Assessing the Prevalence of Cannabis Use Through a Survey About Criminal Activity Versus One About Alcohol, Tobacco, and Other Drugs

Background: The prevalence of cannabis use in the United Kingdom might be underestimated using the Crime Survey of England and Wales. The current study examined whether responding to questions about their cannabis use as part of a crime survey would be less likely to report that they use cannabis compared to those responding to the same questions that are part of a survey about health. Methods: Participants were randomized to be told that the items about cannabis use came from a crime survey versus from a health survey. In addition, the sample was recruited using a representative online sampling method and compared to published rates of self-reported cannabis use collected as part of the Crime Survey for England and Wales. Results: There was no significant difference (p > 0.05) in the proportion endorsing cannabis use between those told the items came from a crime survey versus a health survey. However, self-reported rates of cannabis use collected as part of the online panel (51.3% ever use; 11.9% past year; age range 18-64 years) appeared higher than those reported based on results from the Crime Survey for England and Wales (37.2% ever and 5.8% past year; age range 18-59 years). Conclusion: The current study did not find evidence that manipulating whether participants were told that the items asking about cannabis use came from a survey asking about criminal activity versus one about health had an impact on self-reported cannabis use. However, as prevalence estimates generated by the Crime Survey of England and Wales do appear to be an underestimate of actual levels of cannabis use in the United Kingdom, further research is merited on this topic.

Measuring Alcohol Consumption

This article is an overview of different approaches to measuring alcohol consumption: self-reports and objective measures such as blood alcohol concentration (BAC) and aggregate level measures. These approaches are evaluated as regards their ability to capture quantity, frequency, volume and variability of drinking. This review focuses on self-report measures and on the current knowledge of undercoverage error when compared with sales data. In the comparative evaluation of measures, two analytical aims are examined: a) description and testing of differences across groups for which ordinal information is sufficient and b) establishment of cutoff points and risk relationships for which unbiased interval scale level is required. First, minimal differences were found between self-report measures when the recall period was sufficiently long enough. Second, prospective diaries appear to be stronger measures than retrospective recalls. However, prospective diaries commonly cover only short reporting periods and should be combined with simple retrospective measures to capture rare and infrequent drinking episodes. In regard to undercoverage, the discrepancy cannot be fully explained by non-response or concealment of consumption by drinkers. It is argued that undercoverage of sales data may be more related to sample frame defects–-e.g., the non-inclusion of particular subpopulations such as the homeless or institutionalized.

Past year cannabis use and problematic cannabis use among adults by ethnicity in Ontario

BACKGROUND

Rates of cannabis use differ around the world; in Ontario, the rate of use has been stable since about 2005. Understanding which population groups are at greater risk for problematic cannabis use can help reduce long-term health effects and service expenses. The aim of this study was to explore differences in cannabis use among Canadian adults of different ethnic origins living in Ontario.

METHODS

Data are based on telephone interviews with 11,560 respondents and are derived from multiple cycles (2005-2011) of the Centre for Addiction and Mental Health's (CAMH) Monitor survey, an ongoing cross-sectional survey of adults in Ontario, Canada, aged 18 years and older. Data were analyzed using bivariate cross-tabulations and logistic regression. Problematic cannabis use was determined with a score of 8+ on the ASSIST-CIS to identify moderate/high problematic users.

RESULTS

Lifetime, past year and problematic cannabis use (in the past 3 months) occurs among all ethnic groups: Canadian, East Asian, South East Asian, South Asian, Caribbean, African, East European, South European, North European, and Central West European. When compared to the Canadian group the odds of past year cannabis use was significantly lower for East Asians and South Asians, but higher for the Caribbean group. Significantly higher odds of problematic cannabis use were found for Caribbeans and Northern Europeans compared to Canadians.

CONCLUSIONS

These results of this study provide an important basis for considering the possible impact of the impending legalization of cannabis in Canada among different ethnic groups.

Estimates of Potential Bias in Telephone Substance Abuse Surveys Due to Exclusion of Households without Telephones

This article reports estimates of the bias that may result in telephone substance abuse surveys because of the noncoverage of households without telephones. The study analyzed 1995–1998 data from the face-to-face National Household Survey on Drug Abuse. Residents of households with telephones reported less drug use, less dependence on drugs and alcohol, but more alcohol use than residents of households without telephones. The resulting percentage differences between respondents with telephones and respondents in all households averaged one tenth of a percent (0.1%), and ratios of percentage estimates for all households to households with telephones averaged 1.04. The bias varied by substance, time frame, use versus dependence, and demographic characteristics. For example, use of marijuana ever had less bias than past year cocaine dependence. American Indians/Alaska Natives had the greatest amount of potential bias. For most populations and policy objectives, it may not be worth the added expense of conducting supplementary face-to-face interviews with residents of households without telephones in order to eliminate the bias.

