Territórios urbanos do uso de crack em Belo Horizonte – Minas Gerais, Brasil – Uma análise da “Cracolândia” sob as perspetivas ecológicas do crime

ImportanceIllicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance.ObjectiveTo review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force.Data SourcesMEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020.Study SelectionClinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people.Data Extraction and SynthesisCritical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions.Main Outcomes and MeasuresNumber of times illicit drugs were used; any illicit drug or any cannabis use.ResultsTwenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, −0.08 [95% CI, −0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months’ follow-up. The median absolute risk difference between groups was –2.8%, favoring the intervention group (range, –11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences.Conclusions and RelevanceThe evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.

Over the years, the urban space of Bamenda has experienced a significant surge in crimes in tandem with the prevailing socio-political crisis which has fan the flames for urban disorders and odds. The study aimed to investigate various types of crimes, their spatial distribution, spatial variation/density as well as hotspots in Bamenda urbanscape. The study used questionnaires and key informant interviews to collect quantitative and qualitative data. Spatialisation of urban crime types and manifestation was done in a GIS environment using thematic mapping techniques. Four crime categories/types and their sub-classes were identified; violent crimes (805), property crimes (312), organised crimes (452) and white-collar crimes (76) registered cases as on annual basis, with varying intensities from CBD to the suburbs. Of these recurrent crimes within the urban space, seven neighbourhoods were found to be potential crime hotspots with rising annually recorded crimes. Alongside their annually estimated crimes are; Mobile Nkwen (331), Commercial Avenue (301), Mile 4 Nkwen (213), Ntamulung (237), Rendez-vous (245) Azire New church (196) and Below Foncha (122). The study suggest proper collaboration between the city dwellers and the police for early identification and sourcing of crime scenes through video surveillance and the enforcement of policing within crime hotspot zones as a palliative to curb crimes in Bamenda.

The current study examined demographics, sexual orientation, gender characteristics, and gender minority stress and their association to excessive alcohol, cannabis, and illicit (noncannabis) drug use among 1210 transgender adults living in the United States. The authors conducted a secondary analysis of data that included 680 transgender women (M age=32.63, SD age=12.29) and 530 transgender men (M age=26.14, SD age=7.42). A modified version of the Risk Behavioral Assessment quantified participants' alcohol, cannabis, and illicit drug use in the past 3months. Overall, 21.5% of participants reported excessive alcohol use; no significant differences were found on the rates of excessive alcohol use between transgender women and men. Cannabis use among our sample was 24.4%; trangender men reported significantly higher rates of cannabis use compared to transgender women. Illicit drug (noncannabis) use among our sample was 11.6%; transgender men also reported significantly higher rates of illicit drug use compared to transgender women. Multivariate analyses suggested that gender dysphoria was significantly associated with: excessive alcohol use for transgender women, cannabis use among both transgender women and men, and illicit (noncannabis) drug use among transgender women. A nonheterosexual orientation was associated with increased odds of cannabis use among transgender women and men; a nonheterosexual orientation was associated with greater odds of illicit substance use among transgender men but not among transgender women. Genderminority stressors were independently associated with excessive alcohol use among transgender men and cannabis use among transgender women. The authors suggest that minority stress may only partially account for substance use among transgender people. Consequently, the authors suggest that in addition to minority stress, other biopsychosocial mechanisms should continue to be examined to identify pathways that may lead to the development of effective substance use prevention efforts and treatment programs.

