Suppliers play a critical role in advancing sustainability and competitiveness within supply chains, particularly when circular economy principles are integrated into supplier selection processes. This integration not only supports environmental harm reduction and resource efficiency but also enhances cost savings and overall network performance. The healthcare sector, characterized by high material consumption, energy use, and regulatory demands, faces significant environmental and social challenges. Despite the importance of promoting circularity in healthcare supply chains to reduce medical waste and improve resource efficiency, sustainable circular supplier selection in this sector remains largely underexplored in the literature. To address this gap, an integrated MCDM approach combining the BWM and CODAS was applied in this study. The framework uses SDGs-focused criteria to evaluate supplier alternatives, aligning circular economy objectives with global sustainability targets. BWM ensures a consistent and efficient weighting process with reduced cognitive effort, while CODAS provides a straightforward yet robust method for ranking suppliers. Using the CODAS technique, the supplier alternatives were ranked based on their Hi values, where A1 achieved the top position with a score of 0.504, followed by A4 with 0.434, A2 at 0.082, A5 at -0.250, and A3 with the lowest score of -0.757. This ranking highlights A1 as the most favorable supplier according to the integrated evaluation criteria. The findings offer practical guidance for healthcare organizations seeking to strengthen circular practices and contribute to the Sustainable Development Goals. This study demonstrates the effectiveness of an integrated MCDM approach in supporting strategic sustainable circular supplier selection decisions in the healthcare sector.

Rural people who use drugs face a litany of structural and psychosocial barriers to SSP utilization (e.g., unreliable transportation, stigma). Mobile SSPs may mitigate some barriers, but little is known about acceptability among rural people who use drugs and their preferences for mobile SSP design. This study examines (1) factors associated with willingness to use a mobile SSP among rural people who use drugs, and (2) their desired attributes and services. Data were collected from 259 participants who inject drugs that were recruited through outreach and respondent-driven sampling (RDS) in Appalachian Kentucky. In addition to descriptive analyses, independent variables' associations with the outcome (i.e., being willing to use a mobile SSP) were estimated using generalized estimating equations. All models controlled for lifetime use of a fixed-site SSP. Overall, 59.9% (n = 155) endorsed mobile SSPs as a program they would be willing to use. People with lower income, had less reliable access to transportation, were using methamphetamine, were engaging in syringe sharing and reuse, and who had experienced more overdoses in their lifetime were more willing to use a mobile SSP than were their counterparts. Those who experienced more shame around their drug use were less likely to use a mobile SSP than those who experienced no shame. Participants were receptive to a variety of locations, unit sizes, and staffing models, but the most desired staffing and locations were clinical in nature and most preferred hours of operation were afternoon hours. Findings suggest moderate willingness to engage in mobile SSP services among this population, particularly for people who use drugs who have challenges with transportation and who are engaging in behaviors that increase risk for HIV and HCV. Mobile SSPs may increase accessibility, acceptability, and ultimately, the utilization of critical harm reduction services in Appalachia.

BackgroundThe toxic unregulated drug supply in North America continues to produce high rates of drug deaths. In response, several harm reduction interventions have been introduced and/or expanded, including take-home naloxone (THN). Estimating the impact is challenged by a lack of complete reporting data.ObjectiveThe aim of this study was to estimate the impact of interventions on drug deaths in British Columbia from January 2019 to September 2024.MethodsWe extended on a Bayesian hierarchical Markov chain model of drug poisoning events including interventions for overdose prevention sites and opioid agonist treatment. The extended model uses the reported number of THN kits used and distributed and all kits shipped to sites. These data are incorporated into the likelihood to estimate THN kit use during an opioid poisoning event by region and site type. Simulation studies evaluated the model's performance.ResultsThe estimated probability of THN kit use during an opioid poisoning event was 42.98% (95% credible interval [CrI]: 41.12-44.84) for kits distributed from community sites and 13.41% (95% CrI: 12.57-14.40) for overdose prevention sites. Correctional centers, pharmacy, and emergency department THN kits all had the lowest probability of use at 0.12% (95% CrI: 0.11-0.13), 1.04% (95% CrI: 0.96-1.13), and 0.65% (95% CrI: 0.60-0.71), respectively. The combined rate of deaths averted was 1,294 (95% CrI: 1,138-1,438) per 100,000 persons who inject drugs, which represents 78% (95% CrI: 76-80) of potential deaths.ConclusionDespite the increasing toxicity of the illegal drug supply, harm reduction interventions including THN have had a large impact on the number of drug deaths. Estimates of the impact of THN based on reported use alone would greatly underestimate the total impact.HighlightsWe developed a novel Bayesian hierarchical model to estimate take-home naloxone (THN) kit use during opioid poisonings using incomplete but complementary program and surveillance data.The model provides site-specific and regional estimates of kit use, highlighting significant differences by site type and geography.Simulation studies show the model can estimate the probability of THN kit use under realistic data limitations, supporting its use in policy evaluation.Public health decision makers can use this method to better assess and optimize harm reduction programs when direct usage data are scarce.

