The purpose of this research is to examine the barriers to food security for single adults with mental illness and/or problematic substance use living in supported housing on Vancouver Island. The objectives are: (a) to examine the difference in the level of food security for tenants of supported housing neighbourhoods located in urban versus a rural community; (b) to examine the barriers to food access experienced by the tenants; and (c) to examine which barriers have the greatest effect on the tenants. Using an explanatory case study design, I employ a community-based research method with a social justice perspective as the framework. I have used an explanatory matrix to illustrate the tenant identified barriers to food security and the social structures that affect these barriers. As well, I have made recommendations for integrating food security services and programs into supported housing projects. I have argued that food security is a matter of public health and an integrative approach is needed. I am suggesting a shift on a larger policy scale, to promote the health and well-being of tenants in supported housing. An adequate holistic perspective with an integrated, long-term strategy linking all the determinants of health would result in health-in-all policies. This strategy could reduce the existing health inequities that the tenants in supported housing experience. / Graduate / judy@nahs.ca

Pathological gambling is a maladaptive behaviour associated with diminished self-control over persistent compulsive gambling behaviour despite negative consequences. A significant revision to the clinical perspective of pathological gambling is underway, and the disorder will likely be recognized as a behavioural addiction in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the neurobiological, cognitive and behavioural processes that drive a ‘behavioural addiction’ are unclear. A series of five studies were conducted to investigate cognitive mechanisms associated with neural and behavioural substrates of addictive processes in disordered gambling. Studies 1 through 3 investigated neurobiological correlates of addiction in individuals with pathological gambling as compared to individuals with cocaine dependence, and as compared to non-addicted healthy controls. Study 1 investigated brain activity associated with anticipatory and consummatory reward processing during slot-machine gambling. Study 2 investigated executive control processes by examining functional brain networks associated with loss-chasing behaviour. Study 3 employed voxel-based morphometry (VBM) to explore alterations in grey-matter volumes in individuals with addictive disorders. Studies 4 and 5 investigated the behavioural substrates of addiction in regular gamblers utilizing emerging and novel research techniques. Study 4 examined continuous hand motion trajectories to explore approach biases and implicit processing. Study 5 employed an adaptive testing methodology to explore the influence of gaming machine preferences on cognitive processes and gambling behaviour. Research identified neurobiological and behavioural substrates of gambling-related beliefs and biases that indicate significant contributions of cognitive mechanisms to the development and persistence of a behavioural addiction. Results suggest addictive disorders may share some common features of anticipatory reward processing and brain structure (Studies 1 and 3), while neural signals associated losing outcomes and decision-making during gambling may be specific to disordered gambling (Studies 1 and 2). Furthermore, cognitive distortions in regular gamblers may influence reinforcement and executive control processes (Study 4), and individual preferences for gaming speed may influence cognitions and behaviour during machine gambling. As additional psychological disorders are being considered for classification as behavioural addictions, and clinicians will be faced with the challenges of treating individuals with these non-substance-related addictive disorders, a better understanding of behavioural addictions, through the study of disordered gambling, will be essential under the new diagnostic framework.

Överkonsumtion av alkohol är ett globalt problem som ökar risken för insjuknandet i flera sjukdomar, därmed kommer personer med substansbrukssyndrom i kontakt med många delar av hälso- och sjukvården. Patienter med substansbrukssyndrom upplever att de inte erhåller vård på samma villkor som andra. Syftet med litteraturstudien var att utforska sjuksköterskors inställningar vid vårdandet av personer med substansbrukssyndrom utanför specialiserad beroendevård. En systematisk litteraturstudie med beskrivande design användes som metod för att besvara syftet.  Resultatet består av två kategorier: “Sjuksköterskors inställningar till att vårda patienter med substansbrukssyndrom” och “Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom”. Kategorin ”Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom” bygger på fyra subkategorier: negativa aspekter, positiva aspekter, bristande kunskap och samtal om alkohol. Inställningen till att vårda patienter med substansbrukssyndrom var övervägande negativ. En förbättring av sjuksköterskors kunskaper om omvårdnad vid substansbrukssyndrom skulle kunna bidra till en bättre vårdupplevelse för både sjuksköterska och patient. / Overconsumption of alcohol is a global health issue that increases the risk for several physical and mental health conditions. People who suffer from alcohol dependence will therefore often come in contact with different instances within the health care system. Patients suffering from substance dependence might experience that they don’t receive equal care compared with other patients. The aim of the study was therefore to explore how nurses in general healthcare experience caring for patients suffering from substance dependence in general healthcare, outside of specialized care. A systematic literature review was used to answer the aim of the study. The result consists of two categories: "Nurses' experiences of caring for patients with substance use disorder" and "Nurses' emotional reactions of caring for patients with substance use disorder". The category "Nurses' emotional reactions of caring for patients with substance use disorder" is based on four subcategories: negative aspects, positive aspects, lack of knowledge and discussion about alcohol. Attitudes of caring for patients with substance dependence were predominantly negative. An improvement in nurses' knowledge could contribute to a better care experience for both nurse and patient.

