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We examined the effect on depressive symptoms of a peer network-oriented intervention effective in reducing sexual risk behavior and methamphetamine (MA) use. Current Thai MA users aged 18-25 years and their drug and/or sex network members enrolled in a randomized controlled trial with 4 follow-ups over 12 months. A total of 415 index participants recruited 568 network members. Linear repeated measures models were fit with depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) as the outcome. Among indexes in the intervention condition, mean CES-D decreased from 20.0 to 15.7 (p less than 0.0001) over follow-up. Controlling for covariates and changes in MA and alcohol use, CES-D in this group decreased by 0.35 points per month (95% confidence interval, 0.45, -0.25). All other groups showed minimal changes in CES-D score. The peer-oriented, community-based intervention designed to reduce MA use and sexual risk behavior also resulted in substantial reduction in depressive symptoms, independent of changes in MA use. (Contains 3 tables and 1 figure.)

Background: Despite Thailand's war on drugs, methamphetamine ("yaba" in Thai) use and the drug economy both thrive. This analysis identifies predictors of incident and recurrent involvement in the sale or delivery of drugs for profit amongst young Thai yaba users., Methods: Between April 2005 and June 2006, 983 yaba users, ages 18-25, were enrolled in a randomized behavioural intervention in Chiang Mai Province (415 index and 568 of their drug network members). Questionnaires administered at baseline, 3-, 6-, 9-, and 12-month follow-up visits assessed socio-demographic factors, current and prior drug use, social network characteristics, sexual risk behaviours and drug use norms. Exposures were lagged by three months (prior visit). Outcomes included incident and recurrent drug economy involvement. Generalized linear mixed models were fit using GLIMMIX (SASv9.1)., Results: Incident drug economy involvement was predicted by yaba use frequency (adjusted odds ratio [AOR]: 1.05; 95% confidence interval [CI]: 1.01, 1.10), recent incarceration (AOR: 2.37; 95% CI: 1.07, 5.25) and the proportion of yaba-using networks who quit recently (AOR: .34; 95% CI: .15, .78). Recurrent drug economy involvement was predicted by age (AOR: 0.81; 95% CI: 0.68, 0.96), frequency of yaba use (AOR: 1.06; 95% CI: 1.02, 1.09), drug economy involvement at the previous visit (AOR: 2.61; CI: 1.59, 4.28), incarceration in the prior three months (AOR: 2.29; 95% CI: 1.07, 4.86), and the proportion of yaba-users in his/her network who quit recently (AOR: .38; 95% CI: .20, .71)., Conclusion: Individual drug use, drug use in social networks and recent incarceration were predictors of incident and recurrent involvement in the drug economy. These results suggest that interrupting drug use and/or minimizing the influence of drug-using networks may help prevent further involvement in the drug economy. The emergence of recent incarceration as a predictor for both models highlights the need for more appropriate drug rehabilitation programmes and demonstrates that continued criminalization of drug users may fuel Thailand's yaba epidemic., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Introduction and Aims: Our study examined the incidence of arrest and incarceration, investigated predictors of incarceration and explored the persistence of depression, alcohol use and drug use after incarceration among young methamphetamine users from Thailand., Design and Methods: Participants were aged 18-25 years old and were a part of a 12 month randomised social network trial that aimed to reduce sexual risk and methamphetamine use. Estimates of the incidence of arrest and incarceration over 12 months were calculated. A matched case-control study (n = 73 cases; n = 223 controls) was performed to examine incarceration risk factors using conditional logistic regression. Persistence of drug-risk behaviours were explored after incarceration., Results: Study participants (n = 950) were 72% male, with a median age of 19 years and a median of 9 years of schooling. Frequent drug and alcohol use were reported at baseline. In total, 35% of the sample reported ever having been arrested and 22% reported ever having been incarcerated at baseline. During the 12 month follow up, 16% of the sample was arrested. In univariate analyses, risk factors for incarceration included frequent drug and alcohol use, being less educated, and a history of arrest and incarceration. A high prevalence of drug and alcohol use and involvement in the drug economy persisted after arrest., Discussion and Conclusions: The study indicates a high prevalence of recidivism among this young sample, with continued involvement in drug-risk behaviours after incarceration. Appropriate interventions are needed to address root causes of arrest, largely related to substance use.

