The Role of Mental Health and Substance Use in Homeless Adults’ Tobacco Use and Cessation Attempts

Objective: Although tobacco use is prevalent among adults experiencing homelessness, research deficits exist regarding the mental health, substance use, and demographic correlates of tobacco use behaviors in this population. This study examined whether correlates of tobacco use among housed adults identified by the Center for Disease Control (CDC) were significant correlates of tobacco use and cessation attempts among a sample of homeless adults. Methods: Participants (N?=?421) were adults experiencing homelessness entering permanent supportive housing programs in Los Angeles. Multivariate logistic regression determined associations of lifetime mental health diagnoses, recent substance use, demographic characteristics, and lifetime literal homelessness with daily tobacco use and cessation attempts. Results: Lifetime diagnoses of schizophrenia, posttraumatic stress disorder, depression, bipolar disorder, and illicit substance use were associated with increased odds of daily tobacco use. A lifetime diagnosis of depression was associated with an increased likelihood of a past 3-month tobacco cessation attempt, while illicit substance use was associated with a lower likelihood of a cessation attempt. Conclusions: Findings suggest that demographic and clinical characteristics associated with tobacco use differ among this sample of homeless adults and those identified by the CDC among housed adults. Mental health conditions and substance use appear to be the primary correlates of tobacco use among adults experiencing homelessness and may be critical in efforts aimed at improving cessation.     

The relationship between sight loss and substance use: Users’ perspectives

Background: This UK study emerged from the concerns of a sight loss charity which sought to meet the support needs of its service users with problematic alcohol use. This paper presents findings from one strand of the study focusing on service users’ perspectives. Aims: The aim was to explore the meaning and function of substance use in the lives of people with sight loss. Method: Through purposive and snowball sampling, 17 semi-structured interviews were held with people face-to-face or via telephone. Data were analysed thematically through coding, recoding and categorising data with double coding providing quality control. Results: People were at different stages in their use of substances and their experiences of sight loss. They reported a number of relationships between sight loss and substance use with three main relationships emerging; substance use as, (i) a cause of their sight loss,(ii) a contributor to their sight loss and (iii) a coping mechanism for sight loss. Conclusion: The diverse experiences of people with sight loss and substance problems require an individual and tailored response from substance use professionals. This needs to include routine questioning and accurate information about the medical relationship between sight loss and substance use.     

Prevalence of Polypharmacy and Factors Associated with it Among Saudi Older Adults – Results from the Saudi National Survey for Elderly Health (SNSEH)

Background and ObjectivesThe percentage of Saudi older adults (SOA) is increasing over time. With advanced age, the prevalence of chronic diseases and multiple disabilities are increasing. This leads to increase utilization of multiple medications. The objectives of this study were to describe medication utilization, determine the prevalence of polypharmacy (PP) and factors associated with it among SOA.MethodsThis cross-sectional study was conducted among community-dwelling SOA aged ≥ 60 years old using the Saudi National Survey for Elderly Health (SNSEH). The survey was conducted between 2006 and 2007 by the Ministry of Health on a nationally representative sample of SOA. The data included demographics, socioeconomic and health information such as diseases and medications. Polypharmacy was defined as the concurrent use of medications from ≥ 5 therapeutic classes. A modified Poisson multivariable regression was used to study factors associated with PP controlling for confounders. All analyses were done using STATA 14.ResultsThe study included 2,946 SOA; 50.4% were males, 60.9% were 60–70 years old, and 69.6% were illiterate. The most common medications used among SOA were: Paracetamol (67%), joint pain medications and NSAIDs (50% each), anti-diabetic and multivitamins and minerals (47% each). PP was identified in (51.5%) of participants. The most medication associated with PP were: Paracetamol (79.9%), multivitamins and minerals (71.6%), steroid and DMARDs (70.1%), NSAIDs (66.4%), anti-diabetic and anti-hypertensive (61.3%). Higher risk of PP was associated with diabetes (RR: 1.863; 95% CI: 1.686–2.059), hypertension (RR: 1.829; 95% CI: 1.624–2.060), having pain (RR: 2.282; 95% CI: 1.918–2.713), urinary incontinence (RR: 1.389; 95% CI: 1.238–1.560; ref: no urinary incontinence) or suggestive depression (RR: 1.379; 95% CI: 1.259–1.512). Similarly, compared to low income (<2500 SAR), higher incomes were more likely to have PP. On the other hand, compared to the central region, southern and northern regions were less likely to have PP (RR = 0.741; 95% CI: 0.652–0.843 and RR: 0.736; 95% CI: 0.596–0.908, respectively). Severe cognitive impairment was associated with a lower risk of PP (RR: 0.708; 95% CI: 0.501–1.000).ConclusionThe prevalence of PP among a nationally representative SOA was very high, i.e., 51.5%. Higher risk of PP was associated with many factors such as region, income, diabetes, hypertension, musculoskeletal pain, urinary incontinence, and depression. PP leads to many negative implications such as drug interactions, combined side effects, hospitalization, and death. Therefore, raising the knowledge of health care providers on the consequences of PP and providing medication therapy management services may help decrease the negative consequences of PP and improve therapy outcomes.     

