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Stephenson L, Van Den Heuvel C, Byard RW. Socioeconomic and psychosocial determinants of substance misuse - a national perspective. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00702-6. [PMID: 37682517 DOI: 10.1007/s12024-023-00702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Accurate estimates of population drug use and an understanding of the factors that influence substance choice are essential for the development of appropriate and targeted prevention strategies and campaigns. This review aims to provide an overview of the socioeconomic and psychosocial factors that influence substance use patterns within the Australian population through exploration of current and historical examples of substance misuse. Australia's comparatively large online drug market is reflective of the country's relative geographic isolation and high local drug prices. Legislation, particularly relating to cannabis cultivation and personal use, has evolved significantly in response to increased scientific and commercial applications and changing attitudes towards medical and personal use. Methylamphetamine use is disproportionately high, attributed to Australia's geographic location, high rates of local manufacture, steady cost, and increased purity. Despite the increased cost of cocaine over time, the profile of users appears to dictate rates of use. The prevalence of injecting drug use is driven by a lack of education, perceived risk, stigma, and other social factors. Additionally, psychosocial factors also contribute to substance misuse among specific population subgroups such as petrol sniffing among Indigenous Australians. Understanding the reasons for geographical variability in illicit drug use assists in the interpretation of substance-associated behavior in specific groups/populations and in guiding future intervention efforts and predictions of emerging trends. In addition, an understanding of factors influencing local drug usage may assist forensic practitioners in evaluating the occurrence and effects of particular substances that may emerge as significant factors in drug-related deaths.
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Affiliation(s)
- Lilli Stephenson
- School of Biomedicine, Level 2 Helen Mayo North, The University of Adelaide, Frome Road, Adelaide, 5005, SA, Australia.
| | - Corinna Van Den Heuvel
- School of Biomedicine, Level 2 Helen Mayo North, The University of Adelaide, Frome Road, Adelaide, 5005, SA, Australia
| | - Roger W Byard
- School of Biomedicine, Level 2 Helen Mayo North, The University of Adelaide, Frome Road, Adelaide, 5005, SA, Australia
- Forensic Science SA (FSSA), Adelaide, South Australia, 5000, Australia
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2
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Frank VA, MacLean SJ. Volatile substances are an amorphous category, making it hard to build a comprehensive body of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104181. [PMID: 37673733 DOI: 10.1016/j.drugpo.2023.104181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Vibeke Asmussen Frank
- Research Centre for Management, Organisation and Social Sciences, VIA University College, Aarhus Denmark.
| | - Sarah J MacLean
- Social Work and Social Policy, La Trobe University, Bundoora, Victoria, Australia
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3
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Stephenson L, Grabowski M, van den Heuvel C, Humphries M, Byard RW. Success of Low Aromatic Fuel in Preventing Gasoline Sniffing Deaths. Am J Forensic Med Pathol 2022; 43:354-358. [PMID: 35970515 DOI: 10.1097/paf.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Gasoline (petrol) sniffing is a form of volatile substance misuse that is particularly prevalent within Australian indigenous communities. Although epidemiological studies have shown that gasoline sniffing has decreased over recent years, rates of gasoline sniffing deaths have not been widely reported. Therefore, a study was undertaken to assess the association between the implementation of low aromatic fuel (LAF) and gasoline sniffing deaths. All cases of fatal gasoline sniffing in South Australia between 2000 and 2019 were identified from the Toxicology Database and autopsy reports at Forensic Science South Australia. Furthermore, previous studies of gasoline sniffing deaths were assessed to provide historical context and approximate rates of gasoline sniffing deaths before the current study. The rate of gasoline sniffing deaths decreased significantly ( P = 0.039) over the study period concomitant to an increase in the number of LAF sites nationally. Although not supported by findings of statistical significance because of the small number of cases, this study provides further supportive evidence for the effectiveness of LAF by showing a significant associated decrease in local rates of gasoline sniffing deaths.
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Affiliation(s)
| | | | | | - Melissa Humphries
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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4
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Abstract
Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause ocular effects or visually threatening conditions. Current literature informing eye-care practitioners on these effects is scant. The present scoping review reports the ocular effects of most commonly used drugs and substances of abuse in the teenage and adult populations of North America. Ovid MEDLINE and Ovid EMBASE databases were searched for publications from 1980 to 2019 regarding ocular effects of drug use. The selected papers regarded human subjects, in either teenage or adult population and included all types of studies, including case reports. Publications in English or in French were included. Exclusion criteria were publications about the use of prescriptions drugs, drug withdrawal, and publications about the use of alcohol, tobacco, or cannabis. Some 241 papers were retained and analysed. The use of various drugs and substances can lead to damage to structures throughout the eye, including but not limited to corneal conditions, glaucoma and other optic neuropathies, maculopathies and endophthalmitis. The data presented in this review may help guide clinicians in their diagnosis and treatment of certain ocular conditions, which could otherwise not be linked to drug use.
