Initiation Of Substance Use Research Articles

Diversity in substance use behaviour among street children of Delhi under Bayesian paradigm

BackgroundShannon’s index is one of the measures of biodiversity, which is intended to quantify both richness and evenness of the species/individuals in the ecosystem or community. However, application of Shannon’s index in the field of substance use among the street children has not been done till date.MethodsThis paper is concerned with methods of estimating Shannon’s diversity index (SDI), which can be used to capture the variation in the population due to certain characteristics. Under the consideration that the probability of abundance, based on certain characteristics in the population, is a random phenomenon, we derive a Bayesian estimate in connection with Shannon’s information measure and their properties (mean and variance), by using a probability matching prior, through simulation and compared it with those of the classical estimates of Shannon. The theoretical framework has been applied to the primary survey data of substance use among the street children in Delhi, collected during 2015. The measure of diversity was estimated across different age profiles and districts.ResultsThe results unrevealing the diversity estimate for street children corresponding to each region of Delhi, under both the classical and Bayesian paradigms. Although the estimates were close to one another, a striking difference was noted in the age profile of children.ConclusionsThe Bayesian methodology provided evidence for a greater likelihood of finding substance-using street children, belonging to the lower age group (7-10, maximum Bayesian entropy-3.73), followed by the middle (11-14) and upper age group (15-18). Moreover, the estimated variance under the Bayesian paradigm was lesser than that of the classical estimate. There is ample scope for further refinement in these estimates, by considering more covariates that may have a possible role in initiating substance use among street children in developing countries like India.

Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018.

Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use. We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018. From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001). In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.

Age of Substance Use Initiation and Sexual Violence Victimization among Female Adolescents.

Objective: In this study, I examined the association between age of substance use initiation and sexual violence (SV) among adolescent girls. Methods: Data were drawn from the 2017 Youth Risk Behavior Survey, and the sample included 7526 girls. Logistic regression was used to estimate the relationship between age of initiation of alcohol use, marijuana use and cigarette smoking, and SV, assessed by forced sexual intercourse and experiencing SV. Results: A dose-response association was observed between age of substance use initiation and SV. Across all 3 substance use variables and for both SV outcomes, those who initiated substance use before age 15 were more likely to experience SV than those who initiated at or after age 15, who, in turn, had a higher likelihood of experiencing SV than those who had never initiated substance use. Conclusion: Early initiation of substance use may be a meaningful marker of risk for SV victimization in later adolescence. SV prevention programs could use early initiation of substance use to identify adolescents who are at increased risk for SV and provide them with targeted interventions. To be more effective, primary prevention of SV may need to begin targeting substance use in early adolescence.

Regulatory Focus and Substance Use in Adolescents: Protective Effects of Prevention Orientation

Background: Substance use is a major risk factor for negative health and functioning outcomes among middle schoolers. The purpose of this study was to assess whether individual differences in the adolescents’ goal orientation are associated with elevated or attenuated risk for substance use. Regulatory focus theory stipulates that individuals vary in their strength of orientation toward promotion goals (“making good things happen”) and prevention goals (“keeping bad things from happening”). Objectives: We sought to examine the association between individual differences in regulatory focus and adolescents’ reports of their own and their friends’ substance use. Methods: Participants were 241 seventh grade students who completed measures of regulatory focus (promotion and prevention orientation), self-reported substance use, perceived substance use habits of peers, and demographics. Logistic regression models were used to examine adjusted odds of lifetime tobacco use, alcohol use, and marijuana use for both participants’ own use and their reports of friends’ use. Results: Prevention orientation was associated with lower odds of all self-reported lifetime substance use outcomes (tobacco, alcohol, and marijuana). Prevention orientation was also associated with lower odds of reporting all types of substance use among friends. Promotion orientation was not associated with any self-reported substance use outcome, and was only associated with higher odds of reporting lifetime alcohol use among friends. Conclusions: These findings underscore the importance of regulatory focus as it relates to adolescent substance use. Future research may seek to incorporate regulatory focus within interventions intended to prevent or delay initiation of substance use in adolescents.