Indigenous communities across Turtle Island (North America) have been practicing harm reduction for many decades, though the work is often under documented and underacknowledged. This scoping review serves to explore the current evidence base for opioid-related harm reduction in Indigenous communities, including both academic and grey literature, highlighting the application of harm reduction principles as outlined by the National Harm Reduction Coalition, as well as practices and approaches. Working under the leadership of Indigenous researchers and an Indigenous Advisory Committee, the scoping review included a search of three academic databases, PsycINFO, PubMed/Medline databases, and Ethnic NewsWatch, and three grey literature sources, Google, Harvard Think Tank and Native News databases. A total of sixteen sources met the inclusion criteria in both the academic and grey literature search. Data extraction yielded details surrounding the inclusion of harm reduction principles, the integration of Indigenous epistemologies and worldviews, and implications for harm reduction approaches in Indigenous communities. This scoping review highlights the depth and diversity of community-led, culturally grounded harm reduction practices in Indigenous communities across Turtle Island affirming that they are extensions of longstanding Indigenous ways of knowing, relating, and caring for one another. Advancing Indigenous harm reduction will require sustained investment in Indigenous-led research, programming, and governance and requires a commitment to honoring Indigenous data sovereignty, lived experiences, and the relational knowledge that has long guided this work.

ABSTRACT Background The use of kratom (Mitragyna speciosa) as a harm reduction agent remains poorly understood. Our study determined whether people who use drugs (PWUDs) utilize kratom for its perceived harm reduction benefits. Methods A total of 318 individuals who were undergoing drug rehabilitation and reported to have used kratom participated in this cross-sectional study. Results Majority were males (92%, n = 293/318) and their mean age was 32.7 (SD = 9.9). A majority (80%, n = 253) indicated that kratom offers harm-reduction benefits by mitigating drug-related harms. Similarly, 78% (n = 248/318) perceived that kratom consumption can help PWUDs maintain their abstinence. PWUDs also reported that kratom helped them reduce their frequency of illicit drug use (86%, n = 274/318) as well as intake (83%, n = 264/318). About 70% (n = 222/318) indicated that kratom has effects comparable to methadone and could be used as a substitute. Approximately 74% (n = 236/318) reported that kratom prevented their involvement in risky drug injecting practices. Our findings indicate that ATS poly-drug users are more likely than ATS users to use kratom as a harm reduction agent to minimize drug-related harms (OR = 2.2; 95% CI: 1.23–3.93; p < .007). Conclusions Kratom may be used as a safe harm reduction agent because of its harm-minimizing potential.

We explored the prevalence and correlates of intention to use a harm reduction vending machine (HRVM) among people who use drugs (PWUD) in Nevada (n = 219) from 2022 to 2023. Participants responded to a cross-sectional survey assessing HRVM awareness, intent to use, desired inventory, perceived barriers and facilitators of use, drug use patterns, and sociodemographics. Descriptive statistics, bivariate analyses, and Poisson regression models were conducted. Observations were excluded from the analysis if the demographic variables were missing (n = 6) or if participants reported having used an HRVM before (n = 23), resulting in an analytic sample of n = 190. Results indicated that 30% of participants were aware of HRVMs and 69% expressed intent to use one. Intention to use a HRVM was less common among people who identified as Hispanic and more common among people whose most common source of drug use supplies was a syringe service program. Perceived barriers included not knowing the HRVM locations, lack of transportation, and surveillance concerns. Conversely, perceived facilitators included access to needed supplies, free supplies, and 24/7 access. While awareness of HRVMs was low, future intent to use one was high, suggesting that HRVMs are an acceptable form of service delivery among PWUD.

