The impact of harm reduction programs and police interventions on the number of syringes collected from public spaces. A time series analysis in Barcelona, 2004–2014

BackgroundTo estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014.MethodsWe conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs).ResultsThe number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR = 0.88 (95% CI: 0.82–0.95)], but an increasing trend in the remaining districts [RR = 1.11 (95% CI: 1.05–1.17) and 1.08 (95% CI: 0.99–1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR = 2.72 (95% CI: 1.57–4.71)] and stabilization of the trend thereafter [RR = 0.97 (95% CI: 0.91–1.03)].ConclusionThe overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities.     

Expanding the reach of harm reduction in Thailand: Experiences with a drug user-run drop-in centre

BackgroundDespite an ongoing epidemic of HIV among Thai people who inject drugs (IDU), Thailand has failed to implement essential harm reduction programmes. In response, a drug user-led harm reduction centre opened in 2004 in an effort to expand reduction programming in Thailand.MethodsWe examined experiences with the Mitsampan Harm Reduction Centre (MSHRC) among IDU participating in the Mitsampan Community Research Project (Bangkok). Multivariate logistic regression was used to identify factors associated with MSHRC use. We also examined services used at and barriers to the MSHRC.Results252 IDU participated in this study, including 66 (26.2%) females. In total, 74 (29.3%) participants had accessed the MSHRC. In multivariate analyses, MSHRC use was positively associated with difficulty accessing syringes (Adjusted Odds Ratio [AOR] = 4.05; 95% Confidence Interval [CI]: 1.67–9.80), midazolam injection (AOR = 3.25; 95%CI: 1.58–6.71), having greater than primary school education (AOR = 1.88; 95%CI: 1.01–3.52), and was negatively associated with female gender (AOR = 0.20; 95%CI: 0.08–0.50). Forms of support most commonly accessed included: syringe distribution (100%), food and a place to rest (83.8%), HIV education (75.7%), and safer injecting education (66.2%). The primary reason given for not having accessed the MSHRC was “didn’t know it existed.”ConclusionThe MSHRC is expanding the scope of harm reduction in Thailand by reaching IDU, including those who report difficulty accessing sterile syringes, and by providing various forms of support. In order to maximise its benefits, efforts should be made to increase awareness of the MSHRC, in particular among women.     

Association between adherence to free nicotine replacement therapy and successful quitting

IntroductionProviding free nicotine replacement therapy (NRT) can be a cost-effective strategy for increasing quit attempts and cessation rates at a population level. However, the optimal amount of NRT to provide is unknown. Associations between duration of NRT use and abstinence may be overestimated as a result of reverse causality due to discontinuation following relapse. We examined the association between adherence to 10 weeks of cost-free NRT and quit success at 6-month follow-up, after controlling for reverse causation by excluding participants who reported nonadherence due to relapse.MethodsIndividuals 18 years or older who smoked at least 10 cigarettes daily and intended to quit within 30 days received 10 weeks of NRT at a smoking cessation workshop. There were 3922 participants who attended one of 114 workshops in 70 different localities in Ontario, Canada from 2007 to 2008.ResultsAt end of treatment participants were asked whether they had used “all” of the NRT (20%), “most” of it (28%), “some” of it (47%), or whether they “did not use any” of it (5%). After controlling for reverse causation and adjusting for potential confounding variables, poorer quit success was reported by those who used either some (AOR = 0.43, 95% CI = 0.26–0.69, p = 0.001) or none (AOR = 0.30, 95% CI = 0.09–0.95, p = 0.041) of the NRT versus all 10 weeks. Post-estimation contrasts revealed using some versus most of the NRT was also associated with poorer quit success (p = 0.026).ConclusionsAfter controlling for reverse causation, adherence to 10 weeks of cost-free NRT was associated with successful abstinence at six months post-treatment.     

Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis

The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53–0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03–1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43–0.76; clinical success, RR = 1.34, 95% CI 1.02–1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57–1.21; clinical success, RR = 1.05, 95% CI 0.99–1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.     

HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn,Estonia: Implications for intervention

BackgroundFollowing a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.MethodsIn order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.Results77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR] = 2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR = 2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR = 3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR = 3.02, 95% CI: 1.65–5.54).ConclusionThe injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.     

Are young men who overestimate drinking by others more likely to respond to an electronic normative feedback brief intervention for unhealthy alcohol use?

