Search

Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts. [ABSTRACT FROM AUTHOR]

Background: Deaths due to opioid overdose continue to rise in the United States. Despite availability of effective treatment for opioid use disorder, uptake is low among those who misuse opioids. Methods: This paper explores the role of misconception, stigma, and misinformation in influencing decisions to initiate medications for opioid use disorder among patients and providers. Conclusion: Misinformation about opioids has been prevalent among future healthcare providers and first responders as well as pharmaceutical companies, which may have implications for treatment. Among individuals with opioid use disorder, treatment uptake and adherence have been negatively affected by misconceptions about treatment efficacy and side effects, as well as stigma. We discuss the role of social media, education, and the community, in mitigating misinformation and addressing misconceptions about opioids and treatment options. [ABSTRACT FROM AUTHOR]

Syringe service programs (SSP) increasingly serve rural areas of the United States, yet little is known about access and perceived need for their services. Objectives: This paper presents the HIV and viral hepatitis prevention, testing, and treatment, and, substance use disorder treatment and overdose prevention services offered at three SSPs and which services their clients accessed. Across the three SSPs, 45 clients (people who inject drugs [PWID]), 11 staff, and five stakeholders were interviewed. Results: Most clients (n = 34) reported accessing SSP services weekly and primarily for sterile syringes and injection-related supplies. All clients reported testing for HIV at least once, though concern for acquiring or transmitting HIV was divided between some or no concern. Most clients (n = 43) reported testing for hepatitis C virus (HCV). Concern for acquiring or transmitting HCV was also mixed. Vaccination for hepatitis A and/or B teetered around half (HAV: n = 23) to a third (HBV: n = 15). Most clients (n = 43) knew where to access the overdose countering medication, Narcan. Feelings about substance use treatment options varied, yet most felt not enough were available. Of note, not all assessed services were offered by the sampled SSPs. Conclusions/Importance: The findings help us understand PWIDs' rationale regarding services accessed and preference for particular services. The need for some services was not perceived by those at risk for the illness the services addressed. Discussing risk and providing tailored education is important when providing SSP services to rural residing PWIDs. [ABSTRACT FROM AUTHOR]

Background. American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, especially use of emerging tobacco products such as electronic cigarettes, among AIAN adolescents. Methods. This study investigated the association between hypothesized cultural protective factors (ethnic identity, spirituality, and ceremonial use of traditional tobacco) and past-month use of commercial cigarettes, e-cigarettes, marijuana, blunts, and alcohol among 156 AIAN adolescents in California (mean age = 15.3 years, 55% female). Adolescents from six AIAN schools and afterschool programs completed paper-and-pencil surveys. We used Logistic regression analyses to identify the significant cultural correlates of past-month substance use, controlling for demographic covariates. Results. As hypothesized, strong ethnic identity was protective against cigarette, marijuana, and alcohol use. However, it was not protective against e-cigarette or blunt use. Spirituality was associated with an increased risk of cigarette and marijuana use. Previous ceremonial use of traditional tobacco was not associated with past-month recreational substance use. Conclusions. Results indicate that the associations between cultural factors and substance use vary across substances. Future research should identify cultural factors that protect AIAN adolescents against use of newer products such as e-cigarettes and blunts. [ABSTRACT FROM AUTHOR]

Background: Cognitive enhancement is the use of prescription stimulant medicines by healthy individuals for nonmedical use in academic settings. Commonly used cognitive enhancers (CEs) include methylphenidate, amphetamines, and modafinil. To understand the motivation to use CEs, it is important to look beyond prevalence and explore the extent to which attitudes, beliefs, and intentions predict the decision to use CEs. Objective: The study aimed to investigate what factors explain the decision to use CEs among tertiary students in New Zealand, using the Theory of Planned Behaviour (TPB). Methods: Students from the Schools of Pharmacy, Nursing, Medicine, Law, and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire. The questionnaire elicited students' attitudes, subjective norms, and perceived control toward illicit use of CEs using TPB. An exploratory factor analysis was conducted. Results: Response rate was 88.6% (442/499). Students who perceived CE use to be socially and ethically acceptable were more likely to use CEs (odds ratio, OR: 1.56, 95% confidence interval, 95% CI: 1.153–2.105, p = 0.004). Students who were concerned about the health impact of CE use were less likely to use CEs (OR: 0.54, 95% CI: 0.492–0.826, p = 0.001). Students who believed that CE use was approved were more likely to use them (OR: 1.648, CI: 1.193–2.278, p = 0.002). Conclusion: This research supports the notion that the decision to use CEs is not just an autonomous choice that occurs in isolation. Attitudes on the ethical and social acceptability of CE use were more likely to drive the decision to use CEs. The study provides the impetus for an integrative discussion by health care professionals and academics on the impact of attitudes, social norms, and advocates on the decision to use CEs. [ABSTRACT FROM AUTHOR]

This paper discusses organizations of the oppressed, such as drug user and sex worker groups, and the images of themselves that they construct. We suggest that analysis of these organizationally-produced collective self-images -frequently overlooked in scholarly research -is crucial to understanding the complex internal dynamics of users' and sex workers' organizations and struggles they engage in when defining their collective (organizational) identities and course of action. [ABSTRACT FROM AUTHOR]

