Youth Tobacco Access: Adult Attitudes, Awareness, and Perceived Self-Efficacy in Two Arizona Counties

While a variety of steps have been taken to restrict youth access to tobacco, little has been done to explore adult attitudes, beliefs, and behaviors concerning this issue. To ameliorate this knowledge gap, 828 adults from Arizona's Maricopa and Pima counties were surveyed. Overall, adults perceived that the prevention of youth tobacco access was: an important issue, an issue they are willing to spend money on, and a responsibility shared by all adults. Further, when asked who was most responsible for keeping tobacco away from minors, 65.4% of adults surveyed perceived parents of the youth purchasing tobacco as most responsible. Responding to items soliciting opinions regarding appropriate penalties for minors purchasing tobacco and for those selling tobacco to minors, respondents recommended stiffer punishment for the sellers of tobacco. Almost 10% recommended a night in jail for vendors caught selling tobacco products to minors. Interestingly, respondents exhibited low perceived self-efficacy regarding the prevention of youth tobacco access. The majority of adults agreed that it is easy for minors to gain access to tobacco and that there is nothing they or the community can do to stop minors who wish to purchase tobacco. Future research efforts should investigate how adult self-efficacy can be increased and the impact that such a change would have on efforts to prevent youth tobacco access.     

Examining the link between provider roles and program development: Findings from a process evaluation of a community-based drug prevention program

This paper presents data from a process/formative evaluation of the Real Alternatives Project (RAP), a community-based substance abuse prevention program for “high-risk” adolescents. The challenge of integrating diverse services for a multi-cultural population required the establishment of an innovative provider role—that of the community case counselor. This paper describes the process of role identity among these case counselors within the context of a developing program. Their role evolved from simple case managers to that of generalists. Serving as case managers, counselors, mentors, role models, and advocates, they met clients' multiple needs. Organizational needs were met through their role in implementing and integrating services and their participation in decision making. The evaluation documented and legitimized this process of role and program evolution. The importance of incorporating process evaluation as an equal partner in program development and implementation is discussed.     

Adolescent substance abuse prevention programs: Theories,models, and research in the encouraging 80's

The vaccine to prevent adolescents from using cigarettes, alcohol, and other drugs has not yet been found. Much has been learned about which prevention effortsdo not work. However, in the past decade there are some encouraging findings about whatdoes seem to work. This paper reviews the theories of human behavior and personality development upon which substance abuse prevention strategies have been based, the program models derived from them, and the research literature of the 1980's reporting on the effectiveness of the major program models for preventing adolescent substance abuse. The authors also present unanswered questions about the most effective kinds of prevention programs for different populations.     

Context of Risk for HIV and Sexually Transmitted Infections Among Incarcerated Women in the South: Individual,Interpersonal, and Societal Factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.     

Alcohol/drug exposure, HIV-related sexual risk among urban American Indian and Alaska Native Youth: evidence from a national survey

BACKGROUND: Migration of the native populations from reservations to the urban areas has resulted in mixed ethnicities of American Indian/Alaskan Native (AIAN) children. Minority youth require special attention and services in urban schools as they disproportionately experience poverty, low educational attainment, unemployment, and single‐parent status. METHODS: We used 2005 and 2007 Youth Risk Behavior Survey data to examine alcohol/drug use patterns and their association with sexual risk taking among AIAN only (single‐racial) and biracial youth in combination with White, African American, or Hispanic ethnicities (N = 1178). RESULTS: Overall, one half of the students were sexually active, with significantly higher rates among males; AIAN‐Black students initiated sex earlier than the other groups. Condom nonuse is higher among AIAN‐Whites (>50%) compared to one third of AIAN‐Hispanics and one fourth of AIAN‐Blacks. Nearly 10% of all students, except AIAN‐Blacks, reported lifetime use of heroin/meth. Sexual behavior was significantly associated with episodic drinking. Students with Hispanic background have twice the odds of being sexually active compared to AIANs. CONCLUSIONS: Our findings underscore growing health care needs and targeted prevention initiatives for mixed racial underserved native youth. Urban school settings have potential to deliver services and offer alcohol/drug prevention programs to address the needs of mixed racial native urban youth. Using the School Based Health Clinic model has been successful; we need to reform prevention approaches to accommodate needs of multiracial urban native youth.     

