Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this. Methods: Quantitative and qualitative methods were used. Study I included data  from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach. Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV). Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems. / Baksidestext International studies indicate an increase in mental distress and psychotropic drug use among young people. In this thesis mental distress is reported among 15.5 % of the young people. Of those reporting mental distress 75 % were girls. One quarter of the girls reporting mental distress at 15-16 years of age was incident users of psychotropic drugs one to nine years later. Psychotropic drug use, increase among young people, particularly hypnotic drugs. The young people experience beneficial and undesired effects of the psychotropic drugs. They miss out on professional availability and follow-up, and experience negative reactions related to their psychotropic drug use by their significant others. The public health nurse who discovers psychotropic drug use among young people chooses either to act or not to act in relation to this. Those who choose to act continue to cooperate with the young people and others. An established cooperation was followed by a public health nurse who supports and teaches the young people. The prevalence of mental distress, with a high frequency of initiation of psychotropic drug use among young people should have consequences for health promotion in the school health service. Public health nurses, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the responsibility and opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others.

Anthropologists have written about illicit drug use in the Western cultural context since the 1960s and recent years have seen an increased interest. At the same time, young people have become a significant “risk group” in public health efforts to reduce illicit drug use. In particular, youth living or spending time on the street have been the target of interventions. The following thesis describes youth connected to one such intervention in Victoria, British Columbia, Canada. Youth connected to Bridging the Gap: A Citizen Engagement Initiative in the Interests of Crystal Meth Prevention, Education and Intervention are described in terms of demographic characteristics, health and substance use. They are compared with youth from another study of street-involved youth in the area (Risky Business: Experiences of Street Youth) and a random sample of youth in Victoria (the Healthy Youth Survey). Data were collected in 39 survey-based interviews and 3 qualitative interviews.

The sharing of needles among injection drug users (IDUs) is a common route of Human Immunodeficiency Virus and Hepatitis C Virus transmission. Through the increased utilization of social network analysis, researchers have been able to examine how the interpersonal relationships of IDUs affect injection risk behaviour. This study involves a secondary analysis of data from a cross-sectional study of 156 IDUs from Winnipeg, Manitoba titled “Social Network Analysis of Injection Drug Users”. Multiple logistic regression analysis was used to assess the individual and the social network characteristics associated with needle sharing among the IDUs. Generalized Estimating Equations analysis was used to determine the injecting dyad characteristics which influence needle sharing behaviour between the IDUs and their injection drug using network members. The results revealed five key thematic findings that were significantly associated with needle sharing: (1) types of drug use, (2) socio-demographic status, (3) injecting in semi-public locations, (4) intimacy, and (5) social influence. The findings from this study suggest that comprehensive prevention approaches that target individuals and their network relationships may be necessary for sustainable reductions in needle sharing among IDUs.

The present study examined cross-sectional and longitudinal developmental characteristics of the association between mental health and substance use. N=1182 adolescents aged between 11 and 20 years were recruited from schools in Australia. Participants completed the Youth Self Report (YSR) (Achenbach, 1991a) and reported on their use of alcohol, tobacco, and marijuana, their social ability, their motivation for using substances, their ability to regulate emotion, and the influences of their parents and peers on their substance use. N=561 of time one participants were retained for testing one year later to assess the potential to predict substance use at time two from mental health at time one. Results indicated a clear and consistent cross-sectional association between externalising scores on the YSR and use of the three substances, regardless of gender. The relation between internalising scores and substance use was non-significant. When the relation between externalising scores and substance use was assessed for mediation, only the influence of parents and peers was found to be significant. A cross-sectional structural model developed to account for this association was demonstrated to be invariant across the three substances of interest, and across gender, but not age category. There was no evidence that social skills, emotion regulation, or substance use motives, had roles in mediating the relationship between mental health and substance use. A model was developed to assess the potential to predict substance use at time two from externalising scores at time one. Results showed that externalising scores predicted increases in alcohol use via parent and peer attitudes. Thus, externalising disposition, in the context of a facilitative social environment, was predictive of an increase in alcohol use over time. Structural models developed to account for the predictive relation between externalising scores and use of cigarettes and marijuana proved unstable and could not be tested. Substance use at time one was not predictive of externalising scores at time two. The results of the present research are discussed in relation to their potential to inform the developmental substance use literature, and efforts directed against the development of substance use problems. Limitations of the present research are noted.

