Shisha (waterpipe) smoking in Palestine is a social practice shaped by gender norms. This qualitative study examines the experiences of 50 university students (28 females, 22 males) at An-Najah National University, focusing on how shisha use reflects broader negotiations of autonomy, identity, and social control. Thematic analysis identified six themes: shisha as sanctuary and escape; social surveillance and stigma; honor and shame; health discourses and double standards; peer dynamics and gendered exclusion; and agency in redefining womanhood. Female participants described shisha as a rare space for personal freedom, yet one fraught with risks of exposure, familial censure, and social punishment. Men's use, by contrast, was normalized and free from comparable sanctions. Health warnings were often used to police women's behavior more than men's. Peer groups both enabled belonging and reproduced pressures for conformity among women, while men experienced fewer social risks. The findings illustrate how shisha functions as a contested site where gender, morality, and modernity intersect. This study highlights the need for gender-sensitive approaches that address the social meanings and risks of shisha use in Palestinian society.

American Indian and Alaska Native (AI/AN) communities experienced a disproportionate increase in opioid-related fatal and non-fatal poisonings during the COVID-19 pandemic. Access to treatment, such as medications for opioid use disorder (MOUD), became even more critical, although research among this population is limited. We completed qualitative interviews with substance use disorder (SUD) treatment providers (i.e., MOUD prescribers, non-prescribing clinicians, non-clinical support staff) to assess the impact of COVID-19 on MOUD care among AI/AN adults.

This study was conducted in a descriptive and cross-sectional design to determine the physical health status of individuals with substance use disorders receiving inpatient treatment at an addiction treatment center. Data were collected between April 2023 and April 2024 at the Adult Detoxification Center of a psychiatric hospital in Istanbul, Türkiye. The sample consisted of a total of 261 individuals with substance use disorders (218 males and 43 females) who met the inclusion criteria. Data were collected using the Personal Information Form and the Health Improvement Profile. The most common physical illness among people with substance use disorders is cardiovascular disease. Significant gender-based differences were observed across multiple health domains. In the measurement subscale, women had significantly higher pulse rates compared to men. In the blood test subscale, mean total cholesterol (TC) and low-density lipoprotein (LDL) levels were also significantly higher among women. The screening subscale revealed significant gender differences in dental and eye examinations, breast self-examination, presence of constipation and/or diarrhea, as well as gastrointestinal symptoms, such as bloating, distention, or the need for laxative use. Similarly, lifestyle-related variables-including physical activity, daily alcohol and carbohydrate intake, fluid consumption, cannabis use, and engagement in safe sexual practices-differed significantly by gender. It is important to diagnose, monitor, and risk assess the physical health of individuals with substance use disorders. Therefore, mental health and psychiatric nurses should emphasize physical diagnosis and provide a holistic approach to individuals with substance use disorders.

Preoperative drug screening is not routinely performed in Palestine, which poses challenges for medical management, especially during anesthesia for surgical procedures. We aimed to determine the prevalence and types of illicit drugs through preoperative screening of patients undergoing elective surgeries and to compare these findings with self-reported drug use. A cross-sectional study was conducted in 2024 in the surgical departments of two tertiary hospitals. The study involved 236 participants aged 16-55 years from hospitals in the West Bank, who were interviewed about their drug use history and screened using a multidrug rapid test panel (12 drugs). Informed and parental consent were obtained, and assent was secured from participants under 18 years. Of the 224 participants who agreed to urine testing, 13.4% tested positive for at least one drug: benzodiazepines (3.6%), THC (3.1%), tramadol (2.7%), morphine (2.2%), ketamine (1.8%), and MDMA (0.4%). Cocaine, barbiturates, amphetamine, synthetic cannabinoids, and TCA tested negative in all samples. Additionally, 1.3% were users of multiple drugs. Furthermore, 7.6% reported current illicit drug use, and 3.8% were ex-users. Among those who self-reported illicit drug use, 41.2% tested positive for at least one drug, while 58.8% tested negative. Among participants who did not report illicit drug use, 10.6% tested positive. The study highlights significant discrepancies between urine screening results and self-reports, indicating high illicit drug use among surgical patients. Comprehensive preoperative screening, including interviews and urine tests, is essential for ensuring patient safety.

