Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN).

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

Non-communicable diseases among Palestinian refugees from Syria: a cross-sectional study on prevalence, case management, access to and utilisation of UNRWA Health Services.

BACKGROUND: As of Feb 14, 2014, UNRWA had registered almost 53 000 Palestinian refugees from Syria (PRS) who had fled to Lebanon as the result of the conflict in Syria. Half of the PRS had gone to one of the 12 Palestinian camps, which are overcrowded and of poor infrastructure. Consequently, there is concern for the wellbeing of PRS; in particular, their health status and access to medical care. Little attention has been given to non-communicable diseases (NCDs) in the acute phases of emergencies. Therefore, an assessment of the prevalence of NCDs among PRS, as well as the patterns of use of available health care services by PRS, is warranted. METHODS: A cross-sectional study was conducted in April, 2018, with 1100 PRS residing inside and outside refugee camps across all governorates of Lebanon. A listing of all PRS families was the sampling frame. A random sample of families was selected and contacted, and then one adult randomly selected from each family was approached for data collection. Pregnant women and participants who were too ill to participate were excluded. After obtaining informed verbal consent, we did face-to-face interviews to collect data on household details (such as type of settlement, source of income) and sociodemographic information, major NCDs (for the household representative), lifestyle behaviours, and health-care use. We invited all participants to UNRWA clinics for physical and biochemical measurements. The study protocol was approved by the Institutional Review Board of the American University of Beirut. FINDINGS: We surveyed 959 PRS (59% male [465], 82% married [785], mean age 43 years [SD 12]). A quarter of those interviewed had at least one NCD; the most prevalent were hypertension (23%; 221 of 959), rheumatic diseases (17%; 166), cardiovascular diseases (CVDs, 13%; 126), diabetes (13%; 124), and chronic respiratory diseases (CRDs) (10%; 100). All these NCDs were more prevalent among PRS inside camps than in those residing outside camps, except for diabetes. Most participants who had been diagnosed with NCDs were adhering to their prescribed medications (90-98%). However, of those reporting CVDs, only 56% (71 of 126) had attended at least one follow-up appointment, and of those reporting rheumatic diseases, only 33% (55 of 166) had attended at least one follow-up appointment. About half of participants reported that they checked their blood pressure (55%; 528 of 959) or blood glucose (45%; 430). 111 of 221 (50%) participants with hypertension monitored their blood pressure, and 78 of 124 (63%) participants with diabetes monitored their blood glucose. 133 participants attended UNRWA clinics for measurements; 40% (54) had obesity (>30 kg/cm2), 10% (13) had elevated blood pressure, 12% (16) had stage 1 hypertension, and 8% (10) had stage 2 hypertension. Most participants had normal glucose (67%; 89 of 133), cholesterol (65%; 87), triglyceride (58%; 77), and glycosylated haemoglobin levels (64; 85). A substantial proportion of participants who were tested had undiagnosed diabetes (14%; 33 of 108 reporting no diabetes), undiagnosed hypertension (23%; 19 of 81), uncontrolled diabetes (79% of participants with diabetes; 19 of 24), or uncontrolled hypertension (64% of participants with hypertension; 29 of 45). INTERPRETATION: Further study is needed to understand why the prevalence of NCDs among PRS residing in Palestinian camps is higher than among those living outside, and to understand whether and why access to medicines is a problem, particularly outside camps. The burden of NCDs among PRS is high and their access to services is not optimal; therefore UNRWA should pay special attention to NCD services in this population. UNRWA should invest in efforts to increase awareness of free blood pressure and blood glucose monitoring services in its clinics, and could actively offer free testing in public areas inside camps. Doctors at UNRWA clinics should recommend that patients monitor their disease more frequently and educate them on how to do so. A limitation of the study was the low percentage of participants who attended UNRWA clinics for physical and biochemical measurements. FUNDING: UNRWA.

Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey.

