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Journal of Addiction Medicine and Therapy

Addiction and Psychological Distress among University Students in Lebanon: The Moderating Effect of Gender

Research Article | Open Access

  • 0. The Lebanese National Conference on Health in University research group also includes: Jomaa L, Issa C, Farhat G, Zeghondi H, Gerges N, Sabbagh MT, Saleh N, and Chaaya M.
  • 1. Clinical & Epidemiological Research Laboratory, Lebanese University, Lebanon
  • 2. Charité – Universitätsmedizin University Hospital, Germany
  • 3. Pulmonology department, Balamand University, Lebanon
  • 4. Faculty of Public Health, Lebanese University, Lebanon
  • 5. Laboratoire Santé Travail Environnement, Université Bordeaux Segalen, France
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Corresponding Authors
Pascale Salameh, Clinical & Epidomological Research Laboratory, Lebanese University, Jdeidet El Meten, Chalet Suisse street, Ramza Azzam bldg, 5th floor, Beirut, Lebanon, Tel: 009613385542; Fax: 009611696600
RESULTS

Sample description

Among 3384 university students, there were significantly more bachelor boys (98.1%) than girls (95.1%). Girls were more likely to pursue health studies, humanities and laws, while boys were more likely to study in the fields of business, sciences and computer (p<0.001). There were more boys in private universities (63%) than girls (43.9%); boys were also more likely to come from higher socioeconomic levels (p<0.001). There was no significant difference in their region of living, whilst there was a statistically significant difference with respect to age, boys being slightly older than girls (20.83 versus 20.53; p<0.001) (Table 1).

Psychological distress, substance addiction and dependence among ever users

There were significant differences between boys and girls for all type of addiction and dependence (p<0.001), except for waterpipe dependence (p=0.11): boys were more likely to demonstrate all types of substance addiction and dependence, except for waterpipe that was equally found among boys and girls (Table 2).

Association between psychological distress and addiction types

Among total users, there was a consistent relationship between psychological distress and addiction types; individuals with psychological distress were significantly more likely to show all kinds of substance addiction and dependence (p<0.001). The same applies to boys, while among girls, this relationship was not found concerning smoking addiction measured via ASSIST smoking subscale (p=0.20). An interaction of psychological with sex was thus suspected for association with smoking addiction (Table 3).

Multivariate analyses of addiction and dependence types

Higher psychological distress positively increased all types of substances addiction and dependence, except for waterpipe dependence that was not shown to be associated with psychological distress in multivariate analysis (Table 4). Moreover, performing separate multivariate analyses for boys and girls regarding smoking addiction using the ASSIST smoking subscale showed similar results: psychological distress increased the risk of smoking addiction for both boys and girls, with similar effect of confounding variables. Thus, psychological distress is considered a consistent associate of all types of substances addiction and dependence, except for waterpipe dependence.

Moreover, when further analyzing the subscales of waterpipe dependence and their relationship with psychological distress, we found that psychological distress was neither associated with physiological nicotine dependence related to waterpipe smoking, nor with psychological craving, nor with its positive reinforcement; as expected, a small but significant relationship was found (adjusted beta=0.02; p=0.001) with waterpipe related negative reinforcement (results not shown).

Table 1: Socio-demographic characteristics of the study sample.

Characteristic Boys n=1399(41.3%) Girls n=1980(58.5%) p-value Total n=3384(100%)
Marital status
Married/widow/divorced
Bachelor
27(2.0%)
1368(98.1%)
96(4.9%)
1874(95.1%)
<0.001 123
3242
Field of studies
Sciences & computer
Health sciences
Humanities & Laws
Business & Economy
Engineering
Arts
257(18.6%)
169(12.2%)
173(12.5%)
475(34.3%)
218(15.8%)
92(6.6%)
253(12.8%)
583(29.5%)
552(28.0%)
403(20.4%)
56(2.8%)
126(6.4%)
<0.001  510
752
725
878
274
218
Public University
Private Universities
518(37.0%)
881(63.0%)
1111(56.1%)
869(43.9%)
<0.001 1629
1750
Lives outside Beirut
Lives in Beirut
1164(83.2%)
235(16.8%)
1691(85.4%)
289(14.6%)
0.082 2855
524
Socioeconomic status quartile
Quartile one
Quartile two
Quartile three
Quartile four