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to compare prevalence of JUUL use and JUUL risk perceptions between adolescents living in an urban area versus Appalachian areas of the U.S. Data were drawn from a prospective cohort study of adolescent males (the Buckeye Teen Health Study, or BTHS); our cross-sectional analysis used data from one timepoint, collected between January and December 2019 (N = 873). Chi-square tests and multivariable logistic regression compared JUUL use prevalence and risk perceptions between participants in an urban Ohio county and nine predominantly rural Appalachian Ohio counties. Over a quarter of the sample (29.2%) had ever used JUUL. In the unadjusted model, prevalence of JUUL use was similar between regions but Appalachian participants perceived JUUL as more harmful (p <.001) and more addictive (p =.04) than urban participants. In the adjusted model, region was not significantly related to current JUUL use (OR: 1.20, 95% CI: 0.77, 1.87) or ever JUUL use (OR: 1.15, 95% CI: 0.83, 1.60). JUUL use was similar between urban and Appalachian participants despite regional differences in risk perceptions. Interventions that only target risk perceptions may not be sufficient to prevent adolescent e-cigarette use, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Introductions: In the United States (US), support for cannabis legalization has increased over time. This study examines historical changes in legalization attitudes and the period-specific individual and external influences on these. A systematic search was conducted for publications in PubMed, EMBASE, and PsycINFO up to October 2019. Six studies with a regionally or nationally representative adult US-based populations were included. A secondary analysis was conducted using data from the National Survey of Drug Use and Health. Hierarchical age-period-cohort analysis assessed the trends in perceived harmfulness and availability of cannabis between 1996 and 2018. Ecological comparisons were made between these perceptions and support for cannabis legalization over time. A steep growth in support for cannabis legalization began in the 1990s and continued to grow in a relatively linear manner. Most people developed more liberal views, with no evidence that changes within any one sociodemographic group was disproportionately responsible for the overall attitudinal change. Increases in the proportion of people who use cannabis, non-religious population and political liberalism may partially explain the increased support for legalization. The decline in perceived harmfulness of cannabis, as reflected in the media, may have contributed to the increased support for legalization. However, perceptions of the availability of cannabis remained stable despite significant relaxations in cannabis regulations. The US population has become more accepting of cannabis legalization. The attitudinal change is related to changes in the perceived risks and benefits of cannabis use, influenced by broader political and cultural changes over the study period. [ABSTRACT FROM AUTHOR]

Research has shown independent attention in the role of self-control and health/risk perceptions toward vaping in predicting vaping use among youth and young adults. Yet, there are good theoretical notions to believe that low self-control, perceptions toward vaping, and self-reported vaping are intertwined. To examine whether three different health/risk perceptions toward vaping mediate the effect of low self-control on vaping use among young adults. A survey was administered to 325 undergraduate students attending a large university in the Midwest (Mean age = 19.5; 60.4% female; 73.1% White). Single and multiple mediation modeling strategies were used to assess the mediation hypothesis. Logistic regression results indicate that individuals with low self-control are more likely to vape (O.R. = 1.041, p <.05). Further, when health/risk perceptions are included in the models individually and simultaneously, it reduces the effect of low self-control on vaping between 15% and 37.5%, and renders low self-control to become non-significant. Findings suggest the impact that harm/risk perceptions toward vaping have in engaging in this behavior. Thus, preventative efforts should target potential sources, such as media and advertisements, that may shape young adults' perceptions toward vaping. [ABSTRACT FROM AUTHOR]

Background: Adolescent opioid use and associated opioid poisoning rates have risen dramatically in the United States, yet this group has disproportionally poorer access to evidence-based medication treatment for opioid use disorder (MOUD). Methods: A transdisciplinary cohort (N = 77) who attended a learning series focused on MOUD for adolescents were surveyed with the purpose of understanding the landscape of current adolescent MOUD practices in Washington State; and needs and barriers to providing care. Results: Results indicated that a higher percentage of prescriber participants endorsed support for MOUD for adolescents than nonprescriber participants. Lack of adjunctive support services (i.e., social work; mental health) were cited as the highest barriers to providing this care. Conclusions: We discuss the importance of continued transdisciplinary training and collaboration, as well as funding ancillary services to address barriers to providing adolescent MOUD. [ABSTRACT FROM AUTHOR]

Background Cannabis use in the young population has undergone a significant increase in Europe. Empirical assessments of individual and contextual mediating variables in relation to cannabis use are informative for prevention actions and have yet to be conducted in Spain. Objectives: This study used the 2016 National Survey on Drug Use in Secondary Education in Spain (ESTUDES) to inform on potentially relevant cannabis prevention targets. We examined individual variables (sex, age, and cannabis risk perception), past 30-day legal and illicit substance use, substance-free activities, and contextual factors (perceived accessibility to cannabis) associated to past 30-day cannabis use. Methods: Data were drawn from 35,369 adolescents (% females: 50.1). Structural equation modeling (SEM) was implemented to identify predictors of cannabis use, and indirect paths were tested via bootstrapping to examine the mediating effects of cannabis risk perception and accessibility. Results: Demographics (male sex, higher age), and past 30-day tobacco, alcohol, and illicit substance use were associated with past 30-day cannabis use. Frequency of past-year engagement in hobbies and reading did also predict past 30-day cannabis use. The mediators worked on most of the relationships examined, except for hobbies and illegal substance use in the case of accessibility and reading and hobbies in the case of risk perception. Conclusions/importance: Cannabis use is more likely to emerge in the event of low risk perception and high accessibility. Lower frequency of past year reading and higher engagement in some hobbies that are often carried out alone represent risk factors, which could potentially influence prevention programs. [ABSTRACT FROM AUTHOR]

Background: Multiracial groups are projected to be the fastest growing segment of the U.S. population, more than tripling in size over the next four decades. Marginality Theory suggests that biracial individuals, a subgroup of multiracial, may experience heightened conflict with their ethnic identity due to having to negotiate between two distinct cultures. Research shows that changes in ethnic identity is associated with perceived discrimination, and both are associated with marijuana and alcohol use among multiracial groups. These relationships are sometimes stronger among multiracial individuals than monoracial. Limited research exists among specific biracial groups, such as Black-White biracial individuals, despite unique complexities related to ethnic identity. Research conducted among Black-White biracial individuals is often limited to youth samples and shows disproportionate rates of substance use. Objectives: Given the population increase and disparate substance use outcomes among Black-White biracial youth, it is essential to extend substance use and misuse research to Black-White biracial adults to see if similar disparities exist. The present study examined the direct effect of biracial ethnic identity on marijuana use and alcohol misuse, and indirect effects of perceived discrimination to these relationships among a sample of Black-White biracial adults (n = 195) using a 46-item self-report survey administered online via MTurk. Results: Results revealed that while ethnic identity alone was not associated with marijuana use or alcohol misuse, there were significant indirect relationships between ethnic identity, marijuana use, and alcohol misuse through perceived discrimination. Conclusions/Importance: Findings suggest that substance use interventions should seek to address coping with perceived discrimination among this population. [ABSTRACT FROM AUTHOR]

