This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.

Purpose – The purpose of this paper is to investigate the behaviors of India’s information technology (IT) and business process outsourcing (BPO) employees in relation to diet, exercise, sleep, stress, and social habits. Design/methodology/approach – This was a qualitative research study, using in-depth, semi-structured interviews. Descriptive data were collected from a two-stage purposive sample of 28 IT-BPO employees from three IT companies and two BPOs in Bangalore, India. Findings – The majority of interviewees reported having an unhealthy diet and/or sedentary lifestyle. Lack of time due to demanding work schedules was the largest barrier to diet and exercise. Call-centers were described as a social environment with a young workforce. Research limitations/implications – Given the qualitative study design and limited sampling frame, results may not be generalizable. However, the qualitative data suggests that India’s young IT-BPO employees may be at greater risk of lifestyle-related diseases than the general population. The data also suggests that interventions incorporating social influence may be a promising solution, particularly at international call centers. Originality/value – There is a lack of literature on the lifestyle of IT-BPO employees in India. The results from this study provide qualitative insight on the motives for health behaviors of IT-BPO employees, as well as the barriers and facilitators for leading a healthy lifestyle in this industry. The findings provide the framework for future workplace wellness interventions.

Objectives Nearly 95% of women with opioid use disorder continue to smoke cigarettes during pregnancy. Despite this prevalence and the well-documented adverse effects of smoking on birth outcomes, cigarette smoking is under-addressed in this population. This study examines factors associated with successful smoking reduction among pregnant women with opioid use disorder and the impact of smoking reduction on maternal and birth outcomes. Methods This study is a secondary data analysis of maternal smoking reduction and infant birth outcomes among pregnant women with opioid use disorder (N=118) enrolled in a randomized controlled trial of a contingency management intervention in which escalating monetary vouchers were provided to women who met escalating smoking reduction targets. Results Participants’ ability to meet higher smoking reduction targets was associated with less cocaine use at baseline (p=0.022), higher carbon monoxide levels at baseline (p=0.039), fewer prior quit attempts (p=0.016), participation in the contingency management intervention, and greater adherence with the parent trial protocol. Some clinically relevant associations were found between smoking reduction and birth outcomes, including birth weight, spontaneous abortions, and neonatal abstinence syndrome treatment, but these differences did not reach statistical significance. Conclusions Contingency management promotes smoking reduction, but other factors may be associated with such reduction, including baseline smoking and illicit drug use, prior quit attempts, and willingness to participate in the incentives program. Clinicians caring for pregnant women with opioid use disorder may see greater smoking behavior change if they first encourage smoking reduction before recommending smoking cessation. Future research is needed to determine the level of smoking reduction needed to positively impact birth outcomes.