Rates Of Misuse Research Articles

Positive Behavioral Interventions and Supports and Substance Misuse in Secondary Schools

Amid a proliferation of highly potent opioids, school systems have sought to invest in programs for preventing substance misuse. School teams often prioritize early screening and intervention to prevent student substance misuse; however, given the limited resources of many schools, it is crucial to understand the extent to which commonly available data and existing frameworks are relevant for prevention efforts. In this study, we examined (a) how commonly available data on substance misuse (office discipline referrals [ODRs]) relate to self-reported substance misuse and (b) how positive behavioral interventions and supports (PBIS) implementation across tiers relates to these substance-related outcomes. We found that self-reported substance misuse is significantly related to substance-related ODRs, but that self-report rates are much higher than ODR rates. We also found that Tier 2 PBIS implementation was associated with significantly lower rates of both self-reported substance misuse and substance-related ODRs. These findings suggest that aspects of PBIS implementation could be beneficial in preventing substance misuse, but more research is needed to understand what specific school-based practices best address these student behavioral health needs.

The heart of the matter: a re-iteration of the role of the social determinants of health in addressing health inequity in Central Australia.

The persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific.

Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions. We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results. Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings. Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.

Examining the Myth of Prescribed Stimulant Misuse among Individuals with Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

The literature emphasizes the importance of addressing the misuse of ADHD medications as a potential significant healthcare issue within the general population. Nevertheless, there are no systematic reviews that specifically examine whether the misuse of psychostimulant medication among clinical populations diagnosed with ADHD who are undergoing prescribed stimulant therapy is a rational concern or a false myth. This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched PubMed databases for articles indexed up to 12th July 2023, without language restrictions. Our systematic search generated 996 unique articles. After a full-text revision, 13 studies met the eligibility criteria and were included in the systematic review. In the 50% of the study on the adult population, the reported prevalence of stimulant misuse was 0%. In other studies, the range of stimulant misuse rates varied from 2% to 29%, with no available data specifically focusing on the youth population. It has been noted that misuse of prescribed stimulant treatment is linked with particular subject characteristics, such as older age, prior or more frequent use of ADHD medication, use of short-acting medication, and a history of alcohol/substance misuse diagnosis. Despite certain limitations, our study highlights that while a significant proportion of individuals undergoing psychostimulant treatment for ADHD follow their prescribed medication regimens without resorting to misuse behaviors, there is variability in adherence, with occurrences of misuse behaviors. The misuse of prescribed ADHD treatment appears to be associated with distinct subject characteristics, underscoring the importance for tailored interventions addressing the specific requirements of these individuals to attain optimal treatment outcomes while mitigating misuse risks.

In treating opioid use disorder, does buprenorphine have an increased rate of misuse and diversion compared with buprenorphine–naloxone?

In treating opioid use disorder, does buprenorphine have an increased rate of misuse and diversion compared with buprenorphine–naloxone?

Kv7 channel opener retigabine reduces self-administration of cocaine but not sucrose in rats.

The increasing rates of drug misuse highlight the urgency of identifying improved therapeutics for treatment. Most drug-seeking behaviours that can be modelled in rodents utilize the repeated intravenous self-administration (SA) of drugs. Recent studies examining the mesolimbic pathway suggest that Kv7/KCNQ channels may contribute to the transition from recreational to chronic drug use. However, to date, all such studies used noncontingent, experimenter-delivered drug model systems, and the extent to which this effect generalizes to rats trained to self-administer drugs is not known. Here, we tested the ability of retigabine (ezogabine), a Kv7 channel opener, to regulate instrumental behaviour in male Sprague Dawley rats. We first validated the ability of retigabine to target experimenter-delivered cocaine in a conditioned place preference (CPP) assay and found that retigabine reduced the acquisition of place preference. Next, we trained rats for cocaine-SA under a fixed-ratio or progressive-ratio reinforcement schedule and found that retigabine pretreatment attenuated the SA of low to moderate doses of cocaine. This was not observed in parallel experiments, with rats self-administering sucrose, a natural reward. Compared with sucrose-SA, cocaine-SA was associated with reductions in the expression of the Kv7.5 subunit in the nucleus accumbens, without alterations in Kv7.2 and Kv7.3. Therefore, these studies reveal a reward-specific reduction in SA behaviour and support the notion that Kv7 is a potential therapeutic target for human psychiatric diseases with dysfunctional reward circuitry.

Profile of chronic pain patients with opioid withdrawal syndrome according to psychological factors: a Latent Class Analysis.