The patterns of prescribed and illicit psychoactive drug use by patients before admission to a child and adolescent outpatient psychiatry clinic were evaluated over a 10-year period. The charts of 328 children initially seen by the clinic in 1970, 1975, and 1980 were reviewed retrospectively. Prescribed psychoactive medications and illicit drugs used before admission to the clinic were examined according to initial year of treatment, age, sex, race, and socioeconomic status. The study population included children and adolescents between the ages of one and eighteen; 65% were males and 87% were white. Over the study period, there was little change in the total percentage of patients using prescribed psychoactive medications (range, 23% to 29%); however, the use of psychostimulants increased and the use of neuroleptic drugs decreased. Illicit drug use was reported by 3% of the patients in 1970, 10% in 1975, and 15% in 1980. Over the study period, illicit drug use involved a wider range of drugs and was reported by patients at earlier ages. Boys had higher use rates of prescribed psychoactive medications than girls; however, girls reported using more illicit drugs than boys. Two percent of the study population reported using a combination of prescribed and illicit psychoactive drugs. Over the 10-year study period, there was little change in prescribed psychoactive drug use; however, illicit drug use increased significantly. Additional studies are needed to see if similar patterns exist in other centers.

Drug use and condomless sex among sexual minority men in relationships: Whether relationship quality is a risk or protective factor depends upon what they believe their partners do

Rapid urban growth is characteristic of many cities in Sub-Saharan Africa. In the midst of such growth, insecurity and crimes represent a major emerging issue in these urban centres where the fear of crime and violence persists. The case of Bamenda, a primate city in Cameroon comes to mind. Uncontrolled urban growth has created breeding grounds for the upsurge of urban crimes which show spatial variations in their nature and distribution. In the context of Bamenda, previous studies have investigated city planning with respect to land use and the environment, land use and wetlands, housing patterns and green space development. These studies fall short of providing scientific information on the nature and spatial variations in urban crime and their implications for urban planning. In this study, we purposively sample 150 respondents drawn from targeted neighbourhoods. Using the correlation analysis at 0.5 level of significance, we established a significant relationship (0.784) between urban crime and city planning and development deficiencies on the one hand, and a significant relationship (0.84) between urban crime and neighbourhood socio-economic characteristics on the other hand. The intensity and distribution of urban crimes show a close link with mishaps in city planning and development. This calls for coordinated efforts to support the revision, upgrading and respect of urban planning regulations to ensure adequate access to neighbourhoods in a bid to stem the prevalence of crime. Such a strategy is necessary to support the global objective (at least from a micro perspective) of making cities and human settlements inclusive, safe, resilient and sustainable in line with Sustainable Development Goal 11.

Introduction: Drug use, including marijuana use, illicit drug use and prescription drug misuse, and mental health comorbidity among young adults are pressing public health concerns. Young adults comprise a significant proportion of the total population of medical marijuana patients (MMP). Little is known about the role of MMP status, medicinal orientation towards marijuana use, other marijuana practices, mental health, life events and contextual factors in the patterns of illicit drug use and prescription drug misuse among young adult MMP and non-patient users (NPU). Methods: The current study utilized a mixed-methods design to investigate the relationships between baseline rates and longitudinal trajectories of illicit drug use/prescription drug misuse and marijuana practices/mental health, and to explore the role of life events/contextual factors in the patterns of illicit drug use and prescription drug misuse in a sample of 210 MMP and 156 NPU aged 18-26 at baseline (n=366), recruited in Los Angeles in 2014-15. A subsample of 40 MMP and 22 NPU was selected for qualitative interviews. Results: Findings from the cross-sectional quantitative analysis indicated an association between use of alternative marijuana forms and illicit drug use/prescription drug misuse, with medicinal orientation towards marijuana use (but not MMP status) being protective against illicit drug use. Neither type of drug use was associated with frequency of marijuana use. Findings from the longitudinal quantitative analysis identified two-trajectory (high vs low) solutions for both types of drug use. High use trajectories were associated with the use of alternative marijuana forms, higher anxiety and depression symptoms, and higher drug use severity scores. Neither trajectory type was associated with MMP status, while medicinal orientation towards marijuana use was negatively associated with high illicit drug use trajectory. Only high prescription drug misuse trajectory was associated with higher frequency of marijuana use. Findings from the qualitative analysis revealed three patterns of illicit and prescription drug use/misuse: regular/problematic, recreational/occasional and never use. The majority of regular/problematic users experienced impactful traumatic events/chronic stressful contextual factors, and almost all of them used marijuana to deal with after-effects of use of other drugs. Some recreational/occasional and few never users experienced impactful traumatic events, and the majority self-medicated with marijuana for emotional pain as aftermath of those events. Family history of substance abuse and acceptance of marijuana use by adult family members for some recreational/occasional and some never users could serve as protective factors from initiation/escalation of other drug use. Conclusion: Medicinal orientation towards marijuana use (but not MMP status) was negatively associated with illicit drug use. Use of alternative marijuana forms (but not frequency of marijuana use) had a strong and consistent association with both illicit drug use and prescription drug misuse. Additionally, both types of drug use were associated with worse mental health outcomes. Finally, life events/contextual factors played an important role in initiation/escalation and reduction/cessation of other drug use among regular/problematic users. Use of marijuana helped to cope with the after effects of other drugs among regular/problematic users, while marijuana was used as a self-medication for emotional pain by those recreational/occasional and never users who experienced impactful traumatic events. Overall, the results from cross-sectional, longitudinal, and qualitative analyses showed no relationship between MMP status and illicit/prescription drug use, while we found a strong and consistent protective effect of medicinal motivations for marijuana use.

