WHO ASSIST Research Articles

Prevalence of substance use among inpatients in two tertiary care hospitals in Tehran

ABSTRACT Background Non-medical use of substances among hospitalized patients is a significant medical challenge, disrupting effective patient care particularly in chronic disease conditions. Therefore, this study looked at how often patients admitted to two hospitals in Tehran might use substances. Methods The present study is a descriptive, cross-sectional research. 286 patients admitted to 12 departments of Rasoul Akram and Firoozgar hospitals in Tehran, were selected by simple random sampling. The WHO ASSIST tool was utilized to quantify the frequency of substance use across different categories. Results Our data revealed a lifetime, and recent (past three months) substance use frequency of 87.4% and 83.6% respectively. The most common substances among men were tobacco (81%), opioids (58%), and alcohol (48%), while sedatives (66%), tobacco (48%), and opioids (46%) were the most common substances among women. Young patients (18–39 years) had a history of substance use across all measured drug categories. The highest frequency of drug use was observed in psychiatry, neurology, orthopedics, and surgery departments. Conclusion Our research revealed a relatively high prevalence of drug use among hospitalized patients. These findings underscore the importance of integrating assessments for non-medical drug use and addiction disorders alongside patients’ existing illnesses to ensure comprehensive patient care.

IJCM_189A: Prevalence of Substance use and associated factors among Undergraduate Medical students in a medical school in Jammu City of UT of J&K

Background: Globally, the available literature indicates a disturbing and increasing trend of high levels of alcohol use, illicit drug use and misuse of prescription psychoactive drugs among the medical students. This interferes with the learning of medical students because of the cognitive and psychological impact the substance use can have on an individual and is also a cause of concern because of the direct negative impact substance use can have on the safety of patients, not to mention the conduct and efficiency of future doctors. Objectives: To estimate the prevalence of substance use and the association of various socio-demographic factors associated with substance use among Undergraduate Medical students. Methodology: This was a cross-sectional study conducted among 482 Undergraduate Medical students pursuing M.B.B.S. at GMC Jammu from September to mid-November 2023. First of all the socio-demographic data was collected, followed by an assessment of substance use. It was done using the WHO ASSIST questionnaire, which was distributed to the participants in electronic format (Google form). The participants were instructed to read and answer each question honestly and to the best of their knowledge. Proportions with 95% Confidence Interval were used to summarize the substance use. Results: A total of 482 Medical undergraduates participated in the study. The mean age of the study participants was 20 years (± 1.34). The substance with the most prevalent use was alcohol (12.2%). Tobacco, sedatives and cannabis consumption was reported to be 6%, 1.9% and 1.5% respectively among the respondents. Conclusion: Despite being aware of the potential hazards, medical students continue substance abuse, which is indicative of a lack of awareness about one’s health as well as increased peer and academic pressure and a lack of parental supervision. Proper counselling with well-planned policies should be implemented to address the evil of substance abuse among aspiring doctors.

Screening for problematic opioid use in the emergency department: Comparison of two screening measures.

Earlier intervention for opioid use disorder (OUD) may reduce long-term health implications. Emergency departments (EDs) in the United States treat millions with OUD annually who may not seek care elsewhere. Our objectives were (1) to compare two screening measures for OUD characterization in the ED and (2) to determine the proportion of ED patients screening positive for OUD and those who endorse other substance use to guide future screening programs. A cross-sectional study of randomly selected adult patients presenting to three Midwestern US EDs were enrolled, with duplicate patients excluded. Surveys were administered via research assistant and documented on tablet devices. Demographics were self-reported, and OUD positivity was assessed by the DSM 5 checklist and the WHO ASSIST 3.1. The primary outcome was the concordance between two screening measures for OUD. Our secondary outcome was the proportion of ED patients meeting OUD criteria and endorsed co-occurring substance use disorder (SUD) criteria. We enrolled 1305 participants; median age of participants was 46 years (range 18-84), with 639 (49.0%) Non-Hispanic, White, and 693 (53.1%) female. Current OUD positivity was identified in 17% (222 out of 1305) of the participants via either DSM-5 (two or more criteria) or ASSIST (score of 4 or greater). We found moderate agreement between the measures (kappa=0.56; Phi coefficient=0.57). Of individuals screening positive for OUD, 182 (82%) endorsed criteria for co-occurring SUD. OUD is remarkably prevalent in ED populations, with one in six ED patients screening positive. We found a high prevalence of persons identified with OUD and co-occurring SUD, with moderate agreement between measures. Developing and implementing clinically feasible OUD screening in the ED is essential to enable intervention.

