Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review.

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Longitudinal effects of prenatal substance use and environmental stressors on executive functioning in low-income African American adolescents: A latent growth modeling analysis.

Adverse prenatal substance use and environmental stressors have been linked to prefrontal cortex (PFC) impairments, the brain region that regulates executive functioning. Executive functions (e.g., inhibitory control, working memory, and cognitive flexibility) are crucial for sophisticated cognitive activities throughout child and adolescent development. There is little research on how prenatal substance use and environmental stressors longitudinally program executive functioning in children over time. We investigated the associations between prenatal/environmental stressors (i.e., maternal prenatal substance use, maternal-fetal bonding, and neighborhood disorganization) and executive function performance among low-income African American youth from age 6 until age 18. Analyses were based on four waves of data collected between 1994 and 2014 in the Memphis New Mothers Study, a longitudinal randomized controlled trial that was an intervention during pregnancy and the first two years of the child's life in low-SES women and their first-born children. Mothers and their children were followed longitudinally through 18 years post-childbirth. Prenatal substance use (e.g., prenatal smoke, alcohol, and drug use) and environmental stressor (e.g., food environment, maternal-fetal bonding and neighborhood disorganizations) evaluations were gathered from mothers and children prenatally and postnatally before the age of 4.5 years. Executive function was assessed using the Child Behavior Checklist for impulsivity and inattention, while the coding subscale of the Wechsler Intelligence Scale for Children-Third Edition, the reading recognition subtest of the Peabody Individual Achievement Test, and the digit span subtest of the Wechsler Adult Intelligence Scale were employed to assess working memory at three time periods (6, 12, and 18 years). Covariate-adjusted latent growth models estimated the associations between prenatal substance use and environmental stressors and changes in executive functioning over three time points. Prenatal smoking and alcohol use were associated with changes in impulsivity scores over 12 years. Prenatal alcohol use predicted higher inattention at baseline and a slower rate of change from ages 6 to 18. Neighborhood disorganization at ages 6 and 18 predicted higher inattention and lower working memory in youth at age 18, respectively. Our findings underscore the long-term impact of prenatal substance use exposures and neighborhood environments on cognitive development and highlight the importance of early interventions to mitigate these effects.

Drugs, crime, and racial disparities in the homeless population gathered from a sample of police reports: Evidence from Brazil.

Brazil is one of the most unequal democracies in the world. Although the number of homeless individuals in our country has increased due to the reproduction of people living in extreme poverty, little has been discussed about their welfare and rights. In the present study, we provide analysis with a theoretical-methodological approach directed at homeless people living in the wealthy neoliberal middle-sized southeast city of São Paulo, Brazil's richest state. Data was acquired from police reports with prior permission from the Civil Police of São Paulo and the São Paulo Interior Judiciary Police Department. Our results illustrate that the homelessness phenomenon in Franca appears to be comparable to that of other large urban cities, where Blacks, a minority of the population, make up the bulk of homeless individuals. It also denies that homeless activity increases criminality, emphasizes the difference between Blacks and Whites drug users' criminal behavior, with Whites being more active in theft and robbery and Blacks in trafficking, and extends the idea that drug use by homeless people is stress-related and hence an indicator of a health condition.

Effectiveness of a culturally tailored HIV intervention in promoting PrEP among black women who use drugs in community supervision programs in New York City: a randomized clinical trial.