Background Although use of illicit drugs shows varying degree of heritability, the influence of shared and unique environmental factors predominate among adolescents. We explored factors predicting use of cannabis and other illicit drugs among Finnish adolescent twins. Methods We used longitudinal data from the FinnTwin12–17 study with baseline at age 11–12 and follow-up at ages 14 and 17½, including 4138 individuals. The outcome was self-reported ever use of cannabis or other illicit drugs at age 17½. The potential predictors were measures reported by the twins, their parents or teachers. As individual factors we tested smoking, alcohol use, behavioral and emotional problems; as peer factors: number of smoking friends and acquaintances with drug experience; as family factors: parental substance use, socio-economic status and pre-natal exposure to nicotine. We used logistic regression models, controlling for twinship, age and sex, to compute odds ratios (OR) for each potential predictor. To adjust for within-family confounds, we conducted conditional logistic regressions among 246 twin pairs discordant for drug use. Results 13.5% of subjects had initiated use of cannabis or other illicit drugs by age of 17½. When adjusted for within-family confounds, smoking, drinking, and aggressiveness, as well as smoking and drug use among peers predicted use of illicit drugs. In the final regression model, the significant predictors were female sex, early smoking onset, drinking to intoxication, having smoking peers and acquaintances with drug experience, father's weekly drinking to intoxication, and aggressive behavior among boys. Smoking initiation by age of 12 was the most powerful predictor among individuals (OR = 26, p < 0.001) and within discordant pairs (OR = 22, p < 0.001). Conclusions Early onset smoking is a powerful predictor for subsequent use of illicit drugs among Finnish adolescents, but the causal nature of this relationship needs to be clarified.

Illicit drug use and harms in Australia in the context of COVID-19 and associated restrictions: Anticipated consequences and initial responses.

Illicit substance use has increased in Hispanics. Recent trends also warrant focus on prescription drug misuse, given its increased prevalence among college students. The aims of this study were to assess prescription drug misuse and illicit drug use in Hispanic students, as well as potential theoretically and empirically based risk and protective factors. Hispanic students (n = 435; 59% female) from a U.S. university located on the border with México completed a sociodemographic survey, licit, illicit, and prescription drug use frequency questionnaires, an attitudes and beliefs about prescription drugs survey, the Short Acculturation Scale for Hispanics, the Depression, Anxiety, and Stress Scales, the Collectivist Coping Styles Measure, and the Multidimensional Scale of Perceived Social Support. A hierarchical logistic regression assessed prescription drug misuse predictors including demographics, licit/illicit substance use, attitudes toward prescription drug use, acculturation, distress symptoms, coping style, perceived social support, and the interaction between distress symptoms and acculturation. A negative binomial regression assessed predictors of past 30-day illegal drug use (the same predictors as the previous model except illicit drug use). Results indicated that positive attitudes toward prescription drugs, higher anxiety, and lower depressive symptomatology increased the odds of prescription drug misuse. Past 30-day alcohol use, positive attitudes toward prescription drugs, and higher acculturation predicted past 30-day illicit drug use. Prescription drug misuse was differentially associated with distress symptoms, whereas the convergence model of acculturation was supported regarding illegal drug use. Inconsistent with hypotheses, protective factors were not significantly associated with substance use.