ACCULTURATION, ALCOHOL USE, AND SLEEP AMONG LATINX ADULTS AT RISK FOR ALZHEIMER’S DISEASE AND RELATED DEMENTIAS

Abstract Background Excessive alcohol use can negatively impact sleep. In the U.S., Latinx people are most likely to engage in problematic drinking when compared to other racial/ethnic groups. Acculturation in U.S. society has been suggested as a contributing factor to problematic drinking. Excessive alcohol use and poor sleep are known risk factors for developing Alzheimer’s disease and related dementias (ADRD). Little is known about the interaction between acculturation and alcohol use on sleep outcomes in Latinx adults, especially among those at risk of ADRD. The current study explored whether acculturation to the U.S. moderated the relationship between alcohol use and sleep. Methods A secondary analysis of a community-based sample of 113 Latinx adults, ages 40-60, was conducted. Participants had a parent diagnosed with ADRD. Measures included surveys gauging alcohol use (WHO ASSIST V.30), acculturation (Bicultural Involvement Questionnaire), subjective sleep (Pittsburgh Sleep Quality Index), and objective sleep measures using actigraphy (ActiGraph). A multiple regression analysis was performed to evaluate whether acculturation moderated the relationship between alcohol use and sleep outcomes Results The sample was predominantly female (92%), people born outside the US (74%), with approximately 83% of participants reported lifetime alcohol use. Americanism acculturation (b= 0.30, SE= 0.21, p=0.007) and biculturalism (-b= 0.30, SE= 0.13, p=0.003) significantly moderated the relationship between alcohol use and sleep duration. Implications: Expanded, targeted research and intervention focused on sociocultural factors impacting alcohol use for Latinx people at risk of ADRD must be further explored to identify and intervene in sleep disparities occurring among this population.

Relationship between physical activity and who assist scores in substance addiction clients at the addiction Polyclinic of Prof Ngoerah General Hospital Denpasar

Drug abuse which includes narcotic, psychotropic, and addictive substances can affect the central nervous system function. Substances are often abused because of the pleasurable and calming effects of their use. Physical activity is said to have the potential as an adjunct therapy for substance addiction disorders. The purpose of the study was to determine the relationship between physical activity and WHO ASSIST scores in substance addiction clients. This study used a cross-sectional design on substance addiction clients undergoing treatment at the Addiction Polyclinic of Prof Ngoerah General Hospital Denpasar. Physical activity score checks were conducted using GPAQ questionnaires and WHO ASSIST scores. Data collection to patients as research subjects was carried out after obtaining informed consent. After data collected, the next stages was data analysis using SPSS, with descriptive statistical analysis, normality test and spearman correlation test. From 30 samples, an average GPAQ score of 2099.33 ± 2225.32 was obtained. The average WHO ASSIST score for each substance was highest in tobacco 15.57 ± 8.98 and lowest in hallucinogen 0.70 ± 1.664.

