Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study

Background

The distribution of take-home naloxone (THN) kits has been an important strategy in reducing overdose fatalities among people who use drugs. However, little is known about the use of THN among youth who are street-involved. The present study explores knowledge and possession of THN among street-involved youth in a Canadian setting.

Methods

Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth age 14–28 at enrollment in Vancouver, Canada. Participants completed a standardized questionnaire, which included items related to knowledge and possession of THN, sociodemographic characteristics, and substance use-related factors. Multivariable logistic regression models were used to identify factors independently associated with knowledge and possession of THN.

Results

Between December 2014 and November 2016, 177 youth were interviewed, including 68 females (38.4%). While 126 (71.2%) participants reported knowledge of THN, only 40 (22.6%) possessed a THN kit. Caucasian/white ethnicity was found to be positively associated with both knowledge and possession of THN (both p?<?0.05). Public injection drug use in the last 6 months was found to be positively associated with knowledge of THN, while daily heroin use and daily methamphetamine use were associated with possession of THN (all p?<?0.05). Male gender was negatively associated with possession of THN (p?<?0.05).

Conclusions

These findings highlight important gaps between knowledge and possession of THN among youth and the need to increase participation in THN programs among specific populations including non-white and male youth. Further research is needed to gain a better understanding of the barriers that may prevent certain youth from acquiring THN kits.

     

Polysubstance Use Among Minority Adolescent Males Incarcerated for Serious Offenses

Background

Adolescent juvenile offenders are at high risk for problems associated with drug use, including polysubstance use (i.e., use of a variety of drugs). The combination of juvenile offending and polysubstance use presents a significant public and child health concern.

Objective

This study explored polysubstance use among a sample of youth incarcerated for serious offenses. We examined several risk factors for substance use and delinquency (i.e., early and frequent substance use, prior history of arrests, school expulsion, Black ethnicity), as well as the association between aggression and polysubstance use.

Methods

Data were collected via questionnaires from 373 serious male juvenile offenders upon intake into a secure locked facility. Youth were on average 16 years old, and minority youth were overrepresented (28.1 % Black, 53.1 % Latino). Poisson regressions were used to assess the associations between the risk factors, aggression, and polysubstance use.

Results

Consistent with the literature, Black youth reported less polysubstance use and later age of drug use onset than White and Latino youth. Findings suggest that Latino juvenile offenders and those with an early and problematic pattern of substance use are at heightened risk for polysubstance use. Aggression was not significantly related to polysubstance use, over and above the risk factors.

Conclusions

Given that Latino youth experience low rates of treatment for substance use, the development of culturally-sensitive interventions for these youth is needed. Interventions should also be multifaceted to address the multitude of risk factors associated with polysubstance use among juvenile offenders.

     

Media Managing Mood: A Look at the Possible Effects of Violent Media on Affect

Background

The potential impact of violent media on children’s emotional well-being has been a source of controversy for several decades. To date evidence for a negative impact of violent media on emotional well-being has been mixed and increasingly connected to a “replication crisis” throughout psychological science.

Objective

The current study examines concurrent and prospective relationships between violent media use and symptoms of depression and anxiety in a sample of 536 mostly Hispanic youth (309 males, age range 10–14).

Methods

Youth and parents were surveyed regarding social environment, media use and mental health. 302 youth responded to a 1-year follow-up.

Results

Results indicated that neither violent television use nor violent video game use predicted anxiety or depression concurrently or depression prospectively with this sample.

Conclusions

The impact of media violence use on child mood symptoms appears to be minimal. Further research may wish to focus on particular at-risk groups.

     

Investigating social inequalities in older adults’ dentition and the role of dental service use in 14 European countries

Background

Oral disease, despite being largely preventable, remains the most common chronic disease worldwide and has a significant negative impact on quality of life, particularly among older adults.

Objective

This study is the first to comprehensively and at a large scale (14 European countries) measure the social inequalities in the number of natural teeth (an informative oral health marker) in the over 50-year-old population and to investigate the extent to which such inequalities are attributable to dental service use.

