To compare the prevalences of mental health problems, substance use, and suicidal ideation between first-year and final-year medical students. First- and final-year medical students at ESIC Medical College and Hospital, Faridabad, Haryana, India, were invited to participate in a survey using consecutive sampling. The 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to assess depression, anxiety, and stress. The 10-item Drug Abuse Screening Test was used to assess drug use during the previous 12 months. The 10-item Alcohol Use Disorders Identification Test was used to evaluate alcohol consumption patterns, drinking behaviours, and alcohol-related problems. The six-item Fagerström Test for Nicotine Dependence was used to assess frequency of use, compulsion, and level of nicotine dependence. The four-item Suicidal Behaviour Questionnaire-Revised was used to assess suicidal thoughts and behaviours. Of 160 medical students approached, 20 declined to participate; 140 (70 each from the first and final years) were included in the analysis. Most students were single (90.0% among first-year students and 58.6% among final-year students). Students who were in a relationship had lower DASS-21 scores than those who were single (32.8 vs 40.6, p = 0.03). The mean DASS-21 score was higher among first-year students than among final-year students (41.6 vs 35.7, p = 0.07). However, final-year students had higher proportions of hazardous-to-dependent alcohol use (14.3% vs 1.4%, p = 0.004), moderate-to-severe drug use (17.1% vs 1.4%, p = 0.006), and smoking during the previous year (37.1% vs 7.1%, p < 0.001). Overall, 20.0% of first-year students and 15.7% of final-year students had a high risk of suicidal behaviour. DASS-21 scores were moderately correlated with Drug Abuse Screening Test scores in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as Suicidal Behaviour Questionnaire-Revised scores in both first-year students (r = 0.41, p < 0.001) and final-year students (r = 0.44, p < 0.001). In binary logistic regression, higher DASS-21 scores predicted both high-risk suicidal behaviour (adjusted odds ratio [OR] = 1.06 per unit, p < 0.001) and moderate-to-severe drug use (adjusted OR = 1.08 per unit, p = 0.001). Final-year students had higher odds of moderate-to-severe drug use (adjusted OR = 23.70, p = 0.032), independent of psychological distress. Older age predicted high-risk suicidal behaviour (adjusted OR = 1.65 per year, p = 0.017). Medical students in an Indian hospital experience a high burden of psychological distress. Although first-year students exhibit greater emotional distress, final-year students demonstrate a higher prevalence of substance use, which may reflect maladaptive coping behaviours. Early, continuous, institution-based mental health interventions are needed.
Alcohol and e-cigarettes are commonly used among young adults (YAs), and many co-use both substances. Social influences strongly predict the individual use of alcohol and e-cigarettes, but their role in co-use remains unexplored. We hypothesized that drinking (vs. non-drinking) days are associated with increased risk of being offered and using e-cigarettes, and there is a positive association between total drinks consumed and e-cigarette use. We also hypothesized that passive (being with/around someone using e-cigarettes while drinking) and active (being offered e-cigarettes while drinking) social influences are associated with increased risk of e-cigarette use, and the relationship between total drinks consumed and e-cigarette use is stronger with exposure to such social influences. YAs aged 19-30 who drink heavily (N = 154; 63.0% female; 84.4% White; all recruited from the Northeast U.S.) completed 28 days of daily assessments. Morning reports asked about prior-day alcohol use, e-cigarette use, and social influences. Participants reported 1371 drinking days (33.4% of all days), of which 199 (14.5%) were co-use days and 120 (8.8%) were characterized by e-cigarette offers. Drinking (vs. non-drinking) days were associated with greater risk of being offered and using e-cigarettes. On drinking days, total drinks consumed and social influences were positively associated with e-cigarette use. No interaction effects between total drinks consumed and social influences were found. Alcohol use and quantity are associated with same-day e-cigarette use, and social influences may contribute to YAs' e-cigarette use while drinking. Interventions should consider drinking events as high-risk environments for e-cigarette offers and use.
