Exploring uses of visual arts-based interventions for mental health of marginalized populations: a scoping review.

BACKGROUND: The intentions of this scoping review are to determine current uses of visual arts-based interventions for mental health and trauma support of marginalized populations, and to identify current gaps in knowledge in this emergent field. METHOD: Six databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, JSTOR) were searched for relevant studies. Following the PRISMA guidelines, 38 articles met the inclusion criteria. RESULTS: Most interventions focused on improving the mental health of participants, or to provide opportunities for participants to process their experiences of mental health. Participants reported increased well-being, experiences of relaxation and/or distraction, and processing of mental health experiences. They perceived arts-based interventions as helpful and developed mutual social support with other participants. CONCLUSION: Arts-based interventions have the potential to inform the development of culturally safe and relevant mental health care for marginalized populations beyond current mainstream mental health practices.

Broad evidence of xylazine in the UK illicit drug market beyond heroin supplies: Triangulating from toxicology, drug-testing and law enforcement.

BACKGROUND AND AIMS: Xylazine is a non-opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. METHODS: Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co-detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug-testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug-testing postal service with the date, location, purchase intent and co-detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. RESULTS: By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug-testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. CONCLUSIONS: Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies.

Partner Exclusion from Childbirth During COVID-19 in Canada: Implications for Theory and Policy.

We explore partner exclusion from perinatal care in Canada during the COVID-19 pandemic. Participants' narratives show that pregnant couples frame partner presence as a [human] right that was denied, and articulated this as denial of the "right to experience" and the "right to care." These restrictions deprived birth partners and families of an experience that is important to them, and represent a repudiation of the resurgence of birth as a social event which entails valued forms of care. We show that the medical establishment's commitment to partner presence during perinatal care is weak, although caring masculinity is normative.

Experiences of labour and childbirth among physicians in Canada: a qualitative study.

BACKGROUND: Little is known about physicians' birth experiences and the perceived relation between physicians' professional status and their birth outcomes, particularly in nonsurgical specialties. This study aimed to explore the birth experiences of physicians in Canada and to determine their perception of the relation between their profession, and their birth experiences and obstetric outcomes. METHODS: We undertook a qualitative descriptive study consisting of in-depth interviews with practising physician birthing parents, all members of the Canadian Physician Mothers Group (online Facebook community) who had deliveries between 2016 and 2021. Data were analyzed using conventional content analysis. RESULTS: Fourteen interviews were conducted. Half of the participants worked in primary care specialties. From participants' narratives, we developed 5 themes pertaining to physicians' birth experiences: (negative impact of) professional culture of medicine whereby professional responsibility trumped personal needs; (mixed) impact of medical knowledge whereby participants felt empowered to make decisions and ask questions, but also experienced augmented stress due to knowing what could go wrong; difficulty stepping out of physician role; privileged access to care; and belief in negative impact of physician role on birth outcome. Some participants suggested possible reasons that physicians may have worse birth outcomes than the general public. INTERPRETATION: The professional culture of medicine was largely perceived as a negative, in particular, the pressure to deny one's own needs for the good of patients and colleagues. Physicians' increased access to medical care combined with their higher levels of anticipatory anxiety around childbirth could be exposing them to increased monitoring and surveillance, thus augmenting the likelihood of medical and surgical interventions.

Foregrounding women and household dynamics to inform Article 17: a qualitative description analysis of tobacco farming households in Mozambique.

PURPOSE: This paper examines the intrahousehold dynamics between women and men present in tobacco farming households in Mozambique. Attention to the experiences and realities of the smallholder farmers is crucial for understanding approaches to alternative livelihoods. Intrahousehold dynamics can provide important insights into how these households and their members view tobacco production and engage with the political economy of tobacco farming, how they make decisions, and the rationale and values behind these decisions. METHODS: Data were collected through single-gender focus group discussions (n=8) with 108 participants (men=57, women=51). Analysis was informed by a qualitative description methodology. This research presents a gender-based analysis examining the perspectives, roles, decision-making processes and desires of female and male tobacco farmers in four key tobacco-growing districts in Mozambique. FINDINGS: Throughout this paper, women are found to hold leverage and influence in tobacco farming households, and this leverage is in part gained via the necessity of women's unpaid labour in achieving profitability in tobacco farming. Both women and men are also found to strongly desire and pursue the well-being of the household. CONCLUSION: Women hold agency within tobacco-growing households and participate in decision-making processes regarding tobacco agriculture. Women should be included in future tobacco control policies and programmes pertaining to Article 17.

