Background:Adolescents with co-occurring alcohol use and mental health disorders have better treatment outcomes when caregivers are involved in their treatment. Currently, little is known about why caregiver involvement improves outcomes. Objectives:To facilitate caregiver-involved treatment process research, this study preliminarily examined within- and between-person variability in ecological momentary assessment (EMA) items assessing caregiver-child communication (eg, warmth, conflict), general (eg, monitoring, praise), and substance-specific parenting practices (eg, alcohol reactions and communication), and their correlations with momentary treatment targets (eg, craving, affect, motivation). Design:Fifteen adolescent (Mage = 15.8, range = 13-18, 73.3% male, 73.3% White, 13.3% American Indian or Alaskan Native) and caregiver (Mage = 49.9, 86.7% biological/adoptive mothers) dyads were recruited from an adolescent co-occurring disorders intensive outpatient program. Dyads completed 7 consecutive weeks of EMA, which consisted of morning and random (4x/day) assessments. Methods:Intraclass correlation coefficients (ICCs) examined the magnitude of between- and within-person variability for each item, which were administered to adolescents and caregivers. Within-person correlations examined how parenting practices related to alcohol and cannabis use and intentions, treatment motivation and engagement, and mental health symptoms (morning reports) and alcohol and cannabis craving and positive and negative affect (random assessments). Results:Within-person variability exceeded 20% for all parenting items other than parental reactions to alcohol use. Whereas some items demonstrated patterns consistent with study hypotheses (eg, caregiver warmth was associated with lower alcohol craving and negative affect), others had correlations in the opposite direction of study hypotheses (eg, adolescent disclosure and parental solicitation were positively associated with cannabis intentions). Conclusion:Findings indicate that parenting practices vary across days and moments and are cross-sectionally associated with momentary indicators of treatment outcomes. Future work continuing to develop and test the psychometric properties of daily and momentary parenting practices will be essential for examining caregiver behaviors during treatment that facilitate improved treatment outcomes.
Background:Vaped nicotine use is associated with nicotine dependence, mental health symptoms, and physical health problems in adolescents, and peer nicotine use is a robust predictor of nicotine vaping in adolescents and young adults. Objective:Examine associations between peer nicotine vaping and participant nicotine vaping cessation outcomes or nicotine dependence treatment adherence among adolescents and young adults enrolled in a vaping cessation trial. Design:Exploratory secondary analysis of a 12-week randomized controlled trial with 3-month follow-up. Methods:Participants completed a three arm, 12-week trial of varenicline and counseling, placebo and counseling, or enhanced treatment-as-usual. Participants (N=280; ages 16-25) indicated number of close friends in their broad peer network who use nicotine vapes, and a subset reported on frequency of nicotine vaping among their 10 closest friends as well as frequency of vaping by their best friend. Analyses evaluated the effect of peer vaping on biochemically-verified 7-day nicotine abstinence (end-of-treatment and follow-up) and treatment adherence. Multilevel mixed-effects models accounted for treatment condition. Results:Participants reported a mean of 6.9 (SD=6.8) close peers in their broad peer network used vaped nicotine at baseline; more peers using nicotine vapes was inversely associated with end-of-treatment abstinence (β=-.11, p=.03), and more frequent vaping among participants' top 10 closest peers and best friend vaping frequency were inversely associated with abstinence at end-of-treatment and follow-up (βs=-.25 to -.32, ps≤.05). For every 1 SD increase in participants' best friend's vape frequency, participants were 76% less likely to maintain a vape quit at 3-month follow-up (β=-1.26, p=.044; OR=0.24). Measures of peer vaping were also inversely associated with study medication adherence (βs>=-.52, ps≤.007) and fewer counseling sessions attended (βs=-.49 to -.60, ps≤.008). Conclusion:Peer vaping behavior may be associated with adolescents' capacity to quit vaped nicotine. Interventions that directly address peer network influences may enhance vaping cessation outcomes.
