Preventive medicine
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Preventive medicine · Nov 2015
Review Historical ArticleA literature review on prevalence of gender differences and intersections with other vulnerabilities to tobacco use in the United States, 2004-2014.
This report describes results from a systematic literature review examining gender differences in U. S. prevalence rates of current use of tobacco and nicotine delivery products and how they intersect with other vulnerabilities to tobacco use. We searched PubMed on gender differences in tobacco use across the years 2004-2014. ⋯ Gender differences generally were robust when intersecting with other vulnerabilities, although decreases in the magnitude of gender differences were noted among younger and older users, and among educational levels and race/ethnic groups associated with the highest or lowest prevalence rates. Overall, these results document a pervasive association of gender with vulnerability to tobacco use that acts additively with other vulnerabilities. These vulnerabilities should be considered whenever formulating tobacco control and regulatory policies.
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Preventive medicine · Nov 2015
ReviewSmoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence.
Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. ⋯ Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
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Preventive medicine · Nov 2015
Distribution of naloxone for overdose prevention to chronic pain patients.
In this commentary, we reflect on the growing opioid overdose epidemic and propose that chronic pain patients prescribed opioids are contributing to growing mortality rates. We advocate for expanding naloxone access and overdose prevention training, which has historically been directed when available to injection drug users, to chronic pain patients who may be at high risk for accidental opioid overdose.
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Preventive medicine · Nov 2015
HIV prevention and treatment strategies can help address the overdose crisis.
Since the 1990s, effective HIV prevention and treatment strategies have been coordinated and implemented in the United States, resulting in substantial reductions in HIV-related death and HIV transmission among people who use injection drugs. During the same period, despite substantial long-term funding of War on Drugs policies, opioid addiction, driven by increased prescription opioid use and heroin accessibility, has made overdose the leading cause of accidental injury death in the United States. This commentary describes how the prevention and treatment successes among people who use drugs in the HIV/AIDS epidemic can be applied to address the opioid overdose crisis.
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Prescription opioid abuse and addiction, along with consequences such as overdose death and increasing transition to heroin use, constitute a devastating public health problem in the United States. Increasingly it is clear that overprescription of these medications over the past two decades has been a major upstream driver of the opioid abuse epidemic. This commentary considers the factors that have led to overprescription of opioids by clinicians, discusses recent evidence casting doubt on the efficacy of opioids for treating chronic pain, and describes the ongoing efforts by federal and community stakeholders to address this epidemic-for example, supporting prescription drug monitoring programs and improved clinician training in pain management to help reduce the supply of opioids, increasing dissemination of evidence-based primary prevention programs to reduce demand for opioids, and expanding access to effective opioid agonist therapies and antagonist medications for both treatment and overdose prevention.