Environmental correlates of adolescent substance use and misuse: implications for prevention programs

The research in the areas of peer, family and community environmental effects on adolescent substance use and misuse clearly and consistently shows that peer substance use behavior is the primary predictor of adolescent alcohol use. Peer norms, however, are more important in the prediction of adolescent alcohol misuse. Parental norms and monitoring are secondary to the peer variables, but still of significance in the prediction of adolescent alcohol use and misuse. The intrapersonal construct of susceptibility to peer pressure is as important as the peer and parent variables in the prediction of both alcohol use and misuse in adolescence.     

Cultural patterns and causal processes in adolescent drug use: the case of Greeks versus Americans

Patterns of adolescent drug use in Greece (N = 174) and the United States (N = 2,610) are compared. The rates of self-reported lifetime alcohol and cigarette use are rather similar. For other drugs (marijuana, amphetamines, depressants, cocaine, LSD, PCP, and heroin) there is much more drug use in the United States. A causal model employing variables from social control and social learning theories is applied to drug use in both samples. We conclude that American theories of adolescent deviance assume certain cultural conditions, and therefore may need revision before they can be fruitfully applied to the behavior of young people in other cultures.     

Intergenerational differences in i.v. drug use behaviors: implications for HIV prevention

The spread of the human immunodeficiency virus through the IV-drug-using population poses a serious public health threat. The tendency is to consider one IV drug user much the same as another. However, there are likely subtle differences in the behaviors of IV drug users depending on sexual, ethnic, and age differences. This study looks at the IV-drug-using behaviors of young adults 18 to 25 and adults over the age of 40. The drugs injected and rates of injection do differ for the two groups. This would suggest that HIV prevention should be tailored in response to the age differences of the targeted drug users.     

Estimating population attributable risk for hepatitis C seroconversion in injecting drug users in Australia: implications for prevention policy and planning

Objective   To determine risk factors and estimate their population-level contribution to hepatitis C virus (HCV) burden.
Methods   Established and potentially modifiable risk factors were estimated using partial population attributable risk ( PAR_p ) in a cohort of new injecting drug users (IDUs) in Sydney, Australia.
Results   A total of 204 hepatitis C seronegative IDUs were recruited through street-based outreach, methadone clinics and needle and syringe programmes (NSPs) and followed-up at 3–6-monthly intervals. A total of 61 HCV seroconversions were observed during the follow-up [overall incidence rate of 45.8 per 100 person-years (95% confidence interval: 35.6–58.8)]. Overall, five potentially modifiable risk factors (sharing needles/syringes, sharing other injecting equipment, assisted injecting, frequency of injection and not being in drug treatment) accounted for approximately 50% of HCV cases observed.
Conclusion   While sharing needles/syringes or other injecting equipment were associated most strongly with increased risk of HCV infection, the PAR_p associated with these behaviours was relatively modest (12%) because they are relatively low-prevalence behaviours. Our analyses suggest that more HCV infection could be avoided by changing more common, but less strongly associated behaviours such as assisted injecting or daily injecting. Results suggest that to have a very substantial effect on HCV, a range of risk factors need modifying. The most efficient use of scarce resources in reducing HCV infections will require complex balancing between the PAR for a given risk factor(s), the efficacy of interventions to actually modify the risk factor, and the cost of these interventions.     

Teacher training in affective education for the primary prevention of adolescent drug abuse

Students in the experimental school were exposed over 3 years to teachers trained in a "generic" primary prevention program designed to deal with the affective needs of students. Students were expected to benefit from this exposure by adopting more positive attitudes, behaviors, and norms with regard to themselves, peers, teachers, and school. Ninth graders in the experimental school were compared with 9th graders in a control school; both groups were pretested during the first year of this study and posttested at the end of the third year. For boys, although there was a pattern of negative treatment effects, these were probably artifacts of the research design. For girls, there was no evidence of treatment effects. Analyses within the experimental school revealed a pattern of effects favoring students having the fewest classes with trained teachers. The results are discussed in terms of problems inherent in this type of strategy for the prevention of adolescent substance abuse.     

