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Gill SV, Shin D, Kim TW, Magane KM, Hereen T, Winter M, Helfrich C, Saitz R. A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241238956. [PMID: 38554013 DOI: 10.1177/15394492241238956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.
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John U, Rumpf HJ, Hanke M, Meyer C. Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample. Sci Rep 2023; 13:16764. [PMID: 37798350 PMCID: PMC10556137 DOI: 10.1038/s41598-023-43669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18-64, BRFs and mental disorders had been assessed in 1996-1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017-2018 using residents' registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31-1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.
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Affiliation(s)
- Ulrich John
- Institute of Community Medicine, Department of Social Medicine and Prevention, University Medicine Greifswald, W.-Rathenau-Str. 48, 17475, Greifswald, Germany.
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Monika Hanke
- Institute of Community Medicine, Department of Social Medicine and Prevention, University Medicine Greifswald, W.-Rathenau-Str. 48, 17475, Greifswald, Germany
| | - Christian Meyer
- Institute of Community Medicine, Department of Social Medicine and Prevention, University Medicine Greifswald, W.-Rathenau-Str. 48, 17475, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
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Nisbet J, Jamshidi L, Andrews KL, Stewart SH, Shields RE, Teckchandani TA, Maguire KQ, Carleton RN. Mental health and social support among Royal Canadian Mounted Police cadets. Front Psychol 2023; 14:1092334. [PMID: 36860784 PMCID: PMC9969355 DOI: 10.3389/fpsyg.2023.1092334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Introduction Certain populations, such as public safety personnel (PSP), experience frequent exposures to potentially psychologically traumatic events and other occupational stressors, increasing their risk for mental health challenges. Social support has been evidenced as a protective factor for mental health. However, research examining perceived social support and its associations with symptoms related to mental disorders among PSP recruits is limited. Methods RCMP cadets (n = 765, 72% male) completed self-report surveys assessing: sociodemographic information, social support, and symptoms related to posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Results The results indicated statistically significant associations between higher social support and decreased odds of positive screens for generalized anxiety disorder, social anxiety disorder, and panic disorder (i.e., significant Adjusted Odds Ratios = 0.90 to 0.95). Discussion Cadets' perceived levels of social support are comparable to the Canadian general population and higher than serving RCMP. Social support appears to offer a protective element against anxiety-related disorders among participating cadets. Reductions in perceived levels of social support may be a function of RCMP service. Factors contributing to decreased levels of perceived social support should be considered.
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Affiliation(s)
- Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada,*Correspondence: Jolan Nisbet, ✉
| | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - Katie L. Andrews
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - Sherry H. Stewart
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada,Anxiety and Illness Behavior Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada
| | - Taylor A. Teckchandani
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - Kirby Q. Maguire
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada
| | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK, Canada,Anxiety and Illness Behavior Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada
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Brummer J, Bloomfield K, Karriker-Jaffe KJ, Pedersen MM, Hesse M. Using the alcohol use disorders identification test to predict hospital admission for alcohol-related conditions in the Danish general population: a record-linkage study. Addiction 2023; 118:86-94. [PMID: 35993432 PMCID: PMC10087303 DOI: 10.1111/add.16034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Most studies validating the alcohol use disorders identification test (AUDIT) have either assessed its factor structure and/or test-retest reliability or used diagnostic interviews as validators of current alcohol use disorders. The aim of the present study was to determine whether AUDIT and AUDIT-Consumption (AUDIT-C) scores are associated with subsequent risk of hospital admission for alcohol-related disorders and diseases (ARDDs). DESIGN We used a historical cohort study. Using national registers, survey respondents were tracked from 1 September 2011 to hospitalization for an ARDD, emigration, death, or 31 December 2018, whichever occurred first. SETTING Denmark. PARTICIPANTS Respondents (n = 4522) from a Danish national survey conducted in autumn 2011. MEASUREMENTS Outcome was incident ARDD admission recorded in the National Patient Register. Predictors were AUDIT and AUDIT-C scores, and covariates were age, gender, highest level of education and previous psychiatric disorder. FINDINGS During the study period, 56 respondents had a first-time ARDD admission. Respondents who scored above the 8-point AUDIT cut-off and respondents who scored above the 5-point AUDIT-C cut-off had a significantly increased risk of being admitted for an ARDD compared with respondents who scored below the cut-offs, (AUDIT: hazard ratio (HR), 4.72; 95% CI, 2.59-8.60; AUDIT-C: HR, 7.97; 95% CI, 3.66-17.31). CONCLUSIONS Scores above alcohol use disorders identification test (AUDIT) and AUDIT-Consumption (AUDIT-C) cut-offs are associated with an increased risk of long-term alcohol-related hospital admissions. At widely used cut-offs, the AUDIT-C is a better predictor of alcohol-related hospitalizations among members of the general population than the full AUDIT.
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Affiliation(s)
- Julie Brummer
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark
| | - Kim Bloomfield
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark.,Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.,Institute of Biometry and Clinical Epidemiology, Charité- Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark
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Bischof A, Brandt D, Schlossarek S, Vens M, Rozgonjuk D, Wernicke J, Kannen C, Wölfling K, Dreier M, Salbach H, Basenach L, Mößle T, Olbrich D, König I, Borgwardt S, Montag C, Rumpf HJ. Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study. BMJ Open 2022; 12:e061453. [PMID: 36323482 PMCID: PMC9639078 DOI: 10.1136/bmjopen-2022-061453] [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: 01/24/2023] Open
Abstract
INTRODUCTION Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). METHODS AND ANALYSIS The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. TRIAL REGISTRATION NUMBER DRKS00025994.
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Affiliation(s)
- Anja Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Dominique Brandt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Samantha Schlossarek
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
| | - Maren Vens
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Dmitri Rozgonjuk
- Department of Molecular Psychology, University of Ulm, Ulm, Germany
| | | | | | - Klaus Wölfling
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Dreier
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Harriet Salbach
- Department of Education and Psychology, Free University of Berlin, Berlin, Germany
- start: psychotherapy and coaching, Berlin, Germany
| | - Lara Basenach
- Department of Education and Psychology, Free University of Berlin, Berlin, Germany
- start: psychotherapy and coaching, Berlin, Germany
| | - Thomas Mößle
- Media Protect e.V, Emmendingen, Germany
- State Police College of Baden-Württemberg, Villingen-Schwenningen, Germany
| | - Denise Olbrich
- Center for Clinical Studies, University of Lübeck, Lubeck, Germany
| | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Christian Montag
- Department of Molecular Psychology, University of Ulm, Ulm, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
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6
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Miller AP, Fatch R, Lodi S, Marson K, Emenyonu N, Kekibiina A, Beesiga B, Chamie G, Muyindike WR, Hahn JA. Unhealthy alcohol use and intimate partner violence among men and women living with HIV in Uganda. BMC Public Health 2022; 22:1886. [PMID: 36217183 PMCID: PMC9552439 DOI: 10.1186/s12889-022-14295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Intimate partner violence (IPV) and alcohol use are interrelated public health issues. Heavy and frequent alcohol use increase the risk of IPV, but the relationship between alcohol use and IPV (including recent and lifetime IPV victimization and perpetration) has not been well described among persons living with HIV (PWH) in sub-Saharan Africa. Methods We used baseline data from the Drinker’s Intervention to Prevent Tuberculosis study. All participants were PWH co-infected with tuberculosis and had an Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive score (hazardous drinking) and positive urine ethyl glucuronide test, indicating recent drinking. High-risk drinking was defined as AUDIT-C > 6 and/or alcohol biomarker phosphatidylethanol (PEth) ≥ 200 ng/mL. We measured IPV using the Conflict Tactics Scale. We estimated the association between alcohol use level and recent (prior six months) IPV victimization (recent perpetration was too low to study) using multivariable logistic regression models adjusted for gender, age, assets, education, spouse HIV status, religiosity, depressive symptoms, and social desirability. We additionally estimated the interaction of alcohol use and gender on IPV victimization and the association between alcohol use and lifetime victimization and perpetration. Results One-third of the 408 participants were women. Recent IPV victimization was reported by 18.9% of women and 9.4% of men; perpetration was reported by 3.1% and 3.6% of women and men. One-fifth (21.6%) of those reporting recent IPV victimization also reported perpetration. In multivariable models, alcohol use level was not significantly associated with recent IPV victimization (p = 0.115), nor was the interaction between alcohol use and gender (p = 0.696). Women had 2.34 times greater odds of recent IPV victimization than men (p = 0.016). Increasing age was significantly associated with decreased odds of recent IPV victimization (p = 0.004). Conclusion Prevalence of IPV victimization was comparable to estimates from a recent national survey, while perpetration among men was lower than expected. Alcohol use level was not associated with IPV victimization. It is possible that alcohol use in this sample was too high to detect differences in IPV. Our results suggest that women and younger PWH are priority populations for IPV prevention.
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Affiliation(s)
- Amanda P Miller
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sara Lodi
- Boston University School of Public Health, Boston, MA, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie R Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Exploring changes in temporary abstinence in increasing and higher risk drinkers in England and Dry January participation in users of the Try Dry app in the UK between 2020 and 2021. BMC Public Health 2022; 22:1822. [PMID: 36163053 PMCID: PMC9510241 DOI: 10.1186/s12889-022-14188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups. METHODS We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex. RESULTS The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01]. CONCLUSIONS Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic.
