Substance Abuse Problem Severity Among Rural and Urban Female DUI Offenders

Objectives: Although there has been an overall decline in the rates of driving under the influence (DUI) over the past two decades, this decrease has not occurred uniformly across all groups of DUI offenders. For example, the proportion of female DUI offenders has significantly increased. Furthermore, DUI arrest rates remain higher in less populated areas of the country. The present study examines indicators of problem severity among female DUI offenders across graduated levels of rurality. Methods: A total of 19,094 substance abuse assessment records from females convicted of DUI between 2002 and 2006 in Kentucky were examined. Beale codes were used to define the extent to which the county of conviction was rural. Results: Rurality was significantly and positively associated with multiple DUI offenses, being underage, drug problems, prevalence of DSM-IV-TR substance dependence and abuse criteria, being referred to substance abuse treatment rather than an education only intervention, and referral noncompliance. Blood alcohol concentration and alcohol problems were inversely related to rurality. Conclusion: The study suggests that problem severity among female DUI offenders may be greater in rural areas and could produce challenges for practitioners who assess and treat rural female DUI offenders.     

Gender disparity in utilization rates of substance abuse services among female ex-offenders: a population-based analysis

Abstract

Background: The use and abuse of substances is common among offender populations. Although the female former offender population has risen substantially in recent decades, relatively little is known about their substance abuse treatment experiences. Objective: This study examines disparities in substance abuse treatment utilization among the US population with special focus upon formerly incarcerated female offenders. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n?=?43,093) collected in 2001–2002 and 2004–2005 the authors compared lifetime rates of substance abuse treatment utilization between female and male ex-offenders with the U.S. general population. The sample population covered inpatient and community based substance use treatment, detoxification and rehabilitation programs. It is a nationally representative sample of noninstitutionalized persons over the age of 18. Multinomial logistic regression was performed and likelihood of using substance use treatment and services was calculated using adjusted odds ratios (AOR). Results: Compared to male ex-offenders, female ex-offenders were 52% less likely to use substance-abuse treatment services (AOR?=?0.48, 95% CI?=?0.26–0.89) and 51% less likely to use rehabilitation programs (AOR?=?0.49, 95% CI?=?0.26–0.93). Compared to females in the general population, female ex-offenders were 10 times more likely to use substance-abuse treatment services (AOR?=?10.14, 95% CI?=?5.71–18.00), 10.5 times more likely to use substance detoxification programs (AOR?=?10. 45, 95% CI?=?5.64–19.39); 8 times more likely to use inpatient wards (AOR?=?8.05, 95% CI?=?4.16–15.59); 9 times more likely to use outpatient wards (AOR?=?9.06, 95% CI?=?4.89–16.81), and 12 times more likely to use substance-abuse rehabilitation programs (AOR?=?12.06, 95% CI?=?6.55–22.22). Conclusions: While female ex-offenders were more likely to have used a range of substance abuse services when compared to the general population, they were less likely to use substance-abuse treatment services and rehabilitation programs than male ex-offenders.     

Classification of alcohol use disorders among nightclub patrons: associations between high-risk groups,sociodemographic factors and illicit drug use

Background: Nightclubs are favorable environments for alcohol abuse and the use of other drugs among patrons. Objective: To identify patterns of alcohol use in a high-risk population and their relationship with sociodemographic factors and illicit drug use. Methods: A portal survey technique was used to recruit patrons in 31 nightclubs in the city of São Paulo, Brazil. A two stage sampling method allowed the selection of nightclubs and patrons within a nightclub. A total of 1057 patrons answered to a three stages-survey (nightclub entrance and exit face-to-face interviews and a day-after online questionnaire). Entrance survey offered information on sociodemographic data and history of drug use. The day-after survey used the Alcohol Use Disorders Identifications Test (AUDIT) that identified patterns of alcohol abuse disorders. Data were modeled using an ordered logit regression analysis, considering sample weights. Results: Almost half of the nightclub patrons presented any alcohol use disorder (AUDIT score ≥8). Being male (OR?=?1.68; 95% CI?=?1.09–2.60) and single (OR?=?1.71; 95% CI?=?1.05–2.76) increased the chances for more severe alcohol use disorders. Having a graduate degree (OR?=?0.57; 95% CI?=?0.38–0.87) and age ≥35 years (OR?=?0.48; 95% CI?=?0.27–0.85) decreased the chances of patrons’ alcohol use disorders. The prevalence rates of past-year marijuana, cocaine and inhalants use increased with the increased level of alcohol use disorders. Conclusions: Patrons of nightclubs show higher prevalence rates for any alcohol use disorders than the general population. Patrons could benefit from governmental brief intervention or referral to treatment for alcohol used disorders disclosed in nightclubs.     

