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BackgroundIllicit drug use increases the risk of poor physical and mental health. There are few effective drug prevention interventions.ObjectiveTo assess the acceptability of implementing and trialling two school-based peer-led drug prevention interventions.DesignStage 1 – adapt ASSIST, an effective peer-led smoking prevention intervention to deliver information from the UK national drug education website [see www.talktofrank.com (accessed 29 August 2017)]. Stage 2 – deliver the two interventions, ASSIST + FRANK (+FRANK) and FRANK friends, examine implementation and refine content. Stage 3 – four-arm pilot cluster randomised control trial (cRCT) of +FRANK, FRANK friends, ASSIST and usual practice, including a process evaluation and an economic assessment.SettingFourteen secondary schools (two in stage 2) in South Wales, UK.ParticipantsUK Year 8 students aged 12–13 years at baseline.Interventions+FRANK is a UK informal peer-led smoking prevention intervention provided in Year 8 followed by a drug prevention adjunct provided in Year 9. FRANK friends is a standalone informal peer-led drug prevention intervention provided in Year 9. These interventions are designed to prevent illicit drug use through training influential students to disseminate information on the risks associated with drugs and minimising harms using content from www.talktofrank.com. Training is provided off site and follow-up visits are made in school.OutcomesStage 1 – +FRANK and FRANK friends intervention manuals and resources. Stage 2 – information on the acceptability and fidelity of delivery of the interventions for refining manuals and resources. Stage 3 – (a) acceptability of the interventions according to prespecified criteria; (b) qualitative data from students, staff, parents and intervention teams on implementation and receipt of the interventions; (c) comparison of the interventions; and (d) recruitment and retention rates, completeness of primary, secondary and intermediate outcome measures and estimation of costs.Results+FRANK and FRANK friends were developed with stakeholders [young people, teachers (school management team and other roles), parents, ASSIST trainers, drug agency staff and a public health commissioner] over an 18-month period. In the stage 2 delivery of +FRANK, 12 out of the 14 peer supporters attended the in-person follow-ups but only one completed the electronic follow-ups. In the pilot cRCT, 12 schools were recruited, randomised and retained. The student response rate at the 18-month follow-up was 93% (1460/1567 students). Over 80% of peer supporters invited were trained and reported conversations on drug use and contact with trainers. +FRANK was perceived less positively than FRANK friends. The prevalence of lifetime illicit drug use was 4.1% at baseline and 11.6% at follow-up, with low numbers of missing data for all outcomes. The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met.ConclusionsBoth interventions were acceptable to students, teachers and parents, but FRANK friends was preferred to +FRANK. A limitation of the study was that qualitative data were collected on a self-selecting sample. Future work recommendations include progression to a Phase III effectiveness trial of FRANK friends.Trial registrationCurrent Controlled Trials ISRCTN14415936.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 7. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer). Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK CRC, is gratefully acknowledged.

Background Existing guidance for developing public health interventions does not provide information for researchers about how to work with intervention providers to co-produce and prototype the content and delivery of new interventions prior to evaluation. The ASSIST + Frank study aimed to adapt an existing effective peer-led smoking prevention intervention (ASSIST), integrating new content from the UK drug education resource Talk to Frank (www.talktofrank.com) to co-produce two new school-based peer-led drug prevention interventions. A three-stage framework was tested to adapt and develop intervention content and delivery methods in collaboration with key stakeholders to facilitate implementation. Methods The three stages of the framework were: 1) Evidence review and stakeholder consultation; 2) Co-production; 3) Prototyping. During stage 1, six focus groups, 12 consultations, five interviews, and nine observations of intervention delivery were conducted with key stakeholders (e.g. Public Health Wales [PHW] ASSIST delivery team, teachers, school students, health professionals). During stage 2, an intervention development group consisting of members of the research team and the PHW ASSIST delivery team was established to adapt existing, and co-produce new, intervention activities. In stage 3, intervention training and content were iteratively prototyped using process data on fidelity and acceptability to key stakeholders. Stages 2 and 3 took the form of an action-research process involving a series of face-to-face meetings, email exchanges, observations, and training sessions. Results Utilising the three-stage framework, we co-produced and tested intervention content and delivery methods for the two interventions over a period of 18 months involving external partners. New and adapted intervention activities, as well as refinements in content, the format of delivery, timing and sequencing of activities, and training manuals resulted from this process. The involvement of intervention delivery staff, participants and teachers shaped the content and format of the interventions, as well as supporting rapid prototyping in context at the final stage. Conclusions This three-stage framework extends current guidance on intervention development by providing step-by-step instructions for co-producing and prototyping an intervention’s content and delivery processes prior to piloting and formal evaluation. This framework enhances existing guidance and could be transferred to co-produce and prototype other public health interventions. Trial registration ISRCTN14415936, registered retrospectively on 05 November 2014. Electronic supplementary material The online version of this article (10.1186/s12889-017-4695-8) contains supplementary material, which is available to authorized users.

