Reported Substance Use Research Articles

Do we need urine drug screens in opioid addiction treatment: An observational study on self-report versus urine drug screens

BackgroundThe substance use crisis continues to progress. Medication for Opioid Use Disorder (MOUD) are prescribed to reduce opioid use and related harms; however, many individuals continue to use substances while on treatment. The objective of this study was to describe the temporal and demographic trends of the agreement between self-reported and urine tested substances. MethodsThe current study is a retrospective secondary analysis of three phases of a prospective cohort study (Pilot 2011, Genetics of opioid addiction (GENOA) 2013–2017, and Pharmacogenetics of opioid substitution treatment (POST)) 2018–2022) spanning 2011–2022. We compared the self-reported substance use data for opioids, benzodiazepines, amphetamine/methamphetamine (AMP/MET), and cocaine with urine drug results. We compared the positive predictive value (PPV), false omission rate (FOR), sensitivity, and specificity between (i) different drugs; (ii) by sex, and (iii) age group at enrollment in each phase of the study using self-reported substance use at baseline and retrospective electronic health record data on urine drug screenings collected over the same time period. ResultsOverall, the average PPV and FOR for any drug across all phases was 80.7 % and 37.9 %, respectively. Sensitivity and specificity were highest for cocaine and lowest for benzodiazepines. We found no specific trend by sex. Lastly, we found a higher sensitivity for opioids and AMP/MET in those under 25 years of age compared to other age groups. PPV increased over time for benzodiazepines, AMP/MET and cocaine and FOR was higher during the pilot and POST phases than the GENOA phase. ConclusionOur study highlights the unique challenges associated with ascertaining substance use behaviour for individuals receiving MOUD, indicating many patients will accurately report substance use while others do not. It is therefore important to consider the context of the patient, and the type of the co-substance used to select patient-centred testing as indicated. Therefore, the answer to the question of do we need urine drug screen is yes in some cases.

Lifetime Adversity and Risky Substance Use among Transgender Emerging Adults: Selected Interventions and Clinical Social Work Practice

AbstractThis study investigated multivariate relations between indicators of lifetime adversity and past year risky substance use reported by an Internet-recruited sample of transgender emerging adults from the United States (N = 248, age M = 22.61 years). Canonical correlation analysis (CCA) documented the canonical correlation between canonical variates in this sample (.362), as well as the amount of shared variance (13.1%) between set of variables representing lifetime adversity and past year risky substance use. Examination of the standardized canonical coefficients and structure coefficients highlighted the important contributions of (a) past year drug use and negative consequences of substance use to the synthetic criterion variable and (b) lifetime intimate partner violence to the synthetic predictor variable. Information generated in this study about how specific observed variables contributed to canonical variates may be used to tailor trauma-informed selected interventions in clinical socialwork practice with transgender emerging adults who report substance use problems.

Inhaled Dimethyltryptamine (DMT): Use Patterns and Predictors of Consumption Frequency

ABSTRACT Despite increasing interest in psychedelics and their potential therapeutic effects, research on inhaled N,N-Dimethyltryptamine (DMT) remains limited. Inhaled DMT has a reputation for rapid, dramatic onset and a brief duration, but correlates of use frequency remain poorly understood. A sample recruited from relevant internet sites, including nearly 400 people who had inhaled DMT, reported substance use histories, motivations for use, DMT sources, risk perceptions, and other variables. Generally, participants reported initiation motivated by curiosity about DMT’s effects, interest in psychedelics more broadly, and potential spiritual benefits. Those who had used other psychoactive substances (especially ayahuasca) and who had extracted DMT themselves reported inhaled DMT more frequently. Most (>60%) reported obtaining DMT from a friend and claimed it was “slightly difficult” to procure. Participants most commonly inhaled DMT from a glass pipe, in private homes, frequently alone or in small groups. Salient positives associated with inhaling DMT included psychologically cleansing or cathartic experiences. Associated challenges concerned difficult integration, aversive experiences, or “bad trips.” Participants rated DMT as very or slightly safe. These data underscore the need for continued work on this topic to inform education and harm reduction efforts, particularly as the molecule’s reputation for ameliorative effects receives media coverage.

Substance Use among Youth Presenting to the Pediatric Emergency Department.