Relationship between depression and risk behaviors in a US Military population with HIV infection

This study evaluated the relationships between depression trajectories, depression diagnosis and sexual risk behaviors in the US Military HIV Natural History Study. Risk behavior survey data, a coded diagnosis of depression, available Center for Epidemiological Studies Depression measures, and self-reported depressive symptoms (n?=?662) were utilized. Latent class analysis created 3 classes of depression trajectories, namely, low depression (LD, n?=?378), recent-onset depression (ROD, n?=?170), and high depression (HD, n?=?114) trajectories. Overall, participants with clinically diagnosed depression were less likely to report often using condoms with new sexual partners in the past 3 months than those who have never been diagnosed with depression (OR 0.15, 95% CI 0.49–2.53). Participants with ROD (OR 0.52, 95% CI 0.28–0.97) and HD (OR 0.48, 95% CI 0.24–0.96) trajectories were less likely to report often using condoms with new sexual partners in the past 3 months than those with LD trajectories. Moreover, those with either ROD (OR 2.13, 95% CI 1.19–3.80) or HD (OR 2.74, 95% CI 1.43–5.24) trajectories were more likely to have had sex with ≥2 new sexual partners in the last 3 months than those with LD trajectories. Continued efforts targeting HIV-infected persons with mental health disorders are warranted to reduce sexual risk behaviors.     

National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients

Background

Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States.

RURAL-URBAN DIFFERENCES IN SUBSTANCE USE AND TREATMENT UTILIZATION AMONG PRISONERS

Surveys of incarcerated offenders and arrestees consistently report high rates of both alcohol and drug use in this population. This drug-crime connection has highlighted the need to learn more not only about drug treatment effectiveness, but also about drug treatment utilization. While studies have begun to examine drug treatment utilization, most of these studies have been based on urban substance abusers. Little is known about the extent to which urban and rural substance abusers may be different in terms of treatment utilization. This study, therefore, examines differences between urban and rural drug use patterns and treatment utilization among chronic drug abusers to determine whether, and in what ways, rurality may affect substance abuse and treatment seeking. The study examines these issues in a group of chronic drug users who were incarcerated at the time of the study. Findings show significant differences in drug use and treatment utilization of urban and rural offenders. Chronic drug abusers from rural and very rural areas have significantly higher rates of lifetime drug use, as well as higher rates of drug use in the 30 days prior to their current incarceration than chronic drug abusers from urban areas. Nonetheless, being from a very rural area decreased the likelihood of having ever been in treatment after controlling for the number of years using and race. While problem recognition appears to explain much of the effect of very rural residence on treatment utilization for alcohol abuse, the effects of being from a very rural area on seeking treatment for drug abuse remain statistically significant even after controlling for several other variables. The findings point to the importance of providing culturally appropriate education to very rural communities on the benefits of substance abuse treatment and of providing substance abuse treatment within the criminal justice system.     

Orphans’ perspectives on grief and loss in Botswana

This paper seeks to examine orphaned children’s experiences on grief and loss in Botswana, and its impact on their well-being and make policy recommendations. A cross sectional design which utilized survey questionnaires was employed. Data were collected from 11 districts (3 urban and 8 rural) among orphan children aged 10–18 years. Chi-squared test was used to identify variables believed to be associated with loss and grief. Unadjusted (simple) and adjusted multiple logistic regression was used to investigate factors associated with loss. Of the 732 participants (53.1%) were females and mean age was 13.5 years (SD?=?2.7); and 44.6% of these children had experienced death of a close family member in the past year which had been communicated. Children had access to education, lower primary (19.5%), upper primary (39.1%), junior secondary (32.5%), senior secondary school (6.6%), and (0.3%) in tertiary institutions. Most children (88.6%) had not experienced stigma and discrimination at school; 55.2% lived with grandparents, aunts (23.4%), siblings (11.8%), uncles (4.0%), other relatives (3.5%) and non-relatives (0.1%). Unadjusted logistic regression indicated that loss was significantly associated with having someone to talk to (OR?=?0.72, 95% CI, 0.53–0.98, p?=?0.03), change of residence (OR?=?3.08, 95% CI, 1.94–4.90, p?p?p?p?p?p?=?0.02). Age-specific interventions aimed at addressing the emotional, psychosocial and economic impacts of grief and loss are critical in preventing negative coping behaviors and improving the quality of life of orphans.     

