Introduction to Psychoactive Drugs

Via:  http://goo.gl/mqlmlj
By:  http://goo.gl/WUevak and http://goo.gl/kjharo

Social Networks & Substance Use among At-Risk Emerging Adults Living in Disadvantaged Urban Areas in the Southern U.S.

BACKGROUND AND AIMS:

Substance use and risk-taking are common during emerging adulthood, a transitional period when peer influences often increase and family influences decrease. Investigating relationships between social network features and substance use can inform community-based prevention programs. This study investigated whether substance use among emerging adults living in disadvantaged urban areas was influenced by peer and family social network messages that variously encouraged and discouraged substance use.

DESIGN:

Cross-sectional, naturalistic field study.

SETTING AND PARTICIPANTS:

Lower-income neighborhoods in Birmingham, Alabama, USA with 344 participants (110 males, 234 females, ages 15-25 years; mean = 18.86 years), recruited via respondent-driven sampling.

MEASUREMENTS:

During structured interviews conducted in community locations, the Alcohol, Smoking and Substance Involvement Screening Test assessed substance use and related problems. Predictor variables were network characteristics, including presence of substance-using peers, messages from friends and family members about substance use and network sources for health information.

FINDINGS:

Higher substance involvement was associated with friend and family encouragement of use and having close peer network members who used substances (Ps < 0.001). Peer discouragement of substance use was associated with reduced risk (b = - 1.46, P < 0.05), whereas family discouragement had no protective association.

CONCLUSIONS:

Social networks appear to be important in both promoting and preventing substance use in disadvantaged young adults in the United States.

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By:   Tucker JA1, Cheong J1, Chandler SD1, Crawford SM2, Simpson CA2.

• 1University of Florida, Gainesville, FL, USA.
• 2School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. 

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Premarital First Births: The Influence of the Timing of Sexual Onset Versus Post-Onset Risks in the United States

Motivated by long-standing debates between abstinence proponents and sceptics, we examine how socio-economic factors influence premarital first births via: (i) age at first sexual intercourse and (ii) the risk of a premarital first birth following the onset of sexual activity. Factors associated with an earlier age at first intercourse will imply more premarital first births owing to increased exposure to risk, but many of these same factors will also be associated with higher risks of a premarital first birth following onset. Our analyses confirm previous findings that women from disadvantaged backgrounds are younger at first intercourse and have higher premarital first-birth risks than women from more advantaged backgrounds. However, differences in onset timing have a strikingly smaller influence on premarital first-birth probabilities than do differences in post-onset risks. Our findings thus suggest that premarital first births result primarily from differences in post-onset risk behaviours as opposed to differences in onset timing...

Our empirical results confirm previous findings that women from disadvantaged backgrounds initiate sexual activity earlier and have more premarital first births than those from more advantaged backgrounds. Our hazard regressions reveal strikingly different effects of covariate for the transitions to sexual activity and to a premarital first birth following onset. A standard set of sociodemographic variables have large and statistically significant associations with premarital first birth risks following onset. These same variables have smaller associations with onset risk, and only a subset are statistically significant. These findings provide empirical hints that some aspects of these two processes may be behaviorally distinct. Results from decompositions comparing median onset timing for disadvantaged and advantaged groups show that, net of controls, differences in exposure to risk have only a small influence on the probability of a premarital first birth, but that group differences in post-onset risks have a sizeable influence on the probability of a premarital first birth. This pattern—small effects of differential exposure to risk but sizeable differences in post-onset risks—holds for all the variables we examine.

Why might this be? Some insight can be gleaned by contrasting what is characteristic of sexual onset vs. a premarital first birth. A higher risk of an event usually implies more individuals experiencing the event, and our results show that this holds for premarital first births. Thus, we find that sizeable and statistically significant group differences in post-onset premarital first birth risks imply equally sizeable group differences in the probability of such births. Sexual onset is different. Premarital sexual activity was both close to universal and highly compressed in this birth cohort of women, with estimated group differences in median ages at onset of 0.7 to 9.0 months after conditioning on background controls. Taken together, near universality and compression mean that even sizeable and statistically significant group differences in onset risks imply only modest group differences in onset timing.

These results also speak, in part, to policies such as the abstinence provisions in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act by providing answers to “what if” questions such as “What might be the expected consequence for premarital first births were a policy to delay onset by an amount equal to that for women from intact vs. nonintact families?” Our results suggest that for premarital first births, onset timing plays a quite minor role relative to post-onset risks. This negative finding—that onset timing plays only a minor role—is, we believe, likely to be robust against factors not observed in our data in that the class of unobservables needed to reverse this finding will be far smaller than usual.

Our results thus suggest that policies seeking to influence post-onset behaviors may be far more effective than those seeking to delay sexual onset. But our findings do not distinguish between a variety of post-onset factors, including the frequency of post-onset sexual activity; contraceptive use, knowledge, and consistency; whether pregnancies are planned or unplanned; abortion availability and utilization; and how such options are weighed when individuals confront different sets of circumstances. Our results thus speak to the question of when policies to reduce premarital first births might be most effective, but say little about which post-onset behaviors might be most effectively targeted.

Further caution is warranted in that the outcomes we analyze have been evolving rapidly. In the United States, there have been sharp declines in teen fertility and steady increases in nonmarital fertility, but only modest increases in women’s age at first sexual intercourse, with premarital sexual activity remaining nearly universal. These trends reinforce our belief that our central finding—that for the probability of a premarital first birth, onset timing plays a quite minor role relative to post-onset risks—will likely hold for more recent birth cohorts of women. What has undoubtedly changed are factors influencing post-onset risks—post-onset contraception has improved among sexually active teens and young adults, and there have been sharp increases in births to cohabiting couples. This study thus provides only a first step towards examining these and other proximate determinants, but our findings also suggest that future research on such factors may hold substantial promise for better understanding the behavioral subprocesses underlying nonmarital fertility...

