Hazardous Alcohol Use Research Articles

Sexual Violence and Hazardous Drinking: Exploring Associations With PTSD Symptoms and Gender Among Adults With Probable PTSD and Hazardous Drinking.

Sexual violence is associated with posttraumatic stress disorder (PTSD), but relatively less research has explored whether it is associated with hazardous drinking. PTSD symptoms may indirectly influence the association between sexual violence and hazardous alcohol use. This association may be moderated by gender. The aim of the current study was to cross-sectionally test whether sexual violence is indirectly associated with hazardous drinking through PTSD symptoms and explore whether gender moderates this association. Hypotheses were tested among 631 adults (Mage = 38, 56% men, 78.6% White) with probable PTSD and hazardous drinking who completed online self-report surveys. Results indicated sexual violence, compared with other trauma types, was associated with more severe hazardous drinking. There was a significant indirect effect of PTSD symptoms in this association. There was no evidence of a moderating effect of gender. PTSD symptoms may drive hazardous drinking among sexual violence survivors. Results also underscore associations between sexual violence and alcohol use, regardless of gender. Future work should continue to investigate these associations prospectively.

Impulsivity Moderates the Association Between Hazardous Alcohol Use and Risky Sexual Behaviors Among Cisgender Bisexual Women

Bisexual women report higher rates of alcohol use and risky sexual behavior than lesbian and heterosexual women. Impulsivity (i.e., action without considering negative consequences) is a risk factor for greater alcohol use and sexual behavior, but few studies have examined the impact of impulsivity on alcohol use and sexual behavior among cisgender bisexual women. Consequently, the purpose of this study was to examine the moderating role of impulsivity on the association between hazardous alcohol use and sexual risk-taking among cisgender bisexual emerging adults. Participants were 225 self-identified cisgender bisexual women (Ma ge = 22.77, SD = 3.45) who completed an online survey about their hazardous alcohol use using the Alcohol Use Disorder Identification Test (AUDIT), impulsivity, and sexual behaviors over the past 30 days. A moderated regression model examined main effects of impulsivity and alcohol use severity, and their interaction, on sexual risk-taking. The association between alcohol use severity and sexual risk-taking was moderated by impulsivity. Simple slopes analyses revealed that greater alcohol use severity was associated with greater sexual risk-taking, but this only occurred for participants with average or high scores of impulsivity. These results suggest prevention programs that target alcohol use should address the role that impulsivity may have on risky sexual behaviors among young bisexual women. Future research would benefit from looking at various outcomes related to sexual risk to determine which are most predominantly associated with alcohol use severity and impulsivity.

Mental Health and Substance Use Among Black Women Attending STD Clinics in Baltimore: The Role of Overt and Subtle Discrimination.

Black women are disproportionately impacted by mental health conditions, like depression, posttraumatic stress disorder (PTSD), and substance use harms. Experiences of discrimination may cause and exacerbate these conditions, but little is known about how distinct types of discrimination (overt vs. subtle) may be related to these outcomes. The current study sought to evaluate the associations between overt and subtle discrimination, mental health, and substance misuse outcomes among Black women. Data were drawn from ESSENCE, a retrospective cohort study (2013-2018) on sexual assault and HIV risk among Black women attending sexually transmitted disease (STD) clinics in Baltimore, Maryland (n = 199). Multivariable Poisson regression models tested the associations between overt and subtle discrimination, depressive and PTSD symptoms, and substance misuse while controlling for covariates. Nearly half (42.2%) of participants reported depressive symptoms, and over a third reported severe PTSD symptoms (35.2%). Higher levels of subtle discrimination were associated with increased risk of depressive symptoms (adjusted relative risk [aRR] = 1.32, 95% confidence interval [CI]: 1.16, 1.50, p < .0001), whereas higher levels of overt discrimination were associated with increased risk of severe PTSD symptoms (aRR = 1.22, 95% CI [1.02, 1.46], p = .0287). Neither overt nor subtle discrimination was significantly associated with hazardous alcohol use or daily marijuana use in adjusted models. We identified that subtle discrimination has a unique negative association with depressive symptoms, while overt discrimination is positively associated with PTSD symptoms. This information is critical for tailoring stigma reduction interventions and mental health supports for Black women.

Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study.

Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. One-third (66/200, 33%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns.