Introduction:Kratom and hemp-derived cannabinoid use has increased in the United States. Objective:Assess pharmacists' perceived knowledge of kratom and hemp-derived cannabinoids and whether it improved following continuing education. Methods:This cross-sectional survey was administered to participants immediately before and after attending a live, one-hour continuing education presentation regarding the pharmacology, uses, risks, and legality of kratom and hemp-derived cannabinoids. The novel, investigator-designed, literature-informed survey assessed the frequency with which they were asked about kratom and hemp-derived cannabinoids in practice, perceived knowledge of the uses, risks, and legality of these substances, and participant's perceived self-efficacy regarding counseling patients about them. The post-education survey also contained questions regarding perceived training value. Any pharmacist who attended the presentation and acknowledged consent was eligible to participate. Non-pharmacist attendees were excluded. Results:In total, 99 participants completed the pre-education survey and 63 the post-education survey. Most were never (81.8%) asked about kratom, while about half (48.5%) were never asked about hemp-derived cannabinoids, with 45.5% asked twice per month or less. Prior to education, most pharmacists did not feel confident discussing common uses, risks, or legal/regulatory status of kratom or hemp-derived cannabinoids and had limited understanding of distinctions between cannabis-related terms. Median pre-education scores ranged from 1-2 (out of 5) across all items. Following education, perceived knowledge and self-efficacy improved across all five items (all p<0.0001), each with post-education medians of 4. Conclusion:This exploratory study indicated that Texas pharmacists' perceived knowledge of kratom and hemp-derived cannabinoids was low, but significantly improved following education on the topic. It also indicated they are not often asked about these substances in day-to-day practice, corroborating previous research that people who use these substances rarely discuss their use with their healthcare providers.
Background Stigma can be detrimental to health and wellbeing. Black adults experience various forms of stigma, such as stigma related to receiving psychological help. Stigma prevents treatment initiation, exacerbates psychological distress, and leads to adoption of unhealthy coping mechanisms, such as opioid misuse. Objectives Given the rise in opioid-related overdose deaths among Black adults, the present study aims to examine stigma related to receiving psychological help and its association with depression, anxiety, opioid use, and treatment-related variables among Black adults. Method Informed by Goffman’s Social Stigma theory, stigma classes related to receiving psychological help were examined with a latent class analysis (LCA). Stigma class and its relationship with opioid misuse, anxiety, depression, barriers to treatment, and healthcare distrust was examined. Participants were 809 Black adults stratified by age and sex who reported opioid misuse in the past six months. Results The “high stigma” class was significantly associated with a 1.44 times greater likelihood of recent opioid misuse, more barriers to treatment, and greater healthcare distrust than the “low stigma” class. Sex and age were also highlighted as covariates associated with opioid misuse, mental health, barriers to treatment, and healthcare distrust. Conclusions Experiencing stigma related to receiving psychological help appears to influence health outcomes, such as opioid misuse. It is also connected to experiencing barriers to treatment, making it crucial to focus on stigma experienced among Black adults to minimize negative health and treatment consequences.
Background:Social group memberships and group behaviors are pivotal in supporting or inhibiting adolescents' addiction recovery. Yet most research on social processes has relied on traditional surveys that cannot capture the complex nature of evolving social networks. Social Identity Mapping in Addiction Recovery (SIM-AR) asks respondents to create a visual representation, or map, of their social network, social groups, and social influences. The SIM-AR thus provides a novel, interactive, and detailed means to collect social network information, and does so in a way that is accessible and meaningful to participants. Objectives:This study aimed to pilot and adapt the SIM-AR with adolescents and young adults in addiction treatment and recovery programs so it might be used as a standardized tool for data collection. Design:This was a multi-method study that piloted the SIM-AR approach in both paper-pen and online (oSIM-AR) formats, and used this feedback to update the approach. Methods:Participants (N = 35; Ages 14-19; 71% male) were recruited from addiction treatment and recovery programs to complete a facilitated SIM-AR/oSIM-AR, brief survey, and interview (November 2020-January 2023). We engaged participants in an iterative process so the approach could be modified: 28 completed the paper-pen version and seven completed the online version. Descriptive qualitative analysis was used to examine participant interviews. Results:Adolescents found the SIM-AR process acceptable, "fun," and "helpful." The paper-pen version took ∼30 minutes (M=32.52, SD=11.07) and the online version took <15 minutes (M=13.75, SD=4.31). The paper-pen version generated longer reflection interviews than did the online format (M=25.75, SD=7.46 vs. M=9.46, SD=1.07 min.), suggesting the approaches prompted different degrees of reflection. Conclusion:Support was found for the SIM-AR as an interactive, easy-to-use, and time-efficient measurement tool with adolescents. We plan to implement the SIM-AR in recovery programs to examine whether these programs generate network change. Registration:https://osf.io/8vdcp/?view_only=02544c530b0746dd812a78b9d8c008b3; https://osf.io/4mrp6/?view_only=dca62d77b1dd4e829ea15f3ba1a90611.