INTRODUCTION: Psychiatric disorders are among the leading causes of disability in children and adolescents globally. In Lebanon, a country that has endured a prolonged history of conflict and economic and political uncertainty, mental health surveys in children and adolescents have been limited to specific disorders or specific settings or cities. PALS (Psychopathology in Children and Adolescents in Lebanon Study) is the first study to screen a nationally representative sample of children and adolescents for psychiatric disorders and estimate the national prevalence of children and adolescents at risk of having a psychiatric disorder. METHODS: A nationally representative household sample of 1517 children and adolescents (aged 5 years 0 months to 17 years 11 months) was recruited through a multi-stage stratified proportionate sampling technique between February 2018 and November 2018. Parents and adolescents completed a battery of self-reported scales including the Strengths and Feelings Questionnaire (SDQ), Mood and Feelings Questionnaire (MFQ), Screen for Child Anxiety and Emotional Related Disorders (SCARED), the Peer Relations Questionnaire (PRQ), General Health Questionnaire (GHQ), and Conflict Behavior Questionnaire (CBQ), Child Revised Impact of Events Scale (CRIES), and a demographic/clinical information questionnaire. Logistic regression models were used to examine the correlates of screening positive for psychiatric disorders. RESULTS: About a third of children and adolescents (32.7%, n = 497) screened positive for at least one psychiatric disorder, of whom only 5% (n = 25) reported ever seeking professional mental health help. Academic performance, having a chronic physical illness, higher parental GHQ scores, and involvement in bullying were associated with a higher odds of screening positive for a psychiatric disorder. Higher family income was negatively associated with screening positive for a psychiatric disorder. CONCLUSION: This first national study shows a high prevalence of psychiatric symptoms in Lebanese children and adolescents and an alarming treatment gap. School-based primary prevention programs or screening in primary care settings are key for early detection and management of psychiatric symptoms, and prevention of psychiatric disorders.

Validation of the Arabic Severe Respiratory Insufficiency Questionnaire.

BACKGROUND/OBJECTIVES: Assessment of Health-Related Quality of Life (HRQL) in patients with chronic respiratory insufficiency requiring Home Mechanical Ventilation (HMV) requires a valid measurement tool. The Severe Respiratory Insufficiency (SRI) questionnaire, originally developed in German, has been translated into different languages and tested in different contexts, but has so far not been in use in Arabic-speaking populations. The objective of this study is to validate the Arabic version of the SRI questionnaire in a sample of Arabic-speaking patients from Lebanon. METHODS: Following forward/backward translations, the finalized Arabic version was administered to 149 patients (53 males-96 females, age 69.80 ± 10 years) receiving HMV. Patients were recruited from outpatient clinics and visited at home. The Arabic SRI and the 36-Item Short-Form Health Survey (SF-36) were administered, in addition to questions on sociodemographics and medical history. Exploratory Factor Analysis (EFA) was used to explore dimensionality; internal consistency reliability of the unidimensional scale and its subscales was assessed using Cronbach's alpha. External nomological validity was examined by assessing the correlation between the SRI and SF-36 scores. RESULTS: The 49-item Arabic SRI scale showed a high internal consistency reliability (Cronbach alpha for the total scale was 0.897 and ranged between 0.73 and 0.87 for all subscales). Correlations between the SF-36-Mental Health Component MHC and SF-36-Physical Health Component with SRI-Summary Scale were 0.57 and 0.66, respectively, with higher correlations observed between the SF-36 and specific sub-scales such as the Physical Functioning and the Social Functioning subscales [r = 0.81 and r = 0.74 (P < 0.01), respectively]. CONCLUSION AND RECOMMENDATIONS: The Arabic SRI is a reliable and valid tool for assessing HRQL in patients with chronic respiratory insufficiency receiving home mechanical ventilation.

Impact of a one-year school-based teacher-implemented nutrition and physical activity intervention: main findings and future recommendations.