Predicting Improvement of Transitioning Young People in the Partnerships for Youth Transition Initiative: Findings from a Multisite Demonstration

Prior research has indicated that young people with serious mental health conditions show poorer progress and greater challenges in the transition to adulthood, as reflected by lower rates of employment and postsecondary education, higher rates of criminal justice involvement, and greater interference in daily activities from mental health and substance use disorders. Little knowledge exists, however, regarding improvement on these indicators among young people enrolled in community-based transition support programs and individual characteristics that might moderate this improvement. This study describes rates of improvement on indicators of transition progress and challenges among young people enrolled in a multisite demonstration of transition support programs. Young people in the study showed increased rates of progress and decreased rates of challenges over four quarters of enrollment. Moderation of these changes by individual characteristics including demographic, historical, and diagnostic variables suggested ways of improving transition support programs and avenues for future research.

An exploration of the understandings of drug use from young drug users’ perspectives in the Western Cape: implications for primary prevention

ABSTRACT

The high rate of substance abuse among youth in South Africa is a clear indication of the level to which this issue has infiltrated the South African society. Drug abuse at an early age has been associated with problems, such as risky sexual behaviours, health problems, depression, crime, and ultimately drug addiction, which often occur at a later stage. There are many interrelated reasons and risk factors for drug use among youth and studies have mostly focussed on familial and other broader social environments such as peer/neighborhood factors for use. Less attention has been focussed on the internal or psychological factors at play in the lives of young users. This study aimed to fill this gap by exploring young drug users’ perceptions of the internal or psychological factors cited as their reasons for drug use. A better understanding of the internal risk factors that influence adolescent drug use is crucial for the development of effective prevention strategies. A qualitative method of inquiry was applied to gather in-depth data from a purposive sample of 41 young (14–19 years of age) drug users, at five drug treatment centres in the Western Cape. The findings of this study revealed that internal factors such as a permissive and/or positive attitude towards drugs, a deficit in social skills; a lack of self-esteem, and poor/maladaptive coping mechanisms were at play in the lives of the adolescents in this study. Implications for primary prevention were considered, as these findings underscore the need to consider these internal risk factors when developing interventions to reduce adolescent drug abuse.     

Are Ecological and Social Models Influencing Prevention Practices? An Overview of the State of Affairs in Quebec for Child, Youth and Family Intervention

This paper presents the findings of a study designed to increase empirical knowledge of prevention and promotion practices targeted directly or indirectly at children, youth, and their families in the province of Quebec. A profile of these practices emerged from our analysis of the problems and concerns addressed by projects and programs in Quebec, targets for action, activities, strategies, links between organizations, and types of funding. These prevention and promotion practices are discussed in light of recent analyses and critiques in this field. It is hoped that this examination will encourage a healthy criticism of preventive efforts in Quebec, broaden of the scope of our interventions, and stimulate the creation of links between the actors involved in the welfare of children, youth, and families.     

中国2005--2011年注射吸毒人群艾滋病感染的空间分析

目的　分析2005--2011年中国注射吸毒人群艾滋病流行的空间分布特点及其变化趋势。方法　利用全国艾滋病综合防治信息系统中2005--2011年注射吸毒途径的HIV感染者和艾滋病患者（HIV／AIDS）数据,分析其人口学特征,分别以省份和区县为水平进行空间聚集性分析,并生成热点区县的中心位点。结果　注射吸毒HW／AIDS的性别比、本省户籍与外省户籍比随时间变化而下降,2011年比值分别为6．75和7．01,HIV与AIDS报告例数比则为上升趋势（Z=26．880,P<0．01）。2005年后全国注射吸毒HIV／AIDS例数、以省为水平的空间聚集性及热点省数量呈下降趋势,2009--2011年全国热点省均为2个（四川、云南省）;但以区县为水平的空间分析显示,2010--2011年空间聚集性及热点区县数量有所增加,2005--2011年西部热点区县中心位点局限于新疆,西南部热点区县中心位点有北移倾向。结论　2005—2011年中国注射吸毒人群HIV／AIDS的人口学特征变化具有规律性,表现为省级水平空间聚集性下降,但区县级水平的聚集性和局部热点数量有所增加,且热点出现由边境向内陆地区转移的趋势。     

Reducing Liver Cancer Risk through Dietary Change: Positive Results from a Community-Based Educational Initiative in Three Racial/Ethnic Groups

