Gender Differences in Drug Resistance Skills of Youth in Guanajuato, Mexico

Research is limited or absent on Mexican adolescents' exposure to substance offers, ways of dealing with these offers, and possible gender differences in responses to offers. Extending U.S.-based research, this study examines how youth living in the Mexican state of Guanajuato employ the four drug resistance strategies-refuse, explain, avoid, and leave-that are part of the Keepin' It REAL evidence-based drug prevention intervention. The analysis uses cross-sectional survey data from 702 students enrolled in eight alternative secondary education sites in 2007. Participants reported the drug resistance behaviors they used to deal with offers of alcohol, cigarettes, and marijuana. Using multivariate regression, findings indicate most youth had developed repertoires of drug resistance strategies that involved multiple REAL strategies and some other strategy as well. For those receiving offers, the most common strategy was to refuse the offer with a simple "no." However, males used all the strategies significantly more often than females for situations involving cigarettes and marijuana as well as when using refuse and non-REAL strategies for alcohol. Possible reasons for the gender difference in use of strategies are discussed. The findings can help inform effective prevention programs based on teaching culturally appropriate drug resistance and communication skills.     

Drug Resistance Strategies and Substance Use among Adolescents in Monterrey,Mexico

This study examined drug resistance strategies and substance use among adolescents from Monterrey, Mexico. The focus was strategies that U.S. adolescents use most often to resist using substances, including refuse (saying no), explain (declining with an explanation), avoid (staying away from situations where drugs are offered), and leave (exiting situations where drugs are offered). Using self-administered questionnaire data from a convenience sample of 327 Mexican students enrolled at two secondary schools (preparatorias), we tested whether frequent use of particular drug resistance strategies predicted actual substance use. Multiple regression results showed that different strategies were effective for different substances, that some effects were mediated by number of offers received, and that certain effects were stronger for females than for males. Students using the refuse strategy reported less cigarette use and less binge drinking; those using the avoid strategy reported less alcohol and cigarette use; and those using the leave strategy reported less binge drinking and, for females only, less marijuana use. Use of the explain strategy was not significantly related to substance use after controlling for use of other strategies. Findings are discussed in terms of Mexican cultural values and their implications for the design of prevention programs for Mexican youth. Editors’ Strategic Implications: Replication is necessary to evaluate some of the effects of sampling, the prevention model, implementation, and culture on these findings, but the study underscores the importance of recognizing and understanding the cultural context in which prevention programs—and the clients they serve—exist.     

A Community Stakeholder Analysis of Drug Resistance Strategies of Rural Native Hawaiian Youth

This study examines and validates the drug resistance strategies identified by rural Hawaiian youth from prior research with a sample of community stakeholders on the Island of Hawai'i. One hundred thirty-eight stakeholders with a vested interest in reducing youth substance use (i.e., teachers, principals, social service agency providers, and older youth) completed a web-based survey comprised of 15 drug-related problem situations and 413 responses developed by Hawaiian youth. The findings corroborated the youth-focused findings from prior research. Differences in the endorsement of different strategies were examined based on gender, ethnicity, and age of the stakeholders. Implications for culturally grounded drug prevention in rural Hawaiian communities are discussed.     

Informing Youth About the Age of Sexual Initiation Using Means or Percentages

The common statistical indicator “mean age of first sex” can be misinterpreted by youth to indicate that most of their peers of the same age are sexually initiated, when this is not usually the case. This can jeopardize efforts to delay sexual initiation. University students were randomly assigned to one of two versions of an anonymous survey. They were asked to estimate how common sexual initiation was at a given age upon being presented with statements with different wordings, such as the “mean age of first sex” or “proportions of youth at different ages having had sex.” Their interpretations were compared using logistic regression. Students who were assigned surveys using the indicator “mean age” of sexual initiation had higher odds of overestimating the extent of sexual initiation compared to those assigned surveys using percentages as the indicator, even after adjusting for student’s sex and degree. We encourage the use of the “percentage” of youth, at different ages, who are sexually initiated as a more reliable indicator.     