BACKGROUND: The aim of the current study is to describe the effectiveness of a school-based intervention when delivered by a non-nutrition specialist (trained schoolteachers) as compared to an expert in nutrition. METHODS: Two trials of the same school-based intervention using the same intervention package were delivered, one by nutritionists and another by trained schoolteachers. The intervention focused mainly on dietary behaviours, as well as physical activity. In both trials, purposively selected schools were randomized to intervention or control groups; students (aged 9-11 years) in both groups were compared at post-test on knowledge and self-efficacy scores, as well as dietary and physical activity behaviours, controlling for their baseline status on the various measures. All analyses accounted for clustering at the school level. RESULTS: In both trials, a statistically significantly greater improvement was observed for both the knowledge and self-efficacy scores in intervention vs. school students. When the programme was delivered by trained schoolteachers, frequency of breakfast intake was increased, crisps consumption was reduced, but no change in fruit and vegetable consumption was observed (latter increased when delivered by nutrition professionals only). Physical activity did not improve in both trials. CONCLUSION: Trained schoolteachers can have a positive impact on students' dietary behaviours with the appropriate training to ensure they are equipped with the right information, skills, and resources to deliver the programme with the highest fidelity. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT03040271. Retrospectively registered on 2 February 2017.

Contextual challenges and solutions to undertaking a household adolescent mental health survey in a developing country.

Recent epidemiological evidence for Lebanese adults along with the increased efforts for policy and service planning have demonstrated the importance of screening for rates of psychiatric disorders in the adolescent population. In response to this need, the Beirut Epidemiological Investigation of the Psychological Status of Youth was conducted in a community sample to estimate the prevalence of psychiatric disorders and their correlates among adolescents. The main aim of this report is to provide a synthesis of the research process and challenges faced in completing the first population-based mental health survey among children and adolescents in Lebanon. This report discusses the challenges faced and the lessons learnt in conducting such a survey. Themes discussed include working around the absence of a proper sampling framework, conducting a sound study with limited funding and the absence of a research culture. This report presents evidence-informed recommendations for similar future surveys. The report also establishes that a sound epidemiological survey is possible even where there are limited resources and challenging contexts such as security issues or the absence of a research culture.

Potential use of telephone surveys for non-communicable disease surveillance in developing countries: evidence from a national household survey in Lebanon.

BACKGROUND: Given the worldwide proliferation of cellphones, this paper examines their potential use for the surveillance of non-communicable disease (NCD) risk factors in a Middle Eastern country. METHODS: Data were derived from a national household survey of 2,656 adults (aged 18 years or older) in Lebanon in 2009. Responses to questions on phone ownership yielded two subsamples, the 'cell phone sample' (n = 1,404) and the 'any phone sample' (n = 2,158). Prevalence estimates of various socio-demographics and 11 key NCD risk factors and comorbidities were compared between each subsample and the overall household sample. RESULTS: Adjusting for baseline age and sex distribution, no differences were observed for all NCD indicators when comparing either of subsamples to the overall household sample, except for binge drinking [(OR = 1.55, 95 % CI: 1.33-1.81) and (OR = 1.48, 95 % CI: 1.18-1.85) for 'cell phone subsample' and 'any phone subsample', respectively] and self-rated health (OR = 1.23, 95 % CI: 1.10-1.36) and (OR = 1.16, 95 % CI: 1.02-1.32), respectively). Differences in the odds of hyperlipidemia (OR = 1.27, 95 % CI: 1.06-1.51) was also found in the subsample of 'any phone' carriers. CONCLUSIONS: Multi-mode telephone surveillance techniques provide viable alternative to face-to-face surveys in developing countries. Cell phones may also be useful for personalized public health and medical care interventions in young populations.

Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap.

PURPOSE: Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders. METHODS: Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders. RESULTS: The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders. CONCLUSIONS: A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.

Investigating the association between strategic and pathological gambling behaviors and substance use in youth: could religious faith play a differential role?

OBJECTIVES: This study investigated the link between gambling behaviors and the use of alcohol, drugs, and nonprescribed prescription medications, while exploring the moderating role of distinct religious faiths. METHODS: In 2010, 570 students from the American University of Beirut completed a self-reported, anonymous English questionnaire, which included lifetime gambling and past-year substance use measures. RESULTS: Half (55%) were lifetime gamblers, of whom, 12% were probable pathological gamblers. About 60% were strategic gamblers. Lifetime gamblers were more than twice as likely as nongamblers to report past-year illegal drug use and alcohol abuse. Probable pathological gamblers were also more than four times as likely as nongamblers to report nonmedical prescription drug use, illegal drug use, and alcohol abuse. Compared to nonstrategic gamblers, strategic gamblers had more than three times the odds of illegal drug and cigarette use. The link between alcohol abuse and gambling was stronger among Christians than Muslims. Conversely, Muslims were more likely to report the co-occurrence of various gambling behaviors (lifetime, probable pathological, and strategic gambling) with both illegal drug use and cigarette use. CONCLUSIONS: Gambling and substance use behaviors were strongly linked in this sample of youth from Lebanon, corroborating the evidence from North America. Particularly novel are the co-occurrence of pathological gambling and nonmedical prescription drug use and the potential differential role of religion. (Am J Addict 2014;23:280-287).