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury‐Birch D, Patton R, Pellat‐Higgins T, Phillips C, Phillips T, Pockett RD, Russell IT, Strang J, Drummond C. Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to emergency departments: three-arm pragmatic randomized trial (SIPS Junior high risk trial). Addiction 2022; 117:2200-2214. [PMID: 35315170 PMCID: PMC9540754 DOI: 10.1111/add.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. DESIGN, SETTING AND PARTICIPANTS Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. INTERVENTIONS Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. MEASURES The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. FINDINGS At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. CONCLUSIONS In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.
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Affiliation(s)
- Paolo Deluca
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Simon Coulton
- Centre for Health Services StudiesUniversity of KentCanterburyUK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU HealthQatar UniversityQatar
| | - Sadie Boniface
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute of Alcohol StudiesAlliance HouseLondonUK
| | - Kim Donoghue
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK,Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Eileen Kaner
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ellen Lynch
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Ian Maconochie
- Paediatric Emergency MedicineImperial College London, Queen Elizabeth the Queen Mother Wing, St Mary's HospitalLondonUK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, St Nicholas HospitalNewcastle upon TyneUK
| | - Ruth McGovern
- Institute of Health and Society, Baddiley‐Clark BuildingNewcastle UniversityNewcastle upon TyneUK
| | | | - Robert Patton
- School of Psychology, Elizabeth Fry Building (AD)University of SurreyGuildfordUK
| | | | | | - Thomas Phillips
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Institute for Clinical and Applied Health ResearchUniversity of HullHullUK
| | | | - Ian T. Russell
- Swansea Centre for Health Economics, College of Human and Health SciencesSwansea UniversitySwanseaUK
| | - John Strang
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Colin Drummond
- Addictions DepartmentNational Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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Schiller J, Simonsson B, Molarius A. At-risk drinking, loneliness and self-reported diagnosed depression among older people, 70-84 years of age. Aging Ment Health 2022; 27:1037-1044. [PMID: 35866543 DOI: 10.1080/13607863.2022.2098919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES At-risk drinking of alcohol is increasing in the older population and both at-risk drinking and loneliness have been shown to be risk factors for depression. The aim of this study was therefore to investigate the associations between at-risk drinking, loneliness, and self-reported diagnosed depression in the older population. METHODS The study was based on 10,096 persons aged 70-84 years who answered a survey questionnaire sent to a random population sample in Mid-Sweden in 2017. The overall response rate was 77%. The associations between at-risk drinking, loneliness and depression were analysed using multivariate logistic regression, adjusting for age, educational level, country of birth, economic stress, social support, living alone, physical activity, smoking, BMI, and medication use. RESULTS The prevalence of at-risk drinking during the last 12 months was 8% among men and 4% among women. In total, 8% of the men and 14% of the women suffered from loneliness at least weekly. Having a current diagnosed depression was more commonly reported among women (9%) than among men (5%). At-risk drinking was associated with a higher prevalence of diagnosed depression in both men (OR:1.76; 95% CI:1.03-3.01) and women (OR:1.83; 95% CI:1.06-3.18), compared to moderate drinking when adjusting for loneliness and potential confounders. Furthermore, persons who suffered from loneliness every week had a higher prevalence of diagnosed depression (OR:5.95; 95% CI:3.72-9.53 in men and OR:4.80; 95% CI:3.44-6.69 in women) than those who did not suffer from loneliness. CONCLUSION In this population-based study, both at-risk drinking and loneliness were independently associated with self-reported diagnosed depression among men and women aged 70-84 years. These findings are important for prevention of depression among older people.
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Affiliation(s)
- Jim Schiller
- Unit for Public Health, Region Västmanland, Västerås, Sweden
| | - Bo Simonsson
- Unit for Public Health, Region Västmanland, Västerås, Sweden
| | - Anu Molarius
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden.,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
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A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study. Viruses 2022; 14:v14071555. [PMID: 35891535 PMCID: PMC9316739 DOI: 10.3390/v14071555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.
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Salmi LR, Noël L, Saillour-Glénisson F. [Decision-making process and evaluation of public health interventions]. Rev Epidemiol Sante Publique 2022; 71:101384. [PMID: 35831220 PMCID: PMC9271323 DOI: 10.1016/j.respe.2022.06.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
Objectif Nous proposons un cadre méthodologique destiné aux experts impliqués dans l'appui à la décision concernant les interventions de santé publique. Méthodes Le cadre méthodologique comprend quatre éléments : 1) une série de neuf questions, formulées en termes non techniques, pertinentes pour juger de l'utilité d'une intervention, considérée à un moment donné dans un contexte donné ; 2) une traduction de ces questions en concepts liés à l'évaluation des interventions (définition de l'intervention, de sa cible et de son objectif, efficacités potentielle et réelle, sécurité, efficience et équité) ; 3) une organisation logique des informations nécessaires pour répondre aux questions ; 4) un algorithme permettant de traduire les informations disponibles en recommandations sur l'utilité réelle de l'intervention dans le contexte où les questions ont été posées. Résultats Chaque étape est illustrée par des questions posées sur des interventions de sécurité routière, le dépistage, la transfusion sanguine et des mesures proposées pendant la pandémie de COVID-19. Conclusion La décision peut être facilitée si les experts fournissent aux décideurs un résumé formel des forces et faiblesses des connaissances, fondé sur une analyse de toutes les facettes de l'utilité potentielle d'une intervention.
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Affiliation(s)
- L-R Salmi
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France.
| | - L Noël
- Consultant, F-74940 Annecy-Le-Vieux, France
| | - F Saillour-Glénisson
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de Santé Publique, Service d'information médicale, F-33000 Bordeaux, France
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Dutey-Magni P, Brown J, Holmes J, Sinclair J. Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT. Addiction 2022; 117:580-589. [PMID: 34374144 DOI: 10.1111/add.15662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. DESIGN Cross-sectional diagnostic study based on a nationally-representative survey. SETTINGS Community dwelling households in England. PARTICIPANTS A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. MEASUREMENTS Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. FINDINGS EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). CONCLUSIONS A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
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Affiliation(s)
- Peter Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jamie Brown
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
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Le SM, Trouiller P, Duong TH, Khuat THO, Pham MK, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, Nham TTT, Hoang TG, Feelemyer J, Vu HV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs. Drug Alcohol Rev 2022; 41:697-705. [PMID: 34786755 PMCID: PMC10150937 DOI: 10.1111/dar.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. METHODS We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. RESULTS CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. DISCUSSION AND CONCLUSIONS The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
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Affiliation(s)
- Sao M Le
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Thi H Duong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi H O Khuat
- Supporting Community Development Initiatives, Hanoi, Vietnam
| | - Minh K Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Thuy L Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Quang D Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Thi G Hoang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hai V Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Hong Q Doan
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, Nîmes, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
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Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. Restructuring personal networks with a Motivational Interviewing social network intervention to assist the transition out of homelessness: A randomized control pilot study. PLoS One 2022; 17:e0262210. [PMID: 35061795 PMCID: PMC8782388 DOI: 10.1371/journal.pone.0262210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social relationships play a key role in both substance use and homelessness. Transitioning out of homelessness often requires reduction in substance use as well as changes in social networks. A social network-based behavior change intervention that targets changes personal social networks may assist the transition out of homelessness. Most behavior change interventions that incorporate social networks assume a static network. However, people experiencing homelessness who transition into housing programs that use a harm reduction approach experience many changes in their social networks during this transition. Changes may include disconnecting from street-based network contacts, re-connecting with former network contacts, and exposure to new network members who actively engage in substance use. An intervention that helps people transitioning out of homelessness make positive alterations to their social networks may compliment traditional harm reduction housing program services. METHODS We conducted a pilot randomized controlled trial (RCT) of an innovative Social Network Intervention (MI-SNI), which combines network visualization and Motivational Interviewing to assist adults transitioning out of homelessness. The MI-SNI provides feedback to new residents about their social environments and is designed to motivate residents to make positive changes in both their individual behavior and their personal network. In a sample of 41 adult housing program residents with past year risky substance use, we examined whether participants randomized to receive a MI-SNI showed greater changes in their personal networks over 3 months compared to those receiving usual care. RESULTS There were significant differences in the networks of the MI-SNI group compared to the group receiving usual care at follow-up, controlling for baseline network characteristics. The MI-SNI group had greater reductions in the proportion of their network members who influenced alcohol or other drug use (AOD) use, such as drinking partners, and more frequently changed their relationships in the direction of lower AOD risk with network members who were retained in their networks across waves. CONCLUSIONS This study is the first pilot test of a MI-SNI customized for assisting the transition out of homelessness to test for personal network changes. Results indicate that MI-SNIs can have a positive impact on short-term network changes and thus may serve as a useful adjunct to behavioral change interventions. These findings suggest that a MI-SNI approach may help individuals experiencing homelessness and risky AOD use positively restructure their social networks while transitioning into supportive housing. These promising results suggest the need for a larger RCT test of this innovative intervention approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02140359.
