Double trouble: Exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents

Melitracen and flupentixol (deanxit) use disorder in Lebanon

Introduction

Deanxit is a combination of melitracen and flupentixol, not approved as an antidepressant for sale and use in several countries but still widely available and commonly used among the Lebanese population. The study aimed to assess Deanxit use disorder, assess the source of the medication, and the consumers' awareness of the therapeutic and side effects of Deanxit, among the Lebanese population.

Methods

This is a cross-sectional study that included all patients taking Deanxit and visited the Emergency Department between October 2019 and October 2020. All patients who agreed to participate in the research through written consent forms were contacted by telephone and a questionnaire was filled out.

Results

A total of 125 patients taking Deanxit were included in the study. According to the DSM-V criteria, 36% (n = 45) had a Deanxit use disorder. Most of the participants were females (n = 99, 79.2%), married (n = 90, 72%), and between the ages of 40-65 years (n = 71, 56.8%). Most patients (n = 41, 91%) had Deanxit prescribed by a physician for anxiety (n = 28, 62%), and obtained it using a prescription (n = 41, 91%). Almost half of all patients (n = 60, 48%) did not have sufficient knowledge of the reason it was prescribed, 54.4% (n = 68) were not sure they are taking the medication appropriately, and 19.2% (n = 23) were satisfied by the overall explanation of the physicians concerning Deanxit use.

Conclusion

Deanxit use disorder is underrecognized among Lebanese patients. Most of our patients were prescribed Deanxit by their physicians but reported inadequate knowledge of its side effects and risk of abuse.

Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon

Background

International research showed that common mental disorders such as depression, anxiety, social anxiety, stress, alexithymia and having insecure attachment styles are risk factors for alcohol use disorder (AUD). Our objective was to study the factors associated withAUD in a sample of the Lebanese population.

Methods

During the period lasting from November 2017 to March 2018, a sample of 789 Lebanese participants agreed to contribute to a cross-sectional study (53.23% males). Alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

Results

A high risk of AUD was associated with higher alexithymia (ORa = 1.030; CI 1.009–1.051), depression (ORa = 1.076; CI 1.050–1.103) and suicidal ideation (ORa = 1.253; CI 1.026–1.531) in a significant manner. In opposition, a higher number of kids (ORa = 0.863; CI 0.752–0.991), being a female (ORa = 0.460; CI 0.305–0.694) and higher emotional management (ORa = 0.962; CI 0.937–0.988) were significantly associated with lower AUD risk.

A cluster analysis derived three mutually exclusive clusters. Cluster 1 formed 45.4% of the sample and assembled people with psychological difficulties (work fatigue and high stress, high emotional work fatigue and low emotional intelligence, low self-esteem, high social phobia, high alexithymia); Cluster 2 formed 34.4% of the sample and assembled people with high wellbeing (low suicidal ideation, low emotional work fatigue, depression and anxiety, high emotional intelligence, high self-esteem and low social phobia); whereas cluster 3 formed 20.2% of the sample and represented people with mental dysfunction (high anxiety and depression, high suicidal ideation, low self-esteem and high social phobia, low emotional intelligence, high emotional work fatigue). People with psychological difficulties (cluster 1) (Beta = 5.547; CI 4.430–6.663), and people in distress (cluster 3) (Beta = 7.455; CI 5.945–8.965) were associated with higher AUDIT scores than those with high wellbeing (cluster 2).

Conclusion

AUD seems to be influenced by several factors among the Lebanese population, including alexithymia, stress, anxiety and work fatigue. Healthcare professionals should spread awareness to reduce the prevalence of these factors.

"Everyone Has the Right to Drink Beer": A Stakeholder Analysis of Challenges to Youth Alcohol Harm-Reduction Policies in Lebanon

BACKGROUND

Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies-such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth.

METHODS

We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis.

RESULTS

Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards 'other' stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally.

CONCLUSIONS

Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.