Withdrawal syndrome stands out as the strongest risk factor for Prescription Opioid-Use Disorder (POUD) and is related to psychological and pain impairment in chronic pain population. This study aimed to identify profiles of chronic pain patients with opioid withdrawal based on psychological factors, and to explore the association between the classes and demographic, clinical, and substance use variables. This cross-sectional descriptive study involved 391 patients, 221 of them with interdose withdrawal (mean age=57.91±13.61 years; 68.3% female). Latent Class Analysis (LCA) and bivariate and logistic regression analyses were performed. Two latent classes were identified (BIC=4020.72, entropy=0.70, LRTs p<0.01): Withdrawal syndrome with No Psychological Distress (WNPD; 45.2%, n=100) and Withdrawal syndrome with Psychological Distress (WPD; 54.8%, n=121). The WPD class was more likely to experience craving, anxiety, and depression, and to report higher levels of pain intensity and interference (p<0.01). Patients in this class were younger, visited a higher number of specialists, and showed higher rates of high-dose opioid use, misuse, moderate-severe POUD, and tobacco and anxiolytics use (p<0.05). Only moderate-severe POUD (OR=2.64) and tobacco use (OR=2.28) increased the risk of WPD class membership. Although it is common for chronic pain patients to experience withdrawal symptoms during opioid treatment, more than a half of the participants reported concomitant psychological distress. Establishing differential profiles can help to improve withdrawal syndrome management during the treatment of chronic pain with opioids.

Principals’ Demographic Qualities and the Misuse of School Material Capital in Secondary Schools

Abstract Previous studies tend to not only assess principals’ demographic variables but also use other dependent variables, such as administrative effectiveness, job performance, and student achievement. In the literature, principals’ demographic qualities and the misuse of material capital have been under-assessed. This study used a quantitative approach to investigate the demographic attributes of principals and the abuse of school material capital in secondary schools. Using a questionnaire, data were gathered from 667 secondary school administrators in Cross River State, Nigeria. The findings revealed significant differences in the misuse of school material capital by principals of different ages, professional qualifications, and years of experience. However, major disparities between male and female principals were not identified. More specifically, principals who were older, seasoned, and possessed bachelor’s and Master of Education degrees were efficient managers of school material capital. A high rate of misuse was found among principals who were younger and inexperienced than their counterparts who were young, less experienced, and possessed a postgraduate diploma in education, as well as other professional academic qualifications unrelated to the field of education (e.g., HND, BSc, BA, and MSc). Based on these findings, key implications for quality service delivery and administrative effectiveness were discussed.

A randomized controlled trial of a brief motivational interviewing-based group intervention for emerging adults experiencing homelessness: 24-month effects on alcohol use.

Despite rates of alcohol misuse being higher among emerging adults experiencing homelessness compared to those who are stably housed, there are few brief evidence-based risk reduction programs for this population that focus on alcohol use and assess outcomes for more than 1 year. This study examines alcohol outcomes from a 24-month evaluation of AWARE, a brief motivational interviewing-based group risk reduction intervention for emerging adults experiencing homelessness. In a cluster randomized crossover trial, 18- to 25- year-olds received AWARE (n = 132) or standard care (n = 144) at one of three drop-in centers serving young people experiencing homelessness in Los Angeles County. We evaluated intervention effects on past month alcohol use, consequences, and related cognitions such as motivation to change behavior. AWARE participants showed significant reductions over 24 months in alcohol use and negative consequences from drinking and reported significant increases in their use of drinking protective strategies. Except for drinking frequency, control group participants did not show a significant change in these outcomes. Findings build on earlier work by demonstrating that AWARE is effective in reducing alcohol use and related problems among emerging adults experiencing homelessness over a 2-year period. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review.