Long-term consequences of adolescent cannabis use: Examining intermediary processes

Background: In the United States, perceptions of marijuana’s acceptability are at an all-time high, risk perceptions among youth are low, and rates are rising among Black youth. Thus, it is imperative to increase the understanding of long-term effects of adolescent marijuana use and ways to mitigate adverse consequences. Objectives: To identify the midlife consequences of heavy adolescent marijuana use and the mechanisms driving effects among a Black, urban population. Methods: This study analyzed the propensity score-matched prospective data from the Woodlawn Study, a community cohort study of urban Black youth followed from ages 6–42. After matching the 165 adolescents who used marijuana heavily to 165 non-heavy/nonusers on background confounders to reduce selection effects (64.5% male), we tested the association of heavy marijuana use by age 16 with social, economic, and physical and psychological health outcomes in midlife and the ability of adult drug trajectories (marijuana, cocaine, and heroin use from ages 17–42) and school dropout to mediate effects. Results: Heavy adolescent marijuana use was associated with an increased risk of being poor and of being unmarried in midlife. Marijuana use also predicted lower income and greater anxious mood in midlife. Both adult drug use trajectories and school dropout significantly mediated socioeconomic effects but not marital or anxious mood outcomes. Conclusion: Heavy adolescent marijuana use seems to set Black, urban youth on a long-term trajectory of disadvantage that persists into midlife. It is critical to interrupt this long-term disadvantage through the prevention of heavy adolescent marijuana use, long-term marijuana and other drug use, and school dropout.     

On the importance of peer influence for adolescent drug use: commonly neglected considerations

Peer influence is generally believed to be a major cause of adolescent drug behavior. This paper reviews research findings on friend selection and projection to suggest that the magnitude of friend influence may be overestimated. This paper also observes that, although adolescent drug use is assumed to begin in response to peer group influence, peer groups have rarely been measured in studies of drug behavior. Social network analysis is identified as a promising method for measuring peer groups. The implications of this review for research and programs are considered.     

Drug use contexts and HIV-consequences: the effect of drug policy on patterns of everyday drug use in Rotterdam and the Bronx

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific ‘risk behaviors’ could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro-settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug-related behaviors in their social context and to better assess their relevance to public health–especially to AIDS     

Personalized medicine in women's obesity prevention and treatment: implications for research,policy and practice

The prevalence of obesity in America has reached epidemic proportions, and obesity among women is particularly concerning. Severe obesity (body mass index ≥35 kg m^?2) is more prevalent in women than men. Further, women have sex‐specific risk factors that must be considered when developing preventive and therapeutic interventions. This review presents personalized medicine as a dynamic approach to obesity prevention, management and treatment for women. First, we review obesity as a complex health issue, with contributing sex‐specific, demographic, psychosocial, behavioural, environmental, epigenetic and genetic/genomic risk factors. Second, we present personalized medicine as a rapidly advancing field of health care that seeks to quantify these complex risk factors to develop more targeted and effective strategies that can improve disease management and/or better minimize an individual's likelihood of developing obesity. Third, we discuss how personalized medicine can be applied in a clinical setting with current and emerging tools, including health risk assessments, personalized health plans, and strategies for increasing patient engagement. Finally, we discuss the need for additional research, training and policy that can enhance the practice of personalized medicine in women's obesity, including further advancements in the ‘‐omics’ sciences, physician training in personalized medicine, and additional development and standardization of innovative targeted therapies and clinical tools.     

Cognitive and social learning models of drug dependence: implications for the assessment of tobacco dependence in adolescents

This paper is part of a series that has the goal of identifying potential approaches toward developing new instruments for assessing tobacco dependence among adolescents. The fundamental assumption underlying the series is that contemporary theories of drug dependence offer a rich source of opportunities for the development of theoretically based assessment tools. The present paper focuses on cognitive and social-learning models of drug dependence and the implications of these models for novel assessment instruments. In particular, the paper focuses on Mark Goldman's model of drug expectancies, Albert Bandura's model of self-efficacy, Thomas Wills's model of stress and coping and Stephen Tiffany's cognitive-processing model of drug urges and cravings. In addition to traditional self-report measures, naturalistic and laboratory-based assessments are identified that may yield information relevant to multi-dimensional measurement of tobacco dependence.     

Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention

The importance of sharing infecting equipment in the transmission dynamics of HIV is well established. Comparatively less is known about the sexual behaviour of drug injectors and the risks posed to themselves and their sexual partners through the sexual transmission of HIV. Findings are reported from survey-based interviews undertaken in 1991 which investigated the sexual behaviour of 516 drug injectors, both in and out of treatment in London. The majority of respondents (80%) were sexually active in the 6 months preceding interview. During this time, respondents had a mean of 2.1 non-commercial opposite sex partners. Most (66%) had vaginal intercourse at least once a week, although 68% never used condoms with primary partners and 34% never used condoms with casual partners. Those having sexual intercourse most often were less likely to use condoms. Many had non-injecting sexual partners, and 62% of respondents' primary and casual partners did not inject drugs. Confirmed saliva HIV test results show 10% of respondents to be antibody positive, with a higher rate of prevalence (14% positive) among those with no experience of treatment. This group were also more likely la report casual sexual intercourse. The average rate of partner change, the high proportion of drug injectors with non-injecting partners and the infrequency of condom use within primary and casual relationships indicates the potential for HIV transmission between injectors and their non-injecting sexual partners. The paper concludes by emphasizing the importance of outreach and community-based intervention in safer sex health promotion.     

Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy

BACKGROUND: Alcohol is one of the most important risk factors for burden of disease. OBJECTIVE: To estimate the number of deaths and the years of life lost attributable to alcohol for Canada 2001 using different ways to measure alcohol exposure. METHODS: Distribution of exposure was taken from a major national survey of Canada, the Canadian Addiction Survey, and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific alcohol-attributable fractions (AAFs). For injury, AAFs were taken directly from available statistics. Information on mortality, with cause of death coded according to the International Classification of Diseases version 10 (ICD-10) was obtained from Statistics Canada. RESULTS: For Canada in 2001, 4,010 of all deaths in the group below 70 years of age were attributable to alcohol, 3,132 in men and 877 in women. This constituted 6.0% of all deaths in Canada in this age group, 7.6% for men, and 3.5% for women. The 4,010 deaths are a net figure, already taking into account the deaths prevented by moderate consumption of alcohol. Main causes of alcohol-attributable death were unintentional injuries, malignant neoplasms and digestive diseases. Ischaemic heart disease (IHD) was the biggest cause of death prevented by alcohol, with 78.7% of all alcohol-attributable prevented deaths in the age groups of 70 years and above. A total of 144,143 years of life were lost prematurely in Canada in that year, 113,079 years in men and 31,063 years in women. DISCUSSION: Regardless of the assumptions made, alcohol is a major contributor to mortality in Canada. The impact of alcohol on social life is not confined to mortality, as other studies indicated that alcohol is linked even more strongly to disability and social harm. Alcohol-attributable harm could be substantially reduced, however, if known effective policies were introduced.     

Antiviral resistance during pandemic influenza: implications for stockpiling and drug use

Background  

The anticipated extent of antiviral use during an influenza pandemic can have adverse consequences for the development of drug resistance and rationing of limited stockpiles. The strategic use of drugs is therefore a major public health concern in planning for effective pandemic responses.     

A policy for leishmaniasis with respect to the prevention and control of drug resistance

At the moment no country has a policy designed to control or prevent drug resistance in leishmaniasis. The risk of resistance is high in areas of anthroponotic visceral leishmaniasis, for example North Bihar, India, where the rate in some areas is 60%. Post-epidemic Sudan is also at risk. Zoonotic areas in which HIV co-infection is common could also be at risk as sandflies can become infected from co-infected individuals. Many factors determine the choice of drug for the treatment of visceral leishmaniasis, and drug resistance may not be the over-riding priority. In anthroponotic areas reduction in transmission through public health measures will be important, but the use of two drugs in combination should be seriously considered. Pharmacokinetic and other features of the drugs available, relevant to their use in combination are discussed and tentative suggestions made concerning trials of possible combinations. These include miltefosine plus paromomycin and allopurinol plus an azole. Lessons may be learnt from the experiences of similar problems in malaria, leprosy and tuberculosis. Guidelines are offered for the introduction of policies to use drugs in combination, which differ between anthroponotic and zoonotic areas of transmission.