The problem of this study is to determine the extent to which the Texas Education Agency and selected school districts have implemented the legislative provisions of House Bill 467, enacted by the Sixty-First Texas Legislature. No hypothesis is advanced. The purpose of the study is twofold: first, it describes the sequential development of the crime prevention and drug education program by the Texas Education Agency as mandated through House Bill 467; and second, it determines the current status of the crime prevention and drug education program in selected school districts through the use of a semi-structured personal interview with the individual assigned primary responsibility for coordination of the program in each of the nineteen school districts included in the study. It is the further purpose of this study to determine principal and teacher perceptions toward twenty-two factors related to drug abuse among students. This was accomplished through the use of a perception survey mailed to a random sample of 1,184 teachers and all 149 principals within the nineteen school districts participating in the study. This procedure resulted in the return of usable surveys by 804 teachers and 119 principals.

This study is concerned with drug knowledge and drug abuse attitudes of a sample of pre-adolescent schoolchildren, 90 from an urban community and 204 from two rural communities. The seven hypotheses tested compared drug knowledge levels and drug abuse attitudes with the variables of community of residence, sources of information, racial identity, acquaintance with drug users, and church affiliation. High levels of drug knowledge were found to be related to rural residence, perceived parental disapproval of drug use, frequency of church attendance, and, to a minor degree, to acquaintance with peer group drug users. The sample held negative views of drug abuse and intolerant drug attitudes correlated significantly with rural residence, parental interest in talking about drugs, church affiliation, and frequency of church attendance. High drug knowledge levels and intolerant drug abuse attitudes were related to only the .20 level of significance.

Background: FDA black box warning, Risk Evaluation and Mitigation Strategies (REMS), and CMS national coverage determination (NCD) aim to reduce inappropriate use of erythropoiesis-stimulating agents (ESAs) that are widely used in anemic patients. Previous studies have not linked specific safety interventions to changes in ESA utilization patterns in the inpatient settings nor assessed such interventions on off-label use of the drugs. Ineffectiveness of the intervention and lag time between such interventions and the observed change in clinical practice could lead to serious clinical outcomes. In addition, such interventions may unintentionally reduce on-label and some off-label use of ESAs considered “appropriate” in patients who could otherwise benefit. Objectives: The primary aim of the study is to quantify the impacts of the (1) addition of black box warning, (2) implementation of NCD, and (3) institution of REMS on ESA on-label and off-label utilization patterns of adult inpatients. Demographic, clinical condition, physician, and hospital characteristics of ESAs users by their use category are also described in detail. Methods: Electronic health records in Cerner Database from January 1, 2005 to June 30, 2011 were used. The use of the two erythropoietic drugs: epoetin alfa and darbepoetin alfa were categorized into three groups using ICD-9-CM diagnoses and procedures codes and patients’ medication information. The three categories were (1) on-label use (approved by the FDA); (2) off-label use supported (use for the indications not approved by the FDA, but there is strong clinical evidence to support its use); and (3) off-label use unsupported (use for the indications not approved by the FDA and lacking clinical evidence). The immediate and trend impacts of the interventions on the proportion of ESAs prescribed for each usage category between 2005 and 2011 were assessed using an interrupted time series technique. The likelihood of receiving ESAs among patients with on-label, off-label supported, off-label unsupported indications was assessed using a generalized estimating equation approach with binary logistic regression technique, clustering for hospitals and controlling for potential confounders such as patient characteristics, patient clinical conditions, physician specialty, and hospital characteristics. Results: During the study period, there were 111,363 encounters of ESA use. These encounters represented 86,763 patients admitted to Cerner health system between January 1, 2005 and June 30, 2011. Of these patients, 66,121 were prescribed epoetin alfa only (76.2%); 20,088 darbepoetin alfa only (23.2%); and 554 were prescribed both epoetin alfa and darbepoetin alfa (0.6%). Forty-nine percent of the patients used ESAs for the on-label indications, 8.6% for off-label supported indications, and 42.7% for the off-label unsupported indications. The main uses of ESAs in our sample were for CKD (ONS, 41.1%) and chronic anemia (OFU, 31.8%). From 2005 to 2010, the proportion of visits with ESA ONS and OFS use decreased 53.2% and 81.9%, while ESA OFU increased 112.6%. Results from binary logistic regression using GEE model showed overall decreasing trends in ESA use for the on-label and off-label supported indications, but not off-label unsupported indications. REMS had no impact on the odds of receiving ESAs among patients with on-label and off-label conditions. Black box warning reduced the odds of being prescribed with epoetin alfa in patients with off-label unsupported conditions by 40%. It was also associated with 4% and 15% per month reduction in the odds of using darbepoetin alfa in patients with off-label supported and unsupported conditions. Lastly, there was a significant decline in all categories of ESA use the month after Medicare national coverage determination was implemented. The impact of NCD ranged from a 20% reduction in the odds of off-label supported use to a 37% reduction in on-label use. Age, gender, race, source of payment, admission type, clinical complexity, discharge disposition, and hospital size were significant associated with ESA use on-label and off-label. Conclusion: This study was the first to determine the impact of safety interventions on ESA on-label and off-label utilization patterns in the inpatient settings using the Cerner database. We demonstrated lag between the interventions and observed change in clinical practice, and the relative impacts of three types of safety interventions on on-label and off-label ESA use in the hospital settings. The indirect impact of the reimbursement change was the potential unintended consequence of reducing the likelihood of receiving ESAs for a patient with indicated conditions who could have otherwise benefited from the drugs.