Alcohol Misuse and Correlates with Mental Health Indicators among Firefighters

Background: Stress and repetitive exposures to potentially traumatizing events are inherent to first-responder professions. Firefighters and other crisis responders are often exposed to incidents in their work environments and are at risk of developing acute or posttraumatic symptomatology, depression, and anxiety, as well as harmful patterns of alcohol consumption. Most prior research and theory suggests that many firefighters use alcohol to cope with past and current stressors, and that increased drinking accompanies ongoing exposures to stressful occupational hazards. Objectives: The primary aim of this research was to examine alcohol consumption and mental health variables associated in the literature with alcohol misuse. Participants included 546 predominantly male career firefighters in the U.S. Using a cross-sectional design, we examined alcohol misuse in the context of self-reported depression, generalized anxiety, PTSD, and suicidal ideation using previously validated measures. Results: Based on the AUDIT’s recommended cut score of 8, 38.8% of our sample reported drinking at hazardous levels. Hazardous alcohol use was also significantly associated with several mental health indicators with correlations ranging from .28 to .34. Regression analyses revealed that over 14% of the variance in AUDIT scores could be explained by psychological symptom measures, and 29% of the variance in suicide risk was explained by a model using both alcohol and mental health measures. Conclusions: Findings suggest that psychological distress is associated with hazardous drinking, and that more consistent screening and referral for these issues, as well as multi-level interventions, are needed to effectively address these behavioral health concerns among firefighters.

Work- &amp; family-related stress &amp; the risk of hazardous alcohol use: role of sex and social support

Abstract Background There is a lack of longitudinal studies investigating the effect of individual stress factors on alcohol use behaviour, and how sex and social support may mitigate the effect of these stressors. We aimed to determine the association of work- and family-related stressors with developing hazardous alcohol use over time among habitual drinkers, and to examine the role of sex and social support in these associations. Methods A sample of 4,046 individuals, working and living in Stockholm, age 25-55 years, habitual drinkers, who answered the PART study (Swedish acronym for Mental Health, Work and Social Relations) questionnaire regarding work- and family-related stress (exposures) in 1998-2000 (wave1) and 2001-2003 (wave2) were followed until 2010 (wave3) regarding hazardous alcohol use (outcome) measured using Alcohol-Use-Disorder-Identification-Test (AUDIT) score ( &amp;gt; =8 in men, &amp;gt; =7 in women). Weights for selective attrition were calculated, and crude and multivariate (adjusting for sociodemographic, health- and previous stress-related factors) logistic regression models, yielding Odds Ratios (OR) with 95% Confidence Intervals (CI), were used to estimate the exposure-outcome associations. Analyses were stratified for sex and social support in general and at work. Results Job strain (a combination of high demand and low control) was not statistically significantly associated with hazardous alcohol use (OR, CI: 1.3, 0.9-1.9). Among those reporting any family-related stress, a significantly higher risk was observed (OR, CI: 1.5, 1.1-2.1), particularly among women (OR, CI: 1.7, 1.02-2.7) and those with low social support (OR, CI: 2.1, 1.2-3.6). These associations became non-significant after adjusting for previous family-related stress. Conclusions Public health measures aiming to prevent transitions from habitual to hazardous alcohol use should give special attention to individuals with family-related stress, especially among women and those with low social support. Key messages • While job stress was not significantly associated, those experiencing family-related stress had a higher risk of hazardous alcohol use, especially among women and those without social support. • Individuals experiencing family-related stress, particularly women and those lacking social support, require special attention in public health prevention strategies for risky alcohol consumption.

Examining the link between age of alcohol initiation, adolescent alcohol use and adult substance use

Abstract Background Understanding the relationship between adolescent alcohol use and adult substance use is important for prevention programmes. Existing evidence presents divergent findings and potential mechanisms are debated. Methods We estimated associations between the age of alcohol initiation and alcohol use at age 17 and substance use at age 20 in a nationally representative cohort (n = 4554). Weighted logistic regression models were fitted using Generalised Estimating Equations in multiply imputed and complete case data. Results Our analysis identified that 27% of participants reported first alcohol use at ≤ 14 years old, with 37% engaging in risky alcohol use by age 17. At age 20, 14% reported hazardous alcohol use, while 38% used tobacco, 24% cannabis, and 28% other drugs. The age at which alcohol was initiated and risky alcohol use at 17 years old were both strongly associated with alcohol, tobacco, cannabis and other illicit drug use at 20 years old. Sequential change in effect estimates coupled with non-overlapping confidence intervals suggest a dose-response relationship between age of alcohol initiation and tobacco and other drug use at age 20. Conclusions First use of alcohol at 14 or younger was common. Earlier alcohol initiation and risky alcohol use are each associated with substantially elevated risk for substance use at 20 years old even after accounting for common liability factors. Acknowledgement: Growing Up in Ireland (GUI) is funded by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). It is managed by DCEDIY in association with the Central Statistics Office (CSO). Results in this report are based on analyses of data from Research Microdata Files provided by the CSO. Neither the CSO nor DCEDIY take any responsibility for the views expressed or the outputs generated from these analyses. Key messages • Delaying alcohol initiation and preventing risky alcohol use during adolescence may reduce levels of substance use in young adults. • Self-reported early use of alcohol remains common.

