1
|
Kerr DCR, Bae H. Comparing National College Health Assessment with other surveys of cannabis use and binge drinking among young adult college students 2008-2018. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37167585 DOI: 10.1080/07448481.2023.2201859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Objective: We considered the utility of National College Health Assessment (NCHA) data relative to other national data for studying college students' cannabis use and binge drinking, and drug policy effects. Participants: Survey data on 18-22-year old college students were drawn from the 2008-2018 NCHA, National Survey on Drug Use and Health (NSDUH), Monitoring the Future (MTF), and Healthy Minds Study (HMS). Methods: Prevalence estimates were compared across data sources in terms of level and change from 2008-2018 using linear regressions, separately for men and women. Results: Mean prevalence estimates for 30-day cannabis use and 2-week binge drinking, and linear time trends did not differ significantly among NCHA, NSDUH, and MTF. Conclusions: NCHA prevalence estimates are similar to those from NSDUH and MTF, NCHA has unique strengths, and some weaknesses can be offset. Findings support the value of NCHA for studying college students' substance use and effects of drug policy.
Collapse
Affiliation(s)
- David C R Kerr
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Harold Bae
- Biostatistics Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| |
Collapse
|
2
|
Cornell J, Conchas A, Wang XQ, Fink JC, Chen H, Kane MA, Pilli N, Ait-Daoud N, Gorelick DA, Li MD, Johnson BA, Seneviratne C. Validation of serotonin transporter mRNA as a quantitative biomarker of heavy drinking and its comparison to ethyl glucuronide/ethyl sulfate: A randomized, double-blind, crossover trial. Alcohol Clin Exp Res 2022; 46:1888-1899. [PMID: 36031718 PMCID: PMC9588643 DOI: 10.1111/acer.14931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/02/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The serotonin transporter (SERT) mRNA was previously reported to be a quantitative and pathophysiology-based biomarker of heavy drinking in 5HTTLPR:LL genotype-carriers treated with ondansetron. Here, we validated the potential use of SERT mRNA for quantitative prediction of recent alcohol consumption (in the absence of treatment) and compared it with the known biomarkers ethyl glucuronide (EtG) and ethyl sulfate (EtS). METHODS Binge drinking men and women of European ancestry aged 21 to 65 years were enrolled in a 12-day, in-patient, randomized, double-blind, crossover study, where they were administered three beverage doses (placebo, 0.5 g/kg [0.4 g/kg] ethanol, and 1 g/kg [0.9 g/kg] ethanol for men [women]) individually in three 4-day periods (experiments), separated by minimum 7-day washout period. Diet, sleep, and physical activity were controlled throughout the inpatient experiments. Twenty-nine participants were randomized to receive beverage doses counterbalancing the sequence of treatment and gender within subgroups stratified by SERT genotypes 5HTTLPR:LL+rs25531:AA (LA LA ) versus 5HTTLPR:LS/SS. Peripheral venous blood was collected daily for (1) quantification of SERT mRNA (the primary outcome measure) using qRT-PCR and (2) plasma EtG and EtS levels using tandem mass-spectrometry. RESULTS The association between administered beverage dose and SERT mRNA from completers of at least one 4-day experiment (N = 18) assessed by a linear mixed model was not statistically significant. Significant positive associations were found with beverage dose and plasma EtG, EtS and EtG/EtS ratio (β = 5.8, SE = 1.2, p < 0.0001; β = 1.3, SE = 0.6, p = 0.023; and β = 3.0, SE = 0.7, p < 0.0001, respectively; the C-statistics for discriminating outcomes were 0.97, 0.8, and 0.92, respectively). Additionally, we observed a sequence effect with a greater placebo effect on SERT mRNA when it was administered during the first experiment (p = 0.0009), but not on EtG/EtS measures. CONCLUSION The findings do not validate the use of SERT as a biomarker of heavy drinking. Larger and more innovative studies addressing the effects of placebo, race, gender, and response to treatment with serotonergic agents are needed to fully assess the utility of SERT as a biomarker of heavy and binge drinking.