Tramadol is a widely prescribed painkiller around the world. As a synthetic opioid, it offers a valuable substitute for morphine and its derivatives in African countries. However, the adverse health effects of tramadol use resulting from illicit trafficking, like those caused by fentanyl and methadone in North America, have not been well-documented in Africa. This scoping review aims to shed light on the nature and scope of the nonmedical use (NMU) of tramadol in Africa and its associated health consequences. To carry out our scoping review, we used Arksey and O'Malley's (2005) five-step approach for exploratory analysis and followed Joanna Briggs Institute guidelines for scoping reviews to ensure systematic and replicable studies. We then searched six databases: Medline, Global Health (EBSCO), Scopus, Web of Science, the African Journals online database, and for grey literature via Google Scholar without any time restriction. The articles were imported into Covidence and reviewed by two independent researchers. Eighty-three studies on NMU of tramadol's prevalence or health consequences were selected from 532 titles/abstracts screened, including 60 cross-sectional and six qualitative studies from 10 African countries. Findings from the included studies highlighted five distinct groups significantly affected by the NMU of tramadol. These groups include: 1) young adults/active populations with varying degrees of prevalence ranging from 1.9% to 77.04%, 2) professionals, where drivers exhibit a relatively high prevalence of tramadol NMU, ranging from 7.2% to 35.1%, and commercial motorcyclists, with a prevalence of 76%, 3) patients, who have a high rate of tramadol NMUs, with prevalence rates ranging from 77.1% to 92%, 4) academics, with a considerable rate of tramadol misuse among substance-using undergraduates (74.2%) and substance-using high school students (83.3%), and 5) other individuals impacted in various ways. The health consequences are classified into four distinct types: intoxication, dependence syndrome, withdrawal syndrome and other symptoms. Despite providing a comprehensive global overview of the phenomenon described in the African literature, this systematic scoping review's main limitations stem from the relatively limited exploration of various consequences of the NMU of tramadol, notably those of a social and economic nature. Our review shows that tramadol misuse affects diverse populations in Africa. The prevalence of misuse varies within sub-populations, indicating the complexity of the issue. Professional and academic groups have different rates of misuse across regions. This highlights the need for targeted interventions to address unique challenges contributing to tramadol misuse. Future studies should focus on the social and economic costs of abuse on households to better understand the impact on well-being. Systematic review registration: Open Science Framework: https://osf.io/ykt25/.

Community perspectives on the use of extension offices for behavioral health

Rural communities experience more systemic health disparities than urban communities, particularly around behavioral health. Disparities include a lack of providers, few hospitals, lack of health insurance, stigma, and limited public transportation. This study explored the potential use of Cooperative Extension offices to serve as “hubs” for behavioral health services. We conducted six focus groups (n = 52) in rural communities with high rates of opioid use and misuse. Community stakeholders were asked about the potential benefits and barriers to using Cooperative Extension as a behavioral health hub and what role Extension can play in behavioral health. We identified four major themes related to the extension being used to address behavioral health: the organization is trusted, the organization could provide many services, potential structural and social barriers need to be addressed, and resources are necessary for success. The study found that Extension is trusted, lacks the stigma of a traditional behavioral health setting, and could provide prevention and/or recovery education and a connector to support services. However, Extension is not currently seen as a resource for behavioral health and may have structural barriers and create stigma by providing services. To address these barriers, it was suggested Extension partner with other organizations to extend the reach of existing resources (telehealth and support groups) while focusing on both prevention education and relationship building. Moving forward, participating counties will leverage their partners into a community advisory group to define next steps, develop processes and protocols and begin advertising services/resources, and provide continual feedback on how needs are being met and recommended improvements.

“Itʼs time for a change. I need to. I have to”: Substance misuse recovery turning points of unhoused Alaskans

Substance misuse is a pernicious health concern for many unhoused people. A deep understanding of turning points – what propels someone to take concrete action toward addressing substance misuse – is needed to inform recovery policies and practices. This study sought to identify common elements in turning points among unhoused people vis-à-vis a phenomenological qualitative approach. Twenty people (Mage = 47.47, SD = 9.75; 50% female) who self-identified as being in recovery while unhoused participated in semi-structured interviews in Anchorage, Alaska, a community with high rates of both houselessness and substance misuse. Survival (life- and health-sustaining), individual (intrapersonal), and relational (interpersonal) motivations all shaped turning points. Limitations include the possible underrepresentation of individuals using a harm-reduction approach or capturing differences by housing type. Programs to address substance misuse should consider these motivations. Future research should identify and refine turning points and work to understand how they interact with change processes.

Primary prevention of prescription stimulant misuse in first-year college students

Objective: Eight percent of college students report past year prescription stimulant misuse (nonmedical use of stimulants defined as taking stimulants in a manner other than prescribed). Despite this high prevalence rate, primary prevention efforts are lacking on college campuses. Participants and Methods: A prescription stimulant misuse primary prevention intervention targeting first-year college students was developed, refined, and pilot tested. Existing substance use treatment (motivational interviewing) and time management (cognitive behavioral therapy for adult ADHD) techniques were integrated into the novel brief prevention intervention. Focus groups provided feedback to help refine the prevention intervention. Following refinements, 484 first-year college students were randomly assigned to condition (327 treatment, 157 control) and followed for 3 months. Results: Participants rated the intervention as satisfactory. After controlling for time invariant covariates, condition significantly predicted prescription stimulant misuse. There was a lower rate of past 3-month prescription stimulant misuse reported in the intervention group (4.9%) compared to the control group (11.5%). Academic expectancies remained stable in the intervention group yet increased in the control condition over time. Time management skill ratings remained stable in both groups. Changes in academic expectancies, yet not time management skills, were a partial mediator of the prevention efficacy in prescription stimulant misuse at 3-month follow-up. Conclusions: These results provide preliminary support for the acceptability and efficacy of a brief primary prevention intervention for college student prescription stimulant misuse. Changes in positive prescription stimulant expectancies, yet not time management skills, appear to be potential targets for future preventive efforts.