The present study examined cross-sectional and longitudinal developmental characteristics of the association between mental health and substance use. N=1182 adolescents aged between 11 and 20 years were recruited from schools in Australia. Participants completed the Youth Self Report (YSR) (Achenbach, 1991a) and reported on their use of alcohol, tobacco, and marijuana, their social ability, their motivation for using substances, their ability to regulate emotion, and the influences of their parents and peers on their substance use. N=561 of time one participants were retained for testing one year later to assess the potential to predict substance use at time two from mental health at time one. Results indicated a clear and consistent cross-sectional association between externalising scores on the YSR and use of the three substances, regardless of gender. The relation between internalising scores and substance use was non-significant. When the relation between externalising scores and substance use was assessed for mediation, only the influence of parents and peers was found to be significant. A cross-sectional structural model developed to account for this association was demonstrated to be invariant across the three substances of interest, and across gender, but not age category. There was no evidence that social skills, emotion regulation, or substance use motives, had roles in mediating the relationship between mental health and substance use. A model was developed to assess the potential to predict substance use at time two from externalising scores at time one. Results showed that externalising scores predicted increases in alcohol use via parent and peer attitudes. Thus, externalising disposition, in the context of a facilitative social environment, was predictive of an increase in alcohol use over time. Structural models developed to account for the predictive relation between externalising scores and use of cigarettes and marijuana proved unstable and could not be tested. Substance use at time one was not predictive of externalising scores at time two. The results of the present research are discussed in relation to their potential to inform the developmental substance use literature, and efforts directed against the development of substance use problems. Limitations of the present research are noted.

No description available.

Fundação de Amparo a Pesquisa no Estado do Rio Grande do Sul / Drug addiction is an age-old problem, but currently only public policies have been concerned with interventions to users. Drug use by inmates is a serious health problem so that there is a need for studies to seek alternative solutions. This research aimed to investigate the consumption of psychoactive substances in a sample of inmate male adults. We used the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which evaluates the consumption of drugs in the last three months prior to testing. The test was applied to 139 inmates aged from 19 to 58 years from prisons in southern Brazil. The results showed high rate related to the use of tobacco, alcohol, marijuana and cocaine/crack and that the correlations between the use of different drugs were positive and statistically significant. We conclude that there is a strongly established association between drug use and deprivation of liberty in that context, causing health and safety problems. Furthermore, it is important to expand literature with new studies to provide more data that can support specific interventions to the needs of inmates. / A drogadição é um problema milenar, mas só atualmente as políticas públicas têm se preocupado com intervenções para os usuários. O uso de drogas pelos presidiários evidencia um problema de saúde sério em que há a necessidade de estudos para buscar alternativas de soluções. O objetivo dessa pesquisa foi investigar o consumo de substâncias psicoativas em uma amostra de adultos do sexo masculino privados de liberdade. Foi utilizado o teste Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), que avalia o consumo de drogas de indivíduos nos últimos três meses de vida anteriores a testagem. A aplicação se deu com 139 apenados com idades entre 19 anos e 58 anos dos presídios do Sul do Brasil. Os resultados mostraram o alto índice relacionados ao uso de derivados do tabaco, bebidas alcoólicas, maconha e cocaína/crack e que existem correlações positivas e estatisticamente significativas entre o uso das diferentes drogas. Concluiu-se que há uma associação fortemente estabelecida entre uso de drogas e a privação de liberdade nesse contexto, causando problemas de saúde e de segurança. Também, é importante ampliar a literatura com novos estudos capazes de fornecer mais dados que possam subsidiar intervenções específicas diante das necessidades dos apenados.