Bakgrund: Sjuksköterskor möter personer med substansberoende inom alla vårdformer. Detta är en stigmatiserad patientgrupp som inte alltid upplever att de får vård på lika villkor som andra. En negativ inställning till denna patientgrupp är inte i enlighet med sjuksköterskans etiska kod och utgör ett hinder för god omvårdnad. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors upplevelser av att i sin professionella roll möta personer med substansberoende. Metod: En systematisk litteraturstudie av 10 studier med kvalitativ ansats. Sökningen genomfördes i databaserna PubMed, Cinahl samt PsycINFO. De kvalitetsgranskades och sammanställdes med inspiration av en modell för syntesprocess. Resultat: Fyra huvudteman framkom: a) misstro och negativ inställning till personer med substansberoende, b) kunskapsbrist och organisatoriska brister, c) hinder för god omvårdnad samt d) sympati och vilja att upprätta en god relation. Konklusion: Litteraturstudien visar att sjuksköterskor upplever flera brister och hinder inom omvårdnaden av personer med substansberoende. Det bidrar till att vård inte kan utföras i enlighet med etiska riktlinjer. Det finns behov av mer utbildning, kunskap och stöd i sjuksköterskornas yrkesroll samt vidare forskning för att kunna hitta förbättringsåtgärder som stödjer sjuksköterskan och kan förbättra vården för personer med substansberoende. Nyckelord: substansberoende, sjuköterskor, upplevelse, attityder, stigmatisering / Background: Nurses meet patients with substance use disorders in all forms of care settings. This is a stigmatized group that does not always receive care on equal terms as others. Negative attitudes towards this group are not in accordance with nurses ethical code and is a barrier for good nursing care. Aim: The aim of this systematic review was to illuminate nurses’ experiences of in their professional role encountering patients with substance use disorders. Method: A systematic review of 10 qualitative studies was performed. The search was made in the databases PubMed, Cinahl and PsycINFO. The studies were scrutinized for quality and compiled with inspiration of a model for synthesis. Results: Four major themes emerged; a) distrust and negative attitudes towards patients with substance use disorders, b) lack of knowledge and organizational deficiency, c) barriers for good nursing care, and d) sympathy and will to establish a good relationship. Conclusion: The systematic review shows that nurses experience many barriers in caring for patients with substance use disorders. This leads to inability to provide care according to the ethical guidelines. There is a need for more education, knowledge and role-support as well as further research to find improvements that support nurses’ and could improve the care for patients with substance use disorders. Keywords: substance use disorder, nurses, experience, attitudes, stigma

published_or_final_version / Social Service Management / Master / Master of Social Sciences

Low-income women, including women who receive welfare, are some of the most misunderstood citizens in the U.S. Low-income women often live in extreme situations that are complicated by poverty and multiple issues related to human capital, social support, mental health, and substance use. These factors make low-income women unique in that they contribute not only to the women’s current situations, but to their potential for future self-sufficiency. The majority of previous studies have described these factors as barriers to self-sufficiency. This study explored these factors differently by examining the extent to which human capital is associated with mental health problems and substance use problems and whether those associations are moderated by social support among low-income women. By exploring human capital among low-income women, this study closes a gap in the literature. Previous literature has examined human capital as an outcome of life choices and circumstances. This study is unique in that human capital is conceptualized as a combination of strengths that are employed in unique ways and that help determine whether life outcomes among low-income women will be related. This study examined secondary data collected from 11,495 low-income women who participated in the University of Kentucky’s Targeted Assessment Program (TAP) between July 2005 and July 2011 and is informed by theoretical literature on human capital, social support, and relationships, as well as empirical literature on study factors related to problems experienced by low-income women (i.e., mental health problems, substance use problems, and social support). Study hypotheses were developed to examine the relationships between human capital and mental health and substance use among low-income women and whether social support moderates those relationships. Results indicate that while some human capital factors are indicative of fewer mental health and substance use problems, perceived social support was a significant indicator of each of the mental health and substance use factors. Perceived social support was not found to moderate relationships between predictor and outcome variables.

The purpose of this study is four-fold: (1) to test delinquency theories in social settings that vary by their degree of religiousness; (2) to determine whether delinquency causal processes vary according to the nature of religious ecology; (3) to assess whether variation exists in the rates and types of adolescent offenses committed in these settings; and (4) whether these offenses are a response to unique influences in each context. Religious ecology is measured by tapping a dimension of school religious characteristics, including a school's level of religiousness and a school's religious group composition. Adolescent boys who are exposed to the confines of schools that are predominantly irreligious or disproportionately low in orthodoxy are significantly more likely to engage in delinquency than boys from more moral or highly orthodox schools. Experiences in fundamentalist reference groups also protects youngsters against engaging in substance use episodes, including harmful drugs such as cocaine. These patterns are independent of demographic characteristics such as race, gender, socioeconomic status, family size and community size. To account for religious ecological differences in problem behavior, strain and control theories of delinquency are tested. These testing procedures reveal little support for processes advocated by strain theorists. Not only is structural and interactionist induced strain not correlated with delinquency and substance use, but discrepancies between cultural expectations and perceived realization of these goals do not lead to psychosocial frustration and tension, as implied in many strain models. Control models more aptly account for delinquency and substance use variation in various religious climates, but the strength of religious, school, and family effects varies with the type of offense and the measure of religious ecology. If we measure religious ecology by the nature of denominational composition, religiosity has a uniform effect on delinquency. However, religiosity's effect in settings that vary by religious level is to more strongly inhibit chronic offending in secular disorganized communities. Involvement in delinquency and substance use is probabilistically less likely in moral and highly orthodox settings because religion's social expression is stronger, the broken home phenomenon is weaker and potentially harmful school behaviors and attitudes are unrelated to delinquency in these settings.