Cocaine seizures in Malaysia suggest that it is being used as a transit point to ship the drug to other destinations. Traces of cocaine found in a wastewater study are the only indirect evidence of its use within the country. This study is the first to present a comprehensive and detailed evidence of cocaine use in Malaysia, albeit based on a small sample of users. The context and motives for use, and the sources of supply are discussed. Sixteen respondents who self-reported using cocaine were recruited through key informants and interviewed a virtual platform after informed consent was elicited. Cocaine (a.k.a. ) is used occasionally as a stimulant "party drug" by professionals, primarily to remain alert and focused while socializing, and to enable greater tolerance of alcohol and to experience higher euphoria. Although sold at exorbitant prices, it can be easily obtained through trusted close contacts. To avoid detection, cocaine is used privately at home-based parties and selected pubs with a small group of friends. Cocaine in the form of a white powder is usually snorted irregularly at intervals of thirty minutes to an hour. The consumption of cocaine was not associated with dependence, withdrawal, or adverse health effects in the sample. Further studies are needed to understand the context of cocaine use, its trafficking route, and associated health issues to enable constructive intervention.

Betel quid chewing poses significant public health risks across a range of countries from South to Southeast Asia, particularly in India. We aimed to identify factors influencing betel quid dependence (BQD) among consumers in a rural area of Southern India. A secondary aim was to find out which of the two instruments namely the Motivation to Stop Scale(MTSS), and Stages of Change Behavior scale was a better predictor of BQD among current betel quid users. 400 adult betel quid users were surveyed using the scales. We found that most of the participants were dependent on betel quid. BQD Scale scores increased with the participant's age and the frequency of daily betel quid chewing and decreased with increasing educational attainment, being in the precontemplation stage, and having better self-perceived oral health status. Significant associations were observed between sociodemographic, behavioral, or psychosocial factors and betel quid dependence and the 'Stages of Change' model emerged as a useful predictor of dependency levels, more so than the MTSS scale, indicating its potential application in tailoring cessation interventions.

Drug abuse is a pressing global public health issue. In the West Bank, Palestine, societal stigma around substance use obstructs open conversations and precise evaluations, underscoring the importance of a thorough assessment of drug users in rehabilitation facilities. This study aimed to explore the epidemiology of drug abuse among Palestinian patients in rehabilitation centers and the treatment modalities employed. The study examined 1,141 medical files of patients aged 14-73 years from two rehabilitation centers, covering the period from 2014 to 2023. The majority (73.67%) were young adults (18-39 years), tobacco smokers (97.3%), and alcohol users (44.3%). Additionally, 8.2% of patients were diagnosed with various infections, primarily hepatitis C. Most patients sought treatment voluntarily, with 78.2% entering the centers through self-referral. The most commonly detected substances in the urine samples were cannabis (35.2%), morphine (38.8%), benzodiazepines (32.8%), and ecstasy (21%). Furthermore, 35.37% of patients were prescribed carbamazepine, while 30.71% received methadone, with 61.3% struggling to adhere to their prescribed regimens. The relapse rate was high (82.5%), with 6.2% of patients experiencing three or more relapses. The key factors contributing to relapse included peer influence and withdrawal symptoms. The analysis of treatment modalities employed highlighted a comprehensive integration of pharmacotherapy, psychotherapy, and social support systems, emphasizing a holistic approach to recovery. The insights derived from this study aim to inform policymakers and healthcare providers about the specific needs of drug users in rehabilitation, ultimately contributing to the enhancement of treatment strategies and public health initiatives in the region.