 

272(21.1%)
255(19.8%)
392(30.5%)
368(28.6%)

 

646(35.6%)
383(21.1%)
461(25.4%)
323(17.8%)

<0.001

 

918
638
853
691

Age in years M(SD) 20.83(2.01) 20.53(1.85) <0.001 3384

Table 2: Psychological distress, substance addiction and dependence among ever users.

Characteristic N; Mean (SD) Boys n=1399(41.3%) Girls n=1980(58.5%) p-value Total n=3384
Psychological Distress (BDS22) 1141; 16.34(12.97) 1694; 19.48(14.27) <0.001 2837; 18.21(13.84)
Waterpipe dependence (LWDS11) 394; 10.42(6.24) 397; 9.73(5.83) 0.110 791; 10.07(6.04)
Cigarette dependence (YACD) 443; 14.22(5.95) 162; 12.72(5.98 0.006 605; 13.82(5.99)
Total ASSIST score 484; 3.75(9.29) 674; 1.14(2.87) <0.001 1159; 2.23(6.52)
Tranquilizers ASSIST 866; 1.04(4.80) 1305; 0.58(3.09) 0.007 2173; 0.77(3.87)
Smoking ASSIST 1202; 12.57(11.56) 1560; 5.77(8.95) <0.001 2766; 8.72(10.71)
Alcohol ASSIST 1241; 8.67(8.61) 1731; 3.75(5.80) <0.001 2975; 5.80(7.51)

 

DISCUSSION

In this study, we found consistent relationships between psychological distress and all types of addictions and dependences, except for waterpipe dependence: while boys were statistically more likely than girls to present substance addiction and dependence (p<0.001), a higher psychological distress was associated with higher risk to present these disorders (p<0.001), among both boys and girls and in both bivariate and multivariate analyses. Similar results to ours were found by other researchers in international studies: [6-8], Tavolacci MP, Hagman and Pickard. All have shown that psychologically distressed individuals were more likely to become addicted to substances, while Pickard even argued that drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems [2012].

Sex was not considered to be a moderator of the association between psychological distress and addiction. However, we found that boys were more likely to be substance users, dependent and addicted [21,22], while they were less likely to declare psychological distress when compared with girls, as in other publications [23,24]. Other factors than psychological distress could thus explain different types of addiction. In fact, adjustment variables in multivariate analyses showed that social variables were of primary importance: higher socioeconomic level, studying in a private university, and living or working with other smokers increased the risk of substance dependence. This has been shown in the literature [25,26], and in analyses related to this population sample [14] or other samples of university students in Lebanon [18].

The exception was that waterpipe dependence was not associated with psychological distress (p>0.05) in multivariate analysis; only older age could increase the risk of waterpipe dependence. This could be explained by the recreational use of waterpipe that becomes more accessible with age, and its high acceptability and social normality [27]. This behavior was shown to be related to several factors such as positive reinforcement (smoking for pleasure and smoking to please others), physiological nicotine dependence, and psychological craving that were not related with psychological distress in our sample. Only a small but significant relationship was found between psychological distress and negative reinforcement related to waterpipe, but this was not enough to demonstrate a significant effect at the level of global waterpipe dependence in multivariate analysis. Additional insight into this relationship is necessary with future studies.

Moreover, several methodological points deserve to be discussed: our study being of cross-sectional nature, no cause effect relationships could be concluded about the relationships we found. In addition, although our sample is drawn from all universities in Lebanon, a selection bias could not be excluded due to the sampling nature and response rate of participants. Finally, an information bias is also possible since we relied on participants’ answers for substance consumption and psychological distress assessment. However, we are confident that this bias is of non differential nature, and would only drive the results towards the null. Nevertheless, additional studies would be required to confirm our results

Table 3: Association between psychological distress and addiction and dependence types.

