Investigating the implementation of a novel approach to alcohol screening and brief intervention in Mexico: a mixed-methods study using pseudo-patients.

Introduction: Low- and middle-income countries bear disproportionate burdens from excessive alcohol consumption, yet have fewer resources to identify and intervene with risky drinkers. Low-cost screening and brief intervention (SBI) models offer a tool for addressing this health problem and reducing disparities.

Methods: In this mixed-methods study, trained pseudo-patients visited health clinics in Zacatecas, Mexico, where a novel SBI model was used with trained nonmedical health educators (HEs) conducting SBI in waiting areas.

Self-reported drink driving, enforcement, crashes, and crash reporting: A 6-country comparison.

Objective: The objective of this study was to compare drink driving and related road safety issues in 2 urban areas of 6 countries and develop an equation for estimating the rate of crash underreporting to the police in urban areas of countries that lack this information.

Methods: This study is a secondary analysis of 1 to 2 waves of surveys in pairs of matched medium-sized cities in Belgium, Brazil, China, Mexico, South Africa, and Ohio, United States; the surveys supported evaluation of local alcohol harm reduction efforts. Data were from 2017 to 2019 except 2023 for Mexico.

Effects of the Universal Prevention Curriculum for Schools on Substance Use Among Peruvian Adolescents: A Randomized Trial.

This group-randomized trial assessed the effects of a universal prevention training curriculum for school administrators and teachers that focused on effective strategies to prevent adolescent substance use and related problems. Twenty-eight schools in three regions of Peru were randomly assigned to either an intervention or control condition (14 schools per condition). Repeated cross-sectional samples of 11 to 19-year-old students participated in four surveys from May 2018 to November 2019 (N = 24,529).

Intended and unintended consequences: Changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018 - Controlled and single-series interrupted time series analyses.

Background: The potential misapplication of current opioid prescribing policies remains understudied and may have substantial adverse implications for patient safety.

Methods: We used autoregressive integrated moving average models to assess level and trend changes in monthly 1) prescribing rates, 2) days' supply, and 3) daily morphine milligram equivalents (MME) of incident opioid prescriptions relative to 1) a state medical board initiative to reduce high-dose and -volume opioid prescribing and 2) legislation to limit initial opioid prescriptions for acute and postsurgical pain. We examined outcomes by pain indication overall and by cancer history, using prescribing patterns for benzodiazepines to control for temporal trends.

Screening and brief intervention for alcohol use disorder risk in three middle-income countries.

Background: This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI.

Methods: Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics.

Locked Down: Economic and Health Effects of COVID-19 Response on Residents of a South African Township.

Background: Little research has examined how pandemics affect residents in under-resourced communities. This study investigated how COVID-19 and lockdown policies affected residents of Alexandra, one of Johannesburg, South Africa's lowest-income townships.

Methods: We conducted a telephone survey May 11-22, 2020, while the lockdown and alcohol ban were in effect, of a spatially stratified sample of 353 adult Alexandra residents drawn randomly from voter registration, credit card application, and prior studies' sampling frames.

Etiologic mechanisms in an adapted family-based preventive intervention for underage alcohol use in Mexico: Results of an exploratory pilot study.

Alcohol use represents a global health problem, especially for Latin American youth. As part of the Global Smart Drinking Goals campaign, a family-based preventive intervention was adapted and piloted in Mexico based on an existing evidence-based program, Guiding Good Choices. In this study, we explored the malleability and session-specific mean-level changes in protective and risk factors targeted by the adapted family intervention as related to the prevention of underage alcohol use and abuse.

Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina.

Importance: Rapid reduction or discontinuation of long-term opioid therapy may increase risk of opioid overdose or opioid use disorder (OUD). Current guidelines for chronic pain management caution against rapid dose reduction but are based on limited evidence.

Objective: To characterize the association between rapid reduction or abrupt discontinuation of opioid therapy (vs maintained or gradual reduction) and incidence of opioid overdose and OUD among patients prescribed high-dose, long-term opioid therapy (HDLTOT).

Predictors of Engagement and Attendance of a Family-Based Prevention Program for Underage Drinking in Mexico.

Underage drinking represents a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones, a family-based prevention program, was adapted and piloted in Mexico based on the existing Guiding Good Choices program. Although family-based interventions in the USA are promising for preventing underage drinking, little is known about how adapted versions of these interventions may work in low-middle income countries, such as in Latin America.

The Contribution of Alcohol Beverage Types to Consumption, Heavy Drinking, and Alcohol-Related Harms: A Comparison across Five Countries.

Background: This study examined the relative contribution of alcoholic beverage types to overall alcohol consumption and associations with heavy alcohol use and alcohol-related harms among adults.

Methods: Cross-sectional survey data were collected from adult samples in two cities involved in the Global Smart Drinking Goals (GSDG) initiative in each of five countries (Belgium, Brazil, China, South Africa, United States). Survey measures included past-30-day consumption of beer, wine, flavored alcoholic drinks, spirits, and homemade alcohol; past-30-day heavy drinking; 14 alcohol-related harms in the past 12 months; and demographic characteristics.

Compliance with a law to reduce alcoholic beverage sales and service in Zacatecas, Mexico.

