Why young people's substance use matters for global health

Prospective Intergenerational Associations between Parents' and Children's Illicit Substance Use During Adolescence

OBJECTIVE

Intergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link.

METHOD

Participants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed.

RESULTS

Parent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio [95% confidence interval] = 2.682 [1.328-5.416], p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence.

CONCLUSIONS

The use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence.

From Reactive to Proactive - The Future Life Design to Promote Health and Extend the Human Lifespan

Disease treatment and prevention have improved the human lifespan. Current studies on aging, such as the biological clock and senolytic drugs have focused on the medical treatments of various disorders and health maintenance. However, to efficiently extend the human lifespan to its theoretical maximum, medicine can take a further proactive approach and identify the inapparent disorders that affect the gestation, body growth, and reproductive stages of the so-called "healthy" population. The goal is to upgrade the standard health status to a new level by targeting the inapparent disorders. Thus, future research can shift from reaction, response, and prevention to proactive, quality promotion and vigor prolonging; from single disease-oriented to multiple dimension protocol for a healthy body; from treatment of symptom onset to keep away from disorders; and from the healthy aging management to a healthy promotion design beginning at the birth.

The Changing Relationship Between Hobby Engagement and Substance Use in Young People: Latent Growth Modelling of the Add Health Cohort

Cross-sectional and some longitudinal evidence suggests doing hobbies can reduce substance use, but findings have been inconsistent, and whether associations differ across adolescence remains unclear. This study included 7454 Add Health participants (50% female, 77% White, age mean=14.95 and SD = 1.56). Participants were split into three groups, according to whether they were early (aged 11-14 at baseline), mid (aged 15-16), or late (aged 17-20) adolescents at baseline. The trajectories of binge drinking, marijuana, and tobacco use were analysed in latent growth models across Waves 1-5 (1994-2018). Concurrent associations between substance use and hobby engagement were tested at Waves 1-3 separately in the three age groups. Doing hobbies more frequently was associated with lower odds of binge drinking and marijuana and tobacco use in early adolescence. Although there was initially a similar protective association in mid and late adolescence, this had reversed by Wave 3 for binge drinking and marijuana use, when participants were young adults. This change in the association could be a result of differing social contexts, changes in peer influence, or an indication that creative hobbies are particularly beneficial. It could explain previous inconsistent findings and demonstrates the importance of considering developmental differences when investigating engagement in hobbies.

Healthcare use of young finnish adults with mental disorders - profiles and profile membership determinants

BACKGROUND

Comprehensive, timely, and integrated primary care services have been proposed as a response to the increased demand for mental health and substance use services especially among young people. However, little is known about the care utilization patterns of young people with mental and substance use disorders. Our aim was to characterize profiles of care use in young Finnish adults with mental or substance use disorders, and the potential factors associated with the service use profiles.

METHODS

Primary and specialized care visits of young adults (16-29 years) diagnosed with a psychiatric or a substance use disorder (n = 7714) were retrieved from the national health care register from years 2020 and 2021. K-Means clustering was used to detect different profiles based on the utilization of care services. Multinomial logistic regression was used to analyze the factors associated with different profiles of care use.

RESULTS

Five different profiles were identified: low care use (75%), and use of principally primary health care (11%), student health services (9%), psychiatric services (5%), or substance use services (1%). Female gender was associated with membership in the primary health care focused profiles (OR 2.58 and OR 1.99), and patients in the primary health care and student health services profiles were associated with a better continuity of care (OR 1.04 and OR 1.05). Substance use disorders were associated with psychiatric service use (OR: 2.51) and substance use services (OR: 58.91). Living in smaller municipalities was associated with lower service use when comparing to the largest city.

CONCLUSIONS

Young adults diagnosed with a psychiatric or a substance use disorder had remarkably different and heterogeneous care patterns. Most of the participants had low care utilization, indicating potential gaps in service use and care needs. Measures should be taken to ensure equal access to and availability of mental health services. The profiles that utilized the most services highlights the importance of integrated services and patient-oriented improvement of treatment.

Association Between Religiosity and Spirituality and Cocaine Use: A Systematic Review

Previous literature has evidenced a possible impact on health, mental health, and health-related faith behaviors due to the effects of an individual's spiritual dimension. The aim of this study is to collect and summarize all current data from observational studies regarding the association between religiosity or spirituality (R/S) and cocaine use (CU). A systematic literature search of analytical observational studies on the association between religiosity or spirituality and the use of cocaine was performed in PubMed and Scopus databases. Twenty observational studies were included in this review. Fifteen of the twenty observational studies found that a higher level of religiosity was associated with lower lifetime and actual cocaine use, both in adults and adolescents. However, one study conducted in a sexual minorities sample found that higher religiosity-measured as frequency of private religious activities such as prayer-was associated with a higher probability of cocaine use. Two studies found no evidence of any association between religiosity and cocaine use, and two found mixed results. This review found a possible protective role of religiosity on cocaine use, even if the cross-sectional nature of the greater part of the studies prevented drawing any casual relation. Future studies with a longitudinal approach are required. However, the support of activities aimed at broadening a religious attitude and beliefs could result in creating an environment protective for young people against cocaine use.

Short-term effects of the strengthening families Program (SFP 10-14) in Brazil: a cluster randomized controlled trial

INTRODUCTION

This study reports the evaluation of the short-term effects of the Strengthening Families Program (SFP 10-14), adapted as Famílias Fortes (Strong Families) in Brazil, on preventing adolescent drug use and improving parenting behaviors.

METHODS

A two-arm, parallel cluster randomized controlled trial was conducted in 60 Social Assistance Reference Centers (SARC) from 12 Brazilian municipalities. In each city, the SARC were randomly assigned to the intervention or control group. A total of 805 families participated in the study, each contributing data from one parent or legal guardian and one adolescent totaling 1,610 participants. Data collection occurred before intervention implementation and 6 months after baseline collection. Data were analyzed using multilevel mixed-effects modeling with repeated measures in two different paradigms: Intention to Treat (ITT) and Per protocol (PP). The study was registered in the Brazilian Ministry of Health Register of Clinical Trials (REBEC), under protocol no. RBR-5hz9g6z.

RESULTS

Considering the ITT paradigm, the program reduced the chance of parents and legal guardians being classified as negligent by 60% (95%CI 0.21; 0.78), increased the use of nonviolent discipline by caregivers (Coef 0.33, 95%CI 0.01; 0.64) and decreased the chance of adults exposing adolescents to their drunken episodes by 80% (95%CI 0.06; 0.54). No program effects were observed on outcomes related to adolescent drug use. Similar results were found for the PP paradigm.