Background:Existing opioid overdose reversal (OOR) trainings for first responders frequently demonstrate improvements in naloxone knowledge and overdose response competencies. While some programs have incorporated broader risk reduction and stigma-related content, these domains are less commonly evaluated directly, particularly using instruments designed for first responder populations. The ULM HERO program implemented a comprehensive risk reduction curriculum for Louisiana first responders and developed the Risk Reduction Attitude Scale (RRAS) to evaluate changes in risk reduction attitudes following training. Objective:To evaluate the impact of the ULM HERO program on first responders' risk reduction attitudes using the RRAS. Methods:This IRB-approved study (October 2023-March 2025) used a single-group pre-post design to evaluate 2-hour in-person risk reduction training for first responders. Participants completed pre- and post-training surveys including demographics and the 22-item Risk Reduction Attitude Scale (RRAS). The RRAS demonstrated acceptable reliability and validity using pre-training data. Pre-post changes were assessed using paired t-tests, effect sizes, and adjusted regression models examining occupation and parish differences statewide. Results:The sample included 861 Louisiana first responders, primarily law enforcement (80.8%), representing multiple parishes, most commonly Orleans/Jefferson (60.8%) and Ouachita (14.2%). Overall RRAS scores improved significantly post-training (mean increase 3.73 points; dᶻ = 0.65; p < .001). All occupation-parish subgroups demonstrated significant gains (1.99-7.20 points). The largest improvements and highest adjusted post-training scores occurred among non-law enforcement personnel in Ouachita Parish, indicating differential impact by occupational role and geographic context after accounting for baseline scores and participant demographics statewide. Conclusions:This study demonstrates that a risk reduction focused training program can meaningfully improve attitudes among first responders across multiple parishes in Louisiana. Importantly, improvements were observed across urban and non-urban parishes, including regions traditionally perceived as more conservative. These findings support the scalability of a risk reduction focused training as an effective strategy statewide.
Background Examining associations of substance use (SU) pattern and family factors with severity of SU-related problems is crucial for designing effective interventions. This study was designed to address this under-researched topic in the Arab societies, utilizing the validated Arabic Drug Abuse Screening Test-10 (DAST-10). Methods This observational cross-sectional study enrolled 360 young adult drug users from Alamal Complex for Mental Health, Saudi Arabia. The questions were about SU pattern and family-related variables. Results Parental divorce, family problems, low family emotional support, poor family control, recent SU (during the past year), polysubstance use, and frequent SU showed significant correlations with more severe DAST-categories. Sociodemographic differences, financial capacity, age of starting use, and duration of use showed non-significant correlations with DAST-categories. The groups of complete family, parental death, and no recent SU were associated with significantly lower odds ratios (OR: 0.51, 0.31, 0.14) ( p : 0.013, 0.001, 0.010) indicating associations with lower DAST-categories compared with parental divorce and recent SU groups, respectively. In contrast, groups of no and limited emotional family support, polysubstance use, and SU less than one year were associated with significantly higher odds ratios (OR: 3.00, 3.20, 14.53, 1.78) ( p : 0.005, 0.003, 0.004, 0.031) indicating associations with higher DAST-categories compared with constant emotional family support, single-substance use, and SU more than one year groups respectively. The users with parental divorce, family problems, no and limited family emotional support, no and limited family control, recent SU, frequent use, and polysubstance use showed significantly higher distributions in substantial and severe DAST categories. Conclusions The associations observed are statistically significant, but modest. However, we believe that they remain clinically relevant, as even small associations may have practical significance. The study findings could support designing and implementing culturally tailored, family-centered preventive and therapeutic strategies and interventions, particularly for young adults, in Arab communities.