Factors associated with alcohol and/or drug use at sexual debut among sexually active university students: cross-sectional findings from Lebanon.

BACKGROUND: Sexual activity accompanied by substance use can impair youth decision-making and enhance risk-taking behaviors. Less is known, however, about the sexual values, perceptions and subsequent sexual practices of youth whose sexual debut occurs while using alcohol/drugs. METHODS: A cross-sectional anonymous online survey was conducted in April-August 2012 among undergraduate and graduate university students (aged 18 to 30) attending the 4th largest private university in Beirut. Pearson's Chi-square and regression models were run using Stata/IC 10.0. RESULTS: 940 university students had engaged in oral, anal and/or vaginal sex, of whom 10% admitted to having had consumed alcohol or taken drugs at sexual debut, a behavior that was more common in the males, less religious, non-Arabs, students living alone or who had lived abroad. Students who used alcohol/drugs at sexual debut were twice as likely to have: their first oral and vaginal sex with an unfamiliar partner [odds ratio (OR) = 2.6, 95% confidence interval (CI): (1.6, 4.2) and OR = 2.1 (1.2, 3.5), respectively], controlling for sex, nationality, current relationship status, living abroad after the age of 12, and spirituality. Students who had sex the first time while using alcohol/drugs were three times as likely to report having had 11 or more subsequent sexual partners versus one or two [OR = 3.0 (1.5-6.0)]; and almost twice as likely to ever engage in something sexual they did not want to do [OR = 1.7 (1.1, 2.8)]. Perceived peer pressure to have sex by a certain age [OR = 1.8 (1.1, 2.9)], and perceived peer norms to consume alcohol/drugs before sex [OR = 4.8 (2.3, 9.9)] were also strong correlates of having sex for the first time while using alcohol and/or drugs. CONCLUSIONS: Findings stress the importance of sexuality education for youth, and the need to begin understanding the true interplay--beyond association--between youth sexual practices and substance use behaviors from a broader public health perspective.

Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon.

BACKGROUND: In Lebanon, childhood obesity doubled during the past decade. Preventive measures should start early in life and Schools are considered an important environment to promote energy balance health behaviours. School-based programmes promoting healthy lifestyles are lacking. The purpose of this study was to evaluate the feasibility and effectiveness of a multicomponent school-based intervention to promote healthy eating and physical activity (and prevent obesity) with school children aged 9-11 years in Lebanon. METHODS: The intervention was developed based on the constructs of the Social Cognitive Theory and adapted to the culture of Lebanese and Arab populations. It consisted of three components: class curriculum, family involvement and food service. Eight schools were purposively selected from two communities of different socioeconomic status (SES) in Beirut and, within each school type, were matched on SES, religious sect profile, and then randomly assigned to either the intervention or control group. Anthropometric measurements and questionnaires on determinants of behavioural change, eating and physical activity habits were completed by the students in both groups at baseline and post intervention. Focus group interviews were conducted in intervention schools at the end of the study. Challenges encountered during the programme implementation were also identified, since Lebanon is considered a country with political unrest and no similar research projects were conducted in the area. RESULTS: Students in the intervention group reported purchasing and consuming less chips and sweetened drinks post-intervention compared with controls (86% & 88% less respectively p < 0.001). Knowledge and self-efficacy scores increased for the intervention (+2.8 & +1.7 points respectively p < 0.001) but not for the control group. There was no difference in physical activity and screen time habits and no changes in BMI between groups at post intervention. Interview data from focus groups showed that the programme was generally well accepted. Limitations for better outcomes include the length of the programme and the school environment. CONCLUSION: "Health-E-PALS" intervention is a promising innovative, theory-based, culturally sensitive intervention to promote healthy eating habits and physical activity in Lebanese school children with a potential to be scaled up, replicated and sustained.

