Search

OBJECTIVES: 1) To examine associations between racial discrimination and drug problems among urban-based Aboriginal adults; and 2) to determine whether these associations are best explained by symptoms of psychological stress, distress or post-traumatic stress disorder (PTSD). METHODS: Data were collected through in-person surveys with a community-based sample of Aboriginal adults (N = 372) living in a mid-sized city in western Canada in 2010. Associations were examined using bootstrapped linear regression models adjusted for confounders, with continuous prescription and illicit drug problem scores as outcomes. Mediation was examined using the cross-products of coefficients method. RESULTS: More than 80% of Aboriginal adults had experienced racial discrimination in the past year, with the majority reporting high levels in that period. Past-year discrimination was a risk factor for PTSD symptoms and prescription drug problems in models adjusted for confounders and other forms of psychological trauma. In mediation models, PTSD symptoms explained the association between discrimination and prescription drug problems; psychological stress and distress did not. PTSD symptoms also explained this association when the covariance between mediators was controlled. The results also indicate that participation in Aboriginal cultural traditions was associated with increased discrimination. CONCLUSIONS: Most efforts to address Aboriginal health inequities in Canada have focused on the role Aboriginal people play in these disparities. The current findings combine with others to call for an expanded focus. Non-Aboriginal Canadians may also play a role in the health inequities observed. The findings of this study suggest efforts to reduce discrimination experienced by Aboriginal adults in cities may reduce PTSD symptomology and prescription drug problems in these populations. Key words: Aboriginal; racial discrimination; prescription drugs; posttraumatic stress; Canada Can J Public Health 2015;106(6):e382-e387 doi: 10.17269/CJPH.106.4979 OBJECTIFS: 1) Examiner les associations entre la discrimination raciale et les problemes de toxicomanie chez les adultes autochtones en milieu urbain; et 2) determiner si ces associations s'expliquent mieux par les symptomes du stress psychologique, de la detresse ou de l'etat de stress post-traumatique (ESPT). METHODE: Les donnees ont ete recueillies au moyen de questionnaires administres en personne aupres d'un echantillon communautaire d'adultes autochtones (N = 371) vivant dans une ville de taille moyenne de l'Ouest canadien en 2010. Les associations ont ete examinees a l'aide de modeles de regression lineaire avec reechantillonnage (bootstrap) ajustes en fonction de facteurs confusionnels, les resultats etant les notes obtenues par rapport aux ordonnances continues de medicaments et aux abus de drogues illicites. Nous avons examine la mediation a l'aide des produits croises de la methode des coefficients. RESULTATS: Plus de 80 % des adultes autochtones avaient subi de la discrimination raciale au cours de l'annee anterieure, la majorite indiquant des niveaux eleves de discrimination durant cette periode. La discrimination au cours de l'annee anterieure etait un facteur de risque pour les symptomes d'ESPT et les abus de medicaments sur ordonnance dans les modeles ajustes en fonction des facteurs confusionnels et d'autres formes de traumatisme psychologique. Dans les modeles de mediation, les symptomes d'ESPT expliquaient l'association entre la discrimination et l'abus de medicaments sur ordonnance; le stress psychologique et la detresse ne l'expliquaient pas. Les symptomes d'ESPT expliquaient aussi cette association apres ajustement pour tenir compte de la covariance entre les mediateurs. Les resultats montrent egalement que la participation aux traditions culturelles autochtones etait associee a une discrimination accrue. CONCLUSION: La plupart des efforts pour aborder les iniquites en sante chez les Autochtones du Canada portent sur le role joue par les Autochtones dans ces disparites. Nos constatations, combinees a celles d'autres chercheurs, justifient un elargissement de cette perspective. Les Canadiens non autochtones pourraient aussi jouer un role dans les iniquites en sante observees. Les constatations de notre etude indiquent que des efforts pour reduire la discrimination vecue par les adultes autochtones dans les villes pourraient reduire les symptomes d'ESPT et les abus de medicaments sur ordonnance dans ces populations. MOTS CLES: Indiens d'Amerique nord; discrimination raciale; medicaments sur ordonnance; stress post-traumatique; Canada, Aboriginal peoples experience a disproportionate burden of drug problems with serious implications for health. (1,2) To date, we do not have a common understanding of the determinants underlying these disparities. [...]

