A literatura e as diferentes práticas profissionais em saúde têm evidenciado os benefícios das intervenções que estendem o cuidado à rede de relações mais próximas dos sujeitos/pacientes. Assim como para as questões de saúde em geral, a atenção ao abuso de drogas na adolescência também pode se beneficiar com o olhar ampliado à sua rede de relações, pois estas se evidenciam como importante fonte de apoio que podem ser protetores em relação ao uso drogas e ao enfrentamento das adversidades vivenciadas. Sendo assim, considerou-se relevante um estudo que buscasse identificar e caracterizar as redes de apoio de adolescentes usuários de drogas. Para tal, foi adotado como metodologia o Convoy Model (Modelo de Escolta de Apoio Social) proposto por Kahn e Antonucci. O modelo propõe a análise da rede de apoio por meio de três círculos concêntricos representando três níveis de proximidade e define que sejam avaliados os primeiros 10 sujeitos citados pelo adolescente. Foram analisados, ainda, os aspectos estrutural (características dos integrantes da rede) e funcional (tipos de apoios ofertados e recebidos). Para análise dos aspectos funcionais, os autores propõem seis pré-categorias: confidenciar coisas importantes; ser tranquilizado e estimulado em momentos de incerteza; ser respeitado; ser cuidado em situação de doença; conversar quando está triste, nervoso ou deprimido e conversar sobre a própria saúde. Os sujeitos do estudo foram contatados a partir de um serviço ambulatorial especializado em Ribeirão Preto/ SP. Sobre os 10 adolescentes entrevistados, a média de idade foi de 15,4 anos, oito adolescentes eram do sexo masculino, seis estudavam, três trabalhavam, quatro eram católicos e quatro evangélicos. A média de pessoas residindo na mesma casa que o adolescente foi de cinco pessoas. O tamanho das redes variou entre 05-22 integrantes (média de 12 integrantes). Dentre as 10 primeiras pessoas citadas por cada adolescente, predominou a presença de mulheres; faixa etária de 11-20 anos; residentes na mesma casa que o adolescente, contato pessoal diário com este e membros da família extensa. Oito adolescentes relataram a presença de usuários de drogas em sua rede de apoio. Quantos aos aspectos funcionais, a distribuição dos tipos de apoio recebido foi: confidenciar coisas que são importantes (24 menções); ser tranquilizado e estimulado em momentos de incerteza (21); ser respeitado (49); ser cuidado em situação de doença (31); conversar quando está triste, nervoso ou deprimido (26); conversar sobre a própria saúde (20). Quanto aos tipos de apoio ofertados, temos: confidenciar coisas que são importantes (25); ser tranquilizado e estimulado em momentos de incerteza (15); ser respeitado (62); ser cuidado em situação de doença (46); conversar quando está triste, nervoso ou deprimido (14); conversar sobre a própria saúde (17). Os adolescentes referiram o total de 110 relações de reciprocidade de apoios. As redes de apoio foram compostas majoritariamente por mulheres, membros de sua família e residentes da mesma casa que o adolescente, características associadas às trocas de cuidado à saúde e respeito, conforme apontam os dados. Os tipos de apoio menos citados referem-se ao lidar com sentimentos e emoções, dado este que poderia estar relacionado ao período de menor diálogo com a família, conflitos entre seus membros e maior aproximação com os pares. Tais questões poderiam ser trabalhadas por profissionais nas intervenções terapêuticas. O instrumento utilizado mostrou-se apropriado para a atuação junto a adolescentes, pois permitiu identificar as relações mais significativas, as fontes de apoio (ou ausência deste) bem como identificar na rede relações que podem interferir positiva ou negativamente no tratamento / The literature and the different professional practices in health care have shown the benefits of interventions that extend care to the closest relationships of the patients\' networks. As occurs in health care in general, the treatment of adolescent drug abusers may also benefit from care expanded to their relationships network, because it\'s known that close relationships are an important source of support which may be protective against the drug use and may be helpful to deal with adverse experiences as well. Therefore, it was considered relevant to identify and characterize