Addiction and dependence type - Mean(SD) Psychological distress No psychological distress p-value
                           Total users  
Waterpipe dependence (LWDS11) 10.99(5.96) 9.14(5.71) <0.001
Cigarette dependence (YACD) 15.33(5.81) 12.70(6.02) <0.001
Total ASSIST score 2.90(7.73) 1.52(4.29) <0.001
Tranquilizers ASSIST 1.31(4.99) 0.20(2.17) <0.001
Smoking ASSIST 9.19(10.81) 7.60(9.84) <0.001
Alcohol ASSIST 6.42(7.95) 5.21(6.82) <0.001
                                   Boys  
Waterpipe dependence (LWDS11) 11.55(6.21) 9.59(6.04) 0.004
Cigarette dependence (YACD) 15.86(5.38) 13.32(6.26) <0.001
Total ASSIST score 5.63(11.55) 2.23(5.73) <0.001
Tranquilizers ASSIST 2.06(6.58 0.22(2.37) <0.001
Smoking ASSIST 14.87(11.60) 10.36(10.60) <0.001
Alcohol ASSIST 10.56(9.07) 7.50(7.67) <0.001
                                   Girls  
Waterpipe dependence (LWDS11) 10.51(5.71) 8.54(5.22) 0.002
Cigarette dependence (YACD) 14.13(6.53) 10.50(4.47) 0.001
Total ASSIST score 1.35(3.39) 0.86(2.07) 0.032
Tranquilizers ASSIST 0.89(3.78) 0.20(1.99) <0.001
Smoking ASSIST 5.71(8.62) 5.12(8.37) 0.202
Alcohol ASSIST 4.02(6.05) 3.23(5.24) 0.007

Table 4: Multivariate analyses of addiction and dependence types.

Variables* Beta Adjusted 95% CI p-value Adjusted R² Standardized beta
        0.118  
Smokers at work
Higher psychological distress score
Weekly sport frequency
3.69
0.07
0.88
2.19;5.18
0.03;0.11
0.25;1.51
<0.001
0.002
0.006
  0.263
0.172
0.146
  Waterpipe dependence (LWDS)     0.007  
Higher Age 0.10 0.001;0.20 0.047   0.10
                    Total ASSIST     0.122  
Female sex
Higher psychological distress score
Work smokers
Living in Beirut
Weekly sport frequency
Higher socioeconomic level
-2.81
0.10
1.61
2.75
0.59
0.45
-3.74;-1.87
0.06;0.13
0.69;2.52
1.21;4.28
0.14;1.05
0.05;0.84
<0.001
<0.001
0.001
<0.001
0.011
0.028
  0.20
0.19
0.12
0.12
0.09
0.07
    ASSIST alcohol dependence     0.202  
Female sex
Private university
Work smokers
Higher socioeconomic level
Higher age
Higher psychological distress score
Living in Beirut
Home smokers
-3.90
2.24
2.27
0.98
-0.79
0.03
-1.40
0.88
-4.58;-3.22
1.56;2.93
1.61;2.94
0.68;1.29
-1.21;-0.38
0.01;0.06
-2.41;-0.40
0.19;1.58
<0.001
<0.001
<0.001
<0.001
<0.001
0.004
0.006
0.013
  0.26
0.15
0.15
0.15
-0.08
0.06
-0.06
0.06
ASSIST tranquilizers dependence     0.048  
Higher psychological distress score
Higher socioeconomic level
Weekly sport frequency
Declared good health
Work smokers
0.04
0.28
0.30
-0.48
0.41
0.03;0.05
0.12;0.44
0.12;0.47
-0.87;-0.10
0.04;0.77
<0.001
0.001
0.001
0.013
0.028
  0.16
0.09
0.09
-0.07
0.06
ASSIST Smoking among boys     0.155  
Higher psychological distress score
Home smokers
Work smokers
Higher socioeconomic level
Health studies
Private university
0.22
4.81
3.96
1.35
-3.22
1.76
0.16;0.29
2.87;6.74
2.05;5.86
0.53;2.17
-5.93;0.52
0.01;3.52
<0.001
<0.001
<0.001
0.001
0.019
0.049
  0.24
0.18
0.15
0.12
-0.09
0.08
ASSIST Smoking among girls     0.123  
Work smokers
Private University
Home smokers
Higher psychological distress score
Health studies
Higher socioeconomic level
3.05
2.63
2.90
0.06
-1.86
0.63
1.94;4.17
1.45;3.81
1.73;4.08
0.02;0.10
-3.04;-0.68
0.11;1.14
<0.001
<0.001
<0.001
0.001
0.002
0.017
  0.18
0.15
0.16
0.10
-0.10
0.08

