Harm Reduction Education Research Articles

Drug education in victorian schools (DEVS): the study protocol for a harm reduction focused school drug education trial

BackgroundThis study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons.Methods/DesignA cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials.DiscussionThe benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative, harm reduction approaches with a large, student sample, and the resultant product. The research will provide better understanding of what benefits can be achieved by harm reduction education. It will also produce an intervention, dealing with both licit and illicit drug use that has been thoroughly evaluated in terms of its efficacy, and informed by teacher and student feedback. This makes available to schools a comprehensive drug education package with prevention characteristics and useability that are well understood.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000079842

Reflections on Personal Responsibility: Sorority Members At Risk for Interpersonal Violence

This study explores the phenomenon of interpersonal violence associated with alcohol abuse and sorority membership at a midsized state university in the West. Using Millennial theory as the conceptual framework, 180 reflection papers from women in two sororities were analyzed using qualitative content analysis to determine how they applied harm reduction education and participated in social activities when consuming alcohol. The results indicate little harm reduction application among the cohort, reproduced bystander behavior norms, how organizational challenges contribute to injury, and alcohol consumption promoted heavily as a benefit of membership. The study suggests implications for further research and practice.

Markers and risk factors for HCV, HBV and HIV in a network of injecting drug users in Melbourne, Australia

Current injecting drug users (IDU) in major street drug markets within greater Melbourne were recruited to a longitudinal study on blood borne viruses. Here we investigated risk factors for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV infection in these IDU at the time of their recruitment. Three hundred and eighty-two IDU completed detailed questionnaires on their drug use and risk behaviours, and provided blood samples for serology testing. These data were analysed using univariate and multivariate techniques. The overall prevalence of exposure to HCV, HBV and HIV was estimated at 70%, 34% and <1%, respectively. Independent predictors of HCV exposure were history of imprisonment (RR 1.34, 95% CI 1.19-1.52), use of someone else's needle or syringe (RR 1.23, 95% CI 1.07-1.42), >7.6years length of time injecting (RR 1.21, 95% CI 1.07-1.37), and originating from Vietnam (RR 1.12, 95% CI 1.07-1.18). Independent predictors of HBV exposure were HCV exposure (RR 2.15, 95% CI 1.35-3.43), >7.6years length of time injecting (RR 1.57, 95% CI 1.17-2.13) and originating from outside Australia (RR 1.60, 95% CI 1.22-2.10). Neither prison- nor community-applied tattoos predicted HCV or HBV exposure. Up to 31% of IDU who injected for 1year or less were HCV antibody positive, as were 53% of those who injected for 2years or less. Ongoing engagement with young IDU, through the provision of harm reduction education and resources, is critical if we are to address blood borne viral infections and other health and social harms associated with injecting drug use.

Opportunities to learn and barriers to change: Crack cocaine use in the Downtown Eastside of Vancouver

In 2004, a team comprised of researchers and service providers launched the Safer Crack Use, Outreach, Research and Education (SCORE) project in the Downtown Eastside of Vancouver, British Columbia, Canada. The project was aimed at developing a better understanding of the harms associated with crack cocaine smoking and determining the feasibility of introducing specific harm reduction strategies. Specifically, in partnership with the community, we constructed and distributed kits that contained harm reduction materials. We were particularly interested in understanding what people thought of these kits and how the kits contents were used. To obtain this information, we conducted 27 interviews with women and men who used crack cocaine and received safer crack kits. Four broad themes were generated from the data: 1) the context of crack use practices; 2) learning/transmission of harm reducon education; 3) changing practice; 4) barriers to change. This project suggests that harm reduction education is most successful when it is informed by current practices with crack use. In addition it is most effectively delivered through informal interactions with people who use crack and includes repeated demonstrations of harm reduction equipment by peers and outreach workers. This paper also suggests that barriers to harm reduction are systemic: lack of safe housing and private space shape crack use practices.

Crystal Methamphetamine use among Gay Men in Sydney

Crystal methamphetamine is used by gay men in Sydney in a variety of social and sexual contexts and by various means including injection. This paper presents detailed ethnographic data that explore some of the social and cultural characteristics of Sydney gay men's crystal use and other associated practices. The meaning of these practices is explored through a discussion of cultural boundaries and social exchange that traverses them. These boundaries help to limit drug-related harms in some ways but also generate certain risks. A nuanced understanding of the cultural meaning of various drug use practices may assist in producing culturally relevant harm-reduction education.

Nonpharmacological harm-reduction interventions in British substance-misuse services

The present study was designed to assess the acceptability and availability of harm-reduction interventions, including needle exchange, education regarding safer drug-ingestion methods, complementary/alternative therapies, and safe places where problem drinkers and drug takers may stay after consumption or may consume substances on the premises. We surveyed a nationwide sample of agencies listed in directories of substance-abuse services in England, Wales, and Scotland. Seventy percent (436 of 623 eligible agencies) returned questionnaires. Except for the provision of a safe place where clients could consume their own alcohol and drugs, large majorities of responding agencies rated these harm-reduction options as somewhat or completely acceptable, but only harm-reduction education and alternative therapies were available from a majority of responding agencies.

