Rates Of Substance Use Research Articles

Explaining Substance Use among Puerto Rican Older Adults: Impact of Perceived Discrimination, Perceived Stress, and Social Activities

Background: Despite Puerto Ricans having one of the highest rates of substance use among Hispanic groups in the United States, limited research has focused on the impact of perceived discrimination and stress on substance use among older adults. Individuals who experience stressful events are inclined to engage in harmful behaviors as a coping mechanism. Objectives: Based on the propositions of the General Strain Theory, the current study explores the relationship between perceived discrimination, perceived stress, social activities, and the use of alcohol and cigarettes. Methods: Baseline data from the Boston Puerto Rican Health Study collected in 2014 was used to conduct a logistic regression analysis. Results: The findings reveal that while perceived discrimination is significantly linked to both types of substance use, social activities may serve as a protective factor for cigarette use. Conclusion/Importance: Our study findings emphasize the need to examine perceived discrimination as a stressor impacting the health and well-being of Puerto Ricans in later adulthood. Policy implications for reducing substance use and directions for future research are discussed

Provider perspectives on the impact of COVID-19 on treatment of substance use and opioid use disorders among American Indian and Alaska Native adults.

American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the opioid poisoning crisis, in combination with ongoing treatment barriers resulting from settler-colonialism, systemic oppression and racial discrimination. AI/AN adults are at greatest risk of COVID-19 related serious illness and death. In collaboration with an Indigenous community advisory board and Tribal leadership, this study explored AI/AN treatment provider perceptions of client-relatives' (i.e., SUD treatment recipients) experiences during the pandemic from 2020 to 2022. Providers who underwent screening and were eligible to participate (N = 25) represented 6 programs and organizations serving rural and urban areas in Washington, Utah, and Minnesota. Participants engaged in audio-recorded 60-90 min semi-structured individual interviews conducted virtually via Zoom. The interview guide included 15 questions covering regulatory changes, guidance for telemedicine, policy and procedures, staff communication, and client-relatives' reactions to implemented changes, service utilization, changes in treatment modality, and perceptions of impact on their roles and practice. Interview recordings were transcribed and de-identified. Members of the research team independently reviewed transcripts before reaching consensus. Coding was completed in Dedoose, followed by analyses informed by a qualitative descriptive approach. Five main domains were identified related to client-relative experiences during the COVID-19 pandemic, as observed by providers: (1) accessibility, (2) co-occurring mental health, (3) social determinants of health, (4) substance use, coping, and harm reduction strategies, and (5) community strengths. Providers reported the distinctive experiences of AI/AN communities, highlighting the impact on client-relatives, who faced challenges such as reduced income, heightened grief and loss, and elevated rates of substance use and opioid-related poisonings. Community and culturally informed programming promoting resilience and healing are outlined. Findings underscore the impact on SUD among AI/AN communities during the COVID-19 pandemic. Identifying treatment barriers and mental health impacts on client-relatives during a global pandemic can inform ongoing and future culturally responsive SUD prevention and treatment strategies. Elevating collective voice to strengthen Indigenous informed systems of care to address the gap in culturally-and community-based services, can bolster holistic approaches and long-term service needs to promote SUD prevention efforts beyond emergency response efforts.

Substance Use and Outcomes of Left-sided Valve Replacement in Patients With Infective Endocarditis

BackgroundRising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort. MethodsUsing the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups. ResultsOf the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; P < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; P < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; P < .001) and costlier admissions ($84,949 vs $74,122; P < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; P < .001) but more often died when readmitted (9.6% vs 4.6%; P < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; P = .8) and 90 days (31.8% vs 29.3%; P = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; P < .018). ConclusionsDespite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.

Bayesian spatial mapping of rates of substance use among high-school students in Florida

ABSTRACT Objective In adolescent substance use research, more work has been done in identifying risk factors at individual level while little work was done at community level. The objective of this study is to examine the possible risk factors associated with substance use by high-school students at county level. Methods Data on the percentages of county-level substance use by adolescents and county-level risk factors were obtained from the Florida Department of Health, Division of Public Health Statistics & Performance Management (DPHSM). Spatial beta models were used to examine the associations between risk factors and rates of substance use. Results Geographic variation in rates of substance use by adolescents was observed in Florida, ranging from 6.5% to 28.6% for drug use, and from 14.8% to 36.3% for alcohol. It was found that percentages of black population and individual below poverty level were inversely associated with rates of drug use by adolescents. There were no significant associations between percentages of drug use by adolescents and median income, adult drug use, school suspension, and student emotional/behavioral disability per county. Conclusion Interventions for reducing rates of adolescent substance use may focus on involving parents to monitor financial resources for their children.

