What do we know about preventing drug-related harm through social developmental intervention with children and young people

This chapter examines the evidence for the effectiveness of interventions aiming to reduce drug-related harm by improving conditions for healthy develeopment in the earliest years through adolescence. Of the interventions beginning prior to birth, there is efficacy evidence that family home visitation is a feasible strategy for implementation with disadvataged families and can reduce risk factors for early developmental deficits and thereby improve childhood development outcomes. There is efficacy evidence for strategies such as parent education and school preparation through the pre-school age period. Some of the strongest evidence for efficacy in reducing developmental pathways to drug-related harm comes from interventions delivered through the early school years to improve educational environments. Of the interventions targeting the high school age period, school drug education has been the most commonly evaluated. The evidence suggests that short term reduction in both drug use and progression to frequent drug use may be achievable through this strategy, but the prospects for longer-term and population-level behaviour change is still unclear. In overview, a range of prevention strategies have been developed and evaluated. Most of the exisiting evidence is restricted to efficacy studies and there are future challenges to progress evaluation through to studies of effectiveness. In general, prevention programmes appear more successful where they maintain intervention activities over a number of years and incorporate more than one strategy. Much of the existing research has been based in North America and evaluates discrete programmes. Future research should test effects in other countries, in different social contexts and seek to better understand the interrelated effects of combining interventions within the community. Developmental prevention programmes target different age periods and social settings, hence communities have the challenge of coordinating a mixture of programmes that address the local conditions that adversely influence child and youth development. There are opportunities in this work to coordinate prevention activities using funding from different jurisdictions (e.g., crime prevention, health promotion, mental health, education, substance abuse prevention).

The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions

Objective: This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions.

Methods: Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N = 591) and confirmatory (N = 598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling.

Results: Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach's alpha (α) = 0.86); Health Directed Behavior (four items, α = 0.80); Skill and Technique Acquisition (five items, α = 0.81); Constructive Attitudes and Approaches (five items, α = 0.81); Self-Monitoring and Insight (seven items, α = 0.70); Health Service Navigation (five items, α = 0.82); Social Integration and Support (five items, α = 0.86); and Emotional Wellbeing (six items, α = 0.89).

Conclusion:The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits.

Practice Implications: The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management.

People's war under modern conditions : an investigation into Chinese defence strategy, 1977-2049

This thesis is an investigation of the relevance of ‘people's war’ to contemporary Chinese defence policy. This loose concept has been eroded by 'modernity’, but a guerilla-based defence remains the essential theme. Prior to China's acquisition of nuclear weapons, people's war was the sole element of the state's deterrent policy, aiming to swamp an invader with China's numerical strength. In the 1980s and beyond people's war finds effectiveness through a combination of materiel of middle range technology and the traditional usage of massive manpower. People's war under modern conditions remains essentially defensive, but now incorporates 'active defence’ with accent on greater mobility. However, the central thesis of this work relates to how the traditional strategy may influence nuclear doctrine. This thesis proposes that China could abandon long-range ballistic missiles and adopt a new concept in nuclear strategy: that of, Guerilla Nuclear Warfare. Trained in guerilla tactics and equipped with battlefield nuclear weapons, this would represent the logical extension of China's people's war strategy to the new nuclear conditions associated with superpower research into space-based ballistic missile defences and which, in full deployment, could nullify a Chinese nuclear deterrent based only on 'mid-tech' delivery systems. Guerilla Nuclear Warfare, as a strategy, would involve the irregular use of locally held and controlled tactical nuclear weapons, but it would also be a method of circumventing the proposed Soviet missile defence shield by not challenging it. Guerilla Nuclear Warfare does not exist in the late 1980s, but evidence exists to suggest its development. It cannot yet be proven as the new direction but China's strategic circumstances add weight to available indications: unless the Strategic Defence programs of the established superpowers are arrested then it appears the sole option available to the Chinese for the maintenance of a nuclear deterrent in the early part of the 21st Century.

