Volatile substance misuse among high school students in South America

This article summarizes data from a 2004 study of over 300,000 high school students (aged 13–18 years) in nine South American countries. A probabilistic sample targeted urban secondary schools, utilizing a self-administered questionnaire on prevalence and frequency of substance use. Multivariate analysis showed that volatile substances were the first or second most commonly reported substances used after alcohol and cigarettes in all countries (lifetime prevalence range: 2.67% [Paraguay] to 16.55% [Brazil]). Previous studies have highlighted volatile substance misuse among street children, whereas this study demonstrates that it is common among South American high school students.This work was supported through a collaborative effort between the United Nations Office on Drugs and Crime and the Organization of American States through the Inter-American Drug Abuse Control Commission (CICAD). Study design and project implementation was done through CICAD at the Inter-American Observatory on Drugs. In addition, fieldwork was done through the National Drug Commissions of Argentina, Bolivia, Brazil, Chile, Ecuador, Paraguay, Peru, and Uruguay. Support was also received by NIH/NIDA research project award R01DA021181 as well as from the School of Social Work Vivian A. and James L. Curtis School of Social Work Research and Training Center at the University of Michigan. In addition, support was received from the 1C Research Productivity Grant from National Council of Scientific Development (CNPQ) of the Ministry of Science and Technology of Brazil. (United Nations Office on Drugs and Crime; Organization of American States through the Inter-American Drug Abuse Control Commission (CICAD); R01DA021181 - NIH/NIDA; School of Social Work Vivian A. and James L. Curtis School of Social Work Research and Training Center at the University of Michigan; National Council of Scientific Development (CNPQ) of the Ministry of Science and Technology of Brazil

The Future of US-Colombia Relations

Colombia has been one of the United States’ closest allies in the region, stretching back to the 1950s. Colombia was the only Latin American country to join the Korean War in a direct military role. In 1951, the first 1,000 Colombian soldiers disembarked in South Korea where they maintained a military presence until the end of the war. During the 1960s and 1970s, Colombia became one of the largest recipients of United States assistance in Latin America. The assistance was designed to enable Colombia to develop economically through industrialization, agrarian, and social reforms and helped solidify Colombian-U.S. military relations.1 Colombia’s support of the United States during the war and the U.S.’ economic support of Colombia during the 1960s and 1970s fostered a multi-faceted, long-lasting diplomatic and military relationship between the two countries that has evolved, but remained strong for over half a century.https://digitalcommons.fiu.edu/jgi_research/1006/thumbnail.jp

Feasibility of a virtual reality program to treat children with fear of darkness with nonexpert therapists

Fear of darkness is highly prevalent and stable in children and often ends up becoming a specific situational phobia. The aim of this study is to analyze the feasibility of adapting and applying it through a Virtual Reality (VR) tool by nonexpert therapists. A pre-experimental study was carried out with six participants between the ages of 8 and 12 years old using pre- and posttreatment scales for assessing the fear of darkness. Statistically significant differences with large effects were found in all posttreatment measures: EMO (Roshenthal’s r = 0.64), WCDAN (r = 0.52), and Global item of current fear of darkness (r = 0.59). Using the Reliable Change Index (RCI) as a measure of clinically significant change, four participants improved satisfactorily, one acceptably, and the other did not improve. The results support the feasibility of using an adapted VR program to treat fear of darkness without being an expert therapist. However, more detailed experimental studies need to be carried out in order to analyze its efficacy.Viabilidad de un programa de realidad virtual para tratar niños con miedo a la oscuridad con terapeutas no expertos. El miedo a la oscuridad es muy frecuente y estable en los niños y, a menudo, termina convirtiéndose en una fobia situacional específica. El objetivo de este estudio es analizar la viabilidad de adaptarlo y aplicarlo a través de una herramienta de realidad virtual (RV) por terapeutas no expertos. Se ha llevado a cabo un estudio pre-experimental con seis participantes de 8 a 12 años de edad utilizando escalas de pre y postratamiento para evaluar el miedo a la oscuridad. Se han encontrado diferencias estadísticamente significativas con tamaños del efecto grandes en todas las medidas posteriores al tratamiento: EMO (Roshenthal’s r = 0.64), WCDAN (r = 0.52), e ítem global del miedo actual a la oscuridad (r = 0.59). Al usar el Índice de Cambio Fiable (ICF) como una medida del cambio clínicamente significativo, cuatro participantes mejoraron satisfactoriamente, uno aceptablemente, y el otro no mejoró. Los resultados apoyan la viabilidad de utilizar un programa de RV adaptado para tratar el miedo a la oscuridad sin necesidad de un terapeuta experto. Sin embargo, se necesitan estudios experimentales más detallados para analizar su eficacia