宁波市不同年龄段结核分枝杆菌耐药性研究

目的分析不同年龄组结核分枝杆菌耐药情况,探讨当前结核病耐药性发展趋势。方法根据年龄将1 118例肺结核患者分为青年组(18~39岁),中年组(40~59岁)和老年组(≥60岁);采用WHO/IUATLD规定的1%比例法进行异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)4种抗结核药物的耐药性测定。结果青年组、中年组、老年组初始耐药率分别为30.6%、32.2%、23.3%,获得性耐药率分别为72.2%、63.3%、36.1%,各组间差异均无显著性(P>0.05)。青年组与老年组初始耐药频度从高到低依次为S、H、R、E,中年组为H、S、R、E。中年组耐R最高为9.4%。中、老年组获得性耐药顺序均为H、R、S、E,青年组为H、S、R、E。青年组耐R最高为44.3%。初始及获得性耐多药率均以中年组最高,分别为6.5%和38.3%。结论不同年龄组初始及获得性耐药均有所不同,须加强不同年龄组耐药率的监测,完善现行的结核病防治策略。     

Secondary prevention: an approach to improve the German drug abuse prevention system

Drug prevention in Germany traditionally focuses on primary prevention programmes for children without any drug experience. Only a few programmes have been specifically developed for drug-taking youth, although especially children and adolescents at high risk for drug problems need intervention services which provide helpful support to reduce drug misuse. Empirical studies in two German cities show that prevention services are not available for the high-risk population of drug-taking youth. On an international level several projects are testing out new approaches for drug use prevention for at-risk youth. The primary goal of such secondary prevention programmes is to reduce the incidence and prevalence of drug use and abuse through early detection and intervention strategies. These programmes aim at preventing adolescents who are experimenting with drugs from progressing to misuse or addiction. Testing new prevention strategies to support drug-taking youth in Germany is likely to produce a valuable contribution to our knowledge of effective drug prevention.     

Coping strategies and their associations with levels of disability or pain,among older veterans receiving primary care

Little information is available regarding the types of coping strategies used by older persons with chronic non-cancer pain, or whether specific methods of coping are associated with reduced levels of disability or pain. Our objectives were to (1) identify the types of strategies used by older persons to cope with chronic pain, and (2) determine whether specific strategies are associated with lower levels of disability or pain.Potential participants were drawn from a random (20%) sample of all patients aged 65 years or above receiving primary care at the West Haven VA, and were screened via telephone to determine eligibility status (i.e., pain for ⩾3 consecutive months due to a non-cancer cause). We conducted telephone interviews using an open-ended question to ascertain the types of coping strategies used by participants and inquired about the effectiveness of each method (0 to 5 Likert scale with responses ranging from not at all to extremely effective). We obtained data on participants' levels of disability (days of activity restriction due to pain in past month) and pain (0–10 numeric rating scale), as well as sociodemographics, comorbid conditions, and psychological status using validated instruments. Two reviewers independently coded all open-ended responses and disagreements were resolved by consensus. Similar coping strategies were assembled into discrete categories (e.g., “prays” and “attends church, etc.” for religious activities).Of 938 patients screened for chronic pain, 258 met eligibility criteria, and 210 (81%) participated. Respondents had a mean age of 75 (standard deviation = 5.1) years; most were Caucasian (96%), and male (99%). Commonly reported coping strategies used in the month prior to the interview included medication use in 153/210 (73%), exercise (33%), cognitive strategies such as distraction (31%), religious activities (18%), pacing, i.e., alternating periods of activity with rest (15%), and hot/cold modalities (13%). None of these six coping strategies was associated with lower levels of disability or pain intensity in either bivariate or multivariate analyses. Self-reported effectiveness of the six coping strategies was relatively high, however, with 57% using religious activities and 46% of those using medications rating them as “quite a bit” or “extremely” effective.We identified a broad spectrum of coping strategies used by older veterans with chronic non-cancer pain. Although positive associations were not observed between specific coping strategies and decreased levels of disability or pain, self-reported effectiveness of the coping strategies was high. Future research is planned to determine whether the coping strategies identified in this study are associated with beneficial outcomes in specific domains of health (e.g., emotional well-being) among older persons with chronic pain.     

Adolescents' responses to peer smoking offers: the role of sensation seeking and self-esteem

This article deals with an important topic (youth smoking) and makes a contribution to the literature by validating existing research and extending our understanding of smoking resistance strategies. This study classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of refuse, explain, avoid, and leave (REAL) and explored how personality factors explain adolescents' use of cigarette refusal strategies. Participants were predominantly Hispanic junior high students (6th-8th grades) from schools in the Northeast United States who participated in a survey design (N = 260). The strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with a greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related to the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies. Implications and directions for future research are discussed.     

