Traumatic brain injury (TBI) is a major global public health problem, with a high burden of long-term sequelae that extend beyond acute survival and physical recovery. Sleep disturbances are increasingly recognised as a common and clinically significant consequence of TBI, yet they remain under-recognised and inadequately addressed, particularly in low- and middle-income countries such as Vietnam. This study aimed to assess sleep quality and to identify factors associated with sleep disturbances among patients with TBI in Vietnam. A cross-sectional study was conducted in 2020 through phone interviews among 212 TBI patients in Vietnam. Data on demographics and socioeconomic status, health risk behavior, mental health issues, social support, and sleep quality were collected. Multivariate Tobit regression and Multivariate Logistic Regression models were used to determine factors related to the PSQI score and sleep disturbances among TBI patients. A total of 212 adults with TBI were enrolled (mean age 47.1 ± 17.6 years, and 67.5% were male), nearly half of the participants (47.2%) reported sleep disturbances. The majority experienced mild TBI (93.9%), and road traffic accidents were the leading cause of injury (65.6%). Individuals with sleep disturbances indicated a significantly higher prevalence of depressive symptoms compared with those without sleep disturbances (38.0% vs. 7.1%, p < 0.001). In addition, perceived social support was significantly lower among participants with sleep disturbances than normal sleep quality (p < 0.001). Multivariable regression analysis indicated that being female, hazardous drinking, and higher depressive symptom scores were associated with poorer sleep quality, whereas higher educational levels and stronger perceived social support were associated with better sleep outcomes. This is one of the first studies in Vietnam to examine sleep disturbances and their associated factors among patients with TBI. The findings indicate a high prevalence of sleep disturbances and highlight significant associations between sleep quality and sociodemographic characteristics, depressive symptoms, perceived social support, and health behaviors. This study underscores the importance of recognizing sleep disturbance as a key outcome in TBI care and highlights the need for integrated, multidisciplinary rehabilitation interventions that address sleep, mental health, and social functioning, with particular attention to vulnerable groups such as women, individuals with lower educational attainment, and those with substance use.

BACKGROUND:Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex differences in drug use settings among people who use opioids. METHODS:Data were from the baseline survey of the OASIS project, a community-based study conducted in Baltimore, Maryland (N = 869), focusing on 9 specific types of locations where participants reported drug use in the past 30 days: their own residence, someone else's residence, street, alley, park, abandoned building, public restroom, car, and other locations. Bivariate and multivariable logistic regression models examined associations between sex and drug use settings, adjusting for age, race, education, homelessness, and frequency of drug use. RESULTS:The sample included 346 women and 523 men. In adjusted models, women had significantly lower odds than men of using drugs on the street (aOR = 0.49, 95% CI 0.35-0.70), in alleys (aOR = 0.50, 95% CI 0.35-0.69), parks (aOR = 0.57, 95% CI 0.42-0.78), abandoned buildings (aOR = 0.53, 95% CI 0.38-0.75), cars (aOR = 0.55, 95% CI 0.41-0.73), and other locations (aOR = 0.59, 95% CI 0.37-0.94). Sex was not significantly associated with drug use at one's own residence or someone else's residence. CONCLUSIONS:Women who use opioids were significantly less likely than men to use drugs in public and semi-public settings, which may reflect gendered patterns of stigma, interpersonal violence, and safety concerns. Harm reduction programs should focus on making current drug use settings safer and developing additional safer settings with an emphasis on addressing barriers for women to access harm reduction services, including women-centered overdose prevention centers and household-based overdose response training.

BACKGROUND:Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to address it. METHODS:We conducted a cross-sectional survey of 703 PWUO in Baltimore, MD (2023-2025), to assess xylazine awareness, perceptions, and experiences. Multivariable logistic regression models examined correlates of xylazine awareness and self-reported xylazine-attributed wounds. RESULTS:84.8% of White participants, 48.6% Black participants, 64.3% of males, and 51.4% females had heard of xylazine. Nearly half (45%) of those who used xylazine reported that it caused more severe withdrawal symptoms. In the multivariable model of xylazine awareness, the largest odds ratios were year of survey administration (2024 vs. 2023: aOR = 4.30, 95% CI = 2.91-6.37; 2025 vs. 2023: aOR = 6.32, 95% CI = 3.31-12.07) and White race (aOR = 3.22, 95% CI = 1.85-5.57). Other significant demographic variables included education and gender. In the multivariable model of xylazine-attributed wounds, survey year 2025 vs. 2023 (aOR = 2.65, 95% CI = 1.06-6.61) and injection drug use in the prior year (aOR = 17.74, 95% CI = 5.58-56.39) were statistically significant. CONCLUSIONS:Awareness of xylazine in the drug supply remains incomplete among PWUO, with differences by race, age, and gender. The finding of a strong association of xylazine-attributed wounds and injection drug use should be the focus of future research. These findings underscore the need for enhanced surveillance systems, peer education, and community-based harm reduction strategies. Real-time monitoring and rapid response strategies are essential to protect against health risks of toxic adulterants, such as xylazine, medetomidine, and BTMP, in the drug supply.