Prevalence, Pattern and Determinants of Substance Abuse Among Adolescents in Bagalkot, Karnataka, India

Background: Adolescence is the age of curiosity, experimentation and new roles. This is the age children start to explore the world and test everything around them. Substance abuse is an alarming problem among adolescents in India. The objective is to assess the prevalence, pattern and determinants of substance abuse among adolescents of Bagalkot. Methods: A cross sectional study with a sample of 384 adolescents, selected by disproportional stratified random sampling. WHO ASSIST was used to assess the prevalence and pattern of substance abuse. The data was entered in MS excel sheet and transferred to SPSS 18 for analysis. Results: the mean age of the sample was 16.4 ± 2.44 years. 71.9% were males and 28% were females. Among 384 adolescents 20.3% used to consume tobacco and 21.4% consumed alcohol, 2.6% consumed cannabis, 15.6% had consumed inhalants. Among Tobacco users 53.85% were 18 to19 years of age. Conclusion: The overall substance abuse among adolescents is about 21%. Age, Gender, and Peer pressure, increase the risk of substance abuse. The substance abuse prohibitor strategies must be strengthened to reduce the prevalence of substance abuse among adolescents.

Assessment of the Pattern of Substance Use and Quality of Sleep in Drug Naïve Patients: Depression vs. Mania, a Comparative Study

ABSTRACT Background: Literature reveals that both substance use and sleep are interlinked, and even various aspects of substance use are relevant to sleep. Sleep disturbances are among the most common and consistent symptoms in patients with acute episodes of mood disorders. These psychiatric illnesses commonly co-occur with substance use disorders (SUDs), and the combination has adverse clinical consequences. Aim: To compare the pattern of substance use and quality of sleep in patients with depression and mania. Materials and Methods: A total of 150 patients (75 in each group) of either sex in the age group of 18-65 years visiting the psychiatry department who gave written informed consent were diagnosed using International Classification of Diseases-10 (ICD-10) for either mania or depression including recurrent depressive disorder and bipolar affective disorder. The patients in each group were evaluated using WHO ASSIST version 3 for substance pattern and PSQI for quality of sleep. Results: The most common substance used was tobacco followed by alcohol in both groups with a significant P value of 0.01. When comparing WHO ASSIST grades, 62.7% of depression had low grades whereas 48% of patients with mania had a moderate grade, with a P value of 0.002 which is significant. There was a significant difference in the individual component of PSQI between the two groups and patients in mania had a higher score. Conclusion: There was a significant association between the pattern of substance use and mood disorder. In the study subjects, all the patients in both groups had poor sleep quality. Further substance use and quality of sleep are interrelated with both mood disorders.

The co-morbidity of DSM-V Gambling with DSM-V mental disorders and substance abuse in a Kenyan context of high risk schizophrenia

IntroductionThere is evidence that gambling disorder shares similarities with other types of addictive behavior, such as occurs in substance abuse. In addition, co-morbidity of gambling with mental disorders has been established in school-going students.AimThis study aimed at determining the comorbidity of DSM-V gambling disorder with DSM-V mental disorders and substance abuse in high school, college and university students in Kenya.MethodsThis was a cross-sectional study among 536 high school, college and university students. We collected data on socio-demographic characteristics, economic indicators, DSM-V diagnosis including DSM-V gambling disorder and substance use disorders using the WHO ASSIST tool. Descriptive and inferential analyses were done.ResultsA total of 536 students participated in the study, of which 11.4% (61 out of 536) had DSM-V gambling disorder. Male gender (AOR = 12.0, 95% CI: 4.99–34.3), antisocial personality disorder (AOR = 3.42, 95% CI: 1.34–8.54), tobacco use (AOR = 4.42, 95% CI: 1.15–18.3) and conduct disorder (AOR = 7.56, 95% CI: 2.34–25.1) were predictors of gambling disorder.ConclusionGambling is highly prevalent in Kenya learning institutions at 11.4% and is associated with mental disorders and substance use. There is a need for public awareness of gambling among Kenyan youths.