Ketamine has remained the most commonly used illicit drug among adolescents in Taiwan. A dual process model proposes that addictive behaviors develop in adolescents as a result of an imbalance between an appetitive, approach-oriented system (implicit and explicit attitudes) and a regulatory executive system (cool and hot executive functions). We aimed to examine the appetitive and regulatory processes in adolescent ketamine users in comparison to matched healthy adolescents. Method: The participants were 30 adolescent ketamine users and 32 nondrug controls, matched with gender, age, education years, and education systems. Both groups completed the affective priming task (APT), the stop-signal task (SST), an Iowa Gambling Task (IGT), and finally a Drug Use Disorders Identification Test: Extended (DUDIT-E). Results: The controls had higher positive and negative outcome expectancy with respect to using ketamine compared to the adolescent ketamine users. There was no significant between-group performance difference in APT. The adolescent ketamine users may have shown marginally poorer performance compared to the controls in hot executive functions (IGT), but their cold executive functions (SST) remained intact. Conclusion: The current study reported that the adolescent ketamine users may not have imbalanced dual processes (biased appetitive motivation and impaired regulatory executive process). A different therapeutic focus on adolescent ketamine users may be developed accordingly. More advocacies on ketamine's aversive outcomes are needed, particularly on campus in order to reduce substance misuse. [ABSTRACT FROM AUTHOR]

Improving access to buprenorphine treatment is necessary to address the national opioid use disorder (OUD) crisis. This study investigates attitudes about buprenorphine prescribing among staff at a primary care clinic and compares attitudes before and after implementation of an office-based opioid treatment (OBOT) program. Providers and staff in an academic primary care clinic were surveyed prior to and one year following implementation of an OBOT program. Descriptive statistics, Pearson's Chi-2 tests and logistic regression models were used to compare staff and provider attitudes about use of buprenorphine for OUD and to compare attitudes before and after OBOT implementation. At baseline, 20% of staff indicated strong belief that buprenorphine is an effective treatment for OUD and 16% indicated strong belief that primary care providers should prescribe it. Staff appeared less likely than providers to believe strongly that buprenorphine is effective (OR 0.24, 95% CI= 0.08-.78, p = 0.02; aOR 0.28, 95% CI=.08-1.0, p = 0.05 adjusted for age, race and gender). Following implementation of an OBOT program, the percentage of staff who believed strongly in the effectiveness of buprenorphine for OUD increased from 20% to 40% (p = 0.31), and the percentage who believed that primary care providers (PCPs) should prescribe it increased from 16% to 30% (p = 0.52). Staff in a primary care clinic were less likely than providers to believe in the effectiveness of buprenorphine treatment or that PCPs should prescribe it for OUD. That their beliefs substantially changed after implementation of an OBOT program suggests that direct experience impacts attitudes. [ABSTRACT FROM AUTHOR]

Background: Globally, there is growing concern regarding workers' illicit drug use and its implications for health and workplace safety. Young workers in male-dominated industries, such as construction, may be more susceptible to illicit drug use, risky drinking and its associated harms. Purpose/objectives: To investigate drug use and perceptions of risk among male construction workers, drawing comparisons between workers under 25 years with older age groups. Methods: Workers in Sydney, Australia (N = 511) completed a survey measuring past year illicit drug and alcohol use, psychological distress and perceptions of drug-related risks to health and safety. Prevalence in the total sample was compared with national estimates, and differences between younger and older survey respondents were examined using logistic regression models. Results: Survey respondents' cocaine, meth/amphetamine and cannabis use was significantly higher than estimates of male employees nationally (OR = 6.60, 3.58, 1.61, respectively). Young workers ≤24 were more likely to frequently use illicit drugs, drink heavily, and report psychological distress than those aged 35+. Workers ≤24 were least likely to perceive that drug use posed high risks to health or safety when compared with 25-34 and 35+ age groups. Conclusions/importance: The findings highlight the high prevalence of illicit drug use amongst young construction workers, representing threats to workplace safety even if used outside work hours. Greater emphasis on potential adverse effects of alcohol and drug use and closer examination of contributory workplace factors are required. These findings have practical implications to inform occupational health and safety programs and interventions in high-risk workplaces. [ABSTRACT FROM AUTHOR]

Background: A number of correlates to adolescent substance use have been shown, yet their unique predictive influence is unclear. We investigated the incremental validity of demographics, family background, school variables, risk perception, parental alcohol attitudes, age of first alcohol use, peer group influence, and behavioral variables as they concurrently predicted last month alcohol use, binge drinking, and drunkenness experience frequency. Methods: Hierarchical multiple regression analyses in a sample of N = 743 adolescents (mean age = 15.01). Results: All predictors explained 26–40% of the total variance. Alcohol use was predicted by age, gender, having two working parents, academic family background, relationship to parents, relative risk perception, parental acceptance of alcohol use, age of first use, talking about positive aspects of alcohol, normality of alcohol use among peers, time spent with friends, and going out to clubs. Binge drinking was predicted by age, working parents, school problems, relative risk perception, parental alcohol acceptance, age of first use, talking about positive aspects of alcohol, time spent with friends, and going out to clubs. Drunkenness was predicted by age, relationship to parents, school problems, relative risk perception, age of first use, talking about positive aspects of alcohol, and going out to clubs. Conclusions: Researchers need to take the complexity of adolescent substance use into account when designing studies and interventions. Relative risk perception emerged as the strongest (positive) predictor, indicating that adolescents are able to rather accurately assess their own risk and risk awareness alone does not suffice to engage in protective behavior. [ABSTRACT FROM AUTHOR]