African–American Women’s Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions

Background: Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African–Americans. Substance use may be shaped by social contextual influences from families and peers in African–American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African–American women. Objectives: This study explores the effects of African–American women’s social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use. Methods: Survey data was collected in-person from 521 African–American women. Multivariate logistic models identified the significant correlates of women’s daily use of tobacco and marijuana in the past six months. Results: 52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one’s health was protective against daily marijuana use. Conclusions: Findings stress the need for prevention and intervention efforts for African–American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.     

Testing Young Adults’ Reactions to Facebook Cues and Their Associations with Alcohol Use

Background: Alcohol cues on social media may influence young adults’ drinking patterns, these cues may be pro-social or pro-alcohol in nature. The influence of individual Facebook cues on young adults’ drinking intentions and behaviors remains unknown. Objectives: The purpose of this study was to assess how Facebook cues influence intention to drink, and how intention was associated with Theory of Reasoned Action constructs including alcohol-related attitudes and norms, and future behavior. Methods: Incoming university students completed a pre-college and a 2-year follow-up phone interview. A vignette presented individual Facebook cues representing “pro-social” or “pro-alcohol” sentiments. Participants indicated intention to drink alcohol and their rationale for this intention after each cue. Additional measures included TRA constructs of alcohol-related attitudes and norms, and problem alcohol use. Analyses included a qualitative approach to examine rationales for intention to drink in response to Facebook cues, and linear mixed effects models. Results: Of 338 participants, 56.1% were female, 74.8% were Caucasian. Alcohol-related attitudes and norms were positively associated with intention to drink in response to pro-social and pro-alcohol Facebook cues. Participants’ intention to drink in response to pro-alcohol cues was positively associated with problem alcohol use two years later. Conclusions/importance: Findings illuminate the influence of social media on alcohol-related behaviors and highlight potential future screening approaches.     

Pharmacists’ and physicians’ perception and exposure to drug promotion: A Saudi study

Introduction

Drug promotion has to contribute to a more rational use of drugs. Concerns arise if promotion negatively influences prescribing/dispensing pattern. It is warranted to assess exposure and attitudes to, and acceptance of, drug promotion among pharmacists and physicians.

Methodology

Adopting a randomized, multiple site and cross-sectional survey study, questionnaires (n = 250) were completed by physicians and pharmacists to investigate the exposure, acceptance or skepticism of Saudi physicians/pharmacists to drug promotion as well as their perception of the appropriateness of gifts and to check if they had any teaching/training about dealing with medical representatives (MRs) and Pharma promotion.

Results

Significantly more pharmacists than physicians (32% vs. 23%; p < 0.05) reported being taught or educated about the ethics of drug promotion. The experience level was significantly associated with the teaching or training that the physicians and pharmacists received. Conference registration fees and drug samples were the most appropriate promotional gift for the physicians (67% and 66%, respectively; p < 0.01) whereas for pharmacists, the drug sample was considered the most suitable donation (79%). More pharmacists perceived drug companies as a useful way to gain knowledge about drugs than physicians (75% vs. 65%; p < 0.01). A higher proportion of both groups were accepting drug promotion than those skeptical about it.

Conclusion

The majority of physicians or pharmacists participating in this study have received gifts from pharmaceutical companies. The drug samples and printed educational materials are the most widely accepted gifts. Recent graduates and those with few years of experience had higher teaching/training than experienced physicians and pharmacists in pharmaceutical promotion ethics and tactics to deal with MRs. On the other hand, experienced healthcare team were more approached and targeted by pharmaceutical companies and MRs. It is highly recommended to implement courses/discussion groups on the ethical interaction between healthcare professionals and pharmaceutical companies in the curriculum of both pharmacy and medicine. Updating the physicians and pharmacists after graduation, as part of continued medical/pharmacy education, will eventually improve the healthcare professionals’ capability to act to the patients’ welfare.     

