Smokeless tobacco use among United States Air Force trainees

Background: The prevalence of smokeless tobacco use in the United States Air Force (USAF) exceeds civilian use rates. The prevalence and correlates of smokeless tobacco use were assessed and evaluated in a sample of USAF trainees. Methods: We conducted a cross-sectional survey of USAF technical training school personnel at Joint Base San Antonio-Lackland and Fort Sam Houston (N = 14,810). Survey completion rate was 78%. Logistic regression was used to analyze the associations between demographic variables, tobacco use, and social factors for both regular and infrequent smokeless tobacco (e.g., chewing tobacco, snuff) users. Results: Overall, 16% of Airmen had ever used smokeless tobacco and 10% regularly used smokeless tobacco. In multivariate analyses, men had greater odds than women of regular smokeless tobacco use (adjusted odds ratio [OR] = 15.2; 95% confidence interval [CI]: 10.8–21.5) and infrequent smokeless tobacco use (adjusted OR = 4.2; 95% CI: 3.1–5.7). Smokeless tobacco use was associated with participation in high school sports (adjusted OR = 1.9; 95% CI: 1.6–2.3 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users), smoking cigarettes (adjusted OR = 4.3; 95% CI: 3.6–5.1 for regular users; adjusted OR = 4.0; 95% CI: 3.2–5.0 for infrequent users), or living with someone who used smokeless tobacco (adjusted OR = 2.2; 95% CI: 1.9–2.6 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users). Black or African Americans were less likely than whites to be regular (adjusted OR = 0.3; 95% CI: 0.1–0.4) or infrequent (adjusted OR = 0.3; 95% CI: 0.2–0.4) users of smokeless tobacco. Conclusions: Smokeless tobacco use among incoming Air Force recruits is common and negatively impacts the Air Force's goal to be tobacco-free. Understanding sociodemographic characteristics perpetuating smokeless tobacco use in the Air Force population can inform the development of health promotion interventions.     

Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a Syringe-Exchange Program in Malmö, Sweden

Background: Injection drug users (IDUs) are at increased risk of various medical conditions, including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can lead to life-threatening complications, are common but scarcely studied. Objectives: To investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors associated with having ever had an SSTI. Methods: IDUs were recruited from Malmö SEP (N = 80). They participated in a survey with questions about demographics, drug use, and experience of SSTIs. Factors independently associated with self-reported SSTI ever were assessed using logistic regression analysis. Results: The lifetime reported prevalence of SSTI was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01–1.18), female sex (AOR = 6.75; 95% CI = 1.40–32.47), having ever injected prescribed drugs (AOR = 52.15; 95% CI = 5.17–525.67), and having ever injected in the neck (AOR = 8.08; 95% CI = 1.16–56.08). Conclusions/Importance: SSTI is common among IDUs in Malmö. Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids), are more likely to have had an SSTI.     

Metabolic syndrome among individuals with heroin use disorders on methadone therapy: Prevalence,characteristics, and related factors

