Sporadic Users Research Articles

Factors associated with non-fatal heroin overdose: assessing the effect of frequency and route of heroin administration.

To examine risk factors associated with non-fatal heroin overdose, particularly frequency and route of heroin administration. Data from cross-sectional surveys were analysed as a case-control and as a case cross-over design. 2556 subjects treated for heroin dependence in 164 outpatient facilities in Spain. Prevalence of overdose involving emergency care in the 12 months before treatment admission. CASE CONTROL DESIGN: Odds ratio (OR) adjusted by logistic regression. CASE-CROSSOVER DESIGN: Estimated relative risk (RR) of transient risk of injecting heroin. The prevalence of overdose was 10%. In the case control analysis the cumulative risk of overdose increased as the frequency of heroin use decreased. However, among daily heroin users this risk increased as the frequency of heroin injection rose, with an OR of 6.0 (95% CI: 3.9-9.6) for daily injectors versus non-injectors. Sniffers had a higher risk than smokers among non-daily users, but not among daily users. Other factors associated with increased risk of overdose were: tranquilizers, alcohol or cocaine use, living in certain regions and being long-term HIV+ 0. In the case-crossover analysis, the RR for injecting heroin versus using other routes immediately before overdose was 15.9 (95% CI: 9.5-26.6), and was much higher for non-daily heroin users than for daily users. These findings suggest that the rapid entry of a large quantity of heroin into the blood (as occurs when injecting) involves a high risk of overdose, especially when the heroin tolerance level is low (as occurs in sporadic users).

Validity of questions in the use of specific drug-groups in health surveys.

The aim of this study was to investigate whether morbidity in the general population could be assessed by questions on drug use in the Norwegian Health Survey 1995. A sample of 6,702 persons, aged 20-79 years was interviewed in their homes using computer-assisted personal interviewing (CAPI). The validity of questions on use of analgesics and drugs against dyspepsia/peptic ulcer has been assessed according to categories of self-evaluated health. There was a difference between sporadic and daily users of the drugs to what extent they rated their health as poor. The validity of the drug questions assessed by sensitivity and specificity, showed that only using a dichotomous outcome variable, is too low to give a sufficiently valid measure of the morbidity in the population. Using "yes" or "no" as the only outcome of drug questions has the unfortunate effect of putting together chronic users of drugs with infrequent users for all of the subsequent analyses, which results in a considerable measurement error. This implies a need for improved methods to determine the optimal recall period for different drugs and it is crucial to include more details in questions on drug use to increase the validity of this information.

Drug injection rates and needle-exchange use in New York City, 1991-1996.

Objectives included (1) to develop methods for identifying injection drug users with accelerating injection habits so they might be referred to counseling and treatment and (2) to investigate behavioral correlates of accelerating injection habits, including syringe-exchange program utilization. Data on drug use, enrollment in methadone maintenance, and demographic variables were obtained from 328 subjects who were seronegative for human immunodeficiency virus (HIV) who attended anywhere from 4 to 11 quarterly study visits for interview, HIV pretest counseling and risk reduction counseling, and blood donation for HIV antibody testing. Subjects were recalled 2 weeks after each study visit to receive their results and post-test counseling. We characterized subjects according to their patterns of drug injection as accelerating, decelerating, or stable, using intraindividual regression analyses and categorization rules, and by syringe-exchange use as consistent users, sporadic users, or nonusers. The present subjects included 52% with decelerating, 29% with stable, and 19% with accelerating rates of drug injection. There were 128 subjects (39%) who were categorized as consistent users of syringe-exchange programs, 84 (25%) were categorized as sporadic users, and 116 (35%) were categorized as nonusers. All syringe-exchange groups showed significantly decelerating drug injection. Rates of decline were significantly less, however, among consistent syringe-exchange users than sporadic or nonusers of syringe exchanges. Categorical analysis also showed significant differences among groups, with 30% of consistent syringe-exchange program users having accelerating rates of drug injection compared to 9% of nonusers and 17% of sporadic users. That consistent syringe-exchange users included a larger proportion of individuals whose drug habits were accelerating than did sporadic users or nonusers of syringe exchanges suggests a need for improved identification and counseling of such subjects by syringe-exchange program staff. The present statistical approaches may be of value in targeting such efforts. The ability of a syringe-exchange program to attract a disproportionate share of drug users with accelerating rates of drug injection underscores the importance of these programs to HIV prevention efforts.

Survey on Awareness, Perception, and Extent of Usage of Nutraceuticals and Dietary Supplements in Metro Manila

ABSTRACT A total of 502 subjects (222 men, 280 women), age 20 years and older from 82 randomly selected barangays in Metro Manila were interviewed during the Fifth National Nutrition Survey in 1998 to determine their awareness, perceptions, and extent of usage of nutraceuticals. The majority of respondents, 62.5%, were not aware of nutraceutical products. Among those who were aware, 77.1% were nonusers, 11.7 were regular users, and the rest (11.2%) were sporadic users of nutraceuticals. The duration of use ranged from 1 day only to 2 years; most subjects had used nutraceutical products intermittently for 1 month. The majority of users reported that nutraceuticals made them healthy and that someone had influenced them to take the products. The most popular supplement used was fish oil, followed by aloe vera and multivitamins plus minerals. Calcium and iron supplements were used by some sporadic users. The respondents' agreement or disagreement with six health belief statements revealed their perception of nutraceuticals. There were no significant differences in the perception of users and nonusers with respect to health belief statements. In general, the level of awareness and usage of nutraceutical products in Metro Manila may be considered low.