CONCLUSION

The positive effects on family outcomes suggest preventive potential of the program among the Brazilian population. Long-term evaluations are necessary to verify if the program can also achieve the drug use reduction goals not observed in the short term.

Co-design of digital public health substance use resources: A collaboration between young people and experts

ISSUE ADDRESSED

Substance use and mental illness remain critical issues for young Australians, however, engagement with evidence-based health resources is challenging among this age group. This study aimed to develop engaging, useful digital health resources, underpinned by neuroscience principles, to build awareness of the harms of electronic cigarettes (e-cigarettes) and concurrent alcohol and antidepressant use.

METHODS

A mixed-methods approach was adopted to co-design two evidence-based videos resources. The resources were co-designed with the Matilda Centre's Youth Advisory Board Centre's Youth Advisory Board through a series focus groups and individual feedback reviews. Young people residing in New South Wales were then invited to complete a survey to evaluate the usefulness, relatability and impact on perceived harms associated with each substance pre- and post-viewing resources.

RESULTS

A total of 100 participants completed the survey (mean age = 21.5 years, SD = 2.77, 42% Female, 2% Non-binary). The animated videos were well received, with the large majority (91% and 87% respectively) of participants rating them 'excellent' or 'very good'. After viewing the videos, there was a significant increase in the perception of harm associated with e-cigarette use, monthly (t(99) = 2.76, p = .003), weekly (t(99) = 4.82, p < .001) and daily (t(99) = 4.92, p < .001), and consuming alcohol whilst taking antidepressants both weekly (t(100) = 2.93, p = .004) and daily (t(100) = 3.13, p = .002).

CONCLUSIONS

This study describes a successful co-design process demonstrating how meaningful involvement of young people, alongside traditional research methods, can produce substance use prevention resources that are useful, engaging and increase knowledge of harms among young people. SO WHAT?: To achieve meaningful public health impact researchers, experts and digital creators can work together to co-create substance use educational materials that are engaging, well-liked, while imparting important health knowledge.

Oral administration of coenzyme Q10 ameliorates memory impairment induced by nicotine-ethanol abstinence through restoration of biochemical changes in male rat hippocampal tissues

Substance abuse among adolescents has become a growing issue throughout the world. The significance of research on this life period is based on the occurrence of neurobiological changes in adolescent brain which makes the individual more susceptible for risk-taking and impulsive behaviors. Alcohol and nicotine are among the most available drugs of abuse in adolescents. Prolonged consumption of nicotine and alcohol leads to drug dependence and withdrawal which induce various dysfunctions such as memory loss. Coenzyme Q10 (CoQ10) is known to improve learning and memory deficits induced by various pathological conditions such as Diabetes mellitus and Alzheimer's disease. In the present study we investigated whether CoQ10 treatment ameliorates memory loss following a nicotine-ethanol abstinence. Morris water maze and novel object recognition tests were done in male Wistar rats undergone nicotine-ethanol abstinence and the effect of CoQ10 was assessed on at behavioral and biochemical levels. Results indicated that nicotine-ethanol abstinence induces memory dysfunction which is associated with increased oxidative and inflammatory response, reduced cholinergic and neurotrophic function plus elevated Amyloid-B levels in hippocampi. CoQ10 treatment prevented memory deficits and biochemical alterations. Interestingly, this ameliorative effect of CoQ10 was found to be dose-dependent in most experiments and almost equipotential to that of bupropion and naloxone co-administration. CoQ10 treatment could effectively improve memory defects induced by nicotine-ethanol consumption through attenuation of oxidative damage, inflammation, amyloid-B level and enhancement of cholinergic and neurotrophic drive. Further studies are required to assess the unknown side effects and high dose tolerability of the drug in human subjects.

The role of monitoring skills in mediating the association between parent's hazardous alcohol consumption and adolescents' drinking

BACKGROUND

This study aimed to investigate whether parental monitoring skills mediate the effect of hazardous parental alcohol consumption on adolescents' lifetime alcohol use.

METHODS

This three wave longitudinal study was conducted with 884 families (n = 1,768 participants) to evaluate the effectiveness of a family-based drug prevention program for adolescents and parents across 12 Brazilian cities. We used structural equation mediation modeling to analyze the effect of hazardous parental alcohol consumption at baseline on adolescents' lifetime alcohol use at 12-month follow-up, mediated by parental monitoring skills latent dimension at 6-month follow-up.

RESULTS

We found a significant indirect effect of parents' hazardous alcohol use on adolescents' alcohol use through parental monitoring (OR:1.18, 95%CI:1.02;1.36).

CONCLUSION

Our finding underscores the importance of comprehensive preventive family alcohol approaches targeting adolescent alcohol use, which should consider both parental drinking behavior and monitoring practices.

Effect of a selective personality-targeted prevention program on 7-year illicit substance related outcomes: A secondary analysis of a cluster randomized controlled trial

BACKGROUND

This study evaluated the efficacy of the selective personality-targeted PreVenture program in reducing cannabis and stimulant use over a 7-year period spanning adolescence and early adulthood.

METHODS

A cluster randomized controlled trial was conducted in 14 Australian schools. Schools were randomized to PreVenture, a brief personality-targeted selective intervention, comprising two 90-minute facilitator-led sessions delivered one week apart, or a control group (health education as usual). Only students who scored highly on one of four personality traits (anxiety sensitivity, negative thinking, impulsivity, sensation seeking) were included. Students completed online self-report questionnaires between 2012 and 2019: at baseline; post-intervention; 1-, 2-, 3-, 5.5- and 7-years post-baseline. Outcomes were past 6-months cannabis use, stimulant use (MDMA, methamphetamine or amphetamine) and cannabis-related harms.

RESULTS

The sample comprised 438 adolescents (Mage=13.4 years; SD=0.47) at baseline. Retention ranged from 51% to 79% over the 7-years. Compared to controls, the PreVenture group had significantly reduced odds of annual cannabis-related harms (OR=0.78, 95% CI=0.65-0.92). However, there were no significant group differences in the growth of cannabis use (OR=0.84, 95% CI=0.69-1.02) or stimulant use (OR=1.07, 95% CI=0.91-1.25) over the 7-year period.

CONCLUSIONS

PreVenture was effective in slowing the growth of cannabis-related harms over time, however owing to missing data over the 7-year trial, replication trials may be warranted to better understand the impact of the PreVenture intervention on cannabis and stimulant use among young Australians. Alternative implementation strategies, such as delivering the intervention in later adolescence and/or providing booster sessions, may be beneficial.

Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report

BACKGROUND

Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting.

METHODS

Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy.

RESULTS

Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%).

CONCLUSIONS

Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.

Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies

BACKGROUND

The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use.

OBJECTIVE

We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community.

METHODS

We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences.

RESULTS

Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001).

CONCLUSIONS

Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults.

TRIAL REGISTRATION

PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.

"You have to drink with a little bit of shame": Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia

Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a "normal" part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant's sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant's risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants' perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.

How frequently is alcohol advertised on television in Canada?: A cross-sectional study

AIMS

Alcohol marketing is a commercial driver of alcohol use, including among youth. This study sought to quantify and characterize alcohol advertising on broadcast television in Canada.

METHODS

Open-source television program logs for January to December 2018 submitted to the Canadian Radio-television and Telecommunications Commission by 147 stations with alcohol advertisements were analyzed.

RESULTS

Overall, 501 628 alcohol advertisements were broadcast. Four companies accounted for 83% of advertisements, namely, Anheuser-Busch in Bev (33.7%), Molson Coors (22.7%), Diageo (16.1%), and Arterra Wines Canada (10.8%). On conventional stations, advertising was highest on French-language stations [Median (Mdn) = 3224; interquartile range (IQR) = 2262] followed by those with programming in foreign/mixed languages (Mdn = 2679; IQR = 219) and English-language stations (Mdn = 1955; IQR = 1563). On speciality stations, advertising was most frequent on those primarily focused on sports programming (Mdn = 8036; IQR = 7393), movies and scripted shows (Mdn = 7463; IQR = 5937), and cooking (Mdn = 5498; IQR = 4032). On weekdays, 33% of alcohol ads aired from 6 to 9 a.m. and 3 to 9 p.m. and on weekends, 52% aired from 6 a.m. to 9 p.m. when children or adolescents are more likely to be watching television. On youth-oriented stations (n = 4), 7937 alcohol advertisements were broadcast with most airing from 9 p.m. to midnight (44-45%) or 12-6 a.m. (50%) on both weekdays and weekends.

CONCLUSIONS

While few alcohol advertisements were broadcast on youth-oriented stations, young people in Canada are likely exposed to such advertising on programming intended for older or general audiences (e.g. sports). More research is needed to ascertain the extent to which broadcast television constitutes a source of alcohol advertising exposure among youth and to inform policies aimed at protecting them from the influence of such exposure.

Development and Validation of Brief Family Intervention for Young Adults with Substance Use Disorder: A Qualitative Study

Background

Substance abuse is more prevalent in young adults, putting them at risk for chronic use and early onset of dependence on substances. A well-documented relationship exists between substance use and poor family functioning. Traditional family intervention approaches are time-consuming.

Aim

To develop a brief family intervention for parents of young adults with substance use disorder.

Methods

A qualitative research design was used. Extensive literature searches and key informant interviews (face to face) with young adults (n = 5), their parents (n = 5), and mental health professionals (n = 5) were conducted. The interviews were audio recorded. A thematic analysis was conducted using Braun and Clarke's six-step approach, and intervention strategies were identified by examining the themes. In addition, experts were consulted to ensure the content validity of the BFI.

Results

The BFI program combines psychoeducation and behavioral techniques for parents. BFI involves seven sessions with parents, 45-60 min each, over one week. The BFI sessions consisted of (1) Engagement and Assessment, (2) Healthy Family Functioning, (3) Psychoeducation, (4) Relapse Prevention, (5) Communication Skill Training, (6) Problem-Solving Skill Training, and (7) Parental Monitoring and Supervision.

Conclusion

Considering all stakeholders' perspectives, the BFI manual for young adults with substance use disorder has been developed. However, additional research is required to evaluate its feasibility and effectiveness.

[Cannabis use in adolescents : Narrative Review and Position paper of the "Addiction Disorders in Adolescents" task force of the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP)]

BACKGROUND

Cannabis is the illegal drug most frequently used by Minors in Austria. Due to the gradual decriminalization and legalization that has taken place in many European countries in recent years, the ÖGKJP would like to take a balanced and scientifically based stand on the complex issue of cannabis use and abuse among young people.

METHODS

The authors searched the medline for current studies using searches tailored to each specific subtopic. Furthermore, recognized compendiums were quoted.

RESULTS

While occasional recreational use of cannabis in adults with completed brain maturation and no risk profile for mental disorders is likely to be relatively harmless, early initiation of use with regular use and the increasingly available, highly potent cannabis varieties can lead to explicit and sometimes irreversible neurocognitive brain dysfunction.

CONCLUSION

Legalisation of cannabis consumption for minors needs to be objected to due to the risks of the expected damage in the area of brain development. At the same time, however, it is important to establish sensible legal regulations in order to be able to adequately counteract the fact that over 30% of all European young people occasionally consume cannabis. We are also clearly recommending to not criminalize cannabis users and provide necessary support to vulnerable and addicted cannabis users.

The association of current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes with psychological distress among U.S. adults

This observational study examines the association of current e-cigarette use and dual use of e-cigarettes and cigarettes (dual use) with psychological distress among U.S. adults. We differentiate dual use based on the smoking frequency and compare the relationship between dual use and psychological distress to that of exclusive cigarette smoking with the same smoking frequency. Using data from the 2015-2018 National Health Interview Surveys, we analyzed adults aged 18+ (N = 55,780) who currently use e-cigarettes or/and cigarettes and have no history of using other tobacco products, and adults who never used any tobacco. Multinomial logistic regression models estimate the association of current e-cigarette use and dual use with psychological distress severity (no/mild, moderate, and severe).In the sample, 15.3% and 2.9% of adults experienced moderate and severe psychological distress. Compared to never tobacco users, current exclusive e-cigarette users and dual users who smoke daily had higher odds of moderate and severe psychological distress. Dual users who smoke nondaily had higher odds of moderate, but not severe psychological distress than never tobacco users. Compared to exclusive daily smokers, dual users with daily smoking had higher odds of moderate and severe psychological distress. Compared to exclusive nondaily smokers, dual users with nondaily smoking had higher odds of moderate but not severe psychological distress. Our findings suggest that exclusive e-cigarette use is associated with psychological distress severity. Dual use is associated with higher odds of psychological distress severity compared to never tobacco users and exclusive cigarette smoking, and this association differs by smoking frequency.

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis

AIM

This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes.

METHODS

Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g).

RESULTS

Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies.

CONCLUSION

The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.

