ALCOHOL HARM-REDUCTION APPROACHES ACROSS DIFFERENT POPULATIONS

Context. Certain populations, such as socially marginalized individuals and late adolescents (i.e., aged 17-19), are more prone than others to experience severe alcohol- related harm. However, these populations are often not interested in attaining alcohol abstinence or reducing alcohol consumption to moderate levels. Thus, their needs are not met within traditional primarily abstinence-based service options. In response, harm- reduction approaches have begun to be applied with these populations. The overall aim of this thesis was to contribute to the research on alcohol-related harm reduction in these populations by conducting 5 distinct studies. The two first studies were conducted with chronically homeless individuals with alcohol problems in the US: Study 1 examined their perceptions of twelve-step mutual-help groups (TMGs) and their association with treatment attendance, motivation and alcohol outcomes, whereas study 2 examined this population's use of safer-drinking strategies. Study 3 evaluated substance-use and related problems following exposure to a harm-reduction drop-in center that allows alcohol consumption onsite among socially marginalized alcohol and other drug (AOD) users in Switzerland. Studies 4 and 5 were conducted among US and Swedish high school seniors and prospectively tested a) the moderating effect of drinking intentions on the association between use of protective behavioral strategies (PBS) and alcohol outcomes, and b) the moderating effect of PBS use on the link between alcohol expectancies and alcohol outcomes. Findings. Study 1 found that most chronically homeless individuals with alcohol problems endorsed negative perceptions of TMGs, which were in turn associated with less treatment attendance. Study 2 found that chronically homeless individuals with alcohol dependence were interested in drinking safer and were able to commit to using safer-drinking strategies. Study 3 showed that exposure to a harm-reduction drop-in center that allows alcohol consumption onsite was followed by significant decrease in alcohol use and related problems among socially marginalized AOD users in Switzerland, with greater attendance being related to additional improvement in mental health-related quality of life (QoL) and decrease in drug-related problem severity. Finally, studies 4 and 5 showed that use of PBS was related to future decreases in alcohol use and related consequences among US and Swedish high school seniors. Findings also showed significant interactions between drinking intentions and PBS use (study 4), and between alcohol expectancies and PBS use (study 5). Conclusion. Taken together, findings confirmed that socially marginalized individuals and high school seniors show low interest in traditional approaches aiming abstinence or use reduction. Findings documented, however, that these distinct populations embrace alcohol harm-reduction approaches and that these approaches appear to be related to decreases in alcohol-related harm. Taken together, these findings suggest that alcohol harm-reduction approaches are promising ways to decrease alcohol- related harm across different populations and different cultures (i.e., US, Sweden, Switzerland). -- Contexte. Malgré leurs besoins importants en matière de traitement alcoologique, les personnes socialement marginalisées sont souvent sous-traitées par les traitements visant l'abstinence ou la consommation modérée. Similairement, les approches préventives promouvant l'abstinence ne suscitent généralement que peu d'intérêts et d'effets positifs au sein des jeunes (gymnasiens par exemple), qui sont pourtant connus pour leur usage d'alcool à risque. En réponse, les interventions ciblant ces populations intègrent de plus en plus des principes de réduction des risques et des méfaits. L'objectif général de ce travail de thèse était de contribuer à la recherche dans ce domaine en réalisant 5 études distinctes. Les deux premières études ont été conduites au sein de personnes sans-abris chroniques présentant un problème d'alcool aux États-Unis: L'étude 1 a examiné leurs perceptions des groupes d'entraide mutuelle en douze étapes (GEMs), et l'association entre ces perceptions et la fréquentation des traitements, la motivation et l'usage d'alcool. L'étude 2 a examiné l'usage des stratégies de consommation plus sûre au sein de cette population. L'étude 3 a évalué l'évolution de l'usage de substances et des problèmes associés après l'exposition à un espace d'accueil de jour tolérant la consommation d'alcool au sein de personnes socialement marginalisées en Suisse. Enfin, les études 4 et 5 ont été conduites parmi des gymnasiens aux États-Unis et en Suède et ont testé prospectivement a) l'effet modérateur des intentions de consommer sur le lien entre l'utilisation de stratégies de protection comportementales (SPCs) et l'usage d'alcool, et b) l'effet modérateur de l'usage de SPCs sur le lien entre les attentes liées à l'usage d'alcool et la consommation d'alcool. Résultats. L'étude 1 a montré que la plupart des participants avaient des perceptions négatives des GEMs et que ces perceptions étaient associées négativement à la fréquentation des traitements. L'étude 2 a montré que les participants étaient intéressés à réduire les risques liés à leur usage d'alcool et qu'ils pouvaient s'engager à utiliser des stratégies de consommation plus sûre. L'étude 3 a montré que les participants ont diminué leur usage d'alcool et les problèmes associés au cours de l'évaluation et que chaque mois supplémentaire passé au sein de l'espace d'accueil était associé à une diminution supplémentaire de la sévérité des problèmes liés aux drogues et à une amélioration de la qualité de vie liée à la santé mentale. Les études 4 et 5 ont indiqué que l'usage de SPCs était prospectivement associé à une diminution de la consommation d'alcool et des conséquences associées. Les résultats ont également montré des interactions significatives entre l'usage des SPCs et a) les intentions de consommer (étude 4), et b) les attentes liées à l'alcool (étude 5). Conclusion. Globalement, les études comprises dans ce travail de thèse confirment que les approches visant l'abstinence et la consommation modérée ne suscitent que peu d'intérêt au sein des personnes socialement marginalisées et des gymnasiens. Notre travail indique toutefois que ces populations acceptent les approches visant la réduction des risques et des méfaits et que celles-ci semblent être associées à une diminution des méfaits liés à l'usage d'alcool. De manière générale, ces résultats suggèrent que ces approches sont prometteuses au sein de différentes populations issues de cultures diverses (États-Unis, Suède, Suisse)