This relational survey study aims to examine the relationship between attachment styles, coping styles, and psychological resilience levels in adults seeking treatment for alcohol and substance use disorders. The study was conducted with 208 individuals who applied for treatment at an Alcohol and Substance Addiction Research, Treatment, and Education Center in Türkiye. Data were collected by a personal information form, the Three-Dimensional Attachment Styles Scale, the Connor-Davidson Psychological Resilience Scale-Short Form, and the Coping with Stress Inventory. Percentages and means, student -tests, ANOVA, correlation, and regression analyses were used in the analysis of data. According to the research findings, it was determined that individuals had high secure and anxious attachment scores, and moderate avoidant attachment scores. In addition, it was determined that the participants had moderate psychological resilience, but their ineffective coping with stress scores were high. A positive and significant relationship was found between secure attachment and psychological resilience in individuals with alcohol and substance use disorders. Similarly, a positive significant relationship was found between secure attachment and effectively coping with stress. Finally, it was determined that the most important variables predicting ineffective coping with stress were family relationships, psychological resilience, and avoidant attachment. Based on these findings, it can be said that improving family relationships, increasing psychological resilience, and educating and supporting parents to establish secure attachment relationships can be beneficial in order to protect individuals from substance abuse.

The COVID-19 pandemic may have had many negative consequences, and yet a lot was left in its wake that could help shape mental health discussions in health care settings in Canada. This paper is shaped by stories told by Filipino nurses working in Northern Ontario. While there is a plethora of studies looking at mental health issues among nurses and other health care professionals in Canadian hospitals, a gap still remains in regard to the experiences of nurses and health care workers in Northern Ontario during COVID-19. This study seeks to look at the differentiated experiences of mental health among health care professionals during and after COVID-19. This qualitative study employs a narrative approach to discuss how neoliberal capitalism, gendered racism, substance use and colonialism shaped mental health outcomes among Filipino health care workers. While many studies have focused on mental health issues among health care providers, there has been minimal focus on race-based trauma and the ways in which substance use is employed to reduce mental health issues to an individual issue, leaving pharmaceutical companies free to boost their profits. This paper employs intersectional analysis to argue for a more comprehensive understanding of mental health issues among health care workers and allow an understanding of a culturally informed perspective to inform health care policies. The result to the study depicts the various forms of race-based trauma faced by Filipino health care workers and the use of over-the-counter medication to navigate themselves through the health care system. Note that the paper will employ the term healthcare workers and nurses interchangeably.

Smokeless tobacco use represents a significant public health concern globally, yet comprehensive prevalence data across West Asian populations remain limited. This systematic review and meta-analysis estimated the pooled prevalence of smokeless tobacco use in West Asian countries across age groups and geographic regions. A systematic literature search was conducted across databases from inception to May 2025. Studies reporting prevalence data on smokeless tobacco use in West Asian countries were included. Heterogeneity was assessed using statistics, with subgroup analyses by age and country. Publication bias was evaluated using funnel plots. Meta-analysis was performed using CMA version 3.0 with statistical significance level less than 0.05. Out of 745 fount studies, 22 studies across 11 West Asian countries were included in the meta--analysis. The overall pooled prevalence of smokeless tobacco use was 16% (95% CI: 12%, 21%) with significant heterogeneity (=99.90%,  < 0.001). Age-specific analysis revealed a prevalence of 15% (95% CI: 12%, 18%) among adolescents and 18% (95% CI: 6%, 29%) among adults. Country-specific prevalence varied substantially, ranging from 6% in Iraq to 34% in Lebanon. Saudi Arabia demonstrated the most extreme variation (1%-86%), largely attributed to one outlier study. Funnel plot analysis suggested potential publication bias, though sensitivity analyses confirmed the robustness of pooled estimates. Smokeless tobacco use affects approximately one in six individuals across West Asian populations, with considerable geographic and methodological variation. The substantial heterogeneity observed emphasizes the need for country--specific tobacco control strategies and standardized surveillance methods.

Mental health in Kashmir presents an alarming picture, with reports indicating that nearly 45% of the population experiences psychological distress. This research is undertaken to explore the mental health landscape of Kashmir's youth through Petraitis et al.'s (1995) theoretical framework which investigates various types of risk across various levels. To achieve this objective, themes were generated from in-depth interviews with the relevant stakeholders which were juxtaposed into this existing theoretical framework. Findings showed that while some risk factors are universal, yet Kashmir's transitioning into modernity poses unique mental health challenges. The implication of this study is that there is a need for adapting mental-health modalities through both top-down approaches (that is, culturally-adapting the existing therapeutic modalities) and bottom-up approaches (that is, making tradition palatable to modern sensibilities) in order to improve the mental health landscape of Kashmir.

