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Gerke DR, Atteberry-Ash B, Call J, Hostetter CR. Adolescent Substance Use at the Intersection of Sexual Orientation and Gender Identity. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:577-586. [PMID: 38567540 DOI: 10.1177/29767342241241398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Substance use in adolescence is associated with multiple negative outcomes. Lesbian, gay, or bisexual or transgender or nonbinary (TNB) youth, and those who question their sexual orientation or gender, are more likely to engage in substance use than straight or cisgender youth. However, the extant literature largely considers sexual orientation and gender identity independently. Accordingly, this study examines the associations between the intersectional identities of sexual orientation and gender and substance use to identify those with the greatest need for prevention interventions. METHODS Data were from 36 504 high school students aged 14 to 18 years (mean = 15.7, SD = 1.18) enrolled in the 2019 Healthy Kids Colorado Survey using a statewide stratified random sampling design. Logistic regression models examined the associations between intersectional sexual orientation and gender on marijuana use, prescription drug misuse, and polysubstance use, as well as depression and violence victimization (eg, forced sex, partner violence). RESULTS Adjusted odds of substance use for sexual and gender minority youth varied by intersectional identity and substance. The largest effect sizes were seen for prescription drug misuse, especially among those questioning their gender and sexual orientation and heterosexuals either questioning their gender or who identified as TNB. Effect sizes for marijuana use and polysubstance use were highest for TNB and heterosexual participants. Depression and violence victimization were significantly associated with each substance use outcome. CONCLUSIONS Interventions to reduce substance use in these populations may benefit from targeted interventions for youth with different intersectional identities, and a focus on violence prevention and depression screening and treatment.
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Affiliation(s)
- Donald R Gerke
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jarrod Call
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, WA, USA
| | - C Riley Hostetter
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00140-0. [PMID: 38537736 PMCID: PMC11422521 DOI: 10.1016/j.jaac.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE In 2014, the U.S. National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018) updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices. METHOD The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research. RESULTS Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research. CONCLUSION These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.
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Buchholz C, Bell LA, Adatia S, Bagley SM, Wilens TE, Nurani A, Hadland SE. Medications for Opioid Use Disorder for Youth: Patient, Caregiver, and Clinician Perspectives. J Adolesc Health 2024; 74:320-326. [PMID: 37815763 PMCID: PMC10842045 DOI: 10.1016/j.jadohealth.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Clinical trial data support use of medications for opioid use disorder (MOUD) in adolescents and young adults ("youth"), but qualitative data are lacking on the acceptability and importance of MOUD to youth, caregivers, and clinicians. We assessed how these stakeholders viewed the role of MOUD in treatment and recovery. METHODS We recruited youth aged from 15 to 25 years with opioid use disorder who had received buprenorphine, naltrexone, or methadone and caregivers from a primary care-based youth addiction treatment program. We also recruited clinicians with addiction expertise from social work, nursing, pediatrics, internal medicine, and psychiatry. We conducted semistructured interviews assessing special considerations for MOUD use in youth. Three coders performed inductive and deductive thematic analysis of transcripts. RESULTS Among 37 participants, including 15 youth (age range, 17-25 years), nine caregivers, and 13 clinicians, we identified three themes. (1) Medications support recovery in the short term: Youth described MOUD as beneficial in managing withdrawal symptoms. Notably, some youth and caregivers preferred to limit MOUD duration. (2) Medication adherence is affected by type of medication, dosing regimen, and route of administration. Participants endorsed long-acting, injectable MOUD for ease of use and youth's ability to continue engagement in "normal activities" without daily medication. (3) Caregiver involvement can support medication decisions and adherence. Youth and some clinicians described the need to assess caregiver involvement before incorporating them into treatment; caregivers and other clinicians described caregivers as critical in supporting accountability. DISCUSSION MOUD is evidence-based, and its provision should be developmentally responsive and youth- and family-centered, incorporating caregivers when appropriate.
