Background: Despite substantial global progress against the HIV/AIDS epidemic, the Eastern Europe and Central Asian region has experienced a 43% increase in HIV incidence. The HIV epidemic in Kazakhstan has outpaced that of the region, with the incidence of new infections growing by 73% since 2010. Key populations of people who inject drugs (PWID), female sex workers (FSW) and their sexual partners account for the majority of new infections, where drug policies continue to undermine HIV prevention and control efforts. Kazakhstan has made insufficient progress towards 95-95-95 HIV epidemic control targets, with 78% of people living with HIV (PLWH) knowing their HIV status, of which 57% receive ART, and 48% of those receiving ART achieve viral suppression. Laws, policies and their enforcement can shape social and structural determinants of health, and it is fundamental to understand how punitive legal environments shape the HIV epidemic in Kazakhstan. This dissertation seeks to identify patterns of police violence victimization among FSW who use drugs and examine how police violence is associated with the HIV risk environment. Given the insufficient progress towards 95-95-95 HIV epidemic control targets, this dissertation also seeks to identify how patterns of injection and sexual HIV transmission risk behaviors vary among men and women who inject drugs and examine how criminal-legal involvement is associated with patterns of HIV transmission risk behaviors. Methods: Data on police violence victimization among FSW who use drugs were drawn from Project Nova, a cluster-randomized control trial that evaluated the efficacy of a combination HIV risk reduction and microfinance intervention. A community-based sample of 255 FSW who use drugs were recruited and enrolled between February 2015 and May 2017 in Almaty, Kazakhstan. Latent class analysis (LCA) was used to characterize women into distinct subgroups (i.e., classes) of police violence victimization. Next, multinomial logistic regression was used to examine how police violence victimization subgroups are associated with the physical, social, economic and policy HIV risk environment. Data on injection and sexual HIV transmission risk behaviors were drawn from Bridge, an implementation science study that evaluated the effectiveness of HIV service integration into needle/syringe programs on retention in care and viral suppression for PWID living with HIV in Kazakhstan. A random sample of 450 men and 166 women who inject drugs were recruited and enrolled in Almaty, Shymkent, and Temirtau/ Karaganda between February 2017 and June 2019. Similarly, LCA was used to characterize distinct subgroups of HIV transmission risk behaviors among men and women who inject drugs. Multinomial logistic regression was then used to identify associations between criminal-legal involvement and patterns of HIV transmission risk. Results: Three subgroups of police violence victimization among FSW who use drugs emerged. Just over half were characterized as experiencing low violence victimization (“Low Violence;” 51%); over one-third were characterized as experiencing all forms of police violence victimization (Poly-Victimization; 34%), and 15% were characterized as experiencing primarily discrimination and extortion from the police. Relative to Low Violence, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR= 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (aOR= 2.73 (1.15, 6.50)), injection drug use (IDU) (aOR= 2.00 (1.12, 3.58)), greater number of unsafe injection behaviors (aOR= 1.21 (1.08, 1.35)), homelessness (aOR= 1.92 (1.06, 3.48)), greater drug use stigma (aOR= 1.22 (1.07, 1.39)) and sex work stigma (aOR= 1.23 (1.06, 1.43)), greater number of sex work clients (aOR= 2.40 (1.33, 4.31)), working for a boss/pimp (aOR= 2.74 (1.16, 6.50)), client violence (aOR= 2.99 (1.65, 5.42)), economic incentives for condomless sex (aOR= 2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (aOR= 3.47 (1.42, 8.50)), recent arrest (aOR= 2.99 (1.36, 6.55)) and detention (aOR= 2.93 (1.62, 5.30)), and negative police perceptions (aOR= 8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. Distinct patterns of HIV transmission risk behaviors emerged among men and women, in which men were characterized as having Low Sexual Risk (41.8%), Injection & Sexual Risk (36.4%), and High Injection Risk (21.8%) behaviors. Class membership in the Injection & Sexual Risk and High Injection Risk class was associated with greater criminal-legal involvement, compared to the Low Sexual Risk class. This is demonstrated by higher odds of multiple detentions ((aORInjection & Sexual Risk = 1.28 (1.10, 1.49); aORHigh Injection Risk = 1.25 (1.06, 1.46)) and drug court participation (aORHigh Injection Risk = 5.29 (1.03, 27.20) in the past six months, committing crimes while under the influence of alcohol or drugs (aORInjection & Sexual Risk = 2.79 (1.53, 5.11); aORHigh Injection Risk = 2.76 (1.34, 5.65), and perceived police discrimination (aORHigh Injection Risk = 1.79 (1.01, 3.19). Women who inject drugs were characterized as having Low Injection & Sexual Risk (60.7%), Sex Work Behaviors (8.4%), High Injection Risk (30.7%) behaviors. Class membership in the Sex Work Behaviors and High Injection Risk class was associated with greater odds of being detained (aORSex Work Behaviors= 4.59 (1.27, 16.53) and experiencing verbal police harassment (aORSex Work Behaviors= 3.31 (1.20, 9.15); aORHigh Injection Risk = 2.91 (1.32, 6.40), compared to the Low Injection & Sexual Risk class. Conclusion: Results from this dissertation show that police violence against FSW who use drugs is pervasive in Kazakhstan. Patterns of police violence victimization among FSW who use drugs vary, with multiple forms of police violence victimization being associated with greater HIV susceptibility. This dissertation also demonstrates that men and women who inject drugs and are living with HIV have a high prevalence of injection and sexual HIV transmission risk behaviors, despite low viral suppression, and that patterns of HIV transmission risk behaviors vary by gender. Moreover, criminal-legal involvement is associated with injection and sexual HIV transmission risk, particularly among men who inject drugs. Collectively, these results support drug policy reforms and suggest that decriminalization of drug use and possession may promote enabling environments that support harm reduction, and subsequently reduce HIV transmission through injection and sexual networks of PWID in Kazakhstan.