Female smoking in many Arab countries has historically encountered strong cultural prohibitions, yet evidence suggests growing acceptance under conditions of urbanization and shifting gender norms. This study examines attitudes toward female smoking among individuals affiliated with Palestinian universities through semi-structured Zoom interviews with 50 participants (23 men, 27 women) from universities in the West Bank and Gaza Strip. Using qualitative thematic analysis, we identified six superordinate themes: cultural shifts, family relations, health and psychological factors, religious and moral debates, media portrayals, and pathways toward support. Findings reveal that younger urban women often perceive waterpipe smoking as more socially permissible than cigarettes, whereas more traditional views persist even within academic communities. Participants noted that family tensions, persistent double standards, and concerns about "honor" sometimes lead women to smoke covertly. They also highlighted the need for empathy-based interventions that address both social stigma and mental health challenges. This study enriches regional literature on female smoking by demonstrating how tobacco use can function as a coping mechanism and a contested emblem of autonomy among university communities in Palestine.

This study aims to examine the prevalence of behavioral health problems among Asian American offenders and identify potential risk factors. Findings suggest that Asian American offenders scored higher in psychological distress than Hispanic offenders. They had lower rates of alcohol and drug dependence than white offenders but a higher rate of drug dependence than black and Hispanic offenders. Regression analyses suggest that parental incarceration was associated with higher levels of psychological distress and higher odds of alcohol dependence. Moreover, psychological distress was related to higher odds of alcohol dependence, and drug-related incarceration was associated with higher odds of drug dependence.

Substance use disorder (SUDs) is a currently important public health problem. Attachment styles and codependency are critical aspects to consider in understanding and addressing SUDs. This cross-sectional study aimed to examine the relation attachment style and codependency and affecting factors among individuals with substance use disorders in Eastern Turkey. Using purposive sampling method, 232 individuals with SUDs enrolled in Alcohol and Substance Addiction Treatment Center at Van located in eastern Turkey between June- August 2023. The Adult Attachment Style Scale and the Spann-Fischer Codependency Scale were used. Descriptive measures were used for analysis and Independent Samples T-test and Pearson's correlation coefficient for inferential analysis. Lastly, a multiple linear regression model was run to determine significant predictors of codependency. Variables significantly correlated with participants' attachment style included kind of substances, marital status. Participants' codependency was correlated with having children. There was a weak positive correlation between avoidant attachment style and codependency. A moderate positive correlation was found between anxious/ambivalent attachment style and codependency. Variables significantly correlated with participants' attachment style included kind of substances, marital status. Participants' codependency was correlated with having children. Through the analysis of multiple linear regression, it came to light that significant predictors of codependency in the final model could account for 24.1% of the variance in codependency. The results of the current study provide insight into the relations between substance use, attachment, and codependency. The results are useful for the treatment team in developing a care and treatment plan for individuals with SUDs.

The COVID-19 pandemic has caused a devastating increase in morbidity and mortality; however there is limited understanding of the continued toll of COVID-19 on mental health, opioid and alcohol related deaths.

This study aims to determine the self-stigma of individuals with alcohol dependence in Turkey. In this study, a qualitative research approach and content analysis were used. Also, the phenomenological design was implemented, which is one of the qualitative research approaches. The study group of the research consisted of 37 alcohol-dependent individuals receiving inpatient treatment in an addiction treatment center (AMATEM) in Turkey. The data for this study were collected between January 14 and May 22, 2020. Two main themes emerged: 1) Opinions of Alcohol-Dependent Individuals on Themselves 2) Opinions of Society on Alcohol-Dependent Individuals. Also, seven sub-themes emerged regarding these themes. This study determined the self-stigmatization of alcohol-dependent individuals, their regrets, and the effect of culture and Islamic religion on self-stigmatization. At the research, alcohol-dependent individuals stated that they stigmatized, despised, and loathed themselves and alcohol consumers in general. In line with these results, combatting against social stigma toward alcohol-dependent individuals and providing the individuals stigmatizing themselves (self-stigma) or addicted to alcohol with training on alcohol dependence and stigma prevention are recommended.