BACKGROUND: In the U.S. there are significant racial and gender disparities in the uptake of pre-exposure prophylaxis (PrEP). Black Americans represented 14% of PrEP users in 2022, but accounted for 42% of new HIV diagnoses in 2021 and in the South, Black people represented 48% of new HIV diagnoses in 2021 but only 21% of PrEP users in 2022. Women who use drugs may be even less likely than women who do not use drugs have initiated PrEP. Moreover, women involved in community supervision programs (CSP) are less likely to initiate or use PrEP, More PrEP interventions that focus on Black women with recent history of drug use in CSPs are needed to reduce inequities in PrEP uptake. METHODS: We conducted a secondary analysis from a randomized clinical trial with a sub-sample (n = 336) of the total (N = 352) participants from the parent study (E-WORTH), who tested HIV negative at baseline were considered PrEP-eligible. Black women were recruited from CSPs in New York City (NYC), with recent substance use. Participants were randomized to either E-WORTH (n = 172) an HIV testing plus, receive a 5-session, culturally-tailored, group-based HIV prevention intervention, versus an HIV testing control group (n = 180). The 5 sessions included an introduction to PrEP and access. This paper reports outcomes on improved awareness of PrEP, willingness to use PrEP, and PrEP uptake over the 12-month follow-up period. HIV outcomes are reported in a previous paper. RESULTS: Compared to control participants, participants in this study assigned to E-WORTH had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (OR = 3.25, 95% CI = 1.64-6.46, p = 0.001), and indicated a greater willingness to use PrEP as an HIV prevention method (b = 0.19, 95% CI = 0.06-0.32, p = 0.004) over the entire 12-month follow-up period. CONCLUSIONS: These findings underscore the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, and intention to initiate PrEP. Low uptake of PrEP in both arms highlight the need for providing more robust PrEP-on-demand strategies that are integrated into other services such as substance abuse treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02391233 .

Sustainability of an intervention for the prevention of substance use within Native American communities.

The outcomes of this study revealed the importance of recruiting local Native American tribal community members as participants in an Adult Facilitator Trainee Program for a cultural based intervention, Intertribal Talking Circle (ITC), that addresses prevention of substance use among Native American youth. Survey results indicate that Native-Reliance (cultural identity) and self-efficacy increased among the trainees from base-line to 3-months post the training session. Themes emerged from qualitative interviews conducted with the participants that described their readiness to implement and sustain the Talking Circle intervention program within their tribal communities after the research project was completed.

Associations between vicarious racism and psychoactive substance use depend on strength of ethnic identity.

Racism is a pervasive threat to health with differential impact based on race and ethnicity. Considering the continued perpetration and visibility of racism online and in the news, vicarious racism, or "secondhand" racism when hearing about or witnessing racism being committed against members of one's ethnic or racial group, is a particularly urgent threat in the context of such disparities and their subsequent health consequences. The current study examines if frequency of exposure to vicarious racism and the emotional impact of those experiences are linked to psychoactive substance use, and explores the role of ethnic identity in moderating these relationships. In a cross-sectional survey, 504 adult participants aged 18-78 (M age = 30.15, SD = 11.52, 52.6% female) identifying as Black/African American or Latine reported on their experiences with vicarious racism and alcohol, marijuana, and tobacco use over the past 30 days. Logistic regression was utilized to test hypotheses. Primary findings indicate that greater emotional impact of vicarious racism was associated with a 50% increase in odds of alcohol consumption and that ethnic identity moderated the association between vicarious racism and marijuana use. Greater emotional impact of vicarious racism was related to more marijuana use for those lower on ethnic identity, whereas there was no association for those higher on ethnic identity. Vicarious racism was not related to tobacco use. Results suggest that ethnic identity might be protective in the association of vicarious racism on substance use. Further research on this topic is needed as vicarious racism becomes an increasingly common experience among marginalized populations.

Afrocentric Norms and Substance Use Behaviors Among Black Young Adults.

Despite not displaying higher overall rates of substance use compared to White Americans, the social consequences of substance use disorders for Black Americans, particularly among Black American men, are more damaging. Furthermore, recent data suggest an uptick in substance use-related deaths among Black Americans, raising serious concerns about a growing health disparity that warrants the need for studies to identify factors associated with prevention. For decades, Black cultural theorists have argued that Afrocentric norms are important buffers against maladaptive behaviors in Black Americans, but the association in the context of substance use is still an emerging area. The present study investigated the associations between Afrocentric norms, Afrocentric self-regard, internalized negative stereotypes, and substance use attitudes and behaviors among Black young adults. Self-report questionnaires were administered to measure internalized negative stereotypes, Afrocentric norms, Afrocentric self-regard, substance use attitudes, and substance use from a sample of Black young adults (N = 619). Favorable attitudes toward substance use were found to be positively associated with internalized negative stereotypes but were inversely associated with Afrocentric norms and Afrocentric self-regard. Similarly, substance use reports within the past 30 days were inversely associated with Afrocentric norms, but the relationship to cannabis use was non-significant. Gender differences between Black men and women were also found. Implications for social work are discussed.

Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders.

INTRODUCTION: Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients. METHODS: This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care. RESULTS: Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, p < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, p = .002). Opioid prescription doses did not statistically differ by race. CONCLUSIONS: The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.

Explaining Substance Use among Puerto Rican Older Adults: Impact of Perceived Discrimination, Perceived Stress, and Social Activities.

Background: Despite Puerto Ricans having one of the highest rates of substance use among Hispanic groups in the United States, limited research has focused on the impact of perceived discrimination and stress on substance use among older adults. Individuals who experience stressful events are inclined to engage in harmful behaviors as a coping mechanism. Objectives: Based on the propositions of the General Strain Theory, the current study explores the relationship between perceived discrimination, perceived stress, social activities, and the use of alcohol and cigarettes. Methods: Baseline data from the Boston Puerto Rican Health Study collected in 2014 was used to conduct a logistic regression analysis. Results: The findings reveal that while perceived discrimination is significantly linked to both types of substance use, social activities may serve as a protective factor for cigarette use. Conclusion/Importance: Our study findings emphasize the need to examine perceived discrimination as a stressor impacting the health and well-being of Puerto Ricans in later adulthood. Policy implications for reducing substance use and directions for future research are discussed.

Substance use disorders and disparities in hispanic and non-hispanic older adults.

BACKGROUND: The global longevity revolution increased the older adult population, posing unique health and economic challenges with implications for healthcare, especially substance use disorders (SUD). METHODS: This was a retrospective cohort study of United States older adults, Hispanic and non-Hispanic, who got at least one mental and/or behavioral disorder diagnosis between 2017 and 2021 at age 65 or older. SUD prevalence, prescription frequency changes over time, and comorbidities associated with each medication were compared. RESULTS: Electronic health records for 356,133 older adults (110,236 Hispanics and 245,897 non-Hispanics) were analyzed. Notably, 79 % of Hispanics fell below the 100 % federal poverty level, compared to 60 % of non-Hispanics (P<.001). Non-Hispanics also had significantly more average encounters (P=.003) and diagnoses (P<.001). Regression analysis on alcohol-related disorders indicated that the odd ratios of being male (OR=2.93, P<.000), and having low income (OR=1.62, P<.000), increase the odds for this SUD, while being Hispanic and primarily speaking Spanish decreases the odds for all SUDs considered in this study. CONCLUSIONS: This cohort study revealed significant disparities related to social determinants of health between Hispanic and non-Hispanic older adults and emphasizes the need for continuous surveillance of older adults as with SUDs. Differences in comorbidity patterns imply distinct risk factors within each population, influenced by demographic-specific elements. Recognizing these variations is essential for tailoring culturally sensitive prevention, intervention, and treatment strategies to each population's unique needs.

Cannabis Co-Use Among Black Individuals with Chronic Pain Who Use Opioids: Associations with Other Substance Use and Pain Related Outcomes.

Background Black individuals with chronic musculoskeletal (MSK) pain tend to experience worse pain and opioid use-related outcomes, including other substance co-use, compared with non-Hispanic White individuals. Co-using cannabis with opioids could instigate a cascade of pain-related vulnerabilities and poor outcomes. Here, we test associations between cannabis/opioid co-use and pain-related outcomes among Black individuals with chronic MSK pain. Methods Black adults with chronic MSK pain who use opioids (N=401; 51.62% female, Mage=35.90, SD=11.03) completed online measures of pain intensity/interference, emotional distress, opioid dependence, and risky use of other substances. Results Compared with opioid use alone, opioid and cannabis co-use was associated with elevated anxiety and depression symptoms, opioid dependence, and risky substance use, but not pain. Conclusions Black individuals with chronic MSK pain who co-use opioids and cannabis warrant targeted interventions that address their needs. Tailored interventions could help address disparities in pain-related outcomes and opioid morbidity and mortality rates.

Cultural considerations for substance use and substance use disorders among Black men.

There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.

Racial Disparities in Newborn Drug Testing After Implementation of Question-Based Screening for Prenatal Substance Use.