The Validity of Truant Youths’ Marijuana Use and Its Impact on Alcohol Use and Sexual Risk Taking

Few studies investigating the validity of marijuana use have used samples of truant youths. In the current study, self-reports of marijuana use are compared with urine test results for marijuana to identify marijuana underreporting among adolescents participating in a longitudinal brief intervention for drug-involved truant youths. It was hypothesized that marijuana underreporting would be associated with alcohol underreporting and engaging in sexual risk behaviors. The results indicated marijuana underreporting was significantly associated with self-denial of alcohol use, but not associated with sexual risk behavior. Also, there was an age effect in marijuana use underreporting such that younger truant youths were more likely to underreport marijuana use, compared to older truant youths. Implications for policy and future research are discussed.     

Fatal Injuries Associated with Alcohol Use Among Youth and Adults: 1990–1998

ABSTRACT

The major objective of this study was to compare trends in three types of fatal injuries associated with alcohol use among youth under the legal drinking age and among adults of legal drinking age from 1990–1998. The fatal injuries investigated included homicide, suicide, and motor vehicle-traffic deaths.

Results were: (1) motor vehicle-traffic deaths and homicide were higher among youth under the legal drinking age than among adults of legal drinking age; whereas, suicide was more common among adults of legal drinking age than among youth under the legal drinking age; and, (2) African American, Hispanic, and American Indian male youth under the legal drinking age were at substantial risk of being victims of homicide and motor vehicle-traffic deaths.     

Pharmacy education instruction: Preference and practices,Saudi students’ perception

Aim/Background

The methods of instruction in pharmacy education are crucial and meant to suit the professional development and encompass the advanced variety of services and functions provided by the pharmacists to serve individual patients. The aim of this study was to determine the students’ opinions on the adopted and preferred methods of instruction in pharmacy colleges in Kingdom of Saudi Arabia.

Methods

Opinions of Saudi pharmacy students regarding the adopted methods of learning were measured using a pretested questionnaire combined with Likert-type scales.

Results

Three hundred pharmacy students were interviewed. Direct type of lecturing was dominant (53.7%). The most frequently used language of instruction was combined English and Arabic (48.8%), that was mostly preferred by 52.5% of the students. Handouts were the most adopted post-lecture learning method (48.3%), while only 5.9% used student’s self-written notes. A cocktail of traditional and electronic aids was used as admitted by 68.7% and 59.3% of the students who preferred this lecture delivery method. Almost half (49.3%) of the students agreed of having a routine fair guidance and support when referring to their lecturers.

Conclusion

The study outcomes had revealed a practical guidance to be considered for instituting preferred modes of instruction to upgrading students’ capacities for better understanding and acquiring academic and professional skills.     

Diazepam,alcohol use and violence among male young offenders: ‘The devil's mixture’

Background: Diazepam is a benzodiazepine which has a history of usage among problem drug using groups. It has also been linked to aggression in laboratory settings. This article will examine illicit diazepam use and violence amongst predominantly alcohol-orientated offenders.

Methods: A self-complete survey of male Young Offenders (n?=?172) recruited during their induction into Scotland's only Young Offender's Institution was carried out during 2007. Qualitative interviews (n?=?30) were conducted during 2008 on another sample recruited in the same way.

Results: Survey respondents tended to report alcohol, rather than illegal drugs as being related to their offending behaviour. The exception to this pattern was diazepam, which when used in conjunction with alcohol was associated with violence, including weapon use. The 2008 interviews confirmed this and raised further concerns about the way in which diazepam was being mixed with alcohol, in relation to its mode of action, source of supply, dosage and users’ beliefs.

Conclusion: Although it receives little dedicated research, education or media attention, diazepam was a factor in more (violent) crime among this population than any/all other illegal drugs.     

