the existence of a stereotype rather than a fact.

Using Latent Profile Analysis to Characterize Clinical Heterogeneity and Impulsivity in a Large Residential Addiction Treatment Program

Objectives: Clinical heterogeneity among patients in addiction treatment settings represents a challenge as most of the treatment programs are designed to treat substance use disorders (SUD) generally rather than offering more tailored approaches addressing individual patient needs. Systematic characterization of clinical heterogeneity may permit more individualized care paths toward improving outcomes. Methods: Data were collected from a large inpatient SUD treatment program between April 2018 and March 2020 (n = 1519). Latent profile analysis (LPA) was applied to identify latent clusters based on differences in substance use and co-occurring depression, anxiety, and post-traumatic stress disorder. Results: Five distinct profiles emerged: Profile 1 (38%) exhibited the lowest substance use and lowest psychiatric severity (Overall Low); Profile 2 (39%) exhibited high alcohol and psychiatric severity; Profile 3 (13%) exhibited high opioid severity and low psychiatric severity. Profile 4 (8%) exhibited high cannabis use and high psychiatric severity, and profile 5 (3%) exhibited high polysubstance use other than alcohol and cannabis use. The latter two profiles were younger and exhibited higher self-regulatory deficits. The (High Alc/high psych) and the (High Cann/Psych) profiles exhibited differentially higher psychiatric severity. Profiles showing high polysubstance use, as well as high cannabis use and high psychiatric severity, showed significantly higher impulsive behavior than the others. Conclusions: LPA revealed five clusters of patients varying substantially in terms of SUD and psychiatric severity. Addressing common features of clinical heterogeneity for tailored care paths in a personalized treatment approach may improve treatment outcomes.

Resilience and associated factors in orphaned and separated adolescents in Kenya: Understanding the relationship with care environment and HIV risks

ABSTRACT Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one's material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10–26 living in Charitable Children's Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7–36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors.

Food hardship as a strong predictor of tobacco and cannabis use among youth in WA state

This brief report examines data from The Healthy Youth Survey to understand the likelihood of tobacco and cannabis use for students in Washington state who experienced poverty as measured by participating in the free and reduced lunch (FRL) program or reported food hardship. We conducted descriptive and exploratory statistics and trend analysis of the data to understand differences in substance use between ethnic/racial groups by poverty status. While historically research has documented that experiencing poverty and being from marginalized ethnic/racial minorities are risk factors for substance use among youth, our study is unique because few studies look at the intersection of racial/ethnic differences and poverty and their impact on substance use. Our results align with previous research when the intersectional analysis was by ethnicity and FRL – White students reported significantly higher tobacco and cannabis use, and Black and Mixed-race students had a significantly higher likelihood of cannabis use if they received FRL. However, when the intersectional analysis utilized perceived food hardship and cannabis and tobacco use there were significantly higher rates of use within all race/ethnic categories. Therefore, FRL status may not be a sensitive enough measure to predict tobacco and cannabis use and we recommend additional screening for food hardship.

An Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022.

This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors. Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups. Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students. The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.

Differences in Substance Use and Harm Reduction Practices by Race and Ethnicity: Rhode Island Harm Reduction Surveillance System, 2021-2022.

In the United States, minority populations are disproportionately affected by the overdose epidemic, have higher mortality rates, and unequal access to harm reduction and treatment services. This analysis aims to better understand harm reduction utilization and substance use patterns among minority populations to improve overdose outreach and prevention initiatives in Rhode Island. The present analysis used data from the Harm Reduction Surveillance System from January 2021 to December 2022 (N = 393). Chi-square tests and multivariable regression models were used to investigate differences in substance use behaviors by race and ethnicity. Rhode Island. Participants include individuals who self-reported the use of illicit drugs, currently reside in Rhode Island, and were older than 18 years. Methods of drug use and uptake of harm reduction practices. Among survey participants, 41% were non-Hispanic White, 57% were aged 25 to 44 years, 62% identified as male, and 95% had health insurance coverage. Most participants reported smoking as their method of drug use (90%) and harm reduction practices were underutilized by all race and ethnicity groups. Fewer non-Hispanic Black participants reported carrying naloxone compared to the other race and ethnicity groups. Non-Hispanic Black and Hispanic participants were significantly less likely to inject drugs compared with non-Hispanic White participants (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI], 0.04-0.45) (AOR = 0.40; 95% CI, 0.18-0.90). Smoking was the most common self-reported method of substance administration for all participants, whereas injection was more prevalent among non-Hispanic White participants. There is a continued need for minority-led and culturally informed harm reduction and treatment services for minority populations.