Alcohol Use Disorder (AUD) is a complex condition marked by physical and psychological dependence, often accompanied by lasting changes in brain regions such as the hippocampus that contribute to memory and cognitive impairments. Emerging evidence highlights the role of gut microbiota dysbiosis in AUD and suggests a link between the gut-brain axis, neuroinflammation, and behavioral alterations. Probiotics have been proposed as potential modulators of microbial balance and inflammatory responses, with possible benefits for alcohol-related deficits. This study examined the effects of probiotic treatment on alcohol-conditioned behavior, withdrawal symptoms, selected fecal bacterial populations, and hippocampal alterations in a rat model of ethanol withdrawal. Ninety-six male Wistar rats were assigned to different drinking and treatment conditions and divided into groups for behavioral, neuroanatomical, and microbiological assessments. Conditioned place preference (CPP) was used to evaluate alcohol-related learning, while hippocampal volume, cell density, and fecal Lactobacillus and Enterobacteriaceae levels were measured. Ethanol exposure reduced fecal Lactobacillus levels and was associated with decreased hippocampal volume and altered cell density. Probiotic treatment partially restored Lactobacillus levels and reduced withdrawal severity, but did not significantly restore hippocampal structural parameters. Probiotics reduced CPP acquisition in control rats and accelerated CPP extinction in ethanol-exposed rats, suggesting a limited modulatory effect on alcohol-related behaviors.
We have been funded to examine post-incarceration health and social outcomes for all people incarcerated in New South Wales, Australia, 2000-2022; assess treatment and services for drug dependence and serious mental illness; and project the impact of expanding intervention coverage. We will use a linked cohort, the Prison Outcomes STudy (POST), which we also describe. The POST cohort was established using linked administrative data for all adults (≥ 18 years) admitted to full-time custody in New South Wales, 2000-2022. Custody records were probabilistically linked to 18 health, justice and mortality datasets. We report baseline sociodemographic and custody characteristics and the frequency of key post-release events. 200,486 adults, 15% women (n = 30,698), were incarcerated, with 2,282,367 person-years of follow-up and 11% (257,545 person-years) of follow-up spent in custody. First Nations people comprised 27% of the cohort. Half (48%) of the cohort (n = 95,563) had at least one contact with community mental health services, and 27% (n = 54,100) had received alcohol and other drug treatment. POST will provide population-wide evidence on health and social outcomes after custody, including the effects of treatment for drug dependence and serious mental illness. We will compare across subgroups and the outcomes of post-release service engagement. Mathematical modelling will test the impact of expanding access to care in prison and post-release on outcomes in the community. POST will inform policy and service responses across justice, health and community settings to reduce harms among people who experience incarceration.
Alcohol dependence induced alterations to decision-making are hypothesized to occur in part through long-lasting changes to cortical function. Animal models of chronic alcohol exposure have been used to identify alcohol-related changes to the activity and intrinsic function of cortical neurons, but the extent of such changes across involved cortical circuits is unclear. The secondary or premotor cortex (M2), which is necessary for goal-directed decision-making, shows aberrant in vivo activity during decision-making following chronic alcohol exposure, and targeting M2 activity can restore appropriate decision-making. Here we investigate whether chronic alcohol exposure alters the intrinsic properties and spontaneous transmission of M2 pyramidal neurons in male and female mice. Using a well-validated model of alcohol dependence, chronic intermittent ethanol exposure and repeated withdrawal (CIE), we find that prior CIE exposure reduced intrinsic excitability of M2 pyramidal neurons and altered glutamatergic, but not GABAergic transmission. One to two weeks into withdrawal, M2 neurons from CIE-exposed mice showed a decrease in intrinsic excitability that recovered with additional time in withdrawal. Prior CIE exposure also altered excitatory, but not inhibitory transmission within M2. Early in withdrawal there was an increase in the frequency of excitatory transmission. This change showed adaptation; with additional time in alcohol withdrawal we observed restored frequency but increased amplitude of M2 excitatory transmission. Together, this suggests that chronic alcohol exposure and withdrawal alters M2 neuron function and induces increases in excitatory modulation of M2 circuits.