“Sending the Wrong Message”: Did Medical Marijuana Legalization in California Change Attitudes about and use of Marijuana?

This study was designed to assess the affect of legalization of medical marijuana on drug-related attitudes and use among youths and young adults in selected communities in California and other states. Telephone survey data, collected as part of a study of the Robert Wood Johnson Foundation's Fighting Back initiative, was utilized to examine reported attitudes about and use of drugs in California and other states before and after Californians passed Proposition 215 in 1996. Descriptive, bivariate, and logistic regression analyses were used to examine attitudes and use among 16 to 25 year olds in California and 10 other states. This study found that although some marijuana-related attitudes changed between 1995 and 1999, use did not increase. These findings suggest that recent policy changes have had little impact on marijuana-related behavior.

Child maltreatment rates assessed in a national household survey of caregivers and youth

This paper reports on national estimates for past year child maltreatment from a national household survey conducted in 2011. It also discusses the validity of such estimates in light of other available epidemiology. The Second National Survey of Children Exposed to Violence obtained rates based on 4,503 children and youth from interviews with caregivers about the children ages 0-9 and with the youth themselves for ages 10-17. The past year rates for physical abuse by caregivers were 4.0% for all sample children, emotional abuse by caregivers 5.6%, sexual abuse by caregivers 0.1%, sexual abuse by caregivers and non-caregivers 2.2%, neglect 4.7% and custodial interference 1.2%. Overall, 12.1% of the sample experienced at least one of these forms of maltreatment. Twenty-three percent of the maltreated children or 2.8% of the full sample experienced 2 or more forms of maltreatment. Some authority (teacher, police, medical personnel or counselor) was aware of considerable portions of most maltreatment, which suggests the potential for intervention. Many of the study's estimates were reasonable in light of other child maltreatment epidemiological studies, but comparisons about emotional abuse and neglect were problematic because of ambiguity about definitions.

Community disorder, victimization exposure, and mental health in a national sample of youth

This study considers whether elevated distress among youth living in more disordered neighborhoods can be explained by personal exposure to violence and victimization, level of non-victimization adversity, and family support. Analyses were based on a sample of 2,039 youth ages 10 to 17 who participated in the National Survey of Children's Exposure to Violence, a national telephone survey conducted in 2008. Using structural equation modeling, we find no direct effects of community disorder on distress, once the significant mediating effects of victimization, family support, and adversity are taken into account. Using a comprehensive measure of victimization covering several domains of experiences, we show that past-year exposure to child maltreatment, sexual victimization, peer assault and bullying, and property crime each significantly mediate the community disorder-distress association. A measure of the total number of victimization types to which youth were exposed (i.e., level of "poly-victimization") had the strongest mediating effect.

The impact of the prohibition of benzylpiperazine (BZP) 'legal highs' on the prevalence of BZP, new legal highs and other drug use in New Zealand

BACKGROUND

Benzylpiperazine (BZP) is the psychoactive ingredient in a range of 'legal highs' sold worldwide. BZP was prohibited in New Zealand in 2008.

AIM

To investigate the impact of the prohibition of BZP legal highs on the prevalence of BZP, replacement legal highs and other drugs.

METHODS

A population survey of BZP and other drugs was conducted in 2006 (while BZP was legal) and repeated in 2009 (+12 months after BZP was prohibited). Respondents were asked to provide the reason(s) why they had stopped using BZP. Annual surveys of frequent drug users were conducted from 2006 to 2010.

RESULTS

Last year prevalence of BZP among the general population fell from 15.3% in 2006 to 3.2% in 2009. The most common reasons for stopping BZP use in 2008 were 'it's illegal now' (43%), 'just experimenting' (26%), 'don't know where to get it now it's illegal' (24%) and 'bad hangover effect' (18%). Three per cent of the general population had used any new legal high in 2009. Use of BZP declined among frequent methamphetamine users from 32% in 2006 to 7% in 2010; among frequent ecstasy users from 65% in 2006 to 11% in 2010; and among frequent injecting drug users from 30% in 2007 to 20% in 2010. The use of new legal highs in 2010 was lower than the former use of BZP in 2006.