Submitted by Ronildo Prado (ronisp@ufscar.br) on 2017-08-21T18:23:34Z No. of bitstreams: 1 DissRMJV.pdf: 1824608 bytes, checksum: ecd4f7c09734fdd5358dac170ac641e5 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-08-21T18:23:42Z (GMT) No. of bitstreams: 1 DissRMJV.pdf: 1824608 bytes, checksum: ecd4f7c09734fdd5358dac170ac641e5 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-08-21T18:23:48Z (GMT) No. of bitstreams: 1 DissRMJV.pdf: 1824608 bytes, checksum: ecd4f7c09734fdd5358dac170ac641e5 (MD5) / Made available in DSpace on 2017-08-21T18:23:54Z (GMT). No. of bitstreams: 1 DissRMJV.pdf: 1824608 bytes, checksum: ecd4f7c09734fdd5358dac170ac641e5 (MD5) Previous issue date: 2017-02-23 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / In Brazil and in the world, the use of licit and illicit drugs among adolescents is becoming more frequent and its onset more precocious. This use, even if experimental, according to the literature, occurs around the age of 13. It is of great importance to know and understand the expectations and the reasoning that leads to the use. Thus, the objective of this study was to evaluate groups of Elementary and Middle School students submitted to a school program to prevent alcohol and drug use, before and after receiving preventive interventions. It is a quasi-experimental study with evaluations before and after interventions. A total of 231 adolescents from primary and secondary education in São Carlos-SP, who answered a sociodemographic questionnaire, knowledge about the consequences of drug use, Drug Use Screening Inventory (DUSI - table 1 and area 1) and scales of expectations regarding the use of Alcohol and drugs in adolescents (EEPA-A and EED-A). Descriptive and inferential statistical analyzes were performed using R® Software. The mean age was 13.62 ± 1.6, female (53.25%), 76% of elementary school and 24% of high school, 76% had religion, 85% had participated in alcohol and drugs prevention programs at school. The level of knowledge improved overall among adolescents after the intervention. The frequency of substance use in the last month, alcohol Fem. (T0 = 17% and T1 = 21%) and Male (T0 = 16% and T1 = 21%); marijuana Fem. (T0 = 4% and T1 = 10%) and Male (T0 = 9% and T1 = 7%); And tobacco Fem. (T0 = 5% and T1 = 4%) and Male (T0 = 8% and T1 = 4%); Inhalants /solvents Fem. (T0 = 4% and T1 = 4%) and Male (T0 = 3% and T1 = 3%); Cocaine / crack Fem. (T0 = 3% and T1 = 1%) and Male (T0 = 1% and T1 = 1%); other drugs Fem. (T0 = 17% and T1 = 17%) and Male (T0 = 13% and T1 = 7%)being the most frequently used among substances from 1 to 2 times. Pattern of consumption "non occasional users / users" Fem. (T0 = 42% and T1 = 40%) and Male (T0 = 38% and T1 = 34%); "Harmful use" Fem. (T0 = 8% and T1 = 7%) and Male (T0 = 7% and T1 = 9%); "Dependency indications" Fem. (T0 = 3% and T1 = 6%) and Male (T0 = 2% and T1 = 4%). Regarding the expectations, the use of drugs (EED-A) did not present post-intervention difference, the EEPA-A presented statistical difference in T1, the median was higher in the general group (p-value = 0.0021; p <0 , 05) and Male (P-value = 0.0086, p <0.05). We did not find significant changes in expectations for the adolescents after the intervention. We observed its effectiveness in relation to the use of certain substances and improvement of general knowledge. We conclude that, in addition to the development of specific programs, it is necessary that, in areas of vulnerability to the use of psychoactive substances, other longitudinal actions in the school context be implemented, within the scope of its pedagogical project. / No Brasil e no mundo, o uso de drogas lícitas e ilícitas entre os adolescentes é cada vez mais frequente e seu início cada vez mais precoce. Este uso, mesmo que seja experimental, segundo a literatura, ocorre em torno dos 13 anos. É de grande importância conhecer e entender as expectativas e o raciocínio que levam ao uso. Assim, o objetivo deste estudo foi avaliar grupos de estudantes de Ensino Fundamental e Médio submetidos a um programa escolar para prevenção do uso de álcool e drogas, antes e após receberem intervenções preventivas. Trata-se de um estudo quase-experimental com avalição antes e após a realização de intervenções;. Participaram 231 adolescentes do ensino fundamental e médio de São Carlos-SP, que responderam a um questionário sociodemográfico, conhecimento sobre consequências do uso de drogas, Drug Use Screening Inventory (DUSI - tabela 1 e área 1) e escalas de expectativas frente ao uso de álcool e drogas em adolescentes (EEPA-A e EED-A). Foram feitas análises estatísticas descritivas e inferenciais através do Software R®. A média de idade foi de 13,62±1,6 anos, sexo feminino (53,25%), 76% do ensino fundamental e 24% ensino médio, 76% possui religião, 85% já tinham participado de programas de prevenção sobre álcool e drogas na escola. O nível de conhecimento apresentou melhora de forma geral entre os adolescentes após a intervenção. A frequência do uso de substâncias no ultimo mês, álcool Fem. (T0= 17% e T1= 21%) e Masc. (T0= 16% e T1= 21%); maconha Fem. (T0= 4% e T1= 10%) e Masc. (T0= 9% e T1= 7%); tabaco Fem. (T0= 5% e T1= 4%) e Masc. (T0= 8% e T1= 4%); inalantes/solventes Fem. (T0= 4% e T1= 4%) e Masc. (T0= 3% e T1= 3%); cocaína/crack Fem. (T0= 3% e T1= 1%) e Masc. (T0= 1% e T1= 1%); Outras drogas Fem. (T0= 17% e T1= 17%) e Masc. (T0= 13% e T1= 7%), sendo a frequência mais utilizada entre as substancias 1 a 2 vezes. Padrão de consumo “não usuários/usuários ocasionais” Fem. (T0= 42% e T1= 40%) e Masc. (T0= 38% e T1= 34%); “uso nocivo” Fem. (T0= 8% e T1= 7%) e Masc. (T0= 7% e T1= 9%); “indícios de dependência” Fem. (T0= 3% e T1= 6%) e Masc. (T0= 2% e T1= 4%). Em relação às expectativas, o uso de Drogas (EED-A) não apresentou diferença pós-intervenção, a EEPA-A apresentou diferença estatística em T1, a mediana foi maior no grupo geral (p-valor=0,0021; p<0,05) e Masc. (p-valor=0,0086; p<0,05). Não encontramos mudanças significativas de expectativas pelos adolescentes após a intervenção. Observamos efetividade da mesma em relação ao uso de determinadas substâncias e melhora do conhecimento geral. Concluímos que, para além do desenvolvimento de programas específicos, é necessário que em áreas de vulnerabilidade para o uso de substâncias psicoativas, outras ações longitudinais no âmbito escolar sejam implementadas, de fato, no âmbito de seu projeto pedagógico.