Our primary objective was to determine the frequency and type of substance use in youth presenting to our pediatric ED (PED). Our secondary objective was to identify characteristics associated with higher-risk substance use. We conducted a tablet-based, anonymous, self-administered screening for substance use using a modified version of the Screening to Brief Intervention (S2BI) tool among a convenience sample of 383 patients 12-21 years presenting to an urban, academic PED from February to July 2023. Patients' attitudes toward ED screening and interventions for substance use also were collected. The frequency and type of substance use was analyzed by age group. Ordinal logistic regression was used to identify characteristics associated with higher-risk use (monthly or more substance use) and lower-risk use (past year use), as compared to no past year use. Among 14-17-year-olds (n = 144), 38% reported substance use in the past year; 25% had higher-risk use. Among 18-21-year-olds (n = 172), 67% reported substance use in the past year; 48% had higher-risk use. Alcohol, cannabis, and tobacco were most commonly used. Substance use was rare for 12-13-year-olds. Compared to youth 14-17 years, youth 18-21 years were more likely to have either higher-risk use (aOR 3.81, 95% CI (2.24-6.47)) or lower-risk use (aOR 2.74 (1.41-5.35)), rather than no use. Compared to Asian patients, Non-Hispanic White patients (aOR 5.23 (1.07-25.66)) and Hispanic patients (aOR 3.18 (1.06-9.58)) were more likely to have higher-risk use than no use. Most patients reported that it was important for youth to be asked about substance use in the ED and to be offered help for substance use. Youth substance use was common in this urban, academic PED, and many patients reported higher-risk use. These findings support future research to determine the best practices for ED substance use screening and ED-based interventions for youth.

USING PREDICTIVE ANALYTICS TO IMPROVE SURVEILLANCE OF HEAT-RELATED ILLNESS DURING MILITARY TRAINING

Background: Heat-related illnesses are a critical concern for military personnel, especially those unfamiliar with hot climate regions. The Royal Thai Army (RTA) implements a 10-week military training program encompassing four phases: (1) Heat acclimatization training, (2) Combat fundamentals and unarmed combat training, (3) Armed combat training and tactical training, and (4) Field training exercise and evaluations. Objective: This study aimed to conduct a predictive analysis of heat-related illnesses to enhance prevention programs. Methods: The study utilized secondary data from the RTA Medical Department, incorporating variables such as age, occupation, education, underlying diseases, smoking and alcohol consumption, sleep duration, exercise, medication history, body mass index (BMI), weight loss, body temperature, dark urine, heat rash, and environmental humidity. Multiple machine learning algorithms were employed to develop predictive models. Results: The samples comprised 809 male recruits (103,051 encounters) with an average age of 22. Approximately 12% of the recruits had a BMI ≥30 kg/m2, while nearly 70% and 90% reported tobacco use and alcohol consumption in the past 12 months, respectively. Among the recruits, 16% reported substance use within the preceding 30 days. The eXtreme Gradient Boosting (XGB) model achieved 91% accuracy in predicting heat-related illnesses before Phase 2. The top five predictive variables were Lopburi Province (central region), Songkhla Province (southern region), and Bangkok (capital city), sleep duration before joining military training (hours), and age (years). Conclusion: This study, which applied machine learning techniques to predict heat-related illnesses among Thai recruits, can potentially impact the health and training of military personnel. The comparative analysis of various algorithms identified the XGB model as the optimal performer in predicting heat-related illnesses during the combat fundamentals and unarmed combat training phase. However, it is essential to note that further study is needed to enhance the applicability of our predictive model, which includes expanding its use to new cohorts of Thai conscripts, underscoring our research’s ongoing nature.

Naturalistic substance use before/during MTurk research participation is associated with increased substance demand and craving.

Although crowdsourcing platforms are widely used in substance-use research, it is unclear what percentage of participants use substances at the time of participation and how this might affect data quality, behavioral outcomes, or decision making. We conducted a secondary analysis of data collected on MTurk for a two-session, within-subject experiment recruiting individuals who regularly use alcohol, cannabis, cigarettes, or opioids. We analyzed 527 observations collected across two sessions (Session 1: n = 303, Session 2: n = 224) on measures of substance use before (within 3 hr)/during participation, data quality, demand in hypothetical purchase tasks, delay discounting, and craving. Substance use before/during participation was common (35.7%). Some participants reported substance use before/during both (25.4%) or only one (20.1%) of the sessions. Between-subject analyses of the first session data revealed that participants who used substances before/during participation did not differ on quality measures yet were slower to complete the survey. Controlling for individual differences in demographic variables and typical substance use, using a substance before/during participation was associated with increased hypothetical consumption of substances when the substance was free (demand intensity) and higher craving for substances, but not delay discounting. Substance use before/during MTurk participation among individuals who regularly use substances is prevalent and may impact outcome measures or standardization across sessions in repeated measures designs. Several implications have emerged, including statistically or experimentally controlling for substance use occurring before/during participation, which could improve the validity and rigor of online substance use research, and should be considered a part of best practices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and factors influencing substance abuse among secondary school students in Mbeya City, Tanzania