AimTo tested whether the efficacy of an internet-based brief intervention that included normative drinking feedback varied with estimations of the drinking of others.MethodsThis study is a secondary analysis of a randomized controlled trial showing an intervention effect on weekly drinking. Participants were males with unhealthy alcohol use (mean age [SD] = 20.8 [1.1]). Before the trial, participants were asked to estimate the percentage of men their age who drink more than they do. Using their self-reported drinking data, the “perceived” percentage of people their age and gender who drink more than they do, and data from Swiss statistics, we classified participants as overestimating (>+10%), accurately (− 10% to + 10%) or underestimating (<− 10%) drinking by others.ResultsOf 734 participants with complete data, 427 overestimated, 205 accurately estimated and 102 underestimated the drinking of others. The mean (SD) number of drinks per week was 9.8 (7.9) and AUDIT score was 10.6 (4.2). In stratified negative binomial regression models predicting drinks per week, at 6 months, and controlling for baseline drinks per week, the intervention was effective among those overestimating (IRR[95%CI] = 0.86[0.74;0.98]), but showed no effect among those accurately estimating (IRR[95%CI] = 0.83[0.66;1.03]) or underestimating IRR[95%CI] = 1.21[0.92;1.60]) the drinking of others.ConclusionsPerception of drinking by others appears to be a moderator of effect of an electronic feedback intervention among hazardous drinkers. This finding is consistent with the hypothesis that correcting the perceptions of others' drinking is a potential mechanism of action in normative feedback paradigms.     

Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial

BackgroundLarge amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown.PurposeWe evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids.MethodsA three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong “Quit to Win” Contest. Biochemically validated quitters of the early-informed (n = 379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n = 385, notified at 3-month follow-up) received the incentive at 3 months. The validated quitters of the control group (n = 379) received the incentive at 6 months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24 h) and use of cessation aids at 3-month follow-up.ResultsBy intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24 h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR) = 1.32, 95% CI 1.03–1.69, p = 0.03), but they had similar abstinence (9.2% vs. 9.7%, OR = 0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR = 1.56, 95% CI 1.12–2.18, p < 0.01).ConclusionsThe small cash incentive with early notification increased quit attempt by “self-directed help” but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.     

Environmental conditions,political economy,and rates of injection drug use in large US metropolitan areas 1992–2002

City-specific studies have suggested the quality of the local environment and economic circumstances are associated with greater risk of injection drug use (IDU). No studies have assessed the relation among the quality of the local environment, economic circumstances, and IDU over time across US metropolitan areas. Annual numbers of IDUs in the 88 largest US metropolitan statistical areas (MSAs) were estimated by extrapolating, adjusting, and allocating existing estimates using various data sources. Generalized estimating equations were used to assess the relation among the quality of the local environment, metropolitan political economy, and IDU prevalence using lagged models taking into account potential confounders. MSAs with a worse local environment (measured as a one standard deviation difference) had a greater risk of IDU (relative risk [RR] = 1.03, 95% confidence interval [CI]: 1.01, 1.06); similarly, a one-percentage point worsening of the political economy for an MSA was associated with greater risk of IDU (RR = 1.04–1.10). Final models stratified by region indicated heterogeneity of effect by region whereby the quality of the local environment was associated with IDU strongest in the South (RR = 1.12, CI: 1.05, 1.12) followed by the West (RR = 1.04, CI: 1.01, 1.07) and Midwest (RR = 1.03, CI: 1.00, 1.06), and the metropolitan political economy was associated with IDU in the West (RR = 1.03–1.09) and Northeast (RR = 1.04–1.12). Our results underscore the importance of sociopolitical factors as determinants of IDU in MSAs. Structural solutions targeted at improving environmental conditions and economic circumstances should be considered as drug use interventions.     

Prevalence and predictors of high-on treatment platelet reactivity with ticagrelor in ACS patients undergoing stent implantation