Mass Immunizations: A Pocket Guide.

Numerous state, national, and global resources exist for planning and executing mass vaccination campaigns. However, they are disparate and can be complex. The COVID-19 pandemic highlighted the need for clear, easy to use mass vaccination resources. Meanwhile, annual influenza vaccination, as well as outbreaks such as mpox, demonstrates the need for continued emphasis on timely and effective vaccinations to mitigate outbreaks. This pocket guide seeks to combine relevant resources and basic steps for setting up a mass vaccination clinic, utilizing experience from COVID-19 mass vaccination sites.

Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization.

There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual. PERSPECTIVE: This article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.

Re-centering Relationships: Obstetric Violence, Health Care Rationalities, and Pandemic Childbirth in Canada.

Emerging evidence suggests that the COVD-19 pandemic is eroding childbirth rights. Drawing on narratives of women who gave birth in Canada during the pandemic, this article exposes a paradox in that policies aimed at limiting interpersonal contact implicitly acknowledge the connection between health, well-being, and the social context of people's lives, yet they frame this relationality as a liability to be eliminated. They do this despite the many benefits that social support is known to confer for pregnancy and childbirth. I suggest that obstetric violence theory could be expanded to include the perinatal health care system's failure to consider the well-being of pregnant and birthing persons as necessarily interdependent with that of close others. Conscientiously and routinely making the safeguarding of these relationships a priority in perinatal health care planning may strengthen existing health care systems against certain forms of obstetric violence. [childbirth, COVID-19, obstetric violence, relational personhood, Canada].

Methylation of genes and regulation of inflammatory processes on emotional response in young adults with alcoholic parents.

Many Americans are adult children of an alcoholic parent (ACoA), which can confer an increased risk of trauma and hazardous alcohol use, as well as heritable and environmental genetic influence. Psychological health and related neural activity can be influenced by inflammation responses, but it is not clear how these factors interact regarding risk or resilience to hazardous alcohol use. The goals of this study were to better understand the relationships between current alcohol use and inflammation, how these are modified by single nucleotide polymorphisms (SNPs) and/or epigenetic modifications of inflammation-associated genes; and how these alter neural reactivity to emotionally-salient stimuli. To do so, ACoA participants were dichotomized as resilient (not engaged in hazardous alcohol use) or vulnerable (currently engaged in hazardous alcohol use). Measures of blood-oxygen-level-dependent (BOLD) activity within regions of interest (ROIs), SNPs and DNA methylation of specific inflammation regulatory genes, and biological markers of inflammation were compared between these groups. Vulnerable ACoAs exhibited higher plasma C-reactive protein (CRP) and greater BOLD activity in the right hippocampus and ventral anterior cingulate cortex in response to emotional cues as well as reduced methylation of CRP and glucocorticoid-related genes. Path analysis revealed significant relationships between alcohol use, SNPs, DNA methylation of inflammatory-related genes, CRP levels, and BOLD activity to emotional stimuli. Taken together, these findings suggest a complex association related to hazardous alcohol use in ACoAs that may predict current inflammation and neural reactivity to emotional stimuli. A better understanding of these associations could direct the future of individual treatment options.

Can cannabis kill? Characteristics of deaths following cannabis use in England (1998-2020).