People who inject drugs (PWID) in India continue to experience high HIV incidence while coverage of HIV and harm reduction services within this population remains suboptimal in many settings, highlighting the need to identify novel service delivery points. To evaluate the effectiveness of spatially focused upscaling of interventions at observed venues where PWID injected drugs together, we developed an individual-based dynamic transmission model of HIV informed by detailed injection network, service engagement, and injection venue attendance data collected in a sociometric study of PWID (n = 2512) in New Delhi, India. HIV incidence was simulated for different spatial targeting strategies and with increasing service coverage at injection venues according to UNAIDS/UNODC goals. We identified significant decreases in predicted HIV incidence when deploying interventions at frequently visited injection venues (from 6.8 cases/100 person-years to 2.7/100PY for full service coverage at the most-visited venue, and further down to 1.3/100PY for 12 most-visited venues). Prioritizing the most visited venues stratified by spatial clusters provided services to a larger number of individuals versus prioritizing the overall most visited venues, suggesting that service expansion at venues that are spatially distinct with minimal population overlap has a slightly larger impact on reducing HIV incidence.

Background Accurately mapping social and risk networks is critical for understanding and controlling infectious disease transmission, especially among hard-to-reach populations, such as people who inject drugs (PWID). Yet, empirical sociometric network ascertainment remains challenging and resource-intensive. Geometric deep learning may provide a scalable approach to inferring network structure from individual-level data, but its real-world performance and translation to epidemic modeling remain undercharacterized.Methods We trained a graph neural network (GNN) to predict injection partnerships from a longitudinal network study of 2512 PWID in New Delhi, India, using demographic, behavioral, and spatial injection-venue features. We compared the GNN with exponential random graph models (ERGMs), evaluated structural similarity between empirical and imputed networks, and assessed validity in an independent PWID network. To examine translational utility, we calibrated a network-based HIV transmission model on either the empirical or GNN-imputed injection network and compared HIV incidence two years after scaling interventions across venues.Results The GNN achieves balanced predictive performance (accuracy 60.8%, precision 59.4%, recall 67.9%, F1 63.4%), outperforming ERGMs, and yields an imputed network with structural concordance to the empirical network (spectral similarity 0.87). Incorporating venue data increases accuracy from 51.0% to 60.8%. In the external cohort, the GNN maintains performance (F1: 61.3%) and captures structural changes. In the HIV model, calibrating on the GNN-imputed versus empirical network produces incidence curves that differ by at most 0.4 infections per 100 person-years.Conclusions GNN-based network imputation can recover sufficient epidemiologically relevant network structure to preserve conclusions about HIV interventions, illustrating how geometric deep learning can support network-informed epidemic modeling when full sociometric ascertainment is infeasible.