Circular dichroism and bilayer splitting in the normal state of underdoped (Pb,Bi)2_2Sr2_2(Cax_xY1−x_{1-x})Cu2_2O8+δ_{8+\delta} and overdoped (Pb,Bi)2_2Sr2_2CaCu2_2O8+δ_{8+\delta}

We report an ARPES investigation of the circular dichroism in the first Brillouin zone (BZ) of under- and overdoped Pb-Bi2212 samples. We show that the dichroism has opposite signs for bonding and antibonding components of the bilayer-split CuO-band and is antisymmetric with respect to reflections in both mirror planes parallel to the c-axis. Using this property of the energy and momentum intensity distributions we prove the existence of the bilayer splitting in the normal state of the underdoped compound and compare its value with the splitting in overdoped sample. In agreement with previous studies the magnitude of the interlayer coupling does not depend significantly on doping. We also discuss possible origins of the observed dichroism.Comment: 4 RevTex pages, 4 EPS figure

Localized Magnetic States of Fe, Co, and Ni Impurities on Alkali Metal Films

X-ray absorption spectroscopy (XAS) and x-ray magnetic circular dichroism (XMCD) have been used to study transition metal impurities on K and Na films. The multiplet structure of the XAS spectra indicates that Fe, Co, and Ni have localized atomic ground states with predominantly d7, d8, and d9 character, respectively. XMCD shows that the localized impurity states possess large, atomiclike, magnetic orbital moments that are progressively quenched as clusters are formed. Ni impurities on Na films are found to be nonmagnetic, with a strongly increased d10 character of the impurity state. The results show that the high magnetic moments of transition metals in alkali hosts originate from electron localization

COMPARATIVE ANALYSIS OF TECHNICAL, ECONOMICAL AND ENVIRONMENTAL FEASIBILITY OF COGENERATION PLANT USING WOOD BIOMASS

After having identified, in a previous work [6], the possible sites for the location of a new cogeneration plant using wood biomass in the Mountain Community of Carnia, Friuli Venezia Giulia Region (Italy), the technical and economic feasibility and environmental sustainability of such a system has been carried out in order to evaluate the feasibility of the proposed solution

COMPARATIVE ANALYSIS OF TECHNICAL, ECONOMICAL AND ENVIRONMENTAL FEASIBILITY OF COGENERATION PLANT USING WOOD BIOMASS

After having identified, in a previous work [6], the possible sites for the location of a new cogeneration plant using wood biomass in the Mountain Community of Carnia, Friuli Venezia Giulia Region (Italy), the technical and economic feasibility and environmental sustainability of such a system has been carried out in order to evaluate the feasibility of the proposed solution

Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design.

Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions. This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model

Risky substance use and peer pressure in Swiss young men : Test of moderation effects

Peer pressure (PP) toward misconduct is a well-known risk factor for substance use. However, the way it interacts with social factors and the associations of the aspects of PP other than PP toward misconduct have been understudied. This study examined the associations of three aspects of PP with risky substance use and tested whether the associations of PP toward misconduct were moderated by social factors. A representative sample of 5,680 young Swiss males completed a questionnaire assessing risky alcohol, cigarette, and cannabis use, PP toward misconduct, toward peer involvement, and toward peer conformity, as well as social support (SS) and neighbourhood cohesion. Multinomial logistic regression models were used. PP toward misconduct was positively associated with all substance use outcomes. The PP toward misconduct-risky alcohol use association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement, SS, and neighbourhood cohesion. The PP toward misconduct-risky cannabis use association was stronger in individuals reporting high than in those reporting low levels of SS and neighbourhood cohesion. The PP toward misconduct-smoking association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement. The risk for substance use associated with PP toward misconduct varies as a function of social factors. Being well connected with others (high level of PP toward peer involvement and SS), and living in a cohesive neighbourhood may amplify the risk for risky substance use associated with PP toward misconduct

Correlated Electrons Step-by-Step: Itinerant-to-Localized Transition of Fe Impurities in Free-Electron Metal Hosts

High-resolution photoemission spectroscopy and realistic ab-initio calculations have been employed to analyze the onset and progression of d-sp hybridization in Fe impurities deposited on alkali metal films. The interplay between delocalization, mediated by the free-electron environment, and Coulomb interaction among d-electrons gives rise to complex electronic configurations. The multiplet structure of a single Fe atom evolves and gradually dissolves into a quasiparticle peak near the Fermi level with increasing the host electron density. The effective multi-orbital impurity problem within the exact diagonalization scheme describes the whole range of hybridizations.Comment: 10 pages, 4 figure