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While much attention has been given to methamphetamine's wake-promoting properties and the concept of using methamphetamine to increase energy, little is known about the ways people who use methamphetamine manage their use to pursue their functional goals or the challenges they encounter doing so. This qualitative study explores the experiences of people who used methamphetamine to manage wakefulness and reduce sleep as a means to achieve functional goals. We conducted a grounded theory analysis of 202 anonymous letters submitted to an online forum. Five themes emerged from this process: (1) Using methamphetamine to extend wakefulness and reduce the need for sleep; (2) Losing control over wakefulness and the need for sleep; (3) Managing wakefulness and the need for sleep while on methamphetamine; (4) Getting caught in a cycle of wakefulness and sleep; and (5) Sleep disruptions even after ceasing methamphetamine use. Participants believed methamphetamine was critical to meeting their functional goals, and they went to great lengths to try to manage the substance's ill effects. Thus, clients in treatment for methamphetamine use disorder may benefit from interventions addressing their underlying motivations and perceived associations between methamphetamine and meeting functional goals. [ABSTRACT FROM AUTHOR]

This study examines contribution of substance use (including alcohol, cannabinoids, stimulants, narcotics, depressants, and hallucinogens) on the probability of drivers being at-fault for a crash on U.S. public roads, with specific emphasis on older adult drivers. Data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for the years 2010–2018 were employed for 87,060 drivers (43,530 two-vehicle crash pairs) involved in two moving vehicle crashes. The quasi-induced exposure (QIE) method was used to compute the relative crash involvement ratios (CIRs) for each relevant substance and illicit drug. Mixed-effect generalized linear regression models were fit to examine the effect of substance use on the probability of a driver being at-fault for a crash. There were 75.51% males and 73.88% Non-Hispanic Whites in our sample. The CIR for those aged 70–79 years was 1.17, and more than double (2.56) for the ≥80 years old drivers, while being relatively low among drivers of ages 20 to 69. Substance use, in general, disproportionately increased the probability of being at-fault during a crash, regardless of driver's age. Though older drivers are less likely than other age groups to report substance use, presence of substances among older drivers increased the probability of their being at-fault two to four times during a crash across almost all substances. The regression models, after adjusting for driver's sex, road grade, weather, light conditions, distraction, and speeding at time of crash, revealed that older drug-impaired drivers were twice as likely to be at fault in a fatal crash (aOR = 1.947; 95% CI = 1.821, 2.082; <0.0001) compared to their middle-aged counterparts. Similarly, most substance use categories were responsible for the probabilities of higher CIRs among the drivers. These findings necessitate continued efforts to bring awareness to the deadly consequences of "drugged driving," especially among older adult drivers. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is a serious public health problem. Over 3.3 million people worldwide die each year due to alcohol-related causes, which is almost 5.3% of all deaths. This systematic review examines the effectiveness of injectable naltrexone treatment for people with AUD based on randomized clinical trial studies conducted between January 2004 and December 2019. Following PRISMA-P, this review searched PubMed, PsycINFO, CINAHL, Cochrane Library, and Web of Science for relevant studies. The inclusion criteria were AUD treatment, injectable naltrexone, and randomized clinical trials. Only articles written in English, involving human participants, and published in peer-reviewed journals were considered for this review. A total of 11 studies met the inclusion criteria. Ten out of the 11 studies assessed the impact of injectable naltrexone in a 3- to 6-month follow-up period, with one study having a year follow-up. This systematic review indicates that overall, injectable naltrexone therapy produced positive AUD treatment outcomes, including reduced mean time to first drinking day and/or heavy drinking day, decreased number of drinking and/or heavy drinking days, and increased abstinence, frequently at a statistically significant level in the larger studies. However, in all studies, less than half of the participants were completely abstinent after receiving injectable naltrexone. Injectable naltrexone treatment along with psychosocial therapy holds promise for addressing AUD. [ABSTRACT FROM AUTHOR]

Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was "very/extremely harmful" (vs. "not at all harmful") to health (p < 0.001) and people cause a "lot of harm" (vs. "no harm") to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they "often/very often" (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents. [ABSTRACT FROM AUTHOR]

The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the "mother first" orientation while living with HIV, and (3) the impact of the "mother first" orientation on ART adherence and self-care. These findings identify how participants' "mother first" identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA's theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities. [ABSTRACT FROM AUTHOR]

Background: In 2017, the US Department of Health and Human Services declared the Opioid epidemic a public health emergency. In the US, emergency rooms treat more than 1,000 people each day for drug overdose, and 115 of them die. This study examines compositional and contextual factors associated with drug overdose deaths rates in the US. Methods: Local spatial autocorrelation statistics were used to estimate hot spot areas to identify census tracts with high risk of drug overdose death. Logistic regressions investigated the relationship between drug overdose death rates and various compositional and contextual variables across census tracks. Results: The adjusted logistic model shows that compositional variables: depression (OR = 2.47 [2.37–2.58]), poor mental health (OR = 1.71 [1.63–1.79]), median age 1.41 (1.36–1.47) and the percentage of people with a high school diploma (OR = 1.30 [1.24–1.35]) were positively associated with the rate of drug overdose deaths. On the other hand, contextual variables: the percentage having health insurance (OR = 0.66 [0.64–0.69]), the Theil's H index (OR = 0.69 [0.66–0.71]), population density (OR = 0.80 [0.77–0.84]), poverty (OR = 0.90 [0.86–0.95]), and median household income (OR = 0.91[0.86–0.96]) were negatively associated with drug overdose deaths. Discussion: The analysis reveals a consistently strong association between compositional mental health factors and census tract-level death rates from drug overdose. [ABSTRACT FROM AUTHOR]