Patterns of service utilization among youth with substance use service need: a cohort study

BACKGROUND

Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (service type and frequency of visits) among youths with different levels of substance use service needs (low, moderate, and high), and to estimate the extent to which substance use service needs, self-reported health and mental health influenced the frequency of visits and types of service utilized.

METHODS

Data were collected from youth (12-24 years) accessing IYS centres in Canada. Information on socio-demographic factors, substance use in the last month, self-rated health measures, number of service visits, and type of services utilized were included. Poisson regression was used to estimate the relationship between substance use needs and number of service visits and the different type of services utilized.

RESULTS

Of 6181 youths, 48.0% were categorized as low substance use service needs, 30.6% had moderate needs and 21.4% had high needs, with higher proportion of men in the high needs group. Mental health and substance use (MHSU) services were utilized the most across all three groups, followed by counseling. The median number of visits was 4 for the low and moderate needs group and 5 in the high needs group. People with high service needs had 10% higher rate of service visits and utilized 10% more services than people with low service needs (service visits: RR = 1.1 (95%CI: 1.1-1.2); service type: RR = 1.1 (95%CI:1.0-1.1)). The rate of service visits increased by 30 to 50% and the number of services increased by 10-20% for people who rated their health good/fair/poor. Similarly, the rate of service visits increased by 40 to 60% and the number of services increased by 20% for people who rated their mental health good/fair/poor.

CONCLUSIONS AND IMPACTS

Our study highlighted that regardless of service needs, youth who use alcohol and drugs have complex intersecting needs that present once they access integrated youth services.

Development and validation of the Substance Use Protective Strategies Scale (SUPSS) among Polish young adults using various psychoactive substances

Research supports protective behavioral strategies (PBS) as effective in reducing substance use, intoxication, and/or related risks/harms. However, despite the predominance of polysubstance use and common co-occurrence of different substance use disorders (SUDs), previous PBS research has been limited in terms of substance-specific measurement. This study sought to develop and validate a measure of PBS that is not substance-specific. Building from initial pilot work, we tested the psychometric properties of the Substance Use Protective Strategies Scale (SUPSS) in a large sample of young adults (N = 7325, aged 18-30), who reported using multiple psychoactive substances (other than alcohol and nicotine), recruited via social media in Poland. By splitting the sample, we conducted exploratory (n = 3709) and confirmatory factor analysis (n = 3614), which supported a 4-factor structure with 19 items (7 items dropped): Preparation for use (α = 0.66), Manner of use (α = 0.85), Additional concerns (α = 0.74), and Setting (α = 0.62). Configural, metric and scalar invariance were supported across sex, age, and user status for most substance types (cannabis, dissociatives, etc.). Further, the SUPSS factors were strongly associated with substance-related harms (R-squared = 0.495) and SUD symptoms (DUDIT, R-squared = 0.570). Our model fit was adequate (but not excellent), and two subscales had low internal consistency, highlighting the need for further improvement of the SUPSS. Despite its limitations, we found the SUPSS to have strong psychometric properties and it holds promise to enhance PBS research and harm reduction-oriented interventions.

Kratom availability in California vape shops

Kratom products are derived from trees native to Southeast Asia and have dose-dependent stimulant and opioid-like effects. Despite being on the Drug Enforcement Administration "Drugs and Chemicals of Concern List," kratom is legal for sale in most US states. However, there are scarce data on its availability. The goal of this study was to examine kratom availability in vape shops across the state of California and assess shop compliance with a local kratom sales ban (enacted in 2016) in San Diego City. As part of a larger study about retail tobacco marketing near colleges, availability of kratom was assessed in summer 2019 in a random sample of 614 vape shops that was stratified to compare stores near (≤ 3 miles) and distant (>3 miles) from colleges. Logistic regression examined kratom availability as a function of store type (stores that sold vape products only vs. stores selling other tobacco), nearness to college, and tract-level demographics. Kratom was available in 62.4% of observed stores and more often in vape-and-smoke (81.1%) than vape-only shops (11.5%, AOR = 40.4, 95% CI = 23.3-74.1). Kratom availability did not differ by nearness to colleges. In San Diego City, 46.2% of observed stores (95% CI = 28.8-64.5) sold kratom products. Findings indicate that kratom was available in the majority of vape shops and most commonly in vape-and-smoke shops. Widespread availability in tobacco specialty shops suggests the need for research on dual use with tobacco, kratom advertising and cross-product promotion, and the potential of state and local tobacco retail licensing to prohibit sales.

Concentrated disadvantage and functional disability: a longitudinal neighbourhood analysis in 100 US cities

BACKGROUND

Socioeconomic disadvantage related to poverty, unemployment and social disinvestment contributes to significant disparities in community health in the USA. Yet, there remains limited ecological research on the relationship between neighbourhood disadvantage and functional disability. Much of the work in this area has focused on elderly populations without attention to variation across age and sex groups.

METHODS

Using a longitudinal dataset of almost 16 000 neighbourhoods, we examine the relationship between neighbourhood disadvantage and functional disability. Leveraging a series of cross-lagged panel models, we account for reciprocal dynamics and a range of pertinent covariates while assessing differences across age- and sex-specific groups.

RESULTS

Accounting for reciprocal effects, we found that the association between concentrated disadvantage and functional disability varies across age and sex groups. Concentrated disadvantage is most consistently associated with increased functional disability among boys (5-17 years), young men (18-34 years) and middle-aged men (35-64 years). Similar associations are found among girls (5-17 years) and middle-aged women (35-64 years).

CONCLUSION

Local neighbourhood economic conditions are significantly associated with functional disability among relatively young populations of males and females. Exposure to neighbourhood disadvantage and deprivation may accelerate disablement processes and shift the age curve of disability risk.

Alcohol and khat dual use among male adults in Ethiopia: A multilevel multinomial analysis

INTRODUCTION

Substance use has been a long-standing global public health problem with detrimental physical, psychological, social, and economic consequences at individual and societal levels. Large-scale and gender-specific studies on the dual use of alcohol and khat are limited. This study aimed to estimate the prevalence of dual alcohol and khat use and identify associated factors among male adults in Ethiopia.

METHODS

The present study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Prior to data analysis, the data were weighted to ensure a representative sample and obtain a reliable estimate. Multilevel multinomial logistic regression was used to identify the factors associated with alcohol and khat use. Adjusted Odds Ratios (AOR) with 95% confidence interval and P value ≤ 0.05 in the multivariable model were used to identify significant factors associated with alcohol and khat use.