Factors associated with waterpipe tobacco smoking among Lebanese women

Waterpipe tobacco smoking (WTS) has become a serious public health threat in the Middle East and beyond. To estimate the prevalence rates of cigarette and WTS among Lebanese women and describe characteristics associated with each behavior. Secondary analysis of women's health data obtained in a national survey in 2010. Of 2,255 selected women, 78 percent reported no or past long-term WTS. Among the 12 percent of regular waterpipe smokers, 40 percent were light users (mean three waterpipe heads weekly), while 60 percent were heavy users (mean of 11 heads per week). About 70 percent were never or past long-term cigarette smokers. Younger age, location within Greater Beirut (GB) and having professional employment were significantly associated with use of WTS. Older age, GB location, lower education, and ever-married were significantly associated with cigarette smoking. WTS is becoming a socially normative behavior among empowered professional women, who can spare the time and expense to engage in this behavior in easily accessible cafés, which prohibit cigarette smoking. Government, media, and NGO campaigns against smoking should target waterpipe use, not only in Lebanon but also across the Arab world and among Arab communities in the Diaspora with messages different from anti-cigarette campaigns.

Surveying Alcohol Outlet Density in Four Neighborhoods of Beirut Lebanon: Implications for Future Research and National Policy

Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Beirut, Lebanon, and to estimate their proximity to educational institutions. The density of alcohol outlets ranged from 18.30 to 80.95 per km² (average of 39.6 alcohol outlets/km²). The highest number of total alcohol outlets was in the “Hamra & Jamiaa” area, which includes one of the largest private universities in the country. Thirteen out of 109 (12%) alcohol outlets (on and off-premise) were located less 100 m away from educational institutions, in violation of the current licensing law. None of the off-premise and the majority (94%) of on-premise alcohol outlets displayed the “no sale for <18” sign. Findings were indicative of an environment conducive to increased access and availability of alcohol among youth in Lebanon probably attributed to the prevailing weak alcohol policies and their enforcement. Systematic collection and reporting of alcohol outlet densities is critical to understand the alcogenic environment and guide local harm reduction policies.

Prevalence of nonmedical use of prescription-type opioids, methylphenidate, and sedative-hypnotics among university students in the south of Iran: a regression analysis

Background and aim

Nonmedical use of prescription drugs needs particular attention. The aim of this study was to determine the prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use, and related factors in university students.

Methods

In this cross-sectional study, 524 students of Hormozgan University of Medical Sciences were selected by multi-stage sampling in 2016. A self-report questionnaire had been used examining substance use, religious beliefs and parental support. The questions about substance use were prepared based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). Religious beliefs were measured by Kendler's general religiosity questionnaire. Parental support was measured by the Persian version of Aneshensel and Sucoff's scale. All of the analysis was performed using Chi-square test, Fisher exact test, independent-samples t-test and binary logistic regression in SPSS 16 software. The level of significance was 0.05.

Results

The last year prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use was 16.1%, 3.3%, and 10.3%, respectively. The final model of logistic regression indicated hookah use (OR=2.5), methylphenidate use (OR=4.5), sedative-hypnotics use (OR=2.7), and were associated with students' prescription-type opioids use. The protective factor was familial support (OR=0.97) for prescription-type opioids use. Moreover, sedative-hypnotics use (OR=5.7) and illicit drug use (OR=27.6) were associated with methylphenidate use among students.

Conclusions

The results of this study showed that the prevalence of nonmedical use of prescription drugs is considerably high among students and is in need of interventions to reduce the prevalence of these drugs in universities.

Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School

OBJECTIVES

This study aims to evaluate the prevalence of burnout, depressive symptoms, and anxiety symptoms and attitudes toward substance use in medical students as well as their evolution during the 4 years of medical school.

METHODS

A cross-sectional study was carried out at the American University of Beirut Medical Center (AUBMC) between September and December 2016. In total, 176 out of 412 eligible medical students responded. The survey was anonymous and administered via e-mail link to an electronic form. The study included general socio-demographic questions and standardized validated tools to measure depressive symptomatology (PHQ-9), burnout (Burnout Measure), anxiety (GAD-7), alcohol use (AUDIT), and substance abuse (DAST-10) as well as questions pertaining to attitudes toward recreational substance use.

RESULTS

Overall, 23.8% of medical students reported depressive symptomatology, with 14.5% having suicidal ideations. Forty-three percent were found to have burnout. Those who screened positive for burnout were more likely to be males, to be living away from their parents, and to have experienced a stressful life event during the last year. With the exception of burnout, there was no significant difference in the prevalence of depression or anxiety among the 4 years of medical school. There was a significant difference in alcohol use, illicit substance use, and marijuana use during the four medical school years.

CONCLUSIONS

The results of this study show high rates of depression, burnout, and suicidal ideation among medical students from the Middle East region. Increased rates of substance use were detected as well as a more tolerant attitude toward substance use in general, specifically cannabis. It is crucial that medical educators and policymakers keep tackling the complex multifactorial mental health issues affecting medical students and design effective solutions and support systems.

