Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

The genetics of alcohol intake and of alcohol dependence

Background: Because alcohol has multiple dose-dependent consequences, it is important to understand the causes of individual variation in the amount of alcohol used. The aims of this study were to assess the long-term repeatability and genetic or environmental causes of variation in alcohol intake and to estimate the degree of overlap with causes of susceptibility to alcohol dependence. Methods: Data were used from three studies conducted between 1980 and 1995 on volunteer adult male and female Australian twin subjects. In each study, alcohol intake was reported both as quantity X frequency and as past-week data. Repeatability was calculated as correlations between occasions and between measures, and the effects of genes and environment were estimated by multivariate model fitting to the twin pair repeated measures of alcohol use. Relationships between mean alcohol use and the lifetime history of DSM-III-R alcohol dependence were tested by bivariate model fitting. Results: Repeatability of the alcohol intake measures was between 0.54 and 0.85, with the highest repeatability between measures within study and the lowest repeatability between the first and last studies. Reported alcohol consumption was mainly affected by genetic factors affecting all times of study and by nonshared environmental factors (including measurement error) unique to each time of study. Genes that affect alcohol intake do affect alcohol dependence, but genetic effects unique to dependence are also significant; environmental effects are largely unique to either intake and dependence. Conclusions: Nearly all the repeatable component of variation in alcohol intake is due to genetic effects. Genes affecting intake also affect dependence risk, but there are other genes that affect dependence alone. Studies aiming to identify genes that affect alcohol use disorders need to test loci and candidate genes against both phenotypes.

Effects of dopamine receptor D4 variation on alcohol and tobacco use and on novelty seeking: Multivariate linkage and association analysis

The dopamine D4 receptor gene contains a polymorphic sequence consisting of a variable number of 48-base-pair (bp) repeats, and there have been a number of reports that this polymorphism is associated with variation in novelty seeking or in substance abuse and addictive behaviors. In this study we have assessed the linkage and association of DRD4 genotype with novelty seeking, alcohol use, and smoking in a sample of 377 dizygotic twin pairs and 15 single twins recruited from the Australian Twin Registry (ATR). We found no evidence of linkage or association of the DRD4 locus with any of the phenotypes. We made use of repeated measures for some phenotypes to increase power by multivariate genetic analysis, but allelic effects were still non-significant. Specifically, it has been suggested that the DRD4 7-repeat allele is associated with increased novelty seeking in males but we found no evidence for this, despite considerable power to do so. We conclude that DRD4 variation does not have an effect on use of alcohol and the problems that arise from it, on smoking, or on novelty seeking behavior. (C) 2003 Wiley-Liss, Inc.

Relations between acculturation and alcohol use among international students

In the current study, 226 international students attending Florida International University responded to an Web-based questionnaire that assessed self-reported scores for: acculturation, acculturative stress, alcohol use patterns, perceived peer alcohol use, and perceived injunctive social norms for alcohol use. The purpose of the study was to evaluate structural relations among this set of variables using Structural Equation Modeling (SEM) via AMOS 17.0. The results of SEM analyses documented acceptable fit of a model which hypothesized that relations between acculturation and alcohol use variables are mediated partially by acculturative stress, perceived peer alcohol use, and perceived injunctive social norms. While significant path coefficients were documented for paths between (a) acculturation and acculturative stress and (b) acculturative stress and alcohol use, the coefficients had negative signs, contrary to existing studies investigating these relations among immigrant youth. While paths between (a) perceived peer alcohol use or (b) perceived injunctive social norms and participants’ alcohol use were significant, path coefficients between acculturation and either (a) perceived peer alcohol use or (b) perceived injunctive social norms were not statistically significant. In addition, multiple-group comparisons suggested that social support had a significant moderating influence on several significant paths in the structural model. Specifically, international students reporting higher social support reported lower scores for acculturative stress and alcohol use, in contrast to their counterparts who reported lower scores for social support.