Alcohol use disorder (AUD) is a serious public health challenge associated with increased morbidity and mortality. While AUD is more common among males, the sex gap is narrowing; nevertheless, AUD remains underdiagnosed in females. Identifying sex-specific multimorbidity patterns could improve targeted screening and identification. Using the Norwegian Patient Registry, we identified 67,358 individuals with AUD (31.2% female) and age- and sex-matched controls. We compared sex differences in the prevalence of the 20 most common mental and somatic diagnoses within and between the AUD group and controls. We analysed multimorbidity using upset plots and correlation networks. Females with AUD had higher overall multimorbidity than males (median 9 [IQR: 5-14] vs. 6 [3-11] diagnoses). Asthma, eating disorders, and dementia were overrepresented among females with AUD. The most common diagnosis combinations in females with AUD involved overlaps between mental and somatic conditions, particularly other substance use disorders or depression combined with soft tissue disorders, urinary tract infections, or medical abortion. Males predominantly showed within-domain combinations. Correlation network analyses revealed a distinct pain-related cluster linking mental and somatic conditions in females with AUD, but not in control females. Females with AUD experience a disproportionately high level of multimorbidity, with distinct patterns, often involving combinations of somatic and mental diagnoses. Pain conditions serve as important links between mental and somatic comorbidity, especially for females. These findings support further investigation into sex-specific screening protocols, recognition of distinct clinical contact points, and integrated treatment approaches for AUD.
Treatment for alcohol use disorder (AUD) is complicated by person-specific heterogeneity in factors related to AUD risk, maintenance, and recovery. To advance precision treatment, it is important to study sources of variability in the determinants of AUD treatment response. We analyzed interactive voice response data measuring nightly drinking, desire to drink, self-efficacy to resist drinking, and drinking expectancies from two, 12-week randomized placebo-controlled trials of topiramate for drinking reduction (N = 214). World Health Organization risk drinking levels were used to measure both pre-treatment alcohol use and treatment response (i.e., reductions in risk levels). Group iterative multiple method estimation was used to determine the presence and frequency of shared versus person-specific associations between alcohol-related factors and nightly drinking. Associations between indicators of person-specific heterogeneity and pre-treatment alcohol use severity or degree of treatment response were also examined. Few shared pathways between alcohol-related factors and nightly drinking were observed, indicating notable person-specific heterogeneity. Nightly drinking was most often associated with same-day self-efficacy, but only for a minority (i.e., less than 20%) of the full sample. Indicators of person-specific heterogeneity were not associated with pre-treatment alcohol use severity or degree of treatment response (p > .05). Patterns of risk for nightly drinking during topiramate treatment may be largely person specific. More research is needed to develop approaches that target person-specific risk to optimize treatment responses for all individuals receiving pharmacotherapy for AUD.
Introduction. There is sufficient evidence to support the notion that the rate of infection is higher in vulnerable groups than in the wider population. This scoping review sought to further elucidate the relationship between health inequalities and the risk of bacterial infections in high-income countries. Methods. Factors associated with health inequalities were defined as socioeconomic status and deprivation (employment status, income levels and deprivation categories), protected characteristics (age, gender, ethnicity, sexual orientation and disability), inclusion health groups (migration status, sex workers, people who inject drugs and the homeless) and geography (urban or rural dwelling). The published literature search was conducted on Embase, Google and Medline with a grey literature search also conducted. Exclusion criteria were defined as papers that were either published pre-2010, set in low- or middle-income countries or that covered viral, parasitic or fungal pathogens. Key pathogens and infections to include were determined by review of the UK antimicrobial resistance National Action Plan. Results. The search yielded 343 papers, of which 70 were eligible for review. The most frequently reported infections were sexually transmitted infections, infectious diseases, e.g. Mycobacterium tuberculosis, and sexually transmitted blood-borne infections. Most papers reviewed cited multiple health inequalities, most notably ethnicity (21/70), race (18/70), age (14/70), sex (13/70) and socioeconomic status and deprivation and inclusion health groups (sex workers and people experiencing drug and alcohol dependence). Conclusion. Evidence has emerged highlighting an important association between factors commonly associated with health inequalities and the increased risk of bacterial infections within high-income countries. Notably, ethnic populations, members of the LGBTQ+ community, people experiencing homelessness and those of a poor socioeconomic status are at a higher risk of bacterial infection.