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Affiliation(s)
- Connor Buchholz
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lauren A Bell
- Department of Pediatrics-Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Safina Adatia
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah M Bagley
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Timothy E Wilens
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alykhan Nurani
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Zarwell M, Patton A, Gunn LH, Benziger A, Witt B, Robinson PA, Terrell DF. PrEP awareness, willingness, and likelihood to use future HIV prevention methods among undergraduate college students in an ending the HIV epidemic jurisdiction. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37463522 DOI: 10.1080/07448481.2023.2232885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Identify factors associated with PrEP awareness, willingness, and future prevention modalities among undergraduate college students. PARTICIPANTS Undergraduates (N = 701) were recruited from a private university, a public research university, and a private historically Black college and university for an online survey. METHODS Upon multiple imputations, a multivariate logistic model, a multivariate multinomial model, and independent multivariate ordinal logistic models were used to calculate Rubin's rules-pooled adjusted odds ratios for PrEP awareness, willingness, and future HIV prevention methods. RESULTS Only 33.4% of students had heard of and 32.4% were willing to take PrEP. PrEP willingness was higher among sexual minority students compared to heterosexual/straight students (OR = 1.65; 95% CI: 1.03-2.63); p = .036). The likelihood to take a future vaccine or antibody prophylaxis treatment was higher than the likelihood to take injectable PrEP or implants. CONCLUSIONS Interventions to increase PrEP uptake and willingness among undergraduates should emphasize equity in HIV education and include future prevention modalities.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Alyssa Benziger
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Brian Witt
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
- Department of HIV/STD Community Services, Mecklenburg County Public Health, Charlotte, NC, USA
| | - Patrick A Robinson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Debra F Terrell
- Department of Natural and Behavioral Sciences, Johnson C. Smith University, Charlotte, NC, USA
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Marcantonio TL, Weese J, Willis M. Rates of Forced Sexual Experiences Among High School Students From 2001 to 2019. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP21045-NP21069. [PMID: 34989630 DOI: 10.1177/08862605211055155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Public awareness of sexual assault and initiatives aimed at preventing sexual assault continue to increase over the years. However, whether rates of sexual assault have diminished because of such cultural shifts remains unclear. The purpose of this study was to assess if rates of sexual assault (i.e., forced sex) have changed over the past 18 years for adolescent girls and boys as well as potential differences across racial/ethnic identities. Using nationally representative data from the Youth Risk Behavioral Surveillance Survey from 2001 to 2019, we conducted logistic regressions to assess rates of experiences of forced sex by sex and by sex and racial/ethnic identity, while accounting for grade level. Participants included 135,837 high school students. From 2001 to 2019, rates of forced sex maintained for girls; however, there was a decrease over time for boys. For girls, there were inconsistent differences in rates of forced sex by racial/ethnic identities. However, boys who identified as Black, Hispanic, Multi-Racial, and Other Race/Ethnicity were at higher risk to report forced sex than their White peers, until 2015; only Other Race/Ethnicity was at higher risk in 2019. As girls and boys aged, the risk of forced sex increased. Despite prevention efforts, rates of forced sex did not decrease from 2001 to 2019 for adolescent girls disregarding race/ethnicity, and for racial/ethnic minority boys. That rates of forced sex continue to be high is problematic as experiencing sexual assault at an earlier age is associated with myriad consequences. Further, results suggest current prevention initiatives may be inadequate at addressing risk factors for forced sex, and more broadly, sexual assault. Moving forward, researchers and educators may want to re-evaluate the strategies used to address and measure sexual assault experiences.
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Affiliation(s)
- Tiffany L Marcantonio
- Department of Health, Human Performance, and Recreation, 3341University of Arkansas, Fayetteville, AR, USA
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN, USA
| | - James Weese
- Department of Rehabilitation, Human resources and Communication, 3341University of Arkansas, Fayetteville, AR, USA
| | - Malachi Willis
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, 3526University of Glasgow, Glasgow, UK
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MacDonell KK, Naar S. Self-Management Frameworks for Youth Living with Human Immunodeficiency Virus. Pediatr Clin North Am 2022; 69:759-777. [PMID: 35934498 PMCID: PMC11446343 DOI: 10.1016/j.pcl.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV is now a chronic condition that can be managed. Adolescents and emerging adults represent a large proportion of new diagnoses, but struggle with many aspects of HIV-related self-management. Self-management of HIV is critical to maintaining health and involves retention in HIV care, medication adherence to achieve viral suppression, managing substance use, and sexual and general health-related behaviors. This article describes theoretic frameworks for HIV self-management as adapted for youth and reviews self-management interventions developed to improve health outcomes in youth living with HIV identified from a recent systematic review.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Wayne State University School of Medicine, Family Medicine and Public Health Sciences, IBio 6135 Woodward Avenue, Behavioral Health, H206, Detroit, MI 48202, USA.