ABSTRACT

Background: Observational studies have reported a high prevalence of obesity and diabetes in subjects on methadone therapy; there are, however, limited data about metabolic syndrome. The aim of the study was to evaluate the prevalence of metabolic syndrome and related factors in individuals with heroin use disorder on methadone therapy. Methods: A cross-sectional study in individuals with heroin use disorder on methadone therapy at a drug abuse outpatient center. Medical examinations and laboratory analyses after a 12-hour overnight fast were recorded. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Results: One hundred and twenty-two subjects were included, with a mean age of 46.1 ± 9 years, a median body mass index (BMI) of 25.3 kg/m² (interquartile range [IQR]: 21.2–28), and 77.9% were men. Median exposure to methadone therapy was 13 years (IQR: 5–20). Overweight and obesity were present in 29.5% and 17.2% of the participants, respectively. Metabolic syndrome components were low high-density lipoprotein (HDL) cholesterol (51.6%), hypertriglyceridemia (36.8%), high blood pressure (36.8%), abdominal obesity (27.0%), and raised blood glucose levels (18.0%). Abdominal obesity was more prevalent in women (52% vs. 20%, P = >0.01) and high blood pressure more prevalent in men (41.1% vs. 22.2%, P = .07). Prevalence of metabolic syndrome was 29.5% (95% confidence interval [CI]: 16.6–31.8). In the multivariate logistic regression analysis, BMI (per 1 kg/m² increase odds ratio [OR]: 1.49, 95% CI: 1.27–1.76) and exposure time to methadone therapy (per 5 years of treatment increase OR: 1.38, 95% CI: 1.28–1.48) were associated with metabolic syndrome. Conclusions: Overweight and metabolic syndrome are prevalent findings in individuals with heroin use disorder on methadone therapy. Of specific concern is the association of methadone exposure with metabolic syndrome. Preventive measures and clinical routine screening should be recommended to prevent metabolic syndrome in subjects on methadone therapy.     

Combined effects of law enforcement and substitution treatment on heroin mortality

Introduction and Aims. To explore the combined effects of street‐level law enforcement and substitution treatment programs on drug‐related mortality, taking into account prevalence of heroin use and changes in injecting behaviour. Design and Methods. Time trend analysis using annual police reports and case register data of opioid substitution treatments in Switzerland, 1975–2007. Results. Drug‐related mortality increased during times of more intense street‐level law enforcement [odds ratio (OR) 1.32, 95% confidence interval (95% CI) 1.15–1.51], and the number of drug‐related deaths predicted the number of heroin possession offences 2 years later (r = 0.97, P < 0.001). Substitution treatment had a protective effect on drug‐related mortality (OR 0.23, 95% CI 0.18–0.30). Surprisingly, the number of drug‐related deaths was substantially biased by an oscillation period of 14 years (OR 1.24, 95% CI 1.17–1.32). Discussion and Conclusions. Our analysis revealed that the amount of police resources allocated to law enforcement was determined rationally, however, on biased grounds and with untoward consequences. Substitution treatment of heroin users reduced drug‐related mortality in the long run, but different factors masked its impact for several years. Therefore, the introduction—or the expansion—of opioid substitution treatment programs should not be promoted with the argument of an immediate reduction of drug‐related deaths in a country.[Nordt C, Stohler R. Combined effects of law enforcement and substitution treatment on heroin mortality. Drug Alcohol Rev 2010]     

Secular Trends in Prevalence of Alcohol Use Disorder and Its Correlates in Korean Adults: Results from Korea National Health and Nutrition Examination Survey 2005 and 2009

ABSTRACT

The Alcohol Use Disorders Identification Test (AUDIT) has been found to provide an accurate measure for risk of hazardous and harmful alcohol use, as well as possible dependence. Data from 2 representative samples of 7693 adults in the Korea National Health and Nutrition Examination Survey (KNHANES) 2005 and 6276 participants in 2009 were analyzed. The overall age-adjusted prevalence of alcohol use disorder (AUD) in 2009 (38.8%) was higher than that in 2005 (32.7%), with a difference of 6.1% (95% confidence interval [CI], 2.9%–9.3%; P = .0002). Men were about 7 times as likely as women to meet the criteria for AUD (odds ratio [OR] = 7.16; 95% CI, 6.27–8.17). Current smoking was the most important correlate associated with AUD in both genders (women: OR = 6.03; 95% CI, 4.40–8.27; men: OR = 2.83; 95% CI, 2.29–3.48). Among women, unmarried (OR = 1.76; 95% CI, 1.35–2.31), less than high school education (OR = 2.71, 95% CI, 1.86–3.96), and lowest income (OR = 1.45, 95% CI, 1.06–1.97) were associated with AUD. These findings provide the most updated prevalence estimates of AUD in the Korean population and they highlight its strong association with smoking, gender differences, and lower socioeconomic status in the Korean population.     