the support networks of adolescent drug users. Thus, the adopted methodology was the Convoy Model proposed by Kahn and Antonucci. This model proposes the analysis of the support network by three concentric circles which represent three levels of closeness and sets which are rated the first 10 subjects pointed out by adolescents. It proposes also the analysis of the structural (characteristics of network members) and functional (different kinds of support offered and received by adolescents) aspects. To analyze the functional aspects, the authors propose six predefined categories: to confidence important issues; to reassure and encourage in times of uncertainty, to be respectful, to take care in disease situations; to talk when feeling sad, angry or depressed, and to talk about their own health. The adolescents were contacted from a specialized outpatient service in Ribeirão Preto/ SP. About the 10 interviewed, the average age was 15.4 years, eight adolescents were male, six were in rolled at school, three had a job, four were catholic and four were protestant. The average number of persons residing in the same house as the adolescents was five people. The size of network members ranged from 05-22 (mean of 12 members). Among the first 10 people cited by each adolescent, they were predominantly women, aged 11-20 years, living in the same house as the adolescents, daily personal contact with them and members of adolescent extended family. Eight adolescents reported the presence of drug users in their support network. Concerning to the functional aspects, the distribution of the kinds of received support by adolescents was: confide things that are important (24 mentions); be reassured and encouraged in times of uncertainty (21), be respected (49), be cared in disease situations (31); talk when feeling sad, angry, or depressed (26), talk about their own health (20). The kinds of offered support by adolescents were: to be confident about things that are important (25); to reassure and encourage in times of uncertainty (15), to be respectful (62), to take care in disease situations (46); to talk when feeling sad, angry, or depressed (14), and finally, to talk about their own health (17). Adolescents reported the total of 110 reciprocal relationships of support. Support networks were composed mainly of women, family members and residents of the same house as the adolescents, characteristics associated to health care and respect as data suggested. The kinds of support less mentioned were related to dealing with feelings and emotions; this could be due to the period of absence of dialogue with the family, conflicts between family members or also closer relationship with their peers instead of their family. Such issues could be considered by professionals in therapeutic interventions. The Convoy Model was appropriate to work with adolescents because it allowed us to identify the most significant relationships, the sources of support (or the lack of it) and the relationships that can positively or negatively affect treatment

INTRODUÇÃO: Estudos sinalizam que a experiência universitária corresponde a um momento de maior vulnerabilidade para o consumo de álcool e outras drogas. Essa afirmativa decorre da maior prevalência do consumo de substâncias observada entre universitários em comparação a outras amostras populacionais, inclusive jovens não universitários. OBJETIVOS: Avaliar a associação entre o uso de álcool e outras drogas (ilícitas e medicamentos) com variáveis do contexto acadêmico e os significados atribuídos pelos estudantes sobre essa relação. METODOLOGIA: Estudo longitudinal prospectivo de tratamento quantitativo e qualitativo dos dados realizado com 85 estudantes da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foi utilizado um questionário contendo questões estruturadas para avaliar os aspectos envolvidos na experiência estudantil e os instrumentos de pesquisa AUDIT (Alcohol Use Disorders Identification Test) e DUSI (Drug Use Screening Inventory) para avaliar o uso de álcool e de outras drogas, respectivamente. Também foram realizadas entrevistas semiestruturadas com alguns participantes e subsequente análise de conteúdo. RESULTADOS: Homens aumentaram o padrão de binge drinking, indicando um risco substancial nos períodos finais do curso universitário (p<0,001; OR=10), igualmente para os estudantes satisfeitos com o curso (p=0,04; OR=17). Por sua vez, no início do curso, estudantes que se autoavaliaram com desempenho escolar sem prejuízos decorrentes do consumo de drogas, apresentaram um risco três vezes maior para binge drinking, sugerindo um sentimento de onipotência e imunidade aos efeitos do beber excessivo. Ao contrário, a mesma característica foi protetora para o consumo de drogas ilícitas e medicamentos, indicando um possível distanciamento de usuários dessa classe de substâncias. A análise qualitativa das entrevistas revelou uma interação entre um conjunto de categorias, especialmente, a dissociação entre conhecimento e práticas do beber, rotina estudantil estressante, peculiaridades do grupo de amigos, festas e o sentimento de liberdade em não residir com os pais. CONCLUSÕES: Diferentes variáveis parecem atuar em cada momento específico da formação acadêmica. Apesar de não ser possível traçar um perfil que se configure como risco ou proteção, existem aspectos pertinentes ao contexto da vida estudantil associados ao comportamento do consumo de substâncias. Associações observadas revelam a necessidade de ações de curto prazo que se orientem no conceito de redução de danos. Além disso, centros especializados de apoio ao estudante e ações que privilegiem a dimensão psicopedagógica no contexto da formação acadêmica podem ser um importante meio de auxílio imediato aos jovens estudantes. / INTRODUCTION: Several studies have indicated that college years are a period of greater vulnerability to alcohol and other psychoactive drugs use. This evidence stems from the higher prevalence of substance use observed among college students in comparison to others young adults. OBJECTIVE: To evaluate the association between alcohol and other drugs (illicit drugs) use and variables of the academic life, and the meanings attributed by students on this relationship. METHODOLOGY: Longitudinal study, quantitative and qualitative approach, design on a convenience sample of 85 undergraduate students from all courses of the School of Medicine of Ribeirão Preto of University of São Paulo. Alcohol Use Disorders Identification Test (AUDIT) and the Drug use Screening Inventory (DUSI) have been used as measures of alcohol use and others psychoactive drugs use respectively. Structured questionnaire evaluated aspects related to academic life. Semi-structured interviews are conducted with some participants and submitted to content analysis. RESULTS: Men increased binge drinking pattern, indicating a substantial risk in the final periods in college (p <0.001, OR = 10), also for the college satisfied with the course (p = 0.04, OR = 17). However, in the early periods of the course, the low self-rated poor school performance was indicative of a 3-fold increased risk for the same pattern of alcohol use, but this same feature was protective for the consumption of drugs and medicines. Analysis revealed an interaction between a set of categories, particularly dissociation between knowledge and practice of drinking, stressful routine student, peculiarities of peer group, celebrations and sense of freedom in not living with parents. CONCLUSIONS: Different variables appear to act in each specific moment of graduation. Although it is not possible to draw a profile that is set as risk or protection, there are context-relevant aspects of student life behavior associated with substance use. Associations observed reveal the need for short-term actions to be guided by the concept of harm reduction. In addition, specialized centers and student support activities that emphasize psycho-pedagogical dimension in the context of academic life may an important way of helping for college students.