Understanding exercise uptake and adherence for people with chronic conditions : a new model demonstrating the importance of exercise identity, benefits of attending and support

Understanding the factors influencing uptake and adherence to exercise for people with chronic conditions from different ages, genders and ethnicities is important for planning exercise services. This paper presents evidence supporting a new model of exercise uptake and adherence applicable to people with chronic conditions from diverse socio-demographic backgrounds. The study is based on 130 semistructured interviews with people with chronic conditions, including both those who did and those who did not attend exercise services, and supporters of those who attended. Analysis followed the guidelines of ‘framework analysis’. Results show that three factors were particularly important in influencing adherence behavior: (i) exercise identity, (ii) support and (iii) perceived benefits of attending. Social and cultural identities impacted on willingness to exercise, importance of exercise and perceived appropriateness of exercising. Having at least one supporter providing different types of support was associated with high levels of attendance. Those people who valued the social and psychological benefits of attending were more likely to be high attenders. The new model illustrates interaction between these three factors and discusses how these can be taken into account when planning exercise services for people with chronic conditions drawn from diverse socio-demographic groups.

Social engagement among migrant youth: attitudes and meanings

This article explores migrant young people’s engagement, participation and involvement in socially meaningful activi-ties, events and experiences. This type of social participation is approached in the social inclusion literature using the notions of social capital and active citizenship (Bourdieu, 1986; Coleman, 1988; Putnam, 1993; Putnam, 2000). A key objective, therefore, is to explore the attitudes, values and perceptions associated with social participation for young people. They include the meanings that social engagement has for migrant young people, along with drivers and inhibi-tions to active participation. The article focuses on both the motives for being actively engaged as well as perceived barriers to social engagement. It is based on a large study conducted among migrant young people of African, Arabic-speaking and Pacific Islander backgrounds in Melbourne and Brisbane, and presents both quantitative and qualitative (discursive) snapshots from the overall findings, based on interviews and focus groups. While many studies have cen-tred on the management of migration and migrants, this article draws attention to the individuals’ active position in negotiating, interpreting and appropriating the conditions of social inclusion. Accounting for the multidimensional and multilayered nature of social inclusion, the paper highlights the heuristic role of social engagement in fostering the feel-ings of belonging and personal growth for migrant youth.

Keeping connected: the lives of young people with ongoing health conditions in Australia

This chapter draws from a three year longitudinal Australian Research Council (ARC) project conducted in Victoria, Australia with 31 young people who were living with ongoing health conditions. The aim of the Keeping Connected project was to elicit the young people’s views of schooling, their relationships with peers and teachers, and their altered educational opportunities, given their ongoing and widely varying health conditions. Elsewhere in the literature these young people are often described as living with chronic illness (Hopkins et al., 2013; Moss, 2012). Victoria, Australia, is home to more than 1.2 million children and young people, representing just under 25% of the national child population. The Royal Children’s Hospital Education Institute (RCHEI), one of the sponsoring research partners for this study is located in Melbourne, the capital city of Victoria. The study makes a unique contribution to our knowledge of chronic illness, or what we prefer to refer to as ongoing health conditions, which affect 12% of school age students in Australia. One of my ongoing observations is that not all research that is produced in the name of social justice or analysing exclusions in schooling is approached through the repositioning of the qualitative research which has occurred over the past two decades. Throughout this chapter I aim to demonstrate how a post qualitative approach can produce a secondary analysis of data once a large scale project is completed. Data can be reworked and represented through networks of the social world, in this case the networks of living with an ongoing health condition as a young person in Australia at the end of the first decade of the twentieth first century.

People, places...and other people? Integrating understanding of intrapersonal, social and environmental determinants of physical activity

“People or places: what should be the target?” was the provocative title of a keynote session at the fifth Australian National Physical Activity Conference held in Melbourne in 2005. This paper will argue that in fact there need not be major conflict between these views, and that couching recent debate about physical activity promotion as a polarised choice between these presents a false dichotomy. To illustrate this, the paper will consider several problems with singular approaches to understanding and promoting physical activity, and will then describe emerging empirical evidence on the nexus between people and places. To balance an increasing emphasis in the scientific literature on physical environmental determinants of physical activity, the role of intrapersonal and social factors will also be revisited. It is concluded that growing evidence supporting the multiple domains of influence on physical activity justifies calls for multi-disciplinary and multi-sectoral partnerships and approaches to the promotion of active lifestyles.

