A cluster randomized trial of community mobilization to reduce methamphetamine use and HIV risk among youth in Thailand: Design, implementation and results.

Autor: Galai N; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Statistics, Haifa University, Haifa, Israel. Electronic address: ngalai1@jhu.edu., Sirirojn B; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: bangorn.s@cmu.ac.th., Aramrattana A; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: apinun.aramrat@gmail.com., Srichan K; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: kamolrawee@yahoo.com., Thomson N; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: nicholast@unimelb.edu.au., Golozar A; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: asieh.golozar@gmail.com., Flores JM; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: Jose.flores@yale.edu., Willard N; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Ellen JM; Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. Electronic address: jellen@jhmi.edu., Sherman SG; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: ssherman@jhu.edu., Celentano DD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: dcelent1@jhu.edu.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2018 Aug; Vol. 211, pp. 216-223. Date of Electronic Publication: 2018 Jun 19.
DOI: 10.1016/j.socscimed.2018.06.013
Abstrakt: Background: Use of methamphetamines (MA) and other stimulants have consistently been associated with HIV/STI risk globally. We evaluated a community mobilization intervention (Connect to Protect, C2P ® ) to prevent MA use among youth and reduce HIV risk behaviors through community structural changes.
Design: A community-randomized trial in northern Thailand with matched districts randomized to C2P intervention or a standard voluntary counseling and testing (VCT) control. Intervention districts formed stakeholders' coalitions to plan tailored local prevention programs. Two independent random household samples of youth aged 14-24 were surveyed in 2009 and 2012. Lifetime and recent MA use was modeled with multilevel logistic regression.
Results: Intervention initiatives included family-strengthening programs, school-based programs and opening a community drug treatment center. Control communities applied the government-led "war on drugs" approach in addition to youth and family programs. Baseline (N = 1077) and follow-up (N = 1225) samples included 47.5% females and 21.7% aged ≤16. Lifetime MA use in intervention districts reduced from 13.4% to 11.7% compared to reduction from 16.2% to 10.4% in the control districts (non-significant). In models, lifetime MA use was associated with: time (aOR = 0.6, 95%CI: 0.38-0.83), females (aOR = 0.2, 95%CI: 0.15-0.29), increasing age (aOR = 2.4, 95%CI: 1.40-4.20, ages 16-19; aOR = 3.5, 95%CI: 2.00-6.12, ages ≥20), and not being full-time students (aOR = 5.3, 95%CI: 3.77-7.37). Recent MA use showed similar results. Additionally, lifetime MA use was significantly associated with alcohol use, risky sexual behaviors and elevated depressive symptoms.
Conclusions: Delay in developing and implementing specific prevention programs in the intervention districts slowed diffusion of the effect into the communities. Secular trends with contentious civil unrest and active drug-enforcement efforts in the control communities also contributed to the null intervention effect. Longer time and intensified efforts stressing a public health approach are needed to demonstrate the effectiveness of community mobilization in reducing substance use and HIV risk in this rural Thai community.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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