The current study aimed to determine whether cocaine use compromises treatment outcomes for opiate users. Data were collected from 404 opiate users at treatment intake and 1-year follow-up as part of a national treatment outcome study. Because of higher intake measures, cocaine users improved in more outcomes than nonusers, but comparisons between groups found that cocaine users had more coexisting problems. Regression analysis revealed that those who used cocaine at intake were more likely to use cocaine at 1-year follow-up, to commit crime, and to be homeless. It is concluded that treatment for opiate use "works" even in the presence of concurrent cocaine use.

At present, air traffic controllers (ATCOs) exercise strict control over routeing authority for aircraft movement in airspace. The onset of a free flight environment, however, may well result in a dramatic change to airspace jurisdictions, with aircraft movements for the large part being governed by aircrew, not ATCOs. The present study examined the impact of such changes on spatial memory for recent and non-recent locations of aircraft represented on a visual display. The experiment contrasted present conditions, in which permission for manoeuvres is granted by ATCOs, with potential free flight conditions, in which aircrew undertake deviations without explicit approval from ATCOs. Results indicated that the ATCO role adopted by participants impacted differently on short-term and long-term spatial representations of aircraft manoeuvres. Although informing participants of impending deviations has beneficial effects on spatial representations in the short term, long-term representations of spatial events are affected deleteriously by the presentation of subsequent information pertaining to other aircraft. This study suggests strongly that recognition of the perceptual and cognitive consequences of changing to a free flight environment is crucial if air safety is not to be jeopardised.

Introduction: There is limited data informing the use of physical assessment tools, including MMT, during post critical care rehabilitation, in particular, in DTW patients. Aim: To investigate if there is a change in Medical Research Council Sum Score (MRC-SS) in DTW patients enrolled in a specialist weaning and rehabilitation programme. Method: This was a prospective observational cohort study of DTW patients, with rehabilitation potential admitted to a specialist weaning and rehabilitation unit. The MRC-SS was measured on admission, weekly and at discharge by physiotherapists as part of routine care. Patients were categorised as chronic respiratory conditions (CRC), degenerative neuromuscular conditions (DNC) or other diagnoses. Descriptive data is presented as mean (SD); paired T-Tests were used. Results: Thirty-seven patients were included (19 male), age 65 (13) years With CRC (n=12), DNC (n=12) and other diagnoses (n=13). Whole group MRC-SS scores at discharge were higher than on admission, 43(14) and 39(14), respectively. The mean difference between admission and discharge was 4(7); (p=0.00025). Mean difference in MRC-SS between admission and discharge for those categorised as CRC, DNC and other were 8(10); (p=0.009), 2(4); (p=0.045) and 3(5); (p=0.015), respectively. Conclusions: MMT, using MRC-SS, demonstrated change in DTW patients and may be a clinically useful physical assessment tool for this patient group. CRC patients were observed to have the greatest improvement. Work is ongoing to establish the relationship between the change in MRC-SS and functional outcome to assess the clinical utility of this measurement in DTW patients.