RESULTS

This study included 12,688 participants, of which (80.29%) were from rural areas. The mean age of participants was 30.92 years old. The prevalence of neither Alcohol nor Khat users were (33.2%); 95% Confidence Interval (CI) (32.4-34.1) only Khat users (22.0%); 95% CI (21.2-22.7), only Alcohol users (35.6%); 95% CI (34.7-36.4), and dual Alcohol and Khat users were (9.0%); 95% CI (8.5-9.5). At the individual level: being in the age group of 15-29 years and 30-49years increases the odds of Khat chewing by AOR (95%CI) 2.27 (1.75, 2.89) and 1.55 (1.16, 2.07) times, respectively. At the community level: males from Amhara 3.49(1.91, 6.42), and Tigray 2.7(1.49, 5.05) regions were more likely to drink alcohol.

CONCLUSION

The high prevalence of dual alcohol and khat use implies for greater access to evidence-based treatment. Multiple factors are associated with alcohol and khat use at individual and community levels. All male adults would benefit from targeted preventive strategies.

Virtual Pedagogy and Care: Systematic Review on Educational Innovation with Mobile Applications for the Development of Healthy Habits in the Adolescent Population

BACKGROUND

The scientific literature was reviewed to determine the state of the art regarding innovative educational practices that employ mobile health applications with the aim of establishing healthy habits in the adolescent population, following a strategy based on spiral curriculum.

METHODS

The search was conducted in the WOS, Scopus and PubMed databases, discarding any articles that were not published in English, Spanish or French. The search was limited to studies performed in the last 6 years, that is, from 1 January 2017 to 18 March 2023.

RESULTS

From the initial sample of 132 articles selected, the final sample included 9 articles that met the eligibility criteria after a more exhaustive analysis. This systematic review identified one application (11.11%) with topics about sex and reproductive health, two applications (22.22%) that tackled mental health, six applications (66.66%) with topics about nutrition, three applications (33.33%) that contemplate physical activity, and two applications (22.22%) with aspects related to the prevention of harmful habits. The results show a positive relationship between the use of mobile health applications used as innovative didactic resources and the establishment of healthy habits in the adolescent population.

CONCLUSIONS

Digital devices have been incorporated to the lives of humans as fundamental tools for their daily living. Specifically, adolescents are especially attracted to mobile phones. If this resource is used in this population to improve health, it is possible to attain very satisfactory objectives. The results of this review indicate that these devices can be used as a didactic resource in the promotion of health by implementing healthy habits at early ages, thereby contributing to the prevention of chronic diseases in future adulthood.

Determinants of alcohol use among young males in two Indian states: A population-based study

OBJECTIVES

There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low-and middle-income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. We aimed to identify and estimate the determinants of alcohol use in a representative sample of 2716 young men from Bihar and Uttar Pradesh who participated in the 'Understanding the Lives of Adolescents and Young Adults' (UDAYA) study.

METHODS

First, we developed an exploratory conceptual framework of potential alcohol use determinants in the study settings based on available literature. We then estimated the effects of 35 potential alcohol use determinants identified in the conceptual framework (including 14 latent factors identified through exploratory factor analysis) on any alcohol use in the past 3 years and regular alcohol use amongst past three-year drinkers, using mixed-effects logistic models. The determinants explored were operationalised using longitudinal data from the UDAYA study.

RESULTS

Our adjusted models identified 18 determinants for past 3-year alcohol use and 12 determinants for regular use. Distal determinants (e.g., socioeconomic status), intermediate determinants (e.g., parental alcohol use, media use), and proximal determinants (e.g., emotional regulation, early tobacco use) were identified. Geographical variations in both outcomes indicate potential differences in unmeasured community-level determinants (e.g., alcohol availability and acceptability).

CONCLUSIONS

Our findings extend the generalizability of several known determinants across settings, yet highlight the importance of addressing alcohol use in young people as a complex and context-dependent issue. Many identified determinants (e.g., education, media use, poor parental support, early tobacco use) are amenable to intervention through multi-sectoral prevention programs/policies. Such determinants should be the focus of ongoing policy/intervention development efforts in the region, and our revised conceptual framework may inform further research in India or similar South Asian settings.

Delivering substance use prevention interventions for adolescents in educational settings: A scoping review

Currently, a proportion of adolescents use alcohol, tobacco, and illicit drugs, which inevitably harms their health and academic progress. Adolescence is a peak period for substance use initiation and a critical time for preventing substance use problems. Various entities, such as families, schools, and communities, have implemented a variety of interventions to alleviate adolescent substance use problems, and schools play a unique role. To explore the types, characteristics, and effectiveness of substance use interventions in educational settings for adole-scents, we conducted a scoping review and identified 32 studies after screening. We divided the 32 studies according to intervention type, including curriculum interventions focusing on cognitive-behavioral skill enhancement, exercise interventions, peer interventions and family-school cooperation, and electronic interventions. Except for the mixed results on electronic interventions, the results showed that the other interventions were beneficial to different extents in alleviating adolescent substance use problems. In addition, we analyzed and summarized the advantages and challenges of intervening in adolescent substance use in educational settings. Schools can use equipment and human resources to provide adolescents with various types of intervention measures, but they also face challenges such as stigmatization, ineffective coordination among multiple resources, and poor implementation effects. In the future, school-based intervention measures can fully utilize big data and artificial intelligence technology and collaborate with families and communities to intervene appro-priately while paying attention to the comorbidity risks of substance use disorders and psychological health issues.

Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada

INTRODUCTION

Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people.

METHODS

We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use.

RESULTS

The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors.

CONCLUSIONS

These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.

Income Inequality and Socioeconomic Disparities in Alcohol Use Among Eastern European Adolescents: A Multilevel Analysis

PURPOSE

In this study, we tested the "golden youth" hypothesis, which suggests that in Eastern Europe, affluent adolescents are at an increased risk of alcohol use. Also, we hypothesized that the relationship between high socioeconomic position (SEP) and more alcohol use is stronger in countries with wider income inequality.

METHODS

In total, 50,421 adolescents aged 13-15 years were included from 16 Eastern European countries participating in the 2013-2014 Health Behaviour in School-aged Children survey. Multilevel logistic regression analyses were performed.

RESULTS

Affluent adolescents had greater odds of weekly alcohol use (OR = 1.32, 95% CI = 1.23-1.41) and binge drinking (OR = 1.24, 95% CI = 1.16-1.32) than their peers from low-SEP families. However, no significant difference was observed between middle- and low-SEP adolescents. In countries with wider income inequality, the relationship between high family-SEP and weekly alcohol use (p interaction = .006), as well as high family-SEP and binge drinking (p interaction = .007), was stronger compared to countries with lower income inequality.

