Higher Levels Of Substance Use Research Articles

A Comparison of Remote Versus in-Person Assessments of Substance Use and Related Constructs Among Adolescents

Objective: Underreporting of adolescent substance use is a known issue, with format of assessment (in-person vs. remote) a potentially important factor. We investigate whether being assessed remotely (via phone or videoconference) versus in-person affects youth report of substance use patterns, attitudes, and access, hypothesizing remote visits would garner higher levels of substance use reporting and more positive substance use attitudes. Methods: We used the Adolescent Brain and Cognitive DevelopmentSM [ABCD] Study data between 2021-2022 during the COVID-19 pandemic. Participants chose whether to complete assessments in-person (n=615; 49% female; meanage=13.9; 57% White) or remotely (n=1,467; 49% female, meanage=13.7; 49% White). Regressions predicted substance use patterns, attitudes, and access, by visit format, controlling for relevant sociodemographic factors. Effect sizes and standardized mean differences are presented. Results: 17% of adolescent participants reported any level of substance use. Youth interviewed remotely reported more negative expectancies of alcohol and cannabis. In addition, those queried remotely were less likely to endorse use), sipping alcohol, eating cannabis), and reported less curiosity or intent to try alcohol, though these differences did not survive an adjustment for multiple testing. Effect sizes ranged from small to medium. Conclusions: Preliminary evidence suggests youth completing remote visits were more likely to disclose negative expectancies toward alcohol and cannabis. Effect sizes were modest, though 37 of 39 variables examined trended toward restricted reporting during remote sessions. Thus, format of substance use assessment should be controlled for, but balanced by other study needs (e.g., increasing accessibility of research to all sociodemographic groups).

Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment.

Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. DERR1-10.2196/54342.

Are Family Factors Differentially Associated with Externalizing Symptoms Among Youth with Perinatally Acquired HIV?

Youth with perinatally-acquired HIV (PHIV) face unique psychosocial stressors. They are at risk for externalizing problems, including symptoms of oppositional defiant disorder, conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD), as well as risk-taking behaviors, such as substance use (SU). Although family factors have been differentially associated with externalizing and SU behaviors based on youth sex in prior research, there is a dearth of literature considering these processes among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88years, SD = 3.08years; 50.80% male; 85.30% Black or Latinx). Boys exhibited higher levels of ADHD symptoms than girls. Among boys, lower levels of consistency in discipline were associated with higher CD symptoms. Lower levels of family cohesion were associated with higher levels of SU among girls, and higher levels of CD symptoms across youth sex. Findings support the need for family-focused behavioral interventions among youth with PHIV.

Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency.

Adolescents with adverse childhood experiences (ACEs) and suicidality may engage in high levels of substance use to alleviate distress. Most studies of associations among ACEs, suicidality, and substance use rely on retrospective reports by adults. Comparatively less is known about concurrent relationships between ACEs, suicide risk, and substance use in adolescents, which is important for prevention. This study tested if the associations between ACEs and drinking and between ACEs and cannabis use would be even stronger among youth with suicidal ideation or attempt, relative to youth without suicidal ideation or attempt. High schoolers (N = 1,625; 50.8% male; 47.1% female; 2% nonbinary) from western New York completed the Youth Risk Behavior Survey. Ordinal regressions tested main effects and interactions of the number of ACEs and suicidal ideation/behavior (i.e., none, ideation/plan, attempt) on categories of past-month drinking and cannabis days of use, controlling for age, gender, and race/ethnicity. Significant ACEs by suicide interactions on adolescent drinking indicate that the association between ACEs and drinking was stronger for adolescents with suicide attempt adjusted odds ratio (AOR = 2.63) compared to youth with no ideation or attempt (AOR = 1.56) and suicidal ideation/planning only (AOR = 1.58). Main effects of ACEs (AORs = 1.95-2.08) and suicide attempt (vs. no suicidal ideation/attempt [AOR = 2.11] and suicidal ideation/plan [AOR = 2.11]) were associated with greater cannabis use; interactions were not significant. Associations between ACEs and drinking were particularly strong for adolescents with suicide attempt. Conversely, ACEs and suicide attempt were independently associated with cannabis use. Mitigating against ACEs may reduce both adolescent alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico.

Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.