* Adjustment was made upon: private university, sex, marital status, living in Beirut, socioeconomic status, health studies, age, declared good health, frequency of sports per week, having at least one smoker at work, and having at least one smoker at work.

CONCLUSION

University students with psychological distress are considered a high risk group for addiction and dependence; public health efforts should be particularly directed towards this subgroup to decrease their health risk behaviors and prevent further deleterious consequences.

REFERENCES

1. Salameh P, Barbour B. Psychological distress in Lebanese young adults: Construction and validation of the BDS-22 scale. International Journal of Culture and Mental health. 2011; 1-15.

2. Keil RM. Coping and stress: a conceptual analysis. J Adv Nurs. 2004; 45: 659-665.

3. Mc Carron P, Gunnell D, Harrison GL, Okasha M, Davey Smith G. Temperament in young adulthood and later mortality: Prospective observational study. Journal of Epidemiology & Community Health. 2003; 57: 888-892.

4. Massé R, Poulin C, Dassa C, Lambert J, Bélair S, Battaglini A. Elaboration et validation d’un outil de mesure de la de´tresse psychologique dans une population non clinique de Québécois francophone [Results of the construct and criterion validation of the Psychological Distress Manifestations Measure Scale (PDMMS) is a general population). Canadian Review of Public Health. 1998; 89:183-189.

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6. Tavolacci MP, Ladner J, Grigioni S, Richard L, Villet H, Dechelotte P. Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 2009–2011. BMC Public Health. 2013; 13: 724.

7. Hagman BT, Delnevo CD, Hrywna M, Williams JM. Tobacco use among those with serious psychological distress: results from the national survey of drug use and health, 2002. Addict Behav. 2008; 33: 582-592

8. Pickard H. The Purpose in Chronic Addiction. AJOB Neurosci. 2012; 3: 40-49.

9. Asbridge M, Payne E, Cartwright J, Mann R. Driving under the influence of alcohol: examining ethno-specific rates and the mediating effects of psychological distress and harmful and problematic drinking. Accid Anal Prev. 2010; 42: 1408-1415.

10. Grusser SM, Morsen CP, Wolfling K, Flor H. The relationship of stress, coping, effect expectancies and craving. Eur Addict Res. 2007; 13: 31- 38.

11. Landheim AS, Bakken K, Vaglum P. Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry. 2006; 6: 44.

12. Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A. Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend. 2005; 77: 251-258.

13. de Jesus Mari J, Tófoli LF, Noto C, Li LM, Diehl A, Claudino AM, et al. Pharmacological and psychosocial management of mental, neurological and substance use disorders in low- and middle-income countries: issues and current strategies. Drugs. 2013; 73: 1549-1568.

14. Salameh P, Salamé J, Waked M, Barbour B, Zeidan N, Baldi I. Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMJ Open. 2014; 4: e004378.

15. Center for Educational research and Development, Beirut, Lebanon. [List of Universities in Lebanon].

16. Salameh P, Jomaa L, Issa C, Farhat G, Zeghondi H, Gerges N, Sabbagh MT, et al. The Lebanese National Conference for Health in University (LNCHU) study group. Assessment of health risk behaviours among university students: a cross-sectional study in Lebanon. International Journal of Adolescence and Youth. 2012; 1-14.