Background:The Edge On-Edge Off (EO-EO) hypothesis posits that poor sleep quality leads to low daytime arousal, which individuals may combat with caffeine use later in the day (i.e., Edge-On). Greater caffeine use then leads to higher arousal in the evening, which individuals may take advantage of or combat by drinking alcohol (i.e., Edge-Off). Heavy drinking, in turn, disrupts sleep (potentially adding hangover effects to daytime fatigue) and continues the cycle, particularly in the absence of structural barriers to drinking. Objective:The current study examines the behavioral predictions of an EO-EO cycle of alcohol use in which poor sleep quality predicts next-day caffeine use and, in turn, later day drinking. Drinking behaviors then perpetuate this cycle across days through the disruption of sleep. Design:Data came from a 10-day timeline follow-back survey completed by 1496 college students (aged 18-28; 61% female-identifying; 15% African American, 65% White, 12% Asian, 5% multi-racial, and less than 3% American Indian or Pacific Islander). Methods:We estimated Latent Curve Models with Structured Residuals to examine within-person links and serially mediated effects involving poor sleep quality, caffeine and alcohol use, and next night's poor sleep quality, differentiating between cycles occurring during the week versus the college weekend. We also tested the same cycle with napping duration, rather than caffeine use, as the within-day mediator. Results:Findings supported the behavioral predictions of the EO-EO cycle linking poor sleep quality and greater subsequent caffeine and alcohol use, forming a recurring cycle. Evidence for this cycle was limited to the college weekend. Napping duration did not mediate the association between poor sleep quality and greater drinking. Conclusions:The EO-EO cycle was supported primarily during the college weekend. These findings offer a promising proof of concept regarding the EO-EO cycle and point to several future directions for research.
Background:Problematic alcohol use (PAU) negatively affects physical, psychological, and social well-being. This study aims to estimate the community-level prevalence of PAU and identify factors associated with PAU in Central Ethiopia. Methods:A community-based cross-sectional study was conducted in Debre Berhan, Ethiopia, in January and February 2022. We recruited 1,400 adults aged 18 years and older using multistage sampling, and 1,380 completed the study interview. PAU was assessed with the alcohol use disorder identification test (positive AUDIT score). We conducted multivariable logistic regression to identify factors associated with PAU, with predictors selected using least absolute shrinkage and selection operator (LASSO) regression, in the overall sample and in sex-stratified analyses. Results:The prevalence of PAU was 15.5% (95% CI: 13.7% -17.5%) overall, and 26.3% (95% CI: 23.2%-29.6%) and 3.4% (95% CI: 2.2%-5.1%) for men and women, respectively. For the overall sample, factors associated with PAU included being male (AOR = 7.83; 95% CI: 4.59-13.36), unemployment (AOR = 2.73; 95% CI: 1.29-5.78) or engaged in income-generating roles (AOR = 2.38; 95% CI: (1.23-4.58) compared to those in non-income generating roles like housewives and students, smoking (AOR = 5.24; 95% CI: 1.73-15.91), high blood pressure (AOR = 2.04; 95% CI: 1.30-3.21), only one or ≥2 stressful life events (AORs = 1.60 and 1.65; 95% CIs: 1.03-2.47 and 1.05-2.61, respectively), and family history of PAU (AOR = 4.04; 95% CI: 2.09-7.81). For men, smoking (AOR = 5.29; 95% CI: 1.66-16.81), high blood pressure (AOR = 2.33; 95% CI: 1.39-3.90), ≥2 stressful events (AOR = 1.71; 95% CI: 1.04-2.82), and family history of PAU (AOR = 4.10; 95% CI: 1.90-8.84) were associated with greater odds of PAU. For women, being 25-34 years compared to >35 years old (AOR = 8.88; 95% CI: 1.56-50.63), being divorced (compared to married) (AOR = 5.72 95% CI: 1.27- 25.72) were associated with greater odds of PAU, as were only one stressful life event (AOR = 4.05; 95% CI: 1.14-14.36), and family history of PAU (AOR = 10.98; 95% CI: 1.69-71.14). Conclusions:PAU prevalence was high in this sample, significantly higher among men compared to women. Our study highlights the need to implement public health interventions that target risk factors for PAU in Ethiopia. Findings also highlight the need for selective PAU prevention interventions that target individuals with a family history of PAU or exposure to stressful life events.