Offer of financial incentives for unprotected sex in the context of sex work

Introduction and Aims. Commercial sex workers (CSW) are often portrayed as vectors of disease transmission. However, the role clients play in sexual risk taking and related decision making has not been thoroughly characterised. Design and Methods. Participants were drawn from the Vancouver Injection Drug Users Study, a longitudinal cohort. Analyses were restricted to those who reported selling sex between June 2001 and December 2005. Using multivariate generalised estimating equation, we evaluated the prevalence of and factors associated with being offered money for sex without a condom. Results. A total of 232 CSW were included in the analyses, with 73.7% reporting being offered more money for condom non‐use, and 30.6% of these CSW accepting. Variables independently associated with being offered money for sex without a condom included daily speedball use [adjusted odds ratio (AOR) = 1.21, 95% confidence interval (CI): 0.23–0.62], daily crack smoking (AOR = 1.51, 95% CI: 1.04–2.19), daily heroin injection (AOR = 1.76, 95% CI: 1.27–2.43) and drug use with clients (AOR = 3.22, 95% CI: 2.37–4.37). Human immunodeficiency virus seropositivity was not significant (AOR = 0.98, 95% CI: 0.67–1.44). Discussion and Conclusions. Findings highlight the role clients play in contributing to unprotected sex through economic influence and exploitation of CSW drug use. HIV serostatus has no bearing on whether more money is offered for sex without a condom. Novel interventions should target both CSW and clients. [Johnston CL, Callon C, Li K, Wood E, Kerr T. Offer of financial incentives for unprotected sex in the context of sex work. Drug Alcohol Rev 2009]     

Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver,Canada

Background: Studies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness. Objectives: To determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada. Methods: From 2012 to 2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor diagnosed: (1) alcohol/substance use disorder and (2) any other mental health disorder. Results: Of 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR = 0.52, 95% CI [confidence interval]: 0.27–0.99) and an annual income ≥$30,000 CAD (AOR = 0.38, 95% CI: 0.21–0.67) and positively associated with HIV-positive serostatus (AOR = 2.54, 95% CI: 1.63–3.96), recent crystal methamphetamine use (AOR = 2.73, 95% CI: 1.69–4.40) and recent heroin use (AOR = 5.59, 95% CI: 2.39–13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR = 0.25, 95% CI: 0.08–0.81), being a refugee or visa holder (AOR = 0.18, 95% CI: 0.05–0.65), and living outside Vancouver (AOR = 0.52, 95% CI: 0.33–0.82), and positively associated with abnormal anxiety symptomology scores (AOR = 3.05, 95% CI: 2.06–4.51). Conclusions: Mental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring.     

Cold Preparation of Heroin in a Black Tar Market

Background: Black tar heroin is typically prepared for injection with heat which decreases the risk of HIV transmission by inactivating the virus. We received reports that persons who inject drugs (PWID) in Tijuana, Baja California, Mexico, a black tar heroin market, were using only water to dissolve heroin. Objectives: Because Tijuana abuts San Diego County, CA, United States, we undertook the present analyses to determine the prevalence of this practice among PWID in San Diego, California. Methods: PWID completed quarterly behavioral assessments and serological testing for blood-borne viruses. Bivariate and multivariable logistic regression models were constructed to assess for individual, social, and structural correlates of preparing heroin without heat within the preceding 6 months. Results: Nearly half of black tar heroin users (149/305) reported they had prepared heroin without heat within 6 months. In multivariable analysis, cold preparation was independently associated with younger age (10 year decrease; AOR = 1.25; 95% CI 1.03, 1.53), more drug injecting acquaintances (per 5 acquaintance increase; AOR = 1.05; 95% CI 1.01, 1.09) and prefilled syringe use (injecting drugs from syringes that are already filled with drugs before purchase; AOR = 1.86; 95% CI 1.14, 3.02). Conclusions/Importance: To our knowledge, this is the first paper to report that PWID living in a black tar heroin market are preparing heroin without heat. Additional research is needed to determine whether this is an endemic practice or PWID are engaging in new forms of drug preparation in response to changes in the environment.     