The purpose of this research is to explain anabolic steroid use among non-competitive male bodybuilders. Two theories of deviant behavior are used in this research: rational choice theory and social learning theory. This thesis tests these theories on a sample of 50 males from fitness centers and gymnasiums. The results are interpreted in light of their implications for future research on the factors that encourage steroid use and other deviant behavior. / Master of Science

published_or_final_version / Social Work / Master / Master of Social Sciences

by Chan, Hak-man, Christian. / Includes questionaire in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 64-76). / Chapter I. --- INTRODUCTION --- p.1 / Chapter II. --- METHOD --- p.16 / Chapter III. --- RESULTS --- p.26 / Chapter IV. --- DISCUSSION --- p.50 / REFERENCES --- p.64 / APPENDIX --- p.77

"July 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 204-229). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Leung, Wan Chi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 103-111). / Abstracts in English and Chinese ; appendix in Chinese. / abstract --- p.i / 內容摘要 --- p.iii / Table of Contents --- p.V / Chapter Chapter I: --- Introduction --- p.1 / Chapter 1.1 --- Anti-drug Campaign in Hong Kong --- p.2 / Chapter 1.2 --- Harmful Messages on the Internet --- p.5 / Chapter 1.3 --- Theoretical Significance of Study --- p.6 / Chapter 1.4 --- Social implications of this study --- p.8 / Chapter Chapter II: --- Literature Review and Theoretical Framework --- p.10 / Chapter 2.1 --- Third-person effect and perception --- p.10 / Chapter 2.2 --- TPE and Antisocial Messages on the Internet --- p.12 / Chapter 2.3 --- First-person effect and perception --- p.17 / Chapter 2.4 --- Behavioral component of TPE --- p.22 / Chapter 2.5 --- Behavioral component of FPE --- p.27 / Chapter 2.6 --- Perceived effect on self and on others and behavioral consequences --- p.28 / Chapter 2.7 --- Anti-drug Rectifying Behaviors --- p.31 / Chapter Chapter III: --- Methods --- p.37 / Chapter 3.1 --- Data Collection --- p.37 / Chapter 3.2 --- Measurements of Key Variables --- p.39 / Chapter 3.3 --- Measurements of Control Variables --- p.45 / Chapter 3.4 --- Design of Questionnaires --- p.50 / Chapter Chapter IV: --- Findings --- p.52 / Chapter 4.1 --- Descriptive Statistics --- p.52 / Chapter 4.2 --- Hypotheses Testing --- p.55 / Chapter 4.3 --- Answers to Research Questions --- p.57 / Charts and Tables --- p.68 / Chapter Chapter V: --- Discussions and Conclusions --- p.78 / Chapter 5.1 --- TPE of online messages: antisocial and prosocial --- p.78 / Chapter 5.2 --- Perceived effects and behavioral intentions --- p.79 / Chapter 5.3 --- Control Variables --- p.87 / Chapter 5.4 --- Overall Regression Analysis --- p.90 / Chapter 5.5 --- Theoretical Contributions of this study --- p.92 / Chapter 5.6 --- Suggestions for Future Anti-youth-drug-abuse Policies in Hong Kong --- p.93 / Chapter 5.7 --- Limitations and Further Research Directions --- p.102 / Bibliography --- p.103 / Chapter Appendix: --- Questionnaire --- p.112

The purpose of this study was to assess the effectiveness of communication with elderly mental health clients regarding medication concordance.