Background: High prevalence of opioid misuse has been noted among youth and young adults—particularly among those who identify as lesbian/gay or bisexual (LGB). Yet, little is known about the relationship between opioid-related attitudes and misuse among those who identify as LGB. Objectives: This study examined the role of opioid-related attitudes (i.e. acceptance of misuse and risk perception) in relation to ever and past 6-month prescription opioid misuse, stratified by sexual orientation. Methods: This study used a nationally representative, probability-based sample of youth and young adults aged 15–34 (N = 12,745; lesbian/gay = 398, bisexual = 857, heterosexual = 11,490). Data were collected via online surveys in Spring 2018. Wald chi-square tests assessed differences in ever and past 6-month opioid misuse by sexual orientation identity. Weighted adjusted logistic regression models estimated the influence of opioid-related attitudes (acceptance of misuse and risk perceptions) in relation to ever and past 6-month opioid misuse, controlling for demographic characteristics, other past drug use, and psychosocial variables. Results: Logistic regression models indicated that attitudes related to the acceptance of opioid misuse was predictive of (a) higher odds of ever misuse among heterosexual and bisexual individuals and (b) higher odds of past 6-month misuse regardless of sexual orientation. Conclusions: Prescription opioid misuse among LGB youth and young adults may be addressed by shifting key attitudes surrounding opioids. To help stem this deadly epidemic, prevention efforts should be guided by the unique stressors facing the LGB community and focus on reducing the acceptability of misusing opioids. [ABSTRACT FROM AUTHOR]

Background: To address the alarming rise in opioid overdose deaths, states have increased public access to the overdose reversal medication, naloxone. While some studies suggest that increased naloxone accessibility reduces opioid overdose deaths, others raise concerns about unintended consequences, such as increases in risky drug use and opioid re-use post-overdose to counter naloxone-induced withdrawal symptoms. Few studies have examined the impact of expanded naloxone access on the attitudes and behaviors of opioid users. Methods: In this qualitative study, we conducted in-depth, semi-structured interviews with 36 English-speaking opioid users 18+ years of age. Informants were recruited from an urban methadone clinic, a needle exchange program and a residential treatment program. The approximately hour-long interviews focused on users' attitudes and behaviors surrounding naloxone, opioid use and overdose. Transcribed audio-recordings of interviews were analyzed using NVivo. Results: Informants were ambivalent about naloxone, widely acknowledging its life-saving benefits while reporting such negative effects as severe withdrawal symptoms and the promotion of riskier drug use. Naloxone-induced withdrawal, coupled with misperceptions about naloxone's pharmacological effects, prompted overdose survivors to rapidly re-use opioids and refuse hospitalization following an overdose reversal. About half the sample believed naloxone led to greater risk-taking by others, such as fentanyl use or use in higher quantities, but did not endorse riskier drug use themselves. Conclusions: The results suggest the need for targeted education about the pharmacological effects of naloxone and better strategies for managing naloxone-induced withdrawal. Future research should focus on the extent to which naloxone is associated with greater opioid risk-taking. [ABSTRACT FROM AUTHOR]

Background: National data demonstrate significant differences in non-medical prescription drug (NMPD) use, with Whites seeming to be more likely to use compared to non-Whites. College students also appear to be at an increased risk for NMPD use. Objectives: This study examines NMPD use using a component of social identity theory. We propose that a stronger sense of ethnic identity may reduce the likelihood of NMPD use among college students due to ethnic identity's ties to self-esteem and self-efficacy. We also propose that the protective power of ethnic identity may vary according to one's race. Methods: Data for this study were collected from a survey of undergraduate students at a Midwestern university (N = 530). Poisson regression analyses were used to test the relationship between ethnic identity and NMPD use. Of our sample, 135 participants (25.5%) indicated NMPD use over the past year. This percentage is high compared to findings from national college data. Results: Results indicate that a stronger sense of ethnic identity reduced the frequency of NMPD use among young adults. The findings also reveal that the relationship between ethnic identity and NMPD use is moderated by race. Ethnic identity was found to be a protective factor for non-White participants only. Conclusions: This study suggests that ethnic belonging may act as a protective factor against NMPD use among non-White young adults. These findings build upon our understanding of the relationship between ethnic identity and substance use. We conclude with a discussion of directions for future research and intervention programs [ABSTRACT FROM AUTHOR]

Background: Studies show that religiosity is a protective factor against marijuana use. Given many religions' teachings to promote risk perception of substance use, risk perception possibly mediates the relationship between religiosity and marijuana use. Moreover, since males and females differ in religiosity, risk perception, and marijuana use, gender may moderate religiosity's indirect effect on marijuana use through risk perception and religiosity's direct effect on marijuana use. Despite substantial research on religiosity and adolescent marijuana use, little research has targeted the young adult population. Objectives: This study is the first to investigate the conditional nature of religiosity's influence on marijuana use through risk perception among young adults in the U.S. Methods: Using a nationally representative sample from the 2014 National Survey on Drug Use and Health (N = 12,646), conditional process analysis was examined through significant test of the index of moderated mediation. Additionally, mediation analysis was conducted in male (n = 6042) and female (n = 6604) groups separately to further characterize the nature of the relationships. Results: Religiosity's indirect effect on marijuana use through risk perception was found to be significantly different between males and females, while there were no gender differences in religiosity's direct effect on marijuana use. The indirect effect of religiosity on marijuana use via risk perception was significant among both males and females and was larger for females than males. Conclusion: Prevention interventions for young adults' marijuana use that incorporate religiosity should emphasize factors related to risk perception and have a gender informed perspective. Direction for future research is provided. [ABSTRACT FROM AUTHOR]

Objectives: We sought to understand how pharmacists viewed and used a newly implemented prescription drug monitoring program (PDMP). We also sought to understand pharmacist orientation toward dispensing of controlled substances and the people who obtain them. Methods: We conducted three mini focus groups. The focus group findings were used to inform the design of a structured survey. We emailed a survey to 160 pharmacists who were employed in one statewide community chain store; we obtained 48 survey responses. Results: Focus groups findings suggested that, in relation to the dispensing of scheduled prescription medication, pharmacists were either “healthcare” oriented, “law-enforcement” oriented, or an orientation that combined these two perspectives. Surveys suggested that pharmacists found PDMPs easy to use and that they used them frequently - often to contact physicians directly. Surveys suggested that pharmacists were typically either “healthcare” oriented or “mixed” (combined perspectives). Pharmacist orientation was associated with the frequency with which they counseled patients about medication risk and the frequency with which they used the PDMP as the basis for contacting prescribers. Conclusions: Ongoing tracking of pharmacists' use of PDMPs is important both at the implementation stage and as PDMPs develop over time. The orientation construct developed here is useful in understanding pharmacist behavior and attitudes towards patients potentially at risk for misuse of controlled substance medications. Further research on this construct could shed light on barriers and incentives for pharmacist PDMP participation and use and provide guidance for pharmacist training, ultimately enhancing patient care. [ABSTRACT FROM AUTHOR]