Objectives To understand the trade-offs between different statistical modeling approaches, using real world data with small sub-populations, with rare exposures and increasingly rare outcomes. In particular, to compare adjusted regression, inverse probability weighting, and matching. Methods Data for these analyses came from the RADAR (N=1,134) and combined CNICS/JHHCC (N=14,434) cohorts. We estimated prevalence ratios (PRs) for self-reported use of specific substances comparing subpopulations (SP), SP-1 vs SP-3 and SP-2 vs SP-3, where SP-1 was the largest proportion (92% in RADAR, 81% in CNICS/JHHCC), SP2 was moderate proportion (18% in CNICS/JHHCC) and SP-3 was the smallest proportion (8% in RADAR, 1% in CNICS/JHHCC) of the population. We calculated PRs using 1) unadjusted relative risk regression (RR); and adjusted estimates controlling for age, race/ethnicity, study site, and year of interview using: 2) standard adjustment in RR; 3) stabilized inverse probability of treatment weighting (IPTW); and 4) matching with up to 3 matches from SP-1 or SP-2 per SP-3 participant. Results For most substances, all methods yielded consistent estimates. There were large weights in some of the IPTW analyses and in three cases these resulted in substantially divergent estimates. For the comparison between SP-1 and SP-3, the estimate for smoking was 1.3-fold greater in the matched analysis (PR=1.33, 95% CI: 1.02-1.75) than in IPTW (PR=1.03, 95% CI: 0.78-1.37 ATE and PR=1.05, 95% CI: 0.88-1.26 ATT). Even more extreme divergence in estimates was observed for differences between SP-2 and SP-3 with respect to methamphetamine/amphetamine, (IPTW-ATE: PR=1.51, 95% CI: 0.79-2.89; IPTW-ATT: PR=2.36, 95% CI: 1.36-4.12); vs Matching: PR=2.71, 95%CI: 1.47-4.99) and cocaine (IPTW-ATE: PR=1.15, 95% CI: 0.55-2.38; IPTW-ATT: PR=1.81, 95% CI: 1.03-3.18); vs Matching: PR=1.38, 95%CI: 0.76-2.53). Conclusion The combination of a rare exposure and a rare outcome can produce challenges for commonly used confounding adjustment strategies, and it is often best to compare different modeling approaches to gain greater insight.
In 2019, approximately 21 million children in the United States lived with a parent who misused substances, and over 2 million lived with a parent with a substance use disorder (SUD). While parents with SUD are often invested in preventing intergenerational transmission of substance use, there has been little research devoted to addressing this challenge particularly among parents of adolescents. In this narrative review of existing literature, we take a bioecological perspective that includes individual, interpersonal, and societal factors that offer opportunities for intervention. Specifically, we suggest that there is a need to consider key developmental tasks of adolescence—establishing a sense of autonomy, developing personal identity, and cultivating meaning and purpose—in tandem with effective parenting practices and societal considerations to prevent the intergenerational transmission of substance misuse and use disorders among adolescents when a parent has SUD. We offer specific research recommendations and strategies for leveraging impactful preventative interventions.
Background:Stigma related to methadone maintenance treatment (MMT) remains a substantial barrier to treatment engagement among people who use drugs (PWUD). Understanding how MMT-related stigma influences adherence self-efficacy is critical for supporting treatment engagement and optimizing long-term outcomes. Objectives:Our study examined the associations between MMT-related stigma, with a specific focus on anticipated and internalized stigma, and self-efficacy for treatment adherence among PWUD in Vietnam. Methods:We used cross-sectional baseline data collected between April and July 2024 from an intervention trial conducted in 3 provinces of Vietnam. Bivariate correlations and hierarchical multiple linear regression models were used to assess the relationships between 2 forms of MMT-related stigma and self-efficacy for treatment adherence, adjusting for relevant sociodemographic and background characteristics. Results:Among 690 PWUD participants, both anticipated MMT-related stigma (r = -.339, P < .001) and internalized MMT-related stigma (r = -.225, P < .001) were negatively correlated with self-efficacy in treatment adherence. In adjusted regression analyses that included both stigma dimensions and participants' characteristics, only anticipated stigma remained independently associated with lower adherence self-efficacy (B = -0.198, SE = 0.031, β = -.238, P < .001). Conclusions:These findings underscore the importance of integrating strategies to address and reduce MMT-related stigma. Interventions that explicitly address anticipated stigma may be critical for strengthening confidence in treatment adherence and supporting sustained outcomes.