DISCUSSION

Possibly, influenced by the lifestyle choices of their parents, and using alcohol as a status symbol to establish and maintain friendly relationships with peers, Eastern European adolescents from affluent families, particularly in the most unequal settings, are at increased risk of alcohol use, confirming the golden youth hypothesis. Insecure self-image and perceived threat to their high status might be explanatory factors. More research is needed to identify the precise individual and family characteristics responsible for increased alcohol use among wealthy adolescents, especially in Eastern European countries with high income inequality.

Externalizing and internalizing problems as predictors of alcohol-related harm and binge drinking in early adolescence: The role of gender

BACKGROUND

Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting adolescent alcohol-related harm and binge drinking, taking into account the gender differences. We also evaluated if externalizing problems could moderate the association between internalizing problems and alcohol outcomes.

METHOD

We used longitudinal data from 2368 8th grade students across 37 public schools in three Brazilian cities. Linear and logistic regressions were performed to analyze the association between alcohol outcomes and the independent variables (externalization and internalization scores, and sociodemographic variables) according to gender. We also tested the same model with an interaction term between externalizing*internalizing.

RESULTS

Our results suggest that externalizing problems predict adolescents' binge drinking in both genders; it also may predict adolescents' alcohol-related harms, but only in boys. Internalizing problems seem to be a gender-specific risk factor for binge drinking among girls. All findings are independent of comorbid problems and sociodemographic variables.

LIMITATION

The findings should be considered taking into account the short follow-up period from risk factors to the outcomes.

CONCLUSION

Our results highlight the contribution of internalizing and externalizing problems to the development of alcohol-related harm and binge drinking in early adolescence and the need for interventions to prevent early behavioral problems that consider the role played by gender.

Prevalence and Correlates of Tobacco Use in Young People Presenting to Australian Primary Mental Health Services

INTRODUCTION

In Australian youth primary mental health settings it is unclear as to the rates and correlates of tobacco use at service entry.

AIMS AND METHODS

We aimed to delineate the prevalence and correlates of recent tobacco use (eg, cigarettes, chewing tobacco, cigars, etc) in the past 3 months in young people at their first presentation to primary mental health services as a function of age. Cross-sectional self-report measures were collected using a tablet device from young people presenting to one of five Australian primary mental health (headspace) services. Logistic regression assessed correlates of past 3-month tobacco use in adolescents (12-17 years) and young adults (18-25 years).

RESULTS

Regular (at least monthly) tobacco use in the past 3 months was found in 23.4% (n = 247, N = 1055) of the sample. Increasing age (odds ratio [OR] =1.47 per year; 95% confidence interval [CI]: 1.15 to 1.89), male sex (OR = 1.98; 95% CI: 1.02 to 3.83), being in a relationship (OR = 1.96; 95% CI: 1.01 to 3.82), and poorer functioning (OR = 0.95 per unit Social and Occupational Functioning Assessment Scale increase; 95% CI: 0.91 to 0.99) predicted regular tobacco use in adolescents, but not in young adults. Living in a regional location (OR = 2.10; 95% CI: 1.40 to 3.13) and not studying (OR = 0.47; 95% CI: 0.31 to 0.73) predicted tobacco use in young adults. Having a diagnosed mental illness other than depression and/or anxiety predicted tobacco use in both groups (adolescents OR = 2.49; 95% CI: 1.26 to 4.94; young adults OR = 1.80; 95% CI: 1.13 to 2.89).

CONCLUSIONS

Nearly a quarter of young people with mental illness are using tobacco, supporting the need for early intervention approaches. Adapting treatment targets by age could improve the impact of interventions in adolescents versus young adults. Poor functioning and lack of engagement in education were associated with tobacco use in both age groups, respectively; however, more research is needed to determine the direction of these relationships.

IMPLICATIONS

Young people with mental illness have a high prevalence of recent tobacco use and this is evident when they first present to youth primary mental health services. Youth-oriented mental health settings may provide a unique window for tobacco use prevention and early intervention to reduce smoking in people with mental illness, a priority population. Age-specific targeted approaches might be needed in adolescents and young adults.

Illicit drug use in university students in the UK and Ireland: a PRISMA-guided scoping review

BACKGROUND

Interest in the health and well-being of university students has increased in the UK and Ireland in the past two decades as their numbers have grown. Recent high-profile deaths of students after using illicit drugs have highlighted the importance of the topic for policy makers. This scoping review maps the state of the existing literature evaluating use of illicit drugs in university students in the UK and Ireland. It aims to highlight research gaps and inform policy.

METHOD

We conducted a systematic search of papers related to psychoactive drug use in university students in the UK and Ireland published before August 2021. The 18 extracted study characteristics included author(s); year of publication; journal; location of data collection; study design; delivery method (e.g., online survey, in-person, postal survey); number of participants; response rate; participant course of study, year of study, degree level (i.e., undergraduate, postgraduate), gender and age; time-period assessed (e.g., lifetime, current use, past 12 months); primary aim; primary outcome; ethical approval; and funding source.

RESULTS

The PRISMA-guided search strategy identified 1583 papers for abstract review; of 110 papers retained for full-text review, 54 studies met criteria for inclusion for this paper. Primary outcomes were coded into five groups: prevalence and patterns of drug use; factors associated with drug use; attitudes and knowledge about, and motivation for, drug use; supply of drugs; consequences of drug use. The results show that there is no coherent body of research in this area. The prevalence of reported drug use has crept up and the range of substances reported has broadened over time, and attitudes to drugs on average have normalised. However, there are significant methodological limitations that limit the utility of these findings. There was little evidence of published work on prevention of, or intervention to reduce, drug-related harms.

CONCLUSION

The domains identified offer a framework for university administrators, researchers and policy makers to understand the potential response to drug use in university students in the UK and Ireland. Recommendations are made to fill the gaps in the research evidence base.

Digital interventions for substance use disorders in young people: rapid review

BACKGROUND

Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed.

METHODS

Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance.

RESULTS

In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions.

CONCLUSIONS

While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.

