Search

Community activism can be important in shaping public health policies. For example, political pressure and direct action from grassroots activists have been central to the formation of syringe exchange programs (SEPs) in the United States. We explored why SEPs are present in some localities but not others, hypothesizing that programs are unevenly distributed across geographic areas as a result of political, socioeconomic, and organizational characteristics of Iocalities, including needs, resources, and local opposition. We examined the effects of these factors on whether SEPs were present in different US metropolitan statistical areas in 2000. Predictors of the presence of an SEP included percentage of the population with a college education, the existence of local AIDS Coalition to Unleash Power (ACT UP) chapters, and the percentage of men who have sex with men in the population. Need was not a predictor. doi:l 0.2105/AJPH.2005.065961

We investigated the relationship between the drug use norms of young adults' peers (recalled from age 15) and subject's drug use in the past 12 months. Subjects included two samples of 18-24 year olds from a low income, minority neighborhood in New York City: A probabilistically selected household sample, and a targeted sample of users of cocaine, heroin, crack or injected drugs. Norms varied by drug, and were least negative for marijuana, and increasingly negative for cocaine, heroin, crack, and injected drugs. We found a strong relationship between recalled norms and current use both for individual drugs and for a hierarchically defined level of drug use; this relationship remained significant after controlling for sociodemographics and parental and sibling drug use. Intervention programs for young teens that influence peer selection and norms of groups of adolescents should be developed and tested. Research is needed on the social, economic, political, and other determinants of norms in their neighborhood contexts.

New entrants to methadone maintenance treatment programs (MMTP) have been reported to have different drug use patterns than readmissions. This study assesses differences between 211 re-admissions and 128 new admissions to a NYC MMTP. Those new to MMTP were found to be less likely to have ever injected drugs, have used more types of drugs, and used heroin at higher frequencies in the 30 days prior to admission. Within the first three months of treatment, new admissions dropped out at a higher rate than the re-admissions (31% vs.20%, p [is less than] 0.05). The most frequent reasons for dropout, for both groups, included 'lost to contact' and incarceration. Further research on strategies to address polydrug use of MMTP admissions is needed. Efforts to identify concerns of new admissions early in treatment, and programs to continue drug treatment services to incarcerated clients, are indicated. [C] 2001 Elsevier Science Inc. All rights reserved. Keywords: Methadone; Drug abuse treatment; Heroin addiction

Aims: To describe, illustrate, and assess the reliability and construct validity of a method for assessing peer norms regarding drug use and selling. Design and participants: Face-to-face interviews of young adults (age 18-24) selected through multi-stage probability sampling in a low-income, high drug use, urban environment. Measurements: Subjects reported what proportion of their close friends actually encouraged them to use specific drugs, or would have objected to such use, currently and at age 15. Findings: Self-reports of peer norms are highly reliable, and have considerable construct validity in predicting drug behaviors. There is little encouragement of drug use, and substantial objection to use of drugs other than marijuana. While few subjects had many friends who encouraged them to sell drugs, about a third of the subjects said few if any of their friends would object to their selling drugs. Objection to drug use is more common, and encouragement of drug use less common, among women's peers than among men's peers. Conclusions: These items can be used to reliably and validly assess young adults' peer norms regarding drug use. Men and women report different peer norms. [ABSTRACT FROM AUTHOR]

People in high-risk neighbourhoods try to protect their friends, neighbours, relatives and others from the social and physical risks associated with sex and drug use. This paper develops and validates a community-grounded questionnaire to measure such 'intravention' (health-directed efforts to protect others). An initial ethnography, including life-history interviews and focus groups, explored the forms of intravention activities engaged in by residents of Bushwick (a high-risk New York City neighbourhood). Grassroots categories of intraventions were derived and questions developed to ask about such behaviours. Face validity and adequacy of the questions were assessed by independent experts. Pre-testing was conducted, and reliability and validity were assessed. An instrument including 110 intravention items was administered to 57 community-recruited residents. Analysis focused on 57 items in 11 domain-specific subscale. All subscales had good to very good reliability; Cronbach's alpha ranged from .81 to .95. The subscales evidenced both convergent and discriminant validity. Although further testing of this instrument on additional populations is clearly warranted, this intravention instrument seems valid and reliable. It can be used by researchers in comparative and longitudinal studies of the causes, prevalence and affects of different intravention activities in communities. It can benefit public health practitioners by helping them understand the environments in which they are intervening and by helping them find ways to cooperate with local neighbourhood-level health activists.

Some, but not all, "big events" such as wars, revolutions, socioeconomic transitions, economic collapses, and ecological disasters in recent years seem to lead to large-scale HIV outbreaks (Friedman et al, in press; Hankins et al 2002). This was true of transitions in the USSR, South Africa and Indonesia, for example, but not those in the Philippines or (so far) in Argentina. It has been hypothesized that whether or not HIV outbreaks occur is shaped in part by the nature and extent of changes in the numbers of voluntary or involuntary risk-takers, which itself may be related to the growth of roles such as sex-sellers or drug sellers; the riskiness of the behaviors engaged in by risk-takers; and changes in sexual and injection networks and other "mixing patterns" variables. Each of these potential causal processes, in turn, is shaped by the nature of pre-existing social networks and the patterns and content of normative regulation and communication that happen within these social networks-and on how these social networks and their characteristics are changed by the "big event" in question. We will present ideas about what research is needed to help understand these events and to help guide both indigenous community-based efforts to prevent HIV outbreaks and also to guide those who organize external intervention efforts and aid.