Collapse
Affiliation(s)
- Jessica Cornell
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew Conchas
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD (former affiliation)
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Jeffrey C. Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Hegang Chen
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen A. Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD
| | - Nageswara Pilli
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD
| | - Nassima Ait-Daoud
- Department of Psychiatry, University of Virginia, Charlottesville, VA
| | - David A. Gorelick
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | - Bankole A. Johnson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD (former affiliation)
| | - Chamindi Seneviratne
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
- The Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
3
|
Massarwi AA, Cluver L, Meinck F, Doubt J, Lachman JM, Shenderovich Y, Green O. Mediation pathways for reduced substance use among parents in South Africa: a randomized controlled trial. BMC Public Health 2021; 21:1656. [PMID: 34507584 PMCID: PMC8434729 DOI: 10.1186/s12889-021-11651-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty. METHODS The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa's Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects. RESULTS Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty. CONCLUSIONS The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity. TRIAL REGISTRATION Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. The trial can be found by searching for the key word 'Sinovuyo' on the Pan-African Clinical Trials Registry website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119.
Collapse
Affiliation(s)
- Adeem Ahmad Massarwi
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK.
- Department of Social Work, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Franziska Meinck
- School of Social & Political Sciences, University of Edinburgh, Edinburgh, UK
- Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Jenny Doubt
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| | - Jamie M Lachman
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Yulia Shenderovich
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ohad Green
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Shadloo B, Baheshmat S, Rostam-Abadi Y, Shakeri A, Gholami J, Rahimi-Movaghar A. Comparison of self-reported substance use with biological testing among treatment-seeking patients with opioid use disorder. J Subst Abuse Treat 2021; 134:108555. [PMID: 34210569 DOI: 10.1016/j.jsat.2021.108555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/06/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several factors may influence the validity of self-report. In this study, we aimed to assess the validity of self-reported drug use compared to urine testing among treatment-seeking patients with opioid use disorder (OUD). METHODS This cross-sectional study recruited 293 patients with OUD, referred to the Iranian National Center for Addiction Studies (INCAS) clinic, from November 2015 to June 2017. The study compared self-reported opioid use in the past 72 h with the results of urinalysis, using immunoassay technique. We estimated sensitivity, negative predictive value, percent agreement, positive percent agreement, and Cohen's kappa statistics for those with OUD. RESULTS The sensitivity of self-reported opioid use was 85.9%. Percent agreement, positive percent agreement, and Cohen's Kappa statistics between self-reported opioid use and urine testing for morphine in the first month were 88.5%, 78.1%, and 77.0, respectively. Multilevel logistic regression showed that longer treatment duration (OR = 1.21, 95%CI: 1.07-1.37, p-value = 0.002) was significantly associated with the agreement of self-reported opioid use with urine testing. CONCLUSION Self-report can be used as a reliable method for monitoring treatment adherence combined with random urine tests.
Collapse
Affiliation(s)
- Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, No. 486, South Karegar Ave., Tehran 1336616357, Iran.
| | - Shahab Baheshmat
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran; Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
| | - Atena Shakeri
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, No. 486, South Karegar Ave., Tehran 1336616357, Iran.