Age Differences in the Associations Between Incarceration and Subsequent Substance Use, Sexual Risk-Taking, and Incident STI Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort.

Incarceration can lead to different risk behaviors often due to increased distress and disruption of social networks. It is not well known, however, how these associations may differ by age. In this study, we measure age differences in longitudinal associations between incarceration and substance use, sex risk, and sexually transmitted infection (STI) among Black sexual minority men and Black transgender women (BSMM/BTW). We recruited BSMM/BTW from 2009 to 2011 that were part of the HIV Prevention Trials Network 061 study. We compared those less than 30 years old (n = 375) to those 30 years old or greater (n = 794) examining substance use, sex risk, and STI infection stratified by age. Logistic regression with inverse probability weighting was used for the statistical analysis. Approximately 59% of the sample reported incarceration history. In adjusted analysis, incarceration was more strongly associated with alcohol use and stimulant use among older individuals as was sexual risk behaviors including buying and selling sex. Concurrent partnerships were associated with the younger age groups. STI incidence was associated with younger individuals while associations with HIV infection were similar for the two age groups. Understanding differences in substance use and STI risk among age cohorts is imperative to the design and implementation of re-entry programs. Younger BSMM/BTW participating in re-entry support programs may benefit in particular from HIV/STI prevention and care efforts, while post-release substance abuse treatment and harm reduction programs should target older individuals with continued substance abuse.

Gender and substance use among Latinx college students: An application of social structure social learning theory

Social structure social learning theory (SSSL) is a theoretical framework that has been used to understand gender differences in substance use. However, the Latinx community remains understudied in this body of research. Drawing on a Latinx college student sample, we tested the extent to which four social learning mechanisms specified by SSSL theory (positive definitions, neutralizing definitions, differential association, and differential reinforcement) explained gender differences in three substance use outcomes: alcohol intoxication, marijuana use, and illicit prescription drug use. We found that men reported greater levels of all three substance use outcomes, and that the social learning mechanisms mediated between 24% to 44% of these gender effects. We also found some evidence that the effects of differential association and differential reinforcement were stronger for men than women, suggesting that women may exhibit greater resilience when exposed to peer influence. We discuss the implications for SSSL theory and the study of substance use and gender differences in substance use among Latinx populations.