Parenting a High and Growing Population of Youth in the Arab Region: A Scoping Review for an Evidence-Informed Research Agenda.

The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas. Searches of 18 databases resulted in 4,758 records (1995-2018) in all languages. Using Arksey and O'Malley's methodological framework, eligible studies (n = 152) underwent duplicate data abstraction. An evidence gap map was developed using 3i.e.'s platform. Studies were mostly published in English (88%), and lead authors' affiliations were mostly from Arab institutions. Included studies were mostly cross-sectional (89%), quantitative (96%), conducted in a school/university (83%), and surveyed children and adolescents (70%). Most studies (79%) examined parenting influences on youth outcomes. Fewer examined parenting measurement (30%) or evaluated interventions (1%). Mental health and school performance were the most commonly investigated outcomes. The evidence gap map allows researchers who study youth in the Arab world to efficiently and visually delineate the gaps and strategically prioritize research needs. Future studies should employ robust mixed methods study designs, focus on evaluation and psychometric research, engage youth in the research process and explore a more diverse set of outcomes.

Alcohol and illegal drug use behaviors and prescription opioids use: how do nonmedical and medical users compare, and does motive to use really matter?

BACKGROUND/AIMS: This study compares illegal drug and alcohol use behaviors between medical and nonmedical users of prescription opioids (PO) and nonmedical users with distinct motives to use. METHOD: An ethically approved cross-sectional study (2010) was conducted on a representative sample of private university students (n = 570), using a self-filled anonymous questionnaire. RESULTS: About 25% reported using PO only medically and 15% nonmedically. The prevalence of alcohol and illegal drug use was consistently higher among nonmedical than medical PO users. Adjusting for age and gender, lifetime medical users of PO were more likely to use marijuana only (OR = 1.8, 95% CI: 1.1, 2.8), while nonmedical users were at higher odds of using marijuana, ecstasy, cocaine/crack, and alcohol problematically. Compared to nonusers, students who took PO nonmedically for nontherapeutic reasons were more likely to use various illegal drugs, but nonmedical users who took PO to relieve pain/help in sleep were only more likely to use marijuana (OR = 2.5, 95% CI: 1.1, 5.4) and alcohol (e.g. alcohol abuse; OR = 3.8, 95% CI: = 1.4, 10.1). CONCLUSION: Youth who use PO nonmedically to self-treat have a different alcohol and illegal drug-using profile than those who take it for nontherapeutic reasons.

Oral health status in a Lebanese geriatric population.

Background: The sustained growth of older people and the epidemiological shift from communicable to chronic health problems have attracted increased attention to geriatric wellbeing, including oral health. Aims: To evaluate the oral health of urban community-dwelling older people and identify their priority oral health needs. Methods: We recruited 352 adults aged ≥ 65 years in 2015 from social organizations and primary healthcare centres in Beirut and its suburbs. Older people underwent dental examination including the decayed, missing and filled teeth (DMFT) score, gingival health [plaque index (PI) and Periodontal Screening and Recording (PSR)], and dental functional units (FUs). Sociodemographic data were gathered through a structured questionnaire in a face-to-face interview. The participants were stratified into 3 age groups, and according to restoration with partial, complete and no dentures. Statistical analyses included the Mann-Whitney, Kruskal-Wallis and χ2 tests to explore the oral health status by sociodemographics. Results: Missing teeth contributed most to high DMFT score. Mean PI and root caries indices were high. Mean FU scores were low, but higher in women and in complete denture wearers. Lower numbers of remaining mandibular anterior and maxillary posterior teeth, higher DMFT scores, but better periodontal status (lower PSR scores) were found in the older age groups. The more educated participants exhibited the healthier scores. Conclusion: We observed poor oral health, particularly missing teeth and low FUs, in older people, warranting interventions to integrate oral health within the scope of geriatric general health.

Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion.