Methods

Using Wave 5 of the Survey of Health, Ageing and Retirement in Europe, which included internationally harmonized information on over 50,000 individuals across 14 European countries, we calculated Gini and Concentration indices (CI) as well as the decompositions of CIs by socioeconomic factors.

Results

Sweden consistently performed the best with the lowest inequalities as measured by Gini (0.1078), CI by income (0.0392), CI by education (0.0407), and CI by wealth (0.0296). No country performed the worst in all inequality measures. However, unexpectedly, some wealthier countries (e.g., the Netherlands and Denmark) had higher degrees of inequalities than less-wealthy countries (e.g., Estonia and Slovenia). Decomposition analysis showed that income, education, and wealth contributed substantially to the inequalities, and dental service use was an important contributor even after controlling for income and wealth.

Conclusions

The study highlighted the importance of comprehensively investigating oral health inequalities. The results are informative to policymakers to derive country-specific health policy recommendations to reduce oral health inequalities in the older population and also have implications for oral health improvement of the future generations.

     

Assessing the Relationship Between Parental Influences and Wellbeing Among Low Income African American Adolescents in Chicago

Background

African American youth in urban centers often reside in poorly resourced communities and face structural disadvantage, which can result in higher rates of poor behavioral health factors such as mental health problems, juvenile justice system involvement, substance use, risky sex and lower school engagement. While parental monitoring has been shown to be protective with regards to these risk factors, less understood are the effects of parental warmth in conjunction with monitoring.

Objective

This study examined whether parental monitoring and warmth had a main or mediated relationship to behavioral health factors among low income African American youth.

Method

African American youth (n = 638) completed self-administered questionnaires on parenting factors (i.e., monitoring and warmth), mental health, juvenile justice system involvement, substance use, school engagement, and sexual risk behaviors.

Results

Participants reported higher mean parental monitoring versus warmth. Parental monitoring was correlated with lower substance use, delinquency, unsafe sex and higher school engagement. Higher parental warmth in contrast was uniquely correlated with better youth mental health but also higher rates of alcohol, cigarette and marijuana use.

Conclusions

Monitoring their youth at high levels appears to be a common and effective strategy by parents in poorly resourced communities and was associated with lower behavioral health risks. By contrast, parental warmth had both positive and negative associations with behavioral health, suggesting that more research is needed to clarify the circumstances within which parental warmth may be protective or not.

     

Case report: surgical removal of a migrated needle in right ventricle of an intravenous drug user

Background

Illicit drug use has become an increasing public health and social concern in the past decades worldwide. Intravenous injection has an elevated risk of infection. Needle embolism is a rare complication of intravenous drug users, Retained broken needles can lead to local complications, such as infection, but they also have the potential to embolize to heart or lung, and lead to serious complications.

Method

We reported a rare case of an intravenous drug user which a retained broken needle fragments in the inferior wall of the right ventricle.

Results

We performed a successful surgery and give our comments and recommendations for illicit drug use worldwide and in China.

Conclusions

Illicit Drug use becomes a global problem because of its health and social harmfulness. To help drug addicts and provide prevention and treatment services are the obligations and responsibilities of all medical workers.

     

Promotive Factors and Psychosocial Adjustment Among Urban Youth

Background

Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited.

Objective

The current study addresses this limitation by examining the impact of self-efficacy and positive expectations about the future, as promotive factors, on levels of depressive and anxious symptomatology, sense of belonging, and friendship among a sample of urban youth.

Methods

Data are from 1202 4th and 5th grade students enrolled at 27 elementary schools in a high poverty, high minority school district in the Southeastern United States.

Results

Using ordinary least squares regression, analyses reveal that promotive factors are significant predictors of psychosocial adjustment and thus have implications for improving negative outcomes among urban minority youth.

