The ultimate success of preventive interventions relies on their ability to engage and influence the growing presence of subcultural groups. To encourage and guide the development of effective preventive intervention for subcultural groups, four approaches are described, illustrated, and critiqued with respect to their considerations of cultural fit, reach, efficacy and adoption. Those approaches are (a) the prevention research cycle, (b) cultural adaptations of evidence-based interventions, (c) investigator-initiated culturally-grounded approaches, and (d) community-initiated indigenous approaches. Special attention is given to recent advances in the specification of stages in the cultural adaptation of interventions. The paper closes with some conclusions and topics in need of greater attention.
It has been argued that increased levels of treatment for drug abuse are effective in reducing the levels of drug problems. During the 1980s in Ontario levels of treatment increased considerably. More treatment facilities were opened, and the number of drug abuse cases increased by a factor of about seven. It was expected that drug-related problems (mortality, morbidity, and convictions) would decrease, as happened for alcohol problems when alcohol treatment levels increased. However, the results were inconsistent. Hospital separations for drug problems decreased in the late 1970s and then increased in the 1980s. However, deaths from drug psychoses and drug dependency showed an opposite trend. Convictions for cocaine offences increased while those for narcotics, LSD, and hallucinogenic drugs showed a substantial decline from the early 1980s to the present. Significant negative correlations (suggestive of a beneficial impact) were found between treatment rates and three drug-problem measures (deaths rates from drug psychoses and drug dependence, other drug-related deaths, and convictions under the Food and Drug Act); however, a significant positive correlation was found between treatment rates and Narcotic Control Act convictions. Thus, although some of the predicted negative relationships between treatment rates and drug problems were observed, the correlations did not provide a consistent picture of the effects of increased drug treatment. More research is needed to identify better indicators of drug problems and monitor the factors that influence them.
In surveys of alcohol use the alcoholic beverage preferred is sometimes noted but rarely given much attention. What little research exists on how beverage type relates to alcohol problems, delinquency and drug use has produced inconsistent results. This study identifies groups of high school students who drink beer, wine or spirits exclusively as well as those who drink multiple beverage types and examines whether problems are limited to a beverage type or a combination of types.
This study uses data from the 1991 Ontario Student Drug Use Survey. The sampling design employs a stratified (grade by region) single-stage cluster sample of homeroom classes. Students who drank alcohol at least once a month are included (N = 1,557).
Most students (82%) drink a combination of beer, wine and spirits. However, drinker type is not related to alcohol problems, drinking and driving, tobacco use, cannabis use or drug problems, holding constant age, gender and alcohol consumption. Only for heavy drinking and delinquency is there a significant association with drinker type. Exclusive beer and spirits drinkers and drinkers of all three beverages are more likely than the other drinker types to consume five or more drinks on a single occasion and to engage in delinquent behavior.
Drinkers of beer and spirits and all three beverage types are not only heavier drinkers but probably more rebellious and deviant. Wine, if taken exclusively, appears to be the beverage of moderation.
The city has become a defining feature of contemporary human experience, supporting diverse risk and enabling environments. Whilst urban risk environments have been the subject of numerous innovative research projects in recent years, the figure of the enabling environment is less well understood. This paper seeks to develop this figure through reference to recent scholarship in social theory, human geography and urban sociology.
This figure will be illustrated throughout with data drawn from various qualitative research projects conducted in Melbourne, Australia and Vancouver, Canada. This qualitative research highlights the array of enabling characteristics present in urban drug use contexts, characteristics that have yet to be fully explored in relation to the development of innovative settings-based harm reduction strategies.
This research draws attention to the ways particular urban settings support the development of affective and relational networks of "social repair" vital to the maintenance of health and wellbeing. These enabling characteristics serve to build social ties and enhance local networks; increase belonging and "connection to place"; and reinforce local "cultures of care". They also represent resources of enormous potential for harm reduction policy and practice.
Greater attention to the array of assets and opportunities present in urban settings offers fresh insights into the nature of enabling environments and their role in reducing drug related harms and facilitating healthy growth and development.