The concept of culture: A core issue in health disparities

Contemporary discourse contains numerous examples of use of the concept of culture by social and behavioral scientists. Simple reification, where the speaker makes culture into a thing capable of action exemplifies one usage in public discourse. Some quantitative social scientists attempt to characterize people’s cultural identities by means of a single categorical variable, which often “lumps” people into categories such as “Hispanic” or “Black” that in fact have numerous culturally bounded subcategories. Approaches that emphasize cultural process are preferable to those who attempt to categorize; more complex measures of acculturation help investigators to make convincing analyses of circumstances in which health disparities occur. Examples in which investigators make appropriate use of cultural characterizations demonstrate their utility in investigating health disparities in Haitian American women, injecting and noninjecting drug users, Hispanic youth, and adult Hispanics at risk of HIV infection. Focus on culture in the study of health disparities can identify entanglements between structural factors such as poverty and lack of education and cultural factors such as beliefs about health. Qualitative methods coupled with quantitative methods have great potential to improve investigators’ grasp of cultural nuance while capturing the distribution of qualitatively derived behaviors.     

Natural Polyphenols in Cancer Chemoresistance

Resistance to chemotherapy remains a major impediment to the management of most types of cancer. Both intrinsic and acquired drug resistance are mediated by several cellular and molecular mechanisms, including alternative growth-signaling pathways unaffected by specific therapies, alterations in the tumor microenvironment (e.g., hypoxia and angiogenesis), and active transport of drugs out of the cell. Epidemiological studies have validated an inverse correlation between the consumption of dietary polyphenols and the risk of cancer, which has been attributed to polyphenol antioxidant capacity and their potential to inhibit activation of procarcinogens, cancer cell proliferation, metastasis, and angiogenesis, and inhibition or downregulation of active drug efflux transporters. Moreover, polyphenols can induce apoptosis in cancer cells and modulate immune responses and inflammatory cascades. Augmentation of the efficacy of chemotherapy and prevention of multidrug resistance are other important effects of dietary polyphenols that deserve further research, especially after the discovery of tight “crosstalk” between aberrant growth signaling and metabolic dysfunction in cancer cells. In this review, we cover what is currently known about the role of natural polyphenolic compounds in overcoming cancer drug resistance mediated by diverse primary and secondary resistance mechanisms.     

Diverse youth voices and New Zealand public policy

This small, exploratory study, conducted in Auckland, New Zealand, followed on from an earlier review and sought the opinions of young people from diverse communities as to how their voices might be located in public health policy. A focus group was undertaken with 6 youth involving participatory research methods of mind mapping and ranking. Participants created two key themes to direct their mind mapping activity: “a beautiful world to speak in” and “a difficult world to speak in.” Each theme was broken down into 3 sub-themes reflecting participants’ perceptions of having or not having their voices heard. On the one hand, participants appreciated the open environment for communication in the New Zealand context. Yet, concurrently, societal power relationships which unfairly privilege one group over another were identified as limiting youth voice. The study informs the design of a larger participatory research project focused on youth leadership and public health policy in New Zealand and the Pacific Region.     

Patterns of Risky Behaviors Associated with Methamphetamine Use Among Young Thai Adults: A Latent Class Analysis

PurposeMethamphetamine (MA) is the leading illicit drug in Thailand among youth and young adults. Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine.MethodsWe conducted a cross-sectional study in Chiang Mai, Thailand, in 2005–2006 among 1,162 street-recruited methamphetamine smokers 18–25 years of age. Data collected included sociodemographic characteristics, sexual behaviors, and drug use patterns. Latent class analysis was used to describe patterns of activities in which participants reported engaging directly after using MA. Logistic regression was used to examine univariate correlates of class membership, separately by gender.ResultsParticipants were 75% male with a median age of 19 years. More than half of participants reported frequent alcohol use (≥4 days/week) and half of the sample reported smoking MA ≥2 days/ week. Three classes of activities emerged for male participants (n = 863): “work” (job related); “high-risk behaviors” (motorcycle riding, fighting, sex); and “combined” (all activities). Two classes emerged for the women (n = 299): “work” (housework) and “high-risk behaviors.” “High-risk behaviors” and “combined” (men only) classes were associated with more frequent alcohol and methamphetamine use compared with the “work” class.ConclusionsOur study found a distinct typology of behaviors associated with substance abuse among young adults in Thailand. Behavioral typologies allow a better understanding of the nuances of “risky” behaviors and might prove useful in targeting interventions.     

The Self-Reported Strengths and Concerns of Treatment-seeking Obese Youth and Their Caregivers

Our purpose was to identify the self-reported strengths and concerns of 267 obese youths and their caregivers. Measures included a demographic questionnaire and an open-ended questionnaire whereby youth and caregivers were asked to list their top 3 strengths and concerns. Using qualitative methods, themes were deducted for both youth and caregiver strengths and concerns. Youth reported “physical activity” and “school” as a strength, and “weight” as a concern. Caregivers reported “health” and “weight” as their most prevalent concern, whereas “child behavior, character, or outlook” and “family” were strengths. Results were further compared by gender and race. Understanding the self-reported strengths and concerns of obese youth and caregivers can inform future family-based treatment.     