Conclusions

The findings suggests that interventions aimed at increasing self-efficacy and positive expectations about the future may reduce child and adolescent vulnerability to negative outcomes associated with poor psychosocial adjustment.

     

Predictors of mortality among under-five children with severe acute malnutrition,Northwest Ethiopia: an institution based retrospective cohort study

Background

Globally, approximately 19 million children under 5 years are suffering from Severe Acute Malnutrition (SAM). It is a major cause of morbidity and mortality in low-income countries including Ethiopia. However, little is known regarding predictors of mortality among these children in Ethiopia. The current study aimed to assess the potential predictors of mortality among under-five children with SAM admitted to a stabilization center.

Method

A retrospective cohort study was conducted in 527 under-five children who were admitted for SAM at the University of Gondar comprehensive specialized hospital from 2014 to 2016. Data were collected from a randomly selected chart after getting ethical clearance. Data were cleaned, coded and entered to Epi-info (version 7) and analyzed using STATA (version14). The outcome was computed by using tables and graphs. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.

Result

Overall, the median follow-up period was 10 days with interquartile range (Q1, Q3: 8, 17). At the end of the follow-up, the mortality rate was 66(12.52%). Anemia (AHR(Adjusted Hazard Ratio): 2.3, 95% CI: 1.2, 4.5), Shock (AHR: 7.9, 95% CI: 3.7, 16.7), no intake of antibiotics (AHR: 2.3 95% CI: 1.2, 4.4), IV-Fluid (AHR: 3.2, 95% CI: 1.7, 5.8), no intake of F75 (AHR: 6.6,95% CI: 2.9, 14.7) and no intake of F100 (AHR: 3, 95% CI: 1.6, 5.4) were independent predictors of mortality.

Conclusion

The survival status of under-five children with SAM was lower than the national standard protocol. Altered general conditions such as shock, anemia, not adhering to medical and nutritional therapies were identified as predictors of mortality among SAM children. Health education on early medical seeking behavior and adherence on the routine regimens may improve this gap in child survival.

     

Drogenkonsum unter Studierenden der Sozialen Arbeit

Background

The study surveyed extent of drug use among students of social work and explored if there was a relationship between drug use and demands of study program.

Methods

Social work students (n = 240) filled in an online questionnaire about their drug use and rated demands of their study program.

Results

A third of the students took cannabis, 10?% tranquilizer or sleeping pills and almost 10?% amphetamines. Students used cannabis und tranquilizers deliberately to obtain recovery times in everyday student life. However, there were only low rates of brain doping observed.

Conclusion

Students should receive coaching on alternative methods of relaxation and strategies for time management and self-care.

     

Prozessevaluation einer Intervention zur kooperativen Raucherentwöhnung

Background

The study “ENTER: Evaluation of a collaborative smoking cessation intervention” is a cluster-randomized controlled trial to assess the effectiveness of a smoking cessation intervention implemented in the German primary care setting in collaboration with AOK NORDWEST in Westphalia-Lippe and Schleswig-Holstein.

Objectives

A process evaluation was performed with the aim of investigating barriers and facilitators to intervention implementation and giving recommendations for future interventions.

Materials and methods

Between November 2015 and January 2016 semistructured qualitative interviews were conducted with AOK employees and general practitioners of the intervention group. Interviews focused on contextual factors (e.?g. responsibilities for implementing the intervention), the communication between network partners and the process of referring patients to smoking cessation courses.

Results

Overall, 21 interviews were completed (8 AOK employees, 13 general practitioners). Intervention implementation was facilitated because physicians perceived smoking cessation counseling to be important and were supported by their office staff. Challenges were seen in patients’ motivation for participation in smoking cessation courses and meeting the minimum number of course participants.

Conclusions

Successful intervention implementation would be facilitated by motivating patients to participate in smoking cessation courses and informing them about the effectiveness of the courses. Patient’s preferences for different smoking cessation aids should be investigated in order to increase the use of effective aids.