Dietary behaviors and alcohol consumption have been linked to liver disease and liver cancer. So far, most of the liver cancer awareness campaigns and behavioral interventions have focused on preventive behaviors such as screening and vaccination uptake, while few incorporated dietary aspects of liver cancer prevention. We implemented a community-based education initiative for liver cancer prevention among the African, Asian, and Hispanic populations within the Greater Philadelphia and metropolitan New York City areas. Data from the baseline and the 6-month follow-up surveys were used for the assessment of changes in dietary behaviors and alcohol consumption among participants. In total, we recruited 578 participants through community-/faith-based organizations to participate in the educational workshops. The study sample included 344 participants who completed both baseline and follow-up survey. The Hispanic subgroup was the only one that saw an overall significant change in dietary behaviors, with the Mediterranean dietary score increasing significantly from 30.000 at baseline survey to 31.187 at 6-month follow-up assessment (p < 0.05), indicating a trend towards healthier dietary habit. In the African Americans participants, the consumption scores of fruits and poultry increased significantly, while vegetables and red meats decreased. In Asian Americans, the consumption of non-refined cereals, red meats, and dairy products decreased. Alcohol consumption decreased significantly among Hispanics while it did not change significantly among the other two communities. This community-based educational initiative generated different impacts in the three populations, further highlighting the needs for more targeted, culturally tailored efforts in health promotion among these underprivileged communities.     

The hidden dimension: sexuality and responding to the threat of HIV/AIDS in South Sulawesi, Indonesia

Particular Asian countries (notably India, Thailand and Burma) are now estimated to have substantial numbers of HIV positive cases. The critical interacting factors which shape the HIV/AIDS epidemic in specific settings are the sexual and injecting drug using cultures and the governmental and societal responses to the threat of AIDS. This paper explores these factors in South (S.) Sulawesi in Eastern Indonesia. The paper presents recent quantitative and qualitative research findings on sexual culture, AIDS awareness and public health response in relation to the distinctive features of S. Sulawesi's geographical and socio-cultural setting. The paper concludes by discussing the major factors impeding and facilitating HIV/AIDS policy and programme implementation in S. Sulawesi.     

From treatment to prevention: The interplay between HIV/AIDS treatment availability and HIV/AIDS prevention programming in Khayelitsha,South Africa

There is a paucity of research that illustrates the interplay between HIV/AIDS treatment and prevention programs. We describe the central role that public access to antiretroviral (ARV) medication has played in the development and efficacy of HIV/AIDS prevention programming in Khayelitsha, a resource-poor township in the Western Cape of South Africa. We document the range of preventive interventions and services available in Khayelitsha since the early 1990s and explore the impact of ARV availability on prevention efforts and disease stigma on the basis of extensive indepth interviews, supplemented by data collection. The information gathered suggests that the introduction of the mother-to-child-transmission (MTCT) prevention programs in 1999 and the three HIV treatment clinics run by Doctors Without Borders/ Médecins Sans Frontières (MSF) in 2000 were turning points in the region’s response to the HIV/AIDS epidemic. These programs have provided incentives for HIV testing, galvanized HIV/AIDS educators to reach populations most at risk, and decreased the HIV incidence rates in Khayeltisha compared to other areas in the Western Cape. Lessons learned in Khayelitsha about the value of treatment availability in facilitating prevention efforts can inform the development of comprehensive approaches to HIV/ AIDS in other resource-poor areas.     

Prioritization of prevention activities to combat the spread of HIV/AIDS in resource constrained settings: a cost-effectiveness analysis from Chad,Central Africa

In Chad, as in most sub-Saharan Africa countries, HIV/AIDS poses a massive public health threat as well as an economic burden, with prevalence rates estimated at 9% of the adult population. In defining and readjusting the scope and content of the national HIV/AIDS control activities, policy makers sought to identify the most cost-effective options for HIV/AIDS control. The cost-effectiveness analysis reported in this paper uses a mixture of local and international information sources combined with appropriate assumptions to model the cost-effectiveness of feasible HIV prevention options in Chad, with estimates of the budget impact. The most cost-effective options at under US$100 per infection prevented were peer group education of sex workers and screening of blood donors to identify infected blood before transfusion. These options were followed by mass media and peer group education of high risk men and young people, at around US$500 per infection prevented. Anti-retroviral therapy for HIV infected pregnant women and voluntary counselling and testing were in the order of US$1000 per infection prevented. The paper concludes with recommendations for which activities should be given priority in the next phase of the national HIV/AIDS control programme in Chad.     

A question of maturity: The participation,decision-making and rights of children in the context of HIV/AIDS

This article examines international, regional and national sources of law with respect to the rights of children and considers how a strict age of majority affects adolescents' access to health care. Using Rwanda as a case study, this article outlines how a high age of majority, combined with mandatory parental consent, creates barriers for Rwandan adolescents to prevent human immunodeficiency virus (HIV) transmission, learn their status and receive treatment for the disease. It further examines the relevant legal and policy framework of the Rwandan Government in order to suggest successful methods to gauge a child's maturity level for Rwanda and other countries. The article argues for the improvement of adolescents' level of participation in making health decisions, and thereby also increasing their access to HIV/acquired immune deficiency syndrome (AIDS) services.     