| | - Sylvie Naar
- Florida State University, Center for Translational Behavioral Science, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL 32310, USA
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Bagheri Z, Boroumandfar Z, Shirazi M. Self-Care Needs in the Domains of Knowledge, Attitude and Performance of Adolescent Girls with Regard to Drug Addiction and Risky Sexual Behaviors in Iran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:411-416. [PMID: 34703779 PMCID: PMC8491818 DOI: 10.4103/ijnmr.ijnmr_263_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/07/2020] [Accepted: 01/03/2021] [Indexed: 11/09/2022]
Abstract
Background: Knowing about sexual issues and substance abuse is crucial for girls in preventing high-risk behaviors in the medical, social, cultural, and evolutional levels. The aim of this study was to determine the self-care needs of adolescent girls in the domains of knowledge, attitude, and performance with regard to drug use and risky sexual behaviors. Materials and Methods: This cross-sectional study was conducted in the secondary schools located in the third district of Isfahan. Data were collected from 384 female students by systematic random sampling on 2019, and using a four-part questionnaire including demographic characteristics and self-care needs (knowledge, attitude and performance), drug addiction and unsafe sexual behaviors were measured and then were analyzed using descriptive and inferential statistics. Results: According to the adolescents, “familiarity with infectious diseases caused by drug addiction”, “alcohol consumption, drugs and smoking as a way of forgetting problems” and “learning the skills of excitement control,” were their first self-care priorities in terms of awareness, attitude, and performance, respectively. Additionally, “understanding the social and mental effects of relationships with the other sex”, “separating the children's bedrooms from that of parents” and “ways of caring for personal hygiene in menstruation period and travel time” were considered as their first self-care priorities in terms of knowledge, attitude, and performance with regard to sexual behaviors, respectively. Conclusions: Based on the results, more effective interventions to protect the adolescents from being involved in substance use and sexual harmful behaviors are recommended through the training of self-care needs in adolescents.
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Affiliation(s)
- Zahra Bagheri
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Boroumandfar
- Midwifery & Reproductive Health Department, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shirazi
- Community Health Nursing Department, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Khanhkham A, Williams RD, Housman JM, Odum M. Sexual Dating Violence, School-Based Violence, and Risky Behaviors Among U.S. High School Students. J Community Health 2021; 45:932-942. [PMID: 32198599 DOI: 10.1007/s10900-020-00811-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sexual dating violence is associated with several risky health behaviors among adolescents. This study explored the associations between school-based violence, risky health behaviors, and sexual dating violence victimization among U.S. high school students using the 2017 Youth Behavior Risk Survey data. Results indicate a statistically significant correlation (p < .05) between sexual dating violence, sex, sexual identity, and various risky behaviors including bullying, electronic bullying, alcohol use, and physical fighting. These additional behavioral risks experienced by sexual dating violence victims should be further researched to determine impact on overall quality of life and to help guide health education intervention development.
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Affiliation(s)
| | | | | | - Mary Odum
- Texas State University, San Marcos, TX, USA
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9
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Underwood JM, Brener N, Halpern-Felsher B. Tracking Adolescent Health Behaviors and Outcomes: Strengths and Weaknesses of the Youth Risk Behavior Surveillance System. NAM Perspect 2020; 2020:202010a. [DOI: 10.31478/202010a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Tam CC, Benotsch EG, Li X. Sexual enhancement expectancy, non-medical use of prescription drugs, and sexual risk behaviors in college students. Subst Abus 2020; 42:577-586. [DOI: 10.1080/08897077.2020.1803177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Eric G. Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Abstract
Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.
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Affiliation(s)
- Laura K Grubb
- Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Cordova D, Munoz-Velazquez J, Mendoza Lua F, Fessler K, Warner S, Delva J, Adelman N, Fernandez A, Bauermeister J. Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16251. [PMID: 32181747 PMCID: PMC7109616 DOI: 10.2196/16251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/04/2019] [Accepted: 02/10/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. OBJECTIVE This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. METHODS Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. RESULTS Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI -0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI -0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI -0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI -0.39 to 0.72). CONCLUSIONS The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. TRIAL REGISTRATION ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410.
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Affiliation(s)
- David Cordova
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | | | - Frania Mendoza Lua
- School of Social Service Administration, University of Chicago, Chicago, IL, United States
| | | | - Sydni Warner
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Jorge Delva
- School of Social Work, Boston University, Boston, MA, United States
| | | | - Angela Fernandez
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Jose Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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13
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Schranz AJ, Davy-Mendez T, Eron JJ, Napravnik S. Opioid misuse among persons with HIV engaged in care in the Southeastern US. AIDS Care 2019; 33:148-153. [PMID: 31814449 DOI: 10.1080/09540121.2019.1699644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The prevalence of opioid misuse by people living with HIV (PLWH) during the current US opioid epidemic has not been fully described. Among a cohort of persons engaged in HIV care in North Carolina, we examined the prevalence of and risk factors for opioid misuse, defined as self-reported "street" opioid use (e.g., heroin) or nonmedical prescription opioid use on a patient reported outcomes survey. Recent (past three-month) opioid misuse among 1,440 PLWH in care 2012-2017 was 2% (95% CI 2-3%) and lifetime misuse 15% (13-16%). Persons reporting lifetime or recent misuse more commonly had hepatitis C and reported injecting drugs. In multivariable logistic regression models, male-to-male sexual contact was inversely associated with recent or lifetime misuse. White/non-Hispanic race/ethnicity was associated with lifetime misuse and CD4 count and viral load were not associated with opioid misuse. Among 32 persons reporting recent misuse, 81% had a contemporaneous viral load <50 copies/mL. In this cohort of PLWH engaged in care, recent opioid misuse prevalence was similar to general population estimates. Assessments of opioid misuse among PLWH not in care are urgently needed to fully characterize the impact of opioids on all PLWH.