Background: The opioid overdose epidemic continues as a serious world problem, with postoperative opioid prescribing recognized as a critical contributor to opioid use disorder (OUD) development. Identifying risk factors associated with OUD in the perioperative setting is essential for developing targeted prevention strategies. This study aimed to evaluate the association of social determinants of health (SDoHs) and mental health conditions in predicting OUD within 1 year following surgery. Methods: This retrospective cohort study used de-identified electronic health records from the TriNetX Research Network, evaluating over 295 000 matched patients across individual risk factor cohorts. The index event was defined as the first opioid exposure within 3 days after their first surgery. Patients with and without risk factors were propensity score matched and then odds ratios (ORs) and absolute risks were calculated for postoperative OUD within 1 year. Results: Significance at P < .001 was present for all SDoHs assessed with individual ORs ranging from 0.77 (benzodiazepine use, n = 3 026 362) to 8.3 (homelessness, n = 16 997). A cohort with known mixed risk factors showed an additive association with OUD risk. A validation cohort confirmed the methodology, showing no association between levothyroxine use and OUD development (OR 1.0, P = .416, n = 222 471). The definition of OUD in this study was based on ICD-10 coding, which does not perfectly align with DSM-5 diagnostic criteria and may capture patients with persistent opioid use but without formal OUD diagnosis. Conclusions: Key SDoHs and mental health conditions significantly increase the risk of postoperative OUD. These findings underscore the need for preoperative risk stratification and targeted interventions, including multimodal analgesia and integrated mental health care to mitigate OUD risk in surgical populations. Addressing these factors is critical for advancing perioperative care and combating the opioid overdose crisis.
Background:Several eHealth treatments, including the Building Emotional Awareness and Mental Health (BEAM) program, are feasible and effective for mothers with mental health concerns such as depression and/or anxiety. BEAM is a mental health and parenting program that does not directly address substance use. Prior BEAM trials observed high rates of alcohol and cannabis use among participants, despite not recruiting based on substance use. No research has examined BEAM among mothers with mental health concerns and at-risk substance use (ARSU), highlighting the need to understand implementation metrics and symptom trajectories among mothers with depression/anxiety and ARSU (ARSU+) and without ARSU (ARSU-). Objectives:To address this gap, we examined BEAM implementation metrics (retention, session attendance, perceived usefulness, safety) and mental health and parenting stress symptom trajectories over time in mothers with ARSU+ and ARSU-. Design:This was a secondary data analysis of 2 BEAM trials for mothers of infants (6-18 months) and toddlers (18-36 months). Methods:One-hundred-and-ten participants (M age = 31.85) from the BEAM arm of 2 trials: infant (n = 40) and toddler trials (n = 70). Implementation metrics were evaluated against pre-specified benchmarks. Mental health and parenting stress symptom trajectories were examined across time using 2-level mixed models. Results:Treatment adherence and safety benchmarks were met in both groups, the perceived usefulness benchmark was met only in the ARSU+ group, and the retention benchmark was not met for either group. Mental health and parenting stress symptom trajectories were largely similar between ARSU subgroups over time. Conclusion:This study extends evidence on BEAM by showing that mothers with ARSU+ can safely engage with BEAM, have acceptable treatment adherence, and describe BEAM as useful. Retention remains the key implementation barrier for mothers with ARSU+. Future BEAM iterations should prioritize retention-focused supports (eg, proactive engagement, incentives) to strengthen real-world impact.
Background:Adolescent alcohol and other drug use represents a growing public health challenge in South Africa, particularly in the Western Cape, with early onset and high prevalence rates. Despite the urgent need for prevention and treatment programmes (aligned with SDG 3.5), a substantial treatment gap exists, with many young people failing to seek or receive adequate prevention and treatment services. Understanding perceived factors influencing help-seeking among a heterogenous group of adolescents is essential for developing youth-friendly prevention and treatment. Objectives:This research aimed to explore secondary school learners' perspectives on factors that facilitate or hinder health-seeking behaviours in the Western Cape. Methods:A qualitative methodology was adopted, semi-structured interviews were conducted with 84 learners from 11 purposively sampled schools across 7 community clusters in Cape Town. Inductive thematic data analysis was conducted. Results:The findings highlighted perceived facilitators and barriers at individual and service levels. Facilitators and barriers reflected both the perspective of adolescents with lived experience of substance use, and general perceptions of services and adolescent help-seeking. User-level facilitators included self-determination and a desire for change, insight to seek professional help, strong preference for informal help-seeking (especially from parents), and peer encouragement and support. User-level barriers comprised self-stigma, reluctance to stop using substances, lack of knowledge of available services (among adolescents and parents), and fear of parental rejection or punishment. Service-level barriers included access constraints (geographic, financial, programme availability), unappealing and ineffective services, stigma and perceived judgement from educators and fear of confidentiality breaches within schools. Conclusion:To address the treatment gap, interventions should leverage existing trust relationships (parents, peers) and develop clear pathways to professional services, be it preventative or targeted treatment. Schools must shift from punitive to supportive environments that address confidentiality and stigma concerns. Future research should examine help-seeking behaviours among adolescents with documented substance use.