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Background Illicit drug use increases the risk of poor physical and mental health. Few effective school-based drug prevention interventions are available. We adapted an effective school-based peer-led smoking prevention intervention (ASSIST) to deliver information from the UK national drug education website, FRANK Methods We conducted a four-arm pilot cluster-randomised control trial of 1567 students aged 12–13 years in 12 schools in Wales. Three schools each (mean number students per year 131) were randomly allocated to: ASSIST+FRANK, FRANK friends, ASSIST, or usual practice which may or may not include drug eduation. ASSIST+FRANK is a peer-led smoking prevention intervention in UK Year 8 (ASSIST) followed by a drug prevention adjunct in Year 9 (+FRANK). FRANK friends is a stand-alone peer-led drug prevention intervention in Year 9. ASSIST involves 2 days off-site training, plus four follow-up sessions. +FRANK involves 1 day off-site training plus 3 follow-ups. FRANK friends involves 2 days off-site training and four follow-ups. Influential students were trained to disseminate information on the risks of drug use and minimising harms. Primary outcome was the acceptability of the +FRANK and FRANK friends, which was assessed through interviews with students, staff, parents, and intervention staff (n=66), structured observations of delivery (195), exploratory effectiveness analysis (multilevel logistic models), and estimated costs. Secondary outcome was the lifetime use of any illicit drugs at 18 months. Intention-to-treat analyses were conducted unmasked to the intervention allocation. This trial was approved by Cardiff University School of Social Sciences Research Ethics Committee (SREC/ 1103; ISRCTN 14415936). Findings All 12 schools were recruited, randomised, and retained (ASSIST+FRANK 419 students, FRANK friends 440, ASSIST 347, usual practice 361). At the 18 month follow-up the student retention rate was 93% (1460/1567). +FRANK and FRANK friends were acceptable to students, teachers, and parents, and delivered as intended, but FRANK friends was preferred over +FRANK. Some staff felt pressured to meet all the learning objectives for +FRANK in 1 day training versus 2 days in FRANK friends. There could also have been a lack of novelty for +FRANK peer supporters since they had previously experienced the ASSIST intervention. The odds of lifetime drug use at 18 months was marginally lower in both the +FRANK arm and the FRANK friends arm than in the usual practice arm (38 [12·4%] of 307 vs 34 [13·4%] of 254 [odds ratio 0·96, 95% CI 0·58–1·59] and 30 [9·3%] vs 34 [13·4%] [0·70, 0·39–1·24], respectively). The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met. Interpretation Although both interventions were acceptable to students, teachers, and parents, FRANK friends was preferred over +FRANK. There is, therefore, sufficient evidence to warrant a full-scale cluster-randomised controlled trial of FRANK friends. Funding National Institute for Health Research Public Health Research programme (for the research), Public Health Wales (for the intervention delivery).

Objectives: This study explores the gender difference in patterns of drug use, risk behaviour, health and well-being among 934 new attenders at a Dublin syringe exchange.Method: Over the period May 1997 to April 1998 data was collected by means of structured interviews with all clients who presented for the first time at Merchant's Quay health promotion unit. All information collected was based on clients' self-reported behaviour.Results: Of the new clients, 24.3% were female and 75.7% were male. The female clients were significantly younger than their male counterparts (p < 0.0001). The women were significantly more likely to report having a sexual partner who was an injecting drug user (OR 9.04, 95% CI, 5.9-13.9) and to be living with an injecting drug user (OR 1.69, 95% CI, 1.2-2.3). They were also significantly more likely to share injecting equipment with their sexual partner (OR = 3.83, 95% CI, 2.7-5.5) and to report recently sharing injecting paraphernalia (OR = 1.79, 95% CI, 1.3-2.5). However, the interval between initiating intravenous drug use and first presenting at the Merchant's Quay health promotion unit was significantly shorter for female clients (p < 0.0001).Conclusions: One of the most important concerns with regard to illicit intravenous drug use is that of needle sharing, and the associated risks of infection with human immunodeficiency virus and hepatitis. This study highlights the greater personal involvement of women with other drug users, and its consequences in terms of healthrelated problems and risk behaviour. There is a need to address this issue, by taking advantage of the fact that women present for treatment at a younger age than their male counterparts and at a much earlier stage in their injecting career.

© 2012 Whitaker et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. What I Knew was What I Learnt on the Street! Irish Drug Using Sex Workers Accounts of How They Contracted HIV and Hepatitis C

Aims: We sought to examine the fall in age of first drinking in Ireland and to determine whether there were gender differences. We also aimed to determine whether there was a relationship between the per capita alcohol consumption evident when people entered later adolescence and their age of drinking onset. Methods: Information on age of first drinking was based on retrospective recall of 9832 interviewees from the pooled samples obtained from two population surveys. We examined the change in age of first drinking, by birth cohort and by gender, utilizing survival analysis. We utilized Pearson's correlation to explore the relationship between median age of first drinking within each birth cohort and the mean per capita alcohol consumption when that birth cohort was aged 16 years. Results: The average age of first drinking fell steadily and significantly across birth cohorts from the late 1930s to the early 1990s. This change was significantly greater in females. Per capita alcohol consumption was very highly negatively correlated with the median age at which each birth cohort commenced drinking ( r = −0.96, P

Findings from 35 qualitative interviews with drug users who were engaging in or who had engaged in sex work in Dublin, Ireland, illuminated how, because of a result of felt stigma and internalized shame, they tried to hide their drug use, thus endangering their own lives. This group carried multiple layers of stigma because of sex work, drug use (including injecting drug use), and having contracted human immunodeficiency virus (HIV) or hepatitis C virus (HCV). This stigma was powerfully reinforced by the language routinely used by health professionals. To improve the effectiveness of harm-reduction interventions, it is recommended that service providers change their language, in particular in recognition of the human dignity of these clients, but also to help attract and retain drug users in services, and to help reduce the unacceptable mortality levels among drug users.

