Addiction to opiates is a complex public health issue affecting thousands of Canadians. Methadone Maintenance Treatment (MMT) is considered the gold standard in Canada, and the world, for treating opiate dependence. In the past, Canadian research into opiate addiction and the effectiveness of MMT has mostly focused on larger cities: Toronto, Montreal, and Vancouver. This community based research study employed a mixed method approach to gain understanding of the experiences and satisfaction with MMT and other health services available to opiate users in Belleville, Ontario (population 48,000). Surveys (N = 53), focus groups, participant-observation methods and key informant interviews were used to gather data. The results provide an overall picture of the quality of life for opiate users and MMT clients, the quality of care clients receive, and the perceptions of community members regarding MMT. Challenges related to smaller locales are identified along with recommendations for improving MMT health services. / UOIT

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.

The objective of this thesis is to examine random effect models applied to binary data. I will use classical and Bayesian inference to fit generalized linear mixed models to a specific data set. The data analyzed in this thesis comes from a study examining the injection practices of needle exchange clientele in Victoria, B.C. focusing on their risk networks. First, I will examine the application of social network analysis to the study of injection drug use, focusing on issues of gender, norms, and the problem of hidden populations. Next the focus will be on random effect models, where I will provide some background and a few examples pertaining to generalized linear mixed models (GLMMs). After GLMMs, I will discuss the nature of the injection drug use study and the data which will then be analyzed using a GLMM. Lastly, I will provide a discussion about my results of the GLMM analysis along with a summary of the injection practices of the needle exchange clientele. / Graduate / 0463

Thesis (M.A.)--Bowling Green State University, 2007. / Document formatted into pages; contains ix, 61 p. Includes bibliographical references.

The Dr. Peter Centre (DPC), an HIV care facility, provides integrated health care services incorporating harm reduction strategies as part of service provision. These services include a “Harm Reduction Room” for those members who inject drugs, to do so in a supervised environment. In this thesis, I explore the perspectives of DPC members on the harm reduction approach as part of a larger study titled A mixed Method Evaluation of the Impact of the Dr. Peter Centre on Health Care Access and Outcomes for Persons Living with HIV/AIDS who use Illicit Drugs. Thirty DPC members were recruited as part of the qualitative portion of the larger mixed-method study. One-on-one in depth interviews were conducted with each participant and audio-recorded and then transcribed verbatim. Participant narratives reflected positive experiences with nurses and other staff, and with the harm reduction philosophy at the DPC. Narratives from both participants who inject drugs and participants who do not inject drugs indicated support for the harm reduction room because of the safety it provides. Safety was related to reducing the direct harmful effects of injection drugs such as infection and overdose, and also to the refuge from the street and freedom from stigma of drug use that the DPC provides. Participant accounts expressed a sense of acceptance and belonging as a part of the community at the DPC highlighting the role of DPC in shifting drug use patterns. This thesis emphasizes that the harm reduction philosophy and the provision of harm reduction services at the DPC contributes to the overall health and well being of participants. / Graduate