Parental Optimism and Perceived Control over Children's Initiation of Tobacco, Cannabis, and Opioid Use.

Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents’ perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0–18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants’ perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child’s risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10–0.34]) or cannabis (AOR: 0.21 [95% CI 0.12–0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.

The Effects of the COVID-19 Pandemic on the Risk of Youth Substance Use

The Effects of the COVID-19 Pandemic on the Risk of Youth Substance Use

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BackgroundThe primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents’ immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). Methods639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. ResultsParticipants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. ConclusionsWe found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Does prenatal cocaine exposure predict adolescent substance use?

Prenatal cocaine exposure (PCE) has rarely been examined as a predictor of substance use during late adolescence, and few studies have examined both the initiation of substance use and current substance use as outcomes. The present longitudinal study examined PCE, other prenatal exposures, and psychosocial risk factors for their association with substance use in mid to late adolescence. Adolescents (n = 150) followed since birth reported on their use of alcohol, cigarette, and cannabis every 6 months from age 15.0 to 17.5 using a computer-assisted self-administration version of the Youth Risk Behavior Survey. PCE did not predict substance use in a series of growth curve analyses. Several psychosocial risk factors were associated with adolescents' substance use. Having friends who use substances predicted past month cigarette and cannabis use as well as initiation of alcohol and cannabis use, while depressive symptoms predicted initiation of alcohol, cigarette, and cannabis use. The current findings suggest that more proximal psychosocial factors may play a greater role in adolescent substance use than prenatal substance exposure.

Determinants of substance use among young people attending an urban primary health center in Delhi.

Substance abuse remains one of the major challenges in young people, as it is one of the top five causes of disability-adjusted life years (DALY). The present study aims to find the prevalence and determinants of substance use among young people attending an urban primary health center in Delhi. Systematic random sampling was used to enroll the calculated sample size of 190. Substance use was assessed using ASSIST (an Alcohol Smoking Substance Involvement Screening Tool) and brief intervention was given based on the standard guidelines of ASSIST. The total score among the substance users is calculated and divided into Grades 1, 2 or 3. Log binomial regression was performed to quantify the association between substance use and covariates such as age, sex, education, occupation, family history of substance use, socio-economic status and family type. The association was expressed in odds ratio (OR) with 95 percent confidence interval (CI). The mean age of study participants was 18.6 ± 4.1, ranges from 10 to 24 years. Out of 48 substance users, 43.7% were consuming only tobacco, 22.9% were consuming only alcohol and 33.3% were polysubstance users. The history of substance use among family members of participants was found to be 46.3%. Median substance involvement score of tobacco, alcohol and cannabis users was 19 (IQR: 14.5-22), 19 (IQR: 13.5-25) and 22.5 (IQR: 22-23), respectively. Among tobacco users, 2.7% were Grade 1 and 7.2% were Grade 2. Four (16%), 20 (80%) and one (4%) of alcohol users were Grades 1, 2 and 3, respectively. Among the cannabis users, four (100%) were in the Grade 2 category. The median age of initiation of substance use among users was 16 (range 13-21) years. The analysis shows substance use was almost 25 times (adjusted OR = 25.84, 95% CI 5.65-118.09) more common among males and it increase by 2.5 times with a decrease in socio-economic status (adjusted OR = 2.52, 95% CI 1.27-5.02) and the result is significant. The substance use was almost 7 times higher when there is a family history of substance usage (adjusted OR = 7.40, 95% CI 2.15-25.4). Residential and marital status were not significantly associated with substance use. Male sex, lower socio-economic status, participants currently not going to school/college, family history of substance use were found to be significant predictors of substance use among the study participants.

Associations between racial and socioeconomic discrimination and risk behaviors among African-American adolescents and young adults: a latent class analysis.