BACKGROUND:The COVID-19 pandemic amplified the risk environment for people who inject drugs (PWID), making continued access to harm reduction services imperative. Research has shown that some harm reduction service providers were able to continue to provide services throughout the pandemic. Most of these studies, however, focused on staff perspectives, not those of PWID. Our study examines changes in perceptions of access to harm reduction services (e.g., participant reported difficulty in accessing syringes and naloxone) among PWID participating in a longitudinal study conducted through the University of Illinois-Chicago's Community Outreach Intervention Projects field sites during the COVID-19 pandemic. METHODS:A COIVD-19 survey module was administered from March 2020-February 2022 to participants of an ongoing longitudinal study of PWID ages 18-30, who were English-speaking, and were residing in the Chicago Metropolitan Area. Responses to the COVID-19 survey module were analyzed to understand how study participants' self-reported access to harm reduction services changed throughout the pandemic. Baseline responses to the survey were analyzed to compare participant-reported drug use behaviors and perceived access to harm reduction services across COIVD-19 time periods. Mixed effects logistic regression was used to examine difficulty in syringe access as an outcome of COVID-19 time period. RESULTS:Participants had significantly lower odds (AOR = 0.28; 95% CI 0.12-0.65) of reporting difficulty in accessing syringes later in the pandemic. However, the majority of participants reported access to syringes and naloxone remained the same as before the pandemic. CONCLUSIONS:The lack of perceived changes in harm reduction access by PWID and the decrease in those reporting difficulty accessing syringes as the pandemic progressed suggests the efficacy of adaptations to harm reduction service provision (e.g., window and mobile service) during the pandemic. Further research is needed to understand how the COVID-19 pandemic may have impacted PWIDs' engagement with harm reduction services.

In intervention studies, alcohol consumption is often measured by self-report alone, which can be impacted by social desirability, recall, and other biases. Biomarkers and biosensors have gained popularity as objective measurements of alcohol consumption that can improve the accuracy of results. This scoping review provides a narrative overview and describes the use of biomarkers in alcohol intervention studies to inform future research. We conducted a review of alcohol intervention literature including published studies and Clinicaltrials.gov registrations (2000-2021). Randomized controlled trials, quasi-experimental, and nonexperimental studies were included if they piloted or evaluated an intervention aimed at reducing unhealthy alcohol consumption and if an alcohol biomarker was used. Data charting included type of biomarker(s), the country and context of the study location, and a description of how the biomarker was used in analysis. We identified 168 alcohol intervention studies that included at least one biomarker. Blood alcohol content was the most used (N = 76). There was an upward trend in biomarker use over time; 24% of studies were published between 2000 and 2010, and 76% between 2011 and 2021. The use of direct biomarkers, phosphatidylethanol and ethyl glucuronide, and biosensors has increased in frequency over time relative to indirect biomarkers, such as aspartate aminotransferase, carbohydrate-deficient transferrin, and alanine aminotransferase. Most studies were conducted in high-income countries; only 15% were conducted in a low- or middle-income country. More than half of completed studies did not report on comparisons between self-report and biomarker results even when both were collected. Among studies that did report a comparison, 26% reported discordance between self-report and biomarker results. The use of direct biomarkers and biosensors is accelerating. There is a need for more consistency in reporting biomarker/self-report concordance results, more comparisons between multiple biomarkers, and for greater geographic representation within the alcohol biomarker literature.

Background: To improve the efficacy of digital smoking cessation interventions for young adults, intervention messages need to be acceptable and appropriate for this population. The current study compared ratings of smoking cessation and urge reduction messages based on Cognitive Behavioral Therapy (distraction themed) and Acceptance and Commitment Therapy (acceptance themed) in young adults who smoke. Methods: A total of 124 intervention messages were rated by an online Qualtrics panel of N=301 diverse young adults who currently smoked tobacco cigarettes (Age M=26.6 years; 54.8% male; 51.5% racial/ethnic minority; 16.9% sexual or gender minority (SGM); 62.5% daily smoking). Each participant rated 10 randomly selected messages (3,010 total message ratings; 24.3 ratings per message) on 5-point scales (higher scores representing more favorable ratings) evaluating quality of content, quality of design, perceived support for coping with smoking urges, and perceived support for quitting smoking. Mixed models examined associations between message category (distraction vs. acceptance), participant level predictors (sociodemographic variables, readiness and motivation to quit, daily smoking, psychological flexibility), and message ratings. Results: Overall ratings ranged from M=3.61 (SD=1.25) on support for coping with urges to M=3.90 (SD=1.03) on content, with no differences between distraction and acceptance messages. Male participants gave more favorable ratings on the dimensions of support for coping (p<0.01) and support for quitting (p<0.01). Participants identifying as SGM gave lower ratings for message design (p<0.05). Participants with a graduate degree gave higher ratings on support for coping with urges and support for quitting (both p<0.05). Higher motivation to quit was associated with more favorable scores across all dimensions (all p<0.01). Those smoking daily rated messages as less helpful for coping with urges (p<0.01) and quitting smoking (p<0.05) compared to those smoking non-daily. Few interactions were found between message category distraction vs. acceptance and participant characteristics. Conclusions: Distraction and acceptance messages received similar ratings among young adults who smoke cigarettes. Message revisions may be needed to increase appeal to women, SGM, those with lower education, and those less motivated to quit. Messages will be refined and used in an ongoing micro-randomized trial to investigate their real-time impact on smoking urges and behaviors.

