In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration (HRSA)-funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an Academic Health Department (AHD) involving the East Tennessee State University (ETSU) College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessments and community-oriented practice. Similarly, the COPH recognized the need to expand field-based public health practice opportunities for students. Personnel from SCRHD, LIFEPATH, and COPH developed a formal AHD memorandum of understanding during the summer of 2012, launching the program in fall 2012. The COPH/SCRHD model addresses financial barriers experienced by other AHDs by competitively awarding the Coordinator position to a Doctor of Public Health (DrPH) student from the COPH, demonstrating investment in the model by the COPH. The DrPH student gains valuable leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. SCRHD benefits from formally trained graduate-level interns dedicated to long-term work within the community. This AHD offers a unique opportunity for doctoral-level students to develop practical leadership skills in a functioning health department, while enhancing the capacity of SCRHD and COPH to serve their community and stakeholders.

Maintaining the health of Tennesseans depends heavily on a well-trained, efficient public health workforce that can work effectively in a complex environment. In order to assess the training needs of this group, the Tennessee Public Health Training Center-LIFEPATH administered a survey to all governmental public health employees in Tennessee during the summer of 2012. This instrument was modeled after previous assessments conducted by health agencies outside of Tennessee which utilized as their rubric the Core Competencies for Public Health Professionals developed by the Council on Linkages between Academia and Public Health Practice. The goal of this research was to inform and streamline educational efforts of the Tennessee Department of Health (TDOH), LIFEPATH and their partners across the state by identifying specific competency driven training opportunities within the workforce. Participants were recruited via email and directed to SurveyMonkey, an online survey toolkit, where they could complete the questionnaire. Of the 5178 TDOH employees who received the recruitment email, 3086 individuals completed at least one of the competency questions for a response rate of 59.6%. The survey assigned questions pertinent to the eight core competency areas to respondents based on one of three Tiers – Tier 1: Entry Level, Tier 2: Management Level, Tier 3: Leadership Level. Once the data were collected, responses from all three tiers were dichotomized to generate a “Needs Score” which when summarized represented the percentage of responses indicating a lack of knowledge or proficiency in a competency area. Tier 1 respondents had an average needs score of 60.46% in each of the eight core competency areas. Tier 2 had an average needs score of 49.50%, and Tier 3 respondents had an average needs score of 28.91%. This trend shows that individuals in leadership positions within TDOH were more likely to be knowledgeable or proficient in the eight core competency areas. Prior to administering the survey, TDOH job classifications were submitted to an expert panel within the health department. This body was tasked with assigning tiers to specific job classifications. Previous needs assessments that used the eight core competencies had respondents self-select their tier. As a test of validity the LIFEPATH survey asked TDOH employees to select their job classification in addition to tier. A Kappa test of agreement between self-selection of tier and their actual tier determined by TDOH leadership showed moderate agreement (Kappa=0.5089), suggesting that while most respondents selected the correct tier; there remained some confusion regarding tier definitions. This must be considered when evaluating the results of previous studies that utilize only the self-selected tiers to drive their survey. This data has already begun to direct training goals at the state, regional and local levels across Tennessee and will serve as a baseline measure for future evaluations of educational programing’s impact on workforce competency.

Juvenile misuse of prescription drugs in the United States has continuously increased over the last few decades, especially within rural regions of the country. Despite continuous increase in rates of misuse, limited research exists on elements of socialization that may function to prevent drug use. The current study utilized the Monitoring the Future Survey data to explore prescription drug misuse between different populations of juveniles. While using Hirschi’s (1969) theory of social bonds as a theoretical framework, different elements of socialization were explored to determine whether they work to contribute or prevent prescription drug misuse among rural and urban juveniles. Results indicated that parental attachment served as the most substantial protective factor among both populations of juveniles. Additionally, socialization differed in relation to prescription drug use among rural and urban youth. These findings could be implicated in future anti-drug programs that specifically target different regions of the country.

Nonmedical prescription drug (NMPD) use is a well-documented problem among college students, but few studies have examined nursing students' attitudes regarding NMPD. The purpose of this study was to compare nursing and non-nursing students' attitudes, risk factors, and current substance use. This descriptive, comparative design utilized a convenience sampling and social media to reach students over 18 years of age and enrolled in a Midwestern university. Twenty-nine students, 14 non-nursing and 15 nursing students, participated in this online survey. Substance use attitudes were measured using the Drug Attitude Scale (DAS). Risk factors for substance use were used as demographic questions and current drug use was measured using the Drug Abuse Screening Tool (DAST). Logistic regression (Chi-Square/Fisher's Exact) analyses were used to observe the association between risk factors for substance abuse and nursing/non-nursing students. Additionally, a Simple Linear Regression (Two-Sample T-tests) was used to assess the relationship between DAS and DAST scores between nursing/non-nursing students. Prior to discussing the results of the statistical tests, descriptive statistics of the demographic variables of the participants are presented. Data analysis revealed no significant difference in attitude, risk factors, and substance use among nursing students and non-nursing students. Limitations included the low number of participants and access to students via social media only. The fact that nursing students receive additional training in pharmacology, we presume these students know the risks of drug use, therefore nursing students would have a lower rate of substance use; however, this study revealed no significant difference in attitudes or current substance use among nursing and non-nursing students.