Introduction: Depression often co-occurs with amphetamine type stimulant use and can negatively impact drug treatment outcomes. Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options., Methods: Methamphetamine users aged 18-25 years were enrolled in a 12-month randomized behavioral trial in Thailand. Questionnaires were administered every 3 months and included information on substance use and depressive symptoms. Pattern of methamphetamine use during follow-up was characterized into four groups: early cessation, late cessation, relapse and persistent use. Multinomial logistic regression was used to determine the impact of baseline depressive symptoms (CES-D score and % > or =22) on patterns of methamphetamine use during follow-up. Linear and logistic regression was used to determine the impact of patterns of methamphetamine use on depressive symptoms at the end of the trial., Results: No association was found between baseline depressive symptoms and subsequent patterns of methamphetamine use. A significant relationship was found between patterns of methamphetamine use and ensuing depressive symptoms, with those achieving cessation experiencing lower levels of depressive symptoms., Discussion: Many symptoms of depression may resolve with cessation or reduction in methamphetamine use. Clinical and community-based efforts that facilitate drug users' attempts to stop using drugs should be supported as they may contribute to positive cessation outcomes and help to improve overall mental health.

Background: Southeast Asia is experiencing an epidemic of methamphetamine use, a drug associated with risky sexual behaviors, putting a large segment of the population at increased risk for sexually transmitted infections (STIs) and HIV and in need of prevention efforts. Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups., Study Design: We enrolled methamphetamine users aged 18 to 25 years in a 12-month randomized behavioral intervention trial in Chiang Mai, Thailand in 2005. Behavioral questionnaires were administered at visits every 3 months, and biologic specimens were collected at baseline and 12 months to test for common STIs (chlamydia, gonorrhea, HSV-2, and HIV). Poisson regression with robust variance was used to determine risk factors for incident STIs., Results: Overall, 12.7% of 519 participants acquired at least 1 STI. Chlamydia was the most common (10.6%), followed by HSV-2 (4.0%), gonorrhea (2.9%), and HIV (0.6%). Risk factors for both men and women included self-reported incarceration and having a casual sex partner during follow-up, and having a prevalent STI at baseline. Additionally, among women, having 2 or more heterosexual partners, and among men, having a greater frequency of drunkenness were risk factors for STI acquisition., Conclusions: Although HIV incidence is low in this population, incidence of other STIs is high compared with previous studies of young Thai adults. Risk factors for acquisition emphasize the need for new prevention strategies targeted toward current populations at risk.

Purpose: Methamphetamine (MA) is the leading illicit drug in Thailand among youth and young adults. Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine., Methods: We conducted a cross-sectional study in Chiang Mai, Thailand, in 2005-2006 among 1,162 street-recruited methamphetamine smokers 18-25 years of age. Data collected included sociodemographic characteristics, sexual behaviors, and drug use patterns. Latent class analysis was used to describe patterns of activities in which participants reported engaging directly after using MA. Logistic regression was used to examine univariate correlates of class membership, separately by gender., Results: Participants were 75% male with a median age of 19 years. More than half of participants reported frequent alcohol use (>or=4 days/week) and half of the sample reported smoking MA >or=2 days/ week. Three classes of activities emerged for male participants (n = 863): "work" (job related); "high-risk behaviors" (motorcycle riding, fighting, sex); and "combined" (all activities). Two classes emerged for the women (n = 299): "work" (housework) and "high-risk behaviors." "High-risk behaviors" and "combined" (men only) classes were associated with more frequent alcohol and methamphetamine use compared with the "work" class., Conclusions: Our study found a distinct typology of behaviors associated with substance abuse among young adults in Thailand. Behavioral typologies allow a better understanding of the nuances of "risky" behaviors and might prove useful in targeting interventions.

Introduction and Aims: Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA., Design and Methods: Between March 2002 and January 2003, 48 in-depth interviews with young MA users aged 15-2 years in Chiang Mai. Interviews were transcribed verbatim in Thai and translated into English. Data were analysed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management. The current analysis was stratified by gender., Results: Participants were 44% male and the median age was 20 years. At the time of the interviews, 70% were not using MA. A typology of experiences with and feelings about MA's relationship to sexual activity emerged: (1) enhanced libido--individuals who found that MA enhances their sexual experiences (n = 13); (2) decreased libido or no effect--individuals who found that MA detracted from sexual desire (n = 22); and (3) virgins (n = 13)., Discussion and Conclusions: Participants reported several distinct patterns of relationship between MA and sex. Tailored interventions are needed that address specific patterns of sexual behaviors among youth in order to promote sustainable safer sex behaviours in this population.