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Zelnick JR, Daftary A, Hwang C, Labar AS, Boodhram R, Maharaj B, Wolf AK, Mondal S, Amico KR, Orrell C, Seepamore B, Friedland G, Padayatchi N, O'Donnell MR. Electronic dose monitoring identifies a high-risk subpopulation in the treatment of drug-resistant tuberculosis and HIV. Clin Infect Dis 2020; 73:e1901-e1910. [PMID: 33053186 DOI: 10.1093/cid/ciaa1557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In generalized drug-resistant tuberculosis (DR-TB) HIV epidemics, identifying subpopulations at high risk for treatment failure and loss to care is critically important to improve treatment outcomes and prevent amplification of drug resistance. We hypothesized that an electronic dose-monitoring (EDM) device could empirically identify adherence-challenged patients and that a mixed-methods approach would characterize treatment challenges. METHODS A prospective study of DR-TB HIV patients on antiretroviral therapy (ART) initiating bedaquiline-containing regimens in KwaZulu-Natal, South Africa. Separate EDM devices measured adherence for bedaquiline and ART. Patients with low adherence (<85%) to both bedaquiline and ART were identified as high-risk for poor outcomes. Baseline survey, study visit notes and focus group discussions characterized treatment challenges. RESULTS From December 2016-February 2018, 32 of 198 (16%) enrolled DR-TB HIV patients were identified as dual adherence-challenged. In a multivariate model including baseline characteristics, only receiving a disability grant was significantly associated with dual non-adherence at 6-months. Mixed-methods identified treatment barriers including, alcohol abuse, family conflicts, and mental health issues. Compared to adherent patients, dual-adherence challenged patients struggled to prioritize treatment and lacked support, and dual adherence-challenged patients experienced higher rates of detectable HIV viral load and mortality compared to more adherent patients. CONCLUSION EDM empirically identified a subpopulation of DR-TB HIV patients with dual adherence challenges early in treatment. Mixed-methods revealed intense psychosocial, behavioral, and structural barriers to care in this subpopulation. Our data supports developing differential, patient-centered, adherence support interventions focused on psychosocial and structural challenges for subpopulations of at-risk DR-TB HIV patients.
Collapse
Affiliation(s)
- Jennifer R Zelnick
- Graduate School of Social Work, Touro College and University System, NY, NY USA
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Ontario Canada.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Christina Hwang
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA
| | - Amy S Labar
- Vagelos College of Physician & Surgeons, Columbia University, NY, NY USA
| | - Resha Boodhram
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Bhavna Maharaj
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Allison K Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA
| | - Shinjini Mondal
- Department of Family Medicine, McGill University, Montreal, Canada
| | - K Rivet Amico
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa
| | | | | | - Nesri Padayatchi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Max R O'Donnell
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA
| |
Collapse
|
6
|
Arfer KB, O’Connor MJ, Tomlinson M, Rotheram-Borus MJ. South African mothers' immediate and 5-year retrospective reports of drinking alcohol during pregnancy. PLoS One 2020; 15:e0231518. [PMID: 32298313 PMCID: PMC7162489 DOI: 10.1371/journal.pone.0231518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Prenatal alcohol-drinking is often measured with self-report, but it is unclear whether mothers give more accurate answers when asked while pregnant or some time after their pregnancy. There is also the question of whether to measure drinking in a dichotomous or continuous fashion. We sought to examine how the timing and scale of self-reports affected the content of reports. From a sample of 576 black mothers around Cape Town, South Africa, we compared prenatal reports of prenatal drinking with 5-year retrospective reports, and dichotomous metrics (drinking or abstinent) with continuous metrics (fluid ounces of absolute alcohol drunk per day). Amounts increased over the 5-year period, whereas dichotomous measures found mothers less likely to report drinking later. All four measures were weakly associated with birth weight, birth height, child head circumference soon after birth, and child intelligence at age 5. Furthermore, neither reporting time nor the scale of measurement were consistently related to the strengths of these associations. Our results point to problems with self-report, particularly with this population, but we recommend post-birth continuous measures as the best of the group for their flexibility and their consistency with previous research.