BackgroundResidual high-on treatment platelet reactivity (HRPR) predicts outcomes and major cardiovascular events. Ticagrelor has provided pharmacological and clinical evidence of more predictable and more potent antiplatelet effect as compared to clopidogrel. However, so far, few data have investigated the prevalence and predictors of HRPR in unselected patients treated with ticagrelor, that is therefore the aim of the current study.Methods and resultsOur population is represented by 195 patients undergoing coronary stenting for ACS and receiving ASA and ticagrelor. Platelet function was assessed by multiplate impedance aggregometry (MEA) between 1 and 3 months after stenting. Main clinical features and biochemistry parameters were collected. HRPR for ticagrelor was defined for aggregation > 417 AUC after MEA-ADP stimulation. A total of 26 patients, (13.3%), displayed HRPR with ticagrelor. Older age (≥ 70 years, p = 0.002), hypertension (p = 0.02) previous myocardial infarction (p = 0.04), therapy with nitrates and beta-blockers (p = 0.02), diuretics (p = 0.03) and fasting glycaemia (p = 0.05) were associated to HRPR with ticagrelor. By multivariate analysis, age ≥ 70 years (OR [95%CI] = 4.6[1.55–13.8], p = 0.006), concomitant therapy with beta-blockers (OR [95%CI] = 3.2[1.06–9.6], p = 0.04) and platelets count (OR[95%CI] = 1.0007 [1–1.016], p = 0.05) were identified as independent predictors of HRPR with ticagrelor.ConclusionThe present study firstly demonstrates that the occurrence of HRPR in patients treated with ticagrelor is not so futile, as it was observed in 13% of patients treated with ticagrelor. Older age, beta-blockers administration and platelets count are independent predictors of HRPR with ticagrelor.     

Statins in prevention of repeat revascularization after percutaneous coronary intervention—A meta-analysis of randomized clinical trials

Recent prospective cohort studies have shown that patients discharged on statins after percutaneous coronary intervention (PCI) are at lower risks of repeat revascularization and mortality when compared to those not on statins after discharge. However, few randomized clinical trials among post-PCI patients confirmed these beneficial effects. It is needed to evaluate the effects of post-procedural statin therapy on individual clinical outcomes to facilitate the further investigation on identifying the underlying mechanism(s). A meta-analysis of randomized clinical trials was conducted to examine the effects of statin therapy initiated after coronary angioplasty on repeat revascularization, all-cause mortality and myocardial infarction (MI). From relevant reports on Medline (from inception to October 2009), six randomized clinical trials comprising 2979 patients were included. Relative risks were evaluated for pooled data via random effect models. Compared with controls, post-PCI statin therapy was associated with a significantly decreased risk of repeat revascularization (risk ratio (RR) = 0.73, 95% confidence interval (CI), 0.55–0.98, p = 0.04), nonsignificantly decreased risks of all-cause mortality (RR = 0.88, 95% CI, 0.35–2.21, p = 0.79), MI (RR = 0.76, 95% CI, 0.49–1.18, p = 0.23), and target lesion or target vessel revascularization (RR = 0.58, 95% CI, 0.24–1.39, p = 0.22). In conclusion, statin therapy after PCI can reduce the risk of repeat revascularization. Further investigation is needed to identify the underlying mechanism(s).     

Toxic trace metals and human oocytes during in vitro fertilization (IVF)

Trace exposures to the toxic metals mercury (Hg), cadmium (Cd) and lead (Pb) may threaten human reproductive health. The aim of this study is to generate biologically-plausible hypotheses concerning associations between Hg, Cd, and Pb and in vitro fertilization (IVF) endpoints. For 15 female IVF patients, a multivariable log-binomial model suggests a 75% reduction in the probability for a retrieved oocyte to be in metaphase-II arrest for each μg/dL increase in blood Pb concentration (relative risk (RR) = 0.25, 95% confidence interval (CI) 0.03–2.50, P = 0.240). For 15 male IVF partners, each μg/L increase in urine Cd concentration is associated with an 81% decrease in the probability for oocyte fertilization (RR = 0.19, 95% CI 0.03–1.35, P = 0.097). Because of the magnitude of the effects, these results warrant a comprehensive study with sufficient statistical power to further evaluate these hypotheses.     

Transitioning from adequate to inadequate sleep duration associated with higher smoking rate and greater nicotine dependence in a population sample

IntroductionInadequate sleep (≤ 6 and ≥ 9 h) is more prevalent in smokers than non-smokers but the extent to which sleep duration in smokers relates to smoking behaviors and cessation outcomes, is not yet clear. To begin to address this knowledge gap, we investigated the extent to which sleep duration predicted smoking behaviors and quitting intention in a population sample.MethodsData from current smokers who completed the baseline (N = 635) and 5-year follow-up (N = 477) assessment in the United Kingdom Biobank cohort study were analyzed. Multivariable regression models using smoking behavior outcomes (cigarettes per day, time to first cigarette, difficulty not smoking for a day, quitting intention) and sleep duration (adequate (7–8 h) versus inadequate (≤ 6 and ≥ 9 h) as the predictor were generated. All models adjusted for age, sex, race, and education.ResultsWorsening sleep duration (adequate to inadequate) predicted a more than three-fold higher odds in increased cigarettes per day (OR = 3.18; 95% CI = 1.25–8.06), a more than three-fold increased odds of not smoking for the day remaining difficult (OR = 3.90; 95% CI = 1.27–12.01), and a > 8-fold increased odds of higher nicotine dependence (OR = 8.98; 95% CI = 2.81–28.66). Improving sleep duration (i.e., inadequate to adequate sleep) did not predict reduced cigarette consumption or nicotine dependence in this population sample.ConclusionTransitioning from adequate to inadequate sleep duration may be a risk factor for developing a more “hard-core” smoking profile. The extent to which achieving healthy sleep may promote, or optimize smoking cessation treatment response, warrants investigation.     