The effectiveness of cognitive bias modification in reducing substance use in detained juveniles: An RCT

Background and objectiveYoung offenders show high levels of substance use. Treatment programs within detention settings are less effective. Cognitive bias modification (CBM) is a promising supplement to substance use treatment. This study tests the effectiveness of CBM in young offenders to reduce cannabis and alcohol use, and delinquent recidivism. MethodA randomized controlled trial added CBM to treatment as usual (TAU), among 181 youth in juvenile detention centers. In a factorial design, participants were randomly assigned to either active- or sham-training for two varieties of CBM, targeting attentional-bias (AtB) and approach-bias (ApB) for their most used substance. Substance use was measured with the Alcohol and Cannabis Use Disorder Identification Tests. Delinquent recidivism was measured with the International Self-Report Delinquency (ISRD) survey. ResultsAt pretest, participants showed AtB but no ApB for both substances. For alcohol, a decrease was found in AtB in the active-training group. For cannabis, a decrease was found in AtB for both active- and sham-training groups. Regardless of condition, no effects were found on substance use or ISRD scores at follow-up. LimitationsThe sample is judicial, not clinical, as is the setting. TAU and participant goals are not necessarily substance related. ConclusionsYoung offenders show a significant attentional-bias towards substance cues. CBM changed attentional-biases but not substance use. Combining CBM with a motivational intervention is advised. Follow-up research should better integrate CBM with running treatment programs. New developments regarding CBM task design could be used that link training better to treatment.

A Mixed Methods Exploration of Texas School Nurses' Involvement in Addressing Substance Use and Sexual/Reproductive Health Among Students in Alternative High Schools.

Students in alternative high schools (AHSs) have higher levels of substance use and risky sexual behaviors than students in traditional high schools. In this mixed methods study, we examine school nurses' efforts in Texas AHSs to address substance use and sexual/reproductive health. The nurses addressed substance use and sexual reproductive health mostly at the individual level, after students initiated risky behaviors. Nurses' efforts were influenced by district, school, and community factors (e.g., understaffing, outdated programs that weren't evidence-based or tailored to AHS students' behaviors, and family involvement). Usually, nurses were not practicing to their full scope as outlined by the National Association of School Nurses Framework. Substance use was a common reason for AHS placement and could contribute to the school-to-prison pipeline, and AHSs did not always have Narcan on campus to address drug overdoses. Our findings suggest implications for providing equitable health services to this underserved, understudied student population.

A-68 The Relationship Between Brain Injury And Substance Use Patterns In University Students

Abstract Purpose Our prior research has suggested that athletes with history of traumatic brain injuries (TBIs) are at greater risk of single and polysubstance use. The present study further explored the factors associated with this relationship in a large undergraduate population. Methods 894 university students (44% athletes) completed self-reported TBI history (blows to the head or whiplash causing loss of consciousness or memory, or feeling dazed), substance use (Alcohol and Cannabis Use Disorders Identification Tests (AUDIT; CUDIT)) and psychological measures. Relationships between these factors were examined using linear regression models. Results 200 (22.4%) students reported a history of one or more TBIs (45.63% sport-related). TBI history predicted current cannabis and alcohol use, with those with a history of multiple TBIs reporting more problematic use of each substance (ps&amp;lt;.01) as well as greater polysubstance use (p&amp;lt;.001). Past history of depression predicted more problematic cannabis use (p=.007), while past history of anxiety and depression predicted more problematic alcohol use. When examining multiple factors associated with use, history of TBIs (p=.008) and higher current depression symptoms (p=.006) predicted more problematic cannabis use, whereas for alcohol users, history of TBI and female sex was related to more problematic use (p=.041). Conclusions History of TBI predicts higher levels of substance use and polysubstance use and increased number of TBIs and mental health problems may be related to greater risk of hazardous substance use. Consideration of TBI history is essential for identifying players at risk for engaging in problematic behaviours such as hazardous substance use.

Understanding the complexity, patterns, and correlates of alcohol and other substance use among young people seeking help for mental ill-health

PurposeUse of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health.MethodsYoung people (12–25 years old) were recruited from five youth-specific primary mental health (“headspace”) services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression.Results1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups.ConclusionsFindings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.

Predictors of housing instability and stability among Housing First participants: A 24-month study

ABSTRACT This study examined the characteristics of people who experienced housing instability and stability after 24 months of being enrolled in Housing First (HF). A companion study addresses the same objective using qualitative methods. A sequential logistic regression was conducted to determine predictors of unstable and stable housing at 24 months of enrollment in HF in a randomized trial. We applied the Gelberg-Andersen. Behavioral Model for Vulnerable Populations to identify and group predictor variables. Thirty-one percent of the HF participants (N = 302/977) met the study criteria for housing instability (i.e. stably housed for less than 90% of last six months). Residence in Winnipeg, longer accumulated lifetime homelessness, and higher levels of substance use predicted unstable housing. Residence in Toronto and Montreal, older age, being in an ethno-racial minority group (other than Indigenous), higher income, higher perceived housing quality, and having a family physician predicted stable housing. The findings of the study have implications for strengthening HF supports to better address the needs of HF participants who may be at risk of housing instability.