For the common good: Measuring residents\' efforts to protect their community from drug- and sex-related harm

People in high-risk neighbourhoods try to protect their friends, neighbours, relatives and others from the social and physical risks associated with sex and drug use. This paper develops and validates a community-grounded questionnaire to measure such ‘intravention\' (health-directed efforts to protect others). An initial ethnography, including life-history interviews and focus groups, explored the forms of intravention activities engaged in by residents of Bushwick (a high-risk New York City neighbourhood). Grassroots categories of intraventions were derived and questions developed to ask about such behaviours. Face validity and adequacy of the questions were assessed by independent experts. Pre-testing was conducted, and reliability and validity were assessed. An instrument including 110 intravention items was administered to 57 community-recruited residents. Analysis focused on 57 items in 11 domain-specific subscale. All subscales had good to very good reliability; Cronbach\'s alpha ranged from .81 to .95. The subscales evidenced both convergent and discriminant validity. Although further testing of this instrument on additional populations is clearly warranted, this intravention instrument seems valid and reliable. It can be used by researchers in comparative and longitudinal studies of the causes, prevalence and affects of different intravention activities in communities. It can benefit public health practitioners by helping them understand the environments in which they are intervening and by helping them find ways to cooperate with local neighbourhood-level health activists. Keywords: Intravention, drug prevention, harm reduction, community actions, protecting others.SAHARA-J Vol. 5 (3) 2008: pp. 144-15

Predicting Opioid Use Outcomes in Minoritized Communities

Machine learning algorithms can sometimes exacerbate health disparities based on ethnicity, gender, and other factors. There has been limited work at exploring potential biases within algorithms deployed on a small scale, and/or within minoritized communities. Understanding the nature of potential biases may improve the prediction of various health outcomes. As a case study, we used data from a sample of 539 young adults from minoritized communities who engaged in nonmedical use of prescription opioids and/or heroin. We addressed the indicated issues through the following contributions: 1) Using machine learning techniques, we predicted a range of opioid use outcomes for participants in our dataset; 2) We assessed if algorithms trained only on a majority sub-sample (e.g., Non-Hispanic/Latino, male), could accurately predict opioid use outcomes for a minoritized sub-sample (e.g., Latino, female). Results indicated that models trained on a random sample of our data could predict a range of opioid use outcomes with high precision. However, we noted a decrease in precision when we trained our models on data from a majority sub-sample, and tested these models on a minoritized sub-sample. We posit that a range of cultural factors and systemic forms of discrimination are not captured by data from majority sub-samples. Broadly, for predictions to be valid, models should be trained on data that includes adequate representation of the groups of people about whom predictions will be made. Stakeholders may utilize our findings to mitigate biases in models for predicting opioid use outcomes within minoritized communities

Syndemic factors associated with non-fatal overdose among young opioid users in New York City

IntroductionRates of illicit opioid use are particularly high among young adults, yet research on overdose experience and factors associated with overdose in this population remains limited. This study examines the experiences and correlates of non-fatal overdose among young adults using illicit opioids in New York City (NYC).Methods539 participants were recruited via Respondent-Driven Sampling in 2014-2016. Eligibility criteria included: aged 18–29 years old; current residence in NYC; and nonmedical prescription opioid (PO) use and/or heroin use in the past 30 days. Participants completed structured interviews to assess their socio-demographics, drug use trajectories, current substance use and lifetime and most recent overdose experiences, and were tested on-site for hepatitis C virus (HCV) antibodies.Results43.9% of participants reported lifetime overdose experience; of these, 58.8% had experienced two or more overdose events. The majority of participants’ most recent overdoses (63.5%) were due to polysubstance use. In bivariable analyses, after RDS adjustment, having ever overdosed was correlated with: household income of >$100,00 growing up (vs.$51,000-100,000); lifetime homelessness; HCV antibody-positive status; lifetime engagement in regular nonmedical benzodiazepine use, regular heroin injection and regular PO injection; and using a non-sterile syringe in the past 12 months. Multivariable logistic regression identified childhood household income >$100,00 (AOR=1.88), HCV-positive status (AOR=2.64), benzodiazepine use (AOR=2.15), PO injection (AOR=1.96) and non-sterile syringe use (AOR=1.70) as significant independent correlates of lifetime overdose. A multivariable model with multiple overdoses (vs. one) found only lifetime regular heroin use and PO injection to be strong correlates.DiscussionResults indicate a high prevalence of lifetime and repeated overdose among opioid-using young adults in NYC, highlighting a need for intensified overdose prevention efforts for this population. The strong associations of HCV and indices of polydrug use with overdose suggest that prevention efforts should address the complex risk environment in which overdose occurs, attending to the overlapping nature of disease-related risk behavior and overdose risk behavior among young people who inject opioids. Overdose prevention efforts tailored for this group may find it useful to adopt a syndemic conception of overdose that understands such events as resulting from multiple, and often interrelated, risk factors