Prevalence and factors associated with substance use among HIV positive youth attending HIV care and treatment centers in Dodoma, Tanzania

BackgroundSubstance use among people living with HIV is associated with poor health, social, and psychological outcomes. This study assessed the prevalence of substance use and associated factors among youth attending HIV care and treatment centers (CTCs) in Dodoma, Tanzania.MethodsThis cross-sectional study was carried out in Dodoma, Tanzania, from February to April 2020 among youth aged 15–24 attending HIV CTCs. Data was collected using sociodemographic, WHO ASSIST Version 3.0, BDI II, and SERAD questionnaires. Data analysis was done using Stata 17. Descriptive statistics were used to summarize continuous and categorical variables. Univariable and multivariable logistic regression analyses were conducted to determine factors independently associated with substance use.ResultsThe prevalence of substance use was relatively low (6.6%). Older youth (20 to 24 years) were 2% less likely to use substances compared to the younger ones (15 to 19 years) (AOR: 0.07; 95% CI 0.01, 0.83). There were statistically significant decreasing odds of substance use with every year increase in age at HIV diagnosis (OR: 1.66; 95% CI 1.14, 2.41). Being unemployed was statistically significantly associated with decreased odds of substance use among this population (OR: 0.03; 95% CI 0.02, 0.33). Youth who had detectable viral loads were significantly more likely to use substances compared to those with undetectable viral loads (AOR: 12.9; 95% CI 1.07, 156.05).ConclusionsDespite the low prevalence of substance use found in this study, it is important to note that late age of HIV diagnosis, employment, and detectable viral load negatively impacted HIV positive youth with regards to substance use. It is recommended that CTCs emphasize routine screening for substance use among youth who have detectable viral loads.

The prevalence of substance abuse and associated factors among male prisoners in Karachi jails, Pakistan

ObjectiveSubstance abuse and cigarette smoking are now regarded as major public health problems. This study aims to determine the prevalence, risk profile, and associated sociodemographic factors of substance abuse among male prisoners in Karachi jails. MethodsThis descriptive cross-sectional study was carried out among 600 male prisoners in Malir and Central Jails in Karachi. The principal investigator collected the data via one-on-one basis interviews, using a survey questionnaire consisting of the WHO ASSIST version 3, and structured demographic proforma. The data analysis regarding ever and current use of ten substances was done according to the standard instruction manual. A Chi-square test was applied to determine the association between categorical sociodemographic variables and current/ever substance use among prisoners. A p-value of <0.05 was considered statistically significant. ResultsIn this study, 97.1% of prisoners had a history of substance abuse at least once in their lifetime. For the current use of a substance, the majority of the prisoners fell into the low-risk category, except for tobacco for which 80.5% of prisoners were at moderate risk of use. 13%, 12.7%, and 9.5% of prisoners were at high risk for using opioids, cannabis, and tobacco, respectively. Several associations were found between the socioeconomic factors of the study subjects and their substance use. ConclusionThe study demonstrates a high prevalence and alarming current risk profile of substance abuse among prisoners of Karachi Jails. Considering the associated disease burden, substance abuse among prisoners should be considered a public health priority. Further exploration of associated and causative factors can help policymakers devise adequate measures for prevention and rehabilitation.

Tobacco use, determinants and effects on treatment among persons living with HIV/AIDS at Military Hospital in Makurdi, Benue State, Nigeria

Background: Tobacco use is a leading avertable cause of premature death globally. It is commonly used among PLWHIV and with mortality tripling compared to the general population. Its impact on them is multifactorial. This study aims to assess the prevalence, determinants and effects of tobacco and its related products on treatment among persons living with HIV at a military hospital in Makurdi, Benue State, NigeriaMethods: The study was among HIV positive clients ≥18 years who have accessed care for ≥12 months at Nigerian air force hospital, Makurdi of Benue state, Nigeria. A descriptive cross-sectional study was done using adopted WHO ASSIST (V3.0) questionnaire. Simple random sampling method was used to select 700 clients studied.Results: About 138(19.7%) have used Tobacco products and 66 (9.4%) in past 3 months of which 10 (90.3%) were mild users. Of those that ever-used tobacco 114 (82.6%) used Tobacco and other substances; 90 (79.0%) Alcohol, 73 (64.0%) Kola nut, 8 (7.0%) Cannabis and 5 (4.4%) Cocaine. Determinants of use were male gender (AOR 0.23; 95% CI 0.15-0.35) and earning &lt;18,000 (AOR 2.23; 95% CI 1.05-4.70). There were no associations of tobacco use with viral load and CD4 count.Conclusions: Prevalence of Tobacco use was higher than general population. Male gender and low socioeconomic status were determinants of use of tobacco. Addressing this menace of tobacco use is an important political and public health issue.