Characterizing long-acting injectable antiretroviral therapy eligibility and initiation at a safety net academic medical center in the southeastern United States.

Background: Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) extends dosing intervals from daily to every 8weeks. Equitable implementation requires anticipating and addressing barriers to use. We described LAI-CAB/RPV eligibility and initiation among persons with HIV (PWH) receiving care at a Southeastern US academic medical center. Methods: We included PWH ≥18years, in care 01/01/2020-12/31/2021, and participating in the UNC CFAR HIV Clinical Cohort. We characterized LAI-CAB/RPV eligibility, compared those with and without recent detectable viral load (VL), and described clinical outcomes on LAI-CAB/RPV. Results: Among 1672 PWH, 425 (25.4%) had LAI-CAB/RPV drug-resistance. Among 1238 LAI-eligible PWH, 8.9% had detectable VL. Median age was 53 (interquartile range 40, 61), 54.6% were non-Hispanic Black, and 73.6% male. Over one-third lived >50 miles from clinic, one-fifth were uninsured, and 7.4% reported hazardous alcohol use. Gaps in care (prior 12-month) were more common among PWH with detectable VL versus suppressed (23.1% vs 13.9%, p = 0.03). 6/47 initiated LAI-CAB/RPV had detectable VL prior to injection; >95% sustained suppression and those with detectable VL had a rapid decline in viremia. Conclusions: Three-quarters of PWH were eligible for LAI-CAB/RPV, but equitable implementation may require addressing challenges such as distance to care, inconsistent care engagement, and other comorbid conditions, particularly for PWH with viremia.

Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea

Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea

The relationship between co-occurring traumatic experiences and co-occurring mental health domains for veterans resident in Northern Ireland

IntroductionVeterans residing in Northern Ireland (NI) likely experience higher levels of co-occurring lifetime trauma exposure and associated co-occurring mental health symptoms, due to the Troubles. As NI veterans have been subject to little exploration it is difficult to know how to support them. This exploratory study explored the co-occurrence of mental health symptoms as a function of co-occurring traumatic experiences.MethodsTwo latent class analyses (LCA) were conducted on NI veteran data (n = 609). One LCA factored endorsements of 16-lifetime traumatic events, with a separate LCA exploring the co-occurrence of symptoms across six mental health domains. Mental health symptom classes were considered as a function of trauma classes, military-specific variables, gender and age.ResultsThree trauma classes were identified: High Multi Trauma (10.84%); High Combat/Conflict (47.62%); Moderate Combat Conflict (41.54%), and three mental health symptom classes: High Co-occurring Mental Health (19.38%); High Depression Moderate Anxiety/Alcohol (24.63%); Moderate Alcohol/Normative (55.99%). Significant predictors of High Co-occurring Mental Health class membership were UDR service, ‘Worst’ military trauma and High Multi Trauma class membership. Both combat classes had a negative relationship with the High Co-occurring Mental Health. Predictors of the High Depression Moderate Anxiety/Alcohol class were High Multi Trauma class membership and UDR service, with Age and Moderate Combat Class membership having a negative relationship.DiscussionNI veterans could be labelled as ‘traumatised’ due to high levels of combat/conflict exposure, yet the two combat classes seemed unrelated to membership of poorer mental health classes. UDR membership indicated that living in one’s theatre of war could have mental health implications. It was concerning that 45% experienced some co-occurring mental health symptoms with 19% experiencing the poorest symptoms. Hazardous alcohol use appeared unrelated to poor mental health. Further research is needed, utilising robust methods. No clinical inferences are to be made from this exploratory study.