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Affiliation(s)
- Valérie Proulx
- School of Optometry, University of Montreal, Montréal, Canada
| | - Benoit Tousignant
- School of Optometry, University of Montreal, Montréal, Canada.,School of Public Health, University of Montreal, Montréal, Canada
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5
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Thulasirajah S, Michaud J, Doja A, McMillan HJ. Inhaled Solvent Abuse Mimicking Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Child Neurol Open 2020; 7:2329048X20934914. [PMID: 32613026 PMCID: PMC7307582 DOI: 10.1177/2329048x20934914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022] Open
Abstract
Exposure to n-hexane or toluene-containing solvents such as glue or gasoline can
produce clinical symptoms and neurophysiological findings that can mimic chronic
inflammatory demyelinating polyneuropathy. The authors present a case of a boy
with severe sensorimotor polyneuropathy with demyelinating features.
Cerebrospinal fluid testing and magnetic resonance imaging spine did not show
findings typical of chronic inflammatory demyelinating polyneuropathy. His lack
of response to immunosuppressive therapy prompted a nerve biopsy which was
instrumental in confirming a diagnosis of chronic organic solvent exposure,
subsequently confirmed on history. This case highlights the importance of
additional testing to ensure diagnostic certainty which allows appropriate
treatment and/or disease management to be tailored appropriately including in
this instance, the involvement of mental health counseling and avoidance of
immunosuppressant medication.
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Affiliation(s)
- Salini Thulasirajah
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Jean Michaud
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
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Toombs E, Marshall N, Mushquash CJ. Residential and nonresidential substance use treatment within Indigenous populations: a systematic review. J Ethn Subst Abuse 2019; 20:316-341. [PMID: 31185834 DOI: 10.1080/15332640.2019.1622478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Examining treatment outcomes of nonresidential and residential treatment programs may suggest best practices for Indigenous communities delivering treatment services. A systematic review of peer-reviewed and gray literatures comparing treatment outcomes for Indigenous populations was completed. Three studies compared treatment outcomes and reported varying results. Reported outcomes were retention and relapse rates, cultural knowledge, and participant treatment duration. Most retrieved studies described residential treatment outcomes, but it was unclear whether this modality is the best option for Indigenous people seeking treatment. Further research describing treatment modalities, across a continuum of care, situated within culturally developed treatment frameworks is required.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Nicole Marshall
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Christopher J Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Canada.,Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Canada.,Dilico Anishinabek Family Care, Fort William First Nation, Canada.,Centre for Rural and Northern Health Research, Thunder Bay, Canada
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Cooper E, Driedger SM, Lavoie JG. Employing a Harm-Reduction Approach Between Women and Girls Within Indigenous Familial Relationships. Cult Med Psychiatry 2019; 43:134-159. [PMID: 30121724 DOI: 10.1007/s11013-018-9603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
It is important to recognize that experiences of racial and gendered violence are a sad legacy of colonialism. The experiences of historical trauma are on-going. These affect the mental and physical wellbeing of individuals, families and communities. Addressing historical trauma through community-informed practices is central to creating space for meaningful change. This paper outlines results from a seven-week activity-based research workshop conducted on three separate occasions with urban-based First Nations and Metis women and girls (aged 8-12). Using a decolonizing theoretical framework, this paper examines data collected within three specific arts-based activities: empowerment bracelets, "I'm proud of you" charm bracelets and "Who I am" pictures. Women were hesitant to discuss future plans, as many were not confident that their daughters would be in contact with their maternal families when they become teenagers. Girls observed and mimicked the thoughts and actions of their mothers, step-mothers, aunts, older sisters and grandmothers. They demonstrated the role they already play within the discourse of what it means to be female living within their communities. This paper concludes with the implicit harm reduction approach women and girls used when exploring the impacts of trauma while envisioning a healthier future.