Objetivo: Avaliar a taxa proliferativa de células esfoliadas da mucosa bucal clinicamente saudável de usuários de crack. Material e Métodos: esfregaços orais foram coletados de língua e assoalho bucal de 87 indivíduos, divididos em três grupos: os usuários de crack (CRCO), n = 26; fumantes / etilistas (SA), n = 26 e controles (C ), n = 35. Lâminas histológicas foram submetidas à técnica de impregnação pela prata para quantificação do número de AgNORs/núcleo. As imagens foram obtidas por um sistema de captura de imagem adaptado a um microscópio de luz em x1000 ampliação. A média AgNOR por núcleo (mAgnor) e a percentagem de células com mais de 1,2,3 e 4 AgNORs por núcleo (pAgNOR> 1,> 2> 3 um> 4) foram calculados. Resultados: As células esfoliadas de mucosa da língua SA (3,34 ± 0,51 AgNOR / núcleo) exibiram maior taxa de proliferação celular (p <0,05) quando comparado com C (2,81 ± 0,773 AgNORs / núcleo) e CRCO (2,87 ± 0,51 AgNORs / núcleo) . Um aumento (p <0,05) da mAgnor também foi observada nas células do assoalho bucal (3,55 ± 0,57) em comparação com SA C (3,18 ± 0,53) e CRCO (3,28 ± 0,39). Dados semelhantes foram encontrados usando pAgNOR>1,>2,>3 e > 4. Conclusão: usuários de crack não apresentaram alterações na taxa proliferativa celular da mucosa bucal. Diante dos dados apresentados, o consumo de cigarro, em combinação com o consumo de álcool, continua sendo o maior fator prejudicial à mucosa bucal. / Objective: The aim of this study was to evaluate cell proliferation rate of cells exfoliated from clinically healthy mucosa of crack cocaine users. Material and Methods: Oral smears were collected from tongue and floor of the mouth mucosa of 87 individuals divided into three groups: crack cocaine users (CrCo), n=26; smokers/alcohol drinkers (SA), n=26 and controls (C), n=35. Histological slides were silver-stained using AgNOR technique to evaluate cell proliferation rate. Images were obtained by an image capturing system adapted to a light microscope at x1000 magnification. Quantification considered 50 cells by smear in which the number of AgNOR dots was visually counted. Mean AgNOR numbers per nucleus (mAgNOR) and the percentage of cells with more than 1,2,3 and 4 AgNORs per nucleus (pAgNOR>1,>2>3 an>4) were calculated. Results: Cells exfoliated from tongue mucosa of SA (3.34±0.51 AgNOR/nucleus) exhibit higher cell proliferation rate (p<0.05) when compared to C (2.81±0.773 AgNORs/nucleus) and to CrCo (2.87±0.51 AgNORs/nucleus). An increase (p<0.05) in mAgNOR was also observed in floor of the mouth cells (3.55±0.57) in SA when compared to C (3.18±0.53) and CrCo (3.28±0.39). Similar findings were found using pAgNOR>1,>2,>3 e >4. Conclusion: Crack cocaine users did not present changes in cell proliferation rate of oral mucosa. Between the expositions studied here, cigarette smoking in combination with alcohol consumption remain as the most harmful factors to oral mucosa.

Les usages de produits psychoactifs contribuent fortement aux inégalités sociales de santé et sont aussi inégalement distribués suivant le sexe. En utilisant des enquêtes en population générale et adolescente, ce travail montre que les écarts de consommations d’alcool, de tabac, de cannabis et d’autres drogues illicites entre hommes et femmes varient suivant le milieu social, la génération de naissance, le statut scolaire et professionnel et les conditions de travail. Parmi les adolescents, les écarts de consommations entre garçons et filles dépendent moins du milieu social qu’à l’âge adulte, mais les risques d’expérimenter puis de progresser vers des usages fréquents ou problématiques en dépendent au contraire fortement. Ces résultats montrent que les différences d’usages entre hommes et femmes sont des différences de genre, socialement construites et en lien avec le système des inégalités sociales ; ils présentent également quelques déterminants des trajectoires d’usages de drogues. / Licit and illicit drug consumptions are strong contributors to the social inequalities in health, but they are also unevenly distributed among men and women. Using general population and adolescent surveys, this work shows that the differences between men and women in alcohol, tobacco, cannabis and other illicit drugs vary according to the social position, age and birth cohort, occupational and school status as well as according to working conditions. Among adolescents, the variation of the differences between boys and girls with the family socio-economic status are rather low, but the affluence of the family is a key factor for experimenting alcohol and drugs whereas it lowers the risk of transition to frequent and problematic drug use. These results show that the differences in drug use between men and women are gender differences, socially constructed and linked with the system of social inequalities; they also point out some key determinants of the drug use trajectories.