Collapse
Affiliation(s)
- Kodi B. Arfer
- Icahn School of Medicine, Mount Sinai Health System, New York, New York, United States of America
- * E-mail:
| | - Mary J. O’Connor
- Semel Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mary Jane Rotheram-Borus
- Global Center for Children and Families, University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
7
|
Carlsen SEL, Lunde LH, Torsheim T. Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment. Subst Abuse Rehabil 2020; 11:9-18. [PMID: 32099510 PMCID: PMC6996215 DOI: 10.2147/sar.s221618] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid maintenance treatment reduces a person’s use of heroin. However, frequent substance use in treatment is a problem. Aim To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment. Patients and Methods Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants’ social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life. Results There was a significant negative association between time in treatment and use of opioids, b =−0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =−0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = −0.62, SE = 0.23, p = < 0.01. Social dimensions, participants’ adverse experiences, and social resources were not associated with polydrug or opioid use. Conclusion Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients’ opioid use.
Collapse
Affiliation(s)
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| |
Collapse
|
8
|
Huis In 't Veld D, Ensoy-Musoro C, Pengpid S, Peltzer K, Colebunders R. The efficacy of a brief intervention to reduce alcohol use in persons with HIV in South Africa, a randomized clinical trial. PLoS One 2019; 14:e0220799. [PMID: 31430313 PMCID: PMC6701742 DOI: 10.1371/journal.pone.0220799] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Since there is a high prevalence of high risk alcohol use in patients with HIV in Africa, with negative health effects, there is a need for short interventions to reduce alcohol use. Methods We studied the efficacy of a short intervention aiming to reduce alcohol use based on the Information-Motivation-Behavioural Skills Model in patients with HIV with high alcohol use (measured by AUDIT). The study was performed in three outpatient clinics in South Africa. The intervention group received in one-session intervention a personalized feedback on AUDIT results trying to make people aware that they are in the medium- or high-risk drinking category. Both the intervention and the control group received a health education leaflet. Results A total of 560 patients participated in the study with a follow up of 1 year. There was a significant decrease in total AUDIT scores between baseline and follow up points 1 (5 months) and 2 (1 year) in both groups. There was no significant decrease between time points 1 and 2. However, between the intervention and control groups there was no difference in reduction of alcohol use to abstinence or low risk alcohol use over time as there was no difference in absolute decrease in AUDIT-score or percentage of change in AUDIT score. The intervention had no influence on the quality of life outcomes, depression scores, stigma, tobacco use, viral load and therapy adherence at both time points. In all secondary outcomes, there was no significant interaction between intervention and time. Conclusion The brief intervention was not successful at reducing alcohol use both 5 and 12 months after the intervention. However, there was a beneficial effect on reported hazardous or harmful alcohol use at least over a short term follow up period in both study groups. It might be that only an interview and/or the distribution of a health leaflet can be successful in reducing alcohol use but this needs to be investigated with more objective measures of alcohol use. To sustain an effect, most likely repetitive contacts with hazardous or harmful alcohol drinkers will be needed during a long follow up period.
Collapse
Affiliation(s)
- Diana Huis In 't Veld
- Department of Internal Medicine and Infectious Diseases, UZ Ghent, Ghent, Belgium.,Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.,FWO Research Foundation Flanders, Brussels, Belgium
| | - Chellafe Ensoy-Musoro
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, University of Hasselt, Diepenbeek, Belgium
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand.,Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | | |
Collapse
|
9
|
Wildes M, Bigand TL, Layton ME, Wilson M. Cannabis Use and Cognition in Adults Prescribed Opioids for Persistent Pain. Pain Manag Nurs 2019; 21:94-99. [PMID: 31405787 DOI: 10.1016/j.pmn.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adults with persistent pain frequently report cannabis use to help manage their symptoms. The impact of cannabis use on cognition in the presence of concurrent symptoms of depression and anxiety is poorly understood. AIMS Our study explored how cannabis use affects relationships among symptoms of depression, anxiety, and cognition. DESIGN A cross-sectional survey study was conducted. SETTINGS Surveys were distributed at outpatient clinics treating adults for pain in the Pacific Northwestern United States. PARTICIPANTS A total of 150 adults prescribed an opioid medicine for persistent pain were recruited. METHODS A pencil and paper survey was used to collect several self-reported ratings of cognition, symptoms of depression and anxiety, and the average potency of cannabis consumed as measured by the percentage of delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD), as well as frequency of cannabis use. RESULTS Depression, anxiety and cognition significantly worsened as the reported percentage of CBD, THC and overall frequency of cannabis use in the past 30 days increased. Depression and anxiety both significantly predicted worsening cognition in the sample. The relationship between depressive symptoms and cognition was strengthened as reported percentages of CBD use increased. The relationship was the same for anxiety and cognition, although not as strong. CONCLUSIONS More cannabis use, particularly high CBD products, may be linked with increased symptom burdens and may strengthen relationships between negative affect and cognition. Further cannabis research within persistent pain populations is warranted to add evidence that can assist patients in managing mood and mental processes. Nurses should evaluate how negative affective health symptoms may impact cognition among adults with persistent pain using prescription opioid medications, especially in the context of concurrent cannabis use.