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Affiliation(s)
- David P. Kennedy
- RAND Corporation, Santa Monica, California, United States of America
- * E-mail:
| | - Karen Chan Osilla
- RAND Corporation, Santa Monica, California, United States of America
| | - Sarah B. Hunter
- RAND Corporation, Santa Monica, California, United States of America
| | - Daniela Golinelli
- RAND Corporation, Santa Monica, California, United States of America
| | | | - Joan S. Tucker
- RAND Corporation, Santa Monica, California, United States of America
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Kang JM, Cho SJ, Cho SE, Bang T, Chae BD, Yi E, Bae SM, Na KS, Jung J, Kang SG. Mood and Sleep Status and Mental Disorders During Prolonged Winter-Over Residence in Two Korean Antarctic Stations. Nat Sci Sleep 2022; 14:1387-1396. [PMID: 35982827 PMCID: PMC9379312 DOI: 10.2147/nss.s370659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Antarctica is a region with extreme climate, characterized by extreme cold and photoperiod. No research has been conducted on the mental health of Korean Antarctic dispatchers. The aim of this study was to investigate the status of mental illness and changes in mood and sleep among Korean crew members staying for a long-term period in the Antarctic station. METHODS From 2017 to 2020, crew members who were dispatched from South Korea to two Antarctic stations for a one-year period participated in this study. The crew were evaluated for mood and sleep status and mental illness through psychological tests and interviews by board-certified psychiatrists once before departure and twice during their stay in Antarctica. The incidence of mental illness was confirmed and changes in sleep and depression were analyzed. RESULTS A total of 88 participants were included in the final analysis, and 7 of them (8.0%) were diagnosed with mental disorders such as insomnia in early winter. The total Beck Depression Inventory (BDI) score increased significantly in the early winter period, and the total Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Inventory (PSQI) scores increased in both early and late winter. The difference in changes in mood and sleep symptoms before, during, and after dispatch between the two stations was not significant. CONCLUSION This is the first study to investigate the mental illness and mood and sleep status of Korean crews dispatched to Antarctica. In early winter, there were significant increases in mental illness and depressive symptoms, and a worsening of sleep status.
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Taemo Bang
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Byung Do Chae
- Unit of Frontier Exploration, Korea Polar Research Institute, Incheon, Republic of Korea
| | - Eojin Yi
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Min Bae
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Schmits E, Glowacz F. Changes in Alcohol Use During the COVID-19 Pandemic: Impact of the Lockdown Conditions and Mental Health Factors. Int J Ment Health Addict 2022; 20:1147-1158. [PMID: 33424513 PMCID: PMC7781407 DOI: 10.1007/s11469-020-00432-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic has led to governments taking a number of restrictive measures. Confinement at home during the COVID-19 crisis could have major implications on mental health and alcohol use behaviors among the whole population. The present study focuses on the role of individual characteristics, contextual factors, and mental health variables on alcohol consumption. A sample of 2871 adults (79% women) were recruited from the general population through an online self-report questionnaire. Sociodemographic data, lockdown conditions, occupational/physical activity, proximity of contamination, mental health (anxiety, depression, and intolerance of uncertainty), and alcohol consumption (frequency, quantity, and changes) have been assessed. Among participants, 49.1% of the population reported stable alcohol consumption, 24.5% reported a decreased in alcohol consumption since the beginning of the lockdown and 26.4% reported an increase in consumption. Our findings indicate that those individuals who increased their alcohol consumption during the lockdown are often older, working from home, more likely to have children, higher educated, and consume alcohol more frequently and in higher quantities. They also have a greater proximity to contamination and higher levels of anxiety and depression. Our results are discussed in terms of preventive implications.
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Affiliation(s)
- E. Schmits
- grid.4861.b0000 0001 0805 7253Psychologie Clinique de la Délinquance, Unité de Recherche Adaptation, Résilience et Changement (ARCh), Faculté de Psychologie, Logopédie et Sciences de l’Education (FPLSE), Université de Liège, Liège, Belgium
| | - F. Glowacz
- grid.4861.b0000 0001 0805 7253Psychologie Clinique de la Délinquance, Unité de Recherche Adaptation, Résilience et Changement (ARCh), Faculté de Psychologie, Logopédie et Sciences de l’Education (FPLSE), Université de Liège, Liège, Belgium
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John U, Rumpf HJ, Hanke M, Meyer C. Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study. PLoS Med 2021; 18:e1003819. [PMID: 34727120 PMCID: PMC8562854 DOI: 10.1371/journal.pmed.1003819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. METHODS AND FINDINGS A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption. CONCLUSIONS The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.
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Affiliation(s)
- Ulrich John
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- * E-mail:
| | - Hans-Juergen Rumpf
- University of Luebeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP, Luebeck, Germany
| | - Monika Hanke
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
| | - Christian Meyer
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
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Choo WY, Lee U, Park JH, Shin YC, Sim M, Oh KS, Shin DW, Jeon SW, Kim MK, Cho SJ. The association between alcohol use and suicide attempt in employees. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: This study aimed to analyze the alcohol use patterns that may influence suicide attempt in employees who have suicidal ideation.Methods: The 15,199 participants were classified into three groups according to suicide risk severity. Participant scores on the Alcohol Use Disorders Identification Test-Korea (AUDIT-K), subscale for drinking amount/frequency (AUDIT-C, items 1–3), subscale for dependence/related problems (AUDIT-D/P, items 4–10), and other sociodemographic and psychiatric scales were analyzed between the groups using one-way analysis of variance (ANOVA) and the chi-square test, followed by post hoc analysis using the Bonferroni correction.Results: A statistically significant difference between all three groups was observed for AUDIT-D/P scores after post hoc analysis (P < 0.001), indicating an increasing trend for greater suicide risk. This trend was present in both sexes and across all age groups above 30 years old.Conclusion: Alcohol dependence/related problems are significantly associated with suicide attempt among employees. Assessing and preventing suicide risk according to these issues may minimize socioeconomic losses due to suicide.
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Kekibiina A, Adong J, Fatch R, Emenyonu NI, Marson K, Beesiga B, Lodi S, Muyindike WR, Kamya M, Chamie G, McDonell MG, Hahn JA. Post-traumatic stress disorder among persons with HIV who engage in heavy alcohol consumption in southwestern Uganda. BMC Psychiatry 2021; 21:457. [PMID: 34535103 PMCID: PMC8449437 DOI: 10.1186/s12888-021-03464-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to describe the prevalence of PTSD symptoms and its associated factors in persons living with HIV (PLWH) in Uganda who engage in heavy alcohol use. METHODS We analyzed baseline data from the Drinkers Intervention to Prevent Tuberculosis study which enrolls PLWH with latent tuberculosis who engage in heavy alcohol consumption. Using the primary care Post Traumatic Stress Disorder (PTSD) screening scale from the DSM-5 (PC-PTSD-5), probable PTSD was defined as reporting ≥3 of 5 assessed symptoms. We conducted the Alcohol Use Disorders Identification Test-Consumption and assessed demographics, smoking, symptoms of depression, and spirituality/religiosity. RESULTS Of 421 participants enrolled from 2018 through 2020, the majority (68.2%) were male, median age was 40 years (interquartile range [IQR]: 32-47), and median AUDIT-C score was 6 [IQR: 4-8]. Half (50.1%) of the participants reported ever experiencing a traumatic event, and 20.7% reported ≥3 symptoms of PTSD. The most commonly reported PTSD symptoms in the past 1 month in the entire sample were avoidance (28.3%), nightmares (27.3%), and being constantly on guard (21.6%). In multivariable logistic regression analyses, level of alcohol use was not associated with probable PTSD (adjusted odds ratio [AOR] for each AUDIT-C point: (1.02; 95% CI: 0.92-1.14; p = 0.69); however, lifetime smoking (AOR 1.89; 95% CI: 1.10-3.24) and reporting symptoms of depression (AOR 1.89; 95% CI: 1.04-3.44) were independently associated with probable PTSD. CONCLUSIONS AND RECOMMENDATIONS A history of traumatic events and probable PTSD were frequently reported among persons who engage in heavy drinking, living with HIV in Uganda. Level of alcohol use was not associated with probable PTSD in this sample of PLWH with heavy alcohol use, however other behavioral and mental health factors were associated with probable PTSD. These data highlight the high prevalence of PTSD in this group, and the need for screening and interventions for PTSD and mental health problems.
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Affiliation(s)
- Allen Kekibiina
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Nneka I. Emenyonu
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Kara Marson
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Brian Beesiga
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Sara Lodi
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Winnie R. Muyindike
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.459749.20000 0000 9352 6415Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moses Kamya
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Michael G. McDonell
- grid.30064.310000 0001 2157 6568Elson S Floyd College of Medicine, Washington State University, Spokane, WA USA
| | - Judith A. Hahn
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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20
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Sherman SG, Tomko C, White RH, Nestadt DF, Silberzahn BE, Clouse E, Haney K, Galai N. Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers. Sex Transm Dis 2021; 48:648-653. [PMID: 33633073 PMCID: PMC8360669 DOI: 10.1097/olq.0000000000001400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population. METHODS Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia). RESULTS Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion. CONCLUSIONS More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.
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Affiliation(s)
- Susan G. Sherman
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Tomko
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca Hamilton White
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Danielle Friedman Nestadt
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Emily Clouse
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Haney
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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21
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Sieben A, A.W. van Onzenoort H, J.H.M. van Laarhoven K, Bredie SJ, van Dulmen S. Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis. J Cardiovasc Nurs 2021; 36:489-497. [PMID: 32501862 PMCID: PMC8366598 DOI: 10.1097/jcn.0000000000000702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately. OBJECTIVE The first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined. METHODS In this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013. RESULTS Cardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present. CONCLUSION This study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.