The longitudinal influence of physical activity on adolescent alcohol use

The purpose of this research was to explore the influence of physical activity on depressive symptomatology and adolescent alcohol use during an underexplored transition from middle school to high school. The study initiative is supported by the fact that research has shown a unique and simultaneous decrease in physical activity (CDC, 2010), increase in depressive symptomatology (SAMHSA, 2010) and increase in alcohol use (USDHHS, 2011) during middle adolescence. A risk and resilience framework was used in efforts to conceptualize how these variables may be inter-related. Data from waves I and II of the National Longitudinal Study of Adolescent Health (Add Health, Bearman et al., 1997; Udry, 1997) was used (N = 2,054; aged 13–15 years). The sample was ethnically and racially diverse (58.2% White, 24% African American, 11.7% Hispanic, and 6.1% other). Structural equation models were developed to test the potential influence physical activity has on adolescent alcohol use (e.g., frequency of alcohol use and binge alcohol use) and whether any of the relationship was mediated by depressive symptomatology or varied as a function of gender. Results demonstrated that there was a significant influence of structured physical activity (e.g., sports) on adolescent alcohol use. However, contrary to the proposed hypothesis, engaging in structured physical activity appeared to contribute to greater binge drinking among adolescents. Instead of demonstrating a protective feature, the findings suggest that engaging in structured physical activity places adolescents at risk for binge drinking. Furthermore, no significant relationships, positive or negative, were found for the influence of physical activity (structured and unstructured) on frequency of alcohol use. The findings regarding mediation revealed binge drinking as a mediator between physical activity (structured) and depressive symptomatology. These findings provide support for research, practice, and policy initiatives focused on developing a more comprehensive understanding of alcohol use drinking behaviors, physical activity involvement, and depressive symptomatology among adolescents, which this study demonstrates are all associated with one another. Results represent an initial step toward evaluating these relationships at a much younger age.

Alcohol-Involved Sexual Assault and Mental Health Outcomes: The Role of Alcohol Use Characteristics

Thesis (Ph.D.)--University of Washington, 2016-08

Regional versus urban differences in teenage alcohol use: Does parental disapproval account for these differences?

- Objective To investigate if parental disapproval of alcohol use accounts for differences in adolescent alcohol use across regional and urban communities. - Design Secondary data analysis of grade-level stratified data from a random sample of schools. - Setting High schools in Victoria, Australia. - Participants A random sample of 10273 adolescents from Grade 7 (mean age=12.51 years), 9 (14.46 years) and 11 (16.42 years). - Main outcome measures The key independent variables were parental disapproval of adolescent alcohol use and regionality (regional/ urban), and the dependent variable was past 30 days alcohol use. - Results After adjusting for potential confounders, adolescents in regional areas were more likely to use alcohol in the past 30 days (OR=1.83, 1.44 and 1.37 for Grades 7, 9 and 11, respectively, P<0.05), and their parents have a lower level of disapproval of their alcohol use (b=-0.12, -0.15 and -0.19 for Grades 7, 9 and 11, respectively, P<0.001). Bootstrapping analyses suggested that 8.37%, 23.30% and 39.22% of the effect of regionality on adolescent alcohol use was mediated by parental disapproval of alcohol use for Grades 7, 9 and 11 participants respectively (P<0.05). - Conclusions Adolescents in urban areas had a lower risk of alcohol use compared with their regional counterparts, and differences in parental disapproval of alcohol use contributed to this difference.

Pregnancy, alcohol intake, and intimate partner violence among men and women attending drinking establishments in a Cape Town, South Africa township.

The highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates. For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa. Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%). Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex. High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners. Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy. Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.

An integrated alcohol abuse and medical treatment model for patients with hepatitis C.

BACKGROUND: Patients with chronic hepatitis C virus (HCV) infection have high rates of alcohol consumption, which is associated with progression of fibrosis and lower response rates to HCV treatment. AIMS: This prospective cohort study examined the feasibility of a 24-week integrated alcohol and medical treatment to HCV-infected patients. METHODS: Patients were recruited from a hepatology clinic if they had an Alcohol Use Disorders Identification Test score >4 for women and >8 for men, suggesting hazardous alcohol consumption. The integrated model included patients receiving medical care and alcohol treatment within the same clinic. Alcohol treatment consisted of 6 months of group and individual therapy from an addictions specialist and consultation from a study team psychiatrist as needed. RESULTS: Sixty patients were initially enrolled, and 53 patients participated in treatment. The primary endpoint was the Addiction Severity Index (ASI) alcohol composite scores, which significantly decreased by 0.105 (41.7% reduction) between 0 and 3 months (P < 0.01) and by 0.128 (50.6% reduction) between 0 and 6 months (P < 0.01) after adjusting for covariates. Alcohol abstinence was reported by 40% of patients at 3 months and 44% at 6 months. Patients who did not become alcohol abstinent had reductions in their ASI alcohol composite scores from 0.298 at baseline to 0.219 (26.8% reduction) at 6 months (P = 0.08). CONCLUSION: This study demonstrated that an integrated model of alcohol treatment and medical care could be successfully implemented in a hepatology clinic with significant favorable impact on alcohol use and abstinence among patients with chronic HCV.