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Personal interviews exploring attitudes toward prescription drug abuse were completed by 17 residents over 18 years of age from Kentucky's Pike and Letcher counties. In respect to prescription drug abuse research nationwide, much research has been conducted in eastern Kentucky; however, there are seemingly few studies measuring the thoughts and feelings of community members toward the issue. Data gathered during these interviews were coded and themed for emergent content that revealed the prevalence of drug abuse in communities, the role of medical professionals in prescription drug abuse, and a lack of preventative measures to control the cyclic pattern of prescription drug abuse in eastern Kentucky communities. The thesis concludes by examining why the need for eliminating underlying social problems is most important in decreasing the amount of prescription drug abuse in the area.

This study examines student's nonmedical prescription drug (NMPD) and marijuana use and whether anxiety, depression, ADD or ADHD symptoms are associated with their use and if students are self-medicating to alleviate symptoms. The method of obtaining this information was provided by a total of 278 college students who voluntarily and anonymously completed a Web-based survey. This study fills in the gaps of previous research and reveals the most frequent NMPD's used by students and their overall perceptions of their intended effects of the drug and answers why students do not seek professional help for their anxiety, depression and impulsivity symptoms. Results from the survey indicate that students who report NMPD use self- reported higher symptoms of anxiety, depression and impulsivity. NMPD users reported higher percentages of other substance abuse compared to nonusers. The most prominent NMPD's used by students are Adderall and Vicoden or Codeine. Data also indicates student's primary reasons for their NMPD use are related to academic purposes; as opposed to nonacademic. This analysis is further supported by the fact that the majority of NMPD users did not use before they began college and do not use while classes are not is session. Furthermore, students perceive their overall intended effects of their NMPD use to be beneficial, despite the known risks associated with their drug use. By examining college student's current NMPD use we can provide alternative solutions to students who are self-medicating as a coping mechanism for underlying issues or mental health disorders. Also, we can provide them with the necessary services in order to address their problems professionally.

Bakgrunn: Misbruk av vanedannende legemidler er et viktig folkehelseproblem. Enkelte pasienter går fra lege til lege og driver såkalt legeshopping for å skaffe seg mest mulig av denne typen legemidler. Dette er et problem i forhold til å kunne begrense legemiddelmisbruket i befolkningen. Fastlegeordningen, som ble innført i Norge i 2001, er blant annet ment å skulle begrense mulighetene til legeshopping. Det er ikke tidligere gjort studier som kan kartlegge omfanget av legeshopping i en befolkning, verken i Norge eller andre land. FORMÅL: Kartlegge omfanget av legeshopping i befolkningen i Norge, og forsøke å klarlegge i hvilken grad bruk av flere leger kan skyldes shopping etter legemidler eller andre årsaker. MATERIALE OG METODE: Studere data fra det norske Reseptregisteret (NorPD) for kalenderåret 2004, som blant annet viser antallet leger benyttet, mengde utlevert av det aktuelle legemiddelet og samtidig mengde utlevert av benzodiazepiner og opioider for alle brukere av de vanedannende legemidlene diazepam, karisoprodol og kodein kombinasjoner sammenlignet med alle brukere av de ikke-vanedannende legemidlene esomeprazol, metformin og salbutamol. RESULTATER: De aller fleste pasienter bruker kun en eller to leger for å få utlevert samme legemiddel i løpet av ett kalenderår. Andelen som bruker tre eller flere leger er imidlertid mer enn dobbelt så høy for de vanedannende legemidlene som for de ikke-vanedannende, og for de som bruker fem eller flere leger, er andelen nesten ti ganger større. Med økende antall leger som er benyttet, er dessuten økningen i både utlevert mengde av legemidlet og samtidig mengde utlevert av benzodiazepiner og opioider langt mer uttalt for de vanedannende legemidlene enn for de ikke-vanedannende. KONKLUSJON: Det foregår etter innføringen av fastlegeordningen fortsatt en begrenset, men klar legeshopping blant pasienter som ønsker å få tak i mest mulig av vanedannende legemidler. Dette forhold må tas alvorlig av både de forskrivende legene og helsemyndighetene. / BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping. AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons. MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol. RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines. CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities. / <p>ISBN 978-91-85721-60-3</p>

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.