Discrimination is a common stressor among African Americans and may increase vulnerability to risk behaviors, such as early initiation of substance use, substance use problems, and physical aggression; however, few studies have examined different types of discrimination and their associations with patterns of risk behaviors. This study examines the relationship between experiences of racial and socioeconomic discrimination and risk behaviors in African-American adolescents and young adults. We investigated associations of two discrimination types with risk behavior patterns identified with latent class analysis in a high-risk sample of African Americans (N = 797, Mage = 17.9years, 50.2% female). Four distinct classes of risk behaviors were characterized by High Use and Aggression (10%), Moderate Use and Aggression (10%), High Alcohol (17%), and Low Use and Aggression (63%). Classes that exhibit general risk behaviors, including substance use and aggression, were significantly associated with racial and socioeconomic discrimination, even in the fully adjusted model. Relative to other classes, the High Use and Aggression class demonstrated an elevated likelihood of experiencing both racial and socioeconomic discrimination. Findings support a link between racial and socioeconomic discrimination and risk behavior in African-American youth, which may be stronger for socioeconomic discrimination. Understanding the relationship between discrimination and risk behavior can inform future interventions to prevent substance misuse and conduct problems in youth. Further study is needed to elucidate the relationship between discrimination and other risk behaviors.

School Climate as a Universal Intervention to Prevent Substance Use Initiation in Early Adolescence: A Longitudinal Study.

Initiation of substance use often starts during adolescence, with tobacco and alcohol use frequently preceding the use of marijuana and other illicit drugs. Studies suggest that a positive school climate may prevent substance use while promoting healthy student behaviors. The purpose of this study was to determine the longitudinal associations between school climate and substance use initiation in a group of middle school students. Parallel latent growth curve modeling was used to examine changes among study variables longitudinally using a sample of 2,097 sixth-, seventh-, and eighth-grade students across 16 regional schools located in three counties in West Virginia. Results suggest that a positive school climate may prevent substance use initiation (β = -0.07 to -0.25, p < .01). However, perceptions of school climate decreased on their own over time (β = -0.28 to -0.66, p < .01). Furthermore, substance use initiation also increased as students grew older (β = 0.96 to 0.99, p < .01) and reduced the effects of school climate longitudinally (β = -0.07 to -0.24, p < .01). Early substance use initiation may be a warning sign of other underlying student issues and requires additional school support to foster student success. Findings suggest that a positive school climate may delay substance use initiation and promote school success. School climate may, therefore, be useful as an intervention to support school-based health promotion.

Substance use behaviors in adolescent and young adult cancer patients: Associations with mental and physical health.

Cancer diagnosis in adolescents and young adults (AYAs) coincides with the developmental initiation of substance use and emergence of affective disturbance. We examined substance use behaviors and risk-stratified associations with mental and physical health, as well as objective indicators of tobacco and cannabis use and concordance with self-report and medical records. AYAs were 15 to 39 years at cancer diagnosis and ≥18 years and ≥6 months postdiagnosis at study enrollment. Risk-stratified groups included nonsmoker/nondrinker, nonsmoker/drinker, smoker/drinker. Assessments included demographics, past year tobacco, alcohol, and cannabis use, depression, anxiety, sleep, and physical activity. Urine analysis provided biochemical verification of tobacco and cannabis use. Participants included 100 AYAs (60% male) with primarily hematological cancers (88%). Past year alcohol, tobacco, and cannabis use prevalence rates were 80%, 15%, and 33%, respectively. A minority (non-users) refrained from both alcohol and tobacco (20%), while most were exclusively alcohol users (65%) or alcohol and tobacco co-users (15%). Relative to other sub-groups, co-users reported more depressive and anxious symptoms, while non-users reported more physical activity. More frequent tobacco and cannabis use were associated with more depressive and anxious symptoms, while more frequent alcohol use was associated with lower physical activity. There were no group differences or associations with sleep quality. There was considerable discordance between tobacco use self-report, biochemical verification, and medical record documentation. Substance use among AYAs is common and detrimental to mental and physical health, especially among more frequent users and co-users, highlighting the need for early assessment and intervention.

