RESUMEN
Since 1981, Alaskans have had the ability to enact by referendum local restrictions in alcohol sales, importation, and possession, known as "local options." Intended to empower rural communities to reduce alcohol abuse and associated violence and trauma, the "local option" laws have led to unintended consequences as individuals in alcohol-restricted communities seek intoxication from both legal and illegal sources of alcohol. Based on 68 interviews with 72 community members in eight rural sites in Alaska, this article examines these unintended consequences of local options restrictions and provides context to the challenges rural communities face in implementing alcohol policies.
Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Bebidas Alcohólicas , Alcoholismo/etnología , Alcoholismo/prevención & control , Población Rural , Adulto , Alaska/etnología , Femenino , Humanos , Masculino , Investigación CualitativaRESUMEN
BACKGROUND: Abuse of harmful legal products that can be inhaled or ingested is a serious and growing problem in many rural Alaskan communities, and particularly so among preteens. METHODS: This study analyses data collected during baseline measurements of a 5-year NIH/NIDA-funded study entitled A Community Trial to Prevent Youth's Abuse of Harmful Legal Products in Alaska. Youth in 8 communities located throughout the state participated in a survey during the fall of 2009 to measure the prevalence and availability of harmful legal products (n=697). The goal of the analysis presented here is to compare the contextual factors of inhalant users and non-users in rural Alaskan communities. RESULTS: As reported in national surveys of substance use among youth, participants in this study indicated using alcohol more than any other substance. Inhalants were the second-most common substance abused, higher than either cigarettes or marijuana. Lifetime use varied among demographic factors such as age, gender and ethnicity as well as contextual factors including academic performance, parent employment, household living situation and income. When compared to non-users, significantly larger proportions of participants reporting lifetime inhalant use indicated easy availability of inhalants in their home, school and retail outlets. Users were also significantly more likely than non-users to have consumed alcohol. CONCLUSION: Results of this study may inform the development of effective interventions in other rural communities.
Asunto(s)
Abuso de Inhalantes/epidemiología , Población Rural/estadística & datos numéricos , Adolescente , Alaska/epidemiología , Niño , Estudios Transversales , Demografía , Femenino , Humanos , MasculinoRESUMEN
This study assesses the implementation quality of Think Smart, a school-based drug prevention curriculum that was designed to reduce use of harmful legal products (HLPs; e.g., inhalants and over-the-counter drugs), alcohol, tobacco, and other drugs among 5th- and 6th-grade students in frontier Alaska. Participating in the study were eight communities that took part in a larger randomized control trial to assess the short-term effects of the Think Smart curriculum. Video-recorded observations of the 12 core and 3 booster lessons were conducted in 20 classrooms. Ninety-five sessions were randomly selected from 228 usable videodiscs, and two pairs of researchers observed each video recording to code level of dosage, adherence to curriculum design, and teachers' delivery skills. Inter-rater reliability for all implementation quality measures was very high. An expert panel consisting of 16 scientists reviewed the results of the implementation study and concluded that the level of dosage and adherence to the curriculum design was at least as high as those yielded by similar studies. However, the panel assessed the delivery quality to be only marginal in comparison to results of other studies. The experts concluded that the implementation quality of the Think Smart curriculum was adequate even though the teachers' delivery skills were only marginal. A bootstrapping analysis, in which 1,000 samples were drawn for each implementation quality result, found the expert judgments to be reliable. The authors conclude that despite some limitations, video-recorded observations, as well as expert judgment, provide strong methodologies that should be considered for future implementation quality studies.
Asunto(s)
Curriculum , Servicios Preventivos de Salud/organización & administración , Población Rural , Instituciones Académicas , Trastornos Relacionados con Sustancias/prevención & control , Alaska , Niño , Humanos , Servicios Preventivos de Salud/normas , Evaluación de Programas y Proyectos de SaludRESUMEN
PURPOSE: Preliminary results are presented from a feasibility study of a comprehensive community prevention intervention to reduce the use of inhalants and other harmful legal products (HLPs) among adolescents in three Alaskan frontier communities conducted in 2004-2007. The legal products used to get high include over-the-counter drugs, prescription drugs, and common household products. Community mobilization, environmental and school-based strategies were implemented to reduce access, enhance knowledge of risks, and improve assertiveness and refusal skills. METHODS: Pre- and post-intervention survey data were collected from 5-7th grade students from schools in three communities using standardized instruments to assess knowledge, assertiveness, refusal skills, perceived availability, and intent to use. The intervention consisted of community mobilization and environmental strategies to reduce access to HLPs in the home, at school, and through retail establishments. In addition, the ThinkSmart curriculum was implemented in classrooms among 5th grade students to increase the knowledge of harmful effects of HLPs and improve the refusal skills. Data were analyzed using hierarchical linear models that enable corrections for correlated measurement error. RESULTS: Significant increases in knowledge of harms related to HLP use and decreases in perceived availability of HLP products were observed. The environmental strategies were particularly effective in reducing the perceived availability of HLPs among 6th and 7th graders. DISCUSSION: Although limited by the absence of randomized control groups in this preliminary study design, the results of this study provide encouragement to pursue mixed strategies for the reduction of HLP use among young people in Alaskan frontier communities.