Collapse
Affiliation(s)
- Megan Wildes
- Multicare Neuroscience Institute, Spokane, Washington; College of Nursing, Gonzaga University, Spokane, Washington
| | - Teresa L Bigand
- College of Nursing, Washington State University, Spokane, Washington
| | - Matthew E Layton
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Translational Addictions Research Center, Washington State University, Pullman, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington; Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Translational Addictions Research Center, Washington State University, Pullman, Washington.
| |
Collapse
|
10
|
Sibanda NC, Kornhaber R, Hunt GE, Morley K, Cleary M. Prevalence and Risk Factors of Emergency Department Presentations with Methamphetamine Intoxication or Dependence: A Systematic Review and Meta-analysis. Issues Ment Health Nurs 2019; 40:567-578. [PMID: 31025889 DOI: 10.1080/01612840.2018.1553003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Methamphetamine intoxication presentations to emergency departments (EDs) including trauma centres, general EDs and psychiatric emergency services have risen world-wide. Objectives: A review of the clinical characteristics of patients presenting to a trauma centre or ED with methamphetamine intoxication or dependence to aid development of health service policy and training for health personnel. Methods: PubMed, PsycINFO, CINAHL and Scopus (1990-2017) were searched. A systematic review of all clinical characteristics was conducted, and a meta-analysis undertaken for variables with standard measures (prevalence, age, gender); 23 studies met the inclusion criteria of which 17 could be used in the meta-analysis. Results: Methamphetamine-related presentations were characterised by cardiac complications, psychiatric symptoms and aggression with safety risk to health personnel. The pooled prevalence of methamphetamine positive cases in emergency settings was higher in studies using toxicology analysis to determine methamphetamine use (8 studies, 22.8% 95% CI 15.4-32.5) compared to self-reporting (9 studies 5.7%, 95% CI 2.8-11.2, Q = 12.42, p < 0.001). Pooled variance of methamphetamine positive cases was 57.1% in men and 42.9% in women. The mean age of those who were methamphetamine positive was 28.4 years and for those methamphetamine negative cases it was 38.4 years. Conclusions: In this review, we found a higher prevalence of methamphetamine use amongst males and in the younger demographic. Targeted training programmes for frontline staff and management approaches for prompt multi-disciplinary service engagement are recommended as well as appropriate resourcing, such as mental health staff in EDs or mental health beds to accommodate this subgroup of the patient cohort.