CONCLUSIONS

Unpleasant side-effects and the prohibition contributed to a decline in BZP use. The overall level of legal high use was lower following the prohibition of BZP.

Family context, victimization, and child trauma symptoms: variations in safe, stable, and nurturing relationships during early and middle childhood

Based on a nationally representative sample of 2,017 children age 2-9 years, this study examines variations in "safe, stable, and nurturing" relationships (SSNRs), including several forms of family perpetrated victimization, and documents associations between these factors and child trauma symptoms. Findings show that many children were exposed to multiple forms of victimization within the family (such as physical or sexual abuse, emotional maltreatment, child neglect, sibling victimization, and witnessing family violence), as evidenced by substantial intercorrelations among the different forms of victimization. Moreover, victimization exposure was significantly associated with several indices of parental dysfunction, family adversity, residential instability, and problematic parenting practices. Of all SSNR variables considered, emotional abuse and inconsistent or hostile parenting emerged as having the most powerful independent effects on child trauma symptoms. Also, findings supported a cumulative risk model, whereby trauma symptom levels increased with each additional SSNR risk factor to which children were exposed. Implications for research and practice are discussed.

Infant victimization in a nationally representative sample

OBJECTIVE

The objectives of this research were to (1) obtain estimates of child maltreatment and other forms of personal, witnessing of, and indirect victimization among children aged 0 to 1 year in the United States and (2) examine associations between infant victimization exposure and the infant's level of emotional and behavioral symptoms.

METHODS

The study is based on a cross-sectional national telephone survey that included caregivers of a sample of 503 children under 2 years of age.

RESULTS

Nearly one-third of the sample of infants (31.6%) had experienced some form of personal, witnessing, or indirect form of victimization. The rate of infant maltreatment by caregivers (2.1%) was significantly lower than among older preschool-aged children. However, the rate of infant assault by siblings was considerable at 15.4%. The greatest risk of assault occurred in households with young siblings; nearly 35% of the infants with a sibling aged 2 to 3 years were assaulted in the year before the interview. Witnessing family violence was also relatively common among the infants (9.5%). Victimization was associated with emotional and behavioral problems; sibling assault and witnessing family violence had the highest correlations with infant symptom scores.

CONCLUSION

The results of this study highlight the need for attention to infant victimization that considers a wider array of victimization sources and a broader scope of prevention efforts than has been typical in the child-maltreatment field.

'I have no interest in drinking': a cross-national comparison of reasons why men and women abstain from alcohol use

AIMS

To examine country differences in reasons for abstaining including the association of reasons with country abstaining rate and drinking pattern.

PARTICIPANTS

Samples of men and women from eight countries participating in the GENACIS (Gender Alcohol and Culture: an International Study) project.

METHODS

Surveys were conducted with 3338 life-time abstainers and 3105 former drinkers. Respondents selected all applicable reasons for not drinking from a provided list. Analyses included two-level hierarchical linear modelling (HLM) regression.

FINDINGS

Reasons for abstaining differed significantly for life-time abstainers compared to former drinkers, by gender and age, and by country-level abstaining rate and frequency of drinking. Life-time abstainers were more likely than former drinkers to endorse 'no interest', 'religion' and 'upbringing' and more reasons overall. Gender differences, especially among former drinkers, suggested that norms restricting drinking may influence reasons that women abstain ('no interest', 'not liking taste') while drinking experiences may be more important considerations for men ('afraid of alcohol problems', 'bad effect on activities'). Younger age was associated with normative reasons ('no interest', 'taste', 'waste of money') and possibly bad experiences ('afraid of problems'). Reasons such as 'religion', 'waste of money' and 'afraid of alcohol problems' were associated with higher country-level rates of abstaining. Higher endorsement of 'drinking is bad for health' and 'taste' were associated with a country pattern of less frequent drinking while 'not liking effects' was associated with higher drinking frequency.

CONCLUSIONS

Reasons for abstaining depend on type of abstainer, gender, age and country drinking norms and patterns.

Taxation reduces social disparities in adult smoking prevalence

BACKGROUND

The CDC, the WHO, and the World Bank promote increases in the price of cigarettes as an effective and important tobacco-control strategy. This study was designed to assess the extent to which the association between the price of cigarettes and smoking prevalence, as measured monthly, varies by income group.