Thecoexistence of substance use disorders (SUD) and other mental disorders - commonly referred to as dual disorders (DD) - is highly prevalent and clinically significant. Although various terms have been used over time (e.g., psychiatric comorbidity, dual pathology), the lack of a standardised definition has created inconsistencies in diagnosis, communication, research, and treatment. Epidemiological studies estimate that 30-80% of individuals with SUD have co-occurring psychiatric disorders, with prevalence depending on the substance involved, gender, age, and the population studied (general population, people in emergency rooms, mental health addiction facilities, harm reduction facilities, prison). Compared to individuals with a single disorder, people with DD exhibit more severe psychopathological symptoms, higher suicide risk, increased relapse rates, poorer treatment adherence, more medical comorbidities, and worse psychosocial outcomes, including unemployment, homelessness, and social exclusion. Despite extensive evidence, both SUD and other mental disorders often remain underdiagnosed and undertreated, partly due to diagnostic complexities such as overlapping symptomatology and the syndromic nature of psychiatric classifications. Additional barriers include the structural separation between mental health and addiction services and limited integrated care expertise. The "wrong door syndrome" exemplifies how patients are frequently directed to services unable to address both conditions, leading to suboptimal outcomes. Furthermore, individuals with DD are often excluded from clinical research, limiting the evidence base for tailored interventions. Improving the detection and treatment of DD is a major challenge for mental health and addiction systems. Integrated, holistic treatment approaches from the outset are essential to optimise outcomes for this highly vulnerable population.

This paper argues that street medicine should be formally integrated into clinical ethics frameworks and medical professional standards as an ethic of harm reduction. Drawing on widely cited harm reduction principles, particularly pragmatism, respect for dignity and incrementalism, this reframing clarifies the clinical duty of care under conditions of structural constraint. The escalating crisis of homelessness, which contributes to premature mortality and leaves nearly three-quarters of people experiencing homelessness with unmet healthcare needs, is a result of systemic exclusion, not individual failure. While traditional harm reduction addresses acute risks like substance use, street medicine extends this philosophy to chronic structural crises, adapting standards to environments where compliance, adherence and stability are unattainable. By synthesising the public health philosophy of harm reduction with clinical practice, this paper demonstrates that street medicine fundamentally challenges the stability assumptions of conventional bioethics. The analysis shows that the four principles of bioethics require reinterpretation: autonomy becomes relational, beneficence prioritises mitigating avoidable suffering, non-maleficence expands to actively counter structural harms and justice is achieved through the direct reallocation of clinical presence. Formalising this ethic is the necessary next step to hold the healthcare system accountable, ensuring that the duty to sustain dignity and life is met for the most structurally marginalised populations.

To characterize long-term sex-specific trends in past-year methamphetamine use in the United States and to assess whether prevalence trajectories differ between males and females, with implications for the practice of addiction medicine. We analyzed nationally representative, repeated cross-sectional data from the National Survey on Drug Use and Health spanning 2002-2022 (N=1,155,417). Survey-weighted annual prevalence estimates of past-year methamphetamine use were calculated by sex. Survey-weighted logistic regression models, including a sex-by-year interaction were used to test whether temporal trends differed by sex. Past-year methamphetamine use was consistently more prevalent among males than females throughout the study period. Annual prevalence declined in the early 2000s and increased after the mid-2010s in both sexes, with larger increases among males. Male prevalence increased from 0.8% (95% CI: 0.6-1.0) in 2002 to 1.4% (95% CI: 1.0-1.8) in 2022, whereas female prevalence increased from 0.6% (95% CI: 0.5-0.7) to 0.7% (95% CI: 0.6-0.8). Additional analyses confirmed significantly different temporal trajectories between males and females. From 2002 to 2022, methamphetamine use in the United States demonstrated persistent and widening sex differences, with higher prevalence and larger increases among males than females in the past decades. These findings support the importance of incorporating sex-informed approaches into addiction medicine screening, prevention, harm reduction, and treatment planning.