Within‐subject haemoglobin variation in elite athletes: a longitudinal investigation of 13 887 haemoglobin concentration readings

The Athlete Biological Passport (ABP) estimates individualized reference ranges for key blood markers, such as haemoglobin concentration ([Hb]), using predetermined population mean, between‐ and within‐subject variances. Here, we aim to reassess previously published estimates for within‐subject [Hb] variance and determine whether sex‐, analyzer‐, sport‐, or season‐specific values are required. Our reference population contains 7723 male (mean ± SD, 22.3 ± 4.6 years of age) and 6164 female (21.6 ± 4.3) athlete observations from 49 sports. [Hb] was calculated using one of three cytometers; Bayer‐H3 (1997–1999, n = 4554), ADVIA‐120 (1999–2010, n = 8636) and Sysmex XT‐2000i (2010–2012, n = 697). The final model was a linear mixed model for [Hb] with analyzer (H3, ADVIA, Sysmex), sex (male, female), sport (power‐endurance, endurance, skill, team, disabled and non‐athletes), season (summer, winter), and the interaction between sex and sport as fixed effects and athlete as a random effect. The model included an exponential correlation structure to allow for within‐subject autocorrelation, and allowed different within‐subject variances for each sport. Within‐subject [Hb] variance (g²/L²) was significantly less for power endurance (35.09, 95% CI 33.50 to 36.76), disabled (25.82, 95% CI 21.71 to 35.28) and non‐athletes (34.30, 95% CI 28.53 to 35.87) than for endurance (40.35, 95% CI 39.62 to 47.22) and team sports (38.70, 95% CI 37.68 to 39.76) athletes. No new evidence was found to justify adjusting the current within‐subject [Hb] variance estimate. Copyright © 2015 John Wiley & Sons, Ltd.     

Predictors of Illicit Drug Use Among Prisoners

Background: The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. Objectives: To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. Results: Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26–0.98). Participants aged 37–89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19–0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04–5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13–5.69). Conclusions: Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.     

The willingness of people who inject drugs in Boston to use a supervised injection facility

ABSTRACT

Background: In Massachusetts, the number of opioid-related deaths has increased 350% since 2000. In the setting of increasing overdose deaths, one potential intervention is supervised injection facilities (SIFs). This study explores willingness of people who inject drugs in Boston to use a SIF and examines factors associated with willingness. Methods: A cross-sectional survey of a convenience sample of 237 people who inject drugs and utilize Boston's needle exchange program (NEP). The drop-in NEP provides myriad harm reduction services and referrals to addiction treatment. The survey was mostly self-administered (92%). Results: Results showed positive willingness to use a SIF was independently associated with use of heroin as main substance (odds ratio [OR]: 5.47; 95% confidence interval [CI]: 1.9–15.4; P = .0004), public injection (OR: 5.09; 95% CI: 1.8–14.3; P = .002), history of seeking substance use disorder (SUD) treatment (OR: 4.99; 95% CI: 1.2–21.1; P = .05), having heard of SIF (OR: 4.80; 95% CI: 1.6–14.8; P = .004), Hispanic ethnicity (OR: 4.22; 95% CI: 0.9–18.8; P = .04), frequent NEP use (OR: 4.18; 95% CI: 1.2–14.7; P = .02), current desire for SUD treatment (OR: 4.15; 95% CI: 1.2–14.7; P = .03), hepatitis C diagnosis (OR: 3.68; 95% CI: 1.2–10.1; P = .02), posttraumatic stress disorder (PTSD) diagnosis (OR: 3.27; 95% CI: 1.3–8.4; P = .01), report of at least 1 chronic medical diagnosis (hepatitis C, human immunodeficiency virus [HIV], hypertension, or diabetes) (OR: 3.27; 95% CI: 1.2–8.9; P = .02), and comorbid medical and mental health diagnoses (OR: 2.93; 95% CI: 1.2–7.4; P = .02). Conclusions: Most respondents (91.4%) reported willingness to use a SIF. Respondents with substance use behavior reflecting high risk for overdose were significantly more likely to be willing to use a SIF. Respondents with behaviors that contribute to public health burden of injection drug use were also significantly more likely to be willing to use a SIF. Results indicate that this intervention would be well utilized by individuals who could most benefit from the model. As part of a broader public health approach, SIFs should be considered to reduce opioid overdose mortality, decrease public health burden of the opioid crisis, and promote access to addiction treatment and medical care.     