"We Want to See Youth That Would Be Better People Than Us": A Case Report on Addressing Adolescent Substance Use in Rural South Africa

Research suggests that substance use, particularly among adolescents may lead to increased illegal activities as well as physical and social health consequences. Around the world, communities, overburdened with adolescent and youth substance use, are finding ways to address this public health threat. Using a case study based on a focus group discussion with nine founding members, this paper reports on the case of Sibanye-a rural community coalition whose mission is to reduce the burden of adolescent substance use on families in rural South Africa. The focus group discussions were audio-recorded, transcribed verbatim, and analyzed using Nvivo 12. This work highlights the power of an engaged collective effort in addressing key community issues, even in rural areas of emerging economies where health and community infrastructure may be limited. The Sibanye coalition taps into its collective wealth of community knowledge to provide social contributions and aesthetics to help adolescents abstain from substance use and sexual risk behaviors. These activities offer adolescents safe places to meet each other, health education, and the ability to structure their free time meaningfully. Engaging community residents, particularly disadvantaged groups, should be central to any local and national strategies for promoting health and well-being.

Interplay between genetic risk and the parent environment in adolescence and substance use in young adulthood: A TRAILS study

Many adolescents start using tobacco, alcohol, and cannabis. Genetic vulnerability, parent characteristics in young adolescence, and interaction (GxE) and correlation (rGE) between these factors could contribute to the development of substance use. Using prospective data from the TRacking Adolescent Individuals' Lives Survey (TRAILS; N = 1,645), we model latent parent characteristics in young adolescence to predict young adult substance use. Polygenic scores (PGS) are created based on genome-wide association studies (GWAS) for smoking, alcohol use, and cannabis use. Using structural equation modeling we model the direct, GxE, and rGE effects of parent factors and PGS on young adult smoking, alcohol use, and cannabis initiation. The PGS, parental involvement, parental substance use, and parent-child relationship quality predicted smoking. There was GxE such that the PGS amplified the effect of parental substance use on smoking. There was rGE between all parent factors and the smoking PGS. Alcohol use was not predicted by genetic or parent factors, nor by interplay. Cannabis initiation was predicted by the PGS and parental substance use, but there was no GxE or rGE. Genetic risk and parent factors are important predictors of substance use and show GxE and rGE in smoking. These findings can act as a starting point for identifying people at risk.

A longitudinal study of protective factors against substance use in early adolescence. An ecological approach

BACKGROUND

Adolescent substance use has been widely related to different individual, school, family and community factors. Yet, the number of studies with all these variables together in a model from an ecological perspective is still low, and they rarely used a longitudinal design. The aim of this study was to explore, from an ecological perspective, the prospective impact of different individual, school, family and neighbourhood factors on adolescent substance use.

METHODS

This was a longitudinal study with a one-year follow up. There were 881 participants (M_age = 12.57; 48.1% females) at wave 1, of which 686 (M_age = 13.51; 51.8% females) were followed-up at wave 2. Validated questionnaires were used for data collection.

RESULTS

Regression analyses showed that higher substance use was predicted by high family socio-economic status cross-sectionally and longitudinally, and it was related to low neighbourhood socio-economic status cross-sectionally only. Participants who disliked school and had a poor academic performance were more likely to use substances, both cross-sectionally and longitudinally.

CONCLUSIONS

The inclusion of families in substance use prevention programmes could be a key component in these interventions. Moreover, promotion of a positive school climate could protect adolescents from using substances.

Binge drinking in Brazilian adolescents: results of a national household survey

This study aimed to estimate the prevalence of binge drinking and other alcohol consumption patterns and analyze the sociodemographic characteristics associated with binge drinking among Brazilian adolescents aged 15 to 17 years. A cross-sectional household survey including 2,315 adolescents from the 2019 Brazilian National Health Survey who answered a questionnaire on alcohol consumption (weekly frequency, average amount consumed in a drinking day, and binge drinking). A descriptive analysis of alcohol consumption by sociodemographic characteristics and a multivariable logistic regression model were performed. The prevalence of binge drinking (past 30 days) was 8.1% (95%CI: 6.2-10.3). Adolescents who did not attend school (OR = 2.8; 95%CI: 1.6-5.0) had greater odds of binge drinking than adolescents attending school. Higher socioeconomic status (measured via wealth score) was also associated with higher odds of binge drinking compared with lower socioeconomic status (e.g., 5th quintile vs. 1st quintile: OR = 2.9; 95%CI: 1.1-7.7). Girls had lower odds of binge drinking (OR = 0.5; 95%CI: 0.2-0.8) than boys. The prevalence of binge drinking among adolescents, especially boys, who did not attend school and had higher socioeconomic status was high. Monitoring alcohol consumption patterns in adolescents may provide important information on policies or actions to prevent binge drinking.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

"The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

BACKGROUND

Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention.

METHODS

This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data.

RESULTS

Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments.

CONCLUSION

These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).

Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada

BACKGROUND

Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services.

METHODS

We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need.

RESULTS

Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods.

CONCLUSIONS

This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.

Association between binge eating and physical violence perpetration among U.S. college students

BACKGROUND

To date, no known research has explored the link between binge eating and physical violence perpetration despite overlapping psychological constructs that underpin these behaviors (i.e., emotion regulation difficulties, impulsivity). Therefore, this study aimed to determine the association between binge eating and self-reported physical violence perpetration.

METHODS

Cross-sectional data from four survey years (2016-2020) of the national (U.S.) Healthy Minds Study (N = 6210) were analyzed. Unadjusted (Independent samples t test) and adjusted (logistic regression) analyses were conducted to determine the associations between binge eating in the past four weeks and violence perpetration in the past 12 months, while adjusting for potential confounders.

RESULTS

The unadjusted mean number of days of binge eating was significantly higher among participants who reported physical violence perpetration (M = 2.6, SD = 5.2) compared to those who did not (M = 1.8, SD = 3.7). Logistic regression analysis demonstrated that each additional day of binge eating was associated with 5% higher odds (95% confidence interval 1.02-1.09) of self-reported physical violence perpetration, while adjusting for potential confounders.

CONCLUSIONS

Results from this study are the first known to identify an association between binge eating and physical violence perpetration among U.S. college students. Findings are supported by the potential mechanistic overlap of emotion regulation and impulsivity associated with both binge eating and violence perpetration, underscoring the need for more research.

Updated systematic review of Australian school-based prevention programmes for alcohol and other drugs: a review protocol

INTRODUCTION

Adolescent onset substance use is associated with neurodevelopmental, social and psychological harms. Thus, alcohol and other drug prevention programmes are essential to promote health and well-being during this period. Schools are uniquely positioned to deliver such prevention programmes. The last decade has seen a large expansion of school-based alcohol and drug prevention programmes in Australia, warranting an update of the comprehensive review conducted by Teesson et al in 2012. This proposed review aims to (1) identify school-based substance use prevention programmes that have been trialled in Australia since 2011, (2) evaluate their efficacy and (3) identify intervention components associated with effectiveness. This will assist schools in identifying and adopting effective evidence-based programmes and inform future programme development, evaluation and policy.

