Preventive medicine
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Preventive medicine · Nov 2022
Trends and distinct profiles of persons who inject drugs in the United States, 2015-2019.
Drug injection represents a major health problem in the US, with severe health consequences including the transmission of blood-borne infections. An examination of the most recent trends in drug injection is warranted by the fast-evolving drug epidemic and recent policy changes such as the federal funding ban on needle exchange programs. This research examines current drug injection trends, patterns, and socioeconomic and behavioral profiles of people who inject drugs (PWID). ⋯ The methamphetamine injection group reported greater risks of experiencing serious psychological distress, suicidality, and limited substance use treatment. Special attention is needed for those who primarily injected methamphetamine. Programs to promote harm reduction and increase access to addiction treatment need to be expanded in at-risk communities while accounting for their distinct socioeconomic and drug use/misuse profiles.
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Preventive medicine · Nov 2022
The social determinants of substance use associated with deaths of despair: Individual risks and population impacts.
As the incidence of deaths from external causes including poisonings, suicide, and alcohol-related liver disease, increases in countries such as the United States and Canada, a better understanding of the fundamental social determinants of the substance use underlying these so-called "deaths of despair", at the population level, is needed. Using data from the nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles) (N = 30,729), the independent associations between age, sex, marital status, immigrant status, race/ethnicity, education, income, rurality, affective health and the use of illicit substances, opioids (without distinction for prescription status), problematic levels of alcohol, and combined past-year use (≥2) of substances, were explored using multivariate logistic regression, marginal risk, and population attributable fraction estimation, with propensity score-adjusted sensitivity analyses. Males, those who were under 29 years, without a partner, born in Canada, White, or had an affective disorder reported both higher use of individual substances and multiple substances in the past year. ⋯ Between 10% and 45% of illicit substance, problematic alcohol, and polysubstance use prevalence was attributable to non-partnered marital status, non-immigrant status, and White race/ethnicity. Of opioid use prevalence, 25% was attributable to White race/ethnicity, 13% to affective disorder status and 4% to lower-income. Though not all substance use will result in substance-related morbidity or mortality, these findings highlight the role of social determinants in shaping the intermediary behavioural outcomes that shape population-level risk of "deaths of despair".
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Preventive medicine · Nov 2022
Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.
The study aims to analyze inequalities in Covid-19 outcomes in Brazil in 2020/2021 according to the per capita Gross Domestic Product (pcGDP) of municipalities. All cases of Severe Acute Respiratory Syndrome (SARS) who were hospitalized or died, regardless of hospitalization, registered in Brazil in 2020 and 2021 were analyzed (n = 2,902,742), including those with a confirmed diagnosis of Covid-19 (n = 1,894,165). ⋯ Municipalities in the lowest pcGDP decile had (i) 30% (95%CI 28%-32%) higher lethality from Covid-19, (ii) three times higher proportion of patients with SARS without the collection of biological material for the diagnosis of Covid-19, (iii) 16% (95%CI 15%-16%) higher proportion of SARS patients testing in a period longer than two days from the onset of symptoms, (iv) 140% (95%CI 134%-145%) higher absence of CT scan use. There is deep socioeconomic inequality among Brazilian municipalities regarding the occurrence of Covid-19 negative outcomes.
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Preventive medicine · Nov 2022
Availability and content of clinical guidance for tobacco use and dependence treatment - United States, 2000-2019.
Evidence-based treatments for tobacco use and dependence can increase cessation success but remain underutilized. Health professional societies and voluntary health organizations (advising organizations) are uniquely positioned to influence the delivery of cessation treatments by providing clinical guidance for healthcare providers. This study aimed to review the guidance produced by these organizations for content and consistency with current evidence. ⋯ Documents endorsed: screening (74%), pharmacotherapy (68%), counseling (89%), or follow-up (37%). Few documents endorsed more recent evidence-based treatments including combination nicotine replacement therapy (18%), and text- (11%) and web-based (11%) interventions. Advising organizations have opportunities to address identified gaps and enhance clinical guidance to contribute toward expanding the provision of comprehensive tobacco cessation support.
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Preventive medicine · Nov 2022
Wildfire smoke and symptoms affecting mental health among adults in the U.S. state of Oregon.
The physical and mental health impacts of wildfires are wide-ranging. We assessed associations between exposure to wildfire smoke and self-reported symptoms affecting mental health among adults living in Oregon. We linked by interview date and county of residence survey responses from 5807 adults who responded to the 2018 Behavioral Risk Factor Surveillance System's depression and anxiety module with smoke plume density, a proxy for wildfires and wildfire smoke exposure. ⋯ Medium or heavy smoke for 6 or more weeks in the past year, compared to ≤4 weeks in the past year, was associated with a 30% higher prevalence of being unable to stop or control worrying more than half the time during the past two weeks (prevalence ratio: 1.30, 95% confidence interval: 1.03, 1.65). Among adults in Oregon, selected symptoms affecting mental health were associated with extended durations of medium and heavy smoke. These findings highlight the burden of such symptoms among adults living in communities affected by wildfires and wildfire smoke.