Child protective services begin with an intake (screening) decision to accept or reject maltreatment reports. This crucial decision may lead to significant positive or negative outcomes for children and families. Little is known about characteristics that intake decision-makers share or factors that influence the decision-making process. Racially-biased intake practices have been blamed for contributing to African American children’s disproportionate overrepresentation in the child welfare system. Concerns have emerged that social workers may hold negative stereotypes about African Americans and parents who use drugs. Stereotypical biases may influence decisions in reports alleging parental drug use and/or involving African American families. This study was conducted to examine the influence of race and parental drug-use allegations on intake decision-making. It was also conducted to identify factors that influence decision-making and to determine whether concepts drawn from naturalistic decision theory and attribution theory are relevant to intake decision-making. A conceptual model for describing decision-making was proposed and tested. Equivalent materials design was employed. Respondents completed an on-line questionnaire that included 24 vignettes describing hypothetical maltreatment concerns. Race and drug use were manipulated between two instrument versions. Respondents completed a 45-item scale measuring racial and parental drug use bias. They also described their application of policy to decision-making and the degree to which they engaged in different types of mental simulation (a naturalistic decision theory strategy) in making decisions. Eighty-seven child protective services intake decision-makers in Virginia participated (67% response rate). The findings suggest that respondents’ decisions were not influenced by racial bias but were influenced by parental drug use bias. Respondents’ parental drug use bias scores were higher than their racial bias scores. Social workers’ racial bias scores were higher than other respondents’ scores. A set of nine primary decision-factors used frequently in decision-making was identified. Finally, respondents reported using their discretion in adhering to CPS policy depending upon their concern for children’s safety. The research contributes to understanding the intake decision-making process. Findings related to worker characteristics, relevant decision-factors, and decision-making behaviors may influence practice and future research. Findings also suggest that naturalistic decision theory concepts warrant further attention and study.

The non-medical use of prescription drugs is an important public health concern. Non-medical use of prescription stimulants (NMUPS), specifically medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), is particularly concerning. One timely concern regarding NMUPS, especially among young adults, is their role in appetite suppression/weight loss. Indeed, some individuals are motivated to misuse such drugs for the purpose of losing weight. Engaging in NMUPS for weight loss has been examined only minimally in the research literature. However, extant data demonstrate that this behavior is associated with other unhealthy behaviors and poor psychosocial health. Limitations of prior research include the exclusive use of college student samples and little attention to relevant health behavior theory. The current study investigated NMUPS for weight loss in a national, young adult sample (n = 1526), ages 18-25 years, utilizing Amazon’s Mechanical Turk. Motivations and attitudes about NMUPS were evaluated, within the framework of the Theory of Planned Behavior (TPB). A structural equation model (SEM) was analyzed, which included attitudes; social norms; and perceived behavioral control (PBC) to lose weight without stimulants, as predictors of engaging in past year NMUPS for weight loss. Approximately 12.0% of participants reported lifetime NMUPS for weight loss, and of these, 48.4% reported past year use. Findings demonstrate that use is related to disordered eating and unhealthy weight loss behaviors, including vomiting; high rates of other substance use; and psychological concerns, including body dissatisfaction and depressive symptomatology. These results suggest that NMUPS for weight loss is associated with a variety of negative consequences and users are not well-informed regarding medication knowledge. The SEM provided adequate overall fit to the data; two of the four social norms and both PBC factors were significantly associated with NMUPS for weight loss. This study extends the literature on the utility of the TPB in examining NMUPS, and provides the first research on utilizing the TPB to examine NMUPS for weight loss. Methods aimed at increasing PBC regarding stimulant use and weight loss, and emphasizing healthful and sustaining weight loss strategies, improving mental health, and educating about polysubstance use are potential intervention targets.