Socio-Demographic and Clinical Profiles of Cannabis Abusers Admitted for Treatment in a Tertiary Healthcare Facility in Uyo, South-South Nigeria

Background: Cannabis is one of the commonly abused psychoactive substances worldwide. The increasing abuse of this psychoactive substance is recognized as a significant public health problem in many developing countries. A proper assessment of the patterns and trends of cannabis use disorders will be useful because of the increasing number of cannabis abusers worldwide and demand for appropriate treatment.&#x0D; Aims: This study examined the socio-demographic and clinical characteristics of cannabis abusers admitted for treatment in a tertiary healthcare institution in the South-South region of Nigeria.&#x0D; Materials and Methods: This was a retrospective study involving 105 subjects of cannabis abusers admitted for treatment over a one year period from August 2017 to July 2018. Socio-demographic and clinical variables were obtained from a careful chart review using a 35 item questionnaire. Diagnoses were made according to the International Classification of Disease Criteria (ICD-10).&#x0D; Results: 105 subjects were included in this study. The mean age of patients was 29.71±8.2. The mean age of initiation of substance use was 19.05±3.0 years. Males were predominantly involved in cannabis abuse practices. The age of initiation of substance use was significantly different between the male and female subjects (t=-2.86, P=.009). The age of initiation and duration of substance use was significantly related to the risk of developing substance dependence and psychotic symptoms.&#x0D; Conclusion: Cannabis was commonly abused by people who were often unemployed, single, young males involved in multiple drug abuse. The low mean duration of use, multiple substance abuses together with increasing frequency of psychiatric morbidity forms a major challenge for our mental health care services. There is the need for preventive, curative, and rehabilitative strategies to reduce the public health impact of this scourge.

Correlates of Pregnant Women's Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care.

Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use interventions that are integrated within prenatal care. Our study examines demographic and clinical correlates of participation in an initial assessment and counseling intervention integrated into prenatal care in a large healthcare system. The sample comprised Kaiser Permanente Northern California pregnant women with a live birth in 2014 or 2015 who screened positive for prenatal substance use via a self-reported questionnaire and/or urine toxicology test given as part of standard prenatal care (at ~ 8weeks gestation). Of the 11,843 women who screened positive for prenatal substance use (median age = 30years; 42% white; 38% screened positive for alcohol only, 20% for cannabis only, 5% nicotine only, 17% other drugs only, and 19% ≥ 2 substance categories), 9836 (83%) completed the initial substance use assessment and counseling intervention. Results from multivariable logistic regression analyses indicated that younger age, lower income, single marital status, and a positive urine toxicology test predicted higher odds of participation, while other/unknown race/ethnicity, greater parity, receiving the screening later in pregnancy, and screening positive for alcohol only or other drugs only predicted lower odds of participation (all Ps < .05). Findings suggest that integrated substance use interventions can successfully reach vulnerable populations of pregnant women (e.g., younger, lower income, racial/ethnic minorities). Future research should address whether differences in participation are due to patient (e.g., type of substance used, perceived stigma) or provider factors (e.g., working harder to engage traditionally underserved patients).

Risk and protective factors for repeated overdose after opioid overdose survival

BackgroundNonfatal opioid overdose (OD) is an opportunity to identify patients who may benefit from interventions to reduce repeated overdose (rOD). In this study, we sought to determine risk and protective factors associated with rOD. MethodsIn this retrospective cohort study of 4,155 patients aged 18–64 who presented to one of 16 emergency departments in a single Western Pennsylvania health system between July 2015 and January 2018 for index opioid overdose (iOD) and survived to discharge, we identified demographic and clinical factors association with rOD within one-year. Relative risk of repeated opioid overdose was estimated using adjusted Cox proportional hazard ratios (aHRs). Results14.9 % of patients (95 % CI 13.9–16.1) had a rOD, with 29 % occurring within 30 days from iOD. The adjusted hazard of opioid overdose was increased for male patients (aHR = 1.19; 95 % CI 1.01, 1.41), those with pre-iOD diagnoses of anxiety (aHR = 1.41; 95 % CI1.13, 1.77), depression (aHR = 1.44; 95 % CI 1.17, 1.78), substance use disorders (aHR = 1.30; 95 % CI 1.09, 1.55), and alcohol use disorder (aHR = 1.52; 95 % CI 1.02, 2.25). The hazard was lower for individuals prescribed an opioid in the 90 days prior to iOD (aHR = 0.59; 95 % CI 0.37, 0.97) and those admitted to the hospital for iOD (aHR = 0.56; 95 % CI 0.37, 0.86). ConclusionWe found that, among ED patients who survive an initial OD, mental health and substance use diagnoses are associated with a higher hazard of repeated overdoses whereas opioids prescriptions and admission are associated with lower hazards.