The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland

OBJECTIVE: To assess the prevalence of ear, nose and throat (ENT) symptoms experienced by individuals living in Scotland, and their use of GP or hospital services for these problems. METHODS: A cross-sectional postal self-completed questionnaire was sent to a random sample of 12,100 households throughout Scotland. 15,788 individuals aged 14+ years living in the 7244 households who returned the questionnaire (adjusted response rate 64.2%) participated in the study. RESULTS: Roughly a fifth of respondents reported currently having hearing difficulties, including difficulty following conversations when there is background noise and hearing problems causing worry or upset; few wore a hearing aid regularly. A fifth reported noises in head or ears (tinnitus) lasting more than five minutes. In the previous year, between 13 and 18% of respondents reported persistent nasal symptoms or hayfever, 7% sneezing or voice problems and 31% had at least one episode of severe sore throat or tonsillitis. Nearly 21% of all respondents reported ever having had dizziness in which things seemed to spin around the individual; 29% unsteadiness, light-headedness or feeling faint; 13% dizziness in which the respondent seemed to move. Important gender, age, occupation and deprivation differences existed in the occurrence of these ENT symptoms. There was considerable variation in the proportion of individuals consulting their GP or being referred to hospital for different problems. CONCLUSIONS: ENT problems occur frequently in the community, and most are managed without consulting medical services. Whilst reasonable for many problems, there are likely to be important groups in the community with ENT problems that might benefit from modern interventions.     

Progress in the establishment and strengthening of national immunization technical advisory groups: Analysis from the 2013 WHO/UNICEF joint reporting form,data for 2012

The majority of industrialized and some developing countries have established National Immunization Technical Advisory Groups (NITAGs). To enable systematic global monitoring of the existence and functionality of NITAGs, in 2011, WHO and UNICEF included related questions in the WHO/UNICEF Joint Reporting Form (JRF) that provides an official means to globally collect indicators of immunization program performance. These questions relate to six basic process indicators.     

The role of neuroactive steroids in ethanol/stress interactions: proceedings of symposium VII at the Volterra conference on alcohol and stress, May 2008

This report summarizes the proceedings of the symposium VII on the role of neuroactive steroids in stress/alcohol interactions. The production of GABAergic neuroactive steroids, including (3α,5α)-3-hydroxypregnan-20-one and (3α,5α)-3,21-dihydroxypregnan-20-one is a consequence of both acute stress and acute ethanol exposure. Acute, but not chronic ethanol administration elevates brain levels of these steroids and enhances GABA_A receptor activity. Neuroactive steroids modulate acute anticonvulsant effects, sedation, spatial memory impairment, anxiolytic-like, antidepressant-like, and reinforcing properties of ethanol in rodents. Furthermore, these steroids participate in the homeostatic regulation of the hypothalamic-pituitary-adrenal axis. Therefore, it is not surprising that neuroactive steroids are involved in ethanol/stress interactions. Nevertheless, the interactions are complex and not well understood. This symposium addressed the role of neuroactive steroids in both stress and alcohol responses and their interactions. Professor Giovanni Biggio of the University of Cagliari, Italy presented the effects of juvenile isolation stress on neuroactive steroids, GABA_A receptor expression, and ethanol sensitivity. Professor Howard Becker of the Medical University of South Carolina, USA presented evidence for neuroactive steroid involvement in ethanol dependence and drinking behavior. Professor Patrizia Porcu of the University of North Carolina, USA described a potential neuroactive steroid biomarker that may predict heavy drinking in monkeys and mice. These presentations provide a framework for new theories on the nature of ethanol/stress interactions that may be amenable to therapeutic interventions.     

The financial impact of a state adopting a personal/philosophical belief exemption policy: Modeling the cost of pertussis disease in infants, children and adolescents

State school immunization exemption policies help reduce the risk of individual and community disease. Assessing the costs of vaccine preventable disease associated with a state adding a philosophical/personal belief school exemption policy is useful for making future policy decisions. Two formulas were developed to estimate the infant, child and adolescent hospitalization and non-medical costs of pertussis disease that are associated with adding a philosophical/personal belief school exemption policy. The parameter estimates were obtained from peer reviewed literature and the Centers for Disease Control and Prevention. The state of Iowa was used as an example in order to demonstrate how the formulas can be applied. The annual projected impact of pertussis disease in Iowa is $273,365 without a philosophical/personal belief exemption policy and an average of $410,047 (range of $281,566-$582,267) with adding a personal belief exemption policy. We project that adding a philosophical/personal belief exemption will cost 50% more dollars annually.