Purpose Tourism destinations increasingly pursue digital transformation, yet most initiatives remain efficiency-focused. Existing research provides a limited empirical explanation of how digital capability, environmental literacy and ethical artificial intelligence (AI) jointly enable regeneration beyond sustainability. To address this gap, this study aims to develop and test a smart regenerative tourism transformation model explaining how digital readiness, organizational capability and ethical governance support net-positive destination renewal. Design/methodology/approach Survey data were collected from 543 tourism managers in Malaysia, Singapore and Thailand. Partial least squares structural equation modeling (PLS-SEM) was used to test eight hypothesized relationships linking smart tourism infrastructure, digital accessibility and inclusion, eco-literacy and net-zero commitment and regenerative destination governance to tourism digital transformation capability (TDTC), regenerative tourism innovation and regenerative destination transformation, with AI and data-ethics climate as a moderator. Findings The results indicate that smart infrastructure, inclusivity and governance strengthen TDTC, which, in turn, supports regenerative tourism innovation and regenerative destination transformation. A strong AI and data-ethics climate amplifies these relationships. These findings are based on managerial perceptions and suggest, rather than confirm, destination-level regenerative progress. Research limitations/implications This study’s cross-sectional design limits causal inference, as relationships remain correlational despite procedural and statistical checks. Future research should adopt longitudinal, experimental or panel data approaches to track TDTC over time. Additionally, incorporating objective indicators, such as AI ethics audits and digital investment records, can enhance validity. Expanding the sample to include diverse cultural contexts and adopting multi-stakeholder approaches will provide richer insights. Finally, dynamic-system modeling can better capture feedback loops between digitalization, governance and regeneration, advancing the understanding of regenerative tourism in evolving destinations. Practical implications This study provides evidence for advancing regenerative digital transformation in Southeast Asian tourism. It confirms that smart tourism infrastructure, digital accessibility, eco-literacy and regenerative governance collectively enhance digital transformation outcomes. AI and data ethics climate play a crucial moderating role, ensuring ethical digital progress. Tourism boards must invest in inclusive digital ecosystems, ensuring that technology empowers local communities and businesses. Governments should integrate eco-literacy and sustainability into programs, while transparent AI frameworks should be adopted to ensure fairness. The findings support the creation of an Association of Southeast Asian Nations (ASEAN) regenerative tourism data network to align digital standards and promote sustainable, inclusive tourism. Social implications This study highlights the role of digital transformation in fostering social inclusion and community well-being. By ensuring that technology enhances accessibility and empowers local communities, destinations can reduce socioeconomic inequalities and promote equitable growth. Regenerative governance frameworks and AI ethics are crucial for building trust and accountability in digital tourism, ensuring that innovations benefit all stakeholders. The integration of eco-literacy and sustainability practices further supports societal regeneration, encouraging active participation in conservation efforts and sustainable tourism practices. The proposed ASEAN regenerative tourism data network offers a model for fostering inclusive, responsible digital engagement across tourism destinations. Originality/value This study offers a tri-country empirical examination of how ethical AI conditions the transformation of digital capability into regenerative value creation. It advances tourism theory by positioning digital transformation as a morally governed organizational capability that supports socio-ecological renewal rather than efficiency or harm reduction alone.

The opioid and stimulant overdose crisis has increasingly intersected with queer sexual cultures, particularly through party-and-play (PnP) practices embedded within hookup, dating, and companionship apps (HUDCAs). While public health research has documented elevated risks associated with app-mediated, substance-involved sex, health education in secondary schooling has largely failed to address these realities. This conceptual article examines how curricular silence around HUDCAs and PnP functions as structural erasure, rendering queer adolescent youth – especially BIPOC queer youth – hyper-visible in risk surveillance yet invisible in curricular care. Drawing on Foucauldian analyses of power and silence, queer theory (QT), and critical race theory (CRT), the article argues that omission operates as a biopolitical mechanism that displaces sexual learning into unstructured digital spaces without guidance or harm-reduction support. Through historical parallels with HIV/AIDS education, the analysis demonstrates that educational discomfort has often preceded survivability-oriented intervention. The article concludes by proposing a queered, harm-reduction-centered framework for secondary school health education that integrates HUDCA literacy, PnP-informed harm reduction, and attention to racialized inequities, reframing education as anticipatory preparation rather than abandonment.

