Estimating the Production, Consumption and Export of Cannabis: The Dutch case

Highlights

• Availability of indicators to estimate the illegal cannabis market is limited.
• Uncertainty is inherent in estimates of the size of illegal cannabis markets.
• Models are valuable to assess the size and uncertainty of illegal market estimates.
• Between 171 and 965 tons (95% IE of 271 to 613 tons) of Dutch cannabis is produced.
• Between 53 and 937 tons (95% IE of 206 to 573 tons) of Dutch cannabis is exported.

Abstract

Background

Quantifying an illegal phenomenon like a drug market is inherently complex due to its hidden nature and the limited availability of reliable information. This article presents findings from a recent estimate of the production, consumption and export of Dutch cannabis and discusses the opportunities provided by, and limitations of, mathematical models for estimating the illegal cannabis market.

Methods

The data collection consisted of a comprehensive literature study, secondary analyses on data from available registrations (2012-2014) and previous studies, and expert opinion. The cannabis market was quantified with several mathematical models. The data analysis included a Monte Carlo simulation to come to a 95% interval estimate (IE) and a sensitivity analysis to identify the most influential indicators.

Results

The annual production of Dutch cannabis was estimated to be between 171 and 965 tons (95% IE of 271 to 613 tons). The consumption was estimated to be between 28 and 119 tons, depending on the inclusion or exclusion of non-residents (95% IE of 51 to 78 tons or 32 to 49 tons respectively). The export was estimated to be between 53 and 937 tons (95% IE of 206 to 549 tons or 231 to 573 tons respectively).

Conclusion

Mathematical models are valuable tools for the systematic assessment of the size of illegal markets and determining the uncertainty inherent in the estimates. The estimates required the use of many assumptions and the availability of reliable indicators was limited. This uncertainty is reflected in the wide ranges of the estimates. The estimates are sensitive to 10 of the 45 indicators. These 10 account for 86% to 93% of the variation found. Further research should focus on improving the variables and the independence of the mathematical models.

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By:  M. van der Giessen (Mark), M.M.J. van Ooyen-Houben (Marianne)¹, D.E.G. Moolenaar (Debora)¹

Erasmus University Rotterdam, Rotterdam School of Management,bBurgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands

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Assessing Reactive and Proactive Aggression in Detained Adolescents Outside of a Research Context

The Reactive Proactive Aggression Questionnaire (RPQ) is a self-report tool for assessing reactive aggression (RA) and proactive aggression (PA). This study contributes to the literature by testing the psychometric properties of the RPQ across detained boys from various ethnicities whilst using data that were gathered during clinical assessments. The factorial, convergent, and criterion validity, and the internal consistency of the RPQ scores received strong support in the total sample and across four ethnicity groups. Also, three groups of boys were identified, with the group including boys with high levels of both RA and PA including the most severe boys in terms of anger, delinquency, alcohol/drug use, and psychopathic traits, and having the highest prevalence rate of conduct disorder and substance use disorder. Together, these findings suggest that the RPQ may hold promise for assessing RA and PA in detained boys, even when confidentiality and anonymity of the information is not guaranteed.

… Results from confirmatory factor analyses (CFA) supported the two-factor structure over the one-factor structure of the RPQ, and showed that a significant distinction can be made between reactive aggression and proactive aggression in detained adolescent males. Specifically, all model fit indices were indicative of an acceptable or good model fit in the total sample and in youths from various ethnicities, except for the χ²/df ratio for the total sample. However, with increasing sample size and a constant number of degrees of freedom, the χ² value increases, and theχ²/df ratio, therefore, may suggest to reject a plausible model [38]. Because the χ²/df ratio was below the cut-off value in three subgroups and because all the other fit indices supported the two-factor model of the RPQ, this model can be considered to be acceptable in the total sample as well.

Our findings also provide support for the convergent validity of the RPQ scores. At the zero-order level, RPQ total, RA and PA scores, were positively related to other indices of aggressive behavior and features of anger-irritability. Also, after controlling for the PA score, only the RA score remained significantly related to anger and irritability, but was no longer related to aggressive CD symptoms. These results support the view that reactive, but not proactive aggression, is often accompanied with anger and a loss of impulse control [4,5]. Although some of the aggressive CD symptoms can occur as an uncontrolled response to frustration or anger (e.g., forcing someone into sexual activity, initiating fights, using a weapon that can cause serious physical harm), the RA score was never significantly related to aggressive CD symptoms after controlling for the PA score. Yet, after controlling for the RA score, the PA score remained significantly related to aggressive CD symptoms (Table 3) in the total sample and Dutch and Moroccan boys. This suggests that the aggression displayed by detained youths with a CD diagnosis is likely to be premeditated and planned, a notion that is supported by the finding that only the PA score was positively related to aggressive conduct disorder (Tables 4, ​,55).