Introduction The opioid overdose crisis necessitates the development of effective treatment and harm reduction practices. Recent increases in opioid use disorder (OUD) and overdose rates among women in tandem with lower medications for opioid use disorder (MOUD) treatment utilization rates make a case for investigating the barriers faced by women with OUD in accessing MOUD treatment. To inform future interventions, this study examines factors that impede access to MOUD treatment and explores evidence-based solutions through triangulating the perspectives of affected women as well as criminal legal and health professionals who work with women with OUD. Methods Semi-structured interviews ( N = 42) were conducted from May to June 2022 to assess participants’ lived experiences with MOUD treatment. Participants included criminal-legal involved women with a lifetime history of OUD and MOUD use ( N = 20), criminal legal professionals ( N = 10), and substance use disorder (SUD) treatment professionals ( N = 12) who work with women with OUD. We used a thematic qualitative data analysis process to identify common barriers to accessing MOUD treatment. Results The thematic analysis identified three categories of factors impeding MOUD treatment accessibility: (1) financial barriers (including program difficulties procuring grant funding and individuals’ concerns regarding insurance coverage), (2) travel hardships (including inadequate public transportation infrastructure and lack of access to personal vehicles), and (3) insufficient provider availability (including demand that exceeds the supply of open spots in MOUD treatment programs and a limited number of treatment facilities). Conclusion There was substantial consensus among the three groups, and participants identified financial barriers, travel hardships, and insufficient provider availability as barriers to accessing MOUD treatment. Our study's results make a strong case for addressing travel-related hardships. To best serve affected women, solutions such as allocated transportation, gas mileage reimbursement, bus passes, flexible take-home treatment options, and alternative medication dispensing settings should be implemented to mitigate transportation-related barriers to accessibility.

BACKGROUND:Drug-related death is a significant public health challenge in the United States (U.S.). While social capital has emerged as a macro-social construct of interest in understanding the predictors of drug overdose, most research has examined this construct at the individual and neighborhood-level. This ecological study aims to investigate the association between county-level social capital and drug overdose mortality across 50 U.S. states and the District of Columbia. METHODS:County-level social capital, as measured by a social capital index (SCI), was obtained from the U.S. Congress' Social Capital Project. The SCI incorporates indicators related to family structure stability, confidence and trust in institutions, community cohesion, social network structure and volunteerism. County drug overdose mortality data from 2017 to 2019 were obtained from the National Vital Statistics System restricted-use data files. The association between county-level social capital and drug overdose mortality was assessed by multi-level negative-binomial regression models. RESULTS:In a sample of 2,992 counties, SCI ranged from -4.32 standard deviation below to 2.97 standard deviation above the average SCI across counties. After adjusting for covariates, a one standard deviation increase in SCI was associated with a 24 % decrease in drug overdose death rate (adjusted IRR: 0.76; 95 % CI: 0.71, 0.81). CONCLUSION:In this study, counties with high social capital had significantly lower rates of drug overdose deaths than counties with low social capital. Policymakers may consider interventions aimed at promoting factors that mediate the effects of social capital on drug overdose mortality, as a way to tackle this public health challenge.

BACKGROUND AND OBJECTIVES:In the past decade, the increasing availability and prevalence of fentanyl in the drug supply have heightened the risk of fatal overdose and increased the frequency and severity of opioid withdrawal symptoms. We aimed to examine how opioid withdrawal impacts engagement in harm reduction behaviors among people who use drugs. METHODS:Data came from a community-based research study in Baltimore, Maryland, conducted from 2022 to 2024. Participants were adults who used heroin, fentanyl, or prescription opiates to get high in the past month (N = 676). Structured surveys assessed withdrawal as a barrier to testing drugs for potency and overdose prevention. Logistic regression models were used to identify correlates of engagement in harm reduction during periods of withdrawal. RESULTS:Half the sample (46.6 %) reported that withdrawal "always" or "often" prevented them from testing drugs, and 66.6 % agreed that withdrawal was a barrier to overdose prevention. Depression symptoms (adjusted odds ratio (aOR): 1.56, 95 % CI 1.09-2.25), increased opioid use per week (aOR: 1.12, 95 % CI 1.03-1.22), and White race (aOR: 1.75, 95 % CI 1.16-2.62) were independently associated with lower engagement in drug testing and overdose prevention during withdrawal. CONCLUSIONS:Withdrawal significantly impacts engagement in harm reduction behaviors, even among those with high awareness and receptivity to drug testing and overdose prevention strategies. Withdrawal management and mental health support are emergent and critical components for harm reduction interventions to prevent overdose morbidity and mortality among people who use drugs.