Addressing India’s alcohol misuse crisis: The urgent need for screening and brief intervention to bridge the healthcare gap

India faces a significant challenge with alcohol misuse, as evidenced by the national survey revealing that 57 million out of 160 million persons with alcohol use exhibit harmful or dependent patterns, necessitating professional assistance. The Global Status Report on Alcohol and Health (2018) indicates a rising per capita alcohol consumption in the Southeast Asian Region, with India contributing substantially. To address this, implementing policies and programs to curb hazardous alcohol use is crucial. Despite a shortage of mental health professionals in India, they remain the primary caregivers for those with alcohol-related issues. Only one in five individuals with problematic alcohol use can access professional help. I argue for adopting Screening and Brief Intervention (SBI) to bridge this healthcare gap. SBI is a concise, structured counseling approach that proves effective and scalable. It can be delivered by various healthcare providers, including doctors, nurses, counselors, and paramedics. Hence, it can be seamlessly integrated into primary care, emergency, and nonclinical settings. The efficacy of SBI extends to electronic formats, providing a scope of expansion through telehealth. The WHO advocates SBI by its SAFER initiative aimed at reducing negative alcohol-associated health and social consequences. SBI is effective across age groups, including adolescents and young adults, constituting most of India’s population. Emerging evidence suggests that SBI is acceptable, feasible, and effective in the Indian context. Universal or targeted SBI can be a pivotal tool in achieving the Sustainable Development Goals (2030) and global commitments for noncommunicable diseases, fortifying efforts to prevent and treat alcohol misuse.

A randomized controlled trial testing the efficacy of the eCHECKUP TO GO on drinking games participation and behavior among high school seniors

BackgroundAmong high school students, seniors report the highest levels of hazardous drinking behavior, including playing drinking games. Technology-based interventions are a promising approach for reducing hazardous drinking behavior among this age group. Objectives: This randomized controlled trial investigated the efficacy of the eCHECKUP TO GO, an online personalized feedback intervention, on reducing the frequency of playing drinking games, the number of drinks consumed while playing drinking games, and the number of drinks consumed on occasions when drinking games were played among high school seniors (ClinicalTrials.gov Identifier NCT03613818). Method: Participants were recruited from two high schools. Class periods were randomized to the intervention condition or an assessment-only control condition. Participants completed online surveys at baseline, 30-day, and 6-month assessments. The subsample in this study (N = 109) consisted of high-risk drinkers (i.e., students reporting binge drinking in the past two weeks at baseline). Results: We did not find any significant differences in frequency of playing drinking games between the intervention and control conditions. For number of drinks consumed, students in the intervention condition reported a significant reduction in the number of drinks consumed while playing drinking games (p < 0.01) and total number of drinks consumed on drinking game occasions (p < 0.04) at the 30-day follow-up relative to students in the control condition. Reductions within the intervention group were sustained at the 6-month follow-up. Conclusions: Results support the efficacy of the eCHECKUP TO GO for decreasing hazardous alcohol use among high school seniors.

Containment Measures and Alcohol Consumption Among Drinking Higher Education Students Before and During the COVID-19 Pandemic: A Multilevel Analysis in 25 Countries.

Hazardous alcohol use tends to be more prominent among higher education students. The COVID-19 pandemic severely altered student life, raising questions on its impact on students' alcohol use patterns. The current study examined cross-country variations in drinking behaviors (weekly drinking and binge drinking), and the extent to which these variations were associated with containment measures implemented during the first wave of the COVID-19 pandemic. Data were obtained from the COVID-19 International Student Well-being Study, covering students in 25 middle- and upper-high income countries. Data on government responses were retrieved from the Oxford COVID-19 Government Response Tracker. Multilevel multinomial logistic regression analyses were performed on weekly drinking (n = 44,212) and binge drinking (n = 32,785). Considerable cross-country variation existed for weekly drinking and binge drinking. In the majority of countries, a self-reported decrease in weekly drinking and a substantial self-reported decrease in binge drinking were observed. Closings of schools were associated with decreases in weekly drinking, while limitations on social gatherings were associated with increases in weekly drinking. The stringency index was associated with reporting decreased binge drinking. The study findings demonstrate a number of small yet significant associations between containment measures and changes in student drinking behaviors. Future studies are required to uncover why some students increased their alcohol consumption, particularly in countries with stricter limitations on social gatherings.