BACKGROUND: Cannabis is the most widely used illegal drug but is rarely considered a causal factor in death. AIMS: This study aimed to understand trends in deaths in England where cannabinoids were detected at post-mortem, and to evaluate the clinical utility of post-mortem cannabinoid concentrations in coronial investigations. METHODS: Deaths with cannabinoid detections reported to the National Programme on Substance Abuse Deaths (NPSAD) were extracted and analysed. RESULTS: From 1998 to 2011, on average 7% of all cases reported to NPSAD had a cannabinoid detected (n = 110 deaths per year), rising to 18% in 2020 (n = 350). Death following cannabis use alone was rare (4% of cases, n = 136/3455). Traumatic injury was the prevalent underlying cause in these cases (62%, n = 84/136), with cannabis toxicity cited in a single case. Polydrug use was evident in most cases (96%, n = 3319/3455), with acute drug toxicity the prevalent underlying cause (74%, n = 2458/3319). Cardiac complications were the most cited physiological underlying cause of death (4%, n = 144/3455). The median average Δ9-tetrahydrocannabinol post-mortem blood concentrations were several magnitudes lower than previously reported median blood concentrations in living users (cannabis alone: 4.3 µg/L; cannabis in combination with other drugs: 3.5 µg/L). CONCLUSIONS: Risk of death due to cannabis toxicity is negligible. However, cannabis can prove fatal in circumstances with risk of traumatic physical injury, or in individuals with cardiac pathophysiologies. These indirect harms need careful consideration and further study to better elucidate the role cannabis plays in drug-related mortality. Furthermore, the relevance of cannabinoid quantifications in determining cause of death in coronial investigations is limited.

Making good care essential: The impact of increased obstetric interventions and decreased services during the COVID-19 pandemic.

PROBLEM & BACKGROUND: Since the onset of the COVID-19 pandemic in Canada, policies have been implemented to limit interpersonal contact in clinical and community settings. The impacts of pandemic-related policies on experiences of pregnancy and birth are crucial to investigate and learn from. AIM: To examine the impact of pandemic policy changes on experiences of pregnancy and birth, thereby identifying barriers to good care; to inform understandings of medicalization, care, pregnancy, and subjectivity during times of crisis; and to critically examine the assumptions about pregnancy and birth that are sustained and produced through policy. METHODS: Qualitative descriptive study drawing on 67 in-depth interviews with people who were pregnant and/or gave birth in Canada during the pandemic. The study took a social constructionist standpoint and employed thematic analysis to derive meaning from study data. FINDINGS: The pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarian section) in response to pandemic stresses and uncertainties. Intervention use here is an outcome of negotiation and collaboration between pregnant people and their care providers as they navigate pregnancy and birth in stressful, uncertain conditions. DISCUSSION: Continuity of care throughout pregnancy and postpartum, labour support persons, and non-clinical services and interventions for pain management are all essential components of safe maternal healthcare. However, pandemic perinatal care demonstrates that they are not viewed as such. CONCLUSION: The pandemic has provided an opportunity to restructure Canadian reproductive health care to better support and encourage out-of-hospital births - including midwife-assisted births - for low-risk pregnancies.

Increased use of birth interventions during the COVID-19 pandemic?: An exploratory qualitative study.

Context: Since the onset of the COVID-19 pandemic policies have been implemented to limit disease transmission and manage patient flow in clinical settings, including perinatal healthcare settings. Emergent literature indicates increased medicalization of childbirth during the pandemic, however experiences of pregnancy and birth remain unexplored. Understanding the impact of pandemic policies on healthcare practices is important for planning better care in future. Objective: To examine how people in Canada who gave birth during the COVID-19 pandemic were affected by pandemic-related policies, especially policies aimed at limiting interpersonal contact to reduce SARS-CoV-2 transmission. Study Design: exploratory qualitative descriptive study. Dataset: Semi-structured telephone interviews. Population studied: 67 participants were recruited. Study inclusion was extended to anyone aged 18 years or more who was located in Canada and was pregnant or had given birth during the COVID-19 pandemic. Intervention/Instrument (for interventional studies): N/A. Outcome Measures: N/A. Results: Findings suggest that the pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarean section) in response to pandemic stresses and uncertainties on the part of both healthcare providers and pregnant people themselves. Some participants pushed for non-medically necessary interventions as a means of averting the possibility that their partner would be banned from attending the birth (e.g. if the partner contracted COVID-19). Some participants reported being offered interventions as a means of controlling patient flow and in response to clinicians' fears of healthcare system collapse in the event of escalating infection rates. Conclusions: For some people in Canada, giving birth during the COVID-19 pandemic entails medicalization and implementation of non-medically necessary interventions. If healthcare systems are increasing intervention use at the same time that the "safety net" intended to catch the complications from those interventions is reduced, then birthing people are being exposed to extra risk precisely when it is most important to minimize it. Continuity of care throughout pregnancy and postpartum, labour support persons, and non-medical forms of care are all essential components of safe maternal healthcare, however pandemic perinatal care demonstrates that they are not viewed as such.

