"We do it ourselves": strengths and opportunities for improving the practice of harm reduction.

BACKGROUND: Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS: Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS: Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS: Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

Validation of the Flexible and Rigid Cognitive Restraint Scales in a General French Population.

Distinguishing between flexible and rigid cognitive restraint (CR) may be useful for understanding the role of CR in dietary behavior and weight status. This study aimed to translate and adapt the flexible and rigid CR scales to the French context and test their psychometric properties. Construct validity, internal consistency, and test-retest reliability were examined in a sample of 620 individuals. Confirmatory factor analysis of the scales found a two-factor structure (flexible CR: 12 items; rigid CR: 15 items) that provided a good fit and supported the initial solution (χ2 = 584.7, df = 322, CFI = 0.96, RMSEA = 0.052 [0.045, 0.059], TLI = 0.95). Higher flexible and rigid CR were associated with higher CR overall, emotional eating (TFEQ-R21) and eating disorders (SCOFF), and lower intuitive eating (IES-2). In addition, higher flexible CR was associated with lower impulsivity (BIS-11) while higher rigid CR was associated with higher uncontrolled eating (TFEQ-R21) and lower self-esteem (RSES), satisfaction with life (SWLS), and optimism (LOT-R). Flexible and rigid CR internal consistency was satisfactory (McDonald ω = 0.77 and 0.74, respectively) and test-retest reliability was good (ICC = 0.81 and 0.79, respectively). This study validated a flexible and rigid CR tool in a French population and confirmed that these two types of CR represent distinct eating behaviors.

Trends in breastfeeding practices and mothers' experience in the French NutriNet-Santé cohort.

BACKGROUND: France has one of the lowest rates in the world regarding breastfeeding initiation and duration. Few studies have explored breastfeeding practices in France since the middle of the twentieth century, or following from initiation to cessation. The purpose of our study was to determine trends in breastfeeding over the past decades regarding public health recommendations, and to examine mothers' perceptions about factors known to have an impact on breastfeeding support and cessation. METHODS: From the NutriNet-Santé cohort, 29,953 parous women (launched in 2009 to study relation between nutrition and health), were included in the present study. Using web-questionnaires, they were asked retrospectively if they had breastfed their youngest child or not, and if so, the duration of exclusive and total breastfeeding. For those who had breastfed, we investigated their perceptions about support at initiation and during the entire breastfeeding period and reasons for breastfeeding cessation. We also asked those who did not breastfeed about their perceptions and reasons for infant formula feeding their youngest child. Analyses were weighted according to the French census data. RESULTS: In the NutriNet-Santé cohort, 67.3% of mothers breastfed their youngest child. The proportion of breastfed children increased over the past few decades, from 55.0% (95% CI 54.3, 55.6) in the 1970s to 82.9% (82.4, 83.4) in the 2010s. Total and exclusive breastfeeding duration went from 3.3 months and 2.4 months respectively in the 1970s to 5.9 months and 3.2 months respectively in the 2010s. Most mothers felt supported at initiation and during the breastfeeding period. A reported desire to have breastfed longer than two months was 59.5%. Mothers who did not breastfeed did it by choice (64.3%). They did not feel guilty (78.2%) and did not perceive a problem not to breastfeed (58.8%), but almost half of them would have liked to have breastfed (45.9%). CONCLUSION: Breastfeeding duration has increased in the past decades but did not reach the public health recommendations threshold. Targets other than mothers have to be considered for breastfeeding education, like the partner and her environment, to increase breastfeeding practices. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov ( NCT03335644 ).

Dispositional optimism is associated with weight status, eating behavior, and eating disorders in a general population-based study.

OBJECTIVE: The objective of this cross-sectional study was to assess whether optimism is associated with body mass index (BMI), eating behavior and eating disorders (EDs) in a population-based study. METHOD: In 2016, a total of 32,805 participants aged ≥18 years from the NutriNet-Santé cohort completed the Life Orientation Test-Revised, assessing dispositional optimism. Height and weight were self-reported. Eating behavior was assessed with the revised 21-item Three-Factor Eating Questionnaire. Risk of EDs was evaluated with the Sick-Control-One-Fat-Food Questionnaire. Linear and Logistic regression was used to analyze the association between optimism, BMI categories, eating behavior and ED risk, controlling for sociodemographic, lifestyle and depressive symptom characteristics. RESULTS: Our sample was composed of 73.5% women, and the mean age was 55.39 ± 13.70 years. More optimistic participants were less likely to be underweight (OR = 0.82; 95% CI: 0.75, 0.89), or obese, particularly class III obese (BMI ≥40 kg/m2 ) (OR = 0.69; 95% CI: 0.56, 0.84) compared with less optimistic individuals. Optimism was negatively associated with cognitive restraint (ß = -.07; 95%CI: -0.08; -0.06), emotional eating (ß = -.17; 95% CI: -0.19, -0.16) and uncontrolled eating (ß = -.10; 95% CI: -0.11, -0.09). In addition, more optimistic participants had a lower risk of EDs (OR = 0.60; 95% CI: 0.56, 0.64). DISCUSSION: Our findings showed that optimism was associated with weight status, eating behavior and risk of EDs in both women and men. The causal structure of the underlying observed association remains unclear and should be further investigated.