OBJECTIVE: To examine the association of universal question-based screening for prenatal substance use on racial inequities in prenatal and newborn drug testing. METHODS: We conducted a retrospective cohort study of 32,802 live births of patients receiving prenatal care at an academic medical center in the midwestern United States from 2014 to 2022, before and after implementation of question-based screening in 2018. Primary outcomes included prenatal and newborn drug test orders. Logistic regression models using a generalized estimating equation framework assessed associations with question-based screening and results, birthing parent age, race, ethnicity, marital status, and insurance type. Charts of patients who indicated difficulties stopping substance use were audited for guideline-directed care. RESULTS: A total of 12,725 of 14,992 pregnant people (85.3%) received question-based screening. Implementation of question-based screening was associated with a decrease in prenatal urine test orders (5.0% [95% CI, 4.6-5.3%] before implementation, 3.1% [95% CI, 2.8-3.4%] after implementation; P <.001), with Black birthing parents having the largest reduction in prenatal urine drug testing (10.3% [95% CI, 9.0-11.7%] before implementation, 4.9% [95% CI, 3.9-5.9%] after implementation). However, rates of newborn drug testing did not change (4.7% [95% CI, 4.4-5.0%] before implementation, 4.5% [95% CI, 4.2-4.8%] after implementation; P =.46), and clinicians continued to order significantly more newborn drug tests for newborns of Black birthing parents compared with other race and ethnicity groups. CONCLUSION: Implementation of question-based screening for substance use in pregnancy was associated with decreased prenatal urine drug testing but no change in overall newborn drug testing or racial inequities in newborn drug testing for Black birthing people. Further policy efforts are warranted to improve substance use treatment and to eliminate racial inequities in punitive policies such as newborn drug testing and subsequent child protective services reporting.

Experiences of sexist discrimination as a potential explanatory factor for alcohol and drug misuse among Latina young adult women.

RATIONALE: Marianismo beliefs, or traditional female gender role beliefs among Latinas, have been found to serve as risk or protective factors linked with health risk behaviors in prior studies, including alcohol and drug misuse. However, limited research has examined potential factors that may contribute to or explain these associations. Sexist discrimination, which can serve as a significant stressor that may contribute to substance misuse, is one potential factor that may link marianismo beliefs and substance misuse among Latina young adult women. OBJECTIVE: This study examined sexism as a potential mediator of hypothesized negative associations between five marianismo beliefs (Family Pillar, Virtuous and Chaste, Subordinate to Others, Silencing Self to Maintain Harmony, and Spiritual Pillar) and alcohol and drug misuse using structural equation modeling. METHOD: Participants included 611 cisgender Latina full-time college student young adult women in the U.S. ages 18-26 who participated in an online cross-sectional survey about their health and behaviors. RESULTS: Results delineated experiences of sexism as a significant risk factor for alcohol and drug misuse and as a potential explanatory factor that may partly explain associations between certain marianismo beliefs (i.e., Virtuous and Chaste beliefs) and substance misuse. Specifically, experiences of sexism partially accounted for the negative association between endorsement of the Virtuous and Chaste belief and increased alcohol and drug misuse among Latina young adults. CONCLUSIONS: Prevention and intervention efforts should take a culturally responsive, gender-informed approach to address substance misuse among Latina young adults and address the negative influence of sexism on health.

As Long As it Lasts-Older Substance Users, Brittle Ties and Danish Health Care.

In this article, we examine a group of older marginalized substance-using citizens and their relations to Danish health care. We offer empirical examples collected through ethnographic fieldwork, about how they handle their health situation and encounters with the Danish healthcare system. Analytically, we particularly draw on the concept of disposable ties, and suggest the term "brittle ties" to nuance the term and examine how perceived individual autonomy is weighted against health care trajectories and how these citizens often prefer to fend for themselves or lean on provisional networks rather than enter into health care trajectories and follow-up treatment.

Risk factors of substance use treatment gaps among a nationally representative sample of black American adults in relation to sexual minority status and health insurance coverage.

BACKGROUND: Little research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors. METHOD: This cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015-2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps. RESULTS: Sexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39-2.89; Bisexual: AOR = 2.35, 95% CI = 1.77-3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33-4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26-1.78). CONCLUSION: The results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth.

Importance: Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective: To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants: This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures: Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results: Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance: In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.