METHODS

Australian population survey data collected monthly from January 1991 to December 2006 were used to estimate Poisson regression models to assess the impact of the price of cigarettes on smoking prevalence across three income groups. Analyses were conducted in 2008.

RESULTS

There was strong evidence that real price and prevalence were negatively associated (p<0.001) and that the association was stronger in lower-income groups (p<0.001). One Australian dollar increase in price was associated with a decline of 2.6%, 0.3%, and 0.2% in the prevalence of smoking among low-, medium-, and high-income groups, respectively.

CONCLUSIONS

Increasing the price of cigarettes not only is an effective tobacco-control strategy to lower smoking prevalence in the general population, but also may provide a means of reducing social disparities in smoking.

[The impact of a verbal consent form on the participation rate in a telephone survey]

OBJECTIVE

To assess the impact of a consent form on the participation rate in a telephone survey about gambling and money.

METHOD

Four different consent forms were tested. The first consent form globally met the academic ethics committee requirements, while the second and third forms excluded some elements. Finally, the fourth form was similar to the introduction generally used by private survey firms.

RESULTS

Even when the consent form required by academic ethics committees was shortened, the private firm introduction led to the best participation rate. However, participants who received the private firm introduction indicated that they wished they had been better informed before the interview started.

CONCLUSION

The discussion highlights the delicate situation of academic research wishing to meet ethics requirements as well as conduct valid and representative research.

Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence

OBJECTIVES

We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence.

METHODS

We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws.

RESULTS

Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence.

CONCLUSIONS

Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

Gender and the assessment of at-risk drinking: evidence from the GENACIS Canada (2004-2005) telephone survey version of the AUDIT

The alcohol use disorders identification test (AUDIT) is widely used in general population surveys as a method of determining prevalence of hazardous drinking. However, its interpretation has been questioned particularly regarding the unequal contribution of the items to the total score, specifically, that the drinking frequency item contributes disproportionately to the score and may lead to inappropriate identification of some drinkers as hazardous drinkers. To explore these issues further as well as possible gender differences in the applicability of the AUDIT, we conducted analyses using a modified version of the AUDIT (AUDIT(M)) as part of a general population survey that used random digit dialing and computer-assisted telephone interviewing. Item and factor analyses were performed separately for men and women, and the impacts of excluding the frequency of drinking item in the measurement of mean scores, percentages and types of problems for men and women were examined. We found that the AUDIT(M) items loaded onto three distinct dimensions for both men and women: frequency of drinking; usual quantity and frequency of heavy-episodic drinking; problem consequences from drinking. In addition, we found that excluding the frequency question may give a more meaningful estimate of the percent of drinkers actually at risk of experiencing problems from drinking for both men and women. Finally, although our analyses identified only minor gender differences in the structure of the AUDIT and good sensitivity for identifying problem drinkers among both men and women, significant gender differences in the types of problems experienced suggest that use and interpretation of the AUDIT should routinely take gender into consideration.

Can we talk? Importance of random-digit-dial surveys for injury prevention research

Prevention research in public health requires quality data. In injury prevention research, "official" data sources, such as medical or law enforcement data, often do not possess the required depth or completeness. Self-reported data can fill this gap. Such data allow us to understand knowledge, attitudes, exposures, and behaviors associated with injury risk. Self-reported data are also needed to understand outcomes that are often missing from official sources, such as victimization by an intimate partner that is not reported because of concerns about legal consequences and less severe injuries from suicide attempts that go untreated. Data on risk and protective factors and specific types of violence exposures can often only be obtained by directly asking those affected. In addition, "official" data sources are rarely representative. Random-digit-dialing (RDD) surveys are a method of obtaining representative self-reported data. The RDD approach is relatively cost effective, handles non-English-speaking households with relative ease, and possesses a well-developed theory for constructing sample weights. However, there are significant challenges to using RDD surveys. These include declining participation rates; possible self-selection bias, since potential respondents can choose to opt out of the survey; and, with sensitive topics such as intimate partner violence, the need to anticipate potential risks for participants. This theme issue provides suggestions for how we can improve the design and implementation of RDD surveys in a manner that is both practical and ethical.