Purpose: Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study examines factors associated with initiation of MA use., Methods: Between March 2002 and January 2003, 48 in-depth interviews with young MA users were conducted in advance of a randomized, MA harm reduction, peer outreach intervention trial. The interviews were conducted in the city of Chiang Mai and the surrounding district. Data were inductively analyzed using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management., Results: Participants were 57% male and had a median age of 20 years (range 15-31 years). A culture of MA ubiquity characterized participants' initiation stories. Drug ubiquity encompassed three elements: the extent of MA use within peer networks; the availability of MA; and exposure to MA before initiation. All participants were introduced to MA by people close to them, most often by their friends. Internal reasons for trying MA were curiosity, a way to lose weight or to enhance hard work, and a way to "forget life's problems." With the prevalence of MA use among participants' peers, initiation seemed inevitable., Conclusions: Initiation was characterized as ubiquitous in terms of peer networks' use and availability. Because of the prevalent norm of MA use, these data indicate that interventions targeting social networks and young Thais before MA initiation are needed.

Aim: To understand factors influencing cessation intentions among young Thai methamphetamine (MA) users, a population with dramatically increasing rates of MA use., Design and Participants: A total of 48 in-depth interviews conducted between March 2002 and January 2003 with current and recent MA users aged 15-29 years., Setting: Chiang Mai city and surrounding district, Thailand., Measurement: Interviews addressed family history, drug use patterns and influences, cessation history, drug treatment experiences and sexual behavior. Data were analyzed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management., Findings: Cessation intentions were motivated by a range of internal and external influences, including attitudes towards continued MA use shaped by recognition of negative impact on self and others; influence of family, peers, partners and community stigma; perceptions on cessation and drug treatment; and external facilitators and situational barriers, such as extensive peer pressure and drug availability. In most cases, multiple factors operated simultaneously. Some variation according to duration of use and treatment status was observed., Conclusions: Evidence-based interventions addressing MA use among Thai young people are urgently needed. These data support the continuation of evidence-based drug treatment at levels adequate to address the population need and implementation a multi-faceted approach that aims to enhance identified cessation influences in this population and minimize contextual barriers to cessation.

Internalized sexual stigma is an important contributor to LGBT mental health disparities. In Thailand, the absence of validated instruments represents a research barrier. The study's purpose was to translate and evaluate the psychometric properties of the Revised Internalized Homophobia (IHP-R) scale. Based on the cross-cultural principle, team translation was applied. The IHP-R was translated by the principal author and reviewed by bilingual Thai nurses, and clarifications were made. Multidisciplinary experts provided back translation and reconciled the finalized Thai version. The psychometric properties were established in 412 Thai LGBT individuals. Data was collected via online and paper-pencil surveys and analyzed using SPSS. Most participants were male, age ranged 18–53, with moderate levels of internalized homophobia (M = 2.3, SD = 1.04). The inter-item and item-total correlations were.38-.63 and.55-.68. The content validity index was high (I-CVI, S-CVI/UA/Ave = 1). The exploratory factor analysis confirmed one construct of internalized sexual self-stigma (factor loading =.702–.816). Scores on IHP-R were correlated with stress and experiences of discrimination (r =.14 and.12). Internal consistency reliability was also high (Cronbach's alpha coefficient =.83). The IHP-R Thai version has high psychometric properties and is appropriate for LGBT research in Thailand. [ABSTRACT FROM AUTHOR]

Background: Transgender women (TW) are at disproportionate risk of acquiring HIV, but their participation in HIV treatment and prevention studies remains low. This manuscript aims to evaluate TW's perspectives on study recruitment and retention to provide insights to researchers on designing a cohort study for this population. Methods: Thirteen TW who were at least 18 years and living in Bangkok, Thailand, were recruited by purposive sampling in January 2017–February 2017. All participated in a focus group discussion, and five participated in the additional one-on-one in-depth interviews. Thematic analysis was performed from the interview transcripts to identify themes regarding cohort study recruitment and retention. Results: The median (interquartile range, IQR) age of 25.8 (23.4–29.1) with 23.1% and 69.2% identified as females and TW, respectively, participated in the study. The analysis shows that TW highly value friendship, and maintaining a good relationship with the participants will improve recruitment and retention. Further, TW also suggested employing well-connected and respected TW influencers and community leaders to facilitate recruitment and retention, especially through online platforms. Other facilitators include having the opportunities to learn more about HIV and access to TW-friendly healthcare service, while the barriers are competing priorities and lack of a TW-centered approach. Conclusion/Policy Implication: This study elucidates the existing barriers and facilitators to research participation for TW. The findings also underscore the importance of involving study participants in designing research to ensure that the study is acceptable and culturally appropriate for TW to participate. [ABSTRACT FROM AUTHOR]