OBJECTIVE: We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. METHODS: In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non- Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. RESULTS: Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non- AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. CONCLUSIONS: AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART. KEY WORDS: Aboriginal populations; antiretroviral therapy, highly active; intravenous drug users; treatment outcomes; health-related quality of life OBJECTIF : Nous avons compare la qualite de vie liee a la sante (QVLS) de patients autochtones et non autochtones atteints du VIH apres le debut d'une therapie antiretrovirale hautement active (TAHA) a Edmonton (Alberta) et cherche a savoir si leur etat clinique (numeration des lymphocytes CD4 et charge virale) pouvait expliquer les differences observees. METHODE : En 2006-2007, des patients admissibles ayant entame une TAHA en 1997-2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. A l'aide de modeles de regression lineaire multiple, nous avons compare les cotes sommaires de sante physique (CSP) et de sante mentale (CSM) de quatre groupes : les Autochtones infectes par le VIH via l'utilisation de drogues par injection (Aut./UDI); les Autochtones non-UDI (Aut./non-UDI); les non-Autochtones UDI (non-Aut./UDI); et les non-Autochtones non-UDI (non-Aut./non-UDI). Pour determiner si l'etat clinique pouvait expliquer les differences observees entre ces groupes, nous avons adapte un modele en tenant compte des caracteristiques sociodemographiques (age et sexe) et du nombre d'annees depuis le debut de la TAHA seulement, puis en tenant compte, en plus, de l'etat clinique actuel. RESULTATS : Quatre-vingt-seize patients etaient admissibles (35 % d'Autochtones, 42 % d'UDI). Compte tenu des caracteristiques sociodemographiques et du nombre d'annees depuis le debut de la TAHA, les Aut./UDI (p=0,008), les Aut./non-UDI (p=0,002) et les non-Aut./UDI (p=0,002) avaient des cotes CSP inferieures a celles des non-Aut./non-UDI. En tenant aussi compte de l'etat clinique, ces relations demeuraient significatives pour les Aut./non-UDI (p=0,027) et les non-Aut./UDI (p=0,048), mais pas pour les Aut./UDI (p=0,12). Les Aut./UDI et les non-Aut./UDI avaient tendance a presenter des CSM inferieures a celles des non-Aut./non-UDI, mais ces relations n'etaient pas significatives, et elles s'affaiblissaient apres la prise en consideration de l'etat clinique actuel. CONCLUSION : La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI etait significativement inferieure a celle des non-Aut./non-UDI. Ces differences semblent s'expliquer en partie par un moins bon etat clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inegalites observees dans la QVLS physique peuvent etre reduites si l'on ameliore l'etat clinique des patients, par exemple en ameliorant l'observance de la TAHA. MOTS CLES : populations autochtones; therapie antiretrovirale hautement active; toxicomanie intraveineuse; resultat therapeutique; qualite de vie liee a la sante, In Canada, Aboriginals and non-Aboriginals infected with HIV do not appear to receive equal benefit from highly active antiretroviral therapy (HAART). After starting HAART, Aboriginals have been shown to experience [...]