Caring Adults: A Brief Report Assessing Adults' Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas.

Objectives: As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults' needs with regard to engaging in sexual health conversations with youth and young adults. Methods: A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes. Results: Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants' comfort. Conclusions: To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.

Starchy food consumption in French adults: a cross-sectional analysis of the profile of consumers and contribution to nutritional intake in a web-based prospective cohort.

BACKGROUND: French Nutritional Guidelines recommend eating starchy foods at each meal, according to appetite, and advise to vary sources. However, the proportion of energy from carbohydrates is currently too low in many Western European countries. METHODS: Consumption of the different types of starchy foods was assessed among 80,209 adult participants in the French NutriNet-Santé cohort (78% women, mean age 42.9 ± 14.5). Description of starchy food consumption according to sociodemographics was provided as well as the contribution of starchy food to nutritional intake. Determinants of adherence to starchy food nutritional guidelines were estimated using multivariable polytomous logistic regression. RESULTS: Starchy foods contributed approximately 22% of the energy intake, 75% of the complex carbohydrate intake and 36.1% of the fibre intake. About 43% of the subjects had intakes in line with the French Nutritional Guidelines concerning starchy foods. Men met the recommendation more frequently (55 vs. 33% for women), but were also more likely to exceed the recommendation (9.5 vs. 1.3%), even after adjustment for energy intake. According to our multivariable model, starchy food consumption increased also with age. CONCLUSIONS: A higher consumption of starchy foods should be promoted in the French population in order to increase the part of the energy intake coming from complex carbohydrates.

Membrane peroxidation by lipopolysaccharide and iron-ascorbate adversely affects Caco-2 cell function: beneficial role of butyric acid.

BACKGROUND: Membrane lipid peroxidation may play a role in immune-mediated bowel diseases. OBJECTIVE: We examined the effects of lipopolysaccharide (LPS), a ubiquitous endotoxin mediator of gram-negative bacteria, alone and in combination with iron-ascorbate, on enterocyte function. Furthermore, we assessed the antioxidant capacity of butylated hydroxytoluene (BHT) and butyric acid, which are known to play a significant role in the welfare of intestinal mucosa. DESIGN: Differentiated intestinal Caco-2 cells were used to study the induction of membrane peroxidation by LPS (100 micro g/mL) and iron-ascorbate (0.2 and 2 mmol/L, respectively) and to examine the beneficial effects of BHT and butyric acid. RESULTS: A significant dose-dependent increase in malondialdehyde, accompanied by lower apical membrane fluidity and significantly decreased sucrase activity, was observed when Caco-2 cells were incubated with LPS. LPS also augmented paracellular permeability ([(14)C]polyethylene glycol flux), prostaglandin E(2) production, and cyclooxygenase-2 (EC 1.14.99.1) expression. These abnormalities were exacerbated by the coadministration of iron-ascorbate, but most of them were suppressed by butyric acid and BHT. CONCLUSION: Bacterial endotoxin and prooxidants may overwhelm antioxidant defenses and become deleterious to enterocyte function, whereas butyric acid and BHT may provide antioxidant protection.

The antioxidant BHT normalizes some oxidative effects of iron + ascorbate on lipid metabolism in Caco-2 cells.

We showed recently that iron + ascorbate can impair the assembly of intestinal lipoproteins. However, we could not determine whether these changes were caused by iron + ascorbate-mediated lipid peroxidation per se. We therefore conducted studies to evaluate how antioxidants antagonize the iron + ascorbate-induced derangements. To this end, Caco-2 cells, a reliable experimental intestinal model, were incubated with iron + ascorbate (0.2 mmol/L each) alone or with different concentrations of catalase, mannitol, tocopherol or BHT. Exposing Caco-2 cells to iron + ascorbate increased malondialdehyde levels fourfold (P < 0.0001); this effect was decreased markedly (P < 0.02) in the presence of BHT. Furthermore, BHT normalized the abnormal intracellular events involved in fat absorption, i.e., lipid esterification, cholesterol synthesis and apolipoprotein production. On the other hand, it did not fully restore the secretion of lipids and lipoproteins. Thus, our current data imply that iron + ascorbate-catalyzed lipid peroxidation is partially responsible for the disturbances observed in intestinal lipid transport.