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Affiliation(s)
- Asher J Schranz
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Thibaut Davy-Mendez
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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14
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Barnett TE, Thompson EL, Litt DM, Lewis MA. Correlates of Nonmedical Prescription Opioid Use Among U.S. Adolescents. Am J Prev Med 2019; 57:e175-e179. [PMID: 31564603 DOI: 10.1016/j.amepre.2019.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The purpose of this study is to assess risk factors, including other substance use, for nonmedical prescription opioid use among U.S. adolescents. METHODS A secondary data analysis of the 2017 Youth Risk Behavior Survey was conducted (n=10,175) in 2018. The outcome was nonmedical prescription opioid use. Predictor variables included other substance use, mood, sleep, academic performance, and demographic characteristics. Survey-weighted procedures in SAS, version 9.4 were used, and an adjusted logistic regression model was conducted. RESULTS Among the sampled adolescents, 13.8% (95% confidence limit=12.4%, 15.3%) reported nonmedical prescription opioid use. Nonmedical prescription opioid use was more likely among participants aged 15 years (versus 16 years), American Indian/Alaskan Natives, and those who reported being sad or hopeless. All other substance use was significantly associated with increased odds of nonmedical prescription opioid use. Nonmedical prescription opioid use was 1.5 times more likely among electronic vapor users (AOR=1.58, 95% CI=1.34, 1.86), 2 times more likely among cigarette (AOR=2.49, 95% CI=2.16, 2.88) and marijuana users (AOR=2.45, 95% CI=2.05, 2.93), and almost 3 times as likely among alcohol users (AOR=2.98, 95% CI=2.18, 4.07). CONCLUSIONS Study findings suggest a need for more interventions for nonmedical prescription opioid use among adolescents in the U.S. Information on nonmedical prescription opioid use should be added to all substance use prevention programs for adolescents. Moreover, future research needs to identify longitudinal predictors of adolescent nonmedical prescription opioid use to inform prevention efforts.
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Affiliation(s)
- Tracey E Barnett
- School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas.
| | - Erika L Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Dana M Litt
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
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Cimpian JR, Timmer JD, Birkett MA, Marro RL, Turner BC, Phillips GL. Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities. Am J Public Health 2019; 108:S258-S265. [PMID: 30383423 DOI: 10.2105/ajph.2018.304407] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. METHODS We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. RESULTS Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. CONCLUSIONS Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.
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Affiliation(s)
- Joseph R Cimpian
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Jennifer D Timmer
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Michelle A Birkett
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Rachel L Marro
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Blair C Turner
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Gregory L Phillips
- Joseph R. Cimpian is with the Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY. Jennifer D. Timmer is with the Department of Educational Psychology, University of Illinois at Urbana-Champaign, Champaign. Michelle A. Birkett, Rachel L. Marro, Blair C. Turner, and Gregory L. Phillips II are with the Department of Medical Social Sciences, Northwestern University, Chicago, IL
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Gender and Race Informed Pathways From Childhood Sexual Abuse to Sexually Transmitted Infections: A Moderated Mediation Analysis Using Nationally Representative Data. J Adolesc Health 2019; 65:267-273. [PMID: 31043345 PMCID: PMC7962873 DOI: 10.1016/j.jadohealth.2019.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Although data suggest child sexual abuse is linked with increased risk of contracting asexually transmitted infection (STI), the mechanisms through which these experiences are connected remain understudied. Moreover, there is a need to explore how race/ethnicity and gender influence these processes. METHODS The present study examined the mediational pathways from child sexual abuse to risky sexual behavior to STIs and further evaluated the role of depressive symptomatology and nonmedical prescription drug use on the relationship between child sexual abuse and risky sexual behavior. In addition, race and gender were examined as moderators to account for potential different effects of these mechanisms on females and males and on different racial and ethnic groups. A nationally representative sample of 4,181 youth from the Add Health dataset was used. RESULTS Results from a moderated mediation model indicated risky sexual behavior partially mediated the pathway from child sexual abuse to STI contraction and depressive symptomatology and nonmedical prescription drug use partially mediated pathway from child sexual abuse to risky sexual behavior. Race and gender moderated the relationship between risky sexual behavior and STI contraction. CONCLUSIONS Findings underscore the need for STI prevention efforts among adolescents to focus on risk factors beyond risky sexual behaviors, such as childhood sexual abuse and mental health screening that includes depressive symptomatology and nonmedical prescription drug use. In addition, findings emphasize the need to further examine the different effects on different racial/ethnic and gender subgroups, particularly black women.
