Multisectoral Strategies Research Articles

Abstracts from USP DI

To evaluate the consistency of the relationship between early drug use in adolescence and illegal drug use in adulthood as proposed in the “gateway theory” and to determine whether pre-existing depressive symptoms modifies this relationship. We used contractual data from the National Longitudinal Study of Adolescent to Adult health data spanning a 14 year period. We assessed the relationship between gateway drugs at baseline (age 11–20 years) and drug use in adulthood using generalized estimating equation (GEE) regression models. Gateways drugs used in early adolescence were significantly associated with marijuana use, illegal drugs and cocaine in older adolescence, but over time these relationships were not consistent in adulthood. Changes in the pattern of psychoactive drug use were important predictors of drug use in adulthood. A history of higher depressive symptoms was associated with higher frequencies of psychoactive drug use over time. Users of mental health services in adolescence were less likely to use drugs in older adolescence and in adulthood. Relationships between early drug use and later drug use in adulthood cannot be solely explained by the gateway hypothesis. Collectively, adolescent drug prevention and treatment programs should apply theory-based and evidence-proven multisectoral intervention strategies rather than providing a brief counseling on individual's behaviors. This evidence should include understanding that changes in behavior should involve broader analyses of the underlying social context for drug use and in particular the role of the community social norms in driving a group's behaviors.

Health practices and indices of a poor urban population in Indonesia. Part II: Immunization, nutrition, and incidence of diarrhea.

This second section in a two-part study of health indices and practices among a poor urban population in Indonesia focuses on problems related to immunization, nutrition, and incidence of diarrhea. Through a survey of 690 mothers and 593 children in two slum communities in Jakarta, we found that 1) 65% of the children were mildly to severely malnourished according to Gomez criteria, with malnutrition most prevalent among the poorest; 2) 75% of the mothers reported exclusive breastfeeding of their infants during the first four months after birth, but breastfeeding decreased sharply with increasing socioeconomic status; 3) of the 19% of one- to three-year-old children who were incompletely immunized, most were likely to be missing their measles and DPT3 immunizations; and 4) 28% of the mothers reported that at least one of their under-three-year-old children had diarrhea in the last month, with frequency of reporting highest among poor mothers and those using water from vendors. We concluded that selective interventions should be accompanied by development of a comprehensive health infrastructure that permits uninterrupted service delivery and follow up of those identified as high risk. Such a comprehensive primary health care system should be part of a multisectoral development strategy.

Rio reconstruction and flood prevention in Brazil

Until the Rio Flood Reconstruction and Prevention Project, disaster-related projects funded by the World Bank focused primarily on reconstruction, especially immediate, short-term recovery. The Rio de Janeiro project was notable as a targeted effort to reduce disaster vulnerability by promoting long-term multisectoral development strategies. It taught that reconstruction projects must address specific disaster vulnerabilities as well as cross-sectoral needs in Improving urban environmental management. The project represents a significant step towards developing a strategy for long-term prevention and mitigation of natural disasters and environmental degradation. It is also a good example of an effort to develop support for long-term environmental policies by strengthening indigenous managerial and planning capabilities—something that was not possible in short-term recovery projects.

National Investment Planning and equity policy in developing countries: The challenge of decentralized administration

The impact of national economic planning in developing countries over the past three decades has been severely limited. Little evidence supports the contention that it has either directly improved investment decisions for stimulating economic growth or significantly affected development policymaking. Constraints on implementing national planning in Asia include weaknesses of political and administrative support for national plans, deficiencies in their content, difficulties of relating plan priorities to investment decisionmaking, ineffectiveness or inappropriateness of comprehensive planning methods and techniques, and inadequate administrative capacity to implement and evaluate multisectoral investment strategies. Changes in Asian development policy toward growth with equity imply the need for more decentralized methods and arrangements for planning, creation of a stronger relationship between policy planning and program implementation, and diffusion of administrative capacity among a wide variety of public and private institutions to generate, formulate and implement investment policies and projects.