Rural-urban differences in substance use and treatment utilization among prisoners.

Surveys of incarcerated offenders and arrestees consistently report high rates of both alcohol and drug use in this population. This drug-crime connection has highlighted the need to learn more not only about drug treatment effectiveness, but also about drug treatment utilization. While studies have begun to examine drug treatment utilization, most of these studies have been based on urban substance abusers. Little is known about the extent to which urban and rural substance abusers may be different in terms of treatment utilization. This study, therefore, examines differences between urban and rural drug use patterns and treatment utilization among chronic drug abusers to determine whether, and in what ways, rurality may affect substance abuse and treatment seeking. The study examines these issues in a group of chronic drug users who were incarcerated at the time of the study. Findings show significant differences in drug use and treatment utilization of urban and rural offenders. Chronic drug abusers from rural and very rural areas have significantly higher rates of lifetime drug use, as well as higher rates of drug use in the 30 days prior to their current incarceration than chronic drug abusers from urban areas. Nonetheless, being from a very rural area decreased the likelihood of having ever been in treatment after controlling for the number of years using and race. While problem recognition appears to explain much of the effect of very rural residence on treatment utilization for alcohol abuse, the effects of being from a very rural area on seeking treatment for drug abuse remain statistically significant even after controlling for several other variables. The findings point to the importance of providing culturally appropriate education to very rural communities on the benefits of substance abuse treatment and of providing substance abuse treatment within the criminal justice system.     

Clinical significance of cytotoxin-associated gene A status of Helicobacter pylori among non-steroidal anti-inflammatory drug users with peptic ulcer bleeding: a multicenter case-control study

Background: The role of Helicobacter pylori infection and especially of the cytotoxin-associated gene A (CagA) product strain in peptic ulcer bleeding among non-steroidal anti-inflammatory drugs (NSAIDs) users remains controversial. Methods: A case-control study was carried out including 191 consecutive chronic NSAIDs users admitted to hospital because of peptic ulcer bleeding. Peptic ulcer was verified by endoscopy. Controls comprised 196 chronic NSAIDs users without signs of bleeding of similar age and gender to cases. Multivariate regression analysis was performed for further evaluation of the relationship between H. pylori, CagA status and other risk factors. Results:H. pylori infection was present in 121 (63.4%) cases compared with 119 (60.7%) controls (odds ratio (OR)?=?1.14, 95% CI, 0.76-1.72). CagA-positive strains were found to be significantly more frequent in cases than in controls (65/106 versus 41/99 P?=?0.008). Current smoking (OR?=?2.65; 95% CI, 1.14-6.15; P?=?0.02), CagA status (OR?=?2.28; 95% CI, 1.24-4.19; P?=?0.008), dyspepsia (OR?=?6.89; 95% CI, 1.84-25.76; P?=?0.004) and past history of peptic ulcer disease (OR?=?3.15; 95% CI, 1.43-6.92; P?=?0.004) were associated significantly with increased risk of bleeding peptic ulcer. Conclusions: The results suggest that CagA-positive H. pylori infection is associated with a more than 2-fold increased risk of bleeding peptic ulcer among chronic NSAIDs users.     

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

Abstract

Background: Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients. Objectives: This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment. Methods: Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n?=?66), past but not current use (n?=?124) or current use (n?=?49). Results: Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI]?=?3.9 [1.0–15.7] and 5.2 [1.6–17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI]?=?2.9 [1.1–7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI]?=?8.1 [1.94–33.44]). Conclusion: Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.     

Racial Differences in Treatment Effect among Men in a Substance Abuse and Domestic Violence Program

Background: It isunclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. Objectives: This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. Methods: From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). Results: African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. Conclusions and Scientific Significance: At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.     