Medications as a source of paraben exposure

BackgroundParabens are used as antimicrobial excipients in some pharmaceuticals. Parabens may adversely affect reproduction.ObjectivesDetermine whether paraben-containing medication contributes to high urinary paraben concentrations.MethodsIndividuals at a fertility clinic provided multiple urine samples during evaluation/treatment and reported 24-h use of medications and personal care products (PCP). Repeated measures models compared specific gravity-adjusted urinary methyl, propyl, and butyl paraben concentrations between samples “exposed” and “unexposed” to paraben-containing medication.ResultsEleven participants contributed 12 exposed and 45 unexposed samples, among which paraben concentrations did not differ. Use within 7 h was associated with 8.7-fold and 7.5-fold increases in mean methyl (P = 0.11) and propyl (P = 0.10) paraben concentrations, respectively, after adjusting for PCP use. However, these associations decreased to 1.3-fold (P = 0.76) and 2.6-fold (P = 0.34), respectively, after removal of one influential individual.ConclusionParaben-containing medications contributed to higher urinary paraben concentrations within hours of use.     

Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack

AimsTo analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors in a clinical non-experimental setting.DesignRetrospective study.SettingA community drug service in London, UK.Participants325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine).MeasurementsLogistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start (or at the date of transfer to another service).FindingsFor the general model participants choosing methadone were more likely to use heroin at follow up (OR = 2.36, 95% CI: 1.40–3.17) as were daily crack users on methadone (OR = 2.62, 95% CI: 0.96–7.16).For the methadone model only daily crack use predicted heroin use at follow up (OR = 2.62, 95% CI: 0.96–7.16).For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR = 0.85, 95% CI: 0.75–0.95; OR = 1.31, 95% CI: 1.06–1.60 and OR = 6.04, 95% CI: 1.26–28.92). Both use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR = 6.68, 95% CI: 0.37–119.59; OR = 106.31, 95% CI: 3.41–3313.30) and daily (OR = 57.49 (95% CI: 2.37–1396.46; OR = 170.99 (95% CI: 4.61–6339.47) users.ConclusionsMost of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. Crack use was a significant predictor of heroin abstinence at follow up in all models, however for buprenorphine only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.     

Broncho-Vaxom in pediatric recurrent respiratory tract infections: A systematic review and meta-analysis

ObjectivesAssess the efficacy and safety of Broncho-Vaxom in pediatric recurrent respiratory tract infections (RRTIs).MethodsPublished randomized controlled trials (RCTs) of Broncho-Vaxom for pediatric RRTI were searched using PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang Data, and VIP databases up to January 2017. Risk of bias was evaluated in accordance to the guidelines of the Cochrane collaboration and the level of evidence was graded according to the GRADE.Results53 RCTs involving 4851 pediatric patients were included in this meta-analysis. It showed that Broncho-Vaxom was positively correlated with a reduction in the frequency of respiratory infection [MD = − 2.33, 95% CI (− 2.75, − 1.90), P < 0.00001] compared to the control group. The Broncho-Vaxom group was more effective than control groups in relation to the duration of antibiotics course, infections, fever, cough, and wheezing, increasing serum immunoglobulin levels (IgG, IgA or IgM), and T-lymphocytes subtype (CD3 +, CD4 +, or CD8 +). However, Broncho-Vaxom had higher adverse event rates [RR = 1.39, 95% CI (1.02, 1.88), P = 0.04]; these were not serious and did not influence the treatment course.ConclusionBroncho-Vaxom shows a good efficacy for pediatric RRTIs on the basis of routine therapy (e.g. anti-infection and antiviral therapy). However, the level of evidence was low and more international multicenter clinical trials are needed to explore the efficacy and safety of Broncho-Vaxom.     