Background: Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM bar closing time and 10 PM cut-off for alcohol sales by off-premises stores.

Methods: Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law.

Association Between Statewide Opioid Prescribing Interventions and Opioid Prescribing Patterns in North Carolina, 2006-2018.

Objective: To examine the impact of three sequential statewide policy and legislative interventions on opioid prescribing practices among privately insured individuals in North Carolina.

Methods: An interrupted time series approach was used to examine level and trajectory changes of new and prevalent opioid prescription rates, days' supply, and daily morphine milligram equivalents before and after implementation of a 1) prescription drug monitoring program, 2) state medical board initiative, and 3) legislative action. Analyses were conducted using individual-level claims data from a large private health insurance provider serving North Carolina residents, ages 18-64 years, from January 2006 to August 2018.

A Comparison of Chinese Adults Who Consume Homemade versus Commercial Alcohol.

Little is known about adults in China who drink homemade alcohol, and whether they are at elevated risk of harms relative to those who drink alcohol from commercial sources. : We describe and contrast adults in China who regularly consume either homemade or commercially available alcohol, or both. : Household-based in-person interviews were conducted in 2018 with adults in Jiangshan and Lanxi.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico.

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made.

State Medical Board Policy and Opioid Prescribing: A Controlled Interrupted Time Series.

Introduction: In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy.

Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH.

Background: No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving.

Objectives: To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage.

Methods: Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use.

Alcohol Availability, Use, and Harms Among Adolescents in Three Mexican Cities.

Alcohol remains readily available to youth in most countries. We examined the associations between both the on- and off-premises commercial availability of alcohol to youth and their alcohol use, heavy episodic drinking, and alcohol-related harms. We conducted the study using data from a survey of a sample of 594 students in central Mexico between 12 and 17 years of age in 2016.

Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data.

Background: In the US, medication assisted treatment, particularly with office-based buprenorphine, has been an important component of opioid dependence treatment among patients with iatrogenic addiction to opioid analgesics. The predictors of initiating buprenorphine for addiction among opioid analgesic patients have not been well-described.

Methods: We conducted a time-to-event analysis using data from the North Carolina (NC) Prescription Drug Monitoring Program (PDMP).

Crash patterns in two Chinese secondary cities, with comparisons to crash patterns in the United States.

Evaluations of drink-driving crash interventions and crash burden in middle-income countries often rely on assumptions supported by data from the United States. We described crashes using pooled survey data across 2 Chinese agricultural cities in the 600,000 population range and then assessed comparability of selected crash characteristics to those in the United States. We conducted household interviews on drinking and related harms with representative samples of 1,500 people aged 18 and over in both Jiangshan and Lanxi, China.

Design and outcome measures for the AB InBev Global Smart Drinking Goals evaluation.

We describe the rationale for and design of an independent evaluation of the Global Smart Drinking Goals (GSDG) program. The primary purpose of this program, supported by the AB InBev Foundation, is to reduce harms associated with alcohol use by 10%. Our evaluation focuses on the effects of prevention strategies sponsored by the Foundation that are being implemented in six city pilots located in as many countries.

Health Care Utilization and Comorbidity History of North Carolina Medicaid Beneficiaries in a Controlled Substance "Lock-in" Program.

Medicaid "lock-in" programs (MLIPs) are a widely used strategy for addressing potential misuse of prescription drugs among beneficiary populations. However, little is known about the health care needs and attributes of beneficiaries selected into these programs. Our goal was to understand the characteristics of those eligible, enrolled, and retained in a state MLIP.

Associations between implementation of Project Lazarus and opioid analgesic dispensing and buprenorphine utilization in North Carolina, 2009-2014.

Background: Project Lazarus (PL) is a seven-strategy, community-coalition-based intervention designed to reduce opioid overdose and dependence. The seven strategies include: community education, provider education, hospital emergency department policy change, diversion control, support programs for patients with pain, naloxone policies, and addiction treatment expansion. PL was originally developed in Wilkes County, NC.

Trajectories of dispensed prescription opioids among beneficiaries enrolled in a Medicaid controlled substance "lock-in" program.

Purpose: "Lock-in" programs (LIPs) are used by health insurers to address potential substance (eg, opioid) misuse among beneficiaries. We sought to (1) examine heterogeneity in trajectories of dispensed opioids (in average daily morphine milligram equivalents (MMEs)) over time: prior to, during, and following release from a LIP, and (2) assess associations between trajectory patterns and beneficiary characteristics.

Methods: Medicaid claims were linked to Prescription Drug Monitoring Program records for a cohort of beneficiaries enrolled in the North Carolina Medicaid LIP (n = 2701).

Community Readiness to Prevent Opioid Overdose.

Effective community-based actions are urgently needed to combat the ongoing epidemic of opioid overdose. Community readiness (CR) has been linked to communities' support for collective action, which in turn has been associated with the success of community-wide prevention strategies and resulting behavior change. Our study, conducted in North Carolina, assessed the relationship between CR and two indices of opioid overdose.

Evaluating short- and long-term impacts of a Medicaid "lock-in" program on opioid and benzodiazepine prescriptions dispensed to beneficiaries.

Background: Insurance-based "lock-in" programs (LIPs) have become a popular strategy to address controlled substance (CS) (e.g., opioid) misuse.