Background: Aboriginals are over-represented in Canada's HIV epidemic and are commonly infected with HIV via injection drug use (IDU); however, little is known about the impact of Aboriginal ethnicity on mortality after starting highly active antiretroviral therapy (HAART). Therefore, we compared mortality rates between Aboriginal and non-Aboriginal HIV patients and between IDU and non-IDU HIV patients after they initiated HAART. Methods: We conducted a retrospective cohort study of antiretroviral-naive patients starting HAART January 1999-June 2005 (baseline), followed until December 2005. We constructed two Cox proportional hazards models, one to estimate all-cause and one to estimate HIV-related mortality hazard ratios (HRs), considering sex, and baseline age, CD4 cell count, HIV RNA level, calendar year, and HAART regimen as potential confounders. Results: The 548 study patients were followed for 1,889.8 person-years; 194 (35%) were Aboriginal, 255 (46%) were IDUs. We observed 55 deaths; 47% were HIV-related. In multivariable models, Aboriginals experienced higher all-cause (HR=1.85, 95% CI=1.05-3.26, p=0.034) and HIV-related (HR=3.47, 95% CI=1.36-8.83, p=0.009) mortality rates compared to non-Aboriginals; and, compared to patients with other exposures, IDUs experienced higher all-cause (HR=2.45, 95% CI=1.31-4.57, p=0.005) but similar HIV-related (p=0.27) mortality rates. Conclusions: Compared to non-Aboriginals, Aboriginal HIV patients suffer higher all-cause and HIV-related mortality rates after starting HAART. The strongest and most significant predictor of higher all-cause mortality was IDU. Future research should examine reasons for the observed poorer survival of Aboriginal and IDU HIV patients after initiating HAART to develop interventions to improve the prognosis for these vulnerable populations. Key words: Antiretroviral therapy, highly active; mortality; Aboriginal populations; intravenous drug use Contexte : Les Autochtones sont surrepresentes dans l'epidemie de VIH qui sevit au Canada, le plus souvent en raison de l'utilisation de drogues par injection (UDI); pourtant, on sait peu de choses sur l'impact de l'ethnicite autochtone sur la mortalite apres le debut d'une therapie antiretrovirale hautement active (TAHA). C'est pourquoi nous avons compare les taux de mortalite de patients autochtones et non autochtones atteints du VIH et ceux d'UDI et de non-UDI atteints du VIH apres le debut d'une TAHA. Methode : Nous avons mene une etude de cohortes retrospective aupres de patients naifs de traitement antiretroviral ayant entame une TAHA entre janvier 1999 et juin 2005 (groupe de reference), que nous avons suivis jusqu'en decembre 2005. Nous avons construit deux modeles de Cox (modeles des risques proportionnels), l'un pour estimer les coefficients de danger (QD) pour toutes les causes de mortalite et l'autre pour la mortalite liee au VIH, en tenant compte des facteurs confusionnels possibles (sexe, age au depart, numeration des lymphocytes CD4, niveaux d'ARN VIH, annee civile et regime TAHA). Resultats : Les 548 patients a l'etude ont ete suivis sur 1 889,8 personnes-annees; 194 (35 %) etaient Autochtones, et 255 (46 %) etaient des UDI. Nous avons observe 55 deces, dont 47 % lies au VIH. Dans les modeles multivaries, les Autochtones affichaient des taux superieurs pour la mortalite toutes causes confondues (QD=1,85, IC de 95 %=1,05-3,26, p=0,034) et la mortalite liee au VIH (QD=3,47, IC de 95 %=1,36-8,83, p=0,009) comparativement aux Non-Autochtones. Par rapport aux patients ayant d'autres expositions, les UDI affichaient des taux superieurs de mortalite toutes causes confondues (QD=2,45, IC de 95 %=1,31-4,57, p=0,005), mais leurs taux de mortalite liee au VIH etaient semblables (p=0,27). Conclusion : A comparer aux Non-Autochtones, les patients autochtones atteints du VIH ont des taux superieurs de mortalite toutes causes confondues et de mortalite liee au VIH apres le debut d'une TAHA. La variable predictive la plus forte et la plus significative de la mortalite toutes causes confondues etait le statut d'UDI. Dans les futurs travaux de recherche, il faudrait se pencher sur les raisons des moins bons taux de survie observes chez les patients autochtones et les UDI atteints du VIH apres le debut d'une TAHA afin d'elaborer des interventions susceptibles d'ameliorer le pronostic de ces populations vulnerables. Mots cles : therapie antiretrovirale hautement active; mortalite; population d'origine amerindienne; toxicomanie intraveineuse, Highly active antiretroviral therapy (HAART) has dramatically reduced mortality among human immunodeficiency virus (HIV)-infected individuals. (1,2) However, since the introduction of HAART, higher rates of mortality have been observed among [...]