     

“It’s on everyone’s plate”: a qualitative study into physicians’ perceptions of responsibility for smoking cessation

Background

Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians’ perceptions of responsibility for smoking cessation.

Methods

Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N?=?55). Data analysis followed the framework approach.

Results

The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care.

Conclusions

The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and –as suggested by comments by several participants- the government.

     

Relationship Education for Youth in High School: Preliminary Evidence from a Non-controlled Study on Dating Behavior and Parent–Adolescent Relationships

Background

Relationship education (RE), often employed for adults, has become increasingly available for teenagers. However, non-romantic relationships are rarely assessed as a potential outcome domain influenced by RE.

Objective

Informed by life course theory and the ecological systems perspective, this study examines the influence of RE on both dating and parent–adolescent relationships, and the associations between such changes.

Methods

Using a one-sample, non-controlled design, we conducted repeated measures analysis of covariance, and hierarchical linear regression analyses to examine the influence of RE participation on 3658 ethnically diverse adolescents’ knowledge and use of healthy skills in their parent–adolescent and dating relationships and whether these changes are linked.

Results

Results indicate significant and positive influences on participants’ knowledge and use of healthy relationship skills in their parent–adolescent and dating relationships. Further, results indicate that change in the current dating relationship is associated with concurrent change in the parent–adolescent relationship.

Conclusion

The results of this study provide preliminary evidence for a spillover effect of relationship education efforts, which are traditionally focused on the youth dating relationships, to parent–adolescent relationship dynamics. Future research considering multiple domains of RE outcomes for youth is warranted and future RE development and implementation may consider integrating parents to maximize program outcomes.

     

Academic and Mental Health Outcomes of Youth Placed in Out-of-Home Care: The Role of School Stability and Engagement

Background

Youth placed in out-of-home care are at significant risk of low academic achievement and poor mental health. Few studies have considered the potential effects of school-related factors, such as school placement stability and school engagement, on youth outcomes.

Objective

The current study examined the potential main effects of school placement stability and engagement on academic achievement and mental health. Furthermore, we examined whether school-related factors moderated the association between home placement stability and youth outcomes.

Methods

Participants included 420 youth (age 6–14 at baseline) placed in out-of-home care participating in a national longitudinal study of youth in contact with the child welfare system. Youth, caregivers, and caseworkers provided relevant information at baseline, 18, and 36 months. Hierarchical regression models were constructed to test potential main and moderating effects of school engagement and school placement stability on youth mental health and academic achievement prospectively, while accounting for relevant covariates.

Results

School placement stability was an independent predictor of youth internalizing and externalizing symptoms, but was not significantly associated with academic outcomes. Furthermore, there were no main effects of school engagement or home placement stability on youth outcomes and school-related factors did not moderate the relationship between home placement stability and youth outcomes.

Conclusion

For children and adolescents who do not have the benefit of a stable, safe, or caring home environment, school stability may be contribute to an environment that can foster healthy development.

     

Deprivation is associated with worse physical and mental health beyond income poverty: a population-based household survey among Chinese adults

Purpose

In studying health inequality, poverty as measured by income is frequently used; however, this omits the aspects of non-monetary resources and social barriers to achieving improved living standard. Therefore, our study aimed to examine the associations of individual-level deprivation of material and social necessities with general physical and mental health beyond that of income poverty.

Methods

A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed between 2014 and 2015. Income poverty and a Deprivation Index were used as the main independent variables. General health was assessed using the validated 12-item Short-Form Health Survey version 2, from which physical component summary and mental component summary were derived.

Results

Our results in multivariable ordinal logistic regressions consistently showed that, after adjusting for income poverty, socio-demographic and lifestyle factors, being deprived was significantly associated with worse physical (OR 1.66; CI 1.25–2.20) and mental health (OR 1.83; CI 1.43–2.35). Being income poor was also significantly associated with worse mental health (OR 1.63; CI 1.28–2.09) but only marginally with physical health (OR 1.34; CI 1.00–1.80) after adjustments.