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22
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Parrish C, Whitney BM, Nance RM, Puttkammer N, Fishman P, Christopoulos K, Fleming J, Heath S, Mathews WC, Chander G, Moore RD, Napravnik S, Webel A, Delaney J, Crane HM, Kitahata MM. Substance use and HIV stage at entry into care among people with HIV. Arch Public Health 2021; 79:153. [PMID: 34454630 PMCID: PMC8401238 DOI: 10.1186/s13690-021-00677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Information regarding the impact of substance use on the timing of entry into HIV care is lacking. Better understanding of this relationship can help guide approaches and policies to improve HIV testing and linkage. METHODS We examined the effect of specific substances on stage of HIV disease at entry into care in over 5000 persons with HIV (PWH) newly enrolling in care. Substance use was obtained from the AUDIT-C and ASSIST instruments. We examined the association between early entry into care and substance use (high-risk alcohol, methamphetamine, cocaine/crack, illicit opioids, marijuana) using logistic and relative risk regression models adjusting for demographic factors, mental health symptoms and diagnoses, and clinical site. RESULTS We found that current methamphetamine use, past and current cocaine and marijuana use was associated with earlier entry into care compared with individuals who reported no use of these substances. CONCLUSION Early entry into care among those with substance use suggests that HIV testing may be differentially offered to people with known HIV risk factors, and that individuals with substances use disorders may be more likely to be tested and linked to care due to increased interactions with the healthcare system.
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Affiliation(s)
- Canada Parrish
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Bridget M. Whitney
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Robin M. Nance
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Nancy Puttkammer
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Paul Fishman
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Katerina Christopoulos
- grid.266102.10000 0001 2297 6811University of California San Francisco, San Francisco, CA USA
| | - Julia Fleming
- grid.245849.60000 0004 0457 1396Fenway Institute, Boston, MA USA
| | - Sonya Heath
- grid.265892.20000000106344187University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Geetanjali Chander
- grid.21107.350000 0001 2171 9311Johns Hopkins University, Baltimore, MD USA
| | - Richard D. Moore
- grid.21107.350000 0001 2171 9311Johns Hopkins University, Baltimore, MD USA
| | - Sonia Napravnik
- grid.10698.360000000122483208University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Allison Webel
- grid.67105.350000 0001 2164 3847Case Western Reserve University, Cleveland, OH USA
| | - Joseph Delaney
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA ,grid.21613.370000 0004 1936 9609University of Manitoba, Winnipeg, MB Canada
| | - Heidi M. Crane
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Mari M. Kitahata
- grid.34477.330000000122986657University of Washington, 1705 NE Pacific Street, Seattle, WA 98195 USA
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23
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Deluca P, Coulton S, Alam MF, Boniface S, Cohen D, Donoghue K, Gilvarry E, Kaner E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett RD, Russell I, Strang J, Drummond C. Brief interventions to prevent excessive alcohol use in adolescents at low-risk presenting to Emergency Departments: Three-arm, randomised trial of effectiveness and cost-effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103113. [PMID: 33487528 PMCID: PMC8261826 DOI: 10.1016/j.drugpo.2021.103113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Alcohol consumption and related harm increase rapidly from the age of 12 years. We evaluated whether alcohol screening and brief intervention is effective and cost-effective in delaying hazardous or harmful drinking amongst low-risk or abstaining adolescents attending Emergency Departments (EDs). METHODS This ten-centre, three-arm, parallel-group, single-blind, pragmatic, individually randomised trial screened ED attenders aged between 14 and 17 years for alcohol consumption. We sampled at random one third of those scoring at most 2 on AUDIT-C who had access to the internet and, if aged under 16, were Gillick competent or had informed consent from parent or guardian. We randomised them between: screening only (control intervention); one session of face-to-face Personalised Feedback and Brief Advice (PFBA); and PFBA plus an electronic brief intervention (eBI) on smartphone or web. We conducted follow-up after six and 12 months. The principal outcomes were alcohol consumed over the 3 months before 12-month follow up, measured by AUDIT-C; and quality-adjusted life-years. FINDINGS Between October 2014 and May 2015, we approached 5,016 eligible patients of whom 3,326 consented to be screened and participate in the trial; 2,571 of these were low-risk drinkers or abstainers, consuming an average 0.14 units per week. We randomised: 304 to screening only; 285 to PFBA; and 294 to PFBA and eBI. We found no significant difference between groups, notably in weekly alcohol consumption: those receiving screening only drank 0.10 units (95% confidence interval 0.05 to 0.18); PFBA 0.12 (0.06 to 0.21); PFBA and eBI 0.10 (0.05 to 0.19). INTERPRETATION While drinking levels remained low in this population, this trial found no evidence that PFBA with or without eBI was more effective than screening alone in reducing or delaying alcohol consumption.
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Affiliation(s)
- Paolo Deluca
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK.
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sadie Boniface
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Kim Donoghue
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - Thomas Phillips
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK,Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Rhys D. Pockett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - Ian Russell
- Medical School, Swansea University, Swansea, Wales, UK
| | - John Strang
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London UK
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24
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Albaugh MD, Ottino-Gonzalez J, Sidwell A, Lepage C, Juliano A, Owens MM, Chaarani B, Spechler P, Fontaine N, Rioux P, Lewis L, Jeon S, Evans A, D’Souza D, Radhakrishnan R, Banaschewski T, Bokde ALW, Quinlan EB, Conrod P, Desrivières S, Flor H, Grigis A, Gowland P, Heinz A, Ittermann B, Martinot JL, Paillère Martinot ML, Nees F, Papadopoulos Orfanos D, Paus T, Poustka L, Millenet S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Potter A, Garavan H. Association of Cannabis Use During Adolescence With Neurodevelopment. JAMA Psychiatry 2021; 78:2781289. [PMID: 34132750 PMCID: PMC8209561 DOI: 10.1001/jamapsychiatry.2021.1258] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/18/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Animal studies have shown that the adolescent brain is sensitive to disruptions in endocannabinoid signaling, resulting in altered neurodevelopment and lasting behavioral effects. However, few studies have investigated ties between cannabis use and adolescent brain development in humans. OBJECTIVE To examine the degree to which magnetic resonance (MR) imaging-assessed cerebral cortical thickness development is associated with cannabis use in a longitudinal sample of adolescents. DESIGN, SETTING, AND PARTICIPANTS Data were obtained from the community-based IMAGEN cohort study, conducted across 8 European sites. Baseline data used in the present study were acquired from March 1, 2008, to December 31, 2011, and follow-up data were acquired from January 1, 2013, to December 31, 2016. A total of 799 IMAGEN participants were identified who reported being cannabis naive at study baseline and had behavioral and neuroimaging data available at baseline and 5-year follow-up. Statistical analysis was performed from October 1, 2019, to August 31, 2020. MAIN OUTCOMES AND MEASURES Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. Anatomical MR images were acquired with a 3-dimensional T1-weighted magnetization prepared gradient echo sequence. Quality-controlled native MR images were processed through the CIVET pipeline, version 2.1.0. RESULTS The study evaluated 1598 MR images from 799 participants (450 female participants [56.3%]; mean [SD] age, 14.4 [0.4] years at baseline and 19.0 [0.7] years at follow-up). At 5-year follow-up, cannabis use (from 0 to >40 uses) was negatively associated with thickness in left prefrontal (peak: t785 = -4.87, cluster size = 1558 vertices; P = 1.10 × 10-6, random field theory cluster corrected) and right prefrontal (peak: t785 = -4.27, cluster size = 1551 vertices; P = 2.81 × 10-5, random field theory cluster corrected) cortices. There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. Longitudinal analysis revealed that age-related cortical thinning was qualified by cannabis use in a dose-dependent fashion such that greater use, from baseline to follow-up, was associated with increased thinning in left prefrontal (peak: t815.27 = -4.24, cluster size = 3643 vertices; P = 2.28 × 10-8, random field theory cluster corrected) and right prefrontal (peak: t813.30 = -4.71, cluster size = 2675 vertices; P = 3.72 × 10-8, random field theory cluster corrected) cortices. The spatial pattern of cannabis-related thinning was associated with age-related thinning in this sample (r = 0.540; P < .001), and a positron emission tomography-assessed cannabinoid 1 receptor-binding map derived from a separate sample of participants (r = -0.189; P < .001). Analysis revealed that thinning in right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up. CONCLUSIONS AND RELEVANCE Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.
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Affiliation(s)
- Matthew D. Albaugh
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | | | - Amanda Sidwell
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Claude Lepage
- McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Anthony Juliano
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Max M. Owens
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Bader Chaarani
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Philip Spechler
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Nicholas Fontaine
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Pierre Rioux
- McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Lindsay Lewis
- McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Seun Jeon
- McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Alan Evans
- McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Deepak D’Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arun L. W. Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry, Psychology, and Neuroscience, Social, Genetic & Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Patricia Conrod
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry, Psychology, and Neuroscience, Social, Genetic & Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Antoine Grigis
- NeuroSpin, Commissariat à l’Energie Atomique, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
- corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale U A10 “Trajectoires développementales en psychiatrie” Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 “Trajectoires développementales en psychiatrie,” Paris, France
- Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Paris, France
- AP-HP Sorbonne Université, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | | | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliane H. Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
- corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry, Psychology, and Neuroscience, Social, Genetic & Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- Centre for Population Neuroscience and Precision Medicine, Institute of Psychiatry, Psychology, and Neuroscience, Social, Genetic & Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- Centre for Population Neuroscience and Precision Medicine Research Group, Department of Psychiatry and Psychotherapy, Campus Charite Mitte, Humboldt University, Berlin, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Institute for Science and Technology of Brain-inspired Intelligence, Fudan University, Shanghai, PR China
| | - Alexandra Potter
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
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25
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Vera M, Obén A, Juarbe D, Hernández N, Pérez-Pedrogo C. Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:91-103. [PMID: 35813157 DOI: 10.1016/j.jbct.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n=30), ABBT (n=30), or treatment as usual (TAU) (n=30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.