Made available in DSpace on 2014-06-11T19:29:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-09Bitstream added on 2014-06-13T19:17:02Z : No. of bitstreams: 1 anacleto_aaa_me_bauru.pdf: 1209451 bytes, checksum: 094c11bb316384eb3e170678be19c80a (MD5) / Uma nova modalidade de atendimento para enfrentar a problemática do uso de drogas e suas consequencias psicossociais refere-se a uma proposta de redução de danos (PRD). Ainda desconhecida por muitos e polêmica entre diferentes profissionais, essa proposta representa um novo olhar sobre as populações vulneráveis e procura garantir a saúde pública, por meio de ações que tentam reduzir os danos causados pelo consumo de drogas lícitas e ilícitas, bem como práticas sexuais de risco para DTS/AIDS, com esclarecimento e orientações ao invés de proibição e punição. A implementação dessa proposta pro parte de psicólogos às pessoas que se encontram em situação de vulnerabilidade pelo exercício de práticas de risco e seus familiares ainda é um tema pouco estudado. Este estudo objetivou investigar a opinião de psicólogos, sejam esses atuantes em clínicas particulares ou em um Centro de Atenção Psicossocial, sobre a proposta de Redução de Danos e sua relação com os temas de sexualidade e vunerabilidade, por meio de entrevistas e análise de conteúdo em categorias temáticas: o conceito de redução de danos, a avaliação da proposta de redução de danos, a articulação da redução de danos com a sexualidade e a implicação da redução de danos em suas atuações profiessionais. Os dados revelaram a falta de informalção referentes ao tema da política de redução de danos nos dois grupos de psicólogos e como suas ações ainda são incipientes nos espaços de promoção de saúde pública. Espera-se contribuir para o esclarecimento e o debate necessário entre os psicólogos que atuam junto a profissionais da saúde no atendiemnto a esta população beneficiando enfim o pleno desenvolvimento humano / A new modality of treatment to address the problem of drug abuse and its psychosocial consequences refors to a proposal for Harm Reduction (PRD). Still unknown to many and controversy between the experts, this proposal represents a new focus on vulnerable population and seeks to ensure public health, through actions that attempt to reduce damage caused by the consumption of licit and ilicit drugs and sexual practices risk for HIV/AIDS, with clarification and guidance rather than prohibition and punishment. The implementation of this proposal by psychologists for people who find themselves in a vulnerable situation by the exercise of risk practices and their relatives is still little research. This study aimed to investigate the option of psychologists, are those working in private practices or in a Psychosocial Care Center on the proposal of Harm Reduction and its relation to the themes of sexuality and vulnerability, through interviews and content analysis themes: the concept of harm reduction, assessment of the proposed harm reduction, the articulation of harm reduction with sexuality and the implication of harm reduction in their profissional appearances. The data revealed the lack or information regarding the issue of harm reduction policy in the two groups of psychologists and how their actions are still incipient in the spaces to promote public health. Expected to contribute to the classification and necessary debate among psychologists who work with health providers to care for this population ultimately benefiting the full human development

This dissertation 1) described prevalence and correlates of poly-tobacco use among US youth and young adults; 2) addressed positive and negative transitions of e-cigarettes among US youth and adults and 3) examined the 2-year transition of dual e-cigarette/cigarette use among US adults in relation to nicotine dependence (ND) symptoms, interest in quitting, and cardiovascular disease (CVD) factors. Data from 2013-2016 of the Population Assessment of Tobacco and Health Study were used. In the first study, 3.6% of youth (12-17years) and 18.3% of young adults (18-34years) were current poly-tobacco users between 2013-2014. Common poly-tobacco products combination was cigarettes and e-cigarettes for youth and young adults. Among youth, heavy drinking was associated with higher odds of poly-tobacco use. Factors associated with higher odds of poly-tobacco use among young adults included males, younger adults (18-24years), those with lower levels of educational attainment, residing in the South, heavy drinking, and marijuana use. In the second study, between 2013-2016, e-cigarette use increased only in youth. Young e-cigarette users were more likely to be never cigarette smokers compared to older users. Among youth e-cigarette users at each wave, the proportion of never cigarette smokers rose from 24.1% in Wave 1 to 42.6% in Wave 3 (p=0.0001 for trends). Among adult e-cigarette dual users in Wave 1, 8.8% transitioned to no tobacco use at Wave 3, 6.2% to mono e-cigarette use, while 85% either relapsed to cigarettes (53.5%) or continued dual use (31.5%). In the final study, among 1,870 adult dual tobacco users from Wave 1, 25·8% (95% CI 23·5-28·3) remained dual users 2 years later, 11·9% (95% CI 10·5-13·5) reported no tobacco use (cessation transition), 7·0% (95% CI 5·5-8·7) reported e-cigarette mono use (harm reduction transition), and 55·3% (95% CI 52·6-58·0) reported cigarette mono use (relapse transition). In the adjusted regression analysis, ND severity was associated with lower odds of cessation (OR 0·36; 95% CI 0·15-0·88) and harm reduction (OR 0·18; 95% CI 0·04-0·82) transitions. Interest in quitting and CVD factors were not associated with cessation or harm reduction. Collectively, our study findings emphasize the need for stricter tobacco regulatory policies to prevent another tobacco epidemic.