Collapse
Affiliation(s)
- Njabulo Churchill Sibanda
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
| | - Rachel Kornhaber
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
| | - Glenn E Hunt
- b Discipline of Psychiatry , University of Sydney , Sydney , New South Wales , Australia
| | - Kirsten Morley
- c Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health , University of Sydney , Sydney , New South Wales , Australia
| | - Michelle Cleary
- a School of Health Sciences, College of Health and Medicine , University of Tasmania , Sydney , New South Wales , Australia
| |
Collapse
|
11
|
Magidson JF, Fatch R, Orrell C, Amanyire G, Haberer JE, Hahn JA. Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa. AIDS Behav 2019; 23:1656-1667. [PMID: 30560484 PMCID: PMC6535416 DOI: 10.1007/s10461-018-2364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Individuals are initiating antiretroviral therapy (ART) at earlier HIV disease stages. Unhealthy alcohol use is a known barrier to successful HIV treatment outcomes, yet it is unclear whether the problem varies by disease stage. We measured alcohol use with an objective biomarker (phosphatidylethanol [PEth]), comparing individuals (n = 401) with early (CD4 > 350 cells/mL, WHO Stage 1) versus late (CD4 < 200 cells/mL) ART initiation in HIV care in Uganda and South Africa (SA). We examined the association between CD4 count and biomarker results using multivariable regression modeling, and compared PEth results to self-report to assess underreporting. Overall, 32.2% (n = 129) had unhealthy alcohol use (PEth ≥ 50 ng/ml). Early ART initiation was significantly associated with unhealthy alcohol use in Uganda (AOR 2.65; 95% CI: 1.05–6.72), but not SA (AOR 1.00; 95% CI: 0.46–2.17). In Uganda, 23.2% underreported unhealthy alcohol use versus 11.6% in SA (χ2 = 9.30; p < 0.01). Addressing unhealthy alcohol use is important as patients initiate ART earlier, yet challenging due to underreporting.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 1147B Biology-Psychology, College Park, MD, 20742, USA.
| | - Robin Fatch
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Department of Medicine and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
12
|
Christodoulou J, Stokes LR, Bantjes J, Tomlinson M, Stewart J, Rabie S, Gordon S, Mayekiso A, Rotheram-Borus MJ. Community context and individual factors associated with arrests among young men in a South African township. PLoS One 2019; 14:e0209073. [PMID: 30653530 PMCID: PMC6336339 DOI: 10.1371/journal.pone.0209073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town. METHODS Data were collected from a stratified community sample of 906 young men aged 18-29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests. RESULTS Significant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests. CONCLUSIONS When considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men. TRIAL REGISTRATION ClinicalTrials.gov registration #NCT02358226, registered Nov 24, 2014.
Collapse
Affiliation(s)
- Joan Christodoulou
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, United States of America
| | - Lynissa R. Stokes
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States of America
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jackie Stewart
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Stephan Rabie
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Gordon
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Andile Mayekiso
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, United States of America
| |
Collapse
|
13
|
Okafor CN, Christodoulou J, Bantjes J, Qondela T, Stewart J, Shoptaw S, Tomlinson M, Rotherman-Borus MJ. Understanding HIV Risk Behaviors Among Young Men in South Africa: A Syndemic Approach. AIDS Behav 2018; 22:3962-3970. [PMID: 30003507 PMCID: PMC6330132 DOI: 10.1007/s10461-018-2227-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18-29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (aOR = 5.10, 95% CI 3.10, 8.29; p = < .001) compared to reporting neither factor. Also, food insecurity and violence (aOR = 2.89, 95% CI 1.63, 5.11; p = < .001) as well as food insecurity and polydrug use (aOR = 2.73, 95% CI 1.54, 4.84; p = < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction.
Collapse
Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
| | - Joan Christodoulou
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, Los Angeles, USA
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Tembinkosi Qondela
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jackie Stewart
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mary Jane Rotherman-Borus
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| |
Collapse
|
14
|
Breet E, Bantjes J, Lewis I. Chronic substance use and self-harm in a primary health care setting. Afr J Prim Health Care Fam Med 2018; 10:e1-e9. [PMID: 29943610 PMCID: PMC6018521 DOI: 10.4102/phcfm.v10i1.1544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced. AIM To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA. METHODS Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses. RESULTS Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19-20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77-11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44-9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16-15.7, p < 0.001). CONCLUSION The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patientswho present in primary health care settings.
Collapse
Affiliation(s)
- Elsie Breet
- Department of Psychology, Stellenbosch University.
| | | | | |
Collapse
|