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Affiliation(s)
- Mildred Vera
- Center for Evaluation and Sociomedical Research, Department of Health Services Administration, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Adriana Obén
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Deborah Juarbe
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Norberto Hernández
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Coralee Pérez-Pedrogo
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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26
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Jackson SE, Garnett C, Shahab L, Oldham M, Brown J. Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data. Addiction 2021; 116:1233-1244. [PMID: 33089562 PMCID: PMC8436745 DOI: 10.1111/add.15295] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England. DESIGN/SETTING Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown. PARTICIPANTS A total of 20 558 adults (≥ 16 years). MEASUREMENTS The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant). FINDINGS The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj = 1.32, 95% CI = 0.64-2.75). CONCLUSIONS Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.
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Affiliation(s)
- Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Claire Garnett
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Melissa Oldham
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
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Conigrave JH, Bradshaw EL, Conigrave KM, Ryan RM, Wilson S, Perry J, Doyle MF, Lee KSK. Alcohol consumption and dependence is linked to the extent that people experience need satisfaction while drinking alcohol in two Aboriginal and Torres Strait Islander communities. Addict Sci Clin Pract 2021; 16:23. [PMID: 33849650 PMCID: PMC8042904 DOI: 10.1186/s13722-021-00231-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use is a key concern for Aboriginal and Torres Strait Islander ('Indigenous Australian') communities. Due to systematic disadvantage and inter-generational trauma, Indigenous Australians may be less likely to have satisfied basic psychological needs (autonomy, competence, and relatedness). When people are need-thwarted, they may engage in compensatory behaviours to feel better in the short-term. We explore the relationship between perceived basic psychological needs satisfaction and alcohol consumption use among Indigenous Australians. Better understanding the functions that alcohol may play for some Indigenous Australian drinkers may aid communities, clinicians, and policy makers in improving programs for reducing drinking-related harms. METHODS We performed a cross-sectional survey of Indigenous Australians (aged 16 years or older) living in two South Australian communities. Participants were eligible if they had consumed any alcohol in the past 12 months. Spearman correlations and linear regressions were used to determine if feeling more autonomous, competent, and related to others (need satisfied) while drinking, was linked to alcohol consumption and dependence. RESULTS Controlling for participant demographics, reporting feeling need satisfied while drinking was linked to drinking more alcohol per day, reporting more frequent symptoms of alcohol dependence, spending more money on alcohol, and scoring higher on the AUDIT-C. CONCLUSIONS Unhealthy drinking may partly stem from attempts to satisfy basic psychological needs. Programs which support Indigenous Australians to meet basic psychological needs could reduce attempts to meet psychological needs through alcohol consumption.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia. .,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.
| | - Emma L Bradshaw
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Richard M Ryan
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - Scott Wilson
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,Aboriginal Drug & Alcohol Council SA, Aboriginal Corporation, Underdale, SA, Australia
| | - Jimmy Perry
- Aboriginal Drug & Alcohol Council SA, Aboriginal Corporation, Underdale, SA, Australia
| | - Michael F Doyle
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Drug Health Services, Level 6 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.,National Drug Research Institute, Faculty of Health Sciences,, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
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28
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Schindler AG, Baskin B, Juarez B, Janet Lee S, Hendrickson R, Pagulayan K, Zweifel LS, Raskind MA, Phillips PEM, Peskind ER, Cook DG. Repetitive blast mild traumatic brain injury increases ethanol sensitivity in male mice and risky drinking behavior in male combat veterans. Alcohol Clin Exp Res 2021; 45:1051-1064. [PMID: 33760264 DOI: 10.1111/acer.14605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is common in civilians and highly prevalent among military service members. mTBI can increase health risk behaviors (e.g., sensation seeking, impulsivity) and addiction risk (e.g., for alcohol use disorder (AUD)), but how mTBI and substance use might interact to promote addiction risk remains poorly understood. Likewise, potential differences in single vs. repetitive mTBI in relation to alcohol use/abuse have not been previously examined. METHODS Here, we examined how a history of single (1×) or repetitive (3×) blast exposure (blast-mTBI) affects ethanol (EtOH)-induced behavioral and physiological outcomes using an established mouse model of blast-mTBI. To investigate potential translational relevance, we also examined self-report responses to the Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C), a widely used measure to identify potential hazardous drinking and AUD, and used a novel unsupervised machine learning approach to investigate whether a history of blast-mTBI affected drinking behaviors in Iraq/Afghanistan Veterans. RESULTS Both single and repetitive blast-mTBI in mice increased the sedative properties of EtOH (with no change in tolerance or metabolism), but only repetitive blast potentiated EtOH-induced locomotor stimulation and shifted EtOH intake patterns. Specifically, mice exposed to repetitive blasts showed increased consumption "front-loading" (e.g., a higher rate of consumption during an initial 2-h acute phase of a 24-h alcohol access period and decreased total daily intake) during an intermittent 2-bottle choice condition. Examination of AUDIT-C scores in Iraq/Afghanistan Veterans revealed an optimal 3-cluster solution: "low" (low intake and low frequency), "frequent" (low intake and high frequency), and "risky" (high intake and high frequency), where Veterans with a history of blast-mTBI displayed a shift in cluster assignment from "frequent" to "risky," as compared to Veterans who were deployed to Iraq/Afghanistan but had no lifetime history of TBI. CONCLUSIONS Together, these results offer new insight into how blast-mTBI may give increase AUD risk and highlight the increased potential for adverse health risk behaviors following repetitive blast-mTBI.
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Affiliation(s)
- Abigail G Schindler
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA
| | - Britahny Baskin
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA
| | - Barbara Juarez
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Suhjung Janet Lee
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Rebecca Hendrickson
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen Pagulayan
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Larry S Zweifel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA.,Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Murray A Raskind
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Paul E M Phillips
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA.,Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Elaine R Peskind
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - David G Cook
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, USA.,Department of Pharmacology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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29
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Madden M, Morris S, Ogden M, Lewis D, Stewart D, O'Carroll RE, McCambridge J. Introducing alcohol as a drug in medicine reviews with pharmacists: Findings from a co-design workshop with patients. Drug Alcohol Rev 2021; 40:1028-1036. [PMID: 33648016 DOI: 10.1111/dar.13255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol poses a range of potential problems to people taking medications, but health professionals are usually not comfortable talking about drinking with patients. The Medicines and Alcohol Consultation aims to increase the capacity of pharmacists to conduct person-centred reviews in which alcohol is regarded as another drug to be discussed alongside medications. This paper explores sensitivities in discussing alcohol and views on the legitimacy of the Medicines and Alcohol Consultation intervention concept at a pharmacy-user intervention co-design workshop. METHODS A co-design workshop was held with 14 people recruited from UK community pharmacies who regularly drank alcohol and took medications for long-term conditions. This formed one element of a broader, iterative, intervention co-production process. Workshop discussions were audio-recorded and analysed thematically. RESULTS The basic intervention concept resonated well, though not entirely unproblematically. Participants were interested in receiving information on how medications interact with alcohol and how this might affect their own conditions, with which to make their own informed choices. Linking alcohol use to medicines gave legitimacy to pharmacists to raise alcohol in medicines reviews. Sensitivity in talking about alcohol was linked to vulnerability to negative judgement. DISCUSSION AND CONCLUSIONS Changing the framing of alcohol in medicines reviews, away from being regarded as a 'lifestyle issue' to being considered a drug directly linked to medicines use, safety and effectiveness, was welcomed by participants in this study.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, University of York, York, UK
| | | | - Margaret Ogden
- Department of Health Sciences, University of York, York, UK
| | - David Lewis
- Department of Health Sciences, University of York, York, UK
| | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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30
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Nance RM, Trejo MEP, Whitney BM, Delaney JAC, Altice FL, Beckwith CG, Chander G, Chandler R, Christopoulous K, Cunningham C, Cunningham WE, Del Rio C, Donovan D, Eron JJ, Fredericksen RJ, Kahana S, Kitahata MM, Kronmal R, Kuo I, Kurth A, Mathews WC, Mayer KH, Moore RD, Mugavero MJ, Ouellet LJ, Quan VM, Saag MS, Simoni JM, Springer S, Strand L, Taxman F, Young JD, Crane HM. Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load. Clin Infect Dis 2021; 70:867-874. [PMID: 30994900 DOI: 10.1093/cid/ciz299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/11/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. METHODS This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4-2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). CONCLUSIONS Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.
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Affiliation(s)
- Robin M Nance
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Maria Esther Perez Trejo
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Bridget M Whitney
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Joseph A C Delaney
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Fredrick L Altice
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Curt G Beckwith
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Chinazo Cunningham
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | - Carlos Del Rio
- Department of Global Health, Emory University, Atlanta, Georgia
| | - Dennis Donovan
- Department of Psychiatry, University of Washington, Seattle
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill
| | | | | | | | - Richard Kronmal
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Irene Kuo
- Department of Epidemiology, George Washington University, Washington, DC
| | - Ann Kurth
- School of Nursing, Yale University School of Medicine, New Haven, Connecticut
| | - W Chris Mathews
- Department of Medicine, University of California-San Diego, UCSD Medical Center
| | | | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Vu M Quan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael S Saag
- Department of Medicine, University of Alabama-Birmingham
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle
| | - Sandra Springer
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lauren Strand
- Department of Biostatistics, University of Washington, Collaborative Health Studies Coordinating Center, Seattle
| | - Faye Taxman
- Department of Criminology, George Mason University, Fairfax, Virginia
| | | | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
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31
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Williams EC, McGinnis KA, Rubinsky AD, Matson TE, Bobb JF, Lapham GT, Edelman EJ, Satre DD, Catz SL, Richards JE, Bryant KJ, Marshall BDL, Kraemer KL, Crystal S, Gordon AJ, Skanderson M, Fiellin DA, Justice AC, Bradley KA. Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence? AIDS Behav 2021; 25:203-214. [PMID: 32617778 DOI: 10.1007/s10461-020-02950-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH). Dynamic longitudinal associations are understudied. Veterans Aging Cohort Study (VACS) data 2/1/2008-7/31/16 were used to fit linear regression models estimating changes in adherence (% days with ART medication fill) associated with changes in alcohol use based on annual clinically-ascertained AUDIT-C screening scores (range - 12 to + 12, 0 = no change) adjusting for demographics and initial adherence. Among 21,275 PLWH (67,330 observations), most reported no (48%) or low-level (39%) alcohol use initially, with no (55%) or small (39% ≤ 3 points) annual change. Mean initial adherence was 86% (SD 21%), mean annual change was - 3.1% (SD 21%). An inverted V-shaped association was observed: both increases and decreases in AUDIT-C were associated with greater adherence decreases relative to stable scores [p < 0.001, F (4, 21,274)]. PLWH with dynamic alcohol use (potentially indicative of alcohol use disorder) should be considered for adherence interventions.