The research literature on MDMA (ecstasy/molly) use has largely relied on samples of ravers/club-goers, gay men, and international populations (e.g., United Kingdom, Australia). As a result, very little is known about MDMA use among African Americans. This study aimed to address this gap by adding to the limited amount of research with this population. The goal of this study was to identify and characterize the perceived risks that African Americans associate with using MDMA. Surveys (n = 100) and in-depth interviews (n = 15) were conducted with African American young adults in Southwest Florida between August 2014 and November 2015. Almost the entire sample (91%) associated risks with their MDMA use. The most prevalent types of perceived risks associated with MDMA use were physical harm (e.g., dehydration, fatal overdose, and cardiac damage). Qualitative interview data are also presented to better contextualize these perceived risks. These data provide insight into the risks most salient on the minds of African Americans, and can be used to begin developing and tailoring interventions that target MDMA use among this population. While more research is needed on this topic, these results represent a step forward in our understanding of MDMA use among African Americans. [ABSTRACT FROM AUTHOR]

Background: As of January 1, 2017, eight states have approved laws for recreationalmarijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S. Objective: To examine changes in adolescent marijuanause behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions. Method: Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools. Results: Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to marijuana increased (from 46% to 52%). Proximity of recreational marijuana stores was not significantly associated with perceived ease of access to marijuana. Conclusions/Importance: In the first study of adolescent marijuana use and perceptions after state retail implementation of recreational marijuana, there was little change in adolescent marijuana use but a significant change in perception of ease of access. Public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies. [ABSTRACT FROM AUTHOR]

Background:Given increases inmarijuana use and driving under the influence (DUI), it is critical to identify those at risk in order to inform intervention efforts. Objectives: We used a socioecological framework to examine correlates of level of marijuana use and DUI in the past month among young adult marijuana users. Methods:We recruited 1567 participants aged 18-34 years via Facebook ads targeting tobacco andmarijuana users in August 2014 to complete an online survey assessing marijuana use and DUI, as well as related multilevel factors. Analyses focused on 649 participants reporting past 30-day marijuana use. Results: The sample was an average age of 24.48 (SD = 5.10), 43.9% female, and 76.4% White and used marijuana an average of 17.86 (SD = 11.29) days in the past month. Notably, 48.4% reported driving aftermarijuana use at least once in the past month, and 74.0% were passengers. Multivariable regression indicated that greater use was associated with: being older; being male; greater symptoms of dependence; residing in a state with recreational marijuana legalized; having a medical marijuana card; having parents and more friends who use; higher coping motives; lower perceived harm to health; and less concern about driving after marijuana use (adjusted R-squared=0.294). Correlates of driving after using marijuana in the past month included: being younger; more frequent use; having more friends who use; higher enhancement motives; and less concern about driving after using (Nagelkerke R-squared = 0.442). Conclusions/Importance: Interventions and campaigns should address social norms and risk perceptions regarding marijuana use, particularly as it relates to DUI. [ABSTRACT FROM AUTHOR]

Background: Attitudes and beliefs about drug use have been shown to be robust correlates of use of drugs such as alcohol, marijuana, and cocaine; however, little is known regarding attitudes or beliefs about new psychoactive substances (NPS). We sought to examine attitudes and beliefs about NPS and how they relate to self-reported use in a high-risk population--electronic dance music (EDM) party attendees. Method: 1,048 individuals (age 18-40) were surveyed entering EDM parties in New York City in 2016. We queried lifetime use and attitudes and beliefs specific to NBOMe, 2C series drugs, "bath salts" (synthetic cathinones), tryptamines, dissociative NPS, and synthetic cannabinoids. Results:More than half the sample reported being unfamiliarwith NPS other than "bath salts" and synthetic cannabinoids. "Bath salts" received the highest ratings of strong disapproval (34.3%), followed by synthetic cannabinoids (23.3%), compared to other NPS (10-14%). "Bath salts" were perceived to be a great risk by 43.1% of the sample, followed by synthetic cannabinoids (27.0%), and other NPS (12-16%). "Bath salts" were reportedly least likely to be used if offered (2.9%). In multivariable models, reporting no disapproval towards use was associated with increased odds of reporting use of 2C drugs, "bath salts", and tryptamines. Having friends who use and reporting intent to use or willingness to use if offered were also associated with use of various NPS classes. Conclusions: This study delineated attitudinal and belief-related correlates of use of various NPS classes. Results can inform prevention effects as NPS continue to emerge. [ABSTRACT FROM AUTHOR]

In the United States, buprenorphine products (namely buprenorphine/naloxone combination) and methadone are the primary forms of medication-assisted treatment (MAT) that are authorized for addressing opioid addiction. Although treatment ideologies differentiate MAT programs, much of the provision in the US reflects a model of “high threshold, low tolerance.” This model is discussed with a focus on structural and programmatic barriers that shape access to and retention in MAT. The critique continues with a discussion of multifaceted stigma that reinforces spoiled identities and diffuses into treatment settings. The social control mechanisms that are imposed in MAT are strikingly similar to those reflected in criminal justice settings, namely probation, parole and community corrections more generally. Parallels are drawn between the “addict” and the “felon” and how they are monitored, tracked, and controlled. These factors have major implications for recovery. [ABSTRACT FROM PUBLISHER]

Over 300,000 patients with an opioid use disorder (OUD) receive methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in New York and New Jersey, areas (largely but not exclusively coastal) impacted by Hurricane Sandy (Sandy) on October 29th, 2012. Disruption of methadone dispensing and other services can have severe consequences to patients (and treatment seekers) such as relapse, dropping out of treatment and resumption or increase in HIV/HCV injection risk behaviors. To facilitate OTP preparedness and response, we developed recommendations for OTPs for future emergencies. Using both qualitative and quantitative measures, we obtained data from OTP directors, staff, patients and out-of-treatment persons to learn how OTPs prepared for the impending hurricane, whether recovery efforts were successful, and what impact the hurricane has had. We observed a wide range of preparation and recovery efforts among participating programs. Director, staff, and patient perspectives on programs' responses and storm impact often differed. Triangulated data suggest that program responses were adequate for a majority of patients. For a sizeable minority of patients, program responses were very successful; for at least 20% of the clinics, program planning and responses were inadequate to meet the needs of patients. Among the recommendations made for sustaining continuity of care in future emergencies are: a focus on improving communication, procuring transportation, guest dosing, and take home provisions. [ABSTRACT FROM PUBLISHER]