Nicotine and tobacco products (NTP) and cannabis co-use entail unique risks. However, research on the correlates of co-use is limited, focusing on small samples, subpopulations, or specific correlates, without holistically examining multiple risk behaviors. Using an exploratory, hypothesis-generating approach, this study aimed to identify classifiers of past 30-day co-use of cannabis and NTP using random forest regression in a nationally representative adolescent sample. Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS). Participants were 20,103 US adolescents in grades 9-12. Complete-case analyses included 8263 participants. The sample was 51.9% male and racially and ethnically diverse. The primary outcome was a binary indicator of past 30-day co-use of cannabis and NTPs. Classifiers included demographic, behavioral, and psychosocial factors. Random forest regression, including hyperparameter tuning, importance ranking of classifiers, and model robustness measures, were conducted in complete-case and multiply imputed data. Ten variables emerged as consistent and strongest classifiers of co-use, including past 30-day alcohol use (Mrank=1.00; SD=0.00), ever having had sexual intercourse (Mrank=2.36; SD=0.50), past 30-day binge drinking (Mrank=2.64; SD=0.50), and alcohol or drug use during last sexual intercourse (Mrank=4.00; SD=0.00). Models using imputed data achieved lower OOB error rates compared to the complete-case model. Among US adolescents, alcohol use and sexual behavior were the most salient classifiers of cannabis and NTP co-use. These findings highlight the importance of holistic examinations of multiple health risk behaviors.
Concurrent use of tobacco and cannabis is common among youth, yet the association between cannabis use and tobacco cessation remains unclear. This study examines the relationship between past 30-day cannabis vaping and four tobacco cessation indicators among a nationally representative sample of youth who use tobacco in the United States. We analyzed pooled 2023-2025 data from the National Youth Tobacco Survey. Participants (n = 5444) were middle and high school students who reported past 30-day tobacco use. Multivariable logistic regression examined the association between past 30-day cannabis vaping and four tobacco cessation indicators (quit intentions, quit attempts, cravings, use within 30min of waking), controlling for number of tobacco product categories used, sex, race/ethnicity, school level, and survey year. An interaction between cannabis vaping and number of tobacco product categories used (single, dual, ≥ 3) was tested to assess whether associations differed across tobacco use patterns. Past 30-day cannabis vaping was associated with lower odds of quit intentions (aOR: 0.76; 95%CI: 0.62-0.94) and higher odds of nicotine dependence symptoms, including cravings (aOR: 1.68; 95%CI: 1.35-2.09) and use within  30min of waking (aOR: 1.83; 95%CI: 1.42-2.36), relative to no cannabis vaping in past 30-days. The interaction between cannabis vaping and number of tobacco product categories used was not significantly associated with any of the four outcomes. Past 30-day cannabis vaping was associated with lower quit intentions and greater nicotine dependence among youth who use tobacco. Addressing cannabis use may be important for improving tobacco cessation efforts among this population.
Previous literature identified cannabis as a potential opioid withdrawal management tool. We conducted an exploratory analysis on cannabis and opioid use among a community sample of people who inject drugs (PWID) and use opioids. We also considered the role that material hardship (inaccessibility of food, shelter, clothing, water, housing) plays in the relation between cannabis use and opioid withdrawal. We surveyed 472 PWID in Los Angeles, CA and Denver, CO between 2021 and 2022 on cannabis use frequency, material hardship, and opioid withdrawal frequency. We used Poisson and zero-inflation regression to examine associations between cannabis use and opioid withdrawal with material hardship as a moderator. Material hardship significantly moderated the association between cannabis use and opioid withdrawal. At low levels of material hardship, higher cannabis use was significantly associated with lower opioid withdrawal frequency. Conversely, at high levels of material hardship, higher cannabis use was significantly associated with higher opioid withdrawal frequency. Material hardship may influence if and how cannabis may be used for opioid withdrawal management. Interventions should aim to address gaps in basic needs access among PWID.
Traditional craving models do not assess competing desires and account for craving as a function of attempts to change problematic drinking behaviors, thereby limiting the utility of the information obtained. The Ambivalence Model of Craving defines craving as the coactivation of both desires to consume (approach) and to avoid consuming alcohol (avoidance). The current study examined the daily associations between approach/avoidance, and drinking in those diagnosed with alcohol use disorder (AUD), including how treatment status moderated such relationships. Individuals diagnosed with AUD (n = 98) provided daily reports on drinking and approach/avoidance inclinations for 90-days. At the end of the first 30 days, participants were offered treatment. Multilevel negative binomial hurdle modeling was conducted to examine within-person effects of approach, avoidance, treatment status, and their interaction on drinking likelihood and quantity. A significant Approach×Avoidance×Treatment-Status interaction was found for drinking likelihood. On days not enrolled in treatment, higher approach was associated with increased drinking likelihood. On days enrolled in treatment, as avoidance increased, the effect of approach on drinking likelihood was attenuated, with such effects more robust at average and low levels of approach. Approach was also associated with a small increase in number of drinks consumed on drinking days; these findings did not vary by avoidance nor treatment status. Conclusion These findings reiterate the importance of adopting a multidimensional framework of craving that considers co-occurring approach and avoidance and suggests that craving processes may operate differently among individuals who are endorsing some degree of motivation for change.