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Hamilton KM, Falletta L, Fischbein R, Kenne DR. Nonmedical use of prescription drugs during sexual activity as a predictor of condom use among a sample of college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:459-468. [PMID: 29979955 DOI: 10.1080/07448481.2018.1486843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Objective: To examine the impact of nonmedical use of prescription drugs (NMUPD) during sexual activity on the frequency of condom use among a sample of college students. Participants: Students attending a large Midwestern University (N = 4284) during April 2015. Methods: Retrospective cross-sectional analysis of survey data using logistic regression. Results: Respondents and/or their sexual partners who engaged in NMUPD during sexual activity were significantly less likely to use condoms during 75% or more of past 12-month sexual encounters compared to respondents who had not engaged in lifetime and past 12-month NMUPD. Although not statistically significant, trends suggest that respondents who engaged in NMUPD during sexual activity may be less likely to use condoms than those who engaged in lifetime or past 12-month NMUPD but not during sexual activity. Conclusions: Findings suggest a need for specific strategies for reducing risk behaviors related to prescription drugs and sexual activity.
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Affiliation(s)
- Kelsey M Hamilton
- a Kent State University, College of Public Health , Kent , Ohio , USA
| | - Lynn Falletta
- a Kent State University, College of Public Health , Kent , Ohio , USA
| | - Rebecca Fischbein
- b Northeast Ohio Medical University, Family and Community Medicine , Rootstown , Ohio , USA
| | - Deric R Kenne
- a Kent State University, College of Public Health , Kent , Ohio , USA
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18
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Cruz MAD, Gomes NP, Campos LM, Estrela FM, Whitaker MCO, Lírio JGDS. Impacts of sexual abuse in childhood and adolescence: an integrative review. CIENCIA & SAUDE COLETIVA 2019; 26:1369-1380. [PMID: 33886765 DOI: 10.1590/1413-81232021264.02862019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
This article identifies the impacts of sexual abuse in childhood and adolescence. We conducted an integrative literature review in September 2018 using the Virtual Health Library. A search was conducted using the following descriptors: Sexual Abuse of Children and Adolescents and Sexual Abuse or Child Development. The inclusion criteria were open access full-text original articles published between 2013 and September 2018 in Portuguese, English or Spanish. Sixteen eligible articles were selected after reading the titles and abstracts. The full texts of these articles were read and organized into a table. The studies show that sexual abuse in childhood and adolescence has lifelong psychological, physical, sexual and social impacts. The findings of this study can help alert health care professionals to the importance of investigating the signs and symptoms of sexual abuse given the multiple impacts of abuse on victims' lives.
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Affiliation(s)
- Moniky Araújo da Cruz
- Escola de Enfermagem, Universidade Federal da Bahia. R. Basílio da Gama 241, Canela. 40231-300 Salvador BA Brasil.
| | - Nadirlene Pereira Gomes
- Escola de Enfermagem, Universidade Federal da Bahia. R. Basílio da Gama 241, Canela. 40231-300 Salvador BA Brasil.
| | - Luana Moura Campos
- Escola de Enfermagem, Universidade Federal da Bahia. R. Basílio da Gama 241, Canela. 40231-300 Salvador BA Brasil.
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Clayton HB, Andrzejewski J, Johns M, Lowry R, Ashley C. Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity? Addict Behav 2019; 93:122-128. [PMID: 30708337 PMCID: PMC8189289 DOI: 10.1016/j.addbeh.2019.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/09/2018] [Accepted: 01/14/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity. METHODS Data from the 2015 national Youth Risk Behavior Survey (n = 15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity. RESULTS All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR = 2.39;95% CI:2.15,2.65 vs aPR = 1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12). CONCLUSIONS The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.
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Affiliation(s)
- H B Clayton
- Divison of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA.
| | - J Andrzejewski
- Oakridge Associated Universities, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, USA
| | - M Johns
- Divison of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA
| | - R Lowry
- Divison of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA
| | - C Ashley
- Divison of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, USA
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20
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Pampati S, Lowry R, Steiner RJ. Substance use, violence experiences, and mental health issues: are these health risks associated with HIV testing among sexually experienced U.S. high school students? AIDS Care 2019; 31:1106-1113. [PMID: 31129997 DOI: 10.1080/09540121.2019.1619666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
HIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9-12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing.