Background:Cigarette smoking remains the leading preventable cause of illness and death in the United States and young adults are a priority population. This study aimed to investigate the feasibility of conducting a pilot micro-randomized trial (MRT) among young adults, using smartphone messages to reduce smoking urges in high-risk situations and combining Ecological Momentary Assessments (EMA) and geofence-based delivery. Methods:Participants were recruited online and completed surveys on Qualtrics and an EMA app to report smoking situations over 14 days (assessment phase). Assessment phase data were used to generate individual risk profiles [by combining timestamps, Global Positioning System (GPS), and self-reported data] with the highest likelihood of smoking for each participant. We used geofencing to generate geospatial buffers around these high-risk locations and intervention messages were triggered when a mobile device entered a geofence during specific time windows. In the following 30-day intervention phase, participants were prompted to complete up to 3 geofence-triggered EMAs daily. Each geofence-triggered EMA was followed by an intervention message and the type of message (distraction, acceptance, control) was randomized at each time point (within-subject). Urge level was the primary proximal outcome assessed in a follow-up EMA up to 15 minutes after message delivery. Analyses investigated the feasibility of study procedures, including geofence triggers, within-subject randomization, EMA survey completion rates, and smoking urge reports before and after message delivery. Cigarette smoking cessation and reduction outcomes at 45-day follow-up were also investigated. Results:A total of 8 participants were included in analyses (mean age 26.3 years; 50% male; 37.5% non-Hispanic White). In the assessment phase, participants completed between 4 and 51 real-time smoking reports. At least 2 geofences were created per participant, with a maximum of 9 geofences for one participant. In the intervention phase, between 11 and 90 geofence EMAs were triggered per participant. Compliance with EMAs was high (90.1% of geofence-triggered, 93.9% of follow-up EMAs). Within-subject randomization was successful and urge ratings declined from pre- to post-message assessments for control (k=98; mean difference =0.20), acceptance (k=99, mean difference =0.36) and distraction messages (k=94, mean difference =0.37). At 45-day follow-up, 1 participant (12.5%) reported no cigarette smoking during the past 7 days and abstinence was confirmed remotely using saliva cotinine testing. Half of participants (n=4, 50%) reduced their number of cigarettes per day (CPD) from baseline to follow-up by 50% or more. Findings also demonstrated the need for robust prevention of fraudulent research participant enrollment, as 10 participants were excluded due to GPS locations outside of the United States. Conclusions:Results indicate potential technical feasibility of an app-based MRT using intervention messages triggered by geofence locations. Findings will inform a fully powered MRT to investigate message efficacy to reduce smoking urges and smoking in young adults. Trial Registration:ClinicalTrials.gov (NCT05991934).

Background: Climate change and sustainability are highly interconnected. Addressing climate change requires major social change and collective action. The current study examined the prevalence of, and factors associated with, four climate change activism behaviors in a U.S. nationally representative sample. Methods: Data were derived from the Pew Research Center American Trends Panel conducted in April 2021 of 13,749 panelists. Key outcomes included (1) attending a protest or rally addressing climate change, (2) volunteering for a climate change activity, (3) donating money to an organization focused on climate change, and (4) contacting an elected official to urge them to address climate change. Multivariable logistic regression models examined the independent associations with psychosocial and demographic variables. Results: A fourth (24.7%) of participants reported engagement in one or more climate change activism behaviors. Of those who reported climate change activism, most (54.7%) only engaged in one activity. In the multivariable regression models, individual and social factors were significantly associated with all four climate action outcomes. Factors include social network communications and social norms variables, such as encouragement to take action, criticism for not taking action, and climate change communication frequency. Discussion: This study’s findings indicate that over 41 million U.S. adults reported having donated money to an organization focused on addressing climate change in the prior year, 25 million volunteered, and 26 million contacted an elected official. The association of social and communication variables with climate change activism suggests the importance of training people to talk about and encourage others to engage in climate change activism.