Nonmedical Prescription Drug Use among Adolescents: Global Epidemiological Evidence for Prevention, Assessment, Diagnosis, and Treatment

Purpose of review

This paper reviews the most recent epidemiological evidence on adolescent NMPD use. Particular attention is given to prevention, assessment and diagnosis of disorder, and treatment.

Recent findings

While international in scope, global evidence is only available for NMPD use, morbidity and mortality estimates. Prevention strategies, assessment and treatment are U.S.-centric. The literature on prevention strategies lacks high-quality evidence. Assessment, diagnosis and treatment of NMPD use disorder have more robust evidence bases. Despite this, screening for NMPD (and other drug) use disorders is infrequent and insensitive, leading to incomplete treatment provision. Treatments are shown to be safe and effective, but disparities in provision prevent wide-scale amelioration of the adolescent NMPD use problem.

Summary

Mental health care professionals and primary care physicians with adolescent patient populations should become involved in preventative strategies mentioned in this review. Additionally, higher screening rates will lead to less downstream problems related to NMPD use.

Sleeping pill use in Brazil: a population-based, cross-sectional study

OBJECTIVES

This study aimed to assess the prevalence of sleeping pill use in Brazil.

DESIGN

A population-based cross-sectional study with a three-stage cluster sampling design (census tracts, households and adult residents) was used.

SETTING

The Brazilian 2013 National Health Survey was used.

PARTICIPANTS

The study population consisted of household residents aged ≥18 years. A total of 60 202 individuals were interviewed, including 52.9% women, and 21% reported depressive symptoms.

OUTCOMES

The primary outcome was sleeping pill use, which was self-reported with the question, 'Over the past two weeks, have you used any sleeping pills?' The prevalence was calculated and stratified according to sociodemographic characteristics. The associated factors were identified from prevalence ratios (PRs) obtained through a Poisson regression with robust variance and adjusted for sex and age.

RESULTS

The prevalence of sleeping pill use was 7.6% (95% CI 7.3% to 8.0%), and the average treatment duration was 9.75 (95% CI 9.49 to 10.00) days. Self-medication was found in 11.2% (95% CI 9.6% to 12.9%) of users. The following factors were associated with sleeping pill use: female sex (PR=2.21; 95% CI 1.97 to 2.47), an age of ≥60 years (PR=5.43; 95% CI 4.14 to 7.11) and smoking (PR=1.47; 95% CI 1.28 to 1.68). Sleeping pill use was also positively associated with the severity of depressive symptoms (p<0.001), whereas alcohol intake was inversely associated (PR=0.66; 95% CI 0.56 to 0.77).

CONCLUSIONS

One in every 13 Brazilians adults uses sleeping pills. There is a lack of information about the reasons for this use. Actions are required to raise awareness about the risks. The results could assist programmes in targeting rational sleeping pill use and the identification of factors demanding intervention.

Time Trends and Policy Gaps: The Case of Alcohol Misuse Among Adolescents in Lebanon

BACKGROUND

Monitoring studies are crucial for informing and reforming local policies.

OBJECTIVES

Using the Lebanon 2005 and 2011 Global School-based Student Health Surveys (GSHS), alcohol time trends were described, policy gaps were identified, and harm reduction policy recommendations were made.

METHODS

In 2005 and 2011, 100 (n = 5109 students) and 44 (n = 2784 students) middle schools were surveyed, respectively. Self-reported cross-sectional data on alcohol use among 7-9th graders in private and public schools was collected including 30-day prevalence, lifetime drunkenness, alcohol-related problems, and sources of alcohol.

RESULTS

In 2011, the majority (87%) had alcohol before turning 14. Between 2005 and 2011, past 30-day alcohol use had increased by 40% and lifetime drunkenness by 50% in the total sample (122% among females with a narrowing in the gender gap). Drinking was regular for more than a third of the past 30-day drinkers (drank two or more drinks on the days they drank). Male adolescents were more likely to obtain alcohol from "stores" or "through their friends" whereas females' main source was their "family." One in twenty reported experiencing alcohol-related problems (e.g., getting into fights with family/friends and skipping school). Conclusion/Importance: Evidence-informed policy implications include enforcing a minimum legal drinking age, regulating alcohol advertising, and marketing particularly those targeting youth and women, and ensuring the availability of youth-friendly services. Public messages to increase awareness among all stakeholders including youth, their parents, and larger community are also needed.