The thesis explores chronic leg ulceration experienced by young people who inject drugs (PWID). The applied health research study, in two phases, used a sequential explanatory mixed methods design. Phase 1 involved a survey of 200 people who injected drugs to investigate the prevalence of skin problems and leg ulceration, together with the identification of risk factors for ulceration. Phase 2 involved a series of fifteen qualitative semi-structured interviews that explored the results relating to risk factors with a sample of PWID who had experienced leg ulceration, and investigated participants’ perceptions of appropriate harm reduction methods. Main findings There were three research questions in this study: 1) What is the extent of skin problems and chronic leg ulceration in young people who inject drugs? The study identified a high prevalence of leg ulceration as 15%. 60% of the sample had experienced a skin problem. Each reported skin complication is clearly defined. 2) What causes chronic leg ulceration in young people who inject drugs? Leg ulceration experienced by PWID in this study was directly linked to deep vein thrombosis (DVT), as well as injecting in the groin and the leg. DVT was strongly associated with groin and leg injecting. The acceptance amongst injectors of the groin and leg as a site of choice has occurred with a lack of awareness of the long-term consequences of damage to the limb. 3) What are appropriate harm reduction measures in young people who inject drugs? Harm reduction methods related to the development of leg ulceration have been absent across schools and drug services. Training for healthcare workers which enables them to identify risk factors should be developed, and harm reduction information related to leg ulceration should be included in drug education within schools, and instigated within drugs services. This applied health research has led to a number of practice-focused recommendations surrounding clinical care including early detection of venous insufficiency and accessible services to prevent, assess, and treat venous disease in PWID. The original contribution to knowledge is three-fold: 1. Leg ulcers have been found to be highly prevalent in young people who inject drugs. 2. Ulceration is predominantly caused by venous thrombosis due to injecting in the legs or groin. 3. Harm reduction related to the development of venous disease has lacked impact and effect.

BACKGROUND: Drug abuse is a social problem with psychosocial and physical complications. The lifestyle of injection drug users (IUD) increases the risk of infectious as well as of non-infectious diseases. The workers of low-threshold programmes are often the first ones to encounter the physical complications of injection drug users, and the workers are accordingly often the ones who take the initiative in dealing with those complications. Mapping the possible solutions of injection drug users' complications by the workers of low-threshold programmes would respond to the needs for methodological approach widely available to the workers of low-threshold programmes. AIMS: The present thesis aims to describe the possible solutions to physical complications of injection drug users through mapping the solutions in the practice of the low-threshold programmes workers for drug users in Prague. SAMPLE: All the seven low-threshold programmes facilities based in Prague were appealed to participate on the research. Thirty eight respondents participated in the study (39 % outreach programs, 53 % drop-in centre, 8 % combined services) METHODS: The present research was carried out via questionnaire research. The output data was analysed through descriptive statistics. The standardized questions of the...

Introduction: Prostitution is a phenomenon naturally related to different type of risky behavior such as drug use. There is an easier access to psychoactive substances in the sex business environment where becoming drug addict can be more accelerated. Psychoactive substances can be used as a way of breaking moral boundaries while working in sex business. The experts believe that drug use contributes to relaxation and reduces both mental and physical barriers when providing sexual services. Goals: The goal of this dissertation is to look into the issue of prostitution in the Czech Republic in the years 2010 to 2014 to map out the illegal drug use and presence of sexually transmitted diseases within the sex business. Methods: The practical part of this dissertation was based on secondary analysis of data obtained by long term research by the organization Rozkoš bez rizika (Pleasure without Risk) in sex business. The data analysis was taken between the years 2010 and 2014. Results: Sexual services are mostly provided in night clubs by girls and women in the age of 21-30, women of the Czech nationality, single women. The highest level of education is mostly practical school without graduation. The concentration of sex workers in capital Prague and in the border area with Germany and Austria was...