Mental health symptom burden in elite ice hockey players and its association with self-reported concussive events

BackgroundSome studies suggest that elite athletes experience adverse mental health symptoms at rates commensurate with the general population, despite the well-established buffering effects of exercise. Within contact sports, such as ice-hockey, recurrent concussions may be a source of this discrepancy. We compared the point prevalence of various mental health outcomes with other athlete and general population samples, as well as investigated their relationship with concussive events.MethodsWe surveyed 648 active ice hockey players from the top two men’s tiers and the top women’s tier in Swedish elite ice hockey on lifetime concussive events, hazardous alcohol use, problematic social media use, depression, anxiety, and burnout.ResultsHazardous alcohol use was more prevalent among male ice hockey players (29.5% AUDIT-C ≥ 6) compared to other athlete and general population samples, while other mental health symptoms were less common. Female ice hockey players reported higher hazardous alcohol consumption (36.4% AUDIT-C ≥ 4) than another athlete sample and more burnout (19.1%) than the general population. After adjusting for covariates, athletes with 3+ concussive events had 2.1 times the odds of elevated depressive symptoms and 3.5 times the odds of elevated burnout symptoms compared to those with no concussion history. Treating lifetime concussive events as a continuous predictor revealed positive correlations with all outcomes except for hazardous alcohol use.ConclusionsMental health outcome rates among active elite ice hockey athletes differ from those of other athlete and general population samples, whilst concussive events may be particularly linked to elevated symptoms of depression and burnout.

Hazardous alcohol consumption across different industries in Sweden: a pooled cross-sectional study.

The current study aims to (i) examine differences in hazardous alcohol consumption across different industries in Sweden and (ii) assess to what degree any such difference can be attributed to a differential distribution of nicotine use, health, and work environments among individuals working in these industries. A pooled cross-sectional study was conducted including all participants of the survey of Health, Work Environment, and Lifestyle Habits between 2012 and 2023 (n = 54378), collected by an occupational health service company (Feelgood). The survey contained self-reported information on alcohol use, industry, nicotine use, health, and work environment. Crude and adjusted odds ratios with 95% confidence intervals were obtained by pooled logistic regression analyses. Hazardous alcohol use was highly prevalent in the current study population (37%), especially among individuals in the accommodation/food service, arts/entertainment/recreation, and the construction industry. Compared to individuals working in education, individuals in these industries had >1.6-fold increased odds of reporting hazardous alcohol consumption. Differences in nicotine use and physical work environment between the industries explained some of the differences in hazardous alcohol consumption between industries, while differences in health and psychosocial work environment had limited effects on the estimates. We identified several industries in the Swedish workforce where hazardous alcohol use is highly prevalent. While differences in nicotine use, health, and work environment explained a part of these risk differences, most of the risk differences remained.

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Abstract Purpose: Cannabis use has been linked to alleviating symptoms such as sleep issues, mental health, and physical problems resulting from cancer treatment among cancer survivors. However, in the US general population, evidence suggests that an increase in cannabis use increases the risk for cardiovascular disease including high blood pressure, type 2 diabetes, and high cholesterol. This is even more alarming since users who have been diagnosed with cancer have an even greater independent risk of cardiovascular events due to the toxicities of cancer therapeutic drugs. Given the US trend in cannabis legalization and decriminalization and the limited knowledge of the association between cannabis use and cardiometabolic biomarkers among cancer survivors, we aim to assess the independent associations between cannabis use and several cardiometabolic biomarkers and explore racial/ethnic and sex differences among a sample of cancer survivors from the All of Us (AoU) Program. Methods: Cross-sectional cannabis data and cardiometabolic risk factor biomarkers were obtained from adult cancer survivors in the AoU Research Program from 2018-2022. Cannabis use was defined as never use (in a lifetime or past three months), occasional use (twice or monthly in the past three months), and frequent/regular use (weekly or daily). Cardiometabolic outcomes included cardiovascular (e.g., systolic, diastolic blood pressure, hypertension), immune (i.e., White Blood Cell [WBC] counts, C-reactive protein [CRP]), and metabolic systems biomarkers (e.g. waist-to-hip ratio, lipids, HbA1c), were dichotomized from continuous values to elevated vs normal where high values, defined by clinically established cutoffs or &amp;gt;75th percentile, represented elevated biomarkers. Multivariable logistic regression and stratified models if interactions were statistically significant, adjusting for treatment, smoking, hazardous alcohol use, and sociodemographic variables were used. Results: Our cohort (N=6,985) consisted of 7.6% Hispanic, 6.2% Black, and 86.2% White survivors. Overall, 8.2% of survivors reported occasional and frequent/regular cannabis use, with Black survivors (9.7%) reporting a greater proportion of frequent/regular use compared to White (3.2%) and Hispanic (4.7%) survivors. Similarly, female (2.8%) survivors reported a lower frequency of frequent/regular cannabis use compared to male (4.2%) survivors. Compared to never users, frequent/regular users were 3.35(95% CI=1.10-10.53) times as likely to report elevated WBC count. No significant associations were found between cannabis use and CRP, cardiovascular, and metabolic systems biomarkers. Similarly, no race/ethnicity or sex (both pinteraction &amp;gt; 0.05) differences were found in the cannabis and WBC association. Conclusion: Our results underscore that more frequent cannabis use may have a detrimental effect on immune risk factors like WBC counts among survivors. Being that high WBC may be predictive of cardiovascular diseases and mortality, future studies should explore the longitudinal effects of cannabis use on WBC. Citation Format: Angel Arizpe, Claudia M. Toledo-Corral, Carol Y. Ochoa-Dominguez, Stephanie Navarro, Sue E. Kim, Albert J. Farias. Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B014.

