RESUMEN
This paper provides a brief overview of the history of Massachusetts' opposition to smoking. It describes the current Massachusetts Tobacco Control Program and its smoking intervention programmes; changes in public opinion, perceptions and attitudes toward smoking; and programme impact. Massachusetts has been successful in developing a comprehensive intervention that has had encouraging results in changing public attitudes about smoking and in helping smokers to quit.
Asunto(s)
Fumar/epidemiología , Fumar/tendencias , Adolescente , Adulto , Femenino , Humanos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Cese del Hábito de FumarRESUMEN
BACKGROUND: Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. OBJECTIVES: The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building, and shared leadership. METHODS: The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. RESULTS: The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. CONCLUSION: Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts.
Asunto(s)
Promoción de la Salud , Servicios de Salud Mental/organización & administración , Nicotiana , Plantas Tóxicas , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Humanos , Massachusetts , Fumar/economía , ImpuestosRESUMEN
BACKGROUND: This paper examines whether the Massachusetts Tobacco Control Program is affecting the rates of smoking and smokeless tobacco use among Massachusetts' youth. METHODS: School survey data from the Massachusetts Prevalence Study were analyzed to estimate differences between 1993 and 1996 rates of youth cigarette and smokeless tobacco use, attitudes toward smoking, and awareness of cigarette ads and promotions of antismoking messages. RESULTS: Lifetime and Current Smoking rates declined significantly among middle school males, contrasting with stable national trends. Among girls in this age group, Lifetime and Current Smoking did not change significantly. Hispanic middle school students exhibited a significant decline in Lifetime Use. There were no significant changes in Lifetime or Current Smoking rates among high school students. Lifetime use of smokeless tobacco declined among middle school students while Current Use declined among both middle and high school students. Students reported declines in awareness of cigarette ads or promotions and increases in awareness of antismoking messages. CONCLUSIONS: These results provide evidence for cautious optimism regarding the impact of tobacco control, but indicate that these efforts should begin earlier and that additional research is needed to understand and address the problems of tobacco use by girls.
Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/tendencias , Adolescente , Publicidad/tendencias , Actitud , Concienciación , Femenino , Humanos , Masculino , Massachusetts/epidemiología , Prevalencia , Prevención del Hábito de Fumar , Encuestas y CuestionariosRESUMEN
Data from 443,812 admissions to publicly funded detoxification centers in Massachusetts (fiscal year 1984 to fiscal year 1996) were analyzed to assess changes in the population served. Substantial increases in admissions of women, African Americans, and Hispanics were apparent. Mean age at admission declined and unemployment increased. A 25% decline in admissions reporting alcohol use was coupled with a twofold increase in reported cocaine use and a fourfold increase in heroin use. Detoxification services have evolved. The older, white, male alcoholic is no longer the primary consumer. Policy initiatives (e.g., increased services for women) and the changing epidemiology of drugs abuse (e.g., increased access to heroin) contributed to the changing population served in detoxification centers.
Asunto(s)
Alcoholismo/economía , Readmisión del Paciente/economía , Centros de Tratamiento de Abuso de Sustancias/economía , Trastornos Relacionados con Sustancias/economía , Adulto , Anciano , Alcoholismo/rehabilitación , Control de Costos , Estudios Transversales , Femenino , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
There is increased interest in documenting the characteristics and treatment outcomes of clients served with Alcohol, Drug Abuse, and Mental Health Block Grant funds. The evolution of federal client-based management systems for substance abuse treatment services demonstrates that data collection systems are important but require continued support. A review of the Massachusetts substance abuse management information system illustrates the utility of a client-based data set. The development and implementation of a comprehensive information system require overcoming organizational barriers and project delays, fostering collaborative efforts among staff from diverse agencies, and employing considerable resources. In addition, the need to develop mechanisms for increasing the reliability of the data and ongoing training for the users is presented. Finally, three applications of the management information system's role in shaping policy are reviewed: developing services for special populations (communities of color, women, and pregnant substance abusers, and injection drug users), utilizing MIS data for evaluation purposes, and determining funding allocations.
Asunto(s)
Redes de Comunicación de Computadores/organización & administración , Sistemas de Información Administrativa , Centros de Tratamiento de Abuso de Sustancias/organización & administración , Trastornos Relacionados con Sustancias/terapia , Redes de Comunicación de Computadores/instrumentación , Control de Costos/métodos , Recolección de Datos/métodos , Control de Formularios y Registros , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interinstitucionales , Massachusetts , Técnicas de Planificación , Administración en Salud Pública , Centros de Tratamiento de Abuso de Sustancias/economía , Trastornos Relacionados con Sustancias/economía , Resultado del Tratamiento , Estados UnidosRESUMEN
A comparison was made between the toxic effects of chronic chlorpromazine, haloperidol or atropine on the guinea pig intestinal tract. Chlorpromazine, administered at a dose of 30 mg/kg/day, IP for 7 days, produced marked pathologic changes in the guinea pig cecum, consisting of inflammation, edema and hemorrhage. None of these effects were noted when haloperidol, 2 or 10 mg/kg/day or atropine 30 mg/kg/day were similarly administered. Similar toxic effects may occur in humans on long-term chlorpromazine or other phenothiazine therapy, thereby accounting for the paralytic ileus observed with these drugs.
Asunto(s)
Atropina/toxicidad , Clorpromazina/toxicidad , Sistema Digestivo/efectos de los fármacos , Haloperidol/toxicidad , Animales , Sistema Digestivo/patología , Femenino , Cobayas , Masculino , Músculo Liso/efectos de los fármacos , Músculo Liso/patología , Plexo Mientérico/efectos de los fármacos , Plexo Mientérico/patologíaRESUMEN
The isolated myenteric plexus-longitudinal muscle preparation from guinea pigs which had previously been administered morphine chronically 100 mg/kg/day, 7 days) shows a pronounced contraction when exposed to naloxone. Exposure of the preparation to indomethacin (6.7 micrograms/ml) for 10 minutes prior to naloxone inhibits this withdrawal response. A single dose of indomethacin, 1 mg/kg, given on the 6th day on morphine, also inhibits the naloxone contraction. These results suggest the involvement of a prostaglandin in the opiate withdrawal response in the ileum.