Psychosocial Determinants of Teens’ Online Engagement in Drug Prevention Social Media Campaigns: Implications for Public Health Organizations

Social networking sites (SNSs) now serve as a primary form of communication among adolescents. Consequently, drug prevention campaigns delivered through SNSs have the potential to reach a wide network of adolescents if teens are willing to engage in the message diffusion process by commenting on, “liking,” following, creating, or sharing prevention messages with their networked peers. However, little is known about the psychosocial factors that influence adolescents’ willingness to participate in drug prevention social media campaigns. We use qualitative methods to explore reasons why adolescents may or may not want to engage in the message diffusion process. We conducted four semi-structured focus groups with a total of 33 high school students from various school- and community-based youth programs in Rhode Island. Focus groups were followed by a brief self-administered questionnaire collecting information about participants’ social media use to augment qualitative findings. Overall, findings reveal that engaging teens in the message diffusion process can be advantageous but difficult to accomplish due to multiple factors. Most notably, asking adolescents to participate in drug prevention campaigns delivered through SNSs means also asking youth to violate online norms that promote drug use, which could in turn subject them to peer reprisal. We conclude that future studies should begin to investigate strategies addressing the various challenges we identified. Meanwhile, prevention specialists should consider alternative or supplemental evidence-based approaches to drug prevention rather than invest resources into activities that may offer little return on investment.     

Consistency Between Parent-Reported Feeding Practices and Behavioral Observation During Toddler Meals

ObjectiveTo assess whether feeding questionnaire responses reflect observed mealtime behavior.DesignCross-sectional associations between self-reported and observed behaviors.SettingParticipants’ homes.ParticipantsParents (n = 75) of toddlers (mean age = 24.7 months) in the US.Main Outcome MeasuresFeeding behavior questionnaires and coded videos of children's dinner meals.AnalysisParents’ questionnaire responses of “never” (or “rarely”) considered consistent with video observation if behavior was not observed; responses of “always” (or “most of the time”) if behavior observed at least once. Proportion (%) of participants observed performing each behavior was calculated for the groups of parents reporting that they “never,” “sometimes,” or “always” used that feeding practice. These were compared across the 3 response groups.ResultsParents reported 6 behaviors consistently (≥70% agreement): allowing child to eat as much as wanted, helping child eat, prompting child to eat, television/screens on during meal, nonfood rewards, and hurrying child. The remaining 8 behaviors fell below the threshold. For many behaviors, all response groups (never, sometimes, always) had similar rates of participants demonstrating the behavior. Only 5 behaviors had observed rates falling in the expected direction (frequency of always > sometimes > never). For some behaviors, the “sometimes” group had a higher (eg, clean plate) or lower (praise) frequency than the other 2 groups.Conclusions and ImplicationsSelf-reported questionnaire responses predicted whether some, but not all, behaviors were observed. Parents’ use of “sometimes” remains difficult to interpret as parents may use “sometimes” inconsistently across behaviors and perhaps to mitigate socially undesirable responses. Self-reports of “sometimes” performing a behavior may have limited utility for prediction of behavior and likely requires additional exploration with the respondent.     

Youth risk behaviour in a Chinese population: a territory-wide youth risk behavioural surveillance in Hong Kong

This cross-sectional study investigated the prevalence rates of different categories of youth risk behaviour by age, sex and parental education. The study population consisted of 26,111 Hong Kong students, aged 10-19 years, recruited from 48 primary (primary grades 4-6) and secondary schools (secondary grades 1-7). Less than one-third of subjects participated in vigorous exercise regularly, about one-third consumed an unhealthy diet frequently, 18% had tried smoking, and 14.5% had seriously considered attempting suicide. Although only 3.4% of students reported experience of sexual intercourse, less than half used a contraceptive device. Older students had higher prevalence rates of health-compromising behaviours than younger students. Female students were more likely to report suicide-related behaviour, attempting weight loss, and non-participation in vigorous physical activities. Students with parents of a lower educational background were more likely to report rarely or never wearing seat belts and bicycle helmets, suicide-related behaviour, smoking, sexual intercourse before 13 years of age, and attempting weight loss. The availability of data on youth health risk behaviours would enable health educators, public health practitioners and clinicians to plan appropriate screening and counselling for risk behaviours in early adolescents.     