Background: Lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to misuse alcohol and other drugs (AOD), compared to the general population. However, LGBT engagement with AOD treatment is often precluded by insensitivity and misunderstanding of LGBT issues. These treatment barriers may be a consequence of either worker attitudes, organizational factors or a combination of both. Few studies have compared service context as an impediment to AOD treatment. Objectives: This pilot study sought to examine and compare staff attitudes, knowledge and awareness of LGBT issues in two state-wide AOD services within Australia. One organization was a government service, whilst the other was faith based. Methods: A cross-sectional study of a convenience sample (N = 130) of workers employed in a state-wide government AOD service (n = 65), and a state-wide non-government service (n = 65) was conducted. Participants self-completed a questionnaire comprising tools previously used to assess staff attitudes, knowledge and awareness of LGBT issues. Results: Few significant differences in attitudes and awareness of LGBT issues between government and non-government respondents were found. Nearly all respondents were supportive of LGBT persons irrespective of organizational context, with a small number of negative views. Although most respondents demonstrated awareness of organizational policies and practices relating to LGBT clients, many were "unsure" or "neutral" of what these might be. Conclusion: It is confirming that the majority of staff report supportive attitudes towards LGBT clients. Findings suggest that organizations need to continue to take leadership to strengthen organizational training and capacity to deliver LGBT friendly AOD treatment practices. [ABSTRACT FROM AUTHOR]

Background: The coaching process is complex and dynamic. Coaches are known to affect athlete attitudes indirectly, through athletes' perceptions and interpretations. This process has been verified with a variety of ethical behaviors. Objectives: The current study investigated the relationships between athletes' perceived doping confrontation efficacy of their coaches and athlete's anti-doping attitudes. Methods: A sample of athletes (N = 96) completed a version of the Doping Confrontation Efficacy Scale that was modified to assess their perception of their coaches' anti-doping confrontation efficacy, and the PEAS (Performance Enhancing Attitude Scale), which assessed their performance-enhancing attitudes. Results: The results of a multiple linear regression model showed that perceived confrontation efficacy significantly predicted athletes' anti-doping attitudes. Specifically, the factor of efficacy with respect to intimacy was the sole significant predictor. Conclusions: These results show that a pattern of athletes' interpretation of coaches' values is related to their own attitudes, much like with cheating and sportsmanship. This finding is consistent with the conceptualization of confrontation in general independent of sport. [ABSTRACT FROM AUTHOR]

Background: Recent data suggests that positive beliefs about electronic cigarettes (e-cigs) use can lead to later e-cig use. Considering that many advertisements claim that e-cigs are superior to cigarettes, individuals' likelihood to view e-cigs more favorably than cigarettes can also influence subsequent e-cig use; however, no studies have directly assessed such a comparison. Objectives: The present study created and validated the Comparing E-Cigarettes and Cigarettes questionnaire (CEAC), which asks individuals to directly compare e-cigs and cigarettes on a number of dimensions, in two independent samples. Methods: In sample 1 (451 undergraduates; mean age = 20.35, SD = 5.44, 72.4% female, 73.4% Caucasian) we explored the factor structure of the CEAC and in sample 2 (699 community adults collected via Amazon's Mechanical Turk; mean age = 34.04, SD = 10.9, 47.7% female, 83.3% Caucasian) we replicated the factor structure. Results: Exploratory factor analysis suggested a three-factor structure: General Benefits (α = 0.80), General Effects (α = 0.86), and Health Benefits (α = 0.88), which was replicated via confirmatory factor analysis, χ2 = 4.36; RMSEA = 0.07, 90% CI = 0.06-0.08; TLI = 0.99; CFI = 0.99, and was relatively invariant across product use and gender. Individuals reported viewing e-cigs as safer and more beneficial than cigarettes and these beliefs were higher in e-cig users. Conclusions: Future work should establish how these comparative beliefs are influenced by e-cig use and/or influence subsequent transition to and increases in e-cig use. Although e-cigs are likely less harmful than cigarettes, and thus these comparative beliefs represent that state of nature, e-cigs are not completely without risk. [ABSTRACT FROM AUTHOR]

Background: Ecological momentary assessment (EMA)—which often involves brief surveys delivered via mobile technology—has transformed our understanding of the individual and contextual micro-processes associated with legal and illicit drug use. However, little empirical research has focused on participant's perspective on the probability and magnitude of potential risks in EMA studies.Objectives: To garner participant perspectives on potential risks common to EMA studies of illicit drug use.Methods: We interviewed 38 persons who inject drugs living in San Diego (CA) and Philadelphia (PA), United States. They completed simulations of an EMA tool and then underwent a semi-structured interview that systematically explored domains of risk considered within the proposed revisions to the Federal Policy for the Protection of Human Subjects or the “Common Rule.” Interviews were transcribed verbatim and coded systematically to explore psychological, physical, social, legal, and informational risks from participation.Results: Participants perceived most risks to be minimal. Some indicated that repetitive questioning about mood or drug use could cause psychological (i.e., anxiety) or behavioral risks (i.e., drug use relapse). Ironically, the questions that were viewed as risky were considered motivational to engage in healthy behaviors. The most cited risks were legal and social risks stemming from participant concerns about data collection and security.Importance: Improving our understanding of these issues is an essential first step to protect human participants in future EMA research. We provide a brief set of recommendations that can aid in the design and ethics review of the future EMA protocol with substance using populations. [ABSTRACT FROM PUBLISHER]