The Co-Occurrence of Conduct Problems and Depressive Symptoms From Childhood to Adulthood for Men: Stability Over Time and Prediction to Substance Use.

The dual pathway hypothesis of risk for substance use was tested by examining risk from symptoms of conduct problems and depressive symptoms in adolescence (from ages 10-11 to 17-18 years) to substance use-including tobacco, alcohol, cannabis, and other illicit drugs-in both early adulthood (approximately from ages 20 to 29 years) and middle adulthood (approximately from ages 29 to 38 years). Hypotheses were tested on a sample of boys who were at risk for conduct problems by virtue of the neighborhoods where they lived in childhood (the Oregon Youth Study; N = 206 at Wave 1). Dual-trajectory modeling (Latent Class Analysis) resulted in a 3-group solution of high, moderate, and low co-occurring symptoms. The latent class of boys with co-occurring symptoms in adolescence showed higher levels of substance use in adulthood; namely, higher levels of cannabis and illicit substance use during early adulthood compared to either of the moderate or low symptom classes, and higher use of cannabis in midadulthood than the low symptom class. Those with co-occurring symptoms also showed, overall, higher vulnerability to use of tobacco in these 2 periods, but not to higher use of alcohol. Regression analyses indicated that the higher substance use of the co-occur group of men was related to their adolescent conduct problems, but was not related to their adolescent depressive symptoms; however, these associations were nonsignificant when adolescent use of the respective substances were included in the models. Thus, the dual-trajectory hypothesis was not supported. However, the findings indicated that, as assessed in the present study, the psychopathology symptoms of boys with conduct problems in adolescence who show risk for later substance use may be complex, involving depressive symptoms.

Psychological Well-Being and Substance Use During the COVID-19 Pandemic: Ethnic/Racial Identity, Discrimination, and Vigilance.

Emerging evidence indicates that the COVID-19 pandemic has exacerbated mental health disparities among Black, Indigenous, and People of Color (BIPOC) through increased exposure to racism. Although ethnic/racial identity (ERI) and mental health were associated among BIPOC young adults pre-pandemic, it is unclear how these associations may differ in the exacerbated hostile racial environment of the pandemic. The current study examined the associations between ERI exploration and commitment within the context of ethnic/racial discrimination (ERD) and race-related vigilance with psychological well-being and substance use as explained by rumination. Data from a cross-sectional online survey of 450 AIAN, Asian, Black, and Latinx young adults (18-25years) collected in April 2020 included demographic variables, standardized measures of ERI, ERD, race-related vigilance, rumination brooding and reflection, substance use, and psychological well-being. Black respondents reported more exposure to ERD than AIAN and Asian young adults. ERI exploration and commitment were positively associated with well-being. ERI exploration, ERD, and rumination were associated with higher levels of substance use. An association between ERI exploration and more substance use and lower well-being was partially accounted for by higher levels of rumination. An association between ERI commitment and more substance use was fully accounted for by higher levels of rumination. Although ERI exploration and commitment were associated with better psychological well-being among BIPOC young adults, a significant association was found between ERI commitment and more substance use as explained by rumination. Public health efforts should cultivate culturally sensitive mental health services to decrease rumination and its negative association with substance use and well-being.

Adverse childhood experiences, psychological well-being, and substance use in Pakistani university students

Adverse childhood experiences are associated with risky health behaviors and adverse health outcomes worldwide, including substance use; yet, relatively fewer studies have examined linkages between adverse childhood experiences and health behaviors and outcomes in low- and middle-income countries, including countries in sub-Saharan Africa and large portions of Asia. Furthermore, fewer studies of adverse childhood experiences have examined the pathways or processes connecting adverse childhood experiences to health behaviors and outcomes. This study addressed these gaps by investigating three competing models of associations between adverse childhood experiences, psychological well-being, and substance use in 595 Pakistani University students (40.5% female; Meanage = 21.96, Standard deviation = 2.37) using path analysis. Controlling for the effects of age, sex, and socioeconomic status, adverse childhood experiences were associated with both diminished psychological well-being and higher levels of substance use. However, psychological well-being and substance use were unrelated and neither accounted for indirect effects of adverse childhood experiences on adjustment. Suggestions for furthering research on adverse childhood experiences, particularly in low- and middle-income countries, are discussed.