The results also supported the criterion validity of the RPQ score in detained male youths. As hypothesized, only the RA score was positively related to depressive feelings, anxiety, and suicide ideation after controlling for the other RPQ scale score. Although there were no clear expectations about the relationship between the RPQ and social problems, the RA score was positively associated with this outcome in the total sample and some ethnicity groups. Overall, our findings are in accordance with recent work, including studies that scrutinized relations with suicide risk, social problems and peer rejection [41, 42], and support the claim that reactive aggression is an indicator of overall poor psychosocial adjustment [13]. However, the results do not support the suggestion that reactive aggression is primarily related to low prosocial behavior, and that proactive aggression has little or no association with prosocial behavior independent of reactive aggression [13]. In contrast, the present study showed that only the PA score was significantly negatively related to prosocial behavior after controlling for the RA score. Given that few studies addressed the relationship between self-reported reactive and proactive aggression and prosocial behavior, future studies are warranted. The finding that a higher PA score was associated with a lower level of prosocial behavior, nevertheless, corresponds with the finding that only PA was positively related to self-reported offenses (Tables 4, ​,55)…

Full article at:   http://goo.gl/O5mjWE

By:  Olivier F. Colins

Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands

Academic Workplace Forensic Care for Youth (Academische Werkplaats Forensische Zorg voor Jeugd), Zutphen, The Netherlands

Olivier F. Colins, Email: ln.muiruc@sniloc.o.

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Perceptions among Dutch Men Who Have Sex with Men & Their Willingness to Use Rectal Microbicides & Oral Pre-Exposure Prophylaxis to Reduce HIV Risk

Oral pre-exposure prophylaxis (PrEP) with antiretroviral (ARV) tablets and topical PrEP or microbicides containing ARV drugs could help to reduce HIV incidence. These methods hold promise for men who have sex with men (MSM) who are at higher risk of acquiring HIV. 

This mixed-methods study in the Netherlands explored perceptions of MSM and their willingness to use oral PrEP and rectal microbicides (RM) if made available. Recruited through social media (Facebook and Twitter), 108 MSM completed online questionnaires. Seven of them consented to discuss the survey results in semi-structured interviews. 

Survey participants preferred a RM that could be applied before and after anal intercourse (60.8%) to daily oral PrEP (20.3%). This preference was based on anticipated user friendliness, hypothetically fewer expected adverse events, and perceptions that RM would be less likely to be confused with ARVs for treatment. 

Those who preferred oral PrEP had stronger beliefs in the effectiveness of pills, perceived its use as easy, and viewed not requiring sexual partner awareness as advantages. No predictive factors were found for the choice of one prevention method over the other. Although Dutch MSM perceive both oral and topical PrEP positively, many barriers exist to the introduction of these products in the Netherlands. These include lack of regulatory approval of oral PrEP, no proven efficacy as yet for RM, and strong HIV stigma within the MSM population. 

In-depth qualitative research is needed to further explore the perceptions of MSM to inform implementation of programmes should these HIV prevention methods become available.

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By:   Marra E1, Hankins CA1,2.

• 1a Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands.
• 2b London School of Hygiene and Tropical Medicine , Amsterdam , The Netherlands. 

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The Impact of Intimate Partner Violence (IPV) on Parenting by Mothers within an Ethnically Diverse Population in the Netherlands

Intimate partner violence (IPV) profoundly affects multiple life domains for the people involved. We report on the experiences of Dutch mothers of various ethnic backgrounds regarding their parenting during and after IPV, their perceptions of the influence of IPV on their parenting, as well as their need for and experiences with support services. We conducted qualitative interviews with 100 mothers in the Netherlands who had experienced IPV. Most reported negative experiences with parenting (both during and after the IPV), a strong effect of the IPV on their parenting, as well as circumstances that aggravated this effect. The mothers had used multiple sources of formal and informal support. Although most evaluated the support that they had received positively, some also mentioned mixed or negative experiences. Many were still in need of support. Relationships with ethnic background and the severity of IPV are discussed...