Cannabis use during pregnancy or lactation is a key topic in healthcare today. It is recommended that patients abstain from perinatal use and healthcare providers are encouraged to discuss use with patients. However, some perinatal individuals continue to use even once educated about the risks. For them, a nuanced approach to counseling that goes beyond warnings of risks is required to promote health and maintain trust. Harm reduction, which views any reduction in harm as a clinical success, is the best evidence-based practice for these patients. However, the essential elements (core components) of this approach have not yet been identified. This limits the approach’s readiness for wider implementation, as it is critical that essential elements are maintained during intervention adaptation and scaling. We used the Consensus on Relevant Elements process to generate an initial list of core components for harm reduction counseling of cannabis using-pregnant and breast-feeding patients. We identified five core components within two domains. Within the domain of provider training, the provider 1) is skilled at facilitating conversation, and 2) is educated about cannabis use. Within the domain of patient-facing work, the provider 3) educates patients about cannabis safety and recommendations, 4) screens for cannabis, and 5) provides a brief harm reduction intervention. Future work to achieve a broader consensus of the core components of this approach should be undertaken to confirm these findings. This work serves as an important first step towards equipping healthcare providers to promote health for perinatal cannabis-using patients.

Initiating weekly long-acting injectable buprenorphine (LAIB) without prior sublingual buprenorphine ("direct-to-inject" or DTI) may reduce buprenorphine initiation barriers. In this case series, we describe outpatient DTI outcomes. We conducted a manual chart review of 24 patients undergoing DTI between October 2024 and February 2025 at 3 New York City sites: 2 harm reduction agency-based clinics and a federally qualified health center. Pre- and post-DTI withdrawal data were collected from chart documentation and provider report. Buprenorphine retention was ascertained using electronic medical record medication administration and prescription data and defined as being within the LAIB therapeutic window or having an active sublingual buprenorphine prescription at 30 and 90 days with no gaps greater than 9 or 14 days, respectively. We also measured median buprenorphine treatment days over 90 days post-DTI. Of the 23 patients with available data, 19 (83%) had no withdrawal symptoms pre-DTI. Of the 20 patients with documented post-DTI withdrawal symptoms, 3 (15%) had no withdrawal, 12 (60%) had mild, 4 (20%) had moderate, and one (5%) patient had severe withdrawal. Thirty days post-DTI, 14 (58%) patients were retained on any buprenorphine formulation, and 11 (46%) patients were retained at 90 days. The median post-DTI buprenorphine treatment days were 77 (range: 9-90). The majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post-DTI, and were retained on buprenorphine at 30 days post-DTI, with nearly half retained at 90 days. DTI is a promising buprenorphine initiation strategy, but further research is warranted.

Harm reduction strategies effectively minimize the immediate health consequences of drug use, such as syringe exchange and overdose prevention. However, the critical role of access to adequate Water, Sanitation, and Hygiene (WASH) services in mitigating these consequences remains underemphasized. This paper argues for the consideration of WASH services as an essential framework within the ongoing evolution of harm reduction, particularly for marginalized people who use drugs (PWUD) facing housing insecurity and limited access to public infrastructure. Lack of access to WASH services forces PWUD into high-risk practices, such as open defecation and using unsafe water for drug preparation and wound cleaning. WASH insecurity among PWUD is strongly associated with elevated risks of skin and soft tissue infections -a leading cause of hospitalization-as well as other infectious diseases, and the exacerbation of chronic conditions (e.g., HIV, Hepatitis C). Beyond direct morbidity, WASH insecurity diminishes dignity, contributing to social exclusion, hygiene-related stigma, and increased vulnerability to gender-based and other structural violence. Drawing on current evidence, this perspective article underscores the necessity of systemic intervention. Harm reduction programs are increasingly called to incorporate WASH items and services, including mobile hygiene units operating under principles of "radical hospitality," and advocate for broader policy solutions like 24/7 public restroom access and Housing First models with integrated WASH facilities. In sum I argue that integrating WASH is not merely a matter of basic amenity; it is a crucial, high-impact strategy for upholding the human rights of PWUD, substantially reducing preventable drug-related harms, and fostering greater social equity.