Background:One of the most problematic modes of alcohol consumption in young adults is risky drinking in single episodes, which typically takes place in social contexts. Several studies have applied the Theory of Planned Behavior to drinking intentions and behavior in young people. However, previous studies show that this model lacks a “bridge” that links a mental process like intentions to a physical process represented by the actual action.Objectives:The aim of the present study is to test the predictive power of the Model of Goal-Directed Behavior plus social influences in order to overcome theory of planned behavior gaps in predicting binge-drinking behavior in young people.Methods:404 undergraduates completed a questionnaire containing measures for the MGB variables, social identity, and group norms. Two weeks later, participants reported how many times they had had five/four or more alcoholic drinks on a single occasion. Structural equation modeling revealed strong support for model validity.Results:The final equation accounted for 66% in intentions to binge drink, and 48% in drinking behavior, while a planned behavior model accounted for the 47% of variance in intentions to binge and 37% of the drinking behavior. Social influences positively affected desire and intentions to drink.Conclusions:Our findings suggest that, compared to other attitude-behavior frameworks, the MGB is preferable in modeling the proximal determinants of binge drinking. Therefore, the distinction between desire and intention and the consideration of social influences seem to be essential to improve the prediction of binge drinking among young people. [ABSTRACT FROM PUBLISHER]

Background: The Asian population in Britain has grown, representing the second largest ethnic group; Bangladeshi, Pakistani, and Indian nationalities are prevalent (Jivraj, 2012; Office for National Statistics, 2013). Yet, we know relatively little about the nature and extent of their substance use. Jayakody et al. (2006) argue ethnic minority groups may be influenced by the norms and values of the dominant culture. Given recreational drug use has undergone a process of normalization in Britain (Aldridge et al., 2011; Parker et al., 1998, 2002), we explore the degree to which this is occurring in a Bangladeshi and Pakistani community of Muslim faith in Northern England; a group typically assumed to reject substance use because of robust religious and cultural values.Objectives: To examine the extent, frequency, and nature of substance use, and associated attitudes.Methods: A cross-sectional study collecting qualitative data from a sample (N= 43) of adolescents accessing a drug service and a range of professionals working with them during 2014. We also present analyses of routinely collected quantitative client data.Results: Adolescent interviewees reported extensive personal experience smoking skunk cannabis, and professionals working in the community confirmed many young Asians smoked it. Its consumption appeared to be accommodated into the daily lives of young people and the supply of it also showed signs of acceptance.Conclusions:Skunk cannabis may be undergoing a process of normalization within some Asian communities in Britain. Our study has significant implications for the normalization thesis, finding evidence for normalization within a subpopulation that is typically perceived to resist this trend. [ABSTRACT FROM PUBLISHER]

Background: As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. Objective: This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Methods: Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18–34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Results: Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults. [ABSTRACT FROM AUTHOR]

Background: University students who complete study abroad experiences are potentially exposed to behaviors, in particular alcohol and drug use, that place their health at risk. There is a need to identify risk and protective factors and highlight knowledge gaps. Methods: A systematic review adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Relevant bibliographic databases and online repositories were systematically searched for both qualitative and quantitative peer-reviewed studies. Results: Eighteen articles were eligible for inclusion. Degree mobility students (DMSs—students pursuing a full bachelor or master degree in a foreign country) and Credit Mobility Students (CMSs—students participating in short term or semester study abroad programmes) show different patterns of at-risk behaviors compared to pre-departure, and to domestic or non-study abroad students. DMSs mostly consumed less alcohol and illicit substances compared to domestic students, but little information on pre-travel behavior and predictors of at-risk behaviors while abroad was available on DMSs. Most studies indicated that CMSs increased their alcohol use while abroad and reduced it when they returned home. However, there is no evidence of an increase in the negative consequences associated with alcohol misuse while abroad. Different pre-departure and abroad factors (e.g., perceptions of peer drinking norms, psychological and sociocultural adjustment abroad) were related to at-risk behaviors in the host country. Conclusions: University students who study abroad are understudied and potentially at risk from alcohol and drug use. Knowledge gaps are discussed in relation to possible future qualitative, mixed methods and longitudinal research. [ABSTRACT FROM AUTHOR]

Background: African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States.Objectives: We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state.Methods: Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas.Results: Numerous important themes emerged from participants’ narratives, including chronic involvement with the criminal justice system (being a “career criminal”), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment.Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services. [ABSTRACT FROM PUBLISHER]

Background: Smoking regret differs by smoker characteristics (dependence) and may be linked to delay discounting (DD), where smaller immediate rewards are preferred to larger delayed rewards. It is hypothesized that those who exhibit stronger tendencies to delay rewards also express fewer future health concerns and possibly less regret about smoking. Objectives: The objective is to determine the interrelationships of regret, dependence, and delay discounting among current smokers. Methods: In July 2010, 1062 smokers completed a 45-minute at-home web based survey and answered questions including regret, dependence (Fagerstrom Test for Cigarette Dependence), and delay discounting (Monetary Choice Questionnaire). Relationships among these variables and perceived future health effects were analyzed using correlations, repeated measures analysis of variance, and generalized linear models. Results: Most smokers (85%) regretted smoking. FTCD and log-k (DD) scores were positively associated (rs = 0.15, p <.001). Though a strong decline in log-k was shown as reward increased (p's <.001), there were no differences in discounting by regret. Regret was positively associated with worries concerning health effects, quality of life, and finances (p's <.001). Little association was found between DD and future health concerns. Conclusions/Importance: Though this study confirms that regret for smoking is associated with perceived future risks as well as supports previous findings between FTCD and DD, it shows little association between DD and perceived future risks. [ABSTRACT FROM AUTHOR]

Background: The abuse and misuse of prescription and nonprescription or the so-called Over–The–Counter (OTC) drugs is a serious and growing public health problem worldwide. The increased availability of these drugs has contributed to a dramatic rise of inappropriate use.Objectives: The aim of this study was to investigate abuse/misuse of prescription and non-prescription drugs in community pharmacies in Aden city—Yemen and to gather information about suspected drug abusers in the community.Methods: A cross-sectional survey using a structured questionnaire randomly distributed to 200 community pharmacies (June–September 2013). Data were coded and analyzed using SPSSResults: A total of 170 pharmacists completed the questionnaire (85.0% response rate), more than half of which (57.7%) suspected drug abuse/misuse in their pharmacies. The top four suspected medications of abuse were Alprazolam, Ketoprofen, Tramadol, and antibiotics. Most participating pharmacists in this study (83.3%) noticed an increasing pattern of abuse/misuse. The majority of suspects of prescription and non-prescription drug abuse (64.1%) were either chewing Khat or carrying it while buying the drug from the pharmacists.Conclusion: Abuse/misuse of prescription and nonprescription drugs is present in community pharmacies in Aden and it is linked to the recreational use of Khat. Current methods for controlling the problem are ineffective, and better methods should be developed. [ABSTRACT FROM PUBLISHER]