Structural gender inequality and gender differences in adolescent substance use: A multilevel study from 45 countries

PurposeAlthough adolescent substance use has declined, young people’s tobacco and alcohol use levels are still among the highest in Europe and North America. Historically, boys reported higher levels of substance use than girls; however, in recent decades gender convergence in adolescent substance use was observed in some, mostly Western, countries. Previous research has shown associations between societal gender inequality and gender differences in some externalizing behaviors in adolescents. Therefore, there is a need to go beyond individual-level associations and apply a socio-ecological perspective when examining gender differences in adolescent substance use. This study examines whether gender differences in adolescent substance use relate to societal gender inequality. MethodsCurrent and lifetime substance use (i.e., alcohol drinking, drunkenness, cigarette smoking) were measured in 11-, 13 and 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n=224,876). Individual data were linked to national gender inequality (Gender Inequality Index, 2018) in 45 countries and regions, and their association was tested using mixed effects (multilevel) logistic regression models ResultsLarge cross-national variations were observed in gender differences in substance use. Greater gender inequality at country level was associated with heightened gender differences in substance use, however with different effects depending on the substance type. For most substances, few gender differences emerge in countries characterized by low levels gender inequality. The largest gender differences were observed in countries characterized by high gender inequality ConclusionsSocietal gender inequality reflects social and cultural norms that relate to adolescents’ engagement with substance use. Public health policy should target societal factors that impact on young people’s behavior.

First Demonstration Project of Long-Acting Injectable Antiretroviral Therapy for Persons With and Without Detectable Human Immunodeficiency Virus (HIV) Viremia in an Urban HIV Clinic.

Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH) based on trials that only included participants with viral suppression. We performed the first LAI-ART demonstration project to include PWH unable to achieve or maintain viral suppression due to challenges adhering to oral ART. Ward 86 is a large HIV clinic in San Francisco that serves publicly insured and underinsured patients. We started patients on LAI-ART via a structured process of provider referral, multidisciplinary review (MD, RN, pharmacist), and monitoring for on-time injections. Inclusion criteria were willingness to receive monthly injections and a reliable contact method. Between June 2021 and April 2022, 51 patients initiated LAI-ART, with 39 receiving at least 2 follow-up injections by database closure (median age, 46 years; 90% cisgender men, 61% non-White, 41% marginally housed, 54% currently using stimulants). Of 24 patients who initiated injections with viral suppression (median CD4 cell count, 706 cells/mm3), 100% (95% confidence interval [CI], 86%-100%) maintained viral suppression. Of 15 patients who initiated injections with detectable viremia (median CD4 cell count, 99 cells/mm3; mean log10 viral load, 4.67; standard deviation, 1.16), 12 (80%; 95% CI, 55%-93%) achieved viral suppression, and the other 3 had a 2-log viral load decline by a median of 22 days. This small demonstration project of LAI-ART in a diverse group of patients with high levels of substance use and marginal housing demonstrated promising early treatment outcomes, including in those with detectable viremia due to adherence challenges. More data on LAI-ART in hard-to-reach populations are needed.

Relationship between Parenting Style and Substance Use Adolescents in Denpasar City

Background: Adolescent is a transition period from childhood to adulthood, seeking self-identity, anti-social behavior, violence and substance use. Parenting style is one of the risk factors determining substance use behavior among adolescents to prevent and overcome this behavior's consequences. This study aims to determine the relationship between parenting style toward substance use among adolescents in Denpasar. Methods: This research is an analytic observational study with a case-control study design. This research sample is adolescent drug users aged 12-25 years who live with their parents aged 0-17 years. The study was carried out in/at the Class IIA Kerobokan Denpasar Prison from August 2020 to September 2020. The data sources are primary data that taken from the PSQ (Parenting Style Questionnaire) and WHO-ASSIST questionnaires. The independent variable is the parenting style, while the dependent variable is the level of substance use. The data were/are analyzed using the chi-square/Fisher exact test with p-value of &lt;0.05 is considered as significant. Result: The results show that there is a significant relationship between unexpected parenting style according to parents/guardians and drug abuse among adolescents (r = 0.34; p &lt;0.05) and that increased the risk of moderate-heavy drug use among adolescents (OR = 5.93; 95% CI = 1.362-25.788; p = 0.011). Conclusions: Unexpected parenting style is associated to/with higher levels of substance use due to guilt, abusive parenting, neglect, which lead to negative self-esteem in children, emotional submission, insecurity and a lack of self-control in children.

Exploring Interventions to Improve the Oral Health and Related Health Behaviours of Adults Experiencing Severe and Multiple Disadvantage: Protocol for a Qualitative Study with Stakeholders.