Measuring Contraceptive Use Patterns Among Teenage and Adult Women

Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

From hackers to luddites, game players to game creators: Profiles of adolescent students using technology

This paper explores a range of responses to computer and video technology as exemplified by a class of Grade 7 and 8 students in alow- to middle-income suburban school in a mid-sized Ontario city. The class was provided with four networked Macintosh LC III computers. The responses, attitudes and behaviours of the students towards technology, both at home and at school, were documented through field notes, observations, concept maps, interviews and journals over the course of a school year. From these observations, classroom 'computer personalities' emerged; students were characterized as hackers, game players, game creators, reluctant users, luddites, eager users and sporadic users of computer technology. Each of the 'personalities' is profiled and patterns of game-playing and game creation are described, classroom uses and home uses of computers are compared, and students' ways of using their free computer time in the classroom context are discussed. Finally, some suggestions for inclusionary practices for schooling with technology are offered.

The role of cues, self-efficacy, level of worry, and high-risk behaviors in college student condom use.

A sample of 879 undergraduate students were recruited from a public university in western New York state during the 1993-94 academic year in order to study condom use among sexually active young people 18-24 years old. A 104-item questionnaire was administered consisting of 5 instruments and single-item measures of sexual behavior and demographics. The instruments were: the Condom Use Self-Efficacy Scale (CUSES), the Perceived Barriers to Condom Use, the Perceived Susceptibility to HIV/AIDS and other STDs, the Cues to Condom Action Scale, and the Perceived Norms scale. 92% of students reported having had sexual intercourse in the past, while 86.75 reported having sexual intercourse in the previous year. About 61% reported having 1 sex partner in the previous 12 months, whereas 35.2% reported having 3 or more partners. 22.4% reported 2 or more 1-night stands. 54.5% reported worrying about HIV/AIDS occasionally, while 23.1% reported doing so frequently. 17.2% (99) of the students were classified as non-users of condoms, 50.2% (289) as sporadic users, and 32.6% (188) as consistent users. 78 (12%) could not be classified. A multiple discriminant function analysis was also conducted to distinguish among the 3 condom user groups totalling 576 cases. The variables were age, gender, frequency of drunkenness during sexual intercourse, number of sex partners, and number of 1-night stands in the past 12 months, perceived barriers, worrying about HIV/AIDS, perceived susceptibility, condom use self-efficacy, and cues to condom action. Two significant functions emerged. Function 1 clearly separated the sporadic users from the consistent users (p 0.001), while Function 2 clearly separated the sporadic users from the non-users (p 0.001). The discriminating variables correctly classified 64.58% of the respondents into the 3 condom user groups. The variables were most effective at correctly classifying non-users (68.7%), consistent users (67.8%), and sporadic users (61.2%). Sporadic users were more diverse with respect to condom use than the other 2 groups.

Food supplement use and related beliefs: Survey of community college students

Food supplement use and related health beliefs were evaluated in 502 community college students from Arizona. Regular users (37%) were students who reported using supplements weekly or daily, while sporadic users (25%) reported taking supplements less than once per week; the remaining 38% were nonusers. The most popular supplements were vitamin C, multiple vitamins, multivitamins plus minerals, calcium, and vitamin E. Amino acids, garlic, aloe vera, yeast, and fish oil were the most popular unconventional supplements reported. Significantly more users than nonusers believed that food supplements increased pep and energy, reduced stress, were necessary to ensure proper nutrition, were needed if people felt tired and run down, and that vitamin C could prevent colds. The findings revealed that supplement use was prevalent among young adults and that supplement users perceived more health benefits of food supplements than nonusers.

Use of codeine analgesics in a general population. A Norwegian study of moderately strong analgesics.

The prescribing of controlled analgesics (codeine, buprenorphine and pentazocine preparations) was studied, using prescriptions from the three pharmacies in the municipality of Tromsø, Norway. All prescriptions dispensed during one year were analysed. The study sample comprised 3083 women (58%) and 2223 men (42%) between 10 and 99 years of age. About 8% of the population had obtained one or more prescriptions of controlled analgesics. Combined codeine preparations were by far the most frequently prescribed subgroups, and the average amount purchased during 1 year was 30 defined daily doses (DDD). The sporadic users were in the majority. A few users had purchased high amounts of controlled analgesics. The prevalence of use, the mean number of defined daily doses of analgesics, and the proportion of 'weekly' drug users was higher in women than men. The prevalence increased significantly with age, from 0.7 to 22.3% in women and from 0.5 to 14.1% in men. The mean number of DDD during one year also increased with age, from 12.6 to 50.6 DDD in women, and from 6.6 to 40.6 DDD in men. The users of buprenorphine and pentazocine differed in several aspects from the codeine users. The highest use of combined codeine preparations was seen in elderly people especially in women. Use of lower codeine doses or intermittent treatment with other drugs e.g. plain paracetamol in adequate doses, may be appropriate alternatives reducing the risk of adverse drug reactions such as nausea and constipation. Monitoring of prescribing and use of controlled analgesics according to certain criteria may uncover possible misuse.