Feasibility and Acceptability of a Trauma-informed Intervention to Leverage Caregivers in Preventing Opioid Use Among Youth Involved in the Legal System.

Youth in the legal system (YILS) report high rates of substance use (SU), complex family/social relationships, and chronic trauma. The current study tested the feasibility of a prevention intervention, Trust-based Relational Intervention® (TBRI®), that leverages family systems by strengthening connection and providing emotional and instrumental guidance and support. TBRI includes the primary TBRI Intervention, comprised of Caregiver Training, Youth Training, and joint youth-caregiver Nurture Groups, and TBRI Family Coaching. With a sample of eight youth-caregiver dyads, the study adopted a mixed-methods design with a multi-informant approach to fulfill two goals: (1) testing TBRI as a prevention intervention for opioid use (OU), other SU, and related issues, and (2) testing the feasibility and acceptability of the TBRI Intervention by virtual delivery. Session attendance and completion rates demonstrated feasibility of recruiting and retaining participants and intervention fidelity. Preliminary results were reported on intervention outcomes, including OU and other SU, illegal activities, and educational attainment. Pre- and post-intervention comparisons showed decreases in youth negative urgency, conduct problems, and hyperactivity. Caregiver and staff participants responded favorably to TBRI and its virtual delivery; youth were more capable of expressing their needs and acknowledged the importance of families in preventing problems after discharge from secure facilities. While acknowledging sufficiency of intervention content, caregivers expressed the desire for more sessions. Results demonstrate the feasibility and acceptability of a trauma-informed, attachment-based prevention intervention for youth and families in contact with the legal system. TBRI is a promising approach for preventing the initiation or escalation of OU among YILS.

Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county

BackgroundGiven high rates of substance use among justice-involved youth, justice systems have attempted to monitor use through drug screening (DS) procedures. However, there is discretion in deciding who is screened for substance use, as not every youth who encounters the system is screened. The aim of the current study was to examine factors associated with selection for and results of oral DS among justice-involved youth assigned to probation to better inform potential DS policy. Electronic court records from 4,668 youth with first-incident records assigned to probation in a midwestern urban county’s juvenile justice system between 2011 and 2016 were included in the analytical sample. Race/ethnicity, gender, age, number of charges and charge type for the current incident were included as independent variables.ResultsMultivariable hierarchical logistic regression analyses indicated that males were more likely to be assigned to DS (aOR = 0.40, 95%CI [0.34, 0.46]), and more likely to test positive for use (aOR = 0.43, 95% CI [0.34, 0.54]) than females. As age increased, youth were less likely to be assigned to DS (aOR = 0.91, 95% CI [0.87, 0.94]), with non-significant differences in DS results. Greater number of charges were associated with a higher likelihood of being assigned to DS (aOR = 1.55, 95% CI [1.43, 1.68]). Youth with violent offenses were more likely to be assigned to DS than those with other offense types (property offenses, drug offenses, statutory offenses, disorderly conduct, and all other offenses), but less likely to test positive for use.ConclusionsMany factors were associated with differences in DS, but these factors were not always associated with differential DS results. Demographic or charge-based decisions may not be appropriate for DS assignment.

A Narrative Review Exploring Attention Deficit/Hyperactivity Disorder in Patients with Early Psychosis.

While both Attention deficit hyperactivity disorder (ADHD) and schizophrenia are considered to have neurodevelopmental origins with associated impairments in executive functioning, there is a paucity of clinical guidelines pertaining specifically to this comorbidity. We sought to summarize the existing literature on ADHD in early psychosis patients, focusing on issues that would be most relevant to clinical practice. For this narrative review, we completed a search on PubMed and PsycINFO with 22 papers meeting criteria for review. Overall, it appears that a diagnosis of ADHD in childhood increases the risk of the subsequent development of a primary psychotic disorder. This risk may be modified by higher rates of substance use and could be related to shared premorbid risk factors for both conditions, such as obstetrical complications. Stimulant use has been associated with the onset of psychotic symptoms in some individuals, but it is unclear whether certain subgroups are more susceptible. Despite the fact that these two conditions co-occur relatively frequently, there is currently a lack of objective diagnostic tests for ADHD specific to populations with primary psychotic disorders, and a paucity of evidence on whether stimulants are effective for ADHD symptoms in this sub-group. Future research is warranted to investigate whether stimulant treatment confers any additional risks for symptom exacerbation in individuals with primary psychotic disorders taking antipsychotic maintenance treatment.