Background: Substance abuse among students has far-reaching social, religious, economic, health and demographic consequences, such as unplanned pregnancies, school dropouts, abortions, maternal and newborn mortality, infection risks and other psychological problems. Our study investigated the prevalence of substance abuse among secondary school students in Mbeya City, Tanzania. Methods: This school-based cross-sectional study was conducted from January to May 2021 among secondary students from Mbeya City, Tanzania. Students completed a self-administered substance use questionnaire. Data were analysed using descriptive statistics. Results: A total of 343 students were requested to participate in the study. However, 300 agreed to indicate 87% response rate. 9.7% (n=59) reported substance use, primarily cannabis, 75% (n=225) and alcohol, 68% (n=204). Friends influenced substance use among 82.7% of users. Reported immediate effects included misbehaviour, 73.7% (n=221) and unprotected sex, 72.3% (n=217). Long-term harms were predominantly brain damage (86.7%). Community education (78%) and media campaigns (76.7%) were suggested to curb use. Conclusion: Substance abuse among a sizable minority of Mbeya City secondary school students is driven by peer influence and has detrimental impacts reported by students themselves. Comprehensive education and preventive strategies engaging families, schools and communities are recommended to address this critical youth issue. Keywords: Substance abuse; cannabis; alcohol; secondary school students; Tanzania.

Prevalence of Substance Use Among Students in Health Colleges in Saudi Arabia: A Cross-Sectional Study.

Substance misuse is a global and substantial health concern that includes the inappropriate use of illicit substances or prescription and over-the-counter medications, which subsequently leads to poor outcomes such as a mental health disorder, financial distress, work malfunction, and academic failure. This study aimed to assess the prevalence of substance use, identify associated risk factors, explore potential complications within this specific demographic, and investigate the relationship between sociodemographic/lifestyle variables such as age, gender, marital status, family income, smoking, physical activity, and academic variables including grade point averages (GPAs), study hours, and the parental educational level with substance use history among students in health colleges in Saudi Arabia. This quantitative, descriptive cross-sectional study employed a questionnaire-based approach to collect data from students in health colleges across the regions of Saudi Arabia in the year 2022. The study found the prevalence of the use of various substances among students in health colleges to be 20.2%. Multiple factors were found to be associated with substance abuse. Smoking habits were the strongest predictor of substance misuse, with 49.1% of smokers reporting a history of substance use, compared to only 15.5% of non-smokers. This makes smoking the most impactful lifestyle factor related to substance use. Sleep patterns also played a significant role. A notable 43.6% of those who took up to two hours to fall asleep reported substance use, followed by 32.4% of those with sleep disorders and 25.5% with poor sleep quality. Unpredictable sleep patterns and a history of sleep disorders further strengthened the link between disrupted sleep and substance misuse. Academic performance, specifically GPA, showed that individuals with lower academic achievement were more likely to report substance use. Among those with a GPA below 3.0, 43.5% had a history of substance use, while only 16.7% of those with a GPA above 4.5 did so. The findings underscored the high prevalence of substance use, even among students in health colleges, and shed light on its connection to specific determinants. This poses a serious public health concern, as substance use is associated with poorer GPA, diminished knowledge acquisition, and overall academic performance. This, in turn, may negatively impact their future roles as healthcare providers, compromising both the quality of patient care and their personal well-being. These results emphasize the need for further investigations to unravel the underlying mechanisms of substance misuse and formulate innovative strategies to address this pressing issue effectively.