The number of individuals in England experiencing homelessness, substance use, and involvement with the criminal justice system is increasing. These issues, referred to as severe and multiple disadvantage (SMD), are often interlinked and co-occur. Health inequalities, particularly poor oral health, persist for those facing these inter-related issues and are closely linked with high levels of substance use, smoking, and poor diet. However, evidence for interventions that can improve these health outcomes for those experiencing these issues is limited. This paper outlines the design of a qualitative study which aims to explore the perspectives of stakeholders to understand what interventions can help to support SMD groups with their oral health and related health behaviours (i.e., substance use, smoking, diet). Interviews and focus groups will be undertaken with stakeholders comprising two groups: (1) individuals with experience of SMD, and (2) service providers (staff and volunteers), policy makers, and commissioners who support such individuals. Public involvement and engagement is central to the project. For example, stakeholders and research partners in policy and practice and people with lived experience of SMD will provide input at all stages of this study. Findings from the study will inform an ‘evidence for practice’ briefing outlining recommendations for policy. Dissemination will occur through presentations to a range of practice, policy and academic beneficiaries, and through peer-reviewed publications.

Investigating the Effectiveness and Acceptability of Oral Health and Related Health Behaviour Interventions in Adults with Severe and Multiple Disadvantage: Protocol for a Mixed-Methods Systematic Review

Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as ‘severe and multiple disadvantage’; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review.

Attachment Styles as Predictors of Substance Use Among Secondary School Students in Nairobi County, Kenya

Substance use is common among secondary school students in Kenya and poses a threat to their health and academic achievement. Therefore, there is need to find out determinants of substance use so that measures can be taken to discourage it. Previous research has shown that attachment styles influence not only adolescents’ adjustment but also their tendency to engage in deviant behaviors like substance use. This study investigated whether attachment styles predict substance use among secondary school students in Nairobi County. The study was based on the attachment theory and attachment security was conceptualized in terms of four attachment styles: secure, preoccupied, dismissing and fearful. A correlational design was adopted for the study. Data was collected using a self-administered questionnaire. The Attachment Styles Questionnaires was used to measure the four attachment styles and substance use was measured on an 11 item likert scale. The study targeted 10,451 Form Three students in 79 public secondary schools in Nairobi County. Three sub-counties were purposively selected and nine schools from the three sub-counties were selected using stratified random sampling. A sample of 385 students was randomly selected from the nine schools. Multiple linear regression analysis was used to test the hypothesis and determine the prediction of substance use by the attachment styles. The main finding of the study was that attachment styles predicted substance use among secondary school students (F = 4.954, P = .001) and accounted for 5.6% of the variance in substance use (R 2 = 0.56). Secure attachment style predicted less substance use (β = -.117, P = .028) whereas dismissing attachment style significantly predicted higher levels of substance use (β = .174, P = .004). The study recommended that guidance and counseling teachers take students’ attachment styles into consideration when tackling substance use and encourage parents and guardians to foster more secure attachment with their children. Keywords: Attachment styles, attachment anxiety, attachment avoidance, secure, preoccupied, dismissing, substance use DOI: 10.7176/JEP/12-30-11 Publication date: October 31 st 2021

Substance use, depression, and loneliness among American veterans during the COVID-19 pandemic.

Background and ObjectivesBehavioral health issues, such as substance use, depression, and social isolation, are of grave concern during COVID‐19, especially for vulnerable populations. One such population is US veterans, who have high rates of pre‐existing behavioral health conditions and may thus be at‐risk for poorer outcomes. The current study aimed to investigate substance use among US veterans during COVID‐19 as a function of pre‐existing depression, loneliness, and social support.MethodsWe investigated the relationship between pre‐pandemic depression and substance use during COVID‐19 using linear (alcohol) and logistic (cannabis) regression among a large sample of US veterans (N = 1230). We then tested if loneliness and social support moderated these effects.ResultsThough there was a decrease in alcohol and cannabis use among the overall sample, veterans who screened for depression prior to the pandemic exhibited higher levels of substance use after the pandemic's onset. Loneliness compounded the effects of depression on rates of alcohol use. Social support was not protective for the effects of depression on either alcohol or cannabis use.Discussion and ConclusionsVeterans with pre‐existing depression may be in need of attention for substance use behaviors. Interventions aimed at alleviating loneliness among veterans may be useful in mitigating alcohol use, but not cannabis use, amid COVID‐19.Scientific SignificanceOur findings are among the first to report tangible behavioral health outcomes experienced by US veterans as a result of COVID‐19. Results can help inform treatment efforts for veterans who are struggling with substance use during and post‐pandemic.