METHODS AND ANALYSIS

Studies published from 2011 will be identified by searching the electronic databases PubMed, PsycINFO, Medline, Embase, ProQuest and Cochrane Library in addition to grey literature searches. Eligible studies will be controlled trials (including randomised controlled trials, cluster randomised controlled trials and quasi-experimental trials) of programmes measuring drug and alcohol related outcomes that are conducted in a school setting and have been trialled within Australia. Records will be independently screened for eligibility by two review authors, with disagreements being resolved by consensus or a third review author where necessary. Data extraction, risk of bias and study quality will also be completed independently by two review authors. A qualitative synthesis of all eligible studies will be presented. In addition, if there are sufficient data to combine studies, a random-effects meta-analysis will be conducted.

ETHICS AND DISSEMINATION

This research is exempt from ethics approval as no primary data are collected, with work instead being carried out on published documents. The findings of this proposed review will be disseminated in a peer-reviewed journal and at conferences.

PROSPERO REGISTRATION NUMBER

CRD42021272959.

Implementation fidelity of a Brazilian drug use prevention program and its effect among adolescents: a mixed-methods study

BACKGROUND

Based on the US DARE-kiR, a version of the Keepin' it REAL program, the Drug and Violence Resistance Educational Program (PROERD) is the most widely implemented Brazilian prevention program. It originates from the translation of the DARE-kiR, a version of the Keepin' it REAL program. Previous results suggest its inefficiency in preventing drug use among Brazilian adolescents. Since kiR fidelity can impact program outcomes, this mixed-methods study evaluates the PROERD implementation fidelity and its effects on preventing drug use among adolescents.

METHODS

Data from two cluster randomized controlled trials (cRCTs) with 4,030 students from 30 public schools in São Paulo (1,727 fifth graders and 2,303 seventh graders), assessed at two-time points, were analyzed quantitatively. After implementing each lesson during the cRCT, 19 PROERD instructors answered fidelity forms. The effect of PROERD fidelity on alcohol, cigarettes, marijuana, inhalant, and cocaine use (the last two only among seventh graders) in the six months prior to follow-up assessment was analyzed by logistic regressions for fifth grade and mixed effect models for seventh graders. For qualitative analysis, semi-structured interviews were conducted with PROERD instructors and investigated by thematic analysis.

RESULTS

Quantitative analysis showed that PROERD implementation fidelity had no impact on drug use among fifth and seventh graders. Conversely, the qualitative analysis revealed important aspects that may influence implementation fidelity and consequently program effectiveness, such as adaptations made by instructors, school infrastructure, among others, besides program application.

CONCLUSION

PROERD requires cultural adaptation to improve its implementation in Brazilian public schools.

Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use

This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.

Peer pressure and social acceptability between hookah pipe users and non-users among a sample of South African adolescents

Background. Hookah pipe smoking is a high-risk phenomenon which is widely seen as an acceptable social practice, but the extent of its acceptability is not very clear among South African youth, nor is the influence of peers very clear.Objective. To establish a link between social acceptability and peer pressure and to compare this relationship among hookah pipe users and non-users in a sample of South African adolescents.Methods. A cross-sectional comparative correlation study was conducted among Grade 9 adolescents attending secondary schools in the Metro East Education District in Cape Town. The final sample comprised 270 participants. A questionnaire was used to collect data which were analysed using SPSS.Results. No relationship was found between peer pressure and social acceptability, but a relationship was found between parental rules and monitoring around tobacco use for hookah pipe users. A significant difference was also found in attitudes towards hookah use among users and non-users.Conclusion. This descriptive study of hookah pipe users and non-users among Grade 9 adolescents is a further study in the quantitative research approach and may be helpful in gaining more insight into understanding how parental rules and monitoring are put in place and why users’ and non-users’ attitudes towards tobacco use differ significantly. The implications and significance of this study are further explained.

Child-centred harm reduction

Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority - both relating to their own use and the effects of drug use among parents or within the family - are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as 'child-centred harm reduction'. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.

A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals

BACKGROUND

Nitrous oxide (N₂O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N₂O use is difficult to quantify but appears to be increasing. Research on N₂O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people.

METHODS

To identify publications reporting the recreational use of N₂O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N₂O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool.

RESULTS

The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N₂O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N₂O-related harms.

CONCLUSION

The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N₂O use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for N₂O use which also includes further consultation and research with both groups. Future research could explore young people's experience of N₂O use including benefits and problems to inform contextually relevant harm reduction strategies.

Child maltreatment and substances use throughout adolescence and adulthood: Data from a Brazilian Birth Cohort

BACKGROUND

Child maltreatment has been associated with substance use later in life, but few studies have used repeated measures.

OBJECTIVE

To assess the association between child maltreatment and use of psychoactive substances from adolescence to early adulthood, and whether this differs by sex.

PARTICIPANTS AND SETTING

3641 participants from the 1993 Pelotas Birth Cohort, Brazil.

METHODS

Child maltreatment (psychological, physical and sexual abuse, and physical neglect) was assessed up to age 15 and use of psychoactive substances (smoking, harmful use of alcohol and use of illicit drugs) was assessed at ages 15, 18, and 22 years. Associations between child maltreatment and use of substances at each time point were analyzed using logistic regression, adjusted for confounders.

RESULTS

Overall, child maltreatment was associated with substance use, and the strength of the associations decreased over time. E.g., the association between psychological abuse and harmful use of alcohol was OR 2.17 (95%CI 1.80, 2.62; p-value < 0.001) at 15 years, OR 1.61 (95%CI 1.31, 1.97; p-value < 0.001) at 18 years, and OR1.55 (95%CI 1.22, 1.96; p-value < 0.001) at 22 years. When sex differences were evident, stronger associations were observed among females. E.g., the association between physical abuse and smoking at 15 years was OR 3.49 (95%CI 2.17, 5.62) in females and OR 0.87 (95%CI 0.30, 2.52) in males (p-value for sex interaction = 0.041).

CONCLUSIONS

Child maltreatment was associated with psychoactive substance in adolescence and early adulthood. Strategies to prevent use of substances could benefit those who suffered maltreatment in childhood.

Structural gender inequality and gender differences in adolescent substance use: A multilevel study from 45 countries

-Societal gender inequality relates to gender differences in adolescent substance use.-The gender gap in adolescent substance use is larger in countries with higher levels of gender inequality.-Girls in these countries were less likely to get drunk, use alcohol or smoke cigarettes than boys.