Young women who inject drugs (YWID) face heightened risks for HIV, hepatitis C, and overdose that are shaped by the relational contexts in which they inject. Injection partnerships, defined as dyadic relationships between people who inject together, remain understudied beyond male-female intimate pairs. We conducted 26 semi-structured interviews with YWID (ages 18-35) in rural Appalachian Ohio to explore dynamics within three partnerships types: dual partnerships with male intimate partners, family partnerships, and friend partnerships, with attention to female peer partnerships as a distinct subset. Guided by the Theory of Gender and Power and Bourdieu's concept of cultural capital, we analysed how access to resources, technical skills, and emotional bonds shaped power and risk across these relationships. Dual partnerships concentrated men's control over money, equipment, and injecting skills, limiting women's ability to negotiate safer practices and at times exposed them to violence. Family partnerships were pragmatic and offered little emotional or harm reduction support. Friend partnerships, particularly between female peers, redistributed injecting skills as care rather than control, fostering mutual protection but also normalizing distributive syringe sharing. Findings highlight female peer partnerships as a promising but underutilized context for harm reduction interventions tailored to YWID in rural settings.

Mobile health units (MHUs) providing medications for opioid use disorder (MOUD) have emerged as a critical strategy to address gaps in opioid treatment access, particularly for marginalized populations. Research has yet to explore stakeholder perspectives on MHUs' implementation, challenges, and long-term sustainability. We conducted semi-structured interviews with 15 stakeholders, including MHU staff, administrators, community partners, and policymakers. Interviews explored experiences with the MHU, barriers and facilitators to patient engagement, and operational challenges. Data were transcribed, coded, and analyzed using a template thematic approach to identify key themes related to implementation and sustainability. Stakeholders endorsed the MHU as a highly accessible and flexible intervention that reduces barriers for people experiencing homelessness, economic instability, and transportation limitations. The MHU facilitated strong patient-provider relationships and access to harm reduction, primary care, and social services. Challenges included staffing shortages, inconsistent funding, limited clinical space, and environmental barriers. Additionally, stigma, political resistance, and law enforcement interactions affected service delivery and patient engagement. Findings highlight the importance of policy and funding mechanisms to ensure the long-term viability of MHUs. Stakeholders recommended expanding outreach, increasing staffing, and integrating additional services. Addressing these challenges is essential to sustaining MHUs as an effective public health intervention for opioid use disorder.

Despite the widespread success of combination antiretroviral therapy in reducing overall HIV morbidity and mortality, people who inject drugs (PWID) continue to experience elevated risk of infection and suboptimal care outcomes. Addressing knowledge gaps related to HIV acquisition and transmission is essential for reducing incident cases of HIV. We assessed HIV transmission misconceptions (e.g., HIV can be transmitted through sharing cigarettes, hugging an infected person) among HIV-negative PWIDs recruited through two syringe service programs in Massachusetts between 2020 and 2025. Participants completed 10 items adapted from the International AIDS Questionnaire, with responses categorized into three groups: 'many misconceptions' (0-7 questions answered correctly), 'few misconceptions' (8-9 correct), and 'no misconceptions' (10 correct). Of 185 participants, 79% held at least one misconception. The most common misconception was that HIV could be transmitted through mosquitoes (55% incorrect). The least prevalent misconceptions related to condom use, drug injection "works" (e.g., cookers, cottons), and hugging (≥ 90% answered correctly). We also observed misconceptions related to syringe sharing (13% incorrect) and mother-to-child transmission (17% incorrect; no difference between women and men). Sociodemographic characteristics did not differ significantly across misconception categories. Participants who reported a recent overdose represented 27% of the full sample but 45% of the 'no misconceptions' subgroup. Misconceptions present since the early era of the HIV epidemic remain prevalent among PWID in this region, despite access to robust harm reduction and HIV prevention services. Findings highlight the importance of dispelling long-standing myths, strengthening education about preventive perinatal transmission, and reinforcing knowledge of injection-specific transmission.