Alcohol and Drug Use among Youth – The Interplay of Future Orientation,Parenting, and Housing Conditions

Background: Past research indicated that future orientation might protect against substance use; however, this potential had not yet been examined in the context of a multiple risk factor model that would include different parenting styles and indicators of the material situation. Additionally, past research draws primarily from a limited set of geographical regions, often using convenience samples of children and adolescents. Objectives: The current study addresses these issues by examining (in)direct relationships between substance use (alcohol, marijuana, hard drugs), future orientation, different parenting styles (authoritarian, authoritative, permissive), and family housing conditions, using a representative sample of Slovenian youth. Methods: Correlational and path analyses were used to test the proposed hypotheses. Additionally, possible mediating pathways were examined and evaluated. Results: Findings indicated a negative relation between future orientation and use of all substances. Next, future orientation fully mediated the effect of authoritative parenting on substance use. Finally, housing conditions had a direct and positive effect on authoritative parenting, a direct and an indirect effect on future orientation and only an indirect (through authoritative parenting and future orientation) effect on substance use. Conclusions: Results, besides indicating the relevance of future orientation in understanding substance use among youth, highlight the importance of authoritative parenting (that spans beyond childhood and adolescence) and housing conditions on the development of future orientation. In addition, findings highlight the importance of the material situation when examining antecedents of substance use among youth that might be missed if only direct effects are observed. Results are discussed in the context of the risk factor paradigm.     

Drug Users’ Test-Retest Reliability of Self-Reported Alcohol Use on the Risk Behavior Assessment

Using data collected from 218 street drug users in 11 cities in the United States, we examined the test-retest reliability of the alcohol-related items on the Risk Behavioral Assessment (RBA; National Institute on Drug Abuse, 1993), an instrument commonly used in drug abuse research. With a 48-hr retest interval, findings indicated excellent to good reliability for the following variables: age of first use, ever used alcohol, and days used alcohol in last 30 days. Items with fair to poor reliability were number of occasions used alcohol in last 30 days without injecting and number of times used alcohol immediately before or during sex. These findings suggest that self-report items on alcohol use from the RBA are generally reliable, particularly items that ask for more general, rather than specific, information.     

Prevalence of American Indian Adolescent Tobacco Use: 1993–2004

Tobacco use rates for American Indian adolescents are examined and compared to rates for non-Indian youth. The data are taken from an ongoing surveillance project of substance use among Indian youth and the Monitoring the Future Project for the years 1993 to 2004. Sample sizes are in the range of 14,000 to 17,000 for non-Indian youth and 600 to 2400 for Indian youth. Tobacco use is considerably higher for Indian youth; however, these rates are following the national trends of significant reductions over the past three years. Indian youth manifested a lower perception of harm from regular tobacco use, which may, in part, account for their higher levels of use. Indian females have had slightly higher rates of lifetime and daily smoking rates than males in the past but recent trends indicate a narrowing of this gap.     

Alcohol Makes You Macho and Helps You Make Friends: The Role of Masculine Norms and Peer Pressure in Adolescent Boys’ and Girls’ Alcohol Use

Peer pressure and general conformity to adult norms have been found to be strongly associated with alcohol use among adolescents; however there is limited knowledge about the sociocultural factors that might influence this relationship. Theory and research suggest that masculine norms might directly and indirectly contribute to alcohol use through peer pressure and general conformity to adult norms. Whereas being male is typically identified as a risk factor for alcohol use, masculine norms provide greater specificity than sex alone in explaining why some boys drink more than others. There is growing evidence that girls who endorse masculine norms may be at heightened risk of engaging in risky behaviors including alcohol use. Data were provided by adolescents living in a rural area in the Northeastern United States and were collected in 2006. This study demonstrated that masculine norms were associated with peer pressure and general conformity and alcohol use for both adolescent girls (n = 124) and boys (n = 138), though the relationship between masculine norms and alcohol use was stronger for boys. The study's limitations are noted and theoretical and practical implications are discussed.     

Is General or Alcohol-Specific Perceived Social Support Associated with Depression among Adults in Substance Use Treatment?

Alcohol use disorders are among the most common mental health disorders in the world and incur considerable costs for individuals and society. Previous research has demonstrated that perceived social support (PSS) may decrease rates of depression and relapse in individuals seeking treatment for alcohol use. The current study developed and investigated a self-report measure for perceived social support for sobriety from alcohol (PSSA) in a sample of men and women in residential treatment for substance use (N = 231), and examined the relationship between general or alcohol-specific perceived social support and depression. Analyses demonstrated sound factor structure, reliability, and validity for the PSSA. Additionally, the new measure of PSS for alcohol sobriety was negatively and uniquely associated with depression, even after controlling for general PSS, enacted social support, and negative social interactions. Overall, findings demonstrated that the PSSA was associated with fewer depressive symptoms, even after accounting for other known correlates of depression. Future research should replicate and extend these findings and examine whether this new measure predicts abstinence from alcohol following treatment.     