Co-morbid diabetes in patients with Crohn's disease predicts a greater need for surgical intervention

Aliment Pharmacol Ther 2012; 35: 126–132

Summary

Background The prevalence of diabetes is increasing rapidly. Given its pro‐inflammatory nature, comorbid diabetes may affect the course of Crohn’s disease (CD). Aim To determine whether comorbid diabetes influences the natural history of CD. Methods We compared a cohort with CD and comorbid diabetes to a nondiabetic control population and calculated the period prevalence of surgical intervention over a 5‐year period. Unadjusted and adjusted odds‐ratios were calculated regarding the need for surgical intervention using univariate and multivariate logistic regression. Results A total of 240 patients were identified, 16 of whom were diabetics (6.7%). The period prevalence of CD‐specific surgery in the diabetic cases was 75.0% and in the nondiabetic controls, 31.7%. The diabetic patients were more obese than the controls (44% vs. 10%; P < 0.0001) and older than the controls (47.4 years vs. 38.6; P < 0.01). There was no difference in the frequency of biologic therapy use, immunomodulator use, smoking, perianal disease, ileal involvement or corticosteroid use between the diabetics and controls. Univariate analysis revealed that diabetes (OR 6.46 [95% CI 2.01–20.8]), smoking (OR 2.46 [95% CI 1.24–4.90]), ileal disease (OR 2.21 [95% CI 1.15–4.24]) and obesity (OR 2.22 [95% CI 1.04–4.77]) were risk factors for needing surgery. After adjustment for covariates, the OR for surgical intervention in diabetics was 5.4 (95% CI 1.65–17.64). Conclusion Co‐morbid diabetes in patients with Crohn’s disease predicts a greater need for surgical intervention.     

Incarcerated intravenous heroin users: Predictors of post-release utilization of methadone maintenance treatment

Incarcerated intravenous heroin users have more problematic patterns of heroin use, but are less likely to access methadone maintenance treatment by their own initiative than heroin users in the community. The present study examined predictors for receiving methadone maintenance treatment post-release among incarcerated intravenous heroin users within a 24-month period. This cohort study recruited 315 incarcerated intravenous heroin users detained in 4 prisons in southern Taiwan and followed up within the 24-month period post-release. Cox proportional hazards regression analysis was applied to determine the predictive effects of sociodemographic and drug-use characteristics, attitude toward methadone maintenance treatment, human immunodeficiency virus serostatus, perceived family support, and depression for access to methadone maintenance treatment after release. There were 295 (93.7%) incarcerated intravenous heroin users released that entered the follow-up phase of the study. During the 24-month follow-up period, 50.8% of them received methadone maintenance treatment. After controlling for the effects of the detainment period before and after recruitment by Cox proportional hazards regression analysis, incarcerated intravenous heroin users who had positive human immunodeficiency virus serostatus (HR = 2.85, 95% CI = 1.80–4.52, p < .001) and had ever received methadone maintenance treatment before committal (HR = 1.94, 95% CI = 1.23–3.05, p < .01) were more likely to enter methadone maintenance treatment within the 24-month follow-up period. Positive human immunodeficiency virus serostatus with fully subsidized treatment and previous methadone maintenance treatment experiences predicted access of methadone maintenance treatment post-release. Strategies for getting familiar with methadone maintenance treatment during detainment, including providing methadone maintenance treatment prior to release and lowering the economic burden of receiving treatment, may facilitate entry of methadone maintenance treatment for incarcerated intravenous heroin users.     