A Network Science Approach to Sex-Polydrug Use Among Black Sexually Minoritized Men and Transgender Women: The N2 Cohort Study.

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex (p < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02-2.14; p = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33-0.98; p = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21-0.64; p < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26-0.84; p = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers (p < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels.

Distal and Proximal Minority Stressors on Patterns of Tobacco and Cannabis Use Among Young Bisexual Women.

Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women. Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use. The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use. Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.

Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019.

As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. We conducted a longitudinal, cross-sectional analysis comparing trends. We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

BackgroundLesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people’s experiences in SU services and recommendations for LGBTQ+- affirming care.MethodsWe conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants’ experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.ResultsPatient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants’ sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures.ConclusionsLGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Examining implementation determinants of a culturally grounded, school-based prevention curriculum in rural Hawai'i: A test development and validation study.

This study examined the implementation determinants of a culturally grounded, school-based drug prevention curriculum in rural Hawai'i. Test development and validation procedures were used to examine the impact of implementation barriers and facilitators of the curriculum in public or charter middle/intermediate schools on Hawai'i Island. A five-phase, mixed-methods approach toward test development and validation was used. These phases included item generation (Phase 1), item refinement and selection (Phase 2), item reduction (Phase 3), reliability testing (Phase 4), and validity testing (Phase 5). Educational administrators, teachers, and staff employed by the Hawai'i State Department of Education (HIDOE) participated in the study. Phases 1 and 2 yielded 50 implementation barriers and 27 implementation facilitators that were evaluated by 204 HIDOE administrators, teachers, and staff. Factor analysis of the barrier items indicated a four-factor solution: (1) Innovation Barriers, (2) HIDOE State-Level Barriers, (3) Teacher-Level Barriers, and (4) Administrator-Level Barriers. Mean comparisons indicated that several barrier and facilitator items differentiated teachers from administrators in the sample. This study contributes to the implementation measurement literature, specifically in the areas of mental health and substance use. It also highlights the importance of addressing multiple contextual levels in the implementation of culturally focused prevention interventions. Examining Implementation Barriers and Facilitators for School-Based Prevention in Hawai'i. Plain Language Summary Compared with other major ethnic groups, Native Hawaiian and Pacific Islander (NHPI) youth have substantially higher rates of substance use and higher adverse mental and physical health effects related to their use. Despite these disparities, educational and community-based practitioners have long struggled with implementing and sustaining promising substance use interventions for NHPI youth. This study contributes to our understanding of measuring implementation barriers and facilitators for substance use prevention for NHPI youth in rural school settings. It contributes to the field of health disparities and health equity promotion, by addressing calls for research to understand factors affecting successful implementation of prevention programs. This is critical toward achieving health equity for underrepresented and vulnerable populations, such as NHPI and rural youth.

Substance Use Disorder and Suicidal Ideation in Rural Maryland

Background Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland. Methods The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender. Results Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation. Conclusions The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

The relationship between substance use and self-reported aspects of social functioning in patients with a psychotic disorder.

In patients with a psychotic disorder, rates of substance use (tobacco, cannabis, and alcohol) are higher compared to the general population. However, little is known about associations between substance use and self-reported aspects of social functioning in patients with a psychotic disorder. In this cross-sectional study of 281 community-dwelling patients with a psychotic disorder, linear regression models were used to assess associations between substance use (tobacco, cannabis, or alcohol) and self-reported aspects of social functioning (perceived social support, stigmatization, social participation, or loneliness) adjusting for confounders (age, gender, and severity of psychopathology). Compared to nonsmokers, both intermediate and heavy smokers reported lower scores on loneliness (E=-0.580, SE=0.258, p=0.025 and E=-0.547, SE=0,272, p=0.046, respectively). Daily cannabis users reported less social participation deficits than non-cannabis users (E=-0.348, SE=0.145, p=0.017). Problematic alcohol use was associated with more perceived social support compared to non-alcohol use (E=3.152, SE=1.102, p=0.005). Polysubstance users reported less loneliness compared to no users (E=-0.569, SE=0.287, p=0.049). Substance use in patients with psychosis is associated with more favorable scores on various self-reported aspects of social functioning.