Introduction: Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth‐friendly services (YFS) and a mobile phone application (app) on adherence to pre‐exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand. Methods: A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self‐assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV‐DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was "PrEP adherence" defined as TFV‐DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week). Results: Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty‐seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p‐value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p‐value 0.54). No HIV seroconversions occurred during 75 person years of follow‐up. Conclusions: Youth‐friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on "prevention‐effective adherence." [ABSTRACT FROM AUTHOR]

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Background: Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15–24 years in northern Thailand. Methods: A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. Results: A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15–17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27–9.95). Participants aged 21–24 years had a greater chance of MA use than those aged 15–17 years (AOR = 2.51; 95% CI = 1.11–5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI = 1.66–15.32). Those who had been physically assaulted by a family member while aged 0–5 years had a greater chance of MA use than those who had not (AOR = 2.29; 95% CI = 1.02–5.12). Those who had been physically assaulted by a family member while aged 6–14 years had a greater chance of MA use than those who had not (AOR = 3.15; 95% CI = 1.32–7.54). Those who had a close friend who used alcohol had a greater chance of MA use than those who did not (AOR = 2.24; 95% CI = 1.24–4.72). Those who had a highly confident personality had a greater chance of MA use than those who did not (AOR = 2.35; 95% CI = 1.17–4.69), and those who smoked had a greater chance of MA use than those who did not (AOR = 8.27; 95% CI = 4.42–15.46). Conclusions: All relevant government and nongovernment agencies together with the Ministry of Public Health Thailand should address MA use among Akha and Lahu youths by properly developing a community health intervention that lowers risk of MA use by addressing family relationships, male youth behaviors, and focused on those individuals with a highly confident personality. [ABSTRACT FROM AUTHOR]

One in five transgender women (TW) are living with HIV, yet little has been published about their health outcomes. We analyzed data from TW (n = 37), cisgender women (CW, n = 165), and cisgender men who have sex with men (MSM, n = 151) in Thailand and Brazil. We hypothesized: (1) TW will have higher odds of depressive symptoms, lower odds of condom use and greater odds of a detectable viral load compared to MSM and CW; and (2) TW will have lower odds of condom use and higher odds of detectable viral load. We found that TW had higher odds of depression (OR 2.2, 95%CI: 1.0, 4.8, p = 0.04) and were less likely than MSM (22% v. 42%, p = 0.01) to use condoms with partners of unknown serostatus. In multivariable models, TW had lower odds than MSM of using condoms with partners with unknown serostatus (OR 0.38, 95%CI: 0.15, 0.90) and CW had lower odds than MSM of using condoms with HIV-negative partners (0.60 [0.38, 0.95], p = 0.029). We found no significant differences in detectable viral load. Disaggregating data by gender is important to understand factors that contribute to viral suppression and HIV transmission risk among people living with HIV. [ABSTRACT FROM AUTHOR]

Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7–12 (aged 13–20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents. [ABSTRACT FROM AUTHOR]

Within Asia, HIV prevalence is highest in Thailand, including thousands of children and adolescents. Care for children born with HIV [perinatal transmission of HIV (PHIV)] will need to focus on adolescents for the foreseeable future. Thai PHIV adolescents experience significant mental health and psychosocial challenges, including treatment adherence. Yet, few, if any, comprehensive interventions for them exist. CHAMP+, an evidence-based intervention adapted for Thailand, was evaluated with a pilot randomized control trial at four HIV clinics. Eighty-eight dyads of 9- to 14-year-old PHIV young adolescents/caregivers were randomized to CHAMP+ or standard of care (SOC). Eleven cartoon-based sessions were delivered over 6 months. Participants completed baseline, 6-month (postintervention), and 9-month surveys, measuring youth outcomes (e.g., mental health and adherence), contextual factors (e.g., demographics and caregiver factors), and self- and social-regulation factors (e.g., HIV knowledge and youth-caregiver communication). Multi-level modeling to account for clustering within individuals was used to assess longitudinal changes within and between groups. All families randomized to CHAMP+ completed the intervention. Although the study was not statistically powered to detect differences in treatment effects, the CHAMP+ group significantly improved at 6 months in youth mental health and adherence, HIV knowledge, youth-caregiver communication, internalized stigma, and HIV-related social support, with most improvements sustained at 9 months and significantly better improvements than the SOC group on a number of outcomes. High levels of baseline viral suppression highlight the importance of reaching these young PHIV adolescents at a period of lower risk before adherence and other challenges emerge. Designed to be delivered with limited cost/resources, CHAMP+ Thailand holds scale-up potential. [ABSTRACT FROM AUTHOR]