Full article at:  http://goo.gl/Vu9OTZ

By:  Lawrence L. Wu, Steven P. Martin, 

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Sex Partner Type, Drug Use and Condom Use Self-Efficacy among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. 

The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. 

Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. 

Women with drug-using partners, especially a steady partner, were least likely to report CCU. 

Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.

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By:  Nehl EJ1, Elifson K1, DePadilla L1, Sterk C1.

• 1 Department of Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University.

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'Becoming a Physician' - Medical Students Get Acquainted with Disadvantaged Populations & Practise Sensitive & Effective Communication

The three-year pre-medical programme 'Becoming a Physician' focuses on different aspects of medical professionalism. Objectives are to increase awareness and sensitivity to disadvantaged populations, and practise sensitive effective communication skills.

The curriculum includes: (1) Visits to treatment centres for people with special needs, mental illnesses, substance abuse issues, physically or sexually abused, and prisoners. Students tour the facility, hold discussions with residents, and discuss ethical professional interrelations to the medical world. Students then write 'reflective diaries' summarizing their thoughts and emotions. (2) Participation in a communication course that focuses on learning by practising patient-oriented communication. Qualitative data were collected from three sources: reflective diaries, students' course evaluations, and interviews with the students' tutors.

Data indicated that the students were very satisfied with the programme. They indicated an increase in awareness of the special needs of diverse populations, and in the sense of efficacy for conducting interviews tailored to patients' needs. Tutors reported a sense of 'personal growth' following their role as mentors.

Interactions of medical students with diverse populations, when accompanied by appropriate feedback mechanisms and strengthening of communication skills, can improve awareness and sensitivity to patients' special needs. This could help students become more sensitive and thoughtful physicians.

Full article at:  http://goo.gl/CgY7fg

By: Riskin A1,2, Kerem NC3, Van-Raalte R3, Kaffman M3, Yakov G3, Aizenbud D3, Ben-Barak A3, Shachor-Meyouhas Y3, Edery R3, Shabtai Musih Y3, Sagi S3,Eidelman O3, Rotschild A3.

• 1Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel, Institute of Technology, Haifa, Israel. arik.riskin@gmail.com.
• 2Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, PO Box 4940, 31048, Haifa, Israel. arik.riskin@gmail.com.
• 3Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel, Institute of Technology, Haifa, Israel.  

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Risk & Resiliency Factors Influencing Onset & Adolescence-Limited Commercial Sexual Exploitation of Disadvantaged Girls

Previous research into age-related variables relevant to girls and young women being involved in commercial sexual exploitation (including prostitution) has not distinguished between its onset and limitation to adolescence and its early onset and persistence into adult life.

The aims of this study were to examine variables associated with adolescent versus adult onset of commercial sexual exploitation and identify potential risk and resiliency factors differentiating adolescence-limited sexual exploitation and early-onset-adult persistent exploitation.

Interviews with 174 vulnerable mostly African-American women, 23% of whom reported commercial sexual exploitation in adolescence and/or adulthood, yielded data, which were analysed using multinomial logistic regressions.

Adolescent sexual victimisation, younger age at first alcohol/drug use, being a victim of intimate partner violence and sense of stigmatisation of sexual self/others were all variables associated with adolescent onset of commercial sexual exploitation. Educational attainment differentiated adolescence limited from adolescent-adult persistent exploitation; exploitation had ceased by adulthood among over two-thirds of those who completed at least high school education, but only 13% of those exploited into adult life had finished high school.

As level of education was linked to cessation of exploitation by adulthood, support for vulnerable girls to complete education at least to high school level may be protective.The link between early onset of substance misuse and persistent exploitation suggests that education and support specifically targeted within this field could reduce likelihood of persistent abuse.Work directed at improvement of self-image may also reduce risk of persistent exploitation.

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By: Reid JA1.

• 1University of Massachusetts Lowell, Lowell, MA, USA.  

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The Nature and Extent of Child Protection Involvement among Heroin-Using Mothers in Treatment: High Rates of Reports, Removals at Birth and Children in Care

A substantial proportion of women in treatment for substance use problems are mothers of dependent children, but only a small number of studies have explored the nature and extent of their child protection involvement with substance-using mothers themselves.

The 171 mothers were disadvantaged and marginalised and had 302 children under the age of 16 years, 99 of whom were in out-of-home care. 

• Nearly half the children in care (n = 42) had been removed at the time of their birth, 
• and half (n = 49) had been removed from a mother who was on an OTP at the time. 

Among the younger children (age 1-2 years), higher proportions had been removed at birth than among the older children. None of the 32 mothers who had a child removed at birth and then gave birth subsequently retained care of their new baby. Women often chose to enter treatment (63.6%) for child-related reasons (35%) and attempted to shield their children from their substance use. Few health services were provided to them outside the availability of OTP.

Entering treatment presents an opportunity for improving outcomes for these women and their children and to reduce future involvement with the child protection system.

Via: http://ht.ly/SpqLd 

By: Taplin S1, Mattick RP.

• 1Institute of Child Protection Studies, Australian Catholic University, Canberra, Australia.
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The Interplay Between Drug-Use Behaviors, Settings & Access to Care: Exploring Attitudes & Experiences of Crack Cocaine Users in Rio De Janeiro & São Paulo, Brazil

Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues.

For study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use.

Disadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.

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