Desert, Harm Reduction, and Moral Education: The Case for a Tortfeasor Penalty

Those found liable for negligently injuring others are required to compensate them, but current practices permit most tort feasors to spread the costs of their liability burdens through the purchase of insurance. Those found guilty of criminal offences, however, are not allowed to shift the burdens of their sentences onto others. Yet the reasons for not allowing criminal offenders to shift such burdens – harm reduction, retribution, and moral education – also appear to retain some force in relation to negligent tort feasors. Arguments for and against limiting the abilities of negligent tort feasors to spread such costs, thus imposing a penalty on them, are discussed. The conclusion reached is that further consideration of such a penalty is warranted.

Involving Street Youth in Peer Harm Reduction Education

To describe and discuss the challenges in evaluation of a participatory action research with street-involved youth.A combination of quantitative and qualitative methods were utilized for both process and outcome evaluations. Process evaluation methods included in-depth individual interviews, focus groups, participant observation, and session debriefing forms. Summative evaluation research included focus testing of the harm reduction video and a survey of video users.Members of the youth team reported favourably on the experience, citing friendship, skills development, fun, and pride of accomplishment among the key benefits of participation. Political tensions arose because of the focus on reducing harm from drug use rather than encouraging abstension. The heavy demands of participatory research and development, resource constraints and the priority given to product development in these kinds of projects necessarily precludes extensive youth participation in the design, implementation and analysis of additional evaluation research. Even when resources are directed towards evaluation, there is a tendency to focus on data collection, which may limit time and resources for data analysis. Finally, there is an inclination to focus on the product development rather than dissemination and impact of the product.Despite the challenges inherent in participatory action research and its evaluation, this project was regarded as an empowering experience by the street youth who participated in it. It is worthwhile to direct resources to evaluation which optimally gives proportional attention to data collection as well as data analysis, and focusses not only on product development but also on its dissemination and impact.

Alcohol harm reduction education in schools: planning an efficacy study in Australia

AbstractThe School Health and Alcohol Harm Reduction Project (SHAHRP) is a 4‐year, quasi‐experimental, evidence‐based intervention research study designed to explore the effects of a student‐focused, secondary school, alcohol education intervention in reducing alcohol‐related harm experienced by school students. The SHAHRP study is unusual in that it has a primary aim of harm minimization rather than non‐use or delayed use. The SHAHRP intervention aims to reduce harm by enhancing students' abilities to identify and deal with high‐risk drinking situations particularly likely to be encountered by young people. The intervention involves eight lessons in the first year with five booster lessons in the subsequent year. The SHAHRP research will follow individual students exposed to both the alcohol and health promotion interventions over 3 successive years taking measures in: knowledge; attitudes; patterns of use; context of use; alcohol‐related harm associated with the student' own use; alcohol‐related harm associated with other people's use of alcohol. This paper describes the evidence‐based conceptual components and design of the study by providing a review of the health and drug education literature particularly related to components that have the potential of influencing behaviour.

A cluster analysis of alcohol-related attitudes and behaviors in the general population.

Alcohol use typologies have previously focused on chronic alcohol abusers and alcohol-dependent populations. This empirical typology was created to profile lifestyle patterns associated with nonclinical patterns of alcohol use. This study used two surveys sent to a commercial mailback panel, sampled to construct a study population demographically representative of the general U.S. population (N = 2,910). A K-means cluster analysis of alcohol use predictor variables and alcohol use generated the typology. The results suggest five distinct psychobehavioral clusters, referred to by the modal patterns of alcohol use for each cluster: nondrinkers, light drinkers, moderate drinkers, episodic drinkers and regular heavy drinkers. These clusters were found to have predictive validity using related health behaviors, psychosocial variables, personality self-descriptors, and media use as criteria. In particular, moderate drinkers had double the income of any other cluster and showed consistently healthy exercise, cigarette use, and diet patterns as well as a relatively high ranking of health as a personal value. Episodic drinkers had the highest levels of sensation-seeking and drug use and were not health oriented in values and behaviors, although their total weekly consumption was only marginally greater than the moderate drinkers. The profile of the moderate drinker cluster is consistent with concerns about lifestyle confounds in the relationship between moderate alcohol consumption and cardiovascular health. The episodic drinker profile is consistent with relatively high risk behaviors; this cluster may be a good target for harm-reduction education and intervention efforts.

Rates of and risk factors for trichomoniasis among pregnant inmates in New York City.

Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission. To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City. Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia. The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis. Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population.

Special care or segregation?

This paper will focus on the identified need for a specialised maternity service for drug-using women in the inner-city area of Manchester and argue that a collaborative initiative was vital if a comprehensive specialist service was to be provided for the increasing number of pregnant drug-using women. The importance of an ongoing harm-reduction education programme for service providers is also emphasised.

Illicit Drugs and Harm Reduction Education

Illicit Drugs and Harm Reduction Education