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Affiliation(s)
- Elizabeth Cooper
- Faculty of Health Sciences, University of the Fraser Valley, Abbotsford, Canada.
| | - S Michelle Driedger
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josée G Lavoie
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Embleton L, Atwoli L, Ayuku D, Braitstein P. The journey of addiction: barriers to and facilitators of drug use cessation among street children and youths in Western Kenya. PLoS One 2013; 8:e53435. [PMID: 23326428 PMCID: PMC3541137 DOI: 10.1371/journal.pone.0053435] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022] Open
Abstract
This mixed-methods study examined barriers to and facilitators of street children’s drug use cessation in Eldoret, Kenya utilizing a cross-sectional survey and focus group discussions with a community-based sample of street-involved children and youth. The primary objective of this study was to describe factors that may assist or impede cessation of drug use that can be utilized in developing substance use interventions for this marginalized population. In 2011, 146 children and youth ages 10–19 years, classified as either children on the street or children of the street were recruited to participate in the cross-sectional survey. Of the 146 children that participated in the survey 40 were invited to participate in focus group discussion; 30 returned voluntarily to participate in the discussions. Several themes were derived from children’s narratives that described the barriers to and facilitators of drug cessation. Specifically, our findings reveal the strength of the addiction to inhalants, the dual role that peers and family play in substance use, and how the social, cultural, and economic context influence or impede cessation. Our findings demonstrate the need to integrate community, family and peers into any intervention in addition to traditional medical and psychological models for treatment of substance use dependence.
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Affiliation(s)
- Lonnie Embleton
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
- * E-mail:
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Embleton L, Ayuku D, Atwoli L, Vreeman R, Braitstein P. Knowledge, attitudes, and substance use practices among street children in Western Kenya. Subst Use Misuse 2012; 47:1234-47. [PMID: 22780841 PMCID: PMC3749375 DOI: 10.3109/10826084.2012.700678] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study describes the knowledge of and attitudes toward substance use among street-involved youth in Kenya, and how they relate to their substance use practices. In 2011, 146 children and youth ages 10-19 years, classified as either children on the street or children of the street were recruited to participate in a cross-sectional survey in Eldoret, Kenya. Bivariate analysis using χ² or Fisher's Exact Test was used to test the associations between variables, and multiple logistic regression analysis was used to identify independent covariates associated with lifetime and current drug use. The study's limitations and source of funding are noted.
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Affiliation(s)
- Lonnie Embleton
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Greenfield BL, Venner KL. Review of Substance Use Disorder Treatment Research in Indian Country: Future Directions to Strive toward Health Equity. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:483-92. [DOI: 10.3109/00952990.2012.702170] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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MacLean S, Cameron J, Harney A, Lee NK. Psychosocial therapeutic interventions for volatile substance use: a systematic review. Addiction 2012; 107:278-88. [PMID: 22248138 DOI: 10.1111/j.1360-0443.2011.03650.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Volatile substance use (VSU) is associated with a range of adverse outcomes, including cognitive impairment and death. It occurs disproportionately within young and marginalized populations. A previous international systematic review of VSU treatment identified no relevant studies. This paper reports on a systematic review of a range of study types concerning psychosocial interventions for VSU. METHODS Search parameters were developed using the Population, Intervention, Professionals, Outcomes, Health care setting and Contexts (PIPOH) tool with input from an expert committee. Included were randomized controlled trials (RCTs), comparative studies with or without concurrent controls, case series studies and grey literature, published in English during 1980-2010. RESULTS The initial search identified 2344 references. After two screening phases, 23 studies of VSU therapeutic interventions remained. Of these, 19 concerned psychosocial interventions, which we discuss as: case management; counselling; recreation and engagement programmes; and residential treatment. Studies were conducted in Australia, Canada, the United States, United Kingdom and Brazil. No RCTs were identified and studies were generally of low evidentiary levels. CONCLUSIONS Even when a range of study types are included, clear conclusions for volatile substance use psychological treatment are not supported, but three intervention types merit further examination: family therapy, activity-based programmes and Indigenous-led residential approaches. Future volatile substance use research could be enhanced by developing and validating outcome measurement tools. Robust multi-site studies are also required.
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Affiliation(s)
- Sarah MacLean
- Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia.
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Dell CA, Seguin M, Hopkins C, Tempier R, Mehl-Madrona L, Dell D, Duncan R, Mosier K. From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:75-83. [PMID: 21333034 DOI: 10.1177/070674371105600202] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.