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the award of Masters of Arts in Demography and Population Studies, 2017 / Background: Risky behaviours among adolescents are notably the most important factors contributing to negative health outcomes of this population group. Adolescents in South Africa are at risk of the HIV infection, unintended pregnancies, unintentional injuries (motor vehicle accidents) and substance and drug abuse. South Africa is regarded as one of the countries with nearly half adolescents living with HIV, as a result of unprotected sex. It is also regarded as one of the countries with motor accidents cases and as a result of reckless driving and substance use. To understand this, there is substantial research on the demographic and socio-demographic determinants of risky behaviour amongst adolescents but little research on the household and community factors. The main aim of this study is to determine the contextual determinants of adolescent risky behaviours in South Africa. Method: This study used data from the South African Youth Life Style Survey of 2008. The study sample size is 3336 adolescents aged 12 to 19 across all nine provinces in South Africa. Risky behaviours are organized using an ecological framework into individual, household, and community levels. Binary- multilevel logistic regression was employed to analyze the data. Results: The results indicated that age, sex, education, race, living arrangements, number of income earners, were significant, however, the relationship between risky behaviours and community level variables were negatively significant. . 3336 adolescents participated in the study, 934 (28.0%) had sexual intercourse and 158 (4.74%) had two or more sexual partners, and 234 (7.01) did not use a condom during their last sex. In terms of substance use, 34.24 % ever used alcohol and about 24.45% ever been a passenger with a driver under the influence. Adolescents who were living with their grandparents (OR=1.07), living in a household with seven or more members (OR=1.06), while residing in had a higher likelihood of engaging in risky behaviours. Findings demonstrated that community level factors were not associated with reports of risky behaviour among adolescents but were influential in shaping the risky behaviour of adolescents. Conclusion: Firstly, results from this research will provide a better understanding of the contextual factors that relate to risky behaviours. Secondly, results from this research will help inform polices such as the National Youth Policy in reducing risky behaviours. Lastly, interventions aimed at reducing risky behaviours among adolescents in South Africa should not only focus on individual level but also on the household and community engagement. / XL2018

Studiens syfte är att undersöka gymnasieelever i årskurs tre och deras motivation till att prioritera sina studier och prestera väl i skolan, samt undersöka vad som kan bidra till problematiken kring att vissa gymnasieelever inte är motiverade till att prioritera sina studier och prestera väl i skolan. Ett visst fokus riktas mot gymnasieelevers alkohol- och narkotikaanvändning, med syftet att undersöka huruvida detta samspelar med bristande studiemotivation. Studien utgår från tidigare forskning på området, vilken fastslår att det existerar ett samband mellan studierelaterad problematik och alkohol- och narkotikaanvändning, samt att andra omkringliggande aspekter i elevers liv kan vara avgörande för studierelaterad problematik och ungas användning av alkohol och narkotika. Tidigare forskning har, tillsammans med vårt teoretiska ramverk hjälpt oss att analysera och diskutera studiens resultat. Det teoretiska ramverket består av ett helhetsperspektiv och andra teoretiska begrepp som KASAM (känsla av sammanhang), gruppkultur, subkultur och avvikande beteende. För att uppnå studiens syfte har vi antagit en kvantitativ ansats och inhämtat vårt empiriska material via en webbaserad enkätundersökning. Vår data har genomgått sambandsanalyser med hjälp av Chi2-test, t-test och variansanalys (ANOVA). Studiens resultat visar att de flesta gymnasieelever sällan är motiverade att gå till skolan på morgonen och spenderar under 30 minuter om dagen på studier utöver skoltid. Samtidigt är det övervägande många som anser att det är av vikt att prestera väl i skolan. De flesta elever skolkar minst någon gång per termin och då på grund av en allmän skoltrötthet. Resultatet visar även att det finns ett samband mellan elevers omgivning och deras studiesituation. Vänners vanor kring skolk återspeglas exempelvis i hur ofta eleven själv skolkar. Detsamma gäller för elevens användning av alkohol och narkotika. Avslutningsvis visar också studiens resultat att det finns samband mellan alkoholanvändning (i vissa fall), cannabisanvändning (i de flesta fallen) och studierelaterad problematik.