The Effect of Childhood Supervisory Neglect on Emerging Adults’ Drinking

This study investigated the effect of childhood supervisory neglect on emerging adults’ drinking. Child supervisory neglect is the most common form of child maltreatment in the United States, but few studies explore supervisory neglect separate from other forms of maltreatment among emerging adults, 18–25 years old. The study sample included (n = 11,117) emerging adults, 18–25 years old who participated in Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health). We conducted separate analyses for male and female emerging adults, because they have different rates of alcohol consumption and alcohol risk behaviors. Our study used latent class analysis to understand how patterns of alcohol risk behaviors clustered together. For males, we found the following four classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, (3) binge-drinkers, and (4) low-risk drinkers or abstainers. For females, we found the following three classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, and (3) low-risk drinkers or abstainers. For both males and females, supervisory neglect increased the odds of membership in the multiple-risk drinkers’ class compared to the low-risk drinkers or abstainers’ class. Single males who did not live with their parents, and who were white had increased odds of being in the multiple-risk drinkers. For females, being more educated, or in a serious romantic relationship increased the odds of membership in the multiple-risk drinkers’ class. Practitioners should ask about histories of supervisory neglect among emerging adults who engage in alcohol risk behaviors.     

Medical Cannabis Users’ Comparisons between Medical Cannabis and Mainstream Medicine

An evidence-based approach is needed to shape policies and practices regarding medical cannabis, thereby reducing harm and maximizing benefits to individuals and society. This project assesses attitudes towards and utilization of medical cannabis and the mainstream healthcare system among medical cannabis users. The research team administered brief hard copy surveys to 450 adults attending an annual public event advocating for cannabis law reform. Among usable responses (N = 392), the majority (78%) reported using cannabis to help treat a medical or health condition. Medical cannabis users reported a greater degree of use of medical cannabis and a greater degree of trust in medical cannabis compared to mainstream healthcare. In comparison to pharmaceutical drugs, medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost. Due to the medical use of cannabis, 42% stopped taking a pharmaceutical drug and 38% used less of a pharmaceutical drug. A substantial proportion (30%) reported that their mainstream healthcare provider did not know that they used medical cannabis. Other issues identified included lack of access to mainstream healthcare, self-initiated treatment of health issues, little knowledge of psychoactive content, and heavy cannabis use.     

The Pharmacokinetics of Pancuronium in Infants,Children and Adults

研究观察年龄对潘库溴铵药代动力学的影响。选择２４例施择期整形外科手术的患者，根据年龄分成三组：１组为５例婴幼儿，年龄０．７５～２．９５岁；２组为１３例儿童，年龄４～１４岁；３组为６例成人，年龄１６～２７岁。静注潘库溴铵１００μｇ／ｋｇ后用改良荧光法测定其血浓度。潘库溴铵的体内过程能用二室开放模型完整描述，年龄愈小，分布容积愈大，血浆清除率愈高，潘库溴铵的血药浓度愈低。Ｖ１（中央室分布容积）、Ｖ２（周边室分布容积）、Ｖｄｓｓ（稳态分布容积）、Ｃｌ（血浆清除率）和ＡＵＣ（曲线下面积）在三组间有明显差别。１组的Ｔ１／２β和ＭＲＴ明显比２、３组长，但Ｔ１／２α和Ｋ２１在三组间无明显差别。     

Saudi school students’ knowledge,attitude and practice toward medicines

The current study was aimed to assess Saudi school students’ knowledge, attitude and practice about medicines. A pretested self-administered questionnaire was used anonymously among 15–20 year-old adolescents attending tertiary schools in Taif City, KSA. A total of 1022 students completed the questionnaires. Only 15.4% of the respondents knew the medicines’ uses. Most of the students 79.6% affirmed that they used to take medicines after consulting physicians, and 45.1% of the students thought that tablet size affects the medicine’s efficacy. More than half of the students knew that high temperatures affect the efficacy of medicines, there was a significant difference between rural and urban areas (P = 0.005). Physicians (50.6%) and community pharmacists (15.7%), were the main students’ reliable sources of information about medicines. The majority of the students 70.5% were interested in learning more about medicines. The younger students ⩽18 years wish to learn more than the older ones (P < 0.014). The study showed that Saudi school students aged 15–20 years old have poor knowledge, misconception and negative attitudes about medicines. Low level of knowledge may expose adolescents to health-related problems. Educational efforts are important to improve students’ practice toward medicines.