Since their introduction to the United States in 2008, synthetic cannabinoids became the most widely used recreational drug behind marijuana, then regressed to an estimated prevalence of less than 1%. Contrary to expectations for a drug declining in use, emergency department presentations and acute poisonings related to the use of synthetic cannabinoids are increasing. Alongside this phenomenon, a growing body of literature is beginning to uncover a relationship between psychosis and synthetic cannabinoid use. A current gap in the literature exists surrounding harm prevention methods and targeted intervention strategies for users of synthetic cannabinoids. To date, no known studies have examined individuals with a history of use of these substances and investigated the reasons they decided to discontinue recreational use. The purpose of the current study was to fill this gap in the literature while also further confirming and expanding existing research on the characterization of synthetic substance use, perceived harm of synthetic cannabinoids, and users’ knowledge about synthetic cannabinoids. Cross sectional survey methods in a non-experimental comparative design was utilized with participants recruited through the online crowd sourcing platform Amazon MTurk. Significant motivating factors for both discontinuation and continuation of synthetic cannabinoid use were found including personal experience, accessibility, preference towards other substance, and questions surrounding the source and purity of the synthetic cannabinoids. It was also found that individuals who currently use synthetic cannabinoids have less general knowledge about the substance class when compared to individuals who have discontinued use. These results suggest that psychoeducational campaigning surrounding general knowledge about the substance class as well as information on the physiological effects of synthetic cannabinoids may be an effective harm reduction method.

People who inject drugs (PWIDs) are the most stigmatized and marginalized people in the general population (Ahern, Stuber, & Galea, 2007; Birtel, Wood, & Kempa, 2017). This group is not easily accessed by typical means of patient outreach and is one of the most underserved populations for primary care, mental health services, and care for chronic infectious diseases associated with injection drug use including HIV and HCV (Ahern et al., 2007; Dean et al., 2000; Livingston, Milne, Fang, & Amari, 2012; Zeremski et al., 2013). Syringe Service Programs (SSPs) can give public health and social support organizations and agencies access to an otherwise underserved population and give PWID potential access to a constellation of care to address multiple comorbidities associated with injection drug use (Barocas et al., 2014; Pollack, Khoshnood, Blankenship, & Altice, 2002; Zeremski et al., 2013). Additionally, the potential access to primary and secondary care that SSPs may connect PWID to, perceived social support is one of the strongest predictors of well-being and mental health among people with stigmatized conditions including HIV/AIDS, HCV, and PWID (Birtel et al., 2017). Wider adoption of SSPs and bridging of SSP clients to Medication Assisted Treatment providers is a potential tool in combating the current opioid epidemic in Tennessee. The Tennessee Poll by ETSU was conducted between March and April of 2017. The Tennessee Poll is an annual statewide public opinion poll conducted by the Applied Social Research Lab (ASRL). In the Tennessee Poll, questions were asked about attitudes and beliefs associated with SSPs and PWID in Tennessee. In a previous project, the research team, using generational demographic categories used in Pew surveys, looked at attitudes about both illicit and medical use of marijuana. In comparison of generations, Millennials were 15.62 times (95% CI 5.6, 43.56, p < .001) more likely to support recreational marijuana legalization versus the reference category (The Silent Generation or the generation before Baby boomers and sometimes called “The Greatest Generation”) and 3.7 times (95% CI 1.47, 9.3, p