In line with findings from several previous studies (Hungerford et al. 2012; Levendosky et al. 2000), the majority of the mothers in this study reported negative experiences with parenting, both during and—though to a lesser extent—after the IPV period. At the time of the interview, more than a quarter of the mothers mentioned being unable to cope with parenting, either incidentally or continuously. In their narratives, there was a strong relationship between the IPV and parenting difficulties (in line with previous studies; Buehler and Gerard 2002; Krishnakumar and Buehler 2000; Letourneau et al. 2011). The severity of the IPV appeared to be related to more negative parenting experiences, and difficulty shielding children from the violence during the IPV period, as well as to parenting problems after the IPV period. In their narratives about how IPV influenced their parenting, mothers emphasized determinants similar to Belsky (1984): child and parent characteristics, sources of stress and support. They mentioned behavior problems of their children as a consequence of the IPV (remarkably mainly emphasized in the after IPV period), diminished personal wellbeing (e.g., mentally, physically, financially) and stress due to the IPV, as well as lack of support by the fathers (e.g., no involvement, undermining behavior, negative parenting practices, legal issues, problems with visiting arrangements), as well as by others in their informal network (especially during the IPV period).

Issues with fathers concerning co-parenting and custody have also been reported in other studies about parenting after divorce in IPV situations (Edleson and Williams 2007; Hardesty et al. 2008; Walker et al.2004). Hardesty and Chung (2006) emphasize the impact of the dominant assumption (within both the legal system and public opinion) that maintaining a relationship with the father is in the best interest of the child. Because of this assumption, mothers’ attempts to protect themselves and their children are often overlooked and undermined, possibly increasing their fear of co-parenting. Our findings are comparable to these results. The mothers in our study reported feelings of being trapped between institutional demands to keep their children safe and the requirement to allow the children contact with their fathers. The limited previous studies that focus on fathering in IPV families confirm that father’s involvement and parenting skills in this context are reduced (Edleson and Williams 2007; Holden and Ritchie 1991).

The fact that mothers’ parenting problems decrease but do not disappear after IPV has ended might be explained by the prolonged impact of IPV on the wellbeing of both mothers and children. The finding that problems with children became more apparent after the IPV period might be related to the dominance of the violence during the IPV, which does not leave much room for sensitivity to the children’s problem signals.

In addition to negative effects of IPV, Levendosky and colleagues (2000) mention positive effects that IPV can have on the parenting of mothers. The mothers in the current study did not explicitly refer to any positive effects. They nevertheless mentioned that they had developed coping strategies for protecting their children from the IPV (or the negative consequences thereof). Strategies employed during the IPV period included avoiding quarrels, sending children away, paying them extra attention, and seeking external help. Strategies adopted after the IPV period included talking about the IPV, emphasizing that their children should not blame themselves, teaching their children that IPV is not normal, offering peace and structure, and stressing the importance of assertiveness in daughters and empathy and respect in sons. As the latter was not always modeled by the mothers and fathers, these goals will not necessarily be achieved (Parke 1996). Nevertheless, following Levendosky et al., such strategies can be classified as positive effects on parenting, in that mothers “mobilized their resources to respond to the violence on behalf of their children” (2000, p. 266).

We identified some differences in parenting practices (including coping strategies), specifically with regard to the period after the IPV. Turkish mothers were most likely to report negative parenting experiences. This finding might have been influenced by in-group collectivism and a lack of support. Within communities in which greater value is attached to family collectivism, there is a stronger tendency to endure violent relationships and to avoid airing one’s dirty laundry (see also Kasturirangan et al. 2004; Yerden 2008). This tendency was especially prevalent among the Turkish, Moroccan, and Hindustani-Surinamese mothers. This finding could be related to the stronger patriarchal culture and collectivism of these ethnic groups, as compared to the more individualistic or matriarchal nature of the Dutch, Afro-Surinamese, and Antillean groups (see also Merz et al. 2009). The Turkish community especially is known for its high level of collectivism and tight internal bonding (Gijsberts and Dagevos 2009). In addition, mothers’ history of immigration may affect the support they can invoke. A relatively high percentage of the Turkish mothers were new immigrants. Newly arrived mothers may have smaller networks and may be less informed about their rights as victims and available support services.

