Men's decrease and women's increase in harmful alcohol use from the 2014 to 2018 national surveys in Taiwan: A harbinger for an emerging national trend in East Asia?

Harm from others' drinking among young adults in Taiwan: Predictors and deteriorating quality of life

INTRODUCTION

This study aimed to investigate the prevalence of different forms of harm from others' drinking (HFOD), predictors and the relationship with multi-dimensional quality of life among young adults in an emerging alcohol market in Asia-Taiwan.

METHODS

Data were extracted from a 2018 household survey with national representativeness on substance use experiences. The analytic sample comprised 4901 participants aged 18-34. Eight items were used to measure HFOD experiences. Five-dimensional quality of life was assessed by the EQ-5D-5L. Multivariable regressions with complex survey analyses were performed to estimate the prevalence and risk association.

RESULTS

Almost 4.2% of young adults experienced any form of HFOD; psychological harm occurred more prevalently than physical harm (3.7% and 1.5%, respectively). Those aged 25-29 and 30-34 had a two- to three-fold risk of HFOD compared with those aged 18-24. Both non-drunk drinking and drunk drinking were associated with an increased risk of psychological HFOD (adjusted odds ratio 2.36 and 5.89, respectively), whereas the risk of physical HFOD was related only to drunk drinking (adjusted odds ratio 7.8). Psychological HFOD victimisation emerged as the strongest predictor for deteriorated quality of life (adjusted b -0.14; 95% confidence interval -0.24, -0.04), especially in the dimensions of pain/discomfort and anxiety/depression. Among HFOD victims, only 33% sought help.

DISCUSSION AND CONCLUSIONS

The HFOD among young adults, commonly exhibited in psychological form, was linked with deteriorated quality of life; nonetheless, young HFOD victims are under-recognised. When devising interventions for alcohol harm, developmental perspectives should be integrated into policies implemented in healthcare and community settings.

The Use of Premixed Drugs in Commodity Packets in the Population: Prevalence and Correlates Revealed by the 2018 National Survey of Substance Use in Taiwan

BACKGROUND

Administering premixed drugs in commodity packets was first reported in Asia in 2015, but there continues to be a dearth of related population-based data. This study aimed at examining (1) the prevalence of drug-packet use in the population and (2) the sociodemographic profiles, particularly gender distribution, of drug-packet users.

METHODS

Data were derived from a survey of 18,626 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling in 2018. Participants anonymously completed a computer-assisted self-interview on tablet computers which covered the use and problematic use of illicit drugs/inhalants, prescription drugs, and other psychoactive substances.

RESULTS

Approximately 1.46% of respondents had a lifetime use of illicit drugs, with drugs in commodity packets (0.18%) being ranked the fifth-most commonly used illicit drugs, higher than nitrous oxide (0.14%) and heroin (0.09%). Ten formats of drug packets were endorsed by users. Approximately 81.6% of persons with drug packet use had lifetime use of other illicit drugs. The correlates of the use of drugs in commodity packets were different from those of the exclusive use of other drugs, particularly concerning the lack of gender differences in the former category in the whole sample and the subgroups of various sociodemographic characteristics and other substance use.

CONCLUSION

Drugs in commodity packets have become a common way of administering illicit drugs in the population in Taiwan, and there were no gender differences among users. Our findings have implications for more efficient drug testing and culturally appropriate intervention for drug-packet use.

Validation of the Chinese Version of Penn Alcohol Craving Scale for Patients With Alcohol Use Disorder

OBJECTIVE

The Penn Alcohol Craving Scale (PACS) is a five-item, single-dimension questionnaire that is used to measure a patient's alcohol craving. We sought to develop the Chinese version of the PACS (PACS-C) and assess its reliability and validity.

METHODS

A total of 160 Taiwanese patients with alcohol use disorder were enrolled in this study. The internal consistency and concurrent validity of the PASC-C with the visual analogue scale (VAS) for craving, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), and the Severity of Alcohol Dependence Questionnaire (SADQ) were assessed. The test-retest reliability of the PASC-C was evaluated 1 day after the baseline measurements. Confirmatory factor analysis (CFA) was performed to examine the psychometric properties of the PACS-C.

RESULTS

The PACS-C exhibited good internal consistency (Cronbach's α=0.95) and test-retest reliability (r=0.97). This scale showed high correlations with the VAS (r=0.81) and YBOCS-hd (r=0.81 and 0.79 for the obsession and compulsion subscales, respectively), and moderate correlation with the SADQ-C (r=0.47). Furthermore, CFA results revealed that the PACS-C had good fit indices under various models.

CONCLUSION

The PACS-C appears to be a reliable and valid tool for assessing alcohol craving in patients with alcohol use disorder in Taiwan.

Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017

Background

Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way.

Objective

To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis.

Design and methods

Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000-2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method.

Results

A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18-80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients.

Conclusion

Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.