Hepatitis B prevalence and risk factors among adults living with HIV in South Africa: a clinic-based cohort study

BackgroundPeople living with HIV (PLHIV) may have concurrent Hepatitis B Virus (HBV) infection, and certain antiretroviral therapies are recommended for HBV-HIV co-infected individuals. Routine screening for Hepatitis B virus may influence management of antiretroviral therapy for PLHIV, but risk factors for co-infection have not been well defined. The objective of this study was to identify risk factors for HBV infection among PLHIV in South Africa.MethodsWe conducted a cross-sectional analysis of a prospective, clinic-based cohort study of adults seeking HIV testing from 2013–2017 in Umlazi township, South Africa. Patients newly diagnosed with HIV were enrolled and subsequently tested for Hepatitis B surface antigen positive (HBsAg +). We used a Poisson linear regression model to assess which factors, pertaining to sociodemographic status, medical history, clinical symptoms, mental health were associated with HBV.ResultsAmong 3,105 PLHIV participants in South Africa, 6% were positive for HBV. Males had a higher HBV prevalence (10.4%) than females (5.2%). Within the HBV-positive group, the mean age was 33.2 years, with 38.3% females and 43.9% having completed high school or higher. About 39.9% reported alcohol use, 24.7% had a smoking history, and 8.3% reported substance use in the past year. Older participants born before 1995, when routine infant HBV vaccination was introduced, were more likely to have HBV. In multivariable analyses, smoking history increased HBV risk in females (aPR = 2.58; 95% CI 1.47–2.52), while alcohol use decreased HBV risk in males (aPR = 0.36; 95% CI 0.19–0.70).ConclusionsIn a South African cohort, roughly one in 16 PLHIV had HBV co-infection, and this rate was higher in males. The most prominent risk factors for HBV infection in PLHIV were alcohol use, higher income, and smoking history, which may help inform targeted treatment and prevention strategies. Creating HBV-specific screening and prevention strategies for PLHIV may be useful for reducing HBV infections.

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Novel Machine Learning HIV Intervention for Sexual and Gender Minority Young People Who Have Sex With Men (uTECH): Protocol for a Randomized Comparison Trial.

Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people. This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages. In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling. This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025. This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults. ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901. DERR1-10.2196/58448.

Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida.

Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients. Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis. Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use. High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.

Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa.

The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.

Observations of substance use treatment engagement during the period of community re-entry following residential treatment

BackgroundThe period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. MethodThis observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. ResultsMost participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). ConclusionFindings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services.

To describe the distribution of alcohol and drug involvement in injurious falls by location and subtype of fall. Using the 2019 National Emergency Medical Services Information System (NEMSIS) dataset we identified 1,854,909 patients injured from falls requiring an Emergency Medical Services (EMS) response and determined the fall location (e.g. indoors or on street/sidewalk) and the EMS clinician's notation of alcohol or drug involvement. We analyzed substance involvement by fall subtype, location of fall and patient demographics. Overall, for 7.4% of injurious falls there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use; alcohol use alone for 18.5% of falls, drugs alone for 1.7% of falls and alcohol and drugs for 0.9% of falls. Substance use prevalence was highest, at 30.3%, in the age group 21 to 64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors; alcohol use alone for 26.3%, drugs alone for 2.6%, and alcohol and drugs for 1.4%. Reported substance use involvement was more frequent for men compared to women for each location type. Overall, 1-in-5 injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage

BackgroundLittle research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors.MethodThis cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015–2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps.ResultsSexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39–2.89; Bisexual: AOR = 2.35, 95% CI = 1.77–3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33–4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26–1.78).ConclusionThe results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.

The Association Between Personality Traits and Substance Use Among Advanced Level Students in Western Province, Sri Lanka: A Cross-sectional Study.

While personality predominantly influences human cognition, emotion, and behavior, there is still an unresolved research gap concerning the association between personality and substance use within the Sri Lankan context. This descriptive cross-sectional study aimed to investigate the association between personality traits and substance use among advanced-level students aged over 18 in Western province, Sri Lanka, in 2023. Data collection was carried out using self-administered paper-pencil questionnaires. The study variables were measured using the brief version of the Big Five Personality Inventory and the Alcohol, Smoking, and Substance Involvement Questionnaire. Data analysis involved the use of the chi-square test and Spearman correlation. Of the 441 enrolled participants, 422 provided correct responses to the questionnaire. Among them, 154 (36.5%) reported substance use. The majority of students initiated substance use at the age of 17. The results reveal a significant association between the openness personality trait and substance use among advanced-level students in Western province. Additionally, there was a statistically significant positive correlation between the extroversion personality trait and amphetamine use among advanced-level students. The findings highlight a significant association between specific personality traits, particularly openness and extroversion, and substance use among advanced-level students in Western province, Sri Lanka. These results emphasize the significance of considering personality factors in understanding and addressing substance use behaviors among youth populations. Further research and targeted interventions are necessary to delve deeper into these associations and develop effective prevention and intervention strategies.

