Suchergebnisse

The focus of this book is on public health psychiatry, from the need for mental health and addiction services, to access to these services. The meeting that featured this topic advanced knowledge of the social and environmental risk factors for psychiatric disorders, and ideas for preventing them as well. Chapters are written by experts from around the world and include such public health concerns as Veteran's mental health, mental health disparities among minorities, causes of addictions, and mortality of these disorders.

Longitudinal research on street-recruited out-of-treatment drug users involves ethical issues concerning enrollment and retention of participants, remuneration and benefits. In contrast to practices of excluding such high-risk populations from research and assuming that they would not comply with a protocol requiring repeated measures over a 12-month period, this report presents examples from 15 years of community-based studies that have enrolled drug-using participants and achieved a 96% retention rate. We also examine ethical issues connected with cash remuneration, and describe methods to elucidate the kinds of benefits that are most meaningful to this population. Findings suggest that the research community must reconsider the ethics of blanket exclusions of such high-risk subjects, and make evidence-based decisions about recruitment, retention, remuneration, and benefits.

The St. Louis EachOneTeachOne (EOTO) project is a National Institute on Drug Abuse (NIDA)-funded cooperative agreement aimed at examining rates of HIV risk behaviors and studying HIV risk reduction interventions among out-of-treatment injection and crack cocaine drug users. This paper uses data collected during the first year of recruitment and enrollment to document the effect of street outreach on HIV risk behavior involvement. The major findings are that: (1) men reported more HIV risk behaviors than did women, but the results failed to show striking racial or ethnic differences; (2) we successfully enrolled women in spite of the fact that our women street contacts were largely ineligible to enroll in EOTO; and (3) actual EOTO enrollees, compared with all street contacts and eligible street contacts, engaged in fewer HIV risk behaviors. These results imply that strategies in addition to street outreach may be needed to enlist more individuals, particularly whites and women who are engaging in the highest risk drug and sexual behaviors.

Over the past twenty-five years, tremendous progress has been made in the area of drug abuse prevention research. The accumulated findings from longitudinal studies of adolescents regarding the factors associated with vulnerability to the substance use and abuse and trends from national surveys of substance use showing their association to societal perceptions of the harmfulness resulting from the use of these substances have informed the development of effective innovative prevention strategies. The 1990s saw a reversal in the perception of the value and importance of drug abuse prevention research with recognition of the field's approach to intervention development and implementation and its scientific rigor in demonstrating intervention impact. This paper reflects on this history anticipating both the positive and negative aspects of the future for the field.

A National Institute on Drug Abuse demonstration project in AIDS prevention among drug users was conducted in St. Louis during the years 1990 through 1994. The main objective was to reduce the spread of HIV by counseling drug users and by improving drug-treatment programs in the area. A second objective was to examine the correlates of risk behavior. A structured interview was administered six times over an 18-month period. Of those persons assessed at baseline (n = 475), 95.0% (n = 451) were also reinterviewed in the last interview at 18 months. Both group and individual level changes in risk behavior were assessed using random regression models. We report on three potential risk behaviors for HIV/AIDS: (1) number of sexual partners, (2) frequency of condom use, and (3) injection drug use. For each risk behavior a separate statistical model was estimated. The results of the random regression models showed significant reductions in number of sexual partners and injection drug use. Additionally, a number of variables, such as perceived risk for AIDS and knowledge of HIV/AIDS, were statistically significant covariates of risk behavior.