Epidemiology of Oral Cancer in Taiwan: A Population-Based Cancer Registry Study

Oral cancer (OC) is one of the most common cancers worldwide, and its incidence has regional differences. In this study, the cancer registry database obtained from 1980 to 2019 was used to analyze the characteristic of incidence of OC by average annual percentage change (AAPC) and an age–period–cohort model. Spearman’s correlation was used to analyze the relationship between the age-standard incidence rates (ASR) of OC and related risk factors. Our results showed that the ASR of OC increased from 4.19 to 27.19 per 100,000 population with an AAPC of 5.1% (95% CI = 3.9–6.3, p value < 0.001) in men and from 1.16 to 2.8 per 100,000 population with an AAPC of 3.1% (95% CI = 2.6–3.6, p value < 0.001) in women between 1980–1984 and 2015–2019. The age–period–cohort model reported a trend of rising then declining for the rate ratio in men, with peaks occurring in the 1975 cohort, with a rate ratio of 6.80. The trend of incidence of oral cancer was related to changes in the consumption of cigarettes and alcohol and production of betel quid, with r values of 0.952, 0.979 and 0.963, respectively (all p values < 0.001). We strongly suggest avoiding these risk factors in order to prevent OC.

Comparisons of psychological distress and self-stigma among three types of substance use disorders receiving treatment-as-usual approaches: real-world data from a 9-month longitudinal study

BACKGROUND

Substance use is an important issue worldwide and people with substance use disorders (SUDs) have been reported to have high levels of psychological distress and self-stigma. Therefore, psychological distress and self-stigma in people with SUDs are considerable.

OBJECTIVE

The present study used a longitudinal design to examine whether treatment-as-usual approaches in Taiwan improve psychological distress and self-stigma among people with three types of SUDs (heroin, amphetamine, and alcohol use disorders).

DESIGN

A 9-month longitudinal design involving four assessments spaced 3 months apart.

METHODS

Convenience sampling was used to recruit people with heroin (n = 112), amphetamine (n = 151), and alcohol (n = 56) use disorders from outpatient psychiatric center in Southern Taiwan. Psychological distress was assessed using the Depression, Anxiety, Stress Scale (DASS-21), and self-stigma was assessed using the Self-Stigma Scale-Short (SSS-S). Generalized estimating equation (GEE) models were constructed to understand between-group differences in psychological distress and self-stigma over time.

RESULTS

Patients with heroin and amphetamine use disorders had lower levels of psychological distress as compared with those with alcohol use disorder. Levels of psychological distress were lower at Time 2 to Time 4 as compared with Time 1. Patients with heroin and amphetamine use disorders had higher levels of self-stigma as compared with those with alcohol use disorder. Self-stigma levels remained stable over time. The dropout rate of receiving treatment-as-usual approach in the 9-month study was 60%.

CONCLUSION

Treatment as usual for SUDs among outpatients in Taiwan may decrease psychological distress but not self-stigma. However, such effects need to be further examined given the high drop-out rates and absence of a control condition. The findings suggest that self-stigma may warrant additional treatment for patients with SUDs.

"Sugar-Sweetened Beverages" Is an Independent Risk From Pancreatic Cancer: Based on Half a Million Asian Cohort Followed for 25 Years

Although the link between sugar-sweetened beverages (SSB) and pancreatic cancer has been suggested for its insulin-stimulating connection, most epidemiological studies showed inconclusive relationship. Whether the result was limited by sample size is explored. This prospective study followed 491,929 adults, consisting of 235,427 men and 256,502 women (mean age: 39.9, standard deviation: 13.2), from a health surveillance program and there were 523 pancreatic cancer deaths between 1994 and 2017. The individual identification numbers of the cohort were matched with the National Death file for mortality, and Cox models were used to assess the risk. The amount of SSB intake was recorded based on the average consumption in the month before interview by a structured questionnaire. We classified the amount of SSB intake into 4 categories: 0–<0.5 serving/day, ≥0.5–<1 serving per day, ≥1–<2 servings per day, and ≥2 servings per day. One serving was defined as equivalent to 12 oz and contained 35 g added sugar. We used the age and the variables at cohort enrolment as the reported risks of pancreatic cancers. The cohort was divided into 3 age groups, 20–39, 40–59, and ≥60. We found young people (age <40) had higher prevalence and frequency of sugar-sweetened beverages than the elderly. Those consuming 2 servings/day had a 50% increase in pancreatic cancer mortality (HR = 1.55, 95% CI: 1.08–2.24) for the total cohort, but a 3-fold increase (HR: 3.09, 95% CI: 1.44–6.62) for the young. The risk started at 1 serving every other day, with a dose–response relationship. The association of SSB intake of ≥2 servings/day with pancreatic cancer mortality among the total cohort remained significant after excluding those who smoke or have diabetes (HR: 2.12, 97% CI: 1.26–3.57), are obese (HR: 1.57, 95% CI: 1.08–2.30), have hypertension (HR: 1.90, 95% CI: 1.20–3.00), or excluding who died within 3 years after enrollment (HR: 1.67, 95% CI: 1.15–2.45). Risks remained in the sensitivity analyses, implying its independent nature. We concluded that frequent drinking of SSB increased pancreatic cancer in adults, with highest risk among young people.