The outcome of a short-term intervention programme for mothers at psychosocial risk was evaluated. The study included 63 mothers and their 0-6-month-old babies who participated in a 6-week intensive treatment programme. Mother-child interaction was assessed in the beginning and at the end of treatment by two independent staff members based on direct observation, and by two control raters who observed video recordings which were arranged in blind order. The mothers were interviewed about the treatment retrospectively. A positive change in several aspects of mother-child interaction, according to the assessments made by the raters and according to the mothers themselves. The number of mothers who were positive toward the treatment rose from 34 in the beginning of the treatment to 56 at the end. In conclusion, a short but intensive intervention seems to have a positive outcome on mother-child interaction, and was in most cases linked to a positive attitude.
People who are street involved such as those experiencing homelessness and drug use face multiple inequities in health and access to health care. Morbidity and mortality are significantly increased among those who are street involved. Incorporation of a harm reduction philosophy in health care has the potential to shift the moral context of health care delivery and enhance access to health care services. However, harm reduction with a primary focus on reducing the harms of drug use fails focus on the harms associated with the context of drug use such as homelessness, violence and poverty.
Ethical analysis of the underlying values of harm reduction and examination of different conceptions of justice are discussed as a basis for action that addresses a broad range of harms associated with drug use.
Theories of distributive justice that focus primarily on the distribution of material goods are limited as theoretical frameworks for addressing the root causes of harm associated with drug use. Social justice, reconceptualised and interpreted through a critical lens as described by Iris Marion Young, is presented as a promising alternative ethical framework.
A critical reinterpretation of social justice leads to insights that can illuminate structural inequities that contribute to the harms associated with the context of drug use. Such an approach provides promise as means of informing policy that aims to reduce a broad range of harms associated with drug use such as homelessness and poverty.
This qualitative study examines parent and child experiences of participation in a multi-component community-based program aimed at reducing offending behaviour, and increasing social competence in boys 6 to 11 years old in Hamilton, Ontario, Canada. The program builds on the concept of crime prevention through social development, and includes structured groups for the identified boy, parents, and siblings.
A sample of 35 families participating in the multi-component program took part in the qualitative study. Individual interviews with the boys, parents and siblings asked about changes in themselves, relationships with family and peers, and school after the group. Interviews were taped, transcribed and content analysis was used to code and interpret the data.
Parents reported improvement in parenting skills and attainment of more effective communication skills, particularly with their children. Parents also found the relationships they formed with other parents in the program and the advice that they gained to be beneficial. Boys who participated in the program also benefited, with both parents and boys reporting improvements in boys' anger management skills, social skills, impulse control, and ability to recognize potentially volatile situations. Both parents and boys described overall improvement in family relationships and school-related success.
The qualitative data revealed that parents and boys participating in the multi-component program perceived improvements in a number of specific areas, including social competence of the boys. This has not been demonstrated as clearly in other evaluations of the program.
Cites: J Am Acad Child Adolesc Psychiatry. 2000 Dec;39(12):1468-8411128323
Cites: Res Nurs Health. 2000 Aug;23(4):334-4010940958
Cites: BMJ. 2001 Jul 28;323(7306):19111473907
Cites: Prev Sci. 2001 Sep;2(3):165-9211678292
Cites: J Am Acad Child Adolesc Psychiatry. 2002 Nov;41(11):1275-9312410070
Cites: Am Psychol. 2003 Jun-Jul;58(6-7):449-5612971191
Cites: J Am Acad Child Adolesc Psychiatry. 1991 May;30(3):393-72055875
Age-cohort variation in childhood trauma was examined in the present study. The data were taken from the 1994/95 Canadian National Population Health Survey of household residents (n = 15,106). Childhood trauma was measured by a seven-item index (items reflected physical abuse, fearful experiences, hospitalization, being sent away from home, and parental disturbance). Reported prevalence of childhood trauma increased with each successively younger age-cohort (range = 31% to 60%). Females showed a larger change than males, and age differences grew more pronounced as trauma exposure increased. The data suggest that childhood trauma has been on the increase over the last few decades. This is in accord with findings from other studies which showed that depression and social problems have also been on the rise. This suggests that adult psychiatric sequelae of early trauma can be expected to show an increase in future years.