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Affiliation(s)
- Colleen Anne Dell
- Department of Sociology and School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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DINGWALL KYLIEM, MARUFF PAUL, CLOUGH ALANR, CAIRNEY SHEREE. Factors associated with continued solvent use in Indigenous petrol sniffers following treatment. Drug Alcohol Rev 2011; 31:40-6. [DOI: 10.1111/j.1465-3362.2010.00279.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The practice of petrol sniffing is a unique and poorly understood phenomenon that is associated with substantial morbidity, mortality and social devastation in affected remote Indigenous communities. For these groups and for the wider community, much mystery has surrounded the practice and its effects. Here we introduce the epidemiology of petrol sniffing among Indigenous groups internationally, review its impact on the brain, behaviour and social functions and summarise related interventions.
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Affiliation(s)
- Sheree Cairney
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia.
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16
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Aging and Health: An Examination of Differences between Older Aboriginal and non-Aboriginal People. Can J Aging 2010; 29:369-82. [DOI: 10.1017/s0714980810000309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLa population autochtone au Canada, beaucoup plus jeune que la population générale, a connu une tendance au vieillissement depuis les dix dernières années. Utilisant les données de l’Enquete auprès des peuples autochtones de 2001 (EAPA) et l’Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2000/2001, cet article examine les différences dans l’état de santé et les déterminants de la santé et l’utilisation de soins de santé entre la population autochtone de 55 ans et plus et la population non-autochtone. Les résultats montrent que la population plus âgée autochtone est plus malsaine que la population non-autochtone parmi tous les groupes d’âge; cependant, les différences dans l’état de santé entre les groupes d’âge semblent converger avec l’augmentation de l’âge. Parmi personnes âgées de 55 à 64 ans, 7 pour cent de la population autochtone rapport trois ou plusieurs conditions chroniques par rapport à 2 pour cent de la population non-autochtone. Pourtant, parmi personnes âgées de 75 et plus, 51 pour cent de la population autochtone rapport trois ou plusieurs conditions chroniques par rapport à 23 pour cent de la population non-autochtone.
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Grandbois D. Stigma of mental illness among American Indian and Alaska Native nations: historical and contemporary perspectives. Issues Ment Health Nurs 2005; 26:1001-24. [PMID: 16283996 DOI: 10.1080/01612840500280661] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.
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Affiliation(s)
- Donna Grandbois
- North Dakota State University, Fargo, North Dakota 58078, USA.
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The embodiment of inequity: health disparities in aboriginal Canada. Canadian Journal of Public Health 2005. [PMID: 16078555 DOI: 10.1007/bf03403702] [Citation(s) in RCA: 340] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health disparities are, first and foremost, those indicators of a relative disproportionate burden of disease on a particular population. Health inequities point to the underlying causes of the disparities, many if not most of which sit largely outside of the typically constituted domain of "health". The literature reviewed for this synthesis document indicates that time and again health disparities are directly and indirectly associated with social, economic, cultural and political inequities; the end result of which is a disproportionate burden of ill health and social suffering upon the Aboriginal populations of Canada. In analyses of health disparities, it is as important to navigate the interstices between the person and the wider social and historical contexts as it is to pay attention to the individual effects of inequity. Research and policy must address the contemporary realities of Aboriginal health and well-being, including the individual and community-based effects of health disparities and the direct and indirect sources of those disparities.
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Erickson PG, Butters JE. How does the Canadian juvenile justice system respond to detained youth with substance use associated problems? Gaps, challenges, and emerging issues. Subst Use Misuse 2005; 40:953-73. [PMID: 16021924 DOI: 10.1081/ja-200058855] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite a juvenile justice system that, since its inception in 1908, has been predicated on meeting the rehabilitative needs of youth, Canada has few specialized programs for substance misusing young offenders, preferring more holistic approaches. This is in keeping with an addictions treatment system that has evolved recently in the direction of more integrated services within the general health care and social services delivery systems. In addition, Canada has tended to emphasize community-based over institutional treatment programs. Nevertheless, for youth in conflict with the law, "substance abuse" is recognized as a significant risk factor for recidivism. The approximately 9000 young persons held in custodial facilities on any given day across the country are exposed to a variety of programs aimed at reducing antisocial behavior and hence, re-offending. Some of these have a substance use component. Programs for Aboriginal youth offer some of the most innovative approaches for particular drug use problems. This article provides an overview of the Canadian response and elaborates features of some programs, particularly Multisystemic Therapy, mainly in the province of Ontario. Few programs have received adequate evaluation, however, and the need for systematic assessment is crucial for the development of future effective interventions for youth with multiple drug and other problems.
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