Substance Use Disorder Prevalence among Female State Prison Inmates

Background: Substance use disorders (SUDs) are prevalent among female inmates. As the female state prison population continues to increase, describing the specific clinical and demographic characteristics of female prisoners remains of paramount importance to better define women’s needs in the state prison system. Objectives: To determine the prevalence and patterns of current DSM-IV SUDs and explore whether particular demographic characteristics are more strongly associated with specific SUD categories. Methods: Data were derived from routine clinical assessments of 801 female inmates incarcerated in the Minnesota Department of Corrections state prison system. The Substance Use Disorder Diagnostic Schedule-IV (Hoffmann NG, Harrison PA. SUDDS-IV: Substance Use Disorder Diagnostic Schedule-IV. Smithfield, RI: Evince Clinical Assessments, 1995) was administered to all inmates as a computer-prompted interview on admission to the prison. Results: Of the inmates, 70.0% were dependent on at least one substance, and 7.9% met criteria for substance abuse. Alcohol dependence (30.2%) and cocaine dependence (30.1%) were the two most prevalent SUDs. The remaining substance dependence diagnoses that predominated were as follows: stimulant dependence, 24.1%; marijuana dependence, 15.6%; and heroin dependence, 9.6%. Over half (56.9%) were dependent on a substance other than alcohol. Prevalence of cocaine dependence [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.92–4.16] was significantly higher among African Americans, whereas prevalence of stimulant dependence (OR = 9.24, 95% CI = 5.40–15.80) was significantly higher among Caucasians. Prevalence of alcohol (OR = 2.12, 95% CI = 1.38–3.25) and heroin (OR = 2.67, 95% CI = 1.50–4.77) dependence was significantly higher among Native Americans. Conclusions and Scientific Significance: SUDs in general, and illicit drug use disorders in particular, are prevalent among female inmates entering a state prison system. Membership to a particular ethnic group may identify a set of inmates at elevated risk for the presence of substance-specific dependence diagnoses.     

Frequency of health service use in the year prior to asthma death

Objective: High frequency health service use (HSU) is associated with poorly controlled asthma, and is a recognized risk factor for near-fatal or fatal asthma. The objective of this study was to describe the frequency of HSU in the year prior to asthma death. Methods: Individuals aged 0–99 years who died from asthma from April 1996 to December 2011 in Ontario, Canada were identified as cases. Cases were matched to 4–5 live asthma controls by age, sex, rural/urban residence, socioeconomic status, duration of asthma and a co-diagnosis of COPD. HSU records in the year prior to death [hospitalization, emergency department (ED) and outpatient visits] were assembled. The association of prior HSU and asthma death was measured by conditional logistic regression models. Results: From 1996 to 2011, 1503 individuals died from asthma. While the majority of cases did not have increased HSU as defined in the study, compared to matched live asthma controls, the cases were 8-fold more likely to have been hospitalized two or more times (OR?=?7.60; 95% CI: 4.90, 11.77), 13-fold more likely to have had three or more ED visits (OR?=?13.28; 95% CI: 7.55, 23.34) and 4-fold more likely to have had five or more physician visits for asthma (OR?=?4.41; 95% CI: 3.58, 5.42). Conclusions: Frequency of HSU in the year prior was substantially higher in those died from asthma. Specifically, more than one asthma hospital admission, three ED visits or five physician visits increased the asthma mortality risk substantially and exponentially.     

Area of residence and alcohol‐related mortality risk: a five‐year follow‐up study

Aims To examine differences in alcohol‐related mortality risk between areas, while adjusting for the characteristics of the individuals living within these areas. Design A 5‐year longitudinal study of individual and area characteristics of those dying and not dying from alcohol‐related deaths. Setting The Northern Ireland Mortality study. Participants A total of 720 627 people aged 25–74, enumerated in the Northern Ireland 2001 Census, not living in communal establishments. Measurements Five hundred and seventy‐eight alcohol‐related deaths. Findings There was an increased risk of alcohol‐related mortality among disadvantaged individuals, and divorced, widowed and separated males. The risk of an alcohol‐related death was significantly higher in deprived areas for both males [hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR 2.67 (95% CI 1.72, 4.15); however, once adjustment was made for the characteristics of the individuals living within areas, the excess risk for more deprived areas disappeared. Both males and females in rural areas had a reduced risk of an alcohol‐related death compared to their counterparts in urban areas; these differences remained after adjustment for the composition of the people within these areas. Conclusions Alcohol‐related mortality is higher in more deprived, compared to more affluent areas; however, this appears to be due to characteristics of individuals within deprived areas, rather than to some independent effect of area deprivation per se. Risk of alcohol‐related mortality is lower in rural than urban areas, but the cause is unknown.     