Return to play guidelines cannot solve the football-related concussion problem

BACKGROUND: High school football players are the single largest cohort of athletes playing tackle football, and account for the majority of sport‐related concussions. Return to play guidelines (RTPs) have emerged as the preferred approach for addressing the problem of sport‐related concussion in youth athletes. METHODS: This article reviews evidence of the risks and effects of football‐related concussion and subconcussive brain trauma, as well as the effectiveness of RTPs as a preventative measure. Literature review utilized PubMed and Google Scholar, using combinations of the search terms “football,”“sports,”“concussion,”“Chronic Traumatic Encephalopathy,”“athlete,”“youth,” and “pediatric.” Literature review emphasized medical journals and primary neuroscientific research on sport‐related concussion and concussion recovery, particularly in youth athletes. RESULTS: Sport‐related concussion is a significant problem among student athletes. Student athletes are more vulnerable to concussion, and at risk of neurocognitive deficits lasting a year or more, with serious effects on academic and athletic performance. RTPs do little to address the problem of sport‐related concussion or the chronic damage caused by subconcussive brain trauma. CONCLUSIONS: Emphasizing RTPs as the solution to the concussion problem in tackle football risks neglecting genuine reforms that would prevent concussions. More effective concussion prevention is needed. Eliminating tackling from school football for youth under 16 is recommended to reduce concussions. Additional modifications to football are recommended to enhance safety and reduce brain trauma at all levels of play.     

Primary and secondary sexual abstinence in high school students.

PURPOSE: To assess reasons for choosing not to have sexual intercourse among two groups: virgins (primary abstainers) and already sexually experienced youth (secondary abstainers). METHODS: 73,464 Minnesota ninth- and twelfth-grade adolescents completed the 1998 Minnesota Student Survey. Respondents identified reasons for abstinence from a checklist from which they could nominate all relevant items. Reasons for each group were analyzed using Chi-square with a conservative criterion value (p <.001) owing to large sample size. Logistic regression was used to examine the associations of gender, grade, and their interactions, with reasons for abstinence. RESULTS: Sixty-six percent reported never having had intercourse (primary abstainers). Among sexually experienced youth, 7.8% reported choosing not to have intercourse (secondary abstainers). Fear of pregnancy was the reason endorsed most often, more by girls than by boys (OR = 26 for primary abstainers, 6.9 for secondary abstainers). Fear of other adverse consequences, such as sexually transmitted infections, parental disapproval, or fear of getting caught, were generally selected by more girls than boys, and by more primary than secondary abstainers. Similarly, more girls and primary abstainers than boys or secondary abstainers generally selected statements reflecting normative beliefs on youth or their friends having intercourse. CONCLUSIONS: Fear of adverse consequences and normative beliefs about the appropriateness of having sexual intercourse were most frequently endorsed as important reasons by both groups of abstainers.     

Alcohol as a Gateway Drug: a study of US 12th graders

BACKGROUND: The Gateway Drug Theory suggests that licit drugs, such as tobacco and alcohol, serve as a “gateway” toward the use of other, illicit drugs. However, there remains some discrepancy regarding which drug—alcohol, tobacco, or even marijuana—serves as the initial “gateway” drug subsequently leading to the use of illicit drugs such as cocaine and heroin. The purpose of this investigation was to determine which drug (alcohol, tobacco, or marijuana) was the actual “gateway” drug leading to additional substance use among a nationally representative sample of high school seniors. METHODS: This investigation conducted a secondary analysis of the 2008 Monitoring the Future 12th‐grade data. Initiation into alcohol, tobacco, and other drug use was analyzed using a Guttman scale. Coefficients of reliability and scalability were calculated to evaluate scale fit. Subsequent cross tabulations and chi‐square test for independence were conducted to better understand the relationship between the identified gateway drug and other substances' use. RESULTS: Results from the Guttman scale indicated that alcohol represented the “gateway” drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs. CONCLUSION: The findings from this investigation support that alcohol should receive primary attention in school‐based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use. Therefore, it seems prudent for school and public health officials to focus prevention efforts, policies, and monies, on addressing adolescent alcohol use.     

Developing Empirically Based, Culturally Grounded Drug Prevention Interventions for Indigenous Youth Populations

This article describes the relevance of a culturally grounded approach toward drug prevention development for indigenous youth populations. This approach builds drug prevention from the “ground up” (i.e., from the values, beliefs, and worldviews of the youth that are the intended consumers of the program) and is contrasted with efforts that focus on adapting existing drug prevention interventions to fit the norms of different youth ethnocultural groups. The development of an empirically based drug prevention program focused on rural Native Hawaiian youth is described as a case example of culturally grounded drug prevention development for indigenous youth; the impact of this effort on the validity of the intervention and on community engagement and investment in the development of the program are discussed. Finally, implications of this approach for behavioral health services and the development of an indigenous prevention science are discussed.