Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug

<p>Abstract</p> <p>Background</p> <p>Due to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users.</p> <p>Method</p> <p>A qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software.</p> <p>Results</p> <p>There was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival.</p> <p>Conclusions</p> <p>The strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.</p

Haptoglobins and hemoglobin-haptoglobin complexes

Haptoglobins are serum glycoproteins which form complexes with hemoglobin. Three phenotypes of haptoglobin exist in serum (Hp 1-1, Hp 2-1, Hp 2-2). The latter two types exist as a series of polymers while the former type exists as a homogeneous protein. All three haptoglobin types consist of β (heavy), chains and α (light) chains which are attached by disulphides. The haptoglobin types differ in their a chains; Hp 1-1 contains only α¹ chains, while Hp 2-2 contains only α² chains and Hp 2-1 contains α¹ and α² chains. The hemoglobin-haptoglobin 1-1 complex consists of one molecule of hemoglobin attached to one molecule of haptoglobin. The thesis has been divided into three parts. The first part (Section III) is concerned with the reaction of haptoglobin with an octameric (double) hemoglobin obtained from an inbred strain of mice. In this hemoglobin each of the hemoglobin dimers is joined together by a disulphide bond. The fact that haptoglobin binds αβ dimers indicates that it is a bivalent molecule like the antibody molecule, immunoglobulin G (IgG). This bivalence and resultant resemblance to IgG is examined by studying the reaction of haptoglobin with this mouse hemoglobin in which the αβ dimer is held together by a disulphide bond. The results of both precipitation studies and acrylamide gel electrophoresis confirm the postulated bivalence of haptoglobin and its resemblance to an antibody. The second part (Section IV) of the thesis is concerned with confirming the results obtained in studying the disulphides of haptoglobin which were obtained by the cysteic acid diagonal technique. These results predicted a model in which the two halves of the haptoglobin molecule were held together by a disulphide bond at position 21α. Also the results predicted an intrachain loop disulphide between half-cystines at positions 35 and 69 in the haptoglobin α chain and an interchain disulphide between a half-cystine at position 73α and the β chain. This structure has been confirmed by studies on a cyanogen bromide fragment isolated from haptoglobin which contains the intact a chain. Also the structure has been confirmed by studies on a haptoglobin derivative in which the molecule has been split in half by the breaking of a disulphide bond. The third part (Section V) of this thesis is an investigation into the nature of the β93 sulphydryl of hemoglobin when hemoglobin is bound by haptoglobin. The results demonstrate that there is a definite change in the environment of this sulphydryl upon formation of the hemoglobin-haptoglobin complex. Studies with (14)C-iodoacetamide demonstrate however that β93 can still react in the HbHp complex.Medicine, Faculty ofBiochemistry and Molecular Biology, Department ofGraduat

Correlates of Secondhand Tobacco Smoke Exposure Among Persons with Severe and Persistent Mental Illness (SPMI) Accessing Community Mental Health Services

To examine the correlates of secondhand tobacco smoke (SHS) exposure in a sample of individuals with severe and persistent mental illness (SPMI) accessing community mental health services. Cross-sectional data were collected from a voluntary sample of 788 individuals with SPMI. Nonsmokers were more likely to be exposed on the street or at a bus stop, in a park or public place; whereas smokers were more likely to report SHS exposure where they lived and at their friend’s homes. In a multivariate model, only number of acquaintances who smoked and the number of sources of SHS exposure remained significantly associated with perceived frequency of SHS exposure when accounting for other correlates. There is a need for the enactment and enforcement of policies to curtail SHS exposure in outdoor, public, settings. Future research will be necessary to better understand the extent and impact of SHS exposure in this population

From knowledge to action: Knowledge translation in the “real world” of clinical psychiatry

Tobacco use disproportionately affects the wellbeing of individuals with severe and persistent mental illness. There are cultural norms regarding smoking in psychiatric settings where cigarette smoking is often viewed as a point of therapeutic connection between clients and providers and used to modify clients’ behaviour. Practitioners are often ambivalent about their clients’ tobacco use and may minimize tobacco’s harms. Given these culturally embedded behaviours, how can we develop and introduce effective, evidence-informed smoking cessation interventions into these institutional settings? To date, much of the knowledge translation (KT) literature has ignored the difficult question of how to support organizational change. In this presentation, we use the CACTUS project as a case study in KT. We begin by examining a commonly used KT framework: the CIHR Knowledge to Action Process. This macro level model describes the iterative steps one moves through when planning and implementing KT. We describe several challenges in using the CIHR framework, focusing on the lack of prescriptive steps within the implementation of interventions stage. We discuss two novel approaches that provided us with much needed direction for engagement with the practice communities. The first approach is Appreciative Inquiry (AI). Rather than being deficit based, AI is a generative process that asks us to consider what might be possible, or what we want more of. The other approach we found helpful is Motivational Interviewing (MI). The principles of MI helped us to think about how to meaningfully engage with practice groups in a positive way. AI and MI complement each other because they both use affirmative approaches to encourage behaviour change.Applied Science, Faculty ofNursing, School ofUnreviewedFacultyResearche