Oxygen and Ventilator Logistics During California's COVID-19 Surge: When Oxygen Becomes a Scarce Resource.

The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.

Women's postpartum experiences in Canada during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The mental health of postpartum women has worsened during the COVID-19 pandemic; however, the experiences that underlie this remain unexplored. The purpose of this study was to examine how people in Canada who gave birth during the pandemic were affected by policies aimed at limiting interpersonal contact to reduce SARS-CoV-2 transmission in hospital and during the early weeks postpartum. METHODS: We took a social constructionist approach and used a qualitative descriptive methodology. Sampling methods were purposive and involved a mix of convenience and snowball sampling via social media and email. Study inclusion was extended to anyone aged 18 years or more who was located in Canada and was pregnant or had given birth during the COVID-19 pandemic. Data were obtained via semistructured qualitative telephone interviews conducted between June 2020 and January 2021, and were analyzed through thematic analysis. RESULTS: Sixty-five interviews were conducted; data from 57 women who had already delivered were included in our analysis. We identified the following 4 themes: negative postpartum experience in hospital owing to the absence of a support person(s); poor postpartum mental health, especially in women with preexisting mental health conditions and those who had had medically complicated deliveries; asking for help despite public health regulations that prohibited doing so; and problems with breastfeeding owing to limited in-person follow-up care and lack of in-person breastfeeding support. INTERPRETATION: Policies that restrict the presence of support persons in hospital and at home during the postpartum period appear to be causing harm. Measures to mitigate the consequences of these policies could include encouraging pregnant people to plan for additional postpartum support, allowing a support person to remain for the entire hospital stay and offering additional breastfeeding support.

Quantification of Flualprazolam in Blood by LC-MS-MS: A Case Series of Nine Deaths.

The emergence of novel designer benzodiazepines continues to be a public health concern. Flualprazolam is one of these drugs. It was initially identified in 2017. User forums suggest it is slightly more potent than alprazolam and has longer-lasting central nervous system depressant effects. Here we report a simple, sensitive liquid chromatography-tandem mass spectrometry method for flualprazolam and report a series of nine cases in which flualprazolam was quantified. As is typical of forensic toxicology in the twenty-first century, all the cases had more than one drug present. None of the deaths could be directly attributed to flualprazolam alone, but all were likely due to a combination of sedative drugs. However, this paper still adds to the data available to allow interpretation of postmortem flualprazolam concentrations.

A critical content analysis of media reporting on opioids: The social construction of an epidemic.

BACKGROUND: The 2000s have seen a proliferation of media reporting about opioid use in North America. Given the significant role that popular media plays in shaping the public's perceptions and understandings of the issues that it represents, analysing the content of this media coverage can help understand public discourse about opioid use. METHODS: We conducted a critical content analysis of Canadian newsprint media reporting on opioids using a sociological lens. We performed a qualitative thematic analysis of these texts, coding 826 articles and applying a critical discourse analysis in our interpretation of the findings. FINDINGS: Our analysis showed a slow transition from a conversation primarily about clinical pain care towards a discussion of criminality, especially the increasingly fluidity of boundaries between prescription opioid use and the illegal drug trade. Patients tend to be dichotomized as either innocently following physician prescriptions or drug-seeking, as an aspect of lives characterized by addiction and street crime. These depictions map onto characterizations of physicians as naively following pharmaceutical industry advice or becoming irrelevant once criminality is introduced. DISCUSSION: The social construction of the opioid epidemic polarizes individuals as good or bad with little attention paid to underlying institutional interests both in the creation of the problem or in the solutions that are proposed. We show that as concerns about harms from opioids become more pronounced, the narrative shifts to home in on illicit street-use with a corresponding uptake of stigmatizing references to so-called addicts. Concurrently, most references to the pharmaceutical industry disappear from view. This framing of the problem defines the kinds of solutions that then seem natural. For example, increased criminalization is suggested for people who use drugs and stigmatizing those who suffer with chronic pain becomes a higher priority than implementing safer and more effective therapies for managing their pain.