Background: Although the majority of research on partner drinking styles has examined married couples, dating partners may influence one another's problem behaviors including alcohol use.Objectives: This study identified patterns of at-risk alcohol use in college women and their dating partners using a person-centered statistical approach (i.e., latent profile analysis).Methods: Participants were 286 college student women in dating relationships. They completed questionnaires regarding their own and their partners' drinking, alcohol use severity, intimate partner violence (IPV), relationship satisfaction, and relationship-specific alcohol expectancies. Data were collected in 2012 through 2013.Results: Results revealed three distinct, latent classes based on both partners' alcohol outcomes. The “Low-Risk” group (58%) consisted of non-heavy drinking partners. In the “High-Risk – Higher Men” class (27%), men drank more than women; however, both men and women were high-risk drinkers. The “High-Risk – Higher Women” group (15%) consisted of high-risk drinking partners but women consumed more alcohol than men. Both high-risk couple groups were more dissatisfied in their relationships and experienced more IPV, but held stronger beliefs about how alcohol influenced their relationship.Conclusions/Importance: Findings indicate that there are several distinct classes of dating couples that differ in relationship problems and beliefs about alcohol's impact on their relationship. Riskier couples differ in behaviors and alcohol-related beliefs from low-risk couples. These findings may inform the development of more efficacious alcohol interventions tailored toward high-risk drinking dating couples. [ABSTRACT FROM PUBLISHER]

Background: Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites.Objective: Understand the persistence of these HIV behaviors.Methods: In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression.Results: A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants.Conclusions: The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process. [ABSTRACT FROM PUBLISHER]

Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse. [ABSTRACT FROM AUTHOR]

Background: Previous research on addiction themed reality television shows has focused on the depiction of addiction and treatment and has concluded that these shows reinforce stigma. Existing research has not investigated the depiction of treatment professionals in these series. Objectives: This study fills the gap in existing research by analyzing the representations of treatment professionals in reality television shows, including the ways that the shows are edited, the statements made by treatment professionals, and interactions between treatment professionals and laypersons. Methods: The data for this study was drawn from two popular reality shows Intervention and Celebrity Rehab with Dr. Drew. Using a total of 117 episodes, a qualitative content analysis of the representations of treatment professionals in the two series was conducted. Results: The data reveal the ways that depictions of treatment professionals are carefully controlled compared to those of people with substance use issues. In addition, treatment professionals are granted opportunities to interpret, explain, and diagnose the behaviors and experiences of people with substance use problem. Finally, when confronted with resistance treatment professionals assert their authority and demand compliance with their orders. Conclusions/Importance: In strategically presenting treatment professionals in sharp contrast to people with substance use problems, these portrayals of treatment professionals actually reinforce rather than contradict the stigma of addiction. [ABSTRACT FROM AUTHOR]

Background: The treatment of alcohol abusers in different cultural contexts does not depend only on the methods used but also on the ways in which treatment providers perceive the problem and relate to their clients. Objectives: This study compares treatment professionals' basic beliefs about alcohol use disorders in two culturally different European countries to find out to what extent these ideas are shaped by the respondents' socio-cultural context, profession, and other background variables. Methods: Similar postal surveys were conducted among professionals working in specialized addiction treatment units in Finland (n = 520) and France (n = 472). The data were analyzed by descriptive statistical methods and logistic regression analysis. Results: Consistent cultural differences were found in almost all the questions asked and they remained significant even after controlling for the other background factors. The French professionals emphasized the addictiveness of alcohol more than their Finnish colleagues. They also believed less in the chances of recovery and attributed more responsibility for the problem to external factors, while the Finns emphasized individual responsibility. Profession, gender and some other background variables also modified beliefs about specific questions. Conclusions: Cultural factors shape the ways in which alcohol use disorders are perceived more pervasively than the other background variables. The French professionals' low trust in treatment and the Finnish professionals' lack of concern for the addiction potential of alcohol and stronger tendency to regard the person as responsible for the problem could be seen as potential impediments to effective ways of helping alcohol abusers in these countries. [ABSTRACT FROM AUTHOR]

Background. Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. Objectives. We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind. Methods. Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity. Results. Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se. [ABSTRACT FROM AUTHOR]

Background: Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence. Objective: To investigate clustering of sexual activity and substance use among youth in Northern Ireland. Method: Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored. Results: Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth. Conclusions: While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender. [ABSTRACT FROM AUTHOR]

Individuals in treatment for substance use continue to smoke at higher rates than the general population of the United States. This editorial presents a different perspective on cigarette smoking that might reflect aspects of the subculture of individuals who, representing a heterogeneous population, smoke while recovering from substance use associated problems. We discuss factors that independently and, in combination, influence cigarette smoking during treatment and recovery from substance use. We conclude that more qualitative research is needed to understand which factors, not typically emphasized in standard tobacco cessation programming, may contribute to cigarette smoking cessation for this population. [ABSTRACT FROM PUBLISHER]

Indigenous peoples the world over have and continue to experience the devastating effects of colonialism including loss of life, land, language, culture, and identity. Indigenous peoples suffer disproportionately across many health risk factors including an increased risk of substance use. We use the term 'Big Event' to describe the historical trauma attributed to colonial policies as a potential pathway to explain the disparity in rates of substance use among many Indigenous populations. We present 'Big Solutions' that have the potential to buffer the negative effects of the Big Event, including: (1) decolonizing strategies, (2) identity development, and (3) culturally adapted interventions. Study limitations are noted and future needed research is suggested. [ABSTRACT FROM AUTHOR]