Growth in Suicide Rates Among Children During the Illicit Opioid Crisis

This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10–17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation—as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health—were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.

Compliance with Glasgow Modified Alcohol Withdrawal Scale Guidelines within Emergency Medicine Utilising Electronic Prescribing Protocols

Abstract Introduction Glasgow Modified Alcohol Withdrawal Scale (GMAWS) allows evidence-based management of patients at risk of alcohol withdrawals within the hospital setting. Adherence to this guideline mitigates risk of patients developing Wernicke-Korsakoff syndrome, a neurological disorder resulting from a thiamine deficiency induced by chronic alcohol consumption1. As Scotland has particularly high rates of alcohol misuse, utilisation of this guideline avoids development of this serious complication with a large at-risk population. However, non-compliance and incorrect prescribing has been prevalent as this can be difficult and time-consuming to manually prescribe leading to errors. This can be avoided by utilising the novel electronic prescribing protocol on Hospital Electronic Prescribing and Medicine Administration (HEPMA) programme. Aim The aim of this quality improvement project was to increase compliance with the GMAWS guideline and ensure correct prescribing within Emergency Medicine. Methods Data collection was supported by the HEPMA team, with daily reports of all identified patients to allow evaluation of GMAWS prescribing as per protocols. Identified patients were confirmed to be on GMAWS and not prescribed thiamine/benzodiazepines for another indication with presence of GMAWS paper chart. Data was initially collected over a two-week period to establish a baseline, with further two-week periods of data collection after interventions. Intervention 1 was distribution of a hospital wide memo regarding GMAWS protocol. Intervention 2 was buzzword teaching on GMAWS with small groups of prescribers. This study did not require ethics approval due to it being a service evaluation / improvement project. Results The data collection following interventions demonstrated improved compliance with HEPMA protocols, evidenced by an increase from 33.3% at baseline to 82.1% compliance. The intervention of buzzword teaching was most impactful with 82.1% compliance recorded following this. An overall increase of 55.6% in the total prescribing of GMAWS signifies an increased awareness of the guidelines and increased confidence with prescribing. Discussion/Conclusion As novel electronic prescribing continues to evolve, pharmacy is a main contributor for advocating optimised prescribing and supporting best practice. Significant learning points included that many patients were on unnecessarily prolonged courses of parental thiamine, which has significant cost and nursing time implications. This is supported by the fact that oral thiamine costs 0.5% of the total cost of giving parental thiamine daily and reduced risks from unnecessary prolonged cannulation. We were able to incorporate this learning into the buzzword teaching to prompt review of parental thiamine prescribed without a clear duration. This project has prompted a review of our health board’s GMAWS guideline to streamline and update guidance in line with updated NICE guidelines. Feedback from the buzzword teaching sessions has been incorporated to improve readability and aid use, via the rationalisation of the GMAWS paperwork. The corresponding HEPMA protocols will then be updated to reflect these changes. Furthermore, this work has influenced other specialities to create and teach the use of HEPMA protocols to optimise treatment.

State Supplemental Nutrition Assistance Program Policies and Substance Use Rates

Introduction. Food insecurity is associated with the development of substance misuse and use disorders (SUD). This study sought to estimate associations between state Supplemental Nutrition Assistance Program (SNAP) eligibility policies and substance-related outcomes. Methods. 2014-2017 SNAP Policy Database and 2015-2019 National Survey on Drug Use and Health state-level estimates were used to estimate associations between state SNAP eligibility policies and alcohol use disorder (AUD), opioid misuse, illicit drug use disorder (IDUD), SUD, and needing but not receiving SUD treatment. State SNAP policies included those that 1) do not disqualify individuals with a felony drug conviction from SNAP and/or 2) expand SNAP eligibility by increasing the income limit or removing the asset test. Analyses were conducted January-May 2023. Results. States that adopted both SNAP eligibility policies had reduced rates of AUD (adjusted rate ratio (aRR): 0.92; 95% CI0.86, 0.99), opioid misuse (aRR:0.94; 95% CI0.89, 0.98), IDUD (aRR:0.91; 95% CI0.85, 0.98), SUD (aRR:0.91; 95% CI0.85, 0.97), and needing but not receiving SUD treatment (aRR:0.92; 95% CI0.87, 0.98) compared to states with neither policy. Among states that did not adopt increases to the income limit or removal of the asset test, those that removed the felony drug disqualification had lower rates of IDUD, SUD, and needing but not receiving SUD treatment, compared to those that maintained a disqualification. Conclusions. Expanded SNAP eligibility could help reduce rates of substance misuse and SUD. Opting out of the federal disqualification on SNAP participation for those with felony drug convictions may be particularly beneficial.