Substance use in sexual minority youth: prevalence in an urban cohort

BackgroundLittle comparative data on substance use (SU) between sexual minority youth (SMY) and heterosexual youth (HET) is available. This study compares the prevalence of SU in an urban cohort between SMY and HET and evaluates demographic and psychosocial predictors of SU.MethodsData came from a prospective-longitudinal cohort study in an urban setting (N = 1297). SU and psychosocial variables such as internalizing symptoms, self-control, sensation-seeking, bullying-victimization, subjective stress, leisure activities, and peer influences were assessed with self-reports at age 17 and 20. SU was stratified by sex and sexual attraction, and the groups were compared using regression models, with demographic and psychosocial variables included as covariates.ResultsSMY- and HET-youth displayed differences in a number of psychosocial variables. Overall, SMY- and HET-youth differed in their 12-months prevalence of SU: At age 17, SMY-females had significantly higher rates of SU than HET-females for cannabis (aOR = 2.14, p = 0.04), ecstasy/MDMA (aOR = 4.29, p = 0.01), and hallucinogens (aOR = 5.59, p = 0.02). At age 20, SMY-females had significantly higher rates of SU than HET-females for tobacco (aOR = 2.06, p = 0.03), cannabis (aOR = 2.24, p = 0.004), ecstasy/MDMA (aOR = 3.93, p < 0.001), stimulants (aOR = 3.45, p = 0.002), and hallucinogens (aOR = 6.65, p < 0.001). SMY-males reported significantly lower rates for tobacco and cannabis than HET-males at age 17. At age 20, they reported significantly higher rates for the use of ecstasy/MDMA (aOR = 2.30, p = 0.04) and hallucinogens (aOR = 2.43, p = 0.03).ConclusionsGiven that psychosocial variables were significant covariates of SMY-status and SU, our results underline the importance of accounting for these when explaining differences in SU between adolescents. While differentiation by sex is established in most studies, such standardized comparisons are lacking with regards to sexual identities. But knowledge about SU of SMY is critical for designing effective interventions. This is especially true for SMY-females: Thus, SU in SMY-females early in life needs to be explored more thoroughly and addressed with adequate prevention measures.

Trends in Self-Reported Fentanyl and Other Illicit Substance Use in South Carolina Emergency Department Patients, 2020-2022

BackgroundOpioid-involved deaths are continuing to increase across the United States, exceeding 100,000 for the first time in 2021. Contamination with, and intentional use of, synthetic opioids such as fentanyl are a major driver of this increase. Utilizing self-report substance use data of patients being treated in the emergency department (ED) can be useful to determine which substances patients are intentionally seeking. Objectives1) Examine changes in self-reported illicit substance use (including fentanyl) over time; 2) Examine changes in the co-occurrence of self-reported fentanyl with other illicit substance use over time. MethodsAll patients presenting to the study EDs that answered anything other than “never” on the National Institute on Drug Abuse Quick Screen and were seen by a peer recovery specialist in the ED between July 1, 2020 and December 31, 2022 were included for analysis. The substance of use as reported by each patient was recorded by the peer recovery specialist. Differences in substance use by type over time were examined using chi-squared tests of proportions. ResultsThere were 7568 patients that met inclusion criteria. Self-reported fentanyl (1760%; p < 0.0001) and cocaine (82%; p = 0.034) use increased, whereas heroin use (16%; p < 0.0001) decreased. ConclusionsSelf-reported fentanyl and cocaine use has increased significantly in South Carolina ED patients between 2020 and 2022. Given the high morbidity and mortality associated with fentanyl and fentanyl analog use, further measures to identify these patients and provide harm reduction and treatment from the ED setting are warranted.

Gender differences in substance use and associated factors among urban refugees in Uganda

ABSTRACT Background: Alcohol and other substances use related problems among refugees is a global public health concern. Although there is substantial research on the use of alcohol and other substances among the refugees, little is known about gender and other factors that might be associated with the use of alcohol and other substances. Our study aimed to assess the prevalence of alcohol and substance use across gender and other specific associated factors among urban refugees living in Mbarara city, Southwestern Uganda. Methods: In a cross-sectional study, 343 refugees were interviewed on the use of alcohol and other substances using the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test. The associated factors included, age, marital status, occupation, duration (length of stay) in Uganda, educational levels, stigma and depression. Linear regression analysis was used to examine the associations between the predictor and outcome variables. Results: No significant gender difference in alcohol use was found, and the overall prevalence of hazardous, harmful or dependent alcohol use among our sample of refugees living in Mbarara city was 43%. There were however, statistically significant gender differences in the use of other substances, with a significantly higher percentage of men than women reporting intermediate, substantial, or severe substance use (45% among men, 37% among women). Higher levels of depression and being separated from one’s spouse were associated with higher levels of alcohol and substance use. In addition, higher age and being male were associated with the use of substances other than alcohol. Conclusions: Our findings indicate a high prevalence of problematic alcohol and substance use among both male and female refugees. Clinical interventions focused on the treatment and prevention of alcohol and substance use among the refugee communities may benefit from focusing on depressive symptoms as well.