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-09T12:50:55Z No. of bitstreams: 2 Dissertação - Camila Bastos Ribeiro - 2015.pdf: 1317896 bytes, checksum: 6090f56f4db25d087b49be30b279912d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-09T12:53:24Z (GMT) No. of bitstreams: 2 Dissertação - Camila Bastos Ribeiro - 2015.pdf: 1317896 bytes, checksum: 6090f56f4db25d087b49be30b279912d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-09T12:53:24Z (GMT). No. of bitstreams: 2 Dissertação - Camila Bastos Ribeiro - 2015.pdf: 1317896 bytes, checksum: 6090f56f4db25d087b49be30b279912d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-11-27 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Studies have reported that illicit drugs can alter immune system function and further suggest a greater commitment related to the use of these drugs, such as increased susceptibility to infection and progression to disease. Considering these effects in the body, we conducted a study to investigate the effect of drug use on the inflammatory response in subjects grouped according to the drug used: marijuana, cocaine and crack users and individuals from more than one drug. Thus, the study groups were: 1. non drug users (control); 2. marijuana users; 3. Cocaine/crack users; 4.cocaine/crack/marijuana users (multiuser). The profile of proinflammatory and anti-inflammatory cytokines and C-reactive protein (CRP) in the plasma of study subjects was investigated. There were also measured the levels of soluble CD14 (sCD14) and lipopolysaccharide (LPS) circulating in the plasma of individuals that are indicative of microbial translocation. We obtained high levels of sCD14, LPS, CRP, IL-6 and IL-8 in multi-user group and decreased levels of IL-6 and TNF- in cannabis user group compared to the control group. This set of findings suggests that illicit drugs may be causing a change in the integrity of the intestinal mucosa multiuser individuals due to the increased presence of LPS and sCD14 was detected in the circulation and changes in the inflammatory response with increased production and / or decreased biomarkers relevant inflammation. / Estudos têm relatado que as drogas ilícitas são capazes de alterarfunções do sistema imune e ainda sugerem um maior comprometimento relacionado ao uso dessas drogas, tais como,maior susceptibilidade a infecções e progressão para doenças. Considerando esses efeitos no organismo, realizamos um estudo parainvestigaro efeito do uso das drogas sobre a resposta inflamatóriaem indivíduos agrupadosconforme as drogas utilizadas: maconha, cocaína oucrack e indivíduos usuários de mais de uma droga. Assim, os grupos de estudo foram: 1. não usuários de drogas (controle); 2. usuários de maconha; 3. usuários de cocaína/crack; 4. usuários de cocaína/crack/maconha (multiusuários).Foi investigadoo perfil de citocinas proinflamatórias e anti-inflamatórias e proteína C reativa (PCR)no plasma dos indivíduos do estudo. Também foram medidos os níveis de CD14 solúvel (sCD14)e lipopolissacarídeo(LPS)circulantes no plasma dos indivíduos, que são indicativos de translocação microbiana. Observamos níveis elevados de sCD14, LPS, PCR, IL-6 e IL-8 no grupo de multiusuários e níveis diminuídos de IL-6 e TNF-no grupo de usuários de maconha em relação ao grupo controle.Esse conjunto de achados sugere que as drogas ilícitas podem estar provocando uma alteração na integridade da mucosa intestinal de indivíduos multiusuários devido à presença aumentada de LPS e sCD14que foi detectada na circulação e alterações na resposta inflamatória com a produção aumentada e/ou diminuída de biomarcadores importantes da inflamação.

INTRODUÇÃO: Estudos sinalizam que a experiência universitária corresponde a um momento de maior vulnerabilidade para o consumo de álcool e outras drogas. Essa afirmativa decorre da maior prevalência do consumo de substâncias observada entre universitários em comparação a outras amostras populacionais, inclusive jovens não universitários. OBJETIVOS: Avaliar a associação entre o uso de álcool e outras drogas (ilícitas e medicamentos) com variáveis do contexto acadêmico e os significados atribuídos pelos estudantes sobre essa relação. METODOLOGIA: Estudo longitudinal prospectivo de tratamento quantitativo e qualitativo dos dados realizado com 85 estudantes da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foi