Determinants of prescription opioid misuse among Black Americans: Evidence from the 2019 National Survey on Drug Use and Health

BackgroundOpioid misuse, including prescription opioid misuse, remains a significant public health concern impacting various ethnoracial groups in the United States, including non-Hispanic Black Americans. This study provides more recent evidence on prescription opioid misuse among Black Americans. MethodsWe used data from the 2019 National Survey on Drug Use and Health to examine the prevalence and determinants of prescription opioid misuse among Black American adults aged 18 and older. We compared these findings to non-Hispanic White American adults. ResultsThe prevalence rate of past-year prescription opioid misuse was very similar among Black (3.4%) and White respondents (3.8%). Adjusted multivariate logistic regression analyses found no significant racial differences in prescription opioid misuse. Religious importance and rurality were negatively associated with misuse only among Black respondents. Depressive episodes, other drug use, age, and risk-taking behaviors were associated with prescription opioid misuse among both Black and White respondents. ConclusionBlack and White Americans remain at risk for prescription opioid-related problems. Religiosity and rurality require further investigation to understand how they may impact misuse among Black Americans.

Adolescents’ assessment of a Family Medication Safety Plan for opioid prescriptions: A qualitative usability study

BackgroundWhen children are injured or have surgery, parents can be hesitant to fill opioid prescriptions and youth may be concerned about using these medications to manage pain. Parents cite a myriad of reasons why they worry about their child using opioids. The MedSMA℞T Families intervention, which includes a Family Medication Safety Plan (FMSP), is a tool designed to support families in learning and communicating about safe prescription opioid use in their homes and with health care providers. ObjectiveThis study’s first aim was to examine adolescents’ experiences with using the FMSP. The second aim of this study was to identify opportunities for future improvement. MethodsAdolescents, aged 12-18 years, were recruited from April 2021 to October 2021. They were recruited through Qualtrics research panels, email listservs, social media, and snowball sampling. Adolescents reviewed the FMSP and then completed a semistructured follow-up interview with a study team member virtually. The interviews were professionally transcribed verbatim, reviewed by the study team for accuracy, and downloaded into NVivo for analysis. Main themes were identified using content and thematic analysis. ResultsAdolescents (N = 65) reviewed the FMSP and participated in the study. Adolescents found the FMSP to be acceptable and useful for prompting discussions with parents about not only opioids, but all medications being used by the youth. Study participants suggested key improvements such as the creation of a kid-friendly or Spanish language version to improve accessibility and uptake by a diverse population of teens. ConclusionAdolescents reported that the FMSP would be a helpful tool for their families. Implementing this tool at the point of prescribing or dispensing is a potential strategy to reduce the rates of opioid misuse, reduce hesitancy, and allow adolescents more agency regarding their health care and medication management.

Is Medical Student Well-being Related to the Overall “Happiness” of a Country?

Previous research has repeatedly shown poor mental health, high rates of substance misuse, and burnout in medical students across many countries. The annual World Happiness Report provides insight into how “happy” countries are and how happiness is measured. Our review aims to identify whether whole population “happiness” across different countries correlates with data looking specifically at burnout in medical students. We found a moderate negative correlation between medical student burnout (disengagement type) and population average life evaluations. There appears, therefore, to be some association between rates of medical student burnout in a country and the overall population average life evaluations. The overall happiness of a country obviously reflects on the whole population, but medical students are, especially under pressure and subject to unusual stressors. In this study, we note various factors which may need further exploration in future studies.

Do Peers, Neighborhood Disorder, Religiosity, Spirituality, and Family Support Influence Polysubstance Use Among Older Youth Transitioning from Foster Care?

ABSTRACT Purpose Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose. Method This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children’s Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances. Results Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p < .001), having deviant peers (RR = 1.15, p < .001), and living in a more disordered neighborhood (RR = 1.13, p < .05), increased the risk engaging in polysubstance use. Discussion Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use. Conclusion Interventions should work to reduce deviant peer relationships among foster youth.