Asunto(s)
Conducta del Adolescente , Servicios de Salud Comunitaria/métodos , Reducción del Daño , Servicios Preventivos de Salud/métodos , Trastornos Relacionados con Sustancias/prevención & control , Administración por Inhalación , Adolescente , Estudios de Factibilidad , Femenino , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Productos Domésticos/efectos adversos , Humanos , Masculino , Modelos Psicológicos , Medicamentos sin Prescripción/administración & dosificación , Medicamentos sin Prescripción/efectos adversos , Medicamentos bajo Prescripción/administración & dosificación , Asunción de Riesgos , Servicios de Salud Escolar , AutoadministraciónRESUMEN
This study tests for the efficacy of a school-based drug prevention curriculum (Think Smart) that was designed to reduce use of Harmful Legal Products (HLPs, such as inhalants and over-the-counter drugs), alcohol, tobacco, and other drugs among fifth- and sixth-grade students in frontier Alaska. The curriculum consisted of 12 core sessions and 3 booster sessions administered 2 to 3 months later, and was an adaptation of the Schinke life skills training curriculum for Native Americans. Fourteen communities, which represented a mixture of Caucasian and Alaska Native populations in various regions of the state, were randomly assigned to intervention or control conditions. Single items measuring 30-day substance use and multi-item scales measuring the mediators under study were taken from prior studies. Scales for the mediators demonstrated satisfactory construct validity and internal reliability. A pre-intervention survey was administered in classrooms in each school in the fall semester of the fifth and sixth grades prior to implementing the Think Smart curriculum, and again in the spring semester immediately following the booster session. A follow-up survey was administered 6 months later in the fall semester of the sixth and seventh grades. A multi-level analysis found that the Think Smart curriculum produced a decrease (medium size effect) in the proportion of students who used HLPs over a 30-day period at the 6 month follow-up assessment. There were no effects on other drug use. Further, the direct effect of HLPs use was not mediated by the measured risk and protective factors that have been promoted in the prevention field. Alternative explanations and implications of these results are discussed.
Asunto(s)
Administración por Inhalación , Curriculum , Instituciones Académicas , Trastornos Relacionados con Sustancias/prevención & control , Alaska , Niño , Recolección de Datos , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de SaludRESUMEN
This article reports results from a feasibility study of a community effort to reduce the availability of legal products that youth can use to get high. The study evaluated the potential of youth purchase attempts to detect actual changes in retail availability of harmful legal products. These results were triangulated with self-reports from retailers about their own policies and practices. Before the intervention, less than half of retailers reported using any of six possible strategies identified as ways to reduce youth access to harmful products, and less than 8% of baseline youth attempts to purchase potentially harmful legal products were refused or questioned. After the low-dosage intervention, retailers reported increased use of three strategies and a statistically significant increase in the percentage of purchase attempts that were either questioned or refused by retail clerks. These findings (a) demonstrate the potential feasibility of retailer-focused environmental strategies and (b) support continued use of youth purchase attempts as a measure of actual retailer behavior.
Asunto(s)
Conducta del Adolescente , Comercio/legislación & jurisprudencia , Política de Salud , Promoción de la Salud , Prevención del Hábito de Fumar , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Factores de Edad , Niño , Recolección de Datos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Asunción de Riesgos , Fumar/legislación & jurisprudenciaRESUMEN
This paper presents results from an application of the Community Readiness Model (CRM) as part of a multi-stage community mobilization strategy to engage community leaders, retailers, parents, and school personnel in preventing youth use of inhalants and other harmful legal products in rural Alaska. The CRM is designed to assess readiness to address a single social problem, based on a limited set of key informant interviews. In this study, researchers conducted 32 baseline and 34 post-intervention community readiness assessment interviews in four rural Alaskan communities. These interviews with key informants from the communities were coded and analyzed using CRM methods to yield readiness scores for each community. The aggregate results were analyzed using hierarchical linear modeling (HLM), and the individual community scores were analyzed in the context of the overall study. Significant positive changes in community readiness were found across six readiness dimensions as well as for the overall readiness score. Variation in the degree of changes in readiness across the four communities is attributed to differences in the intervention's implementation. The implications of these results include the potential for CRM assessments to serve as an integral component of a community mobilization strategy and also to offer meaningful feedback to communities participating in prevention research.