Tonic Sol-fa in contemporary choral music practice : a South African case study

The Tonic Sol-fa method of teaching choral singing was propagated throughout Britain during the nineteenth century with the dual objectives of enhancing Christian worship and achieving social reform. It was then imported to South Africa where it was introduced to indigenous people principally through Christian missionary activity and government schools. Although entirely of foreign origin, Tonic Sol-fa was so fully assimilated into African culture that it became effectively 'indigenised'. Due to its widespread use, it became the mainstay of community choral singing and may now be said to represent a significant exogenous aspect of present-day South African musical identity. However, there is little documentation regarding the type and extent of its use in contemporary choral music practice.

This paper will report on the use of Tonic Sol-fa in representative present-day choral music settings. Interview data collected from choir directors, trainers and teachers in Cape Town indicate that there is far from unanimous agreement on several aspects - in particular, the future of Tonic Sol-fa as a pedagogy and notational system. Improving educational opportunities for indigenous South Africans to undertake professional training in music are now threatening the traditional dominance of Tonic Sol-fa in indigenous culture. Nevertheless this research represents a useful case study of the continuing relevance of Tonic Sol-fa to an indigenous population who have 'made it their own' and developed a vibrant choral tradition which continues to both enrich and sustain their lives.

Healthy markets - healthy people/ : reforming health care in Cambodia

Health care reform has been described as a global epidemic. This thesis deals with nature and experience of health care reform in developing countries. Increasing privatisation, economic transition, and structural adjustment have provided the context for health system changes. Different approaches to reform have been developed by international organisations such as the World Bank, WHO and UNICEF. What has driven national health care reforms? Are such policies really appropriate to developing countries? Has a consensus now emerged in relation to international health policy? Has a new health care ‘model’ appeared? The study of health care reform in Cambodia is a timely opportunity to investigate the implementation of health care reform under extreme conditions. These conditions include a legacy of genocide, long-term conflict, political isolation, and economic transition. This case study uses both qualitative and quantitative methods and multiple sources of data to analyse the reform program. The study reinforces the conclusion that, under conditions of extreme poverty, market based reforms are likely to have limited positive impact. Rather, understanding the cultural conditions that determine demand, delivering health care of a satisfactory quality, providing appropriate incentives for health practitioners, and supporting services with adequate public funding are the prerequisites for improved service delivery and utilisation. Cambodia's strategy of integrated district health service development and universal population coverage may provide an instructive example of reform. Emerging policy issues identified by this case study include the fundamental role of equity in service provision, the influence of the social determinants of health and illness and interest in the appropriate use of evidence in international health policy-making.

Hope of a nation - experiences of social exclusion giving rise to spaces of inclusion for people living with HIV and AIDs in South Africa : a reflection

South Africa has one of the highest rates of HIV/AIDS in the world. No one particular group is affected by the virus – rather, it is indiscriminate. Responses to HIV are diverse, and can be starkly contradictory. This author lived among the Xhosa people in rural Eastern Cape, working in community development. The program was a population-based youth empowerment program around HIV prevention. The work involved engaging youth in a range of civic participation activities, and networking with other community based groups and organisations, health and social services, and government departments. This reflection out a narrative of the lived experiences of social exclusion and social connectedness for people living with HIV/AIDS in rural Eastern Cape. It draws out the paradox of how the high prevalence of stigma and discrimination towards those with the illness, and their subsequent experience of social exclusion, actually creates opportunities for social connectedness through support group participation. This in turn is fashioning an emerging social movement breaking down barriers of stigma, and contributing to broader social change to support HIV action.

The reflection begins by outlining the current context and underlying determinants of the proliferation of HIV in the Eastern Cape, including a discussion of exclusion as a determinant. An exploration of how exclusion is also experienced as an outcome of positive HIV status follows. Finally, an explanation of how the experience of exclusion can be transformed into spaces of connectedness, and implications for health promotion practice in this context is also presented.