The association between cultural identity and substance use varies across studies, highlighting the need to quantify this relationship and identify sources of variability. This meta-analysis quantified the relationship between cultural identity and substance use among North American Indigenous youth, tested potential moderators, and described measurement approaches and tribal nation representation. A systematic literature search identified 18 studies reporting a quantifiable association between cultural identity and substance use with samples of at least 75% Indigenous youth between the ages of 10 and 20 years. Random effects models were used to calculate pooled effect sizes (Pearson's r), and meta-regressions assessed for potential moderating effects of age, sex, measurement approach, and living on a reservation. Overall, there was no significant pooled association between cultural identity and substance use in Indigenous youth (r = -0.003, p = .86). Effects were similar across alcohol, tobacco, and cannabis. However, heterogeneity was high (I2=72%), and funnel plot asymmetry suggested possible publication bias (p = .04). Age, sex, living on a reservation, and measurement approach did not moderate the overall effect (p's > .49). Tribal affiliation was largely not reported. This is the first meta-analysis to quantify the association between cultural identity and substance use among Indigenous youth. Although the overall pooled association was not statistically significant, this likely reflects limitations in how cultural identity is operationalized within quantitative research, leaving the question as to how cultural identity may impact substance use among Indigenous youth as of yet unanswered. Identifying which components of cultural identity are most relevant for Indigenous youth substance use will yield a better understanding of this relationship to inform the development of culturally sensitive interventions.
Since 2016, more than 53,000 Canadians have died from exposure to the toxic unregulated drug supply. In 2020, the British Columbia government implemented a program in which pharmaceutical alternatives to toxic unregulated drugs can be prescribed, known as "prescribed safer supply." Since 2023, the number of prescriptions and prescribers has declined, and people who use drugs (PWUD) in Vancouver have reported community-wide deprescription. We sought to examine the prevalence and predictors of deprescribing in Vancouver, BC. Using data from two Vancouver-based prospective cohorts of PWUD, we included participants who self-reported accessing prescribed safer supply. Generalized estimating equations were used to identify factors associated with deprescribing. Between December 2023 and November 2024, 353 eligible participants were included; 62 (17.6%) were deprescribed. In multivariable analyses, gender self-identification as a woman (adjusted odds ratio [AOR] = 1.92; 95% confidence interval [CI]: [1.06, 3.49]), nonfatal overdose (AOR = 3.35; 95% CI: [1.81, 6.17]), and challenges accessing addiction treatment (AOR = 4.51; 95% CI: [2.48, 8.21]) were positively associated with increased odds of deprescription. Among those deprescribed, 88.7% were deprescribed from tablet hydromorphone. Deprescribed participants reported increased use of unregulated drugs and negative health and social impacts. Negative urine drug screen results (38.7%), missed medication pickup or delivery (24.2%), and diversion (22.6%) were reported as reasons for deprescription. It remains unclear whether deprescribed patients are transitioned to other safer supply medications or drug treatments. More work is needed to assess the scope of safer supply deprescribing and illuminate its social-structural drivers.