Background: In an increasingly digital world, young people are becoming more vulnerable to an emerging form of intimate partner violence, termed digital dating abuse, where technology facilitates abusive behaviors. Though prior studies suggest that alcohol use/problems and emotion dysregulation are predictors of digital dating abuse, findings on whether these associations vary by gender are mixed.Objective: We explored associations among alcohol use/problems, emotion dysregulation, and gender on 3 types of digital dating abuse perpetration: digital coercion (eg, pressuring for explicit images), direct aggression (eg, sending threats online), and monitoring (eg, tracking a partner's online activities). This study also examined the 3-way interaction among these 3 variables to assess their combined influence on digital dating abuse.Design: We aimed to answer the question: Does emotion dysregulation moderate the relationship between alcohol use/problems and types of digital dating abuse (ie, coercion, direct aggression, monitoring)? Is there a difference based on gender?Methods: Participants were (n = 1619) undergraduate students from a public university in the southeastern United States. Sociodemographic information and scores for alcohol use/problems, emotion dysregulation, and digital dating abuse were collected via an online survey. Regression analyses were conducted to evaluate independent and interactive effects among these variables.Results: Alcohol use/problems were consistently associated with all forms of digital dating abuse. While emotion dysregulation predicted digital direct aggression and digital monitoring, it did not predict digital coercion. Notably, alcohol use/problems and emotion dysregulation exhibited an interactive effect on digital monitoring, with higher emotion dysregulation amplifying the relationship between alcohol use/problems and controlling behaviors. When controlling for gender, no significant gender differences emerged across these associations.Conclusion: Findings suggest that interventions addressing alcohol misuse and emotion dysregulation may be effective in preventing digital dating abuse, particularly among young adults.
Background:This study aimed to investigate the complex relationships between smokeless tobacco (SLT) consumption behaviors, socio-demographic factors, and oral health status among patients in Bangladesh, using Structural Equation Modeling (SEM). Methods:A cross-sectional study was conducted from December 2021 to June 2022 with 156 participants included via purposive sampling from a dental outpatient department. Data were collected using a semi-structured questionnaire, translated and piloted for validity, covering socio-demographics, detailed SLT behaviors, and oral health status assessed by clinical dentists using the WHO Oral Health Assessment Form for Adults. Data analysis was performed employing descriptive statistics, Spearman correlations, and SEM to evaluate associations. Results:SEM analysis revealed a strong positive relationship between SLT using behavior and oral health status (path coefficient = 0.99), while the path from socio-demographic factors to oral health was moderately positive (path coefficient = 0.59). Key specific associations included a significant relationship between the duration of SLT use and the need for more urgent treatment interventions (P < .001), with over 70% of participants having used SLT for more than a decade. Furthermore, earlier age of initiation (P = .016), higher frequency of daily use (P = .015), and specific SLT types (P = .022) were significantly associated with treatment urgency. The SEM model demonstrated an acceptable overall fit based on ULS-appropriate indices, including the Root Mean Square Residual (RMR = 0.079), Goodness of Fit Index (GFI = 0.986), Adjusted Goodness of Fit Index (AGFI = 0.981), and Normed Fit Index (NFI = 0.916), indicating a reasonable representation of the observed data. Conclusions:The use of SLT is a major and direct factor associated with poor oral health outcomes, and the length of usage is a crucial risk factor. Although less important, sociodemographic traits are also important.