OBJECTIVE:This study explored factors associated with sleep quality among medical students in Vietnam. DESIGN:Cross-sectional study. SETTING:The study was conducted from December 2019 to February 2020 among medical students in Vietnam. PARTICIPANTS:Medical students were defined as those enrolled in undergraduate medical programmes. 1284 medical students who met the inclusion criteria participated in this study. OUTCOME MEASURES:The Pittsburgh Sleep Quality Index (PSQI) was used to measure participants' sleep quality, with a score of 5 or higher indicating poor sleep quality. Multivariable logistic and linear regression models were employed to identify the factors associated with poor sleep quality. RESULTS:36.6% of the study participants had poor sleep quality. There were statistically significant differences in the percentage of poor sleep quality across genders, health-related quality of life, morbidity status and depression (p<0.05). Depression (Coef.=0.54, 95% CI 0.17, 0.91 and OR=1.50, 95% CI 1.13, 1.99) and any morbidity (Coef.=0.64, 95% CI 0.28, 0.99 and OR=1.44, 95% CI 1.09, 1.88) were factors associated with higher PSQI Score and increased risk of poor sleep quality. In contrast, higher health-related quality of life scores (EuroQOL-5 dimensions-5 Levels Index: OR=0.01; 95% CI 0.002, 0.03 and Coef.=-7.11; 95% CI -8.65, -5.56; and EuroQOL-Visual Analogue Scale: OR=0.99; 95% CI 0.98, 1.00 and Coef.=-0.03; 95% CI -0.04, -0.01) were related to lower PSQI Score and reduced risk of poor sleep quality. CONCLUSIONS:This study reveals that health conditions and psychological well-being were associated with sleep quality among medical students. Reducing stress, improving quality of life and improving morbidity have the potential to improve the sleep quality of medical students.

It is critical to have naloxone readily available in the event of an opioid overdose. This study examines the prevalence of owning and carrying naloxone and factors associated with ownership and carriage among people who use opioids in Baltimore, Maryland, from December 2022 to January 2025. Among the 780 community-recruited study participants who were aged 18 years or older and currently used non-prescription opioids, most (78.2 %) reported owning naloxone, with the majority (69.4 %) keeping it at their residence. While 41.8 % of participants reported always having naloxone available when using drugs, 13.5 % never did. Only 27.0 % were carrying it with them at the time of the interview. Frequent heroin/fentanyl use (aOR: 2.07; 95 % CI: 1.36-3.16) and reporting lower difficulty accessing naloxone (aOR: 2.37; 95 % CI: 1.85-3.05) significantly increased the likelihood of owning naloxone. Experiencing homelessness in the past six months (aOR: 2.09; 95 % CI: 1.40-3.12) and perceiving poor neighborhood treatment due to drug use (aOR: 1.27, 95 % CI: 0.1.08-1.49) increased odds of currently carrying naloxone. Although naloxone distribution programs have successfully improved access, substantial gaps remain in consistent naloxone carriage, necessitating targeted interventions addressing barriers to carriage, including drug use stigma.

BackgroundSexual and Reproductive Health (SRH) service use plays a vital role in improving the health of young people and in preventing negative reproductive health consequences. In this study, we explored awareness, attitudes, and access regarding SRH services among young people ages 15 to 24 in three provinces in Vietnam.MethodsWe conducted a cross-sectional study in three provinces in Vietnam, namely Hanoi, Lao Cai, and Thanh Hoa, from January to December 2019. We used a convenience sampling method to recruit participants. Participants with 10% or more missing data were excluded from the study, resulting in 1,358 out of 1,693 respondents being included in the final analysis.ResultsThere were statistically significant differences in awareness of SRH services between rural (91.1%) and urban (81.9%) areas. However, regarding the variety and scope of SRH services available, participants in urban areas reported awareness of more services. Financial issues were a major barrier to seeking SRH services in both areas, however, rural residents were more likely to report financial barriers.ConclusionOur findings highlight rural/urban differences in awareness, attitudes, and access to SRH services, as well as barriers to the use of SRH services in three provinces in Vietnam. SRH programs for young people must address these gaps and barriers. In addition, it is essential to emphasize synchronized development across regions to ensure equitable health care access for the population.