Obtaining sensitive information from a wary population: a comparison of telephone and face-to-face surveys of welfare recipients in the United States

Recent studies reveal the benefits of technological developments such as audio computer assisted self-interviewing (A-CASI) in interview methodology, especially for surveys of sensitive behavior and information. However, we believe that the selection of mode of administration depends not only on the technology available and the behavior of interest, but also on the specific population under study. We therefore assess survey mode effects on reported rates of alcohol and drug use among welfare recipients, an especially important group for scholars and public health agencies. The sample consisted of adult recipients of Temporary Assistance to Needy Families (TANF) in Oklahoma, January 2001. Adjusting for demographic characteristics, employment, and education, we employ odds ratios to compare 30-day, 1 year, and lifetime prevalence estimates from telephone and face-to-face surveys. Telephone methodology yields similar or higher estimates for lifetime prevalence of alcohol, marijuana, and hard drug use and abuse, though lower estimates of recent use. We discuss our findings in relation to underfunded public health agencies that must efficiently assess and respond to local levels of drug abuse and we conclude that mode selection may depend upon the population under study.

Unmet need for Substance Abuse Treatment of Adults in Massachusetts

This article presents a methodology to estimate the size and cost of eliminating unmet need for substance abuse treatment services among adults who have clinically significant substance use disorders, and applies the approach to Massachusetts' information. Unmet treatment needs were derived using a statewide household telephone survey of 7,251 Massachusetts residents aged 19 and older conducted in 1996-1997, and an index of treatment mix and cost information from state and Medicaid financial data. The study estimates that 39,450 adult state residents (0.81% of the total sample) had a clinically significant past-year substance use disorder, but had not received treatment in the past year. Providing substance abuse treatment and outreach services to them would have required an additional cost of approximately 109 million dollars (17 dollars per capita), of which the state's payer of last resort, the Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS), would need to fund 31 million dollars (5 dollars per capita). The share paid by BSAS (28%) would represent an increase of 42% over its current spending. This paper quantifies an important but sometimes overlooked objective of managed care: to improve access for substance abusers who need but do not seek treatment.

Consequences of declining survey response rates for smoking prevalence estimates

BACKGROUND

Response rates have been declining in statewide tobacco surveys. This study investigated whether there was associated evidence of increasing bias in smoking prevalence estimates.

METHODS

Demographic characteristics of respondents to tobacco surveys in Massachusetts and California were compared to population data in the early 1990s, when response rates were high, and in more recent years, when response rates were lower. State estimates of smoking prevalence at three times were compared with estimates from the Current Population Survey Tobacco Use Supplement (CPS-TUS), conducted by the U.S. Census Bureau.

RESULTS

Under- and over-representation of population subgroups has not changed as response rates have declined. Smoking prevalence estimates from state surveys remain relatively close to the state-specific CPS-TUS estimates.

CONCLUSIONS

There is no evidence that declining response rates have resulted in less accurate or biased estimates of smoking behavior.

Is Telephone Screening Feasible? Accuracy and Cost-Effectiveness of Identifying People Medically Eligible for Home- and Community-Based Services

PURPOSE

To determine the accuracy of a telephone-screening system to identify persons eligible for home- and community-based long-term care.

DESIGN AND METHODS

Data from Michigan telephone screens were compared to data from in-person assessments using the Minimum Data Set for Home Care (MDS-HC). Weighted kappa statistics measured the level of agreement between the two assessments.

RESULTS

Overall, recommendations based on the telephone screen produced a marginal match compared to recommendations based on in-person assessment. "False positives" (individuals scoring as more impaired on the telephone screen than in person) occurred in 27% of all cases, while "false negatives" (individuals scoring as less impaired on the telephone screen) only occurred among 6% of the callers. Neither individual screen questions, source of information, location of the individual, timing between screen and assessment, nor temporal changes accounted for mismatches. Telephone screens resulted in an 11% savings over the cost of providing in-person assessments to all program seekers.

IMPLICATIONS

The telephone screen has utility as a broad targeting mechanism that allows agencies to avoid costly in-person assessments for all program seekers. Evidence does not support use of the telephone screen alone to determine either medical eligibility or a specific level of care.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas

OBJECTIVE

This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices.

MATERIAL AND METHOD

The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared.

RESULTS

The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview.