Conclusions

Income does not capture all aspects of poverty that are associated with adverse health outcomes. Deprivation of non-monetary resources has an independent effect on general health above and beyond the effect of income poverty. Policies should move beyond endowment and take into account the multidimensionality of poverty, in order to address the problem of health inequality.

     

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal,Canada

Background

This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users.

Methods

By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal.

Results

With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV.

Conclusions

Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.

     

Contraceptive utilization among new exotic dancers: a cross-sectional study

Background

Female exotic dancers are a population at high risk of unintended pregnancy. The objective of this study is to describe the reproductive health needs and contraceptive utilization of exotic dancers.

Methods

New exotic dancers (<?6 months dancing) from 26 clubs in Baltimore City/County completed a one-time survey.

Results

Of 117 participants, 96 (82%) had current contraceptive need. The mean age was 24 years, and 55% were black. Sex work (45%), alcohol use disorder (73%), illicit (44%; e.g., heroin, crack, cocaine), and injection drug use (8%) were common. The majority (66%) reported contraception use in the prior 6 months. Condoms were reported by 46% whereas 45% reported non-barrier methods, most commonly hormonal injection. Consistent condom use was rare (3%), and only 11% used a long-acting reversible method.

Conclusions

Despite their unique reproductive health vulnerabilities, female exotic dancers have unmet contraceptive needs. Targeted harm reduction strategies are needed to fill this gap.

     

Income inequality and subjective well-being: a systematic review and meta-analysis

Background

Reducing income inequality is one possible approach to boost subjective well-being (SWB). Nevertheless, previous studies have reported positive, null and negative associations between income inequality and SWB.

Objectives

This study reports the first systematic review and meta-analysis of the relationship between income inequality and SWB, and seeks to understand the heterogeneity in the literature.

Methods

This systematic review was conducted according to guidance (PRISMA and Cochrane Handbook) and searches (between January 1980 and October 2017) were carried out using Web of Science, Medline, Embase and PsycINFO databases.

Results

Thirty-nine studies were included in the review, but poor data reporting meant that only 24 studies were included in the meta-analysis. The narrative analysis of 39 studies found negative, positive and null associations between income inequality and SWB. The meta-analysis confirmed these findings. The overall association between income inequality and SWB was almost zero and not statistically significant (pooled r?=???0.01, 95% CI ??0.08 to 0.06; Q?=?563.10, I ²?=?95.74%, p?<?0.001), suggesting no association between income inequality and SWB. Subgroup analyses showed that the association between income inequality and SWB was moderated by the country economic development (i.e. developed countries: r?=???0.06, 95% CI ?0.10 to ?0.02 versus developing countries: r?=?0.16, 95% CI 0.09–0.23). The association between income inequality and SWB was not influenced by: (a) the measure used to assess SWB, (b) geographic region, or (c) the way in which income inequality was operationalised.

Conclusions

The association between income inequality and SWB is weak, complex and moderated by the country economic development.

     

Evidence-based prevention of cannabis use in flanders is there a role for health economic evaluation?

Objectives

Cannabis is a popular drug in Flanders, in spite of the fact that the prevention of its use lists high on the Flemish political agenda. The Flemish Government aims to prevent cannabis use efficiently and in achieving this, a health economic analysis could be helpful. The possibilities and limitations of applying economic evaluation techniques to the prevention of substance (ab)use, are discussed in this paper.

Methods

A thorough literature search, interviews with key persons, an internet search and an analysis of unpublished reports and documents was performed.

Results

The interrelation between various forms of substance use, and of the array of strategies to prevent this (including the costs thereof), seems to demand a joint evaluation of multiple substances.

Conclusions

More than methodological difficulties, the general lack of knowledge on age- and time-specific health and income effects caused by various forms of substance (ab)use, currently makes the evidence-based evaluation of prevention of cannabis use in Flanders a virtually impossible undertaking.