Background: High levels of depressive symptoms often occur among individuals that use or that are dependent on methamphetamine (MA). Thailand is currently experiencing an epidemic of MA use among youth. Understanding the nature of the relationship between depressive symptoms and MA use and identifying those most at risk can further understanding of prevention and treatment options for youth who use MA and present with depressive symptoms.Methods: In 2011, we conducted a cross sectional epidemiologic study that examined associations between MA use and high levels of depressive symptoms among adolescents and young adults aged 14-29 living in Chiang Mai province, Thailand. A combination of cluster and systematic sampling was conducted to obtain a study sample of participants actively recruited in Chiang Mai province. Depressive symptoms were measured using a Thai translation of the Centers for Epidemiologic Studies Depression scale (CES-D). The independent variables measured reported lifetime and recent MA use within the past 3 months. Multivariate logistic regression models were used to assess associations between MA use and high levels of depressive symptoms.Results: Approximately 19% (n = 394) of the sample reported ever having consumed MA and 31% (n = 124) of lifetime users reported recent MA use within the past 3 months. Recent MA use was associated with high levels of depressive symptoms (aPOR recent use: 2.60, 95% CI: 1.20, 5.63).Conclusions: This is one of the first studies to examine the association between MA use and high levels of depressive symptoms in a general Thai population. The odds of having high levels of depressive symptoms was significantly greater among recent MA users compared to non-users. These findings support the need for policies, programs and interventions to prevent and treat depressive symptoms presenting among MA using Thai adolescents and young adults in rural Chiang Mai province, Thailand to aid in cessation of MA use. Furthermore, additional research is needed to investigate treatment options for adolescents and young adults in Thailand that use MA and present with high levels of depressive symptoms. [ABSTRACT FROM AUTHOR]

Youth substance abuse is widely recognized as a major public health issue in Thailand. This study explores family and community risk and protective factors relevant to alcohol and illegal drug misuse in 1,778 Thai teenagers. Strong family attachment and a family history of antisocial behaviors were strongly associated with nearly all forms of substance abuse, with adjusted odds ratios ranging from 5.05 to 8.45. Community disorganization was strongly associated with self-reported substance use, although involvement in prosocial activities acted as a protective factor. The findings suggest that interventions that promote family cohesion and encourage community involvement may have considerable benefits in reducing substance abuse in Thai adolescents. [ABSTRACT FROM PUBLISHER]

This study, conducted in 2005 to 2007, presents results that are based on a proscriptive cohort design. The sample consisted of 769 residents in 22 drug user treatment programs who stayed in treatment for at least 30 days to one year; 510 former residents (66%) from 21 programs (95%) were interviewed again at a 6-month post-treatment follow-up assessment. A majority of the participants were male, lived with family or relatives, had completed only primary school, and had a full-time or a part-time job prior to entering treatment. The participating therapeutic community (TC) programs were a mixture of volunteer, compulsory-probation, and prison-based programs. In-person interview data and urine testing showed that the self-reported drug use prevalence rates are reliable. The results show large positive treatment effects on 30-day and 6-month illegal drug use and small to medium effects on the severity of alcohol use and related problems. A multilevel regression analysis suggests that residents' reduced stigma, adaptation of the TC model, and frequency of alcohol and drug use-related consequences partially predict treatment success. Study limitations and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Social & Cultural Geography is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To determine the prevalence and types of penile modification and describe the circumstances surrounding this practice among a sample of young methamphetamine users in Thailand.Methods: A mixed methods study was conducted in Chiang Mai, Thailand, in 2005-6. One hundred young men were surveyed for the quantitative study and in-depth interviews were administered to 9 men, 11 women and 1 transgender.Results: The prevalence of penile modification was 51%, with the most common type being inlaying with muk(s) (61%). The majority of modifications were performed in prison or juvenile detention (80%) by a friend (90%). Motivations for penile modification included peer pressure and perceived enhanced female sexual pleasure. In prison, the practice was veiled in secrecy, the conditions under which modification was performed were unhygienic, sometimes leading to infection, and sharing equipment was common. Men and women reported that condom use was more difficult post modification as condoms were more likely to break or leak and less likely to fit correctly. In addition, sexual intercourse was often painful for the female partner.Conclusion: Penile modification is prevalent in this group of young methamphetamine users and is associated with behaviours and consequences that could facilitate the spread of HIV and other sexually transmitted infections. [ABSTRACT FROM AUTHOR]