The illicit use of prescription stimulants (IUPS) is a critical Public Health problem in the college population that represents a unique form of substance use. Namely, the primary motives for IUPS by college students are academic in nature (e.g., Teter, McCabe, LaGrange, Cranford, & Boyd, 2006), which may explain why usage rates as high as 43% have been reported on college campuses (Advokat, Guidry, & Martino, 2008). As the field of IUPS is in its infancy, the IUPS-literature lacks 1) a consistent definition of "illicit use of prescription stimulants", 2) an instrument designed to assess the multiple influences on IUPS behavior, and 3) a theoretical lens (Bavarian, 2010a). Accordingly, the goal of this study was to address these research gaps by examining IUPS at one university located in the Pacific Northwest using the theory of triadic influence (TTI; Flay & Petraitis, 1994; Flay, Snyder, & Petraitis, 2009), an integrated, ecological approach to explaining and predicting health behaviors. The study included five phases of research. The first phase began with a systematic approach to measurement development resulting in a 97-item preliminary instrument, the Behaviors, Expectancies, Attitudes and College Health Questionnaire (BEACH-Q). The measure was reviewed by the dissertation committee, leading to revisions in content and structure. During phase II, the BEACH-Q was evaluated by a convenience sample of five health and measurement professionals, and results suggested good content validity of the instrument (i.e. 35 of the 37 TTI-based covariates received a median rating between "agree" and "strongly agree", and 34 received a mean rating between "agree" and "strongly agree"). In phase III (instrument review by a convenience sample of six undergraduates), all 37 covariates received a median and mean rating between "agree" and "strongly agree", confirming good face validity. In phase IV, one undergraduate classroom was selected to participate in a pilot test of the BEACH-Q, using test-retest methodology. Results from the pilot (N = 39) showed that the instrument had moderate to high internal consistency reliability and modest to high stability reliability. In phase V, the final 96-item version of the BEACH-Q was administered throughout campus using one-stage cluster sampling, with classrooms as the sampling unit and students as the observation unit (N = 520 students in 20 classrooms, eligible student response rate = 96.30%). The prevalence of IUPS during college self-reported by the phase V sample was 25.58%, and the probability of engaging in IUPS did not differ between classrooms (Median Odds Ratio = 1.00). In crude logistic regressions, 24 out of 37 hypothesized theoretical covariates were significantly associated with IUPS in the expected direction, suggesting predictive validity of the BEACH-Q. Nested logistic regression analyses illustrated that, for the full multivariate model including ultimate, distal, and proximal covariates, the following measures in the intrapersonal stream were significantly associated with IUPS during college: race/ethnicity, year in school, academic concern, academic grades, diagnosis with Attention Deficit Disorder, and IUPS avoidance self-efficacy. Significant social situation/context stream covariates in the full model included: residence, varsity sports participation, perceptions of IUPS by friends, family, and faculty, endorsement of IUPS by friends, and perceived prevalence of IUPS among friends. With respect to the sociocultural environment stream, in the full multivariate model, the following covariates were found to be significantly associated with IUPS: financial-related stress, participation in religious activities, positive IUPS expectancies, prescription stimulant knowledge and perceived costs/benefits of IUPS. Lastly, intention to engage in IUPS (an immediate precursor) was positively associated with IUPS. Structural equation modeling was used to test models of IUPS for each of the three streams, as well as one integrated model that included covariates from each stream. The models all demonstrated good model fit, and provided insight into the factors that influence (and suggest the mechanisms of causation) intentions to engage in, and ultimately the behavior of, IUPS. In the intrapersonal stream model, inattention was positively associated with academic concern and inversely associated with avoidance self-efficacy, and avoidance self-efficacy was inversely associated with intentions to engage in IUPS. Moreover, intentions to engage in IUPS and avoidance self-efficacy were both significantly associated with IUPS. In the social situation/context stream model, living on-campus was negatively associated with friends' endorsement of IUPS which was positively associated with perceived prevalence of IUPS among friends, and perceived prevalence was positively associated with intentions to engage in IUPS; all of the direct paths to IUPS, excepting the path from perceived prevalence of IUPS among friends, were significant. In the sociocultural environment model, perception of course demand was significantly associated with both the perception that professors give the most attention to top academic students and attitudes about the impact of prescription stimulants on academics, and these attitudes had a positive association with intentions to engage in IUPS. Moreover, the direct paths from attitudes and intentions to IUPS were significant. The mixed model, including participation in religious activities (sociocultural environment stream), friends' endorsement of IUPS (social situation/context stream), and avoidance self-efficacy (intrapersonal stream), also had significant paths from ultimate to distal to proximal to immediate precursor, and significant direct paths to IUPS. This study successfully achieved its goals. First, the instrument developed was theory-driven, broadly defined IUPS, and was psychometrically strong. The cross-sectional study illustrated that IUPS was prevalent on the campus under investigation, as one in four students had engaged in the behavior during college. Associations of use with theoretical correlates were tested for, and structural equation modeling was used to support one premise of the TTI (i.e. that behavior is multifaceted, and covariates from different streams may interact to influence behavior). The findings also suggest that prevention and intervention plans should be multifaceted in nature. Given that this study's cross-sectional nature limited the ability to make causal inferences, future research involving the BEACH-Q should use longitudinal designs. / Graduation date: 2012

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.