BACKGROUND: On August 4, 2020, Beirut's port experienced one of the strongest non-nuclear explosions in history, killing approximately 200 people, displacing 300,000 persons, and injuring more than 1000 children. METHODS: An online anonymous survey assessed the prevalence of probable mental health disorders (MHDs) and impact of blast-related and other factors controlling for sociodemographics in 801 children aged 8 to 17 years old. RESULTS: About two thirds (64%) were screened positive for probable anxiety using the Screen for Childhood Anxiety Related Disorder, 52% for probable PTSD using CRIES-13, and 33% for probable depression using the Mood and Feelings Questionnaire (MFQ). Children who resided farthest way from the explosion site or were not in Beirut during blast had a significantly lower odds of anxiety and PTSD. Children who sustained any physical injury (vs. none) or witnessed casualties (vs. not) were at higher odds for PTSD. Children of parents who reported that their homes sustained minor damages (vs. no damages at all) were at higher odds for anxiety and PTSD, and temporary displacement (vs. none) increased odds of PTSD only. Poorer perceived economic status, poorer academic performance, having a family member injured in the blast, and prior mental health care seeking were associated with higher odds for all MHDs. CONCLUSION: Our study, the only one to document the mental health impact of the Beirut Port explosion on children, highlights the critical need for an emergency mental health response, prioritizing disadvantaged communities and children with prior mental health problems.

Substance, use in relation to COVID-19: A scoping review.

BACKGROUND: We conducted a scoping review focused on various forms of substance use amid the pandemic, looking at both the impact of substance use on COVID-19 infection, severity, and vaccine uptake, as well as the impact that COVID-19 has had on substance use treatment and rates. METHODS: A scoping review, compiling both peer-reviewed and grey literature, focusing on substance use and COVID-19 was conducted on September 15, 2020 and again in April 15, 2021 to capture any new studies. Three bibliographic databases (Web of Science Core Collection, Embase, PubMed) and several preprint servers (EuropePMC, bioRxiv, medRxiv, F1000, PeerJ Preprints, PsyArXiv, Research Square) were searched. We included English language original studies only. RESULTS: Of 1564 articles screened in the abstract and title screening phase, we included 111 research studies (peer-reviewed: 98, grey literature: 13) that met inclusion criteria. There was limited research on substance use other than those involving tobacco or alcohol. We noted that individuals engaging in substance use had increased risk for COVID-19 severity, and Black Americans with COVID-19 and who engaged in substance use had worse outcomes than white Americans. There were issues with treatment provision earlier in the pandemic, but increased use of telehealth as the pandemic progressed. COVID-19 anxiety was associated with increased substance use. CONCLUSIONS: Our scoping review of studies to date during COVID-19 uncovered notable research gaps namely the need for research efforts on vaccines, COVID-19 concerns such as anxiety and worry, and low- to middle-income countries (LMICs) and under-researched topics within substance use, and to explore the use of qualitative techniques and interventions where appropriate. We also noted that clinicians can screen and treat individuals exhibiting substance use to mitigate effects of the pandemic. FUNDING: Study was funded by the Institution for Social and Policy Studies, Yale University and The Horowitz Foundation for Social Policy. DH was funded by a NIDA grant (R01DA048860). The funding body had no role in the design, analysis, or interpretation of the data in the study.

Does knowing about the long-term health effects of alcohol matter? Evidence from a university sample in Lebanon.

BACKGROUND: Research linking awareness of health effects of alcohol and harmful alcohol drinking status is limited. AIMS: To investigate the association between awareness of long-term alcohol effects and alcohol use disorders. METHODS: University students aged 18-25 years (n = 1155) completed a self-filled survey. Participants were asked if they knew that alcohol causes: (1) problems in the liver; (2) cancers of the mouth, throat, oesophagus and breast; (3) damage to the heart; and (4) weakening of the immune system. Multinomial regression analyses were conducted to assess the association between awareness of long-term alcohol effects and alcohol drinking status, including Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) alcohol use disorders. RESULTS: One third (32.8%) were past-year drinkers and 18% screened positive for DSM-5 alcohol use disorders. Compared to past-year drinkers with no alcohol use disorders, non-past-year ever drinkers were twice as likely to know about the link between alcohol and cancers of the mouth, throat, oesophagus and breast. Past-year drinkers with an alcohol use disorders were less likely to know about this association. Non-past-year ever drinkers (vs past-year drinkers with no alcohol use disorders) were also 2.6 times more likely to know the alcohol liver risks. CONCLUSIONS: There is a strong inverse relationship between awareness of the effects of alcohol and harmful consumption among young people, providing preliminary support for the protective nature of knowledge on alcohol drinking status. Efforts to increase public awareness of the long-term health effects of alcohol may be useful in reducing alcohol-related harm.