The purpose of this study is to compare the drug abusing adolescent, along with his family, with a non-drug abusing adolescent and his family by (l) a comparison of the adolescents on measures of self esteem and perceived parental behavior, (2) a comparison of the parents of drug abusing adolescents with the parents of non-drug abusing adolescents on child-rearing attitudes and on distortion in perceived parental behavior, and (3) an identification of the salient factors contributing to the prediction of drug-using behavior in adolescents. The adolescent's self esteem, his perception of parental behavior, the ability of the parents to predict the child's parental perceptions, and the professed parental attitudes toward confidence and responsibility in child-rearing, all combine to suggest a set of factors differentiating the drug abusing adolescent from the non-drug abusing adolescent.

Harm reduction is an approach that aims to reduce harms related to using drugs. Harm reduction services often fail to consider the needs of women who inject drugs or minimise responses to women’s needs in service design and implementation (Bennett et al., 2000; Brown et al., 2005; EMCDDA, 2006; Levy, 2014a; Pinkham, Stoicesu and Myers, 2012; UNODC et al., 2014). It is therefore crucial to understand the experiences of women who inject drugs from their own perspectives, as well as those of harm reduction workers, in order to develop and implement effective responses to injecting drug use. This thesis explores how ‘harm’ and ‘harm reduction’ are conceptualised by workers and clients at a women-only day syringe exchange programme. It answers the following questions: In what ways do participants’ broader understandings of ‘harm’ and ‘harm reduction’ go beyond the traditional public health model of harm reduction in response to illicit injectable drug use? How are clients and workers’ understandings gendered? These questions were explored empirically through fieldwork in 2013 and 2014 at a harm reduction centre which featured a women-only day syringe exchange programme in Budapest, Hungary. This women-only day was the only gender sensitive harm reduction programme in the country, and the first study undertaken with Roma women who inject drugs in Hungary and female harm reduction workers. In addition, this first research project to use photovoice within a harm reduction context in Hungary. Data were co-produced with respondents according to the principles of Feminist- informed Participatory Action Research, using the method of ‘photovoice’. This method involved providing cameras for clients and employees of the women-only day to photograph their experiences and understandings of harm, harm production, and harm reduction. A significant portion of the data collected for this study was created by female harm reduction workers who worked at the women-only syringe exchange programme. Employees and clients’ images guided the research observations, interviews, and analysis. This meant collaboration between the participants and the researcher through the fieldwork, including the development and implementation of a research output in the form of a public photo exhibition and fundraiser event. The event was called ‘Chicks on the Corner’, and is the source of the thesis title as well as the title of the research project. The theoretical frameworks of zemiology (the study of harm) and black and multiracial feminist thought informed the ontological and epistemological grounding of the Chicks on the Corner project. These frameworks, coupled with the empirical data, produced an argument for the development of a feminist zemiology. The analytical themes that emerged from the Chicks on the Corner project were produced and categorised primarily using participant generated photographs. These images depict the multiple intersecting, overlapping, and mutually reinforcing sources of harm production and attempts at harm reduction in participants’ lives. Analysis of the photographs affirm that women who inject drugs experience an array of harms in addition to physical harms related to their drug use. Harms identified by research participants were categorised using Hillyard and Tombs (2004; 2005) zemiological typology. This typology consists of: physical harms, emotional harms, economic harms, and cultural harms (also known as lack of cultural safety). In addition, a new fifth category of harm was created based on participants’ responses, and is called institutional and political harms. The data from the Chicks on the Corner project show how institutional and political harms contributed to the production of the other four categories of harm. Furthermore, the analysis outlines the numerous challenges workers faced in attempting to provide adequate harm reduction responses while experiencing multiple social harms as well. These novel findings suggest the need for expanded definitions of ‘harm’ in harm reduction theory and practices. The findings from the Chicks on the Corner project complement existing literature on harm reduction theory and practice while also adding to the limited body of research on gender- sensitive approaches to harm reduction. This thesis contributes to an expansion of theoretical understandings of harm and harm reduction in relation to women who inject drugs and harm reduction workers, as well as discussing implications for gender sensitive harm reduction practices. Based on this analysis, I propose the development of feminist zemiology as a way to better understanding harm.