Hepatitis C virus risk among young people who inject drugs

BackgroundInjection drug use (IDU) is the leading risk factor for hepatitis C virus (HCV) transmission in the U.S. While the general risk factors for HCV transmission are known, there is limited work on how these factors interact and impact young people who inject drugs (YPWID).MethodsProject data were drawn from a study of 539 New York City (NYC) residents ages 18-29 who were recruited via Respondent-Driven Sampling and, reported past-month non-medical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug in the past 12 months. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Integrating the observed statistical associations with extant literature on HCV risk, we also developed a qualitative system dynamics (SD) model to use as a supplemental data visualization tool to explore plausible pathways and interactions among key risk and protective factors for HCV.ResultsResults showed a 31% HCV antibody prevalence with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with having shared cookers with two or more people (AOR = 2.17); injected drugs 4–6 years (AOR = 2.49) and 7 or more years (AOR = 4.95); lifetime homelessness (AOR = 2.52); and having been incarcerated two or more times (AOR = 1.99). These outcomes along with the extant literature on HCV risk were used to develop the qualitative SD model, which describes a causal hypothesis around non-linearities and feedback loop structures underlying the spread of HCV among YPWID.ConclusionsDespite ongoing harm reduction efforts, close to a third of YPWID in the community sample have been exposed to HCV, have risks for injection drug use, and face challenges with structural factors that may be preventing adequate intervention. The qualitative SD model explores these issues and contributes to a better understanding of how these various risk factors interact and what policies could potentially be effective in reducing HCV infections

Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection

<p>Abstract</p> <p>Background</p> <p>Prevalence rates for long-term injection drug users in some localities surpass 60% for HIV and 80% for HCV. We describe methods for developing grounded hypotheses about how some injectors avoid infection with either virus.</p> <p>Methods</p> <p>Subjects: 25 drug injectors who have injected drugs 8 – 15 years in New York City. 17 remain without antibody to either HIV or HCV; 3 are double-positives; and 5 are positive for HCV but not HIV. "Staying Safe" methodology compares serostatus groups using detailed biographical timelines and narratives; and information about how subjects maintain access to physical resources and social support; their strategies and tactics to remain safe; how they handle problems of addiction and demands by drug dealers and other drug users; and how their behaviors and strategies do or do not become socially-embedded practices. Grounded theory and life-history analysis techniques compare and contrast doubly-uninfected with those infected with both viruses or only with HCV.</p> <p>Results</p> <p>Themes and initial hypotheses emerging from analyses included two master hypotheses that, if confirmed, should help shape preventive interventions: 1) Staying uninfected is not simply a question of social structure or social position. It involves agency by drug injectors, including sustained hard work and adaptation to changing circumstances. 2) Multiple intentionalities contribute to remaining uninfected. These conscious goals include balancing one's need for drugs and one's income; developing ways to avoid drug withdrawal sickness; avoiding situations where other drug users importune you to share drugs; and avoiding HIV (and perhaps HCV) infection. Thus, focusing on a single goal in prevention might be sub-optimal.</p> <p>Other hypotheses specify mechanisms of enacting these intentionalities. One example is finding ways to avoid extreme social ostracism.</p> <p>Conclusion</p> <p>We have identified strategies and tactics that some doubly-uninfected IDUs have developed to stay safe. Staying Safe methodology develops grounded hypotheses. These can be tested through cohort studies of incidence and prevention trials of hypothesis-based programs to help drug injectors make their injection and sexual careers safer for themselves and others. This positive deviance control-case life history method might be used to study avoiding other infections like genital herpes among sex workers.</p