Prenatal exposure to criteria air pollutants and associations with congenital anomalies: A Lebanese national study.

Maternal exposure to air pollution has been associated with a higher birth defect (BD) risk. Previous studies suffer from inaccurate exposure assessment methods, confounding individual-level variations, and classical analytical modelling. This study aimed to examine the association between maternal exposure to criteria air pollutants and BD risk. A total of 553 cases and 10,214 controls were identified from private and public databases. Two subgroups were then formed: one for a matched case-control design, and another for Feature Selection (FS) analysis. Exposure assessment was based on the mean air pollutant-specific levels in the mother's residential area during the specific BD gestational time window of risk (GTWR) and other time intervals. Multivariate regression models outcomes consistently showed a significant protective effect for folic acid intake and highlighted parental consanguinity as a strong BD risk factor. After adjusting for these putative risk factors and other covariates, results show that maternal exposure to PM2.5 during the first trimester is significantly associated with a higher overall BD risk (OR:1.05, 95%CI:1.01-1.09), and with a higher risk of genitourinary defects (GUD) (OR:1.06, 95%CI:1.01-1.11) and neural tube defects (NTD) (OR:1.10, 95%CI:1.03-1.17) during specific GTWRs. Maternal exposure to NO2 during GTWR exhibited a significant protective effect for NTD (OR:0.94, 95%CI:0.90-0.99), while all other examined associations were not statistically significant. Additionally, maternal exposure to SO2 during GTWR showed a significant association with a higher GUD risk (OR:1.17, 95%CI:1.08-1.26). When limiting selection to designated monitor coverage radiuses, PM2.5 maintained significance with BD risk and showed a significant gene-environment interaction for GUD (p = 0.018), while NO2 protective effect expanded to other subtypes. On the other hand, FS analysis confirmed maternal exposure to PM2.5 and NO2 as important features for GUD, CHD, and NTD. Our findings, set the basis for building a novel BD risk prediction model.

A rapid situation assessment (RSA) study of alcohol and drug use in Lebanon.

BACKGROUND: Research on substance use and misuse in Lebanon is scarce and, when available, focuses on a specific substance or a limited segment of the population. The objective of this Rapid Situation Assessment (RAS) study was to survey the use of multiple substances in diverse segments of the Lebanese population. METHODS: A multi-method and multi-sample survey was conducted to collect quantitative and qualitative data from the academic sector (high school and university students), substance users in treatment or under arrest (prison, detention), and non-institutionalized "street" users. RESULTS: Age of first use of substances started as early as 9 years in the youth sample. Moreover, 12% of the high school students reported smoking one or more packs of cigarettes per day and 9% of the university students met criteria for DSM-IV alcohol abuse. Cannabis represented the most commonly used illicit drug in both high school and university students, and tranquilizers were the most frequently misused medicinal substance. Heroin was responsible for 50% of the treatment admissions, followed by cocaine (20%), and alcohol (20%); heroin was also the most common substance of arrest. Recidivism was almost the rule for heroin users across all treatment settings. Unperceived need for treatment was the most common reason for not seeking treatment in non-institutionalized drug users (47.6%). Injecting drug use was a common behavior noted within substance using populations, in treatment and non-institutionalized (about 50% of them), with a high rate of needle sharing practices. About half of all patients in treatment had a history of police arrests, and about one-third of those in prison ever received prior treatment for substance use. CONCLUSION: The study points towards a growing trend for substance use problems in early adolescence that warrants close monitoring. Further investigation of these patterns is needed since the Lebanese population might have specific pathways of abuse. There is a need to bring together various health, legislative, and academic stakeholders for a continuous appraisal of data from substance abuse studies as evidenced by the recent, although slow, progress in the fields of legislation and treatment that follow such concerted efforts.