utilizado um questionário contendo questões estruturadas para avaliar os aspectos envolvidos na experiência estudantil e os instrumentos de pesquisa AUDIT (Alcohol Use Disorders Identification Test) e DUSI (Drug Use Screening Inventory) para avaliar o uso de álcool e de outras drogas, respectivamente. Também foram realizadas entrevistas semiestruturadas com alguns participantes e subsequente análise de conteúdo. RESULTADOS: Homens aumentaram o padrão de binge drinking, indicando um risco substancial nos períodos finais do curso universitário (p<0,001; OR=10), igualmente para os estudantes satisfeitos com o curso (p=0,04; OR=17). Por sua vez, no início do curso, estudantes que se autoavaliaram com desempenho escolar sem prejuízos decorrentes do consumo de drogas, apresentaram um risco três vezes maior para binge drinking, sugerindo um sentimento de onipotência e imunidade aos efeitos do beber excessivo. Ao contrário, a mesma característica foi protetora para o consumo de drogas ilícitas e medicamentos, indicando um possível distanciamento de usuários dessa classe de substâncias. A análise qualitativa das entrevistas revelou uma interação entre um conjunto de categorias, especialmente, a dissociação entre conhecimento e práticas do beber, rotina estudantil estressante, peculiaridades do grupo de amigos, festas e o sentimento de liberdade em não residir com os pais. CONCLUSÕES: Diferentes variáveis parecem atuar em cada momento específico da formação acadêmica. Apesar de não ser possível traçar um perfil que se configure como risco ou proteção, existem aspectos pertinentes ao contexto da vida estudantil associados ao comportamento do consumo de substâncias. Associações observadas revelam a necessidade de ações de curto prazo que se orientem no conceito de redução de danos. Além disso, centros especializados de apoio ao estudante e ações que privilegiem a dimensão psicopedagógica no contexto da formação acadêmica podem ser um importante meio de auxílio imediato aos jovens estudantes. / INTRODUCTION: Several studies have indicated that college years are a period of greater vulnerability to alcohol and other psychoactive drugs use. This evidence stems from the higher prevalence of substance use observed among college students in comparison to others young adults. OBJECTIVE: To evaluate the association between alcohol and other drugs (illicit drugs) use and variables of the academic life, and the meanings attributed by students on this relationship. METHODOLOGY: Longitudinal study, quantitative and qualitative approach, design on a convenience sample of 85 undergraduate students from all courses of the School of Medicine of Ribeirão Preto of University of São Paulo. Alcohol Use Disorders Identification Test (AUDIT) and the Drug use Screening Inventory (DUSI) have been used as measures of alcohol use and others psychoactive drugs use respectively. Structured questionnaire evaluated aspects related to academic life. Semi-structured interviews are conducted with some participants and submitted to content analysis. RESULTS: Men increased binge drinking pattern, indicating a substantial risk in the final periods in college (p <0.001, OR = 10), also for the college satisfied with the course (p = 0.04, OR = 17). However, in the early periods of the course, the low self-rated poor school performance was indicative of a 3-fold increased risk for the same pattern of alcohol use, but this same feature was protective for the consumption of drugs and medicines. Analysis revealed an interaction between a set of categories, particularly dissociation between knowledge and practice of drinking, stressful routine student, peculiarities of peer group, celebrations and sense of freedom in not living with parents. CONCLUSIONS: Different variables appear to act in each specific moment of graduation. Although it is not possible to draw a profile that is set as risk or protection, there are context-relevant aspects of student life behavior associated with substance use. Associations observed reveal the need for short-term actions to be guided by the concept of harm reduction. In addition, specialized centers and student support activities that emphasize psycho-pedagogical dimension in the context of academic life may an important way of helping for college students.