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Affiliation(s)
- Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
- Department of Health Services, University of Washington, Seattle, WA, USA.
| | - Kathleen A McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kidney Health Research Collaborative, University of California, San Francisco and VA San Francisco Health Care System, San Francisco, CA, USA
| | - Theresa E Matson
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gwen T Lapham
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - E Jennifer Edelman
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Julie E Richards
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Stephen Crystal
- Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Melissa Skanderson
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - David A Fiellin
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Katharine A Bradley
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System-Seattle Division, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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A Cross-Sectional Study on the Affordable Care Act from the Perspective of People Living with HIV: The Interplay between Knowledge, Stigma, Trust, and Attitudes. AIDS Res Treat 2020; 2020:6081721. [PMID: 33376606 PMCID: PMC7744239 DOI: 10.1155/2020/6081721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Many AIDS Drug Assistance Programs (ADAPs) purchased Affordable Care Act (ACA) Qualified Health Plans (QHPs) for low-income people living with HIV (PLWH). To date, little has been published about PLWH's perspective on the ACA. We explored ACA knowledge, HIV stigma, trust in the healthcare system, and ACA attitudes among PLWH with ADAP-funded QHPs in Virginia. Methods Participants were surveyed about demographic characteristics, ACA knowledge, HIV stigma, trust in various healthcare and government entities, and attitudes toward the ACA. Descriptive statistics were used. We assessed for associations (1) between baseline characteristics and correct ACA knowledge, HIV-related stigma, trust, and ACA attitudes and (2) between correct ACA knowledge and the following data: sources of ACA knowledge, HIV stigma, and trust. Results Participants (n = 53) were a vulnerable population based on the assessment of social determinants of health, and 30% had correct ACA knowledge. Almost three-fourths of participants used HIV clinic case managers for ACA information. Participants who used websites for ACA information had correct ACA knowledge more often compared to those that did not (71% vs. 15%; p = 0.001). Those with correct ACA knowledge had lower stigma scores compared to those without correct ACA knowledge (93.8; SD: 15.4 vs. 108; SD: 20.3; p = 0.01). Participants trusted HIV clinicians more than general clinicians and insurance companies. No association was found between having correct ACA knowledge and endorsing having enough information about the ACA to understand how it will impact their HIV care. Conclusions Websites imparted accurate ACA information. HIV clinic case managers were the most used source, and HIV clinicians were a trusted source of information. HIV clinicians and case managers should consider disseminating information about the ACA and its impact on HIV care delivery via internet videos. Lack of internet and stigma are a threat to PLWH gaining actionable healthcare information.
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Rombouts SA, Conigrave JH, Saitz R, Louie E, Haber P, Morley KC. Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review. BMC FAMILY PRACTICE 2020; 21:260. [PMID: 33278891 PMCID: PMC7719241 DOI: 10.1186/s12875-020-01288-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/14/2022]
Abstract
Background Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients. We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings. Methods We conducted a systematic review of articles published worldwide (1998-present) using the following databases; Medline, PsycINFO, Cochrane database of systematic reviews, Cochrane Central Register of Controlled Trials and Embase. The Grey Matters Tool guided the grey literature search. We selected randomised controlled trials evaluating the effectiveness of a primary care model in the management of AUD. Two researchers independently assessed and then reached agreement on the included studies. We used the Cochrane risk of bias tool 2.0 for the critical appraisal. Results Eleven studies (4186 participants) were included. We categorised the studies into ‘lower’ versus ‘higher’ intensity given the varying intensity of clinical care evaluated across the studies. Significant differences in treatment uptake were reported by most studies. The uptake of AUD medication was reported in 5 out of 6 studies that offered AUD medication. Three studies reported a significantly higher uptake of AUD medication in the intervention group. A significant reduction in alcohol use was reported in two out of the five studies with lower intensity of care, and three out of six studies with higher intensity of care. Conclusion Our results suggest that models of care in primary care settings can increase treatment uptake (e.g. psychosocial and/or pharmacotherapy) although results for alcohol-related outcomes were mixed. More research is required to determine which specific patient groups are suitable for AUD treatment in primary health care settings and to identify which models and components are most effective. Trial Registration PROSPERO: CRD42019120293.
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Affiliation(s)
- Susan A Rombouts
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - James H Conigrave
- Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Richard Saitz
- Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA
| | - Eva Louie
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Holmes J, Beard E, Brown J, Brennan A, Meier PS, Michie S, Stevely AK, Webster L, Buykx PF. Effects on alcohol consumption of announcing and implementing revised UK low-risk drinking guidelines: findings from an interrupted time series analysis. J Epidemiol Community Health 2020; 74:942-949. [PMID: 32684524 PMCID: PMC7576577 DOI: 10.1136/jech-2020-213820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/21/2020] [Accepted: 06/06/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND In January 2016, the UK announced and began implementing revised guidelines for low-risk drinking of 14 units (112 g) per week for men and women. This was a reduction from the previous guidelines for men of 3-4 units (24-32 g) per day. There was no large-scale promotion of the revised guidelines beyond the initial media announcement. This paper evaluates the effect of announcing the revised guidelines on alcohol consumption among adults in England. METHODS Data come from a monthly repeat cross-sectional survey of approximately 1700 adults living in private households in England collected between March 2014 and October 2017. The primary outcomes are change in level and time trend of participants' Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores. RESULTS In December 2015, the modelled average AUDIT-C score was 2.719 out of 12 and was decreasing by 0.003 each month. After January 2016, AUDIT-C scores increased immediately but non-significantly to 2.720 (β=0.001, CI -0.079 to 0.099) and the trend changed significantly such that scores subsequently increased by 0.005 each month (β=0.008, CI 0.001 to 0.015), equivalent to 0.5% of the population increasing their AUDIT-C score by 1 point each month. Secondary analyses indicated the change in trend began 7 months before the guideline announcement and that AUDIT-C scores reduced significantly but temporarily for 4 months after the announcement (β=-0.087, CI -0.167 to 0.007). CONCLUSIONS Announcing new UK drinking guidelines did not lead to a substantial or sustained reduction in drinking or a downturn in the long-term trend in alcohol consumption, but there was evidence of a temporary reduction in consumption.
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Affiliation(s)
- John Holmes
- ScHARR, University of Sheffield, Sheffield, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research center, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research center, University College London, London, UK
| | | | | | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | - Penny F Buykx
- ScHARR, University of Sheffield, Sheffield, UK
- School of Humanities and Social Science, University of Newcastle Medical Society, Newcastle, Australia
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A Cross-Sectional Analysis of Tobacco Use and Concurrent Alcohol and Substance Use Among Patients Living with HIV/HCV Co-infection: Findings from a Large Urban Tertiary Center. J Clin Psychol Med Settings 2020; 28:553-561. [PMID: 33001329 PMCID: PMC7528154 DOI: 10.1007/s10880-020-09744-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/29/2023]
Abstract
This study aimed to assess the prevalence of and factors associated with tobacco use among patients living with HIV/HCV co-infection. Patient reported outcomes (PROs) were analyzed of patients living with HIV/HCV co-infection (n = 313) who presented for clinical evaluation and treatment of HCV between 2013 and 2017 at a university-affiliated HIV/HCV Co-infection Clinic. The prevalence of tobacco use in patients living with HIV/HCV co-infection was 48%. Compared to non-smokers, a higher proportion of tobacco smokers had substance use disorders and concurrent alcohol and substance use. In the multivariate analysis, concurrent alcohol and substance use was positively associated with tobacco use. The findings suggest clinical interventions are urgently needed to reduce tobacco use among patients living with HIV/HCV co-infection—a doubly-vulnerable immunocompromised population. Otherwise, failed efforts to dedicate resources and targeted behavioral interventions for this respective population will inhibit survival—especially considering the recent and evolving COVID-19 pandemic.