Background: The aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy (HAART) by HIV‐positive mothers in the Ugandan Kabarole District's Programme for the Prevention of Mother to Child Transmission‐Plus (PMTCT‐Plus). Methods: Our study was a qualitative descriptive exploratory study using thematic analysis. Individual in‐depth interviews (n = 45) were conducted with randomly selected HIV‐positive mothers who attended this programme, and who: (a) never enrolled in HAART (n = 17); (b) enrolled but did not come back to receive HAART (n = 2); (c) defaulted/interrupted HAART (n = 14); and (d) are currently adhering to HAART (n = 12). A focus group was also conducted to verify the results from the interviews. Results: Results indicated that economic concerns, particularly transport costs from residences to the clinics, represented the greatest barrier to accessing treatment. In addition, HIV‐related stigma and non‐disclosure of HIV status to clients' sexual partners, long waiting times at the clinic and suboptimal provider‐patient interactions at the hospital emerged as significant barriers. Conclusions: These barriers to antiretroviral treatment of pregnant and post‐natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population. This would improve their survival and, at the same time, drastically reduce HIV transmission from mother to child., Background Sub‐Saharan Africa has been devastated by the HIV/AIDS epidemic, having more infections and deaths than any other region globally [1]. Uganda is among those countries in the sub‐Saharan region [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.01.002 Byline: T. Cameron Wild (a), John A. Cunningham (b)(c), Richard M. Ryan (d) Keywords: Treatment; Coercion; Motivation; Self-determination theory Abstract: Research on coercion in addiction treatment typically investigates objective sources of social pressure among legally mandated clients. Little research has examined the impact of clients' perceptions of social pressures in generalist addiction services. Clients seeking substance abuse treatment (N =300; 221 males and 79 females; M age=36.6 years) rated the extent to which treatment was being sought because of coercive social pressures (external motivation; [alpha] =.89), guilt about continued substance abuse (introjected motivation; [alpha] =.84), or a personal choice and commitment to the goals of the program (identified motivation; [alpha] =.85). External treatment motivation was positively correlated with legal referral, social network pressures to enter treatment, and was inversely related to problem severity. In contrast, identified treatment motivation was positively correlated with self-referral and problem severity, and was inversely related to perceived coercion (ps Author Affiliation: (a) Centre for Addiction and Mental Health Research Laboratory, University of Alberta, 13-133 Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2T3 (b) Centre for Addiction and Mental Health, Canada (c) University of Toronto, Canada (d) University of Rochester, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.12.013 Byline: J. Lee Westmaas (a), Roberta Ferrence (b), T. Cameron Wild (c) Keywords: Autonomy; Coping; Depressive symptoms; Smoking; Sociotropy Abstract: According to Beck's cognitive theory of depression, autonomy (high achievement concerns) and sociotropy (high interpersonal concerns) are vulnerability factors for depression when achievement or interpersonal stressors, respectively, are experienced. This hypothesis was tested among men and women attempting to quit smoking, an achievement stressor that can provoke depressive symptoms. Smokers recruited from the community (N =210) provided information about their quit attempt through mailed questionnaires. For the 48-h period following the quit, relationships among autonomy, sociotropy, coping, depressive symptoms and lapsing were assessed. Structural equation models supported the trait-congruence hypothesis because greater autonomy, but not sociotropy, was associated with elevated depressive symptoms among both men and women smokers. However, results were stronger for men ([beta] =.47, p =.0001) than for women ([beta] =.20, p =.05). After accounting for autonomy's relationship with depressive symptoms, greater autonomy was inversely associated with lapsing among men ([beta] =-.35, p =.01), but not women. Results point to the potential usefulness of a theoretical approach to understanding relationships between depressive symptoms and smoking cessation, and indicate that autonomous personality may be an important factor in smoking cessation in men. Author Affiliation: (a) Department of Psychology, State University of New York at Stony Brook,Stony Brook, NY 11794-2500, USA (b) Ontario Tobacco Research Unit, University of Toronto and Centre for Addiction and Mental Health, Canada (c) Department of Public Health Sciences and Centre for Health Promotion Studies, University of Alberta, Canada

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.02.006 Byline: John A. Cunningham (a), T. Cameron Wild (b), Anja Koski-Jannes (c) Keywords: Alcohol; Motivation; Life events; Autoremission; Natural history Abstract: A prospective natural history study was conducted of problem drinkers who were thinking about quitting or reducing their alcohol consumption. Two primary constructs, cognitive appraisals and life events, were measured in a mailed-out baseline survey. A one-year follow-up survey identified those who had made reductions in drinking. Partial correlations controlling for baseline drinking severity revealed some support for both cognitive appraisal and life events explanations of change. Author Affiliation: (a) Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1 (b) Centre for Health Promotion Studies, University of Alberta, Centre for Addiction and Mental Health, Canada (c) University of Tampere, Jarvenpaa Addiction Hospital, Finland

Objective: An experimental trial was used to assess the effectiveness of a self-help book and a personalized assessment-feedback intervention, both separately and in combination with each other, in a general population survey. Method: Participants (N = 86; 66.3% male) were recruited through a random digit dialing telephone survey conducted by the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Respondents were randomly assigned to one of four conditions in a two-by-two factorial design: 'no-intervention' control group, 'personalized feedback only,' 'self-help book only' and 'both personalized feedback and self-help book.' Respondents were followed up in 6 months' time, and differences in drinking status were compared between experimental conditions using a multivariate analysis of covariance with baseline drinking severity as the covariate. Results: Support was provided for an interaction hypothesis in which respondents who received both interventions reported significantly improved drinking outcomes at 6-month follow-up, compared with respondents who received just one of the interventions or who received no intervention. Conclusions: Because respondents were recruited from a representative sample of the general population into a randomized trial with a no-intervention control group, this research design maximized both external and internal validity in examining the effectiveness of self-help interventions. (J. Stud. Alcohol 63: 649-654, 2002), ALTHOUGH THE MAJORITY of problem drinkers do Not seek formal treatment, many are interested in self-help interventions (Cunningham et al., 1999; Koski-Jannes and Cunningham, 2001; Werch, 1990). Because self-help interventions [...]