Background:Sipping alcohol during adolescence is a risk factor for later alcohol-related outcomes, but relatively little is known about the context in which sipping occurs. Prior work has primarily examined parental supply of alcohol or sipping as a dichotomous variable without considering the potential heterogeneity in early sipping experiences. Contextual variables related to sipping alcohol may act as important moderators for later risk. Methods:This study examined the ecology of sipping alcohol in a community sample of early adolescents (n = 260, mean age = 11.93). Lifetime sipping, contextual variables related to the first sip experience, sipping with/and or without parental permission, and future intentions to use alcohol were examined. Results:40% of adolescents in this sample reported ever sipping alcohol and 62.5% of these adolescents reported sipping alcohol with parental permission only. Sipping without permission appeared to primarily involve accidental rather than intentional sipping. Most commonly, sipping occurred at social gatherings in the adolescent's or someone else's home, and the alcoholic beverage belonged to a parent, but adolescents reported sipping alcohol in a variety of heterogeneous contexts. Contextual variables generally did not differ across those who sipped with versus without permission, but subsequent sipping behavior did, with adolescents who sipped both with and without permission most likely to be offered or ask for future sips. Consistent with prior work, adolescents who had sipped reported higher future intentions to use alcohol. Conclusion:It is important to educate parents about the risks associated with allowing sipping, as they appear to be the primary drivers of early sipping behavior. The prevalence of accidental sipping warrants further research and may indicate the need for supervision of children and adolescents in contexts where alcohol is available.
Background:The US Food and Drug Administration (FDA) issued a drug safety communication warning of dental-related adverse events (DAE) reported in patients using buprenorphine films or tablets in January 2022. This study utilized more recent data with a broader dental outcome definition beyond what has been previously reported to provide comprehensive evidence of this risk. Objective:Assess the association between buprenorphine use and the risk of DAE among opioid use disorder (OUD) patients. Design:A retrospective cohort study. Methods:Using the Veradigm-MarketScan® linked dataset, adults aged ⩾18 years with an OUD diagnosis between June 30, 2018, and July 1, 2023, and who met our selection criteria were included. Patients were grouped as: (1) BUP users and (2) non-BUP users (control group). We used Prescription Time Distribution Matching (PTDM) and Inverse Probability Treatment Weighting (IPTW) methods to balance potential confounders between the 2 groups. The primary outcome was dental-related adverse events (DAE). Cox proportional hazards models estimated adjusted hazard ratios (HRs). Results:A total of 14 495 OUD adult patients were included. Of these patients, 4199 (28.97%) initiated oral buprenorphine. Among the overall population, most were males, 8742 (60.3%), with an average age of 44.9 years. The absolute risk of DAE was slightly higher among buprenorphine users (2.17%) compared to controls (1.66%). We found an increased risk of DAE in buprenorphine users compared to the control group (adjusted HR, 1.36; 95%CI, 1.04-1.78). Conclusions:There is an increased risk of DAE among buprenorphine users compared to non-users after 6 months of follow-up. Although this risk is modest, this finding suggests the need for increased awareness and preventive interventions among these users.
Background:Rural communities face significant implementation challenges addressing the overdose epidemic, including limited treatment capacity, pervasive stigma toward people who use drugs, and social and political opposition to evidence-based interventions. Objectives:Rather than implementing prescribed harm reduction services that may face community resistance, the Ohio Opioid Project adopted a capacity-building approach to address structural barriers and enhance community readiness for future harm reduction and treatment innovation across 3 rural Appalachian Ohio counties. Methods:This applied implementation project used the Evidence-Making Intervention framework with process evaluation. Mixed-methods formative research included interviews with stakeholders (n = 34) and people who use drugs (n = 30), respondent-driven sampling surveys with people who use drugs (n = 258), organizational network analysis, and surveillance data review. A 9-member Community Leadership Board - including health commissioners, treatment providers, and harm reduction program representatives - co-developed interventions targeting 3 structural barriers: substance use-related stigma, interagency fragmentation, and inadequate provider capacity. Community members served as leadership board representatives, implementation staff, intervention consultants, and data collectors, democratizing research involvement and building local public health capacity. Implementation followed an adaptive approach, allowing activities to evolve based on emerging needs, policy changes, and the COVID-19 pandemic. Results:The service delivery plan included 20+ activities across stigma reduction, interagency coordination, and provider capacity building. Key activities included peer recovery supporter training, law enforcement harm reduction seminars, faith-based stigma reduction forums, conflict resolution processes, establishment of drug court buprenorphine protocols, and HCV telehealth partnerships. Multiple activities were sustained by community partners beyond the research period, including resource clearinghouses, new regional partnerships, and organizational protocols integrating harm reduction into existing services. Conclusions:Capacity-building implementation science can address structural barriers to community-based harm reduction in resistant rural settings. By prioritizing community co-creation and adaptive implementation, this approach created foundational conditions for sustainable harm reduction innovation while respecting local contexts and readiness for change.