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Affiliation(s)
- Sanjana Pampati
- a Oak Ridge Institute for Science and Education (ORISE) , Oak Ridge , TN , USA
| | - Richard Lowry
- b Centers for Disease Control and Prevention, Division of Adolescent and School Health , Atlanta , GA , USA
| | - Riley J Steiner
- b Centers for Disease Control and Prevention, Division of Adolescent and School Health , Atlanta , GA , USA
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21
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First Time Cannabis Use and Sexual Debut in U.S. High School Adolescents. J Adolesc Health 2019; 64:194-200. [PMID: 30413294 DOI: 10.1016/j.jadohealth.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/07/2018] [Accepted: 08/16/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Use of illicit drugs by adolescents might facilitate or trigger other risky behaviors, including early sexual initiation (ESI), multiple partners, and unprotected sex. This study examines whether the age at which adolescents initiate cannabis use is associated with the age of their first sexual intercourse in the U.S. in 2015. METHODS A secondary analysis of data from the 2015 Youth Risk Behavior Surveillance Survey, a cross-sectional, nationally representative survey, was conducted (n = 7,664). Exposure of interest was age of initiation of cannabis use (never used cannabis, age 12 or younger, 13-14 years of age, and age 15 or older) and outcome was ESI (14 years old or younger). Unadjusted and adjusted odds ratios (OR) and their 95% confidence intervals were computed. RESULTS Prevalence of ESI was 15.3%. The proportion of cannabis use was 39.9%. Adolescents starting cannabis use before the age of 15 had higher adjusted odds of ESI (OR ranged 4.2-6.7). This association is modified by sex: while in boys using cannabis before 13 years, the OR is 9 (95% CI 5.2-15.6); in girls, it is 2.8 (95% CI 1.7-4.7). CONCLUSIONS Our findings suggest that there should be sex and drug education programs instituted before the age of 12 ideally, and no later than by age 15 since this time represents a critical period of initiating both behaviors.
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22
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McCumber M, Cain D, LeGrand S, Mayer KH, Murphy DA, Psioda MA, Seña AC, Starks TJ, Hudgens M. Adolescent Medicine Trials Network for HIV/AIDS Interventions Data Harmonization: Rationale and Development of Guidelines. JMIR Res Protoc 2018; 7:e11207. [PMID: 30578242 PMCID: PMC6320398 DOI: 10.2196/11207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program aims to defeat the rising HIV epidemic among adolescents and young adults in the United States. Objective This study aims to optimize cross-study analyses and comparisons of standardized measures (variables) collected in the ATN. Methods Guidelines were developed for harmonizing measures to be collected across ATN studies. Results Eight domains were identified for harmonization—Demographics and Socioeconomic Characteristics, Sexual Behavior and Risk, Substance Use and Abuse, HIV-Positive Cascade, HIV-Negative Cascade, Mental Health, Social Support and Isolation, and Pre-exposure Prophylaxis Cascade. Conclusions The collection of selected key measures in a uniform manner across studies facilitates the characterization of participant populations, comparisons between studies, and pooled analysis of data from multiple studies.
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Affiliation(s)
- Micah McCumber
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Demetria Cain
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Debra A Murphy
- Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, United States
| | - Matthew A Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tyrel J Starks
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States.,Department of Psychology, Hunter College, New York, NY, United States
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep 2018; 15:245-254. [PMID: 29796965 PMCID: PMC6085134 DOI: 10.1007/s11904-018-0393-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic. RECENT FINDINGS Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
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Affiliation(s)
- Asher J Schranz
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA.
| | - Jessica Barrett
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, Ohio State University College of Public Health, 302 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
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24
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Rajan S, Ruggles KV, Guarino H, Mateu-Gelabert P. Heroin Use and Drug Injection among Youth Also Misusing Prescription Drugs. Am J Health Behav 2018; 42:144-155. [PMID: 29320347 DOI: 10.5993/ajhb.42.1.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We identified the prevalence of nonmedical prescription drug use and its relationship to heroin and injection drug use in 4 nationally representative samples of adolescents. METHODS We used the most recent data (2009-2015) from the Youth Risk Behavior Surveillance System (Ntotal= 61,132). Prevalence rates and 95% confidence intervals for prescription drug misuse, heroin use, and injection drug use were calculated across time points, sex, and race/ethnicity subgroups. Using odds ratios, we determined the likelihood of youth reporting nonmedical prescription drug use also reporting heroin and drug injection. RESULTS In 2015, one in 6 adolescents reported recent prescription drug misuse. High rates of nonmedical prescription drug use persisted or increased among Hispanic boys, black boys, and "other" youth, while declining among white youth. Youth who used prescription drugs nonmedically at least once were 17.5 times more likely to have used heroin (CI: 13.7, 22.4) and 14.6 times more likely to have injected drugs (CI: 11.2, 19.2) in their lifetime. CONCLUSIONS Public health programming focused on reducing prescription drug misuse also may reduce youth engagement in heroin and/or injection drug use. Preventive efforts to support communities of color in reducing rates of prescription drug misuse are crucial.