Nicotine dependence and gender differences in smokers accessing community mental health services

Despite evidence of differences in smoking behaviour between women and men, few studies have assessed these differences in individuals with mental illnesses. In this cross-sectional study, we explored gender differences in smoking behaviour among 298 individuals (60% male) accessing community mental health services. Individuals with a psychotic disorder as compared with a non-psychotic disorder, and individuals using a greater number of substances were more likely to be male. Readiness to change, daily cigarette consumption and level of nicotine dependence did not differ between men and women; however, subjective ratings of tobacco addiction were higher in women than in men. Among women, only scores on the subjective tobacco addiction scale were associated with nicotine dependence, while among men, a variety of variables were associated with nicotine dependence. These factors are important for understanding individual differences in tobacco dependence among clients with mental illnesses, and are expected to inform future studies examining tobacco use in mental health treatment populations

Assessing Secondhand Tobacco Smoke Exposure Among Persons with Severe and Persistent Mental Illness

Background • Secondhand tobacco smoke (SHS) exposure increases the risk for cancer, respiratory illness, and cardiovascular disease. • Individuals with severe and persistent mental illness (SPMI) have a higher smoking prevalence than the general population, placing them at increased risk for related morbidity and mortality. • Given the higher smoking prevalence in this population, the risk for SHS exposure among smokers and nonsmokers with SPMI should be an issue of concern. Yet, SHS exposure in this population is understudied. • The purpose of our study was to examine the correlates of SHS exposure in this population. Our specific aims were to: a) Describe the frequency, sources, and feelings towards SHS exposure among individuals with SPMI accessing community mental health services b) Assess factors (i.e., gender, demographics, living situation, primary diagnosis, and substance use history) associated with SHS exposure among smokers and nonsmokers with SPMI accessing community mental health services

In the shadow of a new smoke free policy: A discourse analysis of health care providers' engagement in tobacco control in community mental health

Background: The prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community mental health despite the fact that many individuals with mental illness are heavy smokers and experience undue tobacco-related health consequences. Methods: This qualitative study used methods of discourse analysis to examine the perceptions of health care providers, both professionals and paraprofessionals, in relation to their roles in tobacco control in the community mental health system. Tobacco control is best conceptualised as a suite of policies and practices directed at supporting smoke free premises, smoking cessation counselling and limiting access to tobacco products. The study took place following the establishment of a new policy that restricted tobacco smoking inside all mental health facilities and on their grounds. Ninety one health care providers participated in open-ended interviews in which they described their role in tobacco control. The interview data were analyzed discursively by asking questions such as: what assumptions underlie what is being said about tobacco? Results: Five separate yet overlapping discursive frames were identified in which providers described their roles. Managing a smoke free environment emphasised the need to police and monitor the smoke free environment. Tobacco is therapeutic was a discourse that underscored the putative value of smoking for clients. Tobacco use is an individual choice located the decision to smoke with individual clients thereby negating a role in tobacco control for providers. It's someone else's role was a discourse that placed responsibility for tobacco control with others. Finally, the discourse of tobacco control as health promotion located tobacco control in a range of activities that are used to support the health of clients. Conclusions: This study provides insights into the complex factors that shape tobacco control practices in the mental health field and reinforces the need to see practice change as a matter that extends beyond the individual. The study findings highlight discourses structured by power and powerlessness in environments in which health care providers are both imposing and resisting the smoke free policy.Applied Science, Faculty ofNursing, School ofOther UBCReviewedFacult

Women's Stories/Women's Lives: Creating Safer Crack Kits

In 2004, a research team comprising researchers and service providers launched the Safer Crack Use, Outreach, Research and Education (SCORE) project, aimed at developing a better understanding of the harms associated with crack cocaine smoking and determining the feasibility of specific harm reduction strategies to reduce the likelihood of harms in an inner-city neighbourhood in Canada. The project included several activities, and the ‘women-centred’ activity of constructing harm-reduction kits is the emphasis of this paper. The data for this study are derived from the field notes taken during kit-making sessions with 200 women and from qualitative interviews with the group facilitators. A salient theme of the analysis was the tremendous support that was afforded to women engaging in this activity. Three sub-themes were also identified: (a) creating a safe space, (b) sharing information, and (c) building community. Women-centred activities are an effective means of creating a supportive environment for women and to learn about women’s perspectives concerning the relevance of these activities in their daily lives