A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults

Validation of screening instruments for alcohol and substance use disorders among men and women in Eastern Cape, South Africa

INTRODUCTION

Valid Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) screeners are needed to identify and link people to services. We evaluated the performance of several AUD and SUD screeners in South Africa using the Mini International Neuropsychiatric Interview (MINI)-5 diagnostic gold standard.

METHODS

Adults at primary and tertiary care facilities in Buffalo City Metro, South Africa, were screened by research assistants using the AUDIT and AUDIT-C (AUD), DAST-10 (SUD) and NIDA Quick Screen (AUD and SUD). Nurses administered the MINI-5 to identify AUD and SUD. We assessed the internal consistency, criterion validity, sensitivity and specificity of these tools, stratified by gender.

RESULTS

Among 1885 participants, the prevalence of AUD and SUD were 9.5 % and 1.6 %, respectively. All tools demonstrated adequate internal consistency and criterion validity. A positive AUDIT screen (men: ≥8; women: ≥7) yielded sensitivity/specificity of 70.6/87.3 % (men: 78.7/82.6 %; women: 64.8/89.8 %). A positive AUDIT-C screen (men: ≥4; women: ≥3) yielded sensitivity/specificity of 66.1/82.0 % (men: 64.0/78.8 %; women: 67.6/81.3 %). Endorsing the NIDA alcohol use question yielded sensitivity/specificity of 71.1/68.1 % (men: 74.7/59.7 %; women: 68.6/72.5 %). Endorsing either NIDA substance use questions yielded sensitivity/specificity of 80.6/91.7 % (men: 80.8/89.0 %; women: 80.0/93.1 %). A DAST-10 cut-off of ≥ 3 yielded sensitivity/specificity of 71.0/96.0 % (men: 73.1/83.7 %; women 60.0/97.4 %).

CONCLUSIONS

The AUDIT and AUDIT-C performed similarly among men and women, although lower cut-offs may optimize performance among women. The low number of SUD cases hampered our ability to draw conclusions about the SUD screeners' performance.

Is internet-based cognitive behavioral therapy for alcohol use disorder equally effective for men and women? Implications of a secondary analysis of a clinical trial

Introduction

Excessive alcohol use is a major public health concern, for which internet interventions have shown to be effective. Group-average effects may however mask substantial inter-individual variations in changes; identifying predictors of this variation remains an important research question. Biological sex is associated with pharmacokinetic differences in alcohol tolerance, which is reflected in many national guidelines recommending sex-specific thresholds for excessive drinking. Whether effects of internet interventions are moderated by sex, and whether any moderation is due to confounders, remains largely unexplored.

Aim

To examine sex-differences in outcomes (both response and remission) after an internet intervention for alcohol use disorder, and to identify any confounders.

Method

The current study is a secondary analysis of a randomized controlled trial. After identifying factors in which men and women differed at baseline, mixed effects models were re-run using a subsampling matching strategy.

Results

Men and women differed in baseline sum of drinks and self-rated anxiety. Sex was found to moderate (absolute) response but not remission, neither when using sex-specific or common thresholds for risky drinking. However, after controlling for baseline drinking through subsampling, the difference in response was no longer significant.

Conclusion

Our findings suggest that the apparent sex-difference in treatment response was confounded by intercept-slope correlation - i.e. since men on average drank more at baseline, this offered larger room for decreasing. When conducting studies on internet interventions for addictive disorders, it is crucial to consider which outcomes to use, and how these are operationalized.

Prevalence and Correlates of Dating Violence Victimization Among a U.S.-Based Sample of Autistic Youth

Dating violence victimization is a pervasive public health problem that affects individuals of all age groups, but it holds particular significance during adolescence due to the potential long-term consequences on an individual's physical and psychological well-being, and potential influence on the health of adult relationships. Although there is now ample research on the topic of adolescent dating violence prevalence, risk factors, and consequences, to our knowledge, only four studies have assessed dating violence victimization among autistic youth. The current study was designed to investigate the prevalence of, and risk markers for, dating violence victimization among autistic youth. Specifically, the study had two aims: (a) to estimate the prevalence of dating violence victimization among autistic youth in a U.S.-based sample and (b) to identify correlates of dating violence for autistic youth, which include sociodemographic, mental health, and alcohol-related variables. We found that among participants who were in a romantic relationship in the past year, autistic participants were not any less likely to experience dating violence victimization compared to their non-autistic counterparts (40.7% for autistic youth vs. 38.0% for non-autistic youth). In addition, findings from the current study demonstrate the significant relationships between dating violence victimization and consequences of alcohol use, loneliness, and anxiety among autistic youth. Existing studies, in addition to the results of the current study, suggest the need for tailored dating violence prevention, support, and intervention to support the overall well-being of autistic youth.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BACKGROUND

Childhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA.

OBJECTIVE

To analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI).

PARTICIPANTS AND SETTING

Data from the Global Burden of Disease 2019 Public Database.

METHODS

Summary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant.

RESULTS

In 2019, 1.63 million (95 % UI 0.23-3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78-47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87-47.77], 2019: 23.61 [95 % UI 3.55-54.94]).

CONCLUSIONS

Substantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

BACKGROUND

Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades.

METHODS

Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher's exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades.

RESULTS

Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049).

CONCLUSIONS

We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women.

TRIAL REGISTRATION

NCT, NCT 21-34,978. Registered January 19, 2022.