The Role of Gender in Patients with Borderline Personality Disorder: Differences Related to Hopelessness, Alexithymia, Coping Strategies, and Sensory Profile.

Background and Objectives: Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods: Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results: Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions: Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.

Comparison of alcohol consumption and tobacco use among Korean adolescents before and during the COVID-19 pandemic.

The COVID-19 pandemic has brought significant changes worldwide, and due to the strict "Social Distancing Plan" including school closures, Korean adolescents have experienced unprecedented changes in their lives. Considering the peer effect on adolescents' health behavior impacted due to the changes brought about by the pandemic, it would be interesting to explore differences in substance use in Korean adolescents. This study examines how these risk behaviors among Korean adolescents have changed before and during the COVID-19 pandemic. Korea Youth Risk Behavior Web-based Survey of 87,532 adolescents was used to collect the data for the period 2019, 2020, and 2021. The KYRBWS is conducted by a national institution which uses a stratified two-stage cluster sampling, and the data is statistically reliable and representative of the population. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends, respectively, were calculated to assess the difference across the period (2019, 2020, 2021). Also, the odds ratios (ORs) with 95% CIs for current smoking status and current alcohol use status among 2020 and 2021 participants were compared with those of the 2019 participants using multiple logistic regression analysis. The degree of current smoking status was lower in 2020 and 2021 participants than in the 2019 participants (2020: OR = 0.66, 95% CI = 0.61-0.71; 2021: OR = 0.66, 95% CI = 0.61-0.71). On the same token, current alcohol use status was also lower in the participants during the pandemic than those before the pandemic (2020: OR = 0.70, 95% CI = 0.66-0.73; 2021: OR = 0.70, 95% CI = 0.66-0.73). This study found that alcohol and tobacco use were reduced among Korean adolescents during the COVID-19 pandemic. Despite the decrease, future research on the potential effects of the COVID-19 pandemic on adolescents is warranted.

Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth

BackgroundLesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence. ObjectiveUsing an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth. Participants and settingsA sample of 121,910 LGBTQ youth (grades 6–12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study. MethodsYouth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use. ResultsResults indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use. ConclusionsFindings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.

Examining racial differences in substance use and HCV among birthing women in a midwestern prison

Given limited data in incarcerated pregnant people, our study aimed to examine the rates of substance use in pregnancy, medications for opioid use disorder, mood disorders, and HCV of Black and White incarcerated women. We conducted a retrospective chart review of women from Michigan’s state prison who had a live hospital birth from January 1st, 2010 through May 31st, 2019. Trinity Health provides all delivery care for incarcerated women in Michigan. Rates of maternal substance use and HCV were determined. Comparisons were completed using Fisher’s exact test. Two hundred and eight women delivered in the study period. Racial distribution was Black (n=77) and White (n=131). Rates of drug use in pregnancy were higher among White women (35.1% vs 16.9%, p < 0.01), as was opioid use (24.4% vs 9.1%, p< 0.05) and medications for opioid use disorder (MOUD) (14.5% vs 2.6%, p < 0.05). Of the 21 women who received MOUD, 17 received methadone and four received buprenorphine. All patients who received buprenorphine were White. White women also had higher rates of HCV (23.7% vs 2.6, p< 0.001). Sixty-four (30.8%) and eleven (5.3%) women used tobacco and alcohol respectively in pregnancy, with no statistical difference by race. Among those who gave birth while incarcerated in Michigan, White women had higher rates of drug and opioid use, MOUD, and HCV than Black women. Additionally, no Black women received buprenorphine. Further research investigating the impact of societal-level conditions including racism, poverty, and geographical sentencing patterns on pregnant people is needed. Targeted interventions must be anti-racist and address pre-incarceration factors as well as justice in care.