Perceived unmet need for alcohol and drug use treatments and future use of services: Results from a longitudinal study

BackgroundThis study assessed the association of perceived need for and perceived barriers to treatments for substance use disorder (SUD) with subsequent use of these treatments in community settings.MethodsDrawing on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we examined the association of perceived need and barriers to SUD treatments in waves 1 of NESARC (2001–2002; n = 43,093) with the subsequent use of these treatments in the follow-up wave 2 (2004–2005; n = 34,625).ResultsOnly 8.5% (n = 195) of the 2333 NESARC participants with an untreated 12-month SUD in wave 1 perceived a need for SUD treatment. Participants who reported a perceived need were more likely to use these services in follow-up than those who did not report such a need (14.8% vs. 4.9%, adjusted odds ratio [aOR] = 3.16, 95% confidence intervals [CI] = 1.70–5.90, P < 0.001). Among participants who perceived a need, those who reported pessimistic attitudes towards treatments as a barrier were less likely than others to use services in follow-up (aOR = 0.08, 95% CI = 0.01–0.73, P = 0.027). Other barriers, including financial barriers and stigma were not significantly associated with treatment seeking.ConclusionsThe findings suggest the need for a two-pronged approach to improving treatment seeking for SUD in community settings: one focusing on enhancing recognition of these disorders, the other focusing on educating potential consumers regarding the benefits of SUD treatments.     

High risk injecting behaviour among people who inject pharmaceutical opioids in Australia

BackgroundUse of opioid analgesic medicines has doubled globally over the past decade, with a concomitant increase in prevalence of injection of pharmaceutical opioids (PO), including in Australia. This study investigates types of PO injected, methods used to prepare PO for injection and correlates of recent (last 6 months) PO injection among a large national sample of people who inject drugs (PWID).MethodsThe Australian NSP Survey (ANSPS), conducted annually at ∼50 NSP services across Australia, consists of a brief self-administered questionnaire and provision of a capillary dried blood spot for HIV and hepatitis C antibody testing. Data from 2014 were used to conduct univariable and multivariable logistic regression analysis to determine factors independently associated with recent injection of PO.ResultsAmong 1488 ANSPS respondents who were identified as opioid injectors, 57% (n = 848) reported injection of PO in the previous six months. The majority of PO injectors (85%) reported filtering PO prior to injection, although use of efficacious wheel filters was relatively rare (11%). Correlates of POs injection included daily injection (AOR = 1.65, 95% CI 1.31–2.08), receptive sharing of syringes (AOR = 2.00, 95% CI 1.43–2.78), receptive sharing of drug preparation equipment (AOR = 1.55, 95% CI 1.19–2.01), drug overdose in the previous year (AOR = 1.81, 95% CI 1.36–2.42) and residence in inner regional (AOR = 3.27, 95% CI 2.21–5.23) or outer regional/remote (AOR = 5.50, 95% CI 3.42–8.84) areas of Australia.ConclusionPO injection is geographically widespread among Australian PWID and takes place in the context of poly-drug use. People who inject POs are at high risk of overdose, injection related injury and disease and blood borne viral infections. Harm reduction services that target this group, including in non-urban areas, should deliver health education regarding PO-specific overdose risks, the requirement to adequately filter PO before injection and to ensure that both naloxone and specialist pill filters are readily accessible.     

Examining the effects of drinking and interpersonal protective behaviors on unwanted sexual experiences in college women

IntroductionRecent evidence suggests interpersonal protective behaviors (IPBs) may be more effective than alcohol-based strategies at decreasing alcohol-related sexual consequences. However, no studies have examined individual IPBs to assess their unique influences on specific sexual consequences. The current study used a longitudinal design to examine the direct effects of typical weekly drinking and specific IPBs on unwanted sex. IPBs were also examined as moderators of the relationship between drinking and unwanted sex.MethodsRandomly sampled female drinkers attending a northeastern university (N = 191) completed a baseline survey measuring typical weekly drinking and IPBs and a six-month follow-up assessing unwanted sex. Bootstrapped regression examined the effects.ResultsDrinking predicted unwanted sex after accounting for IPBs (range of bs = .008–.009, SE = .005, 95% CI [.000, .02]). Vigilance-related IPBs were negatively associated with unwanted sex after controlling for drinking (b = −.052, SE = .025, 95% CI [−.107, −.008]). The IPB “Talking to people who know one's potential dating or sexual partner to find out what s/he is like” significantly moderated the drinking–unwanted sex relationship (b = −.009, SE = .004, 95% CI [−.018, −.003]). At above-average drinking levels, women who used this IPB more frequently reported fewer episodes of unwanted sex.ConclusionFindings revealed obtaining information about a potential partner significantly reduced the impact of drinking on unwanted sex for heavier drinkers. Future research examining how women implement this IPB may clarify its role in reducing unwanted sex.