Young people are at risk of sexually transmitted infections (STI), and engage in sex and drug related risk behaviour. This thesis investigates novel methods to reach youth for research and health promotion. Mobile phone text messages (SMS) are convenient, low cost, fast, and popular among youth. SMS has been utilised in sexual health for clinical management, service delivery and health promotion, but few of these projects have been evaluated. Recognising this lack of research led to the design of a randomised controlled trial investigating the use of SMS and email in sexual health promotion. Recruitment of young people for this trial was piloted at Melbourne’s Big Day Out. 939 young people were recruited in several hours; 30% were classified as being at high risk of STI, and 46% had used illicit drugs in the month prior to the survey. Knowledge of STI was poor. Drug use was associated with both sexual risk behaviour and music preference. The study demonstrated that this festival is a valuable site for sex and drugs research and health promotion. The following year, young people were recruited at the music festival and randomised to an intervention group who received regular sexual health SMS and email, or a control group who received no messages. After 12 months, the intervention group had higher STI knowledge than the control group (OR 2.72, 95%CI 1.68, 4.41) and intervention group females were more likely to have had an STI test (OR 2.51, 95%CI 1.11, 5.69). Respondents’ opinions of the messages were favourable. This simple, low-cost, and novel method was shown to be effective in improving young people’s sexual health. At-risk young people are not well represented in sex and drug behavioural surveillance in Australia. As the pilot study identified that a music festival was a suitable site for sex and drug research, the survey was repeated each year. Between 2005 and 2008, the proportion of young people at risk of STI decreased from 34% to 29%, and recent illicit drug use decreased from 46% to 43%. A limitation of the studies described herein is reliance on self-report, which is subject to recall bias; this can be reduced using diaries to collect behavioural data. Participants completed weekly diaries of sexual behaviour and a retrospective questionnaire. Correlation between the diaries and questionnaire was substantial, adding confidence to the validity of results of other studies in this thesis. Diaries can be collected in different ways; SMS has not previously been used for this purpose. Participants were randomised to complete diaries through SMS, online or paper. Online diaries were superior to SMS in completeness and participant preference, but SMS diaries were more likely to be submitted on time. This thesis has tested several novel options for researching and promoting health to young people. Through music festivals, SMS, and email, young people can be reached through settings and media they are familiar with. Use of these novel methods has increased understanding of risk behaviour among youth and been effective in sexual health promotion.

This study investigated the spatial distribution and seasonal variation of pharmaceuticals and personal care products (PPCPs) and illicit drugs in western Hengchun peninsula and Kenting coastal tourist area in Taiwan. We used solid phase extraction (SPE) followed by liquid-chromatography tandem mass spectrometry (HPLC-MS/MS) to determine 22 PPCPs and 10 illicit drugs in water samples. The detected concentrations of PPCPs and illicit drugs ranged from below detection limit to 9350 ng/L, and the most frequently five detected compounds in this area were ampicillin (79%), codeine (63%), caffeine (62%), carbamazepine (61%) and pseudoephedrine (57%). The impact of the special event- Kenting music festival, such as ¡§spring scream¡¨ was also discussed in this study, and the results from PCA and HCA both showed that the concentrations and distributions of PPCPs and illicit drugs were affected by the tourists. In addition, two wastewater treatments plants (WWTPs) were also investigated for seven days during Kenting music festival period. The results indicated that WWTPs did not show enough removal efficiencies in Kenting tourist area during the special event. The impact of the PPCPs and illicit drugs to the aquatic environment and ecology still needs to be further monitored.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine. In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p&lt;0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II). We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p&lt;0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p&lt;0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively.  In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.

This thesis documents my research on the epidemiology of Human Immunodeficiency Virus (HIV), hepatitis C virus (HCV) and other transmissible infections among 'at risk' young people, injecting drug users and sex workers in inner Sydney, and how this contributed to the early understanding of these infections in these potentially vulnerable populations in Australia. It also demonstrates how this work informed the development of innovative health service models in Sydney??s Kings Cross, including the Kirketon Road Centre (KRC) and the Sydney Medically Supervised Injecting Centre (MSIC), to address the public health risks affecting these populations over time. Sub-themes include the establishment of sentinel surveillance systems at KRC to monitor HIV and HCV prevalence and incidence as well as trends in drug use in these populations, considered to be key drivers of these epidemics in Australia. Another sub-theme is the clinical trials of pharmacotherapies for both opioid and psychostimulant dependence and the development of the dual treatment approach to HIV (and later HCV) and drug dependence that built upon this. KRC has been an exemplar of this approach, which has been shown to enhance treatment adherence among people who inject drugs ?? necessary to achieve treatment outcomes comparable to other affected populations. In more recent years my research has also included a focus on the epidemiology, physiology and treatment of opioid overdose and other injecting-related harms among IDUs. Underlying my work over the past 20 years has been my commitment to the social justice belief that health is a basic human right and that these socially marginalised populations should have equitable access to high quality evidence-based health care.