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic.

Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use. Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption. A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020. Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns. The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

Walking the Divide: A Public Health Journey from Manhattan to Harlem.

This paper examines the striking contrasts and inequalities observation by walking from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, policymakers may work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.

Addressing experiences of trauma within Indigenous-focused substance use residential treatment: a systematic review and environmental scan

Indigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms.

“I had Some Memories that Popped up Again From My Childhood:” Perspectives of Incarcerated Women on the Initiation and Continuation of Substance Use

Women’s incarceration has been increasing over the past several decades, representing an incredibly high-need population. Jailed women have the highest rates of substance use and mental health issues compared to other criminal legal populations. Their trajectories into crime differ from men, often attributed to trauma, substance use, and traditional heterosexual partnerships. Using a thematic analysis and data from 42 interviews with jailed women, the current study examines women’s decision to engage in substance use and continuation or cessation of use. Findings contribute to the literature on gendered-pathways by describing their perspectives. Findings inform recommendations for future research and policy implications.

Abstract 15634: Primary Prevention Defibrillator Use in a Safety-Net Setting

Introduction: Disparities in use of implantable cardioverter-defibrillators (ICD) for primary prevention have been documented; however, whether ICDs may be underutilized within a safety-net healthcare system has not been studied. Methods: Using an electronic health record cohort of all patients with heart failure (HF) who received care within the public safety-net system in San Francisco from 2001-2018 linked to device implantation records from two health systems, we identified all patients with ICD implantation (adjudicated with manual chart review) and primary prevention ICD-eligible with no indication for secondary prevention ICD, EF&lt;35% on 2 echocardiograms at least 90 days apart, HF hospitalization (to increase specificity for symptomatic HF), and prescribed beta blocker and ACEi/ARB. For exploratory survival analysis, eligibility and follow up started at the second echocardiogram. Results: Out of 14,230 patients with HF, at least 384 patients were potentially eligible for primary prevention ICD, but only 9 (2.3%) had an ICD implanted (2 CRT-D, 7 ICD). Of these 6 were nonischemic, and 3 had revascularized ischemic cardiomyopathy. Those who received ICD were younger (47 years vs 55 years; p=0.05), with lower rates of substance use (Table). Among 4 patients who died after ICD, median survival after device placement was 2.8 years (range 0.73 to 7.3); among 5 still alive, median follow up is 6.2 years (range 5.5 to 7.0). In an exploratory analysis, survival did not greatly differ by ICD placement (logrank p=0.53; age-adjusted HR 1.55; 95%CI 0.57-4.24). Conclusion: Among individuals receiving care at a safety-net system in San Francisco, even acknowledging that not all barriers to ICD placement are measured, very few guideline-eligible patients received primary prevention ICD. Additional studies are needed to identify patient-level and systems-level barriers to referral and implantation specific to a diverse, publicly insured patient population.

Characteristics Associated with Substance Use and Non-use Among Street Children in Delhi, India: A Community-based Cross-sectional Epidemiological Study.

Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of Delhi. This cross-sectional survey was conducted through six NGOs working with street children, using Respondent Driven Sampling, in nine districts of Delhi (n = 766, 7-18 years). The multivariable model was developed by applying binary logistic regression analysis. The rate of substance use was 49%. Significant association was found between substance use in the past year and increasing age [Odds Ratio: OR (95% Confidence Interval)] [1.22(1.12,1.33)], male sex [4.34 (2.28,8.26)], lacking psychosocial support from family/relatives [3.27(1.84,5.80)], being engaged in earning from illegal sources, [3.04(1.75,5.29)], family use of substance [2.59(1.38,4.89)], presence of substance-using peers [29.86(14.38,62.01)], lack of non-drug-using peers [2.35(1.46,3.79)], and not possessing basic amenities [2.26(1.31,3.93)]. Multiple modifiable factors exist within the family and peer group, including risk and protective factors or a consequence of substance use. Some challenges in the form of difficulty in reaching out to them and poor treatment seeking by those using substances warrant intensification in both primary and secondary prevention initiatives.