College students indicate high use of alcohol and marijuana; cultural influences may affect substance use. This study assessed the associations between alcohol and marijuana past 30-day use, and microaggressions, acculturation, and familism among Latinx college students. Participants ( = 484) completed measures, and structural equation modeling was used to yield results. Findings suggested that microaggressions were a risk factor for alcohol use, ( = -1.29, = .007) while acculturation was a risk factor for marijuana use ( = 1.06, = .011). No other statistically significant associations with alcohol or marijuana past 30-day use were observed. Culturally based prevention and intervention efforts appear warranted.

This study examined current mental health practices in methadone treatment in Vietnam. We conducted 23 interviews with participants with methadone experiences ( = 12), methadone physicians ( = 6), counselors ( = 5), and one focus group with family members. Mental health issues were primarily identified through casual observation, on-site support was limited, and referrals to psychiatric care were rarely pursued. Four factors shaped this situation: (1) a strained patient-provider relationship; (2) an inadequately trained, unstable, unmotivated workforce; (3) participants' financial constraints; and (4) mental health stigma and misconception. Addressing system-level factors to enforce treatment guidelines and improve provider working conditions is critical to improving care quality.

The aim of this study was to assess the effects of expressive writing on drug craving and symptoms of anxiety and depression among Chinese patients experiencing community-based drug use disorder rehabilitation. It was a multicenter, single-blind, randomized controlled trial. A total of 153 participants were recruited and provided with a 4-week intervention. They were randomly assigned to two groups: apart from routine community rehabilitation, one received expressive writing intervention (trial group) and the other received traditional psychological counseling (control group). Data were collected at baseline and after the intervention, while statistical analysis was performed by SPSS 23.0 software. After the 4-week intervention, endpoint scores of anxiety, depression, and drug craving were significantly lower in the trial group than in the control group ( < 0.05). In addition, reductions in anxiety, depression, and drug craving scores were greater in the trial group compared to the control group during the intervention ( < 0.001). Therefore, expressive writing was a safe, noninvasive, effective, and replicable therapeutic approach that worked well in alleviating the psychosocial dilemmas and mental stress of people who misuse drugs in the process of community-based detoxification, relapse prevention, and resocialization.

Studies of high-risk digital media use often treat youth in the United States as a monolith. Here, we present results from an online survey study of 489 U.S. youth (aged 13-23) assessing relationships between drug-related online content exposure and drug use based on racial/ethnic identity. Regression models identified racial/ethnic differences in drug-related content exposure and interaction terms examined whether relationships of interest changed based on racial/ethnic identity. Racial/ethnic (RE)-minority youth had significantly higher odds of frequent exposure to drug-related content online and significant correlations between drug use and content exposure were seen among select populations of RE-minority youth. Assessments of drug-related digital media habits should be considered instrumental to understanding rising rates of drug use within U.S. RE-minority populations.

Tobacco use represents a public health concern in the United States. This study aimed to determine whether the association between sexual identity and tobacco use varied across race/ethnicity groups among U.S. high school students. Data from the Centers for Disease Control and Prevention's 2019 Youth Behavior Risk Survey ( = 13,677) were analyzed using bivariate cross-tabulations and adjusted multivariate logistic regression models with interaction terms. A significant interaction was found between sexual identity and race/ethnicity for current electronic vapor, cigar, and smokeless tobacco use. Sexual identity was most strongly associated with electronic vapor use among Black or African American youth as well as Hispanic or Latino youth and most strongly associated with cigar and smokeless tobacco use among Asian, Native Hawaiian, or Pacific Islander youth. The findings highlight the challenges faced by LGBQ () students of color and the need for culturally tailored interventions for youth with multiply marginalized backgrounds.