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Sims OT, Wang K, Chandler R, Melton PA, Truong DN. A descriptive analysis of concurrent alcohol and substance use among patients living with HIV/HCV co-infection. SOCIAL WORK IN HEALTH CARE 2020; 59:525-541. [PMID: 32873213 PMCID: PMC9494867 DOI: 10.1080/00981389.2020.1814938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The objectives of this study were to estimate the prevalence of concurrent alcohol and substance use among patients living with HIV/HCV co-infection and to compare demographic and clinical characteristics of those with concurrent alcohol and substance to those with alcohol or substance use, and to those who were abstinent. We conducted an analysis of patient reported outcomes data of patients living with HIV/HCV co-infection (n = 327) who transitioned from primary care to sub-specialty care for evaluation of candidacy for HCV treatment at a university-affiliated HIV Clinic. The prevalence of self-reported concurrent alcohol and substance use was 33%. A higher proportion of those with concurrent alcohol and substance use were currently smoking tobacco, and those who were abstinent had higher ratings of health-related quality of life compared to those with alcohol or substance use. To reduce patients' risk for progression to advanced stages of HIV, HCV, and liver-related disease due to continued alcohol and substance and tobacco use, social workers and other health care professionals are encouraged to develop and implement intervention strategies to assist patients living with HIV/HCV co-infection in efforts to achieve behavioral change.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Integrative Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Mathematics and Statistics, College of Arts and Sciences, Georgia State University , Atlanta, GA, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
- School of Nursing, Emory University , Atlanta, GA, USA
| | - Pamela A Melton
- School of Social Work, Tulane University , New Orleans, LA, USA
| | - Duong N Truong
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
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Krist AH, O'Loughlin K, Woolf SH, Sabo RT, Hinesley J, Kuzel AJ, Rybarczyk BD, Kashiri PL, Brooks EM, Glasgow RE, Huebschmann AG, Liaw WR. Enhanced care planning and clinical-community linkages versus usual care to address basic needs of patients with multiple chronic conditions: a clinician-level randomized controlled trial. Trials 2020; 21:517. [PMID: 32527322 PMCID: PMC7291479 DOI: 10.1186/s13063-020-04463-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Many patients with poorly controlled multiple chronic conditions (MCC) also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management of MCC may have limited benefit if patients are struggling to address their basic life needs. Health systems and communities increasingly recognize the need to address these issues and are experimenting with and investing in new models for connecting patients with needed services. Yet primary care clinicians, whose regular contact with patients makes them more familiar with patients’ needs, are often not included in these systems. Methods We are starting a clinician-level cluster-randomized controlled trial to evaluate how primary care clinicians can participate in these community and hospital solutions and whether doing so is effective in controlling MCC. Sixty clinicians in the Virginia Ambulatory Care Outcomes Research Network will be matched by age and sex and randomized to usual care (control condition) or enhanced care planning with clinical-community linkage support (intervention). From the electronic health record we will identify all patients with MCC, including cardiovascular disease or risks, diabetes, obesity, or depression. A baseline assessment will be mailed to up to 50 randomly selected patients for each clinician (3000 total). Ten respondents per clinician (600 patients total) with uncontrolled MCC will be randomly selected for study inclusion, with oversampling of minorities. The intervention includes two components. First, we will use an enhanced care planning tool, My Own Health Report (MOHR), to screen patients for health behavior, mental health, and social needs. Patients will be supported by a patient navigator, who will help patients prioritize needs, create care plans, and write a personal narrative to guide the care team. Patients will update care plans every 1 to 2 weeks. Second, we will create community-clinical linkage to help address patients’ needs. The linkage will include community resource registries, personnel to span settings (patient navigators and a community health worker), and care team coordination across team members through MOHR. Discussion This study will help inform efforts by primary care clinicians to help address unhealthy behaviors, mental health needs, and social risks as a strategy to better control MCC. Trial registration ClinicalTrials.gov: NCT03885401. Registered on 19 September 2019.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.
| | - Kristen O'Loughlin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.,Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Hinesley
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Anton J Kuzel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Bruce D Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paulette Lail Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - E Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Russel E Glasgow
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy G Huebschmann
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Winston R Liaw
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX, USA
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38
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Mauz E, Lange M, Houben R, Hoffmann R, Allen J, Gößwald A, Hölling H, Lampert T, Lange C, Poethko-Müller C, Richter A, Rosario AS, von Schenck U, Ziese T, Kurth BM. Cohort profile: KiGGS cohort longitudinal study on the health of children, adolescents and young adults in Germany. Int J Epidemiol 2020; 49:375-375k. [PMID: 31794018 PMCID: PMC7266535 DOI: 10.1093/ije/dyz231] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Elvira Mauz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robin Houben
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robert Hoffmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jennifer Allen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Almut Richter
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Ursula von Schenck
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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King C, Giang LM, Bart G, Kunkel L, Korthuis PT. HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study. BMC Public Health 2020; 20:421. [PMID: 32228522 PMCID: PMC7106608 DOI: 10.1186/s12889-020-08538-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam. METHODS We assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression. RESULTS Among 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) were virally suppressed. Years since HIV diagnosis (aOR = 1.12, 95% CI 1.06, 1.19) and being married (aOR = 2.83, 95% CI 1.51, 5.34) were associated with an increased likelihood of current prescription for ART at baseline. Greater depression symptoms were negatively associated with receipt of ART (aOR = 0.97, 95% CI = (0.94, 0.9963)). In the HIV suppression model, once adjusting for all included covariates, only receipt of ART was associated with viral suppression (aOR = 25.9, 95% CI = (12.5, 53.8). In bivariate analyses, methamphetamine was negatively correlated with ART prescription (p = 0.07) and viral suppression (p = 0.08). CONCLUSION While fewer than 90% of participants had received ART, 90% of those on ART had achieved HIV viral suppression at baseline, suggesting that interventions to improve uptake of ART in Vietnam are essential for achieving UNAIDS 90-90-90 goals in people who use heroin in Vietnam. Social determinants of health associated with ART and HIV viral suppression suggest that social support may be a key to facilitating both of these steps in the HIV care continuum.
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Affiliation(s)
- Caroline King
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA.
- MD/PhD Program, School of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | | | - Gavin Bart
- Hennepin Healthcare, Minneapolis, MN, USA
| | - Lynn Kunkel
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA
| | - P Todd Korthuis
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
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40
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Fazzino TL, Lejuez CW, Yi R. A behavioral activation intervention administered in a 16-week freshman orientation course: Study protocol. Contemp Clin Trials 2020; 90:105950. [PMID: 31982647 PMCID: PMC7279510 DOI: 10.1016/j.cct.2020.105950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The transition from high school to college is a developmentally sensitive period that is high-risk for the escalation of alcohol use. Although risky drinking is a common problem among freshmen, engagement in treatment services is very low. College alcohol interventions target drinking directly at a time when students may be uninterested in changing their drinking. Approaches that indirectly target drinking may be particularly effective. Behavioral activation (BA) is an intervention that indirectly addresses mental health conditions by guiding individuals to engage in reinforcing activities that align with their values (Lejuez et al., 2001). A pilot study of a BA intervention administered in a semester-long freshman orientation course reported a significant decrease in drinking-related problems compared to students in standard orientation course (Reynolds et al., 2011). METHODS The cluster-randomized trial will test the efficacy of BA administered in a semester-long (16 week) freshman orientation course, compared to a standard orientation course in 540 freshmen spread over 36 course sections (18 sections each). A 5-month post-treatment assessment will measure durability of effects. DISCUSSION The study will test a promising BA intervention that addresses factors limiting participation in other programs by targeting alcohol use indirectly and by integrating an intervention into college curriculum. This study represents a first step toward developing an intervention course that could be widely disseminated to address the persistent college drinking problem and its consequences. CLINICAL TRIALS REGISTRATION NUMBER NCT04038190.
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Affiliation(s)
- Tera L Fazzino
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America.
| | - Carl W Lejuez
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America
| | - Richard Yi
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America
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41
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Loer AKM, Domanska OM, Kuhnert R, Houben R, Albrecht S, Jordan S. Online Survey for the Assessment of Generic Health Literacy among Adolescents in Germany (GeKoJu): Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1518. [PMID: 32120870 PMCID: PMC7084343 DOI: 10.3390/ijerph17051518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
The promotion of health literacy at a young age can protect, maintain and improve health across the life course. Yet to date, a sound data basis on adolescent health literacy as a requirement for the development of strategies to promote health literacy has not been given. This paper presents a study protocol for the online survey "Health Literacy Among Adolescents" (GeKoJu) that collects the first nation-wide representative data on self-reported generic health among adolescents aged 14-17 years in Germany. The objectives of the survey are (1) to assess the distribution of generic health literacy among adolescents in Germany, (2) to identify socio-demographic and social factors in regard to health literacy and (3) to assess the association of health literacy and health-related outcomes. The cross-sectional survey was conducted from September 2019 through December 2019. A two-stage stratified cluster sampling strategy was applied. Individuals invited to participate in the survey (N = 6608) were randomly selected among German-speaking adolescents aged 14-17 years, with permanent residence in Germany. Generic health literacy is measured with the "Measurement of Health Literacy Among Adolescents-Questionnaire" (MOHLAA-Q). Data collection also covers questions on health behavior, subjective health status, personal and social resources, socio-demographic and social factors and health services use. Results of the GeKoJu survey will provide data for the development of strategies to promote generic health literacy among families, in schools, communities and health care.
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Affiliation(s)
- Anne-Kathrin M. Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101 Berlin, Germany; (O.M.D.); (R.K.); (R.H.); (S.A.); (S.J.)