Addiction, childhood experiences and nurse's role in prevention: a qualitative study.

Parenting approach and early childhood experiences are thought to be two important factors in the initiation of substance use. We aimed to explore the nurse's role in the prevention of childhood addiction. In this qualitative study we conducted in-depth interviews with young men and women who were either in treatment for their addiction or were active drug users as well as with family members and nurses. The data analysis followed Strauss and Corbin's constant comparison method. The data analysis revealed six categories: traumatic events during childhood, inappropriate parenting approach, Lack of knowledge and a tolerant attitude toward drug use, turning a blind eye on the threat of drug use, nurses' poor experience of drug use prevention, and the lack of a clear definition of the nurse's role in prevention of drug use. Nurses who work with young people and their families have a special opportunity for prevention, early detection and timely intervention for drug dependency.

School-based interventions for preventing substance use in indigenous children ages 7–13: a scoping review protocol

IntroductionThroughout the world, indigenous peoples share traumatic colonial experiences that have caused gross inequalities for them and continue to impact every aspect of their lives. The effect of intergenerational trauma...

Identifying Competing Life Reinforcers for Substance Use in First Nation Adolescents

Background: Indigenous youth are at increased risk of initiating substance use at early ages and suffer greater negative consequences related to substance use as compared to non-Indigenous youth. Behavioral Theories of Choice suggests that substance use is contingent on the availability of substances and the availability of alternatives to substance use. Objectives: The present study aimed to investigate risk and protective factors associated with substance use in one group of First Nation adolescents. Methods: Using a modified grounded theory approach, the present study conducted qualitative focus groups and individual interviews with fifteen reserve-dwelling (75% female, M age = 15.2 years) First Nation adolescents to assess categories of risk and protective factors based upon Behavioral Theories of Choice. Results: Adolescents identified peer influences, parental/family influences, and community influences and issues as risk and protective factors associated with substance use. Conclusions: Results highlight possible targets of culturally appropriate prevention strategies for Indigenous populations.

Substance Use in Adolescents Presenting to the Emergency Department

Background: Adolescent substance use is a dynamic public health problem. Adolescence is a unique developmental period involving overlapping biological, psychological, and social factors which increase the rates of initiation of substance use. The developing adolescent brain is particularly susceptible to the effects of substances and most adults with substance use disorders began to have symptoms and problems in their adolescent years. Yet, for various reasons, most adolescents who use, misuse, abuse, or are addicted to substances do not perceive the need for treatment. Objective: Drug and alcohol use among adolescents is a common presentation in hospital Emergency Departments (EDs) and presents in different forms including in association with intoxication, withdrawal states, or trauma associated with drug-related events. For many adolescents with substance use, the Emergency Department (ED) is the first point of contact with medical personnel and thus also serves as a potential entry point into treatment. Methods: This article reviews the common ways drug and alcohol problems present in the ED, clinical assessment of the patient and family, screening, laboratory testing, brief interventions in the ED, and referral to treatment beyond the ED. Conclusion: Guidelines on how to manage the shifting terrain of adolescent substance use presenting in EDs across the nation continue to evolve. We highlight that considerable further research is needed to inform effective ED protocols to address this important individual and public health safety concern. Systems of care models which include collaborative teams of diverse stake holders are needed to effectively manage adolescents with substance use disorders.

Initiating Substance Use Disorder Treatment for Hospitalized Alcohol Use Disorder Patients

Initiating Substance Use Disorder Treatment for Hospitalized Alcohol Use Disorder Patients