The Relationship Between Khat Use Disorder and Post-Traumatic Stress Disorder Among Prisoners with Life Time Trauma Exposure in Ethiopia: A Cross-Sectional Study.

BackgroundProblematic khat use is an emerging health problem worldwide. Trauma experience, crime, and substance misuse is closely related. However, there is lack of evidence whether post-traumatic stress disorder (PTSD) and life time trauma exposure has a relationship with problematic khat use among prisoners in our country Ethiopia, or elsewhere. Therefore, this study assessed the relationship between PTSD and life time trauma exposure with khat use disorder among newly admitted prisoners in Bench Shako and West Omo zone correctional institution, Mizan Aman, Ethiopia.MethodsA cross-sectional study was conducted among 411 (N=422) prisoners from April 20 to July 19, 2019, by using a consecutive sampling technique. Trauma exposure and post-traumatic stress disorder were assessed with a life event check list and Post-traumatic stress disorder – civilian version (PCL-C), respectively. The WHO ASSIST tool was used to assess khat, alcohol, and tobacco use disorder. Antisocial personality disorder, criminal, and clinical history were also assessed. The data were entered into Epi-data version 3.1 and then exported to Statistical Package for Social Science version 21. A logistic regression model was used and variables with a p-value less than 0.05 in the final fitting model were stated as independent predictors of PTSD.ResultsNearly one out of four prisoners exposed to life time trauma exposure developed PTSD, and the prevalence of khat use disorder among prisoners with life time trauma exposure and PTSD was 45% and 85%, respectively. Prisoners with khat use disorder had more than 5 times higher odds of association with PTSD than their counterparts (AOR=5.3, 95% CI=2.4–11.8). In addition, antisocial personality disorder (AOR=2.8, 95% CI=1.6–5.5), criminal recidivism (AOR=2.5, 95% CI=1.5–4.3), and being a driver (AOR=2, 95% CI=1.2–3.3) were positively associated with PTSD.ConclusionKhat use disorder was higher among prisoners with life time trauma exposure and PTSD, and khat use disorder was positively associated with PTSD.

Cannabis use, polysubstance use, and psychosis prodrome among first-degree relatives of patients with schizophrenia

ABSTRACT Background Cannabis use and Psychosis are closely associated. Polysubstance use is prevalent among cannabis users. However, previous literature majorly examined the relationship between only cannabis use and schizophrenia disorder. Little is known about the impact of polysubstance use on the onset of prodromal symptoms. There is a scarcity of studies comparing the severity and characteristics of prodromal symptoms between cannabis users and polysubstance users. Aim This study investigates the association between polysubstance use and prodromal symptoms. It also compares the severity and characteristics of prodromal symptoms among individuals with different substance use patterns. Method 246 first-degree relatives of patients with schizophrenia participated in the study, using purposive sampling method. Pattern of substance use and prodromal symptoms were assessed using the WHO ASSIST Scale and PROD-Screen respectively. Result Significant association was found between substance use and symptoms of prodrome (r = −0.57, p < .01). Individuals who consumed more than one substance experienced more severe prodromal symptoms. Prodromal symptoms viz. “hallucinatory and delusional symptoms” and affect and thinking difficulties discriminate the study groups effectively. Conclusion Cannabis plus other substance use increases the risk of prodrome among first-degree relatives of patients with schizophrenia. Polysubstance use causes more thinking, affective, delusionary, and hallucinatory symptoms of prodrome.