The mismeasurement of complexity: provider narratives of patients with complex needs in primary care settings.

PURPOSE: Chronic disease is a global concern. While ample research has aimed to identify the epidemiology of multimorbidity and patient complexity using administrative data, little attention has been paid to the processes of care that treating complex patients entail. Consequently, the concept of patient complexity itself does not directly speak to how challenging it may be to care for a given patient. The purpose of this study was to investigate how primary care providers define, encounter, and manage complex patients, especially those with chronic pain. To our knowledge, this is the first study to move beyond general narrative descriptions of complexity towards an interrogation that is grounded in the work practices of caring for these patients. METHODS: We undertook an institutional ethnography (IE) in Ontario, Canada. IE uses people's everyday work problems as the starting point for an exploration of the often-invisible social relations that orient experiences. Grounded in the everyday experience of primary care providers, we draw here on 51 interviews that were collected as part of our larger IE study, to interrogate the utility of definitions of patient complexity as medical multimorbidity. FINDINGS: Care providers consider patients challenging due to their socio-economic status more so than their medical problems alone. Our data shows that patients' issues are often bound up with poverty, trauma, and mental health concerns, and are challenging for health care providers in part because the interventions needed exceed the scope of their medical expertise, while social issues render the treatment of potentially straightforward medical problems complicated. This was especially so for patients with chronic pain. CONCLUSION: Defining patient complexity as morbidity alone is inadequate; such models neglect syndromes and conditions that are not included in formal disease classifications. Chronic pain should be included among the chronic conditions that are considered to constitute multimorbidity. In order to provide effective patient-centered care, discussions of patient complexity must also attend to the complex social and economic circumstances in which many patients live and include broader issues of inequity and social justice. This approach would enable policies to better support primary care providers who struggle to manage their patients with complex needs across domains of physiological health, mental health, and the quality of their living conditions, and in so doing improve the care that patients receive.

An ethnography of chronic pain management in primary care: The social organization of physicians' work in the midst of the opioid crisis.

BACKGROUND: This study reports on physicians' experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. METHODS: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. FINDINGS: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. INTERPRETATION: Our findings show that care providers find the treatment of patients with chronic pain-especially those patients also experiencing poverty-to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients' social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision.

Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education.

PURPOSE: Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. METHOD: This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. RESULTS: Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. CONCLUSIONS: Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.

Neural and psychological characteristics of college students with alcoholic parents differ depending on current alcohol use.

A significant proportion of college students are adult children of an alcoholic parent (ACoA), which can confer greater risk of depression, poor self-esteem, alcohol and drug problems, and greater levels of college attrition. However, some ACoA are resilient to these negative outcomes. The goal of this study was to better understand the psychobiological factors that distinguish resilient and vulnerable college-aged ACoAs. To do so, scholastic performance and psychological health were measured in ACoA college students not engaged in hazardous alcohol use (resilient) and those currently engaged in hazardous alcohol use (vulnerable). Neural activity (as measured by functional magnetic resonance imaging) in response to performing working memory and emotion-based tasks were assessed. Furthermore, the frequency of polymorphisms in candidate genes associated with substance use, risk taking and stress reactivity were compared between the two ACoA groups. College ACoAs currently engaged in hazardous alcohol use reported more anxiety, depression and posttraumatic stress symptoms, and increased risky nicotine and marijuana use as compared to ACoAs resistant to problem alcohol use. ACoA college students with current problem alcohol showed greater activity of the middle frontal gyrus and reduced activation of the posterior cingulate in response to visual working memory and emotional processing tasks, which may relate to increased anxiety and problem alcohol and drug behaviors. Furthermore, polymorphisms of cholinergic receptor and the serotonin transporter genes also appear to contribute a role in problem alcohol use in ACoAs. Overall, findings point to several important psychobiological variables that distinguish ACoAs based on their current alcohol use that may be used in the future for early intervention.