Objective: This study examined relationships between personal drinking and perceived social norms for alcohol use. It was hypothesized that frequent heavy drinkers (i.e., those consuming five or more drinks at least once a week or greater in the last 12 months) would exhibit biases in sociocultural expectations for alcohol use. Method: A representative sample of Ontario residents who had consumed alcohol in the previous 12 months (N = 937, 51.8% women, mean [SD] age = 42.7 [15.2] years) compared their own alcohol use with the drinking habits of friends, coworkers and the general public. Respondents rated the importance of seven psychosocial factors that might define 'problem drinking' and estimated the number of drinks social and problem drinkers are likely to have in different contexts. Results: Compared with lighter drinkers, frequent heavy drinkers (1) believed that heavy alcohol use is more normative in social reference groups, (2) overestimated the amount of alcohol that social and problem drinkers consume in different contexts, (3) rated several criteria (e.g., frequency of intoxication) as less definitive of problem drinking and (4) did not exhibit pluralistic ignorance (i.e., they shifted private approval of the drinking habits of others to match [mistaken] social norms of reference groups). Conclusions: Frequent heavy drinkers calibrate their beliefs about drinking in reference groups in order to view their drinking as normative. Results are discussed in relation to the development of brief public health interventions., ALCOHOL CONSUMPTION is influenced by a variety of social factors that, in part, determine why one should consume alcohol (e.g., celebration or coping), when it is appropriate to drink (e.g., [...]

In a survey conducted in Ontario, front-line staff of specialized addiction treatment services were asked to indicate the extent to which they believed 53 different treatment processes to be necessary for the effective treatment of people with alcohol and drug problems. Cognitive-behavioural processes were generally rated as almost essential for treatment to be effective. Other processes received mixed ratings, while confrontation and pharmacological treatment were, on average, rated as detrimental. Factor analysis identified three interpretable dimensions of beliefs (a) cognitive-behavioural, (b) disease, and (c) medication. A fourth dimension involved both psychodynamic and conditioning processes and did not clearly correspond with any known therapeutic approach. Scores on scales developed using items from these four dimensions were variously influenced by respondents age, education, place of work, and certification status. Two groups identified using cluster analysis differed primarily with respect to scores on the disease scale. Logistic regression analysis showed that age, certification status, and place of work were associated with membership in these groups. Implications for treatment system development and research are discussed. Keywords - treatment methods; counsellors; disease model; factor analysis; treatment settings.

The impact of asking for a collateral on respondent attrition and the impact of providing versus not providing a collateral on self-reported drinking is evaluated. It is concluded that providing a collateral may have an impact on respondents self-reported drinking.

Research shows differences in the way men and women alter their smoking habit and how they are influenced by respective parterners, family and friends. Data indicate that smoking reduction and social influence are positively releated in men but less in case women.

Objective: Examined predictors of nonresponse among respondents who agreed to receive a follow-up questionnaire on alcohol use after participating in a representative telephone survey, and among respondents who did and did not return the follow-up questionnaire. Method: A total of 2,072 (52.2% female) respondents to a representative monthly telephone survey were assessed on sociodemographic variables and alcohol use. Respondents were asked whether they would be willing to fill out an additional mailed questionnaire on alcohol use and attitudes toward drinking. Almost half (n = 956; 46%) of respondents agreed to participate in the follow-up survey; 430 (45%) of those individuals completed and returned the questionnaire. Results: Agreement to receive the follow-up questionnaire was unrelated to alcohol use. Regarding gender, men were 1.42 times more likely than women to exhibit nonresponse in returning the follow-up questionnaire (95% CI: 1.08-1.42). After adjusting for the impact of demographic factors, respondents who consumed alcohol at least once per week were 1.43 times more likely than respondents who drank less frequently to exhibit nonresponse in returning the questionnaire (95% CI: 1.05-1.93). Respondents who consumed five or more standard drinks at least once per week were 1.83 times more likely to exhibit nonresponse in returning the questionnaire, compared with respondents who engaged in heavy drinking less frequently (95% CI: 1.15-2.92). Conclusions: Mailout questionnaires following a representative telephone survey may bias samples toward obtaining fewer men, fewer weekly drinkers and fewer heavier drinkers. Although the magnitude of these biases were relatively small, epidemiological studies on alcohol use may wish to oversample men and heavier drinkers in follow-up studies recruiting from population surveys. (J. Stud. Alcohol 62: 257-261, 2001), ALCOHOL RESEARCHERS routinely use survey methods to assess drinking patterns and problems (e.g., Dawson, 1998; Harford et al., 1991; Hilton, 1991; Poulin et al., 1997; Rehm and Sempos, 1995). With [...]