High Prevalence of Self-Reported Exposure to Adulterated Drugs Among People Who Experienced an Opioid Overdose in Canada: A Cohort Study

Background: In North America, rates of overdoses are increasing largely due to the adulteration of illicit drugs by illicit synthetic opioids. Objectives: We sought to examine the prevalence and correlates of self-reported exposure to adulterated drugs among people who experienced a non-fatal opioid overdose. Methods: Data were derived from three prospective cohort studies of people who use drugs in Vancouver, Canada between June and November 2016. Multivariable logistic regression analyses were used to examine the prevalence and correlates of self-reported exposure to adulterated drugs. Results: Among 117 participants who reported symptoms consistent with a non-fatal opioid overdose, 78 (66.7%) reported believing the drug was adulterated during their last overdose. Of those, 42 (53.8%) had not perceived adulteration prior to overdose. In the multivariable analysis, engagement in opioid agonist therapy (Adjusted Odds Ratio [AOR]?=?2.79, 95% Confidence Interval [CI]: 1.10, 7.45) was independently associated with having not perceived adulteration prior to overdose. Daily heroin use (AOR = 5.28; 95% CI: 1.92, 15.97) and reporting supervised injection site staff were present at most recent overdose (AOR = 6.16; 95% CI: 1.25, 47.27) were independently associated with having perceived adulteration prior to overdose. Conclusions/Importance: We found a high prevalence of believing adulterated drugs were present for the most recent overdose. Further, the high prevalence of unperceived adulteration prior to overdose supports the need to lower the risk of overdose by providing individuals with options to consume drugs in a safer manner, including supervised consumption sites.     

Patients’ perceptions regarding oral anticoagulation therapy and its effect on quality of life

ABSTRACT

Objective: Anticoagulation clinics have improved the time spent within therapeutic range and decreased hemorrhagic complications and costs in chronic oral anticoagulation. Whether these benefits correlate to patients’ quality of life (QOL) remains to be determined. The impact of patients’ perceptions about anticoagulation on QOL has not been evaluated. The objective of this study was to evaluate prospectively patients’ perceptions and quality of life in patients chronically anticoagulated.

Research design and methods: A cross-sectional study was designed to investigate the prevalence of positive and negative perceptions about oral anticoagulation therapy (OAT) and to identify vulnerable groups. Patients anonymously completed the SF-36 survey and a questionnaire that focused on patients’ perceptions of protection from thrombotic complications or fear of haemorrhage due to the anticoagulation. We related those perceptions to the General Health SF-36 score, to the patient's characteristics, the absolute bleeding risk (i.e. intended International Normalized Ratio [INR]), duration of therapy and medical attention.

Results: One thousand patients were included and 905 questionnaires evaluated. Most patients felt protected and better since the beginning of therapy (71.5% and 61.5%, respectively). Patient characteristics associated with negative perceptions were; female sex (Odds Ratio [OR] 1.58, 95% Confidence Interval [CI] 1.06–2.36, p = 0.01); patients with less than 1 year of therapy (OR 2.16, 95% CI 1.34–3.48, p = 0.006); those not satisfied with medical attention (OR 2.86, 95% CI 1.53–5.18, p = 0.0001); and those that modified their lifestyle (OR 2.75, 95% CI 1.49–4.91, p = 0.0002). Patients with a lower bleeding risk (INR 2.0–3.0) had more negative perceptions than those with a higher risk. Patients with negative perceptions achieved the lowest score in the SF-36 survey. Haemorrhages did not affect patients’ perception or QOL.