How methadone setting, duration of drug career, and dose impact on treatment are assessed. Two hundred fifteen participants were recruited. Analysis revealed significant reductions in drug use at 1 year within all settings, but the pattern varied. Proportions using heroin reduced in all settings, unprescribed benzodiazepines reduced in community, and general practitioner settings and cocaine use reduced in community and Government health board settings. A logistic model controlling for intake methadone dose, setting, previous treatments, and intake heroin use revealed that setting was a significant factor in predicting heroin use at 1 year but was not significant in predicting changes in health. Findings illustrate that drug outcomes improved across all settings, and health did not improve in any setting. For optimum outcomes to be achieved, opiate users must be directed to settings that best match their needs and that the "one-stop-shop for methadone" is not the most effective solution.

The complex systems of the flightdeck (FD) and the Air Traffic Control Centre (ATC) are characterised by numerous concurrently operating and interacting communication channels between people and between people and machines/computer systems. This paper describes work in support of investigating the impact of changes to technologies and responsibilities within this system with respect to human factors. It focuses primarily on the introduction of datalink (text-based communication rather than traditional radio communication) and the move towards freeflight (pilot-mediated air traffic control). Air traffic management investigations have outlined these specific changes as strategies to enable further increases in the volume of air traffic. A systems approach was taken and field studies were conducted. Small numbers of domain experts such as air traffic controllers (ATCOs) were involved in the field-based observations of how people interact with systems and each other. This paper summarises the overall research approach taken and then specifically reports on the field-based observations including the justification, development, and findings of the observation tool used. The observation tool examined information propagation through the air traffic control-flightdeck (ATC-FD) system, and resulted in models of possible information trajectories through the system.

The challenge to anticipate the human factors impact of introducing new technologies into a safety critical environment can be addressed in a number of ways. This paper presents a research programme that utilised both laboratory- and field-based assessments to examine the way in which datalink and freeflight may affect the communication and collaboration between pilots, air traffic controllers, and other actors and artefacts in the flightdeck-air traffic control (ATC) joint cognitive system. An overview of the results from these studies is presented, and guidance is provided as to the likely situations in which this new technology is most likely to be successfully applied. In addition, the methodological approach of combining results from field and laboratory data is discussed.

This paper examines issues underpinning the potential move in aviation away from real speech radiotelephony (R/T) communications towards datalink communications involving text and synthetic speech communications. Using a novel air traffic control (ATC) task, two experiments are reported. Experiment 1 compared the use of speech and text while Experiment 2 compared the use of real and synthetic speech communications. Results indicated that generally there were no significant differences between speech and text communications and that either type could be used without any main effects on performance. However, a number of specific differences were observed across the different phases of the scenarios indicating that workload levels may be more varied when speech communications are used. Experiment 2 illustrated that participants placed a greater level of trust in real speech than synthetic speech, and trusted true communications more than false communications (regardless of whether they were real or synthetic voices). The findings are considered in terms of datalink initiatives for future air traffic management, the importance placed on real speech R/T communications, and the need to develop more natural synthetic speech in this application area.

This study compares the injecting and sexual risk-behaviour of young injectors, with injectors over the age of 25. All respondents presented for the first time at the Merchants' Quay Health Promotion Unit between May 1st 1997 and February 28th 1998. Analysis revealed that the young injectors were significantly more likely to report recently borrowing and lending used injecting equipment, and injecting paraphernalia. Regarding sexual risk behaviour, younger respondents were proportionately more likely to report being sexually active, having multiple sexual partners, and having a regular partner who is an injecting drug user. However, they were significantly more likely than older clients to report condom use. The suggestion is that the harm minimisation message, which reached its zenith in the early 1990s, has now been somewhat de-emphasised in both policy and practice. Consequently, it is not reaching the young injectors who have recently initiated intravenous drug use. Additional strategies are needed this group of drug users, in order to promote positive behaviour changes.