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Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Kelly V. Ruggles
- Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Honoria Guarino
- National Development and Research Institutes, Incorporated, New York, NY, USA
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25
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Clayton HB, Lowry R, Basile KC, Demissie Z, Bohm MK. Physical and Sexual Dating Violence and Nonmedical Use of Prescription Drugs. Pediatrics 2017; 140:peds.2017-2289. [PMID: 29158227 DOI: 10.1542/peds.2017-2289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Little information is available on the associations between nonmedical use of prescription drugs (NMUPD) and dating violence victimization (DVV) among high school students and how associations vary by sex. METHODS We used data from the 2015 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of students in grades 9 to 12. The sample was restricted to students who dated during the 12 months before the survey, resulting in a sample of 5136 boys and 5307 girls. Sex-stratified logistic regression models estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between lifetime NMUPD and DVV. In our analyses, we examined a 4-level DVV measure: no DVV, physical only, sexual only, and both physical and sexual. RESULTS Male students had a significantly lower prevalence of DVV compared with female students. By using the 4-level measure of DVV, after adjusting for covariates, sexual DVV only (aPR = 1.61, 95% CI: 1.21-2.12) and both physical and sexual DVV (aPR = 1.65, 95% CI: 1.26-2.17) were positively associated with NUMPD among boys, whereas among girls, physical DVV only (aPR = 1.42, 95% CI: 1.16-1.75) and both physical and sexual DVV (aPR = 1.43, 95% CI: 1.03-1.99) were positively associated with NMUPD. CONCLUSIONS NMUPD was associated with experiences of DVV among both male and female students. Community- or school-based adolescent violence and substance use prevention efforts would be enhanced by considering the association between DVV and substance use, particularly NMUPD among both male and female adolescents, to address these public health problems.
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Affiliation(s)
- Heather B Clayton
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and
| | - Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and
| | | | - Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and.,US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Michele K Bohm
- Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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26
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De Pedro KT, Gilreath TD, Jackson C, Esqueda MC. Substance Use Among Transgender Students in California Public Middle and High Schools. THE JOURNAL OF SCHOOL HEALTH 2017; 87:303-309. [PMID: 28382667 DOI: 10.1111/josh.12499] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/05/2016] [Accepted: 11/24/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Transgender adolescents face tremendous social stress in families and schools, which often leads to behavioral health disparities. This study assessed whether rates of substance use were higher among transgender adolescents when compared to nontransgender adolescents. METHODS This study is a secondary data analysis of the 2013-2015 California Healthy Kids Survey (CHKS) that examines whether rates of substance use are higher among transgender youth when compared to nontransgender youth. Participants included 4778 transgender and 630,200 nontransgender students in middle and high schools in nearly all school districts in California. The study outcomes were lifetime, recent, and in-school use of cigarettes, tobacco, alcohol, marijuana, cocaine, and ecstasy as well as nonmedical use of prescription painkillers, diet pills, Ritalin or Adderall, and cold medicine. RESULTS Transgender students were about 2-1/2 times more likely as nontransgender students to use cocaine/methamphetamine in their lifetime (odds ratio [OR] = 2.53; 95% confidence interval [CI] = 2.18-2.95) and about 2.8 times as likely to report past 30-day inhalant use (OR = 2.80; 95% CI = 2.41-3.26). Transgender students were more than twice as likely to report past 30-day prescription pain medication use (OR = 2.19; 95% CI = 1.90-2.53) and more than 3 times as likely to use cigarettes in school (OR = 3.37; 95% CI = 2.84-3.99). CONCLUSIONS The study's findings indicate a need for community- and school-based interventions that reduce substance use among transgender youth.
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Affiliation(s)
- Kris Tunac De Pedro
- College of Educational Studies, Chapman University, One University Drive, Orange, CA 92866
| | - Tamika D Gilreath
- Transdisciplinary Center for Health Equity Research, College of Education and Human Development, Texas A&M University, 801 Harrington Tower, College Station, TX, 77843-4222
| | - Christopher Jackson
- College of Educational Studies, Chapman University, One University Drive, Orange, CA 92866
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Friedman SR, Mateu-Gelabert P, Ruggles KV, Goodbody E, Syckes C, Jessell L, Teubl J, Guarino H. Sexual Risk and Transmission Behaviors, Partnerships and Settings Among Young Adult Nonmedical Opioid Users in New York City. AIDS Behav 2017; 21:994-1003. [PMID: 28058567 PMCID: PMC5344710 DOI: 10.1007/s10461-016-1672-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nonmedical prescription opioid use has become widespread. It can lead to heroin use, drug injection and HIV infection. We describe young adult opioid users' sexual risk behavior, partnerships and settings. 464 youth aged 18-29 who reported opioid use in the past 30 days were recruited using Respondent-Driven Sampling. Eligible participants completed a computer-assisted, interviewer-administered risk questionnaire and were tested for STIs and HIV. Participants (33% female; 66% white non-Hispanic) almost all had sex in the prior 90 days; 42% reported more than one partner. Same-sex sex was reported by 3% of men and 10% of women. Consistent condom use was rare. Seven percent reported group sex participation in the last 90 days but lifetime group sex was common among men and women. Young opioid users' unprotected sex, multiple partners and group sex puts them and others at high HIV and STI risk.