Use of alcohol and illicit drugs is a common finding among HIV-infected individuals, but there are many open questions about its impact on adherence to antiretroviral therapy and virological outcomes. Our study aimed to evaluate the impact of the use of alcohol and illicit drugs on the adherence to antiretroviral therapy (ART) among patients starting ART in Salvador, Brazil. We followed up 144 AIDS patients initiating ART for a 6-month period. At baseline, they were interviewed about demographics, behavior, and use of illicit drugs and alcohol. All of them had HIV-1 RNA plasma viral load and CD4(+)/CD8(+) cells count measured before starting therapy. After 60 days of treatment they were asked to answer a new questionnaire on adherence to ART. All patients were monitored during the following months, and new CD4(+) cell count/HIV-1 RNA plasma viral load determinations were performed after 6 months of therapy. Optimal adherence to therapy was defined by self-reported questionnaire, by 95% use of prescribed drug doses, and by using plasma HIV-1 RNA viral load as a biological marker. A total of 61 (42.4%) patients reported alcohol use, 7 (4.9%) used illicit drugs, and 17 (11.8%) used both alcohol and illicit drugs. Being in a steady relationship was protective to nonadherence (95% CI: 0.18-0.84). Missing more than two medical visits was also associated with a 68% higher likelihood of nonadherence (95% CI: 0.10-1.02). After logistic regression we detected a higher risk of nonadherence for patients declaring use of alcohol plus illicit drugs (odds ratio=6.0; 95% CI: 1.78-20.28) or high-intensity use of alcohol (odds ratio=3.29; 95% CI: 1.83-5.92). AIDS patients using alcohol and/or illicit drugs are socially vulnerable, and need specific and flexible programs, combining mental health care, harm reduction strategies, and assisted drug therapy to maximize the chances of successful use of ART.

Background : Illicit substance use is common at music festivals. One could question whether festival attendees deliberately plan to take drugs at such events or whether their illicit (poly)drug use is provoked by specific circumstances, such as the presence of peers or a general belief that others are using drugs at the festival. Objectives : The present study implemented the prototype willingness model, which is a model that assesses whether illicit drug use at music festivals is rather a rational or a more spontaneous decision-making process. Results : A three-wave panel survey was conducted, questioning festival attendees before (n = 304, 60.86% males), during, and after music festival visits. In total, 186 people (59.68% males) between 18 and 55 years (M = 27.80 years; SD = 8.19) completed all three surveys, of which 62.9% had taken one or more different illicit substances at the festival. Positive attitudes toward illicit drug consumption were most firmly related to attendees’ intentions to take drugs at festivals. Additionally, the more festival visitors identified themselves with the prototype of an attendee using drugs, the more likely they were to be willing to use them. The perceived presence of illicit substances at such events was also strongly related to the actual behavior. Conclusion : The findings suggest that illicit drug use at music festivals relates to both a rational choice and an unplanned one.

Traditionally, the prevalence of illicit and problematic drug use in the elderly was thought to be very low (Abrams and Alexopoulos, 1988; Rosenberg, 1995; Crome and Day, 1999; Simoni-Wastila and Yang, 2006). Indeed, in the most recent British Crime Survey respondents over the age of 59 years were not asked about illicit drug use because previous surveys indicated that less than 1% of those aged 60 years and over had taken illicit drugs in their lifetime (personal communication, Home Office Direct Communications Unit, 2007). The vast majority of epidemiological studies of illicit drug use and problematic use in the elderly are from the U.S.A., although studies from other countries are emerging. These epidemiological studies have either been population-based or of convenience samples.