Prevalence and correlates of common mental health problems and recent suicidal behaviour among female sex workers in Nairobi, Kenya: findings from the Maisha Fiti study

AimsAdverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance are associated with poor mental health outcomes in the general population. These risks are likely to be exacerbated among Female Sex Workers (FSWs), however there are few studies examining risks factors for mental health problems among FSWs. We examine the prevalence and correlates of common mental health problems including suicidal behaviour among FSWs in Kenya.MethodMaisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline data were collected from June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, and the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD). Recent suicidal behaviour was defined as reported suicide attempt or suicidal ideation in the past 30 days. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the WHO ASSIST tool (to measure harmful alcohol/substance use in the past 3 months). Descriptive statistics and multivariable logistic regression were conducted in Stata 16.1.ResultOf 1039 eligible FSWs, 1003 FSWs took part in the study (response rate: 96%) with a mean age of 33.7 years. The prevalence of moderate/severe depression was 23.2% (95%CI: 20.7–25.9%), moderate/severe anxiety 11.0% (95%CI: 9.3–13.1%), PTSD 14.0% (95% CI: 12.2–16.5%) and recent suicidal behaviour 10.2% (95%CI: 8.5–12.2%) (2.6% suicide attempt; 10.0% suicidal ideation). Among women with any mental health problem 63.0% also had a harmful alcohol/substance use problem. One in four women (25%; 95%CI: 22.5–27.8%) had depression and/or anxiety and this was independently associated with higher ACE scores, hunger (skipped a meal in last week due to financial difficulties), death of a child, perceived sex work stigma and recent sexual/physical violence. PTSD was associated with higher ACE scores, hunger, increased STI prevalence (chlamydia trachomatis) and recent violence. Recent suicidal behaviour was associated with higher ACE scores, low literacy, hunger, and recent violence. Mental health problems and suicidal behaviour were less prevalent among women reporting social support.ConclusionThe high burden of mental problems among FSWs indicates a need for accessible services tailored for FSWs alongside broader structural interventions addressing poverty, harmful alcohol/substance use and violence. High rates of ACEs among this population indicates the need to consider early childhood and family interventions to prevent poor mental health outcomes.Funding: Medical Research Council and the UK Department of International Development

Surviving but not thriving: Burden of care and quality of life for caregivers of patients with schizophrenia spectrum disorders and comorbid substance use in South Africa.

Schizophrenia and schizophrenia spectrum disorders can be devastating for the patient and family. Early recognition and interventions for caregivers, who form part of an overburdened 'invisible health care system' in resource-limited settings with an extensive mental health treatment gap, are crucial for improved outcomes for patients and carers. The study investigated the burden of care and quality of life (QOL) among caregivers of patients with schizophrenia spectrum disorders and its determinants in South Africa. We conducted a study of 101 matched-paired samples of family caregivers and adult patients (N=202) seeking care from two psychiatric hospitals in South Africa. The assessment consisted of the Zarit Burden Interview for caregiver burden, WHO-Quality of life scale and WHO ASSIST for substance use. Most caregivers (n=81; 80.2%) reported high or severe caregiver burden. None of the four QOL domains surpassed the 60% mark where the observed scores (out of 100) for physical health (56.2, SD=16.2), psychological health (55.3, SD=17,6), social relationships (47.1, SD=19.3) and environment (53.5, SD=16.3). Lower burden was associated with greater QOL score across all four domains among caregivers (p ≤ .05). Lower educational attainment was associated with poorer QOL, and higher household income with higher QOL in certain domains. Patient comorbid alcohol (p ≤ .05) and high-risk cannabis use (p < .02) were the only significant factors of increased caregiver burden scores. The high caregiver burden, and its association with alcohol and cannabis use, suggests the need to address comorbid substance use and early pragmatic support for families.