Objective: As many as one in four adults in North America experiences some problems due to alcohol consumption. Although most of these problem drinkers do not have concerns that are severe enough to merit formal treatment, such drinking has large economic costs and can place the drinker at risk for long-term negative health and social consequences. The present study evaluated a minimal intervention that used normative feedback about population drinking to motivate changes in alcohol use. Method: An intervention pamphlet was mailed to over 6,000 households in Toronto, randomized by block from a region containing almost 10,000 households. In the month after the mailing, a general population survey was conducted in the region to assess alcohol use. Results: Respondents from households receiving normative feedback (n = 472) reported significantly lower alcohol use than controls (n = 225), but this effect occurred only among respondents who met an objective criterion for problem drinking and who perceived some risk associated with their drinking. Conclusions: Viewed from a public health perspective, normative feedback interventions have the potential for a significant payoff because they can be provided at low cost and to problem drinkers who might ordinarily never access any treatment services. (d. Stud. Alcohol 62: 228-233, 2001), ABOUT 20% to 30% of people who consume alcohol in North America are problem drinkers (Institute of Medicine, 1990; Skinner, 1990). The majority of these individuals, although at risk for [...]

Objective: Perceived vulnerability to harm is widely acknowledged as a determinant of behavior change, but little is known about why some drinkers believe that they are personally 'at risk' for problems while others do not. This study examined perceived vulnerability to alcohol-related harm in relation to epidemiological risk status on a standardized problem-drinking measure and two psychosocial measures of drinking context: (1) typical reasons for drinking and cutting down and (2) social network influences related to alcohol use. We evaluated the general hypothesis that these psychosocial variables would independently affect perceived vulnerability to alcohol-related harm, over and above epidemiological risk status. Method: Adults between the ages of 18 and 79 (N = 430; 249 women, 173 men, 8 gender unknown) completed a questionnaire about drinking behavior and drinking-related social and motivational context. Results: There was a positive relationship between problem-drinking status and perceived risk of experiencing harm, and no support for the idea that objectively 'at-risk' drinkers believe that they are less likely to personally experience harm than comparable peers. Drinking motives and social network variables each significantly improved the prediction of perceived vulnerability when epidemiological risk status was controlled. Conclusions: Interventions designed to alter drinkers' risk perceptions should take into account the reasons that people have for drinking and the social network context of alcohol use, in addition to whether or not individuals are 'problem drinkers.' (J. Stud. Alcohol 62:105-113,2001), PERCEIVED VULNERABILITY to harm is recognized as a determinant of health-protective behavior in a variety of theories. Weinstein (1993), for example, argued that the health belief model (Rosenstock et al., [...]

IT IS A TRUISM in research that the more reliable and detailed baseline information that can be gathered about a phenomenon, the more likely investigators are to make valid inferences [...]

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers (1). Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures. Key Words. Alcohol; Drugs; Occupation; Workplace factors, INTRODUCTION Many researchers argue that characteristics of one's employment play a significant role in the development and/or continuation of alcohol and drug problems (2-6). If these assertions are accurate, interventions [...]

Aims Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. Design A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. Setting and participants A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). Intervention Current drinkers interested in receiving alcohol self-help materials ( n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). Measurements Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. Findings Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition ( P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers. Conclusions The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population. [ABSTRACT FROM AUTHOR]

Objective: To identify demo- graphic, health, and behavioral factors associated with smoking behavior in adults with diabetes. Methods: Canadian adults 18+ years with type 1 (n=697) or type 2 (n=1621) were investigated. Logistic regression analyses were conducted separately for both diabetes subgroups. Results: When comparing never versus ever smokers, never versus current smokers,and former smokers who quit versus current smokers, similarities and differences for demographic, health, and behavioral factors were found for the 2 diabetes subgroups. Conclusions: Diabetes type, demographic, health, and behavioral factors should be considered when tailoring smoking cessation and prevention programs. [ABSTRACT FROM AUTHOR]