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Affiliation(s)
- S R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA.
| | - P Mateu-Gelabert
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - K V Ruggles
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - E Goodbody
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - C Syckes
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
| | - L Jessell
- Silver School of Social Work, New York University, New York, NY, USA
| | - Jennifer Teubl
- Sackler Institute of Graduate Biomedical Sciences, New York University, New York, NY, USA
| | - H Guarino
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY, 10010, USA
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Unhealthy Weight Management Practices and Non-medical Use of Prescription Drugs. Am J Prev Med 2017; 52:215-219. [PMID: 27863921 DOI: 10.1016/j.amepre.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-medical use of prescription drugs (NMUPD) has reached epidemic proportions in the U.S. With approximately one in five high school students engaging in NMUPD, it is important to understand behavioral correlates. METHODS Data were combined from the 2011 and 2013 cycles of the Youth Risk Behavior Survey, a nationally representative, cross-sectional survey. After restricting the analytic sample to students who reported a weight loss goal of either staying the same weight or losing weight, logistic regression models were used to estimate adjusted prevalence ratios and 95% CIs for associations between unhealthy weight management practices (UWMPs) and lifetime NMUPD. Individual UWMPs-fasting; taking diet pills, powders, or liquids without a doctor's advice; and vomiting or taking laxatives-and total number of UWMPs were examined. Data were analyzed in 2016. RESULTS UWMPs were more prevalent among female students (21.1% vs 10.7% for fasting; 7.5% vs 5.2% for taking diet pills, powders, or liquids; and 7.6% vs 3.2% for vomiting or taking laxatives). Significant associations between individual UWMPs and NMUPD and between the number of UWMPs and NMUPD were observed. DISCUSSION UWMPs were associated with NMUPD. Health educators in the school setting, as well as other health professionals who provide services to an adolescent population, can focus on healthy weight management strategies, and other substance-specific messages. CONCLUSIONS The association between UWMPs and NMUPD may reflect a constellation of problem behaviors exhibited among some adolescents.
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Parks KA, Frone MR, Muraven M, Boyd C. Nonmedical use of prescription drugs and related negative sexual events: Prevalence estimates and correlates in college students. Addict Behav 2017; 65:258-263. [PMID: 27567398 DOI: 10.1016/j.addbeh.2016.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/19/2016] [Accepted: 08/13/2016] [Indexed: 11/17/2022]
Abstract
The present study of college students investigated (a) the prevalence of nonmedical use of three classes of prescription drugs (stimulants, anxiolytics/sedatives, analgesics), (b) the prevalence of negative sexual events (NSE) associated with any nonmedical use of prescription drugs (NMUPD), and (c) a set of correlates of NSE. The specific NSE were sexual aggression victimization and perpetration, and regretted sex. The correlates of the NSE were sex, race/ethnicity, year in school, psychological symptoms, alcohol use, illegal drug use, and NMUPD. Participants were 509 (254 females, 255 males) randomly-selected college students who reported any NMUPD. The majority (76.2%) of the sample reported ever using stimulants, 38.9% reported ever using anxiolytics/sedatives, and 40.9% reported using analgesics. During NMUPD, 14.3% of the students reported regretted sex, 7.1% of female students reported sexual victimization, and 6.3% of male students reported perpetrating sexual aggression. Multiple logistic regression analyses indicated that anxiolytic/sedative use (Adj. OR=1.99; 95% CI=1.51-2.62) was positively associated with regretted sex, whereas anxiolytic/sedative use (Adj. OR=1.79; 95% CI=1.01-3.16) and psychological symptoms (Adj. OR=1.06; 95% CI=1.02-1.10) were positively associated with sexual victimization. Illegal drug use was positively associated with perpetrating sexual aggression (Adj. OR=4.10; 95% CI=1.21-13.86). These findings suggest that among these college students, NMUPD-associated NSE were not uncommon, and primarily associated with anxiolytic/sedative use. Given the academic, physical, and psychological implications associated with NSE, research needs to further explore the causal nature of these relations.
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Affiliation(s)
- Kathleen A Parks
- Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, USA.
| | - Michael R Frone
- Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Mark Muraven
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA
| | - Carol Boyd
- UM Addiction Research Center, School of Nursing and Women's Studies Department, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48108, USA
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Sexual Risk Behaviors Among Youth Linked To Nonmedical Use of Prescription Drugs. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:103-104. [PMID: 27303867 DOI: 10.1363/48e9516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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