17. World Health Organization. Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and Pilot Brief Intervention: A Technical Report of Phase II Findings of the WHO ASSIST Project. 2003.

18. Salameh P, Jomaa L, Farhat G, Zeghondi H, Gerges N, Issa C, et al. The Lebanese National Conference for Health in Universities study group. The Young Adults’ Cigarette Dependence (YACD) Score: An improved tool for cigarette dependence assessment in university students. Addictive Behaviors. 2013; 38: 2174-2179.

19. Salameh P, Waked M, Aoun Z. Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11). Nicotine Tob Res. 2008; 10: 149-158.

20. Salameh P, Rachidi S, Al-Hajje A, Awada S, Chouaib K, Saleh N, et al. Consumption of psychoactive substances among Lebanese university students: prevalence, associated and protective factors. Eastern Mediterranean Health Journal. 2013.

21. Fouad H, Awa FE, Naga RA, Emam AH, Labib S, Palipudi KM, et al. Prevalence of tobacco use among adults in Egypt, 2009. Glob Health Promot. 2013;.

22. Osuch E, Vingilis E, Ross E, Forster C, Summerhurst C. Cannabis use, addiction risk and functional impairment in youth seeking treatment for primary mood or anxiety concerns. Int J Adolesc Med Health. 2013; 25: 309-314.

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25. Studer J, Baggio S, Deline S, N’goran AA, Henchoz Y, Mohler-Kuo M,et al. Peer pressure and alcohol use in young men: A mediation analysis of drinking motives. Int J Drug Policy. 2014.

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Abstract

Introduction: Psychological distress and addictive behaviors are both common in Lebanon. Although girls are more subject to distress, boys are known to be more prone to addictive behaviors. The objective of the article was to assess the relationship between psychological distress and addictive behaviors, looking particularly at differences between boys and girls among university students.

Methods: A cross-sectional study was conducted among university students from all universities in Lebanon. Addiction to alcohol, cigarettes, and tranquilizers were evaluated according to the ASSIST total scale and subscales, while waterpipe dependence, cigarette dependence and psychological distress were measured using the Lebanese Waterpipe Dependence Scale (LWDS11), Young Adult Cigarette Dependence (YACD) scale and the Beirut Distress Scale (BDS22), respectively. The moderating effect of gender was particularly analyzed.

Results: While boys were statistically more likely than girls to present substance addiction and dependence (p<0.001), , a higher psychological distress was associated with higher risk to present these disorders (p<0.001), among both boys and girls and in both bivariate and multivariate analyses. Sex was not considered to be a moderator of the association between psychological distress and addiction. One exception was waterpipe dependence that was not associated with psychological distress(p0.05) in multivariate analysis.

Conclusion: University students of both sexes with psychological distress should be considered a high risk group for addiction and dependence; public health efforts should be particularly directed towards this subgroup to decrease their health risk behaviors and prevent further deleterious consequences.

Citation

Salameh P, Salamé J, Waked M, Barbour B, Zeidan N, et al. (2015) Addiction and Psychological Distress among University Students in Lebanon: The Moderating Effect of Gender. J Addict Med Ther 3(1): 1010.

Keywords

• University students
• Substance
• Addiction
• Dependence
• Psychological distress

INTRODUCTION

Psychological distress is highly prevalent among university students in Lebanon [1]; it has also long been known to be associated with physical and mental health problems [2], and even to high mortality rates [3]. According to Massé et al., psychological distress may be manifested by changes from a stable emotional state to anxiety, depression, demotivation, irritability, aggressiveness and self depreciation [4,5].

Moreover, in other regions of the world, psychological distress was shown to be associated with substance addiction and all its deleterious consequences, including alcohol and other substances [6-9]. Furthermore, stress has been shown to increase craving in substance abusers [10], while co-morbidity and co-treatment of both psychiatric and substance abuse disorders are well known and recommended, respectively [11,12].