Asunto(s)
Concienciación , Servicios de Salud Comunitaria/organización & administración , Redes Comunitarias/organización & administración , Trastornos Relacionados con Sustancias/prevención & control , Administración por Inhalación , Adolescente , Conducta del Adolescente , Aerosoles , Alaska , Participación de la Comunidad/métodos , Promoción de la Salud/organización & administración , HumanosRESUMEN
Youth use of harmful legal products, including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a growing health problem for American society. As such, a single targeted approach to preventing such a drug problem in a community is unlikely to be sufficient to reduce use and abuse at the youth population level. Therefore, the primary focus of this article is on an innovative, comprehensive, community-based prevention intervention. The intervention described here is based upon prior research that has a potential of preventing youth use of alcohol and other legal products. It builds upon three evidence-based prevention interventions from the substance abuse field: community mobilization, environmental strategies, and school-based prevention education intervention. The results of a feasibility project are presented and the description of a planned efficacy trial is discussed.
Asunto(s)
Conducta del Adolescente , Redes Comunitarias/organización & administración , Promoción de la Salud/organización & administración , Inhalación , Trastornos Relacionados con Sustancias/prevención & control , Adolescente , Ambiente , Humanos , Servicios de Salud Escolar/organización & administraciónRESUMEN
Communities across the nation have become increasingly concerned about inhalant use and use of harmful legal products among youth because of increasing prevalence rates and deleterious health consequences from abusing these products. The increasing concern of communities about inhaling and ingesting legal products has been coupled with increasing awareness and concern about ability of youth to access and abuse a variety of other legal retail products. There are few examples of scientifically designed community prevention projects that seek to reduce youth abuse of such legal products. This article describes a community prevention trial that is designed to reduce sales of inhalants and other harmful legal products to youth and demonstrates how the retailer component of the trial can be rigorously evaluated. It also shows how data from youth purchase attempts can complement survey data from retailers.
Asunto(s)
Conducta del Adolescente/psicología , Aerosoles/provisión & distribución , Servicios de Salud Comunitaria/organización & administración , Control de Medicamentos y Narcóticos/métodos , Drogas Ilícitas/provisión & distribución , Trastornos Relacionados con Sustancias/prevención & control , Administración por Inhalación , Adolescente , Aerosoles/economía , Factores de Edad , Concienciación , Recolección de Datos , Control de Medicamentos y Narcóticos/economía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Drogas Ilícitas/economía , Masculino , Mercadotecnía , Desarrollo de ProgramaRESUMEN
OBJECTIVES: This study examined pre-adolescent use of harmful but legally obtainable products (HLPs) "in order to get high" in 4 communities in northwest and southeast Alaska. These products include inhalants, over-the-counter medications, prescription medications taken without a doctor's prescription and common household products. STUDY DESIGN: Cross-sectional survey. METHODS: A student survey was administered to the 447 students whose parents consented and who agreed to participate. A descriptive analysis with frequencies, percentages, bivariate associations and appropriate statistical tests produced the study results. RESULTS: The lifetime overall use of HLPs among fifth, sixth and seventh grade students in 4 Alaskan communities was 17.4%. The lifetime use of inhalants (6.8%) and prescription medications taken without a doctor's prescription (8.0%) appear to be comparable to use rates from other studies. The use of over-the-counter medications (5.7%) appears to be slightly higher than in other U.S. surveys. The use of common household products was 6.1%. No significant differences in the lifetime or 30-day use were found correlated to region, gender, ethnicity or student grade. There was a strong association between 30-day or lifetime use of some HLPs and the (30-day or lifetime) use of alcohol, cigarettes and smokeless tobacco. CONCLUSIONS: The use of harmful everyday legal products by fifth, sixth and seventh graders in Alaska appears to be similar to data collected in other parts of the country. The possibility that there may be a link between the use of available legal substances and alcohol, tobacco and marijuana deserves additional attention.