Publisher Correction: Hazardous drinking and alcohol use disorders

Publisher Correction: Hazardous drinking and alcohol use disorders

Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study

Background Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18–24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March − 16 April 2023) and post-implementation (period 1, 1 May − 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June − 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21–1.43; p < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9–18.1; p < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5–28.7, p < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.

Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals

BackgroundHazardous alcohol use and alcohol use disorder (AUD) are highly prevalent among clients in mental health services, yet significant gaps remain in the adequate assessment of alcohol use and provision of appropriate alcohol interventions. The aim of this study was to conduct an exploration of (i) alcohol intervention elements used in mental health services and (ii) professionals’ reported barriers and facilitators in identifying and intervening with hazardous alcohol use and AUD.MethodsQualitative data were obtained by conducting semi-structured interviews among a purposive sample of 18 professionals from 13 different Dutch mental health services organizations (i.e., five integrated mental health organizations with addiction services, five mental health organizations without addiction services, and three addiction services organizations without mental health services). Transcripts were qualitatively analyzed using inductive thematic analysis.ResultsIdentified alcohol intervention elements included conducting assessments, brief interventions, treatment, referrals of clients, collaborations with other parties, and providing information to professionals. Professionals mentioned nine barriers and facilitators in the identification and intervention with hazardous alcohol use and AUD, including three aspects of professionals’ behavior (i.e., professionals’ agenda setting, knowledge and skills, and attitudes), actions related to identification and intervening, client contact, collaboration with other parties, and three factors in a wider context (i.e., organizational characteristics, organizational resources, and governmental aspects).ConclusionsAlthough diverse alcohol intervention elements are available in Dutch mental health services, it remains unclear to what extent these are routinely implemented. To better address hazardous alcohol use and AUD in mental health services, efforts should focus on enhancing alcohol training, improving collaboration with addiction services, providing appropriate tools, and facilitating support through organizational and governmental measures.

Hazardous Alcohol Use and Its Effect on Direct-Acting Antiviral Therapy Initiation among People with Active Injection Drug Use and Current Hepatitis C Infection.

Hepatitis C virus (HCV) infection and hazardous alcohol use are both preventable causes of morbidity and mortality among people who inject drugs (PWID). In the general population, hazardous alcohol is associated with a reduced likelihood of HCV treatment initiation. Less is known about the prevalence and impact of hazardous alcohol use on direct-acting antiviral (DAA) therapy initiation among PWID with active injection drug use. PWID were recruited via street outreach in Baltimore, Maryland, between 2018 and 2019 and were enrolled in a study cohort. Participants completed a study survey and underwent HCV testing. Self-reported DAA therapy initiation was evaluated at follow-up visits every six months. Hazardous alcohol use was determined based on an AUDIT-C score of ≥4 for men or ≥3 for women. Data were analyzed using multivariable logistic regression with generalized estimating equations. Of the 720 PWID recruited, 291 had detectable HCV RNA, and only 134 were aware of their HCV infection. The mean (±standard deviation) age of those that were aware of their infection was 48.7 (±10.3) years, with a slight majority (53.0%) being male and predominantly African American (64.9%). The majority (80/134, 59.7%) met criteria for hazardous alcohol use. Only 16 (11.9%) PWID reported DAA therapy initiation within six months, and 20 (14.9%) reported it within 12 months of follow-up. Hazardous alcohol use (aOR = 1.23, 95% CI = 0.43-3.53) was not associated with DAA treatment initiation. There was a high prevalence of hazardous alcohol use, low rates of oral DAA therapy initiation, and no association between self-reported hazardous alcohol use and initiation of oral DAA therapy in our sample of PWID that were aware of their chronic HCV infection. Strategies to increase HCV treatment uptake in PWID with active drug use are urgently needed and should integrate alcohol and drug use evaluation and care.