Increasing rates of cannabis use among young adult college students is concerning, as research suggests that there may be a negative relationship between cannabis use and academic performance. The present study was conducted to investigate the relationships between cannabis use, harm reduction strategies, and college students’ grade point average (GPA). Participants (N = 125) completed an online survey that included a measure of Cannabis Use Frequency, Protective Behavioral Strategies (PBS) for Cannabis, and the New General Self-Efficacy scale. Hierarchical regressions were used to examine whether Cannabis Use Frequency or PBS for Cannabis were associated with GPA after controlling for covariates. Mediation analysis was conducted to determine whether Cannabis Use Frequency explained the relationship between PBS for Cannabis and GPA. Additionally, general self-efficacy was investigated as a potential moderator of the relationship between PBS for Cannabis and GPA. The results did not show a significant relationship between Cannabis Use Frequency or PBS for Cannabis and GPA after controlling for covariates. General self-efficacy did not significantly moderate the relationship between PBS for Cannabis and GPA. While PBS for Cannabis was indirectly related to Cumulative GPA via Cannabis Use Frequency, and its direct effect was associated with Cumulative GPA, the total effect was not significant, suggesting a suppressor effect. To our knowledge, this was the first study to investigate the relationship between PBS for Cannabis and academic performance with official GPA records. Future longitudinal studies are needed to identify strategies that may help students who engage in cannabis use succeed academically.

Alcohol-induced blackouts (AIBs) are more likely to occur when large quantities of alcohol are consumed quickly. Protective behavioral strategies (PBS) may mitigate the risk of experiencing an AIB by reducing the level, speed, and duration of drinking. This study examines daily associations between PBS, drinking measured using a transdermal alcohol concentration (TAC) biosensor, and AIBs among young adults. Participants (N = 168, Mage = 20.8, 53% female, 87% White, 10% Hispanic) wore TAC biosensors and completed daily surveys about their PBS use and AIBs over six social weekends (i.e., Thursday-Sunday). TAC drinking features (peak, rise rate, and rise duration) were extracted from TAC data for each day. Two-level multilevel structural equation models were conducted to examine the associations between PBS (total and individual domains: manner of drinking, stopping/limiting drinking, and serious harm reduction) and AIBs. Approximately 80% of participants experienced at least one AIB (M = 3.08, SD = 2.99). On days when individuals reported using more total PBS and manner of drinking, the associated decrease in TAC features was associated with decreased odds of experiencing an AIB. Days when individuals used more serious harm reduction, the associated increase in TAC features was associated with increased AIB odds. Days when participants used above-average total PBS and manner of drinking were less indicative of risky TAC drinking and AIBs. Days with above-average serious harm reduction were more indicative of risky TAC drinking and AIBs. Findings demonstrate the associations between PBS, real-world intoxication dynamics measured by TAC biosensors, and subsequent AIBs among young adults who engage in risky drinking. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

HIV pre-exposure prophylaxis (PrEP), particularly long-acting injectable formulations (LAI PrEP), has the potential to reduce the number of new infections among people who inject drugs (PWID), especially in low resource settings in the context of low coverage of harm reduction services, high HIV incidence, and substance use and instability. Few studies have examined PrEP perceptions, preferences, and service delivery models among these populations. We aimed to characterize acceptability, perceptions, preferences, and barriers/facilitators of different PrEP options, including LAI PrEP, among a cohort of PWID in New Delhi, India. This mixed methods study (March 2024-March 2025) included focus group discussions (FGDs) followed by cross-sectional survey data covering PrEP awareness, acceptability, and preferences and a discrete choice experiment (DCE) on LAI PrEP. FGDs indicated there was little prior awareness of and interest in PrEP, with concerns about what PrEP medications may do to their body or how it would make them feel. Hesitation surrounding PrEP was also driven by low personal HIV risk perception. Among 389 surveyed, 96% had no prior knowledge of PrEP; 72% indicated they would rather not take PrEP, with 20% preferring LAI PrEP, 5% weekly pills, 3% undecided, and no one preferred daily pills. Preferred characteristics of LAI PrEP were less frequent injections, delivery at existing healthcare clinics, and payment or incentives. PrEP programs of any modality aiming to build demand and deliver PrEP to PWID should consider how these populations often differ substantively in knowledge, needs, and preferences from other populations that have so far been the focus of PrEP campaigns.