Antibiotic use in infancy and the risk of asthma in Mexican American children

Objective: This study examined the associations of antibiotic use in infancy with lifetime doctor-diagnosed asthma and current wheeze among Mexican American children. Methods: In a population-based, cross-sectional investigation, parents of 2023 children 4–18 years of age completed a questionnaire/interview addressing respiratory conditions, antibiotic use, and covariates. Results: In adjusted analyses, among children without history of ear infections in infancy, children who used antibiotics ≥3 times and 1–2 times were more likely to report doctor-diagnosed asthma compared with their peers who did not use antibiotics in infancy [adjusted odds ratio (aOR)?=?5.14, 95% confidence interval (CI): 2.88–9.17, and aOR?=?2.15, 95% CI: 1.26–3.69, respectively, p trend < 0.0001]. The respective aORs for current wheeze were 3.67 (95% CI: 1.95–6.89) and 1.63 (95% CI: 0.91–2.95). Antibiotic use in infancy was not associated with asthma or current wheeze in children who had ear infections in infancy. In additional analyses, antibiotic use in infancy was associated with asthma in children without parental history of asthma or allergies (aOR?=?2.73, 95% CI: 1.70–4.39) but not in those with parental history of asthma or allergies. Among Mexico-born participants born in rural areas, antibiotic use in infancy was associated with a seven-fold increase in risk of asthma (aOR?=?7.21, 95% CI: 1.46–35.65), while the association was non-significant in Mexico-born children born in urban areas in Mexico. Conclusions: Antibiotic use in infancy may increase the risk of asthma and wheezing, but these associations were limited to subgroups of children.     

Smoking,alcohol and family history of cancer as risk factors for small intestinal neuroendocrine tumors: a systematic review and meta-analysis

Objectives: Risk factors for small intestinal neuroendocrine tumors (SI-NETs) are not well understood. The aim of this systematic literature review was to identify risk factors for SI-NET and to further assess these by meta-analysis.

Material and methods: PubMed and abstracts from the ENETS and NANETS were searched for studies published until May 2015. Eligible studies were selected according to the PRISMA statement.

Results: Seven studies evaluating six individual populations were included (study accrual period 1980–2012) in the meta-analysis, involving 765 (range 17–325) cases and 502,282 (range 52–498,376) controls. All studies were case–control by design. The following risk factors were reported in ≥2 studies: family history of any cancer, family history of colorectal cancer, ever alcohol use and ever smoking. The pooled OR was 1.34 (95% CI: 1.12–1.60; p?<?.01; I²?=?0.0%) for family history of any cancer, 1.43 (95% CI: 1.15–1.79; p?<?.01; I²?=?0.0%) for family history of colorectal cancer, 1.04 (95% CI: 0.63–1.72; p?=?.87; I²?=?65.0%) for ever alcohol use and 1.40 (95% CI: 1.06–1.86; p?<?.05; I²?=?49.3%) for ever smoking.

Conclusions: Family history of any cancer, family history of colorectal cancer and history of ever smoking were associated with an increased risk of SI-NET by meta-analysis. Alcohol consumption was not a significant risk factor for SI-NET. However, the studies reporting smoking and alcohol had a high degree of heterogeneity. Therefore, further studies are needed for clarification of smoking and alcohol as risk factors for the occurrence of SI-NET.     

Gender,Occupational, and Socioeconomic Correlates of Alcohol and Drug Abuse Among U.S. Rural,Metropolitan, and Urban Residents

Objective. To estimate the prevalence and correlates of alcohol and drug abuse and dependence among rural, urban, and metropolitan U.S. residents. Methods. The National Comorbidity Survey (NCS) (1990–1992) yielded lifetime risks of psychiatric disorders in a probability sample of 8098 respondents in the 48 contiguous states using DSM‐III‐R for diagnosis. Logistic regressions of alcohol and drug disorders were performed to compare their correlates in rural, urban, and metropolitan areas after stratifying by demographic and socioeconomic variables. Results. Household income was protective only in rural areas. High occupation strata were positively associated with alcohol disorders. Urban and metropolitan women were less likely to report drug disorders. There was no gender difference in rural drug abuse and dependence. Also, high occupation strata were positively associated with drug disorders. Conclusion. Lack of gender differences in rural drug disorders may indicate an increase in drug availability, access, and use among rural women. Workplace alcohol and drug disorders, especially among metropolitan sales, crafts, and service workers should be of concern to policymakers. These results underline the usefulness of using multiple indicators of socioeconomic positions in epidemiologic studies of substance use disorders.