Substance Use Disorders (SUDs) are prevalent among homeless persons and affect housing stability. Little is known about SUD service use and experiences among Veterans housed through the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program, which provides housing subsidies and supportive services. We aimed to examine SUD service use and treatment experiences among HUD-VASH Veterans with SUDs. We analyzed VA Electronic Health Records of HUD-VASH Veterans with SUDs housed between 10/1/2017-9/30/2021 (n = 42,182). We examined sociodemographic and clinical characteristics, SUD service use (e.g., outpatient, inpatient, residential), and quality of care (e.g., evidence-based pharmacotherapy, psychosocial treatment, care continuity). A subsample of 43 participants participated in interviews about substance use, recovery goals, and treatment experiences; qualitative data were analyzed using rapid qualitative methods. Nearly half of participants used outpatient SUD services (47.3%); and 0.5% received an evidence-based psychosocial treatment as operationalized in VA administrative data. Quality metrics showed 19.7% with alcohol use disorder and 42.9% with opioid use disorder received evidence-based pharmacotherapy. Qualitative findings emphasized the importance of SUD treatment readiness, a range of treatment access points, and misaligned patient and provider goals contributing to negative treatment experiences. Although SUD service use is prevalent among HUD-VASH participants, some services may not reflect evidence-based guidelines or match participants' preferences. In delivering SUD services to this group, our data underscore the importance of readiness, treatment access, and patient-provider alignment. Ensuring SUD services are well suited to the goals of homeless-experienced persons can enhance this population's recovery and housing stability.
Overdose fatality review (OFR) teams use cross-sector case review to develop prevention recommendations. We examined whether members' overdose knowledge and attitudes toward methadone, buprenorphine, and harm reduction differed by institutional domain. We analyzed cross-sectional survey data from 145 members of 18 Indiana OFR teams, classified as public health, treatment/recovery/social support (TRSS), or criminal-legal system (CLS). Outcomes included a modified 11-item Brief Opioid Overdose Knowledge questionnaire, 7-point medication effectiveness and acceptability ratings, and Harm Reduction Acceptability Scale scores, for which higher scores indicated less favorable attitudes. One-way ANOVAs with Tukey-adjusted comparisons assessed domain differences. Mean knowledge clustered near the maximum (9.3 of 11) and total and subscale scores did not differ by domain. Public health and TRSS respondents rated methadone (mean differences, 1.50 and 1.19) and buprenorphine (1.79 and 1.06) more effective than CLS respondents (all p < 0.01). Public health respondents rated methadone (1.26, p = 0.02) and buprenorphine (1.29, p < 0.01) more acceptable. CLS respondents reported less favorable harm reduction attitudes than public health and TRSS respondents (differences, 10.69 and 12.47; p = 0.02 and p < 0.01, respectively). Among Indiana OFR members, institutional domain was associated with medication and harm reduction attitudes, but not measured overdose knowledge. The null knowledge finding warrants caution given the apparent ceiling effect. Domain-specific concerns merit consideration in cross-sector implementation efforts.
A variety of personal and environmental resources (recovery capital: RC) support recovery for adolescents. Social identity theory suggests one's alcohol and other drug (AOD) use behavior is strongly influenced by social network behavior. This study examined how the level of pretreatment substance use was associated with RC and social network characteristics among youth entering inpatient treatment. Understanding these relationships may help inform initial treatment engagement and post-treatment transitions. Participants (N = 108; Mage=17.1; 61% male; 70% White) completed standardized measures on admission to inpatient treatment: demographics, past 90-day substance use, recovery capital, and social network composition/behavior. Regression analyses were used to examine relationships between AOD use before treatment and (1) recovery capital and (2) level of identification with network groups. On average, in the 90 days prior to entry into treatment adolescents consumed alcohol on 20.3 days, used cannabis on 46.5 days, and used other substances (e.g., cocaine) on 17.3 days. The mean RC score was 36.8 (range 25-50). Being male and having more treatment days before baseline were associated with higher RC. Pre-treatment substance use was not consistently associated with RC levels. 70% of participants included at least one family or friend group who used AODs. Participants with a recovery group identified more strongly with that group than with substance-using groups (M=7.28 compared to M=6.63 for groups using substances heavily; scale 0-10). Adolescents appear to have flexible social identities and potentially risky post-treatment relationships, highlighting the need to engage them in recovery-supportive networks following treatment.