Multi-level prediction of substance use: Interaction of white matter integrity, resting-state connectivity and inhibitory control measured repeatedly in every-day life.

Substance use disorders are characterized by inhibition deficits related to disrupted connectivity in white matter pathways, leading via interaction to difficulties in resisting substance use. By combining neuroimaging with smartphone-based ecological momentary assessment (EMA), we questioned how biomarkers moderate inhibition deficits to predict use. Thus, we aimed to assess white matter integrity interaction with everyday inhibition deficits and related resting-state network connectivity to identify multi-dimensional predictors of substance use. Thirty-eight patients treated for alcohol, cannabis or tobacco use disorder completed 1 week of EMA to report substance use five times and complete Stroop inhibition testing twice daily. Before EMA tracking, participants underwent resting state functional MRIand diffusion tensor imaging (DTI) scanning. Regression analyses were conducted between mean Stroop performances and whole-brain fractional anisotropy (FA) in white matter. Moderation testing was conducted between mean FA within significant clusters as moderator and the link between momentary Stroop performance and use as outcome. Predictions between FA and resting-state connectivity strength in known inhibition-related networks were assessed using mixed modelling. Higher FA values in the anterior corpus callosum and bilateral anterior corona radiata predicted higher mean Stroop performance during the EMA week and stronger functional connectivity in occipital-frontal-cerebellar regions. Integrity in these regions moderated the link between inhibitory control and substance use, whereby stronger inhibition was predictive of the lowest probability of use for the highest FA values. In conclusion, compromised white matter structural integrity in anterior brain systems appears to underlie impairment in inhibitory control functional networks and compromised ability to refrain from substance use.

Syphilis Treatment Among People Who Are Pregnant in Six U.S. States, 2018-2021.

To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis. Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention's "Sexually Transmitted Infections Treatment Guidelines, 2021" vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care). As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17-2.88 and RR 2.73, 95% CI, 2.47-3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82-2.28 and RR 1.83, 95% CI, 1.58-2.13, respectively). In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings.

Partner incarceration, maternal substance use, and the mediating role of social support: A longitudinal analysis using the future of families and child wellbeing study

IntroductionThe United States is responsible for the highest incarceration rate globally. This study aimed to explore the impact of partner incarceration on maternal substance use and whether social support mediates the relationship between partner incarceration and maternal substance use. MethodsUsing data from the Future of Families and Child Wellbeing Study, a longitudinal cohort following new parents and children, this analysis quantifies the relationship between paternal incarceration and maternal substance use (N = 2823). We analyzed maternal responses in years 3 (2001–2003), 5 (2003–2006), 9 (2007–2010), and 15 (2014–2017). We explored the role of financial support and emergency social support as potential mediators. Confirmatory factor analysis (CFA) was employed to construct support-related mediators. We modeled the impact of partner incarceration and maternal substance use using generalized estimating equations (GEE) to account for repeated measures, adjusting for appropriate confounders (age of mother at child's birth, race, education, employment, and history of intimate partner violence). ResultsNearly half (44.2%, N = 1247) of participants reported partner incarceration. Among mothers who experienced partner incarceration, the odds of reporting substance use were 110% greater than those who reported no partner incarceration (adjusted Odds Ratio [aOR]: 2.10; 95% Confidence Interval (CI):1.67–2.63). Financial support at year 5 accounted for 19.5% (95% CI: 6.03–33.06%) of the association between partner incarceration at year 3 and substance use at year 9; emergency social support at year 5 accounted for 6.4% (95% CI: 0.51–12.25%) of the association between partner incarceration and substance use at year 9. Neither financial nor emergency social support at year 9 were significant mediators between partner incarceration at year 3 and substance use at year 15. ConclusionsThese findings demonstrate that partner incarceration impacts maternal substance use. Financial and emergency support may partially mediate this relationship in the short term, which has important implications for families disrupted by mass incarceration.