The instrumental misuse of prescription stimulants as "study drugs", particularly by college students, is a serious issue that needs to be further investigated. Using data from a sample of 549 University of Central Florida Orlando students, the current study tested the relationship between prescription stimulant misuse and social learning theory, as well as general strain theory. Approximately 17% of participants reported misusing prescription stimulants for academic purposes at least once in the past year. Findings show support for social learning theory; the number of friends who use prescription stimulants and the individual's attitudes about the effectiveness of the drugs are both significant variables. General strain theory was divided into two parts; the first one tests the relationship between strain and negative affect, while the second tests negative affect, strain and prescription stimulant misuse. Overall, general strain theory was not found to explain prescription stimulant misuse. Also, results showed students who binge drink or use other substances are significantly more likely to report prescription stimulant misuse. Potential implications for these findings are discussed, as well as future research directions.

The state of Mississippi is undergoing a prescription opioid epidemic that mimics national trends in which prescribing rates are dropping, yet overdoses involving opioids remain high. In response to the state’s crisis, the PReventing Opioid Misuse In the SouthEast (PROMISE) Initiative was created to provide education for preventing the misuse of prescription opioids. A mail survey and post card intervention were distributed in six Appalachian counties in the state to gather the self-reported attitudes, norms, and perceived behavioral control of residents as it related to using a prescription drug take-box. Descriptive and multivariable analyses indicate the intervention did not increase intention to use prescription drug take-back boxes as a method of disposal. Lack of awareness and inconvenience remain common themes among individuals who chose not to use take-back boxes. Thus, researchers recommend future interventions incentivize prescription disposal.

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京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24093号 / 社医博第124号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 村井 俊哉, 教授 中川 一路 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Pain is a leading cause of disability and the most common reason for clinical care. The field of pain research has focused on sex differences in the recent years with an expansive body of literature demonstrating sex-related differences in pain behavior and responsiveness to pharmacological interventions. Prescription opioids are potent analgesics and the mainstay for the clinical management of moderate-to-severe acute and chronic pain conditions. However, the long-term clinical use of prescription opioids for chronic pain remains controversial due to concerns about severe adverse effects, including tolerance, dependence, and addiction associated with opioid use. The non-medical use and abuse of prescription opioids has become a public health crisis, the problem even arising in a subset of chronic pain patients receiving opioid therapy. The vulnerability factors, specifically the role of pain in the propensity to prescription opioid abuse, are poorly understood. The present research project sought to investigate the propensity to opioid reward as a function of pain in male and female mice by incorporating acute (acetic acid-induced) visceral nociceptive and chronic chemotherapy (paclitaxel)-induced peripheral neuropathic pain models. Sexually dimorphic variations in the sensitivities of mice to nociceptive and allodynic behaviors were initially assessed using the two putative pain models. Following that, the two prescription opioids, morphine and oxycodone were examined under both pain contexts and the capacity of the two prescription opioids to produce reward-related behavioral effects were measured using drug discrimination, conditioned place preference, and intravenous drug self-administration procedures. The presence of acute noxious state but not chronic pain selectively attenuated the discriminative stimulus effects of the prescription opioid, morphine in male mice. The magnitude of modulation of the stimulus effects of opioids by the acute noxious state were further observed to be inversely related to the relative intrinsic antinociceptive effectiveness of the two opioids in reversing the acute noxious state and sex-specific sensitivities of mice to opioid-induced antinociception. In contrast, while no change was observed in opioid-reward as a function of the acute noxious state in both sexes, the presence of paclitaxel-induced chronic pain opioid-selectively and dose-selectively enhanced the conditioned rewarding effect of morphine (0.3 mg/kg dose), and the effect was more pronounced in male relative to female mice. These data were further supported by the self-administration results, in that the reinforcing efficacy (breakpoints under progressive ratio (PR) responding) and the incentive-motivational salience of morphine significantly increased in the presence of chronic pain in male mice, while non-selectively increasing regardless of the presence/absence of pain in female mice. Overall, the converging empirical evidence presented here suggest that these models provide preclinical tools to further understand the overlapping neurobiology of pain and opioid abuse, the behavioral effects of prescription opioids, and advance the development of novel sex-specific pain therapeutics with low addiction liability. / Pharmaceutical Sciences

With food and nutrition insecurity driving diet-related chronic health conditions in urban settings, strategies that facilitate access to fresh fruits and vegetables are imperative. Food is Medicine is a philosophy that embraces the integration of nutrition education and food subsidies into health care. This thesis describes one example of a Food is Medicine program, food prescription programs (FRx), in chronic disease management. While FRx programs vary in length, there are no studies to our knowledge addressing the reasons why patients adhere to FRx long-term. Using a positive deviance approach, we sought to understand positive deviant patient (PDP) practices and characteristics influencing consistent, long-term participation in Temple University's Farm to Families (F2F) fruit and vegetable prescription program. Prior to introducing this case study, I share from an Urban Bioethics lens my reflections on study design, my positionality coordinating research with community members, and how Urban Bioethical principles relate to FRx. I present the F2F case study: we conducted semi-structured, in-depth interviews among 13 PDPs who participated for over three months between 2016 and 2021. Interview transcripts were coded for most common themes. Seven of the 13 PDPs opted to participate in photovoice interviews. I then examine lessons learned from the F2F case study. Lastly, I discuss the sustainability of FRx from an Urban Bioethics lens, starting with considerations of resource allocation of FRx, and ending with integrating FRx into clinical practice and health systems. Despite the complexity of risk factors and sociopolitical forces contributing to food and nutrition insecurity in the United States, food justice is both necessary and achievable. How we as Urban Bioethicists and clinicians choose to approach food insecurity determines our capacity to challenge the status quo and reconstruct the narratives that have perpetuated this issue for far too long. Through a collaborative effort that embraces the experiences of our patients and community members, my aspiration is for food justice to become a reality. / Urban Bioethics

Yes / To compare spectacles bought online with spectacles from optometry practices. Methods: Thirty-three participants consisting of single vision spectacle wearers with either a low (N = 12, mean age 34 ± 14 years) or high prescription (N = 11, mean age 28 ± 9 years) and 10 presbyopic participants (mean age 59 ± 4 years) wearing progressive addition lenses (PALs) purchased 154 pairs of spectacles online and 154 from UK optometry practices. The spectacles were compared via participant-reported preference, acceptability, and safety; the assessment of lens, frame, and fit quality; and the accuracy of the lens prescriptions to international standard ISO 21987:2009. Results: Participants preferred the practice spectacles (median ranking 4th, IQR 1–6) more than online (6th, IQR 4–8; Mann-Whitney U = 7345, p < 0.001) and practice PALs (median ranking 2nd, IQR 1–4) were particularly preferred (online 6.5th, IQR 4–9, Mann-Whitney U = 455, p < 0.001). Of those deemed unacceptable and unsafe, significantly more were bought online (unacceptable: online 43/154 vs. practice 15/154, Fisher’s exact p = 0.0001; unsafe: online 14/154 vs. practice 5/154, Fisher’s exact p = 0.03). Conclusions: Participants preferred spectacles from optometry practice rather than those bought online, despite lens quality and prescription accuracy being similar. A greater number of online spectacles were deemed unsafe or unacceptable because of poor spectacle frame fit, poor cosmetic appearance, and inaccurate optical centration. This seems particularly pertinent to PAL lenses, which are known to increase falls risk. Recommendations are made to improve both forms of spectacle provision. / College of Optometrists