Body mass index, cigarette smoking, and alcohol consumption and cancers of the oral cavity, pharynx, and larynx: modeling odds ratios in pooled case-control data.

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < or =10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

A redução de danos no atendimento especializado em álcool e outras drogas

The harm reduction HR is the official policy of Ministry of Public Health to deal with problem derived from alcohol consumption and other drugs AD. The HR refers to policies and support programs whose purpose is to reduce the risks related to the use of AD, without necessarily decrease individual consumption. This research aim was to analyze the HR conceptions and practices at two specialized institutions for AD users: 1) Psychosocial Care Center Alcohol and Drugs III (CAPSad III); 2) Therapeutic Community Fazenda da Esperança (FE) Dom Bosco. This is a qualitative research that used the following methodological tools: semi-structured interview with 21 professionals; socio demographic file and rounds of conversation with 63 participants users; participant observation and field journal. The interviews with professionals have characterized HR as a less complex and cheap treatment. At FE the HR proposal does not make part of their actions, being considered ―against the human being dignity‖. At CAPSad III is understood as an ―inevitable‖ guideline to service, once users do not remain abstinent. The users understand RD as an improvement in healthy conditions, social relations and work that occurs with the decreasing consumption of AD. They use the HR when they avoid situations that facilitate AD consumption, share relapse prevention strategies and, exclusively at CAPSad III, decrease psychotropic consumption. Stands out as an analyzer the HR comprehension as a less efficient treatment that opposes to the objective of both institutions, which is abstinence. The HR is not operationalize in daily routine by professionals and users as a healthy promotion strategy, however, the users are more affected to HR and produce strategies to face the difficulties arising from the AD consumption

Patterns of alcohol use between genders: A cross-cultural evaluation

Introduction: Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes.Method: A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books.Results and conclusions: Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders. (c) 2006 Elsevier B.V. All rights reserved.

A experiência da toxicomania e da reincidência a partir da fala dos toxicômanos

Este estudo teve como objetivo examinar o fenômeno da toxicomania e sua reincidência a partir da fala dos toxicômanos. Foi realizado em instituição especializada no tratamento da dependência química e problemas relacionados ao uso de álcool e outras drogas, contando com dados do acompanhamento de onze sujeitos. Utilizou-se o referencial teórico psicanalítico para a escuta de indivíduos em situação de toxicomania, com o dispositivo das entrevistas preliminares, dentro do referencial da clínica da urgência em psicanálise. Os resultados do trabalho de escuta e da reflexão apontaram uma série de características psicológicas dos indivíduos estudados de clara relevância para o planejamento de estratégias individuais ou coletivas de atenção ao problema. Destacamos a hipótese de duas modalidades de toxicomania relacionadas com as formas particulares da subjetividade em que ocorre. A questão da reincidência na toxicomania aparece como um falso problema para os sujeitos, que demonstraram que a desintoxicação, concomitante à abstinência e provocada pela internação, é somente um momento de privação, simultaneamente necessária e forçada, do gozo propiciado pela droga. Finda a internação segue-se, geralmente, um novo período de uso. A aceitação da abstinência não significa que os sujeitos fazem uma renúncia, correlata, ao desejo pela droga. É apenas uma parada provavelmente ligada à menor tolerância psíquica à modalidade de gozo em ação na toxicomania, um gozo capaz de confrontar o sujeito com a morte. A abstinência forçada, como estratégia da política pública de saúde, presente no tratamento comum da toxicomania, mostrou conseqüências altamente negativas para o resultado do tratamento, parecendo indicar a necessidade de sua revisão urgente. Procurou-se problematizar a questão da abertura à dimensão subjetiva da experiência dos toxicômanos como estratégia capaz de interferir na trajetória dos sujeitos na relação com as drogas a partir do momento em que buscam ajuda.

Fatores associados a adesão ao curso de capacitação a distância para líderes, voluntários, profissionais e gestores de Comunidades Terapêuticas

Pós-graduação em Saúde Coletiva - FMB

Curso de capacitação para líderes, voluntários, profissionais e gestores de comunidades terapêuticas: o conhecimento em relação ao álcool, crack e outras drogas

Pós-graduação em Saúde Coletiva - FMB