Despite its promise, pre-exposure prophylaxis (PrEP) uptake has been slow in the United States with fewer than 100,000 of the 1.1 million Americans considered at substantial risk for HIV currently taking it. Community health workers play a critical role in promoting PrEP awareness and access in their local communities. However, there is currently limited literature that focuses on barriers faced by community health workers providing PrEP services. The present qualitative study draws upon the social ecological model (SEM) to examine barriers to PrEP uptake from the perspective of community health workers in a large Mid-South U.S. city. Study participants identified several barriers at all five levels of the SEM: individual, interpersonal, community, organizational, and policy. The study findings provide viable entry points for multilevel interventions aimed at promoting PrEP uptake. [ABSTRACT FROM AUTHOR]

Aims: This qualitative study explores and characterises barriers to methamphetamine recovery that emerge from users discussing anonymously their challenges in an online discussion forum. Methods: Anonymous letters and stories (N = 202), which were submitted to an online support forum for methamphetamine users and their loved ones, were analysed in Dedoose software using grounded theory methodology. Findings: Six perceived barriers emerged from the narratives, which were categorised as internal or external. The first three perceived barriers - low self-efficacy, conflicting thoughts about methamphetamine use, and side effects of withdrawal - were related to internal barriers, and the other three perceived barriers - escaping the drug environment, friends and family prevented recovery, and inadequate drug rehabilitation programmes - were related to external barriers. Conclusions: Methamphetamine users participating in an online discussion forum faced many internal and external barriers that impeded their recovery. These identified barriers were remarkably similar to barriers reported by users seeking treatment in conventional settings or recruited from drug networks, which suggests that methamphetamine users, in general, use multiple methods to assist with recovery and face many common barriers. Developing behavioural interventions that include online components may help remove some of the barriers and improve methamphetamine recovery. [ABSTRACT FROM AUTHOR]

The goal of this study is to explore motivating factors for recovering from methamphetamine abuse. The source of data was 202 anonymous letters and stories submitted to an online support platform for methamphetamine users. Qualitative data were analyzed in Dedoose software using grounded theory methodology. Ten primary motivating factors for recovering from methamphetamine abuse were identified and mapped onto four constructs from the Health Belief Model: (1) perceived susceptibility (learning from others and learning from self); (2) perceived severity (fear of death and declining health); (3) perceived benefits (reconnecting with family, reconnecting with society, and recovering self-esteem); and (4) cues to action (hitting rock bottom, finding God, and becoming pregnant). By using data from an online support group and categorizing emerging themes within a theoretical framework, findings from this study provide a comprehensive understanding of factors involved in recovery from methamphetamine abuse and offer further insights in developing theoretically informed interventions for methamphetamine users. This study suggests the utility of online platforms for obtaining anonymous but unique experiences about drug abuse and recovery. Findings may benefit healthcare professionals, counselors, and researchers by helping to develop theoretically informed interventions for methamphetamine abuse. [ABSTRACT FROM PUBLISHER]

Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with a fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed. [ABSTRACT FROM AUTHOR]

This study examines gender effects on client-spousal collateral agreement in substance abuse posttreatment reports and assesses the dependability of spousal collaterals in corroborating these reports. Study participants included 178 male clients with female spousal collaterals (male client dyads) and 58 female clients with male spousal collaterals (female client dyads) who completed follow-up interviews 6 months post admission. Interviews were conducted from July 2002 to June 2004. Levels of agreement were examined by dyad type for responses to 13 questions regarding clients' treatment experiences and treatment effectiveness. A simple kappa coefficient was calculated to measure the degree of nonchance agreement between clients and their spouses using SAS/Base, SAS/Stat, and SAS/IML. Agreement levels between the two dyads were compared and examined whether gender differences in agreement levels were significant. Agreement levels were found to be high, ranging from 80.4 to 97.1% for male client dyads and from 76.5 to 100% for female client dyads. Six of the 13 questions for male client dyads and 8 of the 13 questions for female client dyads revealed excellent or substantial nonchance agreement. Questions related to domestic violence had poor nonchance agreement, with "Victim of domestic violence since treatment" having the lowest score for the male client dyad. Only one question, "Currently on probation or parole," showed a significant difference across genders, as males revealed a significantly higher level of agreement. Moderate to substantial agreement was determined for 11 out of the 13 questions regardless of gender effects. This study provides empirical data affirming the high dependability of spousal collaterals to validate responses about clients' substance abuse following treatment. However, the study revealed a high degree of disagreement among both male client dyads and female client dyads regarding questions related to domestic violence (including whether the client had committed or been a victim of domestic violence). Following rigorous gender analyses, this study reveals little difference overall in agreement levels between gender dyads. [ABSTRACT FROM AUTHOR]

This article discusses the changing systems of food production among Garhwali resettlers who were forcibly displaced due to the construction of the Tehri Dam in North India. Resettling to a drastically new environment affected their traditional food production strategies and rendered them vulnerable to the vagaries of transition, including the forced adaptation to new cash crop-based farming systems, restricted hunting and fishing areas, and limited access to dairy products. These changes led to an inadequate supply of food and nutrients, especially protein, for these resettlers. Using ethnographic methods, this study illustrates that resettling an agrarian community to a new ecological area significantly changes their food production practices in ways that leave them vulnerable to the potential risk of an impoverished diet. [ABSTRACT FROM AUTHOR]