Although the relative morbidity associated with mental, neurological and substance abuse disorders is increasing in low and middle income countries [13], the association between psychological distress and addictive behaviors has not been evaluated in Lebanon. Furthermore, although girls in Lebanon generally declare high psychological distress than boys [1], they often demonstrate lower addiction behaviors and dependence towards smoking and alcohol [14]. The objective of this analysis was to evaluate the relationship between declared psychological distress and addictive behaviors, focusing on differences between boys and girls.

METHODS

Population and sampling

A cross-sectional study was carried out; using a proportionate cluster sample of Lebanese students in public and private universities. A list of universities in Lebanon, provided by the Center for Pedagogic Researches, was used to adjust the sample size [15]. A sample size of at least 3000 individuals was targeted to allow for adequate power for bivariate and multivariate analysis to be carried out.

Although ethical approval was granted by all Internal Review Boards of respective institutions where the study was conducted, most universities’ administrative offices in Lebanon that we approached did not allow drawing a random sample of their enrolled students to participate in the study: they did not provide us with the lists of students and permission was not granted to enter classrooms and search for students nominatively. Thus our research group had to work with a nonrandom sample of students outside their classes. Students were approached on campus during break times between courses by a field worker.

The latter explained the study objectives to the student; and after obtaining oral consent, the student was handed the anonymous and self-administered questionnaire. On average, the questionnaire was completed by participants within approximately 20 minutes. At the end of the process, the completed questionnaires were placed in closed boxes and sent for data entry. During the data collection process, the anonymity of the students was guaranteed. Out of 4900 distributed questionnaires, 3384 (69.1%) were returned to the field worker. Further methodological details are presented in more details elsewhere [16].

Questionnaires

The questionnaire used in this study was composed of several parts, including the socio-demographic part, a detailed active and passive smoking and substance use history, and sports frequency. Socioeconomic status was evaluated using the ratio of mean income per household over the number of persons in the family. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scale, initially developed by the World Health Organization, was used to evaluate addiction to substances [17].

Current cigarette and waterpipe consumption were evaluated. For cigarette dependence, we assessed the Young Adults Cigarette Dependence (YACD) scale: [18], and for waterpipe dependence, the LWDS-11 [19], both of which were developed by our team for the Lebanese population. The YACD was developed for university students; it is composed of sixteen items, loading over six factors: nicotine dependence, craving intensity; positive reinforcement and negative reinforcement [20]. Moreover, psychological distress was measured using the Beirut Distress Scale-22 (BDS22) [1].

Statistical analysis

Data was entered and analyzed using SPSS, version 18.0. Means and standard deviations were used for continuous variables, while percentages were used for qualitative variables. The Student T-test was used to compare means between two groups, while the Chi square test was used to compare percentages. Subgroup analysis was performed for girls and for boys, separately, allowing for evaluation of the moderating effect of gender on the relationship between psychological distress and different types of addiction. Missing values were not replaced due to their low percentage (<10%) for all variables.

Afterwards, multivariate analyses were performed using stepwise descendent multiple regressions for continuous dependent variables (scales of substance addiction and dependence). The psychological distress was considered as the major independent variable, while socio-demographic and other baseline characteristics (such as private university, sex, marital status, living in Beirut, socioeconomic status, health studies, age, declared good health, frequency of sports per week, having at least one smoker at work, and having at least one smoker at work) were used as potential confounders. Adequacy conditions were confirmed before retaining the respective final models (non colinearity; linearity of the relationship; sample adequacy to the model; residuals normality).

Salameh P, Salamé J, Waked M, Barbour B, Zeidan N, et al. (2015) Addiction and Psychological Distress among University Students in Lebanon: The Moderating Effect of Gender. J Addict Med Ther 3(1): 1010

Received : 04 May 2014
Accepted : 14 May 2014
Published : 06 Jun 2014
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JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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