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42
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Britton PC, Conner KR, Chapman BP, Maisto SA. Motivational Interviewing to Address Suicidal Ideation: A Randomized Controlled Trial in Veterans. Suicide Life Threat Behav 2020; 50:233-248. [PMID: 31393029 DOI: 10.1111/sltb.12581] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although the months following discharge from psychiatric hospitalization are a period of acute risk for veterans, there is a dearth of empirically supported treatments tailored to veterans in acute psychiatric hospitalization. METHOD We conducted a randomized controlled trial to test the efficacy of Motivational Interviewing to Address Suicidal Ideation (MI-SI) that explored and resolved ambivalence, and a revised MI-SI (MI-SI-R) that resolved ambivalence, on suicidal ideation (SI) in hospitalized veterans who scored > 2 on the Scale for Suicidal Ideation. Participants were randomized to receive MI-SI plus treatment as usual (TAU), MI-SI-R+TAU, or TAU alone. MI-SI+TAU and MI-SI-R+TAU included two in-hospital therapy sessions and one telephone booster session. Participants completed follow-up assessments over 6 months. RESULTS Participants in all groups experienced reductions in the presence and severity of SI, but there were no significant differences among the groups. For the presence of SI, results were in the hypothesized direction for both MI-SI+TAU conditions. CONCLUSIONS Results are nondefinitive, but the effect size of both versions of MI-SI+TAU on the presence of SI was consistent with prior MI findings. Exploratory analyses suggest MI-SI-R may be preferable to MI-SI. More intensive MI-SI-R with a greater number of follow-ups may increase its effectiveness.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Department of Veterans Affairs, Syracuse Medical Center, Syracuse, NY, USA
| | - Kenneth R Conner
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen A Maisto
- Center for Integrated Healthcare, Department of Veterans Affairs, Syracuse Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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43
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Mournet AM, Bower E, Van Orden KA. Domains of Functional Impairment and Their Associations with Thwarted Belonging and Perceived Burden in Older Adults. Clin Gerontol 2020; 43:95-103. [PMID: 31397645 PMCID: PMC6923585 DOI: 10.1080/07317115.2019.1650406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Functional impairment and social disconnection are risk factors for suicide in later life. This paper examines associations between domains of functional impairment and two forms of social disconnection that are empirically linked to suicide in later life - low (or thwarted) belonging and perceived burden on others.Methods: Participants are 62 older primary care patients (67.68% female, mean age = 72.05) who endorsed feeling lonely or like a burden. Participants completed self-report measures of low belonging and perceived burden (INQ-R) and domains of functional impairment (WHODAS 2.0) at a single time point.Results: Greater perceived burden was associated with greater impairment in activities of daily living ("self-care"), while greater thwarted belonging was associated with greater impairment in social functioning, when controlling for depressive symptoms and age. Domains of mobility, cognition and social participation were not associated with either belonging or perceived burden.Conclusions: Impairment in self-care (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.Clinical Implications: Considering specific domains of functional impairment - rather than functioning more broadly - may facilitate tailored interventions to target suicide risk.
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Affiliation(s)
- Annabelle M Mournet
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Emily Bower
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Kimberly A Van Orden
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Madden M, Morris S, Stewart D, Atkin K, Gough B, McCambridge J. Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications. PLoS One 2019; 14:e0224706. [PMID: 31697723 PMCID: PMC6837440 DOI: 10.1371/journal.pone.0224706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who take multiple medications, experience and understand their alcohol use. The study objective is to explore how people conceptualise the risks posed to their own health from their concurrent alcohol and medicines use. METHODS AND FINDINGS Semi-structured interviews were conducted with a sample of 24 people in the North of England taking medication for long term conditions who drank alcohol twice a week or more often. Transcripts were analysed using a modified framework method with a constructionist thematic analysis. Alcohol was consumed recreationally and to aid with symptoms of sleeplessness, stress and pain. Interviewees were concerned about the felt effects of concurrent alcohol and medicines use and sought ways to minimise the negative effects. Interviewees associated their own drinking with short-term reward, pleasure and relief. Risky drinking was located elsewhere, in the drinking of others. People made experiential, embodied sense of health harms and did not seem aware of, or convinced by, (or in some cases appeared resigned to) future harms to their own health from alcohol use. The study has limitations common to exploratory qualitative studies. CONCLUSIONS Health risk communication should be better informed about how people with long-term health conditions perceive health outcomes over time, and how they adopt experience-based safety strategies in contexts in which alcohol consumption is heavily promoted and weakly regulated, whilst medicines adherence is expected. Supporting people to make active and informed connections between medicines, alcohol and potential personal health harms requires more than a one-way style of risk communication if it is to be perceived as opening up rather than restricting choice.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Stephanie Morris
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Duncan Stewart
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Brendan Gough
- School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
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Reisner SL, Moore CS, Asquith A, Pardee DJ, Sarvet A, Mayer G, Mayer KH. High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States. J Int AIDS Soc 2019; 22:e25391. [PMID: 31536171 PMCID: PMC6752156 DOI: 10.1002/jia2.25391] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Trans masculine people who have sex with cisgender ("cis") men ("trans MSM") may be at-risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre-exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. METHODS Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self-reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). RESULTS The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non-binary gender identity; 32.6% gay-identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05). DISCUSSION The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP. CONCLUSIONS Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.
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Affiliation(s)
- Sari L Reisner
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of PediatricsBoston Children's HospitalHarvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | | | | | - Aaron Sarvet
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Gal Mayer
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
- Global Population HealthHarvard T.H. Chan School of Public HealthBostonMAUSA
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46
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Sims OT, Chiu CY, Chandler R, Melton P, Wang K, Richey C, Odlum M. Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection. J Racial Ethn Health Disparities 2019; 7:28-35. [PMID: 31435855 DOI: 10.1007/s40615-019-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. OBJECTIVES The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. METHOD A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. RESULTS The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. CONCLUSIONS Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA.
- The University of Alabama at Birmingham, Univesity Hall 3137, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Chia-Ying Chiu
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Pamela Melton
- Department of Social Work, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, 104 Bibb Graves Hall, Normal, AL, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Richey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Odlum
- School of Nursing, Columbia University, 560 West 168th Street, New York, 10032, USA
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Blakey SM, Wagner HR, Naylor J, Brancu M, Lane I, Sallee M, Kimbrel NA, Elbogen EB. Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses? THE JOURNAL OF PAIN 2018; 19:797-806. [PMID: 29526669 PMCID: PMC6026045 DOI: 10.1016/j.jpain.2018.02.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
Abstract
The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed. PERSPECTIVE This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TBI, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population.
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Affiliation(s)
- Shannon M Blakey
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - H Ryan Wagner
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Naylor
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mira Brancu
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ilana Lane
- Durham VA Medical Center, Durham, North Carolina
| | | | - Nathan A Kimbrel
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Eric B Elbogen
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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48
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Crane D, Garnett C, Michie S, West R, Brown J. A smartphone app to reduce excessive alcohol consumption: Identifying the effectiveness of intervention components in a factorial randomised control trial. Sci Rep 2018; 8:4384. [PMID: 29531280 PMCID: PMC5847600 DOI: 10.1038/s41598-018-22420-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
Our aim was to evaluate intervention components of an alcohol reduction app: Drink Less. Excessive drinkers (AUDIT>=8) were recruited to test enhanced versus minimal (reduced functionality) versions of five app modules in a 25 factorial trial. Modules were: Self-monitoring and Feedback, Action Planning, Identity Change, Normative Feedback, and Cognitive Bias Re-training. Outcome measures were: change in weekly alcohol consumption (primary); full AUDIT score, app usage, app usability (secondary). Main effects and two-way interactions were assessed by ANOVA using intention-to-treat. A total of 672 study participants were included. There were no significant main effects of the intervention modules on change in weekly alcohol consumption or AUDIT score. There were two-way interactions between enhanced Normative Feedback and Cognitive Bias Re-training on weekly alcohol consumption (F = 4.68, p = 0.03) and between enhanced Self-monitoring and Feedback and Action Planning on AUDIT score (F = 5.82, p = 0.02). Enhanced Self-monitoring and Feedback was used significantly more often and rated significantly more positively for helpfulness, satisfaction and recommendation to others than the minimal version. To conclude, in an evaluation of the Drink Less smartphone application, the combination of enhanced Normative Feedback and Cognitive Bias Re-training and enhanced Self-monitoring and Feedback and Action Planning yielded improvements in alcohol-related outcomes after 4-weeks.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
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49
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Womack JA, Murphy TE, Bathulapalli H, Akgün KM, Gibert C, Kunisaki KM, Rimland D, Rodriguez-Barradas M, Yaggi HK, Justice AC, Redeker NS. Sleep Disturbance Among HIV-Infected and Uninfected Veterans. J Acquir Immune Defic Syndr 2018; 74:e117-e120. [PMID: 27906767 DOI: 10.1097/qai.0000000000001264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Julie A Womack
- *VA Connecticut Healthcare System, West Haven, CT †Yale School of Nursing, West Haven, CT ‡Department of Internal Medicine, Yale School of Medicine, New Haven, CT §Veterans Affairs Medical Center and Department of Medicine, George Washington University, Washington, DC ‖Pulmonary, Critical Care, and Sleep Apnea, Minneapolis Veterans Affairs Healthcare System and University of Minnesota Medical School, Minneapolis, MN ¶Department of Medicine, Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, GA #Medical Service, Michael E. De Bakey Veterans Affairs (VA) Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX
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50
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Bilal U, McCaul ME, Crane HM, Mathews WC, Mayer KH, Geng E, Napravnik S, Cropsey KL, Mugavero MJ, Saag MS, Hutton H, Lau B, Chander G. Predictors of Longitudinal Trajectories of Alcohol Consumption in People with HIV. Alcohol Clin Exp Res 2018; 42:561-570. [PMID: 29265385 DOI: 10.1111/acer.13583] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. METHODS This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. RESULTS We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. CONCLUSIONS Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, Washington
| | | | - Kenneth H Mayer
- School of Medicine, Harvard University, Boston, Massachusetts.,School of Public Health, Harvard University, Boston, Massachusetts.,Fenway Health, Boston, Massachusetts
| | - Elvin Geng
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Karen L Cropsey
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | | | - Michael S Saag
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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