Dimensions of Self-Efficacy among Three Distinct Groups of Condom Users

Condom use self-efficacy can be defined as expectations about one's ability to use condoms under a variety of circumstances. This investigation examined the factor structure of the Condom Use Self-Efficacy Scale (CUSES) in an 18- to 23-year-old college population (N = 339) and tested the ability of the factors to distinguish among three groups of condom users (nonusers, sporadic users, and ritualistic users). Emerging from a principal components analysis were four reliable factors labeled Mechanics, Partner's Disapproval, Assertive, and Intoxicants. Results from a discriminant analysis indicated that sporadic users were best distinguished from ritualistic users by number of sex partners, use of intoxicants, and intensity of alcohol use. The sporadic users had more sex partners, were less confident of their ability to use condoms when intoxicated, and were heavier drinkers than were the ritualistic users. Nonusers were best distinguished from ritualistic users by the factor labeled Assertive. Nonusers were significantly less confident in their ability to discuss condoms and to insist on their use with a sexual partner. Implications of the findings for improving campus-based programs to prevent the spread of human immunodeficiency virus infection and sexually transmitted diseases are discussed.

Recruitment, growth and residence time of fishes in a tropical Australian mangrove system

Twenty fish species accounted for > 96% of the catch by numbers in mangrove habitats in Alligator Creek, in tropical Queensland, Australia. The timing of recruitment, residency status, the period of residence and growth of fish during the time they spent in the mangrove habitat was assessed by examining gonad maturity and following changes in size-frequency plots for each species over 13 months. Five species were permanent residents, completing their life-cycles in mangrove swamps; eight were ‘long-term’ temporary residents, being present for ∼ 1 year as juveniles before moving to other near-shore habitats; and seven were ‘short-term’ residents or sporadic users of the mangrove habitat. Amongst the latter group, four species lived in the mangrove habitat for between 1 and 4 consecutive months, while three engraulid species appeared to move rapidly, and often, between mangrove and other near-shore habitats. One of the resident species spawned and recruited throughout the year, but recruitment for most species was highly seasonal, being concentrated in the late dry season (October) to mid wet season (February) period. Temporary resident species dominated the fish community in the wet season (December–April), but resident species comprised more than 90% of total fish numbers in the mid dry season (August) after temporary residents left the mangroves in the early dry season. Several species had more than one peak of recruitment during the wet season. The cohort of 0 + agedLeiognathus equulus which recruited in December grew more rapidly and remained in the mangroves for a shorter period than the cohort which recruited later in the wet season (February). Only nine of the 20 species examined are strictly dependent on mangrove-lined estuaries, the remaining 11 are captured in significant numbers in other near-shore habitats. Only four of the 20 species are of direct commercial importance in Australia, but most are major prey for several valuable, commercial species harvested both within mangrove habitats and in adjacent shallow shelf habitats.

Evaluation, narcotics and behavioral treatment influences on pain ratings in chronic pain patients.

Changes in self-reported pain ratings were assessed in 95 chronic pain patients from data collected at three times: pretreatment evaluation, initial days of treatment and final days of treatment. These data were collected separately for regular, sporadic and nonusers of narcotic medication. Each patient completed a four-week interdisciplinary behaviorally based noninvasive treatment program. There was an average decrease of 7% in self-reported pain ratings between evaluation and the onset of treatment for the three groups. An additional decrease of 21%, 16% and 10% for the sporadic, nonusers and regular users of narcotics respectively was noted during treatment. Statistical analysis revealed a significant decrease in pain ratings across assessment phases but not between groups. Sporadic users of narcotics showed a pattern more similar to nonusers than to the regular users.

Does dentistry as we know it have a future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.

Trends in the development of oral hygiene habits in Finnish adolescents from 1977 to 1981.

The aim of this study (part of the Juvenile Health Habit Study) was to analyze changes in how frequently certain oral hygiene measures are used, namely toothbrushing and dental flossing in 1977-81. A representative sample of Finnish adolescents aged 12, 14, 16 and 18 yr old, were sent a postal questionnaire in February 1977 (n = 3209), another in February 1979 (n = 4953), and a third one in February 1981 (n = 4705). The response rates for the three questionnaires were 88%, 86% and 88%, respectively. During the years studied no systematic changes occurred in the toothbrushing frequency. When the background factors that are highly correlated with toothbrushing frequency (school career or school success of adolescents, householder's occupation and education, place of residence) were studied, no consistent changes were observed from 1977 to 1981. The percentage of adolescents who used dental floss daily did not change. However, the proportion of sporadic users of dental floss increased from 13% in 1979 to 24% in 1981. Dental health education had little effect on toothbrushing habits and its background variables, although the amount of time spent in dental health education during the same period had increased significantly. Programs of dental health education should be evaluated so that the situation can be improved in the future.