The goal of this research is to explore the relationship between coercion and crime amongst street youths in Mexico. This research relies on Mark Colvin’s (2000) Differential Coercion Theory (DCT). Through semi-structured interviews with street youths in Mexico City, this research explores: (1) the various personal and structural factors that lead youths to the street; (2) the strategies of income generation used by the youths; (3) the youths experiences of victimization, substance use, criminal involvement and institutionalization; and finally, (4) the personal and structural reasons that contribute to youths’ inability to leave the street. Results indicate that in most cases youths experience some form of physical, sexual, verbal, and/or psychological abuse that prompts them to leave home. In other cases, youths simply witnessed the abuse of a significant other or become subject to neglect. Some youths are thrown out of the home due to familial conflict. Results also indicate that on the street, youths are encouraged to display violent behaviours to avoid victimization. Further, youths face a number of needs and are compelled to engage in legitimate or illegitimate sustenance practices. On the street, youths are subject to theft, as well as physical and sexual victimization from peers and police officers. The results also suggest that youths are dependent on various substances as a way to cope with difficult situations. Results also indicate that as a result of crime or drug use, youths are likely to experience institutionalization where physical, verbal, and psychological victimization is experienced. Finally, youths attribute the freedom provided by the street and substance dependency as reasons to stay on the streets. Overall, the results suggest that Mexican street youths experience coercion in various settings. However, to explain the relationship between coercion and crime more research is needed on other explanatory factors. / Thesis (Master, Sociology) -- Queen's University, 2013-10-28 16:29:18.922

Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later. Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis. Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline. Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31). Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.

Title: Has youth participation in organized extracurricular activities and future expectation relevance for antisocial behavior?   Zetterberg, E. (2015). Has youth participation in organized extracurricular activities and future expectation relevance for antisocial behavior? Bachelor thesis in Public Health science. Department of work- and public health science. The academy of health and working life. University of Gävle, Sweden. Adolescent drug use is a threat to public health. Therefore it is important to identify how different factors interact in order to develop successful preventive interventions against youth drug use. The purpose of this study is to investigate the association of participation in organized extracurricular activity, future expectation and drug use. Method: The study is cross-section designed and based on the data material from the last survey, Life and Health Young in 2013 in Uppsala County. The study included 1648 high school students residing in the municipalities of Uppsala, Enköping and Älvkarleby (response rate of 60 %). The data were analyzed by bivariate and multivariate methods. Results: The results indicate that there is an association between participation in organized sports-related extracurricular activity, future expectation and drug use. Young people who have a positive expectation about their future have used less drugs (16%) compared with adolescents who have a negative future expectation (27%). Positive future expectation was also strongly associated with participation in organized sports-related extracurricular activity (both p< 0.001). Conclusions: Being involved in organized extracurricular activity appears to be a determinant of a positive future expectation as well as a positive future expectation seems to be a determining factor for decreased drug use among adolescents. / Ungdomars narkotikaanvändning är ett hot mot folkhälsan. Därför är det viktigt att kartlägga hur olika faktorer samvarierar för att kunna utveckla framgångsrika preventiva insatser mot ungdomars narkotikaanvändning. Syftet med den här studien är att undersöka associationen mellan deltagande i organiserad fritidsaktivitet, framtidstro och narkotikaanvändning. Metod: Studien är av tvärsnittsdesign och bygger på datamaterial från den senaste enkätundersökningen Liv och Hälsa Ung 2013 i Uppsala län. I studien ingick 1648 gymnasieungdomar bosatta i kommunerna Uppsala, Enköping och Älvkarleby (svarsfrekvens på 60 procent). Datamaterialet har analyserats med bivariata och multivariata metoder. Resultat: Resultatet indikerar att det finns en association mellan deltagande i organiserad idrottsrelaterad fritidsaktivitet, framtidstro och narkotikaanvändning. Ungdomar som har en positiv framtidstro har i mindre utsträckning använt narkotika (16%) jämfört med ungdomar som har en negativ framtidstro (27%). Positiv framtidstro var även starkt associerat med deltagande i organiserad idrottsrelaterad fritidsaktivitet (båda p<0.001). Slutsats: Att delta i organiserad fritidsaktivitet tycks vara en bestämningsfaktor för positiv framtidstro liksom att positiv framtidstro tycks vara en bestämningsfaktor för minskad narkotikaanvändning bland ungdomar.