Other more general barriers to finding/seeking support that were mentioned by mothers included financial barriers, psychological barriers, and previous negative experiences. These findings are consistent with those reported by Rodriguez and colleagues (2009). Mothers eventually used multiple sources of informal and formal support. The majority of these mothers judged the support that they had received positively, but mixed or negative experiences were mentioned as well. Most of the mothers from all ethnic groups had experienced more positive support from their families after the IPV period than during this period. With regard to formal support, mothers were most negative about forced support, and they were most positive about easily accessible forms of parental support in places where they feel comfortable and know the people, e.g., support provided by schools and GPs...

  

Full article at: http://goo.gl/Oljt5p

By: Trees Pels, Floor Barbera van Rooij, and Marjolijn Distelbrink

• 1Free University, Amsterdam, The Netherlands ; Verwey Jonker Institute, Utrecht, The Netherlands.
• 2University of Amsterdam, PO Box 15780, 1001 NG Amsterdam, The Netherlands.
• 3Verwey Jonker Institute, Utrecht, The Netherlands.  

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Self-Reported Care Needs of Dutch Homeless People with & without a Suspected Intellectual Disability: A 1.5-Year Follow-Up Study

Cognitive impairment is a prevalent problem among the homeless and seems related to more psychosocial problems. However, little is known about the care needs of the subgroup of homeless people with an intellectual disability compared to those without an intellectual disability and how their care needs develop over time. This study explores self-reported care needs within a broad range of life domains among Dutch homeless people with and without a suspected intellectual disability to gain insight into the transition of self-reported care needs from baseline to follow-up in both subgroups. 

This longitudinal study is part of a cohort study among homeless people who had been accepted for an individual programme plan in four major Dutch cities. The initial cohort consisted of 513 participants who were interviewed in 2011. At 1.5-year follow-up, 336 participants (65.5%) were also interviewed and screened for intellectual disability. Of these participants, 31% had a suspected intellectual disability. For both groups, between baseline and follow-up, the number of 'unmet care needs' decreased significantly and the number of 'no care needs' increased significantly, while at follow-up, participants with a suspected intellectual disability reported 'no care needs' on significantly fewer life domains than those without a suspected intellectual disability (mean numbers 16.4 vs. 17.5). Between baseline and follow-up, 'met care needs' decreased significantly on housing for both groups, and increased on finances and dental care for participants with a suspected intellectual disability. At follow-up, participants with a suspected intellectual disability more often preferred housing support available by appointment than those without a suspected intellectual disability. 

These findings suggest that homeless people who had been accepted for an individual programme plan with a suspected intellectual disability have care needs for a longer period of time than those without a suspected intellectual disability. Providing care to homelesspeople with a suspected intellectual disability might require ongoing care and support, also after exiting homelessness. Support services should take this into account when considering their care provision and planning of services.

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By: Van Straaten B1,2, Rodenburg G1,2, Van der Laan J3,4, Boersma SN3, Wolf JR3, Van de Mheen D1,2,5.

• 1Erasmus Medical Centre, Rotterdam, the Netherlands.
• 2IVO Addiction Research Institute, Rotterdam, the Netherlands.
• 3Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands.
• 4Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
• 5Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.  

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Comparison of STI-related consultations among ethnic groups in the Netherlands

Below:  Reporting rate of STI-related episodes per year (2002 to 2011). a) Reporting rate of STI-related episodes by ethnicity. b) Reporting rate of STI-related episodes by generation of ethnic minorities (EM)

The reporting rate of STI-related episodes increased from 2004 to 2011 among all ethnic groups, and was higher among EM than among native Dutch, except for Turkish EM. After adjustment for gender, age, and degree of urbanization, the reporting rate in 2011 was higher among Surinamese [Odds Ratio (OR) 1.99, 95 % confidence interval (CI) 1.70-2.33], Antillean/Aruban (OR 2.48, 95 % CI 2.04-3.01), and Western EM (OR 1.24, 95 % CI 1.11-1.39) compared with native Dutch, whereas it was lower among Turkish EM (OR 0.48, 95 % CI 0.37-0.61). Women consulted the GP relatively more frequently regarding STIs than men, except for Turkish and Moroccan women.

Most EM consult their GP more often for STI care than native Dutch. However, it remains unclear whether this covers the need of EM groups at higher STI risk. As a first point of contact for care, GPs can play an important role in reaching EM for (proactive) STI/HIV testing.

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