Conclusions: Patients’ perceptions correlated with QOL. We were able to identify patient characteristics associated with poor QOL and thus the group of patients whose negative perceptions most warranted special attention from their clinicians.     

Estimating the size of crack cocaine users in France: Methods for an elusive population with high heterogeneity

BackgroundDespite several sources corroborating an expanding market and increased visibility and greater diversity in users’ profiles, very little is known about the number of crack cocaine users in France.MethodThe estimates rely on a single data source capture–recapture method. Annual data are extracted from treatment centres nationwide. To account for heterogeneity, we use an innovative zero-truncated geometric, regression-based estimator controlling for individual and centre characteristics. We use the well-known Zelterman estimator as a benchmark.ResultsThe number of crack cocaine users received in treatment centres increased dramatically, from 3388 in 2010 to 5143 in 2017 (+52%). The estimated number of crack cocaine users is believed to have tripled over the course of the same period (from 9775, 95% CI [8288–11530] to 28983 [24876–33766], respectively), with prevalences below 1‰, similar to other European countries. The coverage rate (observed number/estimated number of users) decreased in a similar fashion, indicating lower utilization. In particular, females and younger users are underestimated by data from treatment centres.ConclusionThe prevalence of crack cocaine use is fairly low but steadily increasing. The diversity in users’ profiles is a challenge to prevention and public health policies that should expand their scope to a more inclusive perspective of what defines crack cocaine users. Our method overcomes several methodological issues (data sources, data linkage, heterogeneity) and can be easily applied to a wide range of settings.     

Estimating the Prevalence of Crack Dependence Using Capture-Recapture With Institutional and Field Data: A Three-City Study in the Netherlands

The aim of this study was to estimate the prevalence of crack dependence in the three largest Dutch cities (Amsterdam, Rotterdam, The Hague), stratified by gender and age. Three-sample capture-recapture, using data (collected between 2009 and 2011) from low threshold substitution treatment (n = 1,764), user rooms (n = 546), and a respondent-driven sample (n = 549), and applying log-linear modeling (covariates: gender, age, and city), provided a prevalence rate of 0.51% (95% CI: 0.46%–0.60%) for the population aged 15–64 years, with similar estimates for the three cities. Females (23.0% of total estimate) and younger crack users (12.8% aged <35 years) might be underrepresented in drug user treatment services.     

Perceived Devaluation among a Cohort of Street-Involved Youth in Vancouver,Canada

Background: Perceived devaluation is a barrier to seeking mental and physical health services among people who use illicit drugs. Objective: Assessing the prevalence and correlates of perceived devaluation within a cohort of street-involved youth. Methods: Data were drawn from an open prospective cohort of street-involved youth who use illicit drugs (aged 14–26 at study enrollment) between December 2013 and May 2015 in Vancouver, Canada. Perceived devaluation was measured using an adapted version of Perceived Devaluation and Discrimination scale. Multivariable generalized estimating equations were constructed to examine factors independently associated with high perceived devaluation. Results: Among 411 street-involved youth, 95.1% reported high perceived devaluation at some point during the study period. In a multivariable analysis, youth who reported high perceived devaluation were significantly more likely to engage in: unprotected sex (Adjusted Odds Ratio [AOR]?=?1.56, 95% Confidence Interval 1.03–2.37); heavy alcohol use (AOR = 2.31, 95% CI 1.22–4.36); and daily heroin use (AOR = 2.07, 95% CI 1.16–3.70). Youth who resided in the Downtown Eastside neighborhood were significantly less likely to report high perceived devaluation (AOR = 0.41, 95% CI 0.26–0.65). Conclusions: Perceived devaluation was extremely prevalent among street-involved youth in our sample. We also observed that youth most in need of health and social services were significantly more likely to report high levels of perceived devaluation which may result in a reluctance to seek out key services and supports. These findings highlight the need to implement stigma reduction interventions for vulnerable youth in this setting.