Community Health Workers (CHWs) have an extensive involvement in augmenting service capacities in primary care settings. This study sheds light on the unique experiences of CHWs as they navigate barriers and enablers in the Philippine healthcare setting through their journey for professionalization. This study aims to: (1) Describe the roles assumed by CHWs in rural and remote municipalities in the Philippines; and (2) Identify the multi-level barriers and enablers CHWs perceive to influence their performance of these roles. From June to July 2023, the Philippine Primary Care Studies parent program piloted a study on a clinical decision support tool for CHWs, involving 34 CHWs across six focus group discussions. The interviews also touched upon the roles of CHWs and the factors influencing their performance within their local health settings in-depth. A mixed inductive/deductive approach was used to investigate this subset of the FGD data. CHWs assume diverse roles that often surpass health service provision. While their roles were crucial, CHWs described being positioned against a volatile political landscape fraught with material insecurity. They utilized their individual and interpersonal capacities to overcome situational limitations and were augmented with organizational level interventions like improved network connectivity, training, or expanded access to clinical decision-support tools. Amidst resource scarcity, CHWs demonstrated remarkable resilience through their own ingenuity and by maximizing support from their social networks. While their commitment is an asset to the health workforce, support from national policymakers and local governments units are crucial to ensure CHWs remain protected against systemic exploitation. Ensuring accountability and stronger implementation of pre-existing laws to ultimately recognize the role of CHWs are an essential way to support CHWs and improve community health.

BACKGROUND:Fatal and nonfatal opioid overdoses remain a pressing public health challenge. However, engagement in drug overdose prevention and response behaviors may vary across demographic and social contexts. OBJECTIVES:This study examines individual and social determinants of these behaviors among people who use opioids (PWUO), leveraging data from the OASIS study in Baltimore, Maryland (N = 783). Ordered logistic regression models assessed factors associated with three key behaviors: testing-dosing to assess drug potency, naloxone availability while using with others, and solitary drug use. RESULTS:The three key overdose prevention behaviors were not strongly correlated with one another. Racial disparities emerged, with Black participants more likely to engage in test-dosing compared to White participants. Gender differences were also notable, with women less likely to use with others who have naloxone available when using drugs. Social network factors played a key role; having a "running buddy" was strongly protective against solitary drug use. CONCLUSIONS:These findings underscore the importance of tailored harm reduction interventions that address racial and gender disparities, enhance social networks, manage withdrawal, and enhance naloxone availability. Integrating harm reduction skill training into peer-driven naloxone distribution and overdose prevention programs, training non-drug-using network members, and addressing structural barriers may enhance overdose prevention strategies.

Background The co-use of opioids and stimulants is associated with elevated health risks. This study examined patterns of injection drug use and cocaine use frequency among people who use opioids. Methods Cross-sectional data were collected from community-recruited adults who use opioids in Baltimore, Maryland, between December 7, 2022 and January 26, 2025. Participants were categorized into four groups based on injection status and cocaine use frequency. Multinomial logistic regression examined factors associated with group membership, calculating relative risk ratios (RRR) and adjusted relative risk ratios (aRRR) with 95% confidence intervals. Results Of 777 participants (60.7% male, 71.6% Black, median age 52), 29.2% reported past-month injection drug use. Daily/almost daily use was reported for heroin/fentanyl (79.5%), crack cocaine (43.2%), and powder cocaine (9.3%). Four distinct drug use patterns emerged: not inject/lower frequency cocaine use (42.0%), inject/lower frequency cocaine use (9.3%), not inject/higher frequency cocaine use (28.8%), and inject/higher frequency cocaine use (19.9%). Factors significantly associated with injecting and higher frequency cocaine use group membership included: overdose history (aRRR=2.58, 95% CI=1.52-4.38), withdrawal behavior with high overdose risk (aRRR=1.29, 95% CI=1.14-1.46), and using in multiple locations (aRRR=1.09, 95% CI=1.02-1.18). Conclusions Nearly one-fifth of people who use opioids reported both injection drug use and high-frequency cocaine use, and greater frequency of cocaine use was associated with higher overdose risk. Targeted interventions addressing polysubstance use patterns, social networks, and environmental factors are urgently needed to reduce harm among this high-risk population.