The striatum plays a central role in the pathophysiology of addiction. Studies report that cannabis use is associated with greater striatal gray matter volume (GMV), while tobacco use is associated with both greater and lower striatal GMV. However, their combined effects on striatal GMV remain unclear. Using two MRI processing methods, we investigated associations between these substances and striatal GMV. Men and women from eight ENIGMA Addiction sites (N = 302) were parsed into 4 groups; individuals with: co-use (CT, n = 38); cannabis-only use (CO, n = 34); tobacco-only use (TO, n = 61), and controls (CTL, n = 169). Striatal GMV was assessed using (1) Freesurfer-extracted region-specific estimates and (2) voxel-based morphometry using FSL within a striatal mask. Analyses employed 2 × 2 ANCOVAs. With Freesurfer, a main effect of cannabis use (CT and CO) emerged in the right nucleus accumbens, and was replicated using FSL (ps ≤ 0.05). With FSL, main effects of cannabis use were found in the putamen and caudate (ps ≤ 0.01), and were modulated by tobacco use (cannabis-tobacco interaction ps ≤ 0.02). Post-hoc comparisons revealed: CT =  CTL >  TO in the putamen and caudate (ps ≤ 0.04); and CTL >  CO (ps ≤ 0.06) and CT >  CO (p = 0.03) in the caudate. Results demonstrate that in the putamen and caudate, individuals who co-use have greater GMV compared to those who use either substance alone, whereas individuals using either substance alone have lower GMV compared to controls. Future research should replicate our novel findings and investigate the clinical correlates of this unique pattern to clarify the functional significance of these findings.
Maternal smoking in pregnancy is a risk factor for poorer infant health outcomes, yet knowledge on impacts of smoking in the preconception and periconception periods is limited, particularly in fathers. This study examined the association between parental smoking at preconception, periconception and across pregnancy, with infant birth outcomes. Pregnant women and fathers from the longitudinal Triple B Pregnancy Cohort Study (1582 mothers; 805 fathers) were assessed across the perinatal period, and infants assessed at birth. Maternal and paternal smoking was assessed at preconception (3 months pre-pregnancy), periconception (prior to pregnancy awareness), and during pregnancy (trimesters 1-3). Infant birth outcomes included low birth weight, prematurity, small head circumference, small-for-gestational age (SGA), and neonatal intensive care unit (NICU) and/or special care nursery (SCN) admission. Maternal preconception and periconception smoking were associated with higher odds of NICU/SCN admission (aOR = 1·74; aOR = 1·80, respectively). Periconception smoking was associated with higher odds of prematurity (aOR = 2·05). Smoking across pregnancy was associated with higher odds of low birth weight (aOR = 2·77-3·53), prematurity (aOR = 2·79-3·78), SGA (aOR = 2.52-2·76), and admission to NICU/SCN (aOR = 2·21-2·40). Limited evidence was found for associations between maternal smoking and small head circumference, and for associations between perinatal smoking in fathers and adverse infant outcomes. Findings underscore the importance of smoking cessation support for parents prior to, and during the early weeks of pregnancy, to reduce the impacts of smoking on families.
Perinatal substance use disorder (SUD) is associated with adverse maternal and infant health outcomes. Recent data is limited on the role of maternal characteristics in SUD overall and for opioid use disorder (OUD) and cannabis use disorder (CUD), separately. Statewide hospital discharge data was used to describe recent patterns and examine social factors and comorbidities in association with SUD diagnosis outcomes. Birth hospitalizations were identified in the State Inpatient Database from the Healthcare Cost and Utilization Project for MI (2019-2022, n = 398,836) to conduct a population-based serial cross-sectional study. SUD, OUD, and CUD were defined using ICD-10-CM diagnosis F codes based on previous research. Comorbidities were identified using the HCUP Elixhauser Comorbidity Software. Logistic regression models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for each SUD outcome separately. Overall SUD prevalence was 5.5% (n = 21,849), OUD prevalence was 0.8% (n = 3130), and CUD prevalence was 4.5% (n = 17,944). In models adjusting for age and year, factors associated with increased SUD prevalence included Medicaid (PR=4.06, 95% CI:3.94-4.18), lower zip-code based income (PR for Q1 vs. Q4 =4.74, 95% CI:4.41-5.08), higher total comorbidities (PR for ≥2 comorbidities=2.53, 95% CI:2.45-2.61), depression (PR=2.28, 95% CI:2.20-2.36), and Native American race/ethnicity (PR=2.05, 95% CI:1.78, 2.31). Results were generally similar for OUD and CUD. We found a higher maternal SUD prevalence for women with lower zip-code based income and with co-occurring medical conditions including depression, which further increases risk of adverse health outcomes. Results highlight the importance of careful monitoring and support of women with SUD.