Higher and Higher? Drug and Alcohol Use and Misuse among HIV-Vulnerable Men, Trans Men, and Trans Women Who Have Sex with Men in the United States

Background: Substance use (SU) and misuse are disproportionately more common among sexual and gender minority (SGM) individuals compared to their heterosexual peers. Yet, little is known about regional and demographic differences in use and misuse among SGM. In this study, we investigated regional and demographic differences in SU and misuse in a U.S. national, internet-based cohort (n = 6,280) of men and trans persons who have sex with men. Methods: Data collected included the WHO ASSIST (substance) and AUDIT (alcohol) SU scales to estimate recent (≤ 3 months) non-problematic use (≤ 3 ASSIST, ≤ 10 AUDIT) and misuse (≥4 ASSIST, ≥11 AUDIT). We used bivariate and multivariable logistic models to examine demographic and regional factors associated with SU and misuse. Results: Participants reported using alcohol (85.6%), cannabis (53.9%), and inhalants (39.1%) in the past three months. More than one-third self-reported misuse of cannabis, Gamma-Hydroxybutyrate (GHB), inhalants, methamphetamines, and prescription sedatives. We observed regional differences in substance use for cannabis (Southeast aOR = 0.76, 95% CI: 0.63–0.93; West aOR = 1.27, 95% CI: 1.02–1.59, ref. Northeast) and prescription Stimulants (Midwest aOR = 1.39, 95% CI: 1.00–1.93), as well as for cannabis misuse (Southeast aOR = 0.83, 95% CI: 0.69–0.99). We also observed significant associations between socioeconomic factors with use and misuse. Conclusions: Findings suggest geographic differences in misuse of certain substances among men and trans persons who have sex with men in the US, and that socio-economic factors, also play a key role in indicating risk.

Subgrouping University Students Based on Substance Use Pattern: A Latent Class Analysis.

PurposeHigh-risk behaviors are the main causes of death and disability among youth and adults. Entering university might cause students to go through their first-hand experience of using substances.AimThis study aimed to detect the subgroups of students based on substance use and assess the effects of religiosity and parental support as well as other related factors on the membership of students in each latent class.MethodsUsing a multistage sampling method, this cross-sectional study was conducted in 2016 in Hormozgan University of Medical Sciences (n=524). All students completed a self-report questionnaire. This questionnaire contained questions about substance use, religious beliefs and familial support. The questions of substance use were prepared using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). To analyze the data, PROC LCA statistical method was run in SAS9.2.ResultsThree latent classes were identified: 1) nonuser (87.5%), 2) tobacco and illicit drug user (8.7%) and 3) polydrug user (3.8%). Having extramarital sex in the last month (OR=28.29, 95% CI; 8.45–94.76), living alone (OR=4.29, 95% CI; 1.01–18.35) and having a higher score of familial support (OR=0.94, 95% CI; 0.89–0.98) were associated with the polydrug user class. Hookah smoking had the highest (11.1%) and non-medical methylphenidate use had the lowest (2.3%) prevalence among the participants of the study.ConclusionThis study revealed that 12.5% of the students were either tobacco and illicit drug users or polydrug users. Thus, focusing on the religiosity and familial support may help design some preventive programs for this stratum of young adults.

Substance use among young adults in professional degree colleges of urban Bengaluru

Background: Substance use is a significant problem in our societies and is increasing day by day due to factors like easy availability, rapid socioeconomic changes, etc. The professional degree students are at risk as they are exposed to high levels of stress and competition. Aim &amp; Objective: To find out the burden of substance use among young adults in professional degree colleges, to assess the effect of substance use on health among study subjects, to compare the health status between substance users and non-users. Settings and Design: This cross-sectional study was conducted among students studying in various professional degree colleges of Urban Bengaluru between July 2017 to December 2017. Methods and Material: A total of 1400 study subjects were included and administered a pre-tested, semi structured questionnaire and relevant information was obtained using Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) V3.0 scale. Statistical analysis used: Data was entered using MS Excel 2016 and was analysed in Stata 12.1 (Stata Corp, Texas, USA). Z test for proportions, Univariate logistic regression and Multivariate logistic regression were used as appropriate. Results: The overall prevalence of substance use was 35%. Dizziness was the most common health symptoms observed in substance users. Male, students staying in hostels/ paying guest, foreign nationals, substance use in the family and presence of conflict were found to be significant risk factors for substance use. Conclusions: The burden of substance use was observed in about one third of the subjects. Substance use was significantly associated with health problems.

Determinants of Tobacco Smoking Addiction in Rural Indonesian Communities.