Substance use disorders during pregnancy are a concern both to the public and medical community, because the negative consequences can be detrimental to both mother and the fetus. The accurate identification of prenatal drug exposure is necessary to determine appropriate medical and psychosocial intervention, and to identify risk factors that may affect outcomes for the mother and her newborn. The prevalence of prenatal drug exposure is very difficult to estimate because of flaws in all methods of identification. The study is designed to identify risk factors and demographic variables that contribute to nondisclosure of illicit and nonillicit substance use. In addition, this study aims to determine if nondisclosure leads to adverse neonatal outcomes. Newborns delivered with a positive meconium or urine toxicology, and/or known maternal exposure to illicit and nonillicit substances, were identified. Maternal records were reviewed for disclosure of substance use during pregnancy at admission for delivery along with other medical and demographic variables. Women with antenatal prescription drug use that may alter toxicology screens were excluded from analysis. Pediatric records were also reviewed to obtain neonatal variables. One hundred sixty-eight newborns were identified as having prenatal exposure to an illicit or nonillicit substance over the 4-year period. Eighty-six per cent (145/168) of women tested positive or their newborn tested positive for at least 1 illicit substance, and 49% (82/168) tested positive for multiple illicit substances. Fifty-four per cent (91/168) of women did not disclose using at least one illicit drug for which she or her newborn tested positive.With regards to maternal characteristics, there was no statistically significant difference between age (P = 0.958), parity (P = 0.300), or race (P = 0.531), and disclosure or failure to disclose about illicit drug use. However, patients who did not report prenatal illicit drug use (33/82 = 40%) were less likely (P = 0.049) to receive complete prenatal care (defined as 3 or more visits) compared with those who acknowledged their substance use (40/70 = 57%). Substance use disorders during pregnancy are an often underestimated cause of maternal, fetal, and neonatal complications. Limited studies have examined the relationship between maternal characteristics and associated illicit or nonillicit drug use. The absence of correlation between maternal demographics and disclosure of illicit substance use demonstrates the fact that all antepartum patients are at risk for these behaviors. Furthermore, the fact that women who did not disclose their illicit drug use were less likely to seek complete prenatal care reflects the need for physicians to provide a destigmatized healthcare environment, encouraging pregnant women to disclose their substance use so they can be provided with appropriate counseling and treatment.

Years-of-school is negatively correlated with illicit drug use. However, educational attainment is positively correlated with IQ and negatively correlated with impulsivity, two traits that are also correlated with drug use. Thus, the negative correlation between education and drug use may reflect the correlates of schooling, not schooling itself. To help disentangle these relations we obtained measures of working memory, simple memory, IQ, disposition (impulsivity and psychiatric status), years-of-school and frequency of illicit and licit drug use in methadone clinic and community drug users. We found strong zero-order correlations between all measures, including IQ, impulsivity, years-of-school, psychiatric symptoms, and drug use. However, multiple regression analyses revealed a different picture. The significant predictors of illicit drug use were gender, involvement in a methadone clinic, and years-of-school. That is, psychiatric symptoms, impulsivity, cognition, and IQ no longer predicted illicit drug use in the multiple regression analyses. Moreover, high risk subjects (low IQ and/or high impulsivity) who spent 14 or more years in school used stimulants and opiates less than did low risk subjects who had spent <14 years in school. Smoking and drinking had a different correlational structure. IQ and years-of-school predicted whether someone ever became a smoker, whereas impulsivity predicted the frequency of drinking bouts, but years-of-school did not. Many subjects reported no use of one or more drugs, resulting in a large number of “zeroes” in the data sets. Cragg’s Double-Hurdle regression method proved the best approach for dealing with this problem. To our knowledge, this is the first report to show that years-of-school predicts lower levels of illicit drug use after controlling for IQ and impulsivity. This paper also highlights the advantages of Double-Hurdle regression methods for analyzing the correlates of drug use in community samples.