Sex and Gender in Tobacco Reduction - The State of the Evidence

Global prevalence, risk, and mortality from smoking Gender/Sex specific diseases associated with tobacco use Gender/Sex specific reasons for smoking Gender/Sex specific factors in treating tobacco us

Sex and Gender in Tobacco Reduction - The State of the Evidence

Global prevalence, risk, and mortality from smoking Gender/Sex specific diseases associated with tobacco use Gender/Sex specific reasons for smoking Gender/Sex specific factors in treating tobacco us

Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment:a cross sectional analysis

Background: In 2015, an outbreak of HIV was identified among people who inject drugs (PWID) in the Greater Glasgow and Clyde (GGC) area of Scotland, an area which distributes more than 1 million needles and syringes per year. This is the largest such incident in the UK for 30 years. Here, we provide an epidemiological analysis of the impact of the outbreak on HIV prevalence trends in the population and the individual and environmental risk factors associated with infection.Methods: Four cross-sectional, anonymous, bio-behavioural surveys of almost 4000 PWID attending services providing injecting equipment across GGC between 2011 and 2018 were analysed. Participants were recruited by trained independent interviewers and eligible if they had a history of injecting drug use, either current (within the past 6 months) or historical. Interviewers asked participants questions about demographics, behaviours, and service use and to give a dried blood spot sample that was tested anonymously for the presence of blood-borne viruses. Our primary outcome measure was HIV infection status, as determined by the dried blood spot sample. We removed duplicates and participants with missing data and used all remaining participants to examine trends in prevalence of HIV infection, risk behaviours, and intervention coverage. We then did multivariate analysis with adjusted and unadjusted logistic regression to determine individual and environmental factors associated with HIV infection.Findings: The overall GGC sample comprised 3641 PWID; data from 2712 PWID were available for multivariate analysis after further removal of duplicate participants and missing data. Between 2011 and 2018, HIV prevalence in GGC rose from 0·1% (95% CI 0·0–0·6) to 4·8% (3·4–6·2) overall, and from 1·1% (0·2–6·2) to 10·8% (7·4–15·5) in Glasgow city centre. Over the same period, the prevalence of cocaine injecting in all individuals in GGC in our sample rose from 16% (129/805) to 50% (291/583) overall, and from 37% (26/70) to 77% (117/153) in Glasgow city centre. HIV infection was more likely among PWID who had participated in surveys after the start of the outbreak in 2014 (adjusted odds ratio 3·4, 95% CI 1·7–6·7; p=0·00052), been homeless in the past 6 months (3·0, 1·7–5·0; p&lt;0·0001), had had more than five incarcerations since they first began injecting (2·1, 1·2–3·7; p=0·0098); and had injected cocaine within the past 6 months (6·7, 3·8–12·1; p&lt;0·0001). Age (per 1-year increase) was also a significant factor (1·1, 1·0–1·1; p=0·0016) but sex was not (1·7, 0·9–3·2; p=0·083).Interpretation: Despite high coverage of harm reduction interventions, Glasgow has experienced a rapid rise in prevalence of HIV among its PWID population, associated with homelessness, incarceration, and a major shift to injection of cocaine. Robust surveillance through regular HIV testing of high-risk populations is crucial to ensure outbreaks are detected and rapid responses are informed by the best available evidence. Funding: Health Protection Scotland.</p

Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial

Aims To assess the effects of adding motivational interviewing ( MI ) counseling to nicotine patch for smoking cessation among homeless smokers. Design Two‐group randomized controlled trial with 26‐week follow‐up. Participants and setting A total of 430 homeless smokers from emergency shelters and transitional housing units in M inneapolis/ S t Paul, M innesota, USA . Intervention and measurements All participants received 8‐week treatment of 21‐mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7‐day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. Findings Using intention‐to‐treat analysis, verified 7‐day abstinence rate at week 26 for the intervention group was non‐significantly higher than for the control group (9.3% versus 5.6%, P  = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (−13.7 ± 11.9 for MI versus −13.5 ± 16.2 for standard care). Conclusions Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26‐week follow‐up for homeless smokers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98308/1/add12140.pd

Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States

Background and aimsFew longitudinal studies have examined the relationship between food insecurity and substance use. We aimed to investigate this relationship using longitudinal data among women with or at risk for HIV in the United States.DesignWomen's Interagency HIV Study (WIHS), a prospective cohort study.SettingNine sites across the United States.ParticipantsA total of 2553 women with or at risk for HIV.MeasurementsSemi-annual structured interviews were conducted during April 2013-March 2016. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. Outcomes were: any illicit substance use except cannabis; licit or illicit cannabis use; stimulant use (crack, cocaine, or methamphetamine); opioid use (heroin or methadone in a non-prescribed way); and prescription drug misuse (prescription narcotics, amphetamines, or tranquilizers in a non-prescribed way) since the last visit. We used multivariable logistic regression with random effects to examine longitudinal associations of current and previous FS with the outcomes simultaneously, adjusting for socio-demographic factors, HIV serostatus, physical health and health insurance.FindingsAverage number of visits was 4.6. At baseline, 71% of participants were HIV-seropositive, 44% reported marginal, low, or very low FS, and 13% were using illicit substances. In adjusted analyses, current low and very low FS were significantly associated with 1.59 [95% confidence interval (CI)&nbsp;=&nbsp;1.02, 2.46; P = 0.039] and 2.48 (95% CI&nbsp;=&nbsp;1.52, 4.04; P&nbsp;&lt;&nbsp;0.001) higher odds of any illicit substance use, compared to high FS, and also with higher odds of cannabis, stimulant and opioid use, exhibiting a consistent dose-response relationship. Marginal, low, and very low FS at the previous visit were associated with 1.66 (95% CI&nbsp;=&nbsp;1.08, 2.54; P = 0.020), 1.77 (95% CI&nbsp;=&nbsp;1.14, 2.74; P = 0.011), and 2.28 (95% CI&nbsp;=&nbsp;1.43, 3.64; P&nbsp;&lt;&nbsp;0.001) higher odds of current illicit substance use.ConclusionsFood insecurity appears to be longitudinally associated with substance use among US women with or at risk for HIV