CONCLUSIONS

The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

A pilot study of a computer-assisted cell-phone interview (CACI) methodology to survey respondents in households without telephones about alcohol use

An intrinsic drawback with the use of a computer-assisted telephone interview (CATI) survey methodology is that people who live in households without a connected landline telephone are excluded from the survey sample. This paper presents a pilot of the feasibility of a computer-assisted cell-phone interview (CACI) methodology designed to survey people living in households without a telephone about alcohol use and be compatible with a larger telephone based alcohol sample. The CACI method was found to be an efficient and cost competitive method to reach non-telephone households. Telephone ownership was found to make a difference to the typical occasion amount of alcohol consumed, with respondents from households without telephones drinking significantly more than those with telephones even when consumption levels were controlled for socio-economic status. Although high levels of telephone ownership in the general population mean these differences may not have any impact on population alcohol measures they may be important in sub-populations where telephone ownership is lower.

The effectiveness of cannabis crop eradication operations in New Zealand

At present the only information available on the effectiveness of the cannabis crop eradication programme in New Zealand is the total number of cannabis plants destroyed each year. These figures can only provide a very crude measure of the effectiveness of these operations. A better measure would be the percentage of total cannabis production destroyed--known as the drug seizure rate. This paper calculates the seizure rate of the cannabis crop eradication programme in New Zealand using the amount of cannabis reported consumed in the Alcohol and Public Health Research Unit's (APHRU) National Drug Survey. The seizure rate for the 1998 programme is calculated to be 26-31%. This compares favourably with drug seizure rates reported in other countries. The effectiveness of the cannabis crop eradication programme, and its apparent modest share of the total cannabis control budget, raises some intriguing questions about the role an expanded crop eradication programme could play in a future cannabis control strategy.

A 'demand side' estimate of the dollar value of the cannabis black market in New Zealand

The dollar value of an illicit drug market is an important statistic in drug policy analysis. It can be used to illustrate the scale of the trade in a drug; evaluate its impact on a local community or nation; provide an indication of the level of criminality related to a drug; and can inform discussions of future drug policy options. This paper calculates the first ever demand side estimates of the New Zealand cannabis black market. The estimates produced are calculated using cannabis consumption data from the Alcohol & Public Health Research Unit's (APHRU) 1998 National Drug Survey. The wholesale value of the market is estimated to be 81.3-104.6 million dollars a year, and the retail value of the market is estimated to be 131.3-168.9 million dollars a year. These demand side estimates are much lower than the existing supply side estimates of the market calculated using police seizures of cannabis plants. The retail figure is four times lower than the lowest national supply side estimate (636 million dollars) and seven times lower than the highest national supply side estimate (1.27 billion dollars). The demand side estimates suggest a much smaller cannabis economy to fuel organized criminal activity in New Zealand than previous estimates implied.

The relationship between social cohesion and empowerment: support and new implications for theory

Empowerment theory represents an expansive view of individual and collective behavior that includes the active participation of individuals and groups in altering and shaping the socioenvironmental context. Critical to health educators are local interventions that yield participation of community members and empowerment for participants. The concept of social cohesion embraces participation but expands this behavioral emphasis to incorporate notions of trust, connectedness, and civic engagement. This study presents two data sets on the relationship of participation to empowerment. The first replicates and extends previous research by examining participation with interactional as well as intrapersonal empowerment. Second is the examination of how the quality of the participatory experience--the cohesive nature of participation--is related to interactional and intrapersonal empowerment. Findings support and extend previous findings, reliably cluster residents by the degree of connectedness in their participatory experiences, and reveal that social cohesion is related to intrapersonal empowerment.

Substance use, need, and demand for substance user treatment services in patients treated for sexually transmitted diseases in michigan

The association between substance use and communicable diseases, and the need for substance user treatment services for patients treated for communicable diseases, is well documented. This study builds upon this knowledge in that it quantifies the need and demand for substance user treatment services in a large population of patients treated for communicable diseases, specifically, sexually transmitted diseases (STDs), an area in which there is insufficient research published in the literature, but which is essential for policy development. More than 1700 patients treated for STDs in publicly funded clinics in Michigan between 1994-1995 were interviewed about their substance use, consequences of use and demand for substance user treatment services. Results indicated that the rates of substance use and demand for substance user treatment services were significantly higher among persons encountered in the STD clinics compared to the Michigan general adult population; however, a large proportion of STD patients determined to need substance user treatment services according to DSM-III-R criteria for "substance dependence" and "abuse" did not report ever receiving it. These results are followed by a discussion of possible policy implications for planning for substance user treatment services for patients treated for STDs in publicly funded clinics and suggestions for further research.