Purpose To analyze the determinants of tobacco smoking addiction in rural areas. Methods A cross-sectional study was conducted on February 2020. The self-administered questionnaire (α = 0.908) and Perceived Stress Scale–10 were used as tobacco smoking determinants and the WHO ASSIST questionnaire V3.0 to determine its addiction risk. Their correlations were analyzed by Spearman's rank-order approach using the SPSS version 23.0. Results Among 75 male respondents that participated in this study, those on low, moderate, and high addiction risk were 45 (60.00%), 23 (30.67%), and 7 (9.33%), respectively, and significantly correlated with the research questionnaire that consisted three parts: 1. awareness toward the health risk; 2. social control; 3. mass media role in tobacco smoking (p=0.014, 0.004, and 0.009 respectively), but there was no significant correlation with the stress level (p=0.287). Conclusion Increased awareness toward the health risk, good social control, and mass media reporting the danger of tobacco smoking is significantly in correlation with the decreased addiction in rural areas. However, the high perceived stress has no correlation with its increase.

S238. PATIENT ENGAGEMENT TO EARLY INTERVENTION IN PSYCHOSIS SERVICES: RETROSPECTIVE ANALYSIS OF ENGAGEMENT PATTERNS

BackgroundWithin outpatient mental health services there exists an important awareness of the difficulties in engaging and maintaining contact with patients, as well as the understanding of the negative effects of disengagement, including worse patient outcomes and increased healthcare burden. Despite the importance of engagement on service delivery and recovery outcomes, few studies have examined rates and predictors of engagement in the early phase psychosis population. Although better than community care, it has been reported that an average of 30% of patients disengage from specialized early intervention services for psychosis (EIS). We examined rates of disengagement to a 5 year EIS for psychosis, including potential individual risk factors for disengagement at entry to service.MethodsThis cross-sectional cohort study examined engagement to services to a single EIS site from November 2006 to November 2016. Disengagement was determined retrospectively on review of medical records, defined as not attending to clinic services despite repeated attempts by clinicians/clinic for a three month time frame. Gender, age at clinic entry, ethnicity, Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory (DAI-30), General Assessment of Function (GAF), Social and Occupational Functioning Assessment Scale (SOFAS), WHO-ASSIST version 3.0, and the Psychological General Well Being (PGWB)scale at entry to service were examined between groups. . Descriptive statistical and survival analyses for time to disengagement were conducted on the patient data set.Results331 patient records were complete (with above scales) from entry to service to discharge or loss to follow-up. Patients were found to fall into 3 categories with regard to patterns of engagement. The first category we named “engagers” as they remained committed to their care throughout the program and comprised 50% of the sample. The second group were labeled the disengagers (20% of the group) and these were individuals who disengaged at some point in the program and did not return, in contrast to “intermittent engagers“ who comprised 30% of the sample. Intermittent engagers were patients who at some point during their care would meet criteria for disengagement but would re-engage later (still within the 5 years from entry to EIS) and complete the program. Absolute disengagement by the disengager group was predominantly prior to 12 months of treatment (78% of the group) with a survival analysis showing a median time to absolute disengagement of 8 months. The 3 groups though defined based on their engagement status, did not significantly differ in age, gender and ethnicity. Additionally, the clinician reported scores GAF and SOFAS did not differ between the groups. Patterns of substance use differed between the groups. There was a trend toward higher tobacco use in the two groups showing disengagement. Cannabis use did not differ significantly between groups but the pattern of use was highest in the disengagers followed by the engagers and then intermittent engagers. Alcohol use was significantly different between the groups with 81% of the disengagers having problem levels of alcohol use (WHO ASSIST v. 3.0 score above 4), however, there was no correlation between alcohol score and time to disengagement.DiscussionOur retrospective study found a surprisingly large portion of the patient population will wax and wane in their commitment to health services but ultimately maintain attendance to complete the program, suggesting that patients should not be discharged early from EIS for psychosis. Substance use patterns and functional measures may identify patients who are at risk of early disengagement from EIS.