Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study.

Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June-October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention's sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.

Current cannabis-related situation in the Asia-Pacific region.

PURPOSE OF REVIEW: We present information on cannabis policy, demand, and supply in the Asia-Pacific region. METHOD: A systematic review of peer-reviewed articles using PubMed, MEDLINE, and reliable sources was conducted. We classified the policy implemented in each country into conducting research, legalization of medical and recreational use, decriminalization, cultivation, and others. RECENT FINDINGS: In Australia, New Zealand, and Thailand, medical use has been approved, whereas it is limited in South Korea and Singapore and illegal in other countries. Except Australia, none of the Asia-Pacific region countries allows recreational use. China and Japan are expected to approve medical use, whereas Australia and New Zealand work on decriminalization. Most cultivation is allowed and regulated for medical use. Cannabis seizures have changed in accordance with these policies. Although the national surveys of four countries, that is, Australia, New Zealand, Japan, and Thailand were conducted in different years, the use of cannabis among the general population has increased. SUMMARY: Any change in the legal status of cannabis must be undertaken with caution and fully evaluated at each stage to determine the extent to which these changes are leading to increased numbers of users, oversupply, and health risks including cannabis-related harm.

Effectiveness of school- and family-based interventions to prevent gaming addiction among grades 4-5 students in Bangkok, Thailand.

PURPOSE: This study aimed to assess the effectiveness of Participatory Learning School and Family Based Intervention Program for Preventing Game Addiction by Developing Self-Regulation of gaming addiction among students of grades 4 and 5 in Bangkok. METHODS: A quasi-experimental study was implemented among students of grades 4 and 5 at primary schools in Bangkok selected through multistage random sampling. Two comparable schools were randomly assigned to either the intervention or control group. Then, 310 students in the randomly selected classrooms were allocated to each group. The intervention group received the self-regulation program with school and family involvement to prevent gaming addiction. Master teachers attended in-house training on prevention of gaming addiction in children. Parents of these children received a gaming addiction prevention manual and guidelines. The program lasted 8 weeks. The control group received no intervention. Knowledge and Attitude About Gaming Questionnaire, Game Addiction Screening Test (GAST), and Game Addiction Protection Scale were utilized to assess subjects at baseline, immediately after, and 3 months post-intervention. Descriptive statistics, chi-square, and independent t-test were used to describe characteristics of the participants, and repeated measures ANOVA was analyzed to test the effectiveness of the intervention. RESULTS: The findings revealed that there were significant differences in knowledge, attitude, self-regulation, and gaming addiction behaviors (p < 0.05) immediately and 3 months post-intervention. Positive effects of the intervention included increase in knowledge, attitude, and self-regulation, whereas the GAST score was significantly decreased (p < 0.05) immediately and 3 months after the program. CONCLUSION: The program based on self-regulation and school and family participation is effective for preventing gaming addiction in students of grades 4 and 5 in Bangkok, Thailand.

Trends in the use of illicit substances in Thailand: Results from national household surveys.

INTRODUCTION AND AIMS: Thailand borders some of the world's largest methamphetamine and opioid producing countries and trafficking routes. Thailand's 'War on Drugs' campaign was launched in 2003. This study reports trends in illicit substance use in Thailand over the period 2001-2011. DESIGN AND METHODS: National Household surveys on illicit drug use were conducted in 2001, 2003, 2007, 2008 and 2011. A stratified multi-stage cluster random sampling technique was implemented for each survey. Provinces in four regions were systematically selected using a probability proportionate to the size of the targeted population. Participants were interviewed using structured questionnaires on their history of substance use. RESULTS: The prevalence of illicit drug use within the past drastically decreased from 4.5% in 2001 to 1.0% in 2003 (P < 0.05). Since 2003, the prevalence of illicit use within the past year varied between 1.0% and 1.3%. By 2011, it was estimated that 0.84% have used kratom (a substance derived from Mitragyna speciosa) within the past year. Around 0.20% and 0.19% reported using cannibis and yaba (metamphetamine tablet) within a year of the 2011 survey. Other types of illicit drugs were less commonly used in Thailand. DISCUSSION AND CONCLUSIONS: There was a decrease in prevalence of illicit drug use within the past year between 2001 and 2003 in Thailand. Since 2003, the past year prelavence of illicit drug use has remained relatively stable. From 2001 to 2011, cannabis, kratom and yaba have remained the three most commonly reported types of illicit drugs used in Thailand.

Evaluation of Alcohol Screening and Community-Based Brief Interventions in Rural Western Kenya: A Quasi-Experimental Study.

AIMS: To assess the effectiveness of community-based alcohol brief interventions (ABI) implemented by community-health workers with and without motivational talks (MT) by former drinkers, in reducing harmful and hazardous alcohol consumption. METHODS: We conducted a three-arm quasi-experimental study (one control and two intervention groups) between May and December 2015 in Kakamega County, Kenya. Participants were hazardous or harmful alcohol drinkers with an Alcohol Use Disorders Identification Test (AUDIT) score of 8-19 at baseline. One intervention group received only ABI while the other received ABI + MT. The interventions' effects on AUDIT scores were analysed using linear mixed models. Logistic regression was used to analyse the interventions' effects on low-risk drinking (AUDIT score <8) after 6 months. RESULTS: The study included 161 participants: 52 in the control group, 52 in the only ABI group and 57 in the ABI + MT group. The mean AUDIT scores were lower in the intervention groups at 1, 3 and 6 months post-intervention; the ABI + MT group showed a greater reduction. The mean AUDIT scores over a 6-month period were lower in both intervention groups compared with the control group. The odds of low-risk drinking were almost two times higher in both intervention groups than in the control group, although the effect of only ABI on low-risk drinking was not significant. CONCLUSIONS: ABI + MT and only ABI were associated with a reduced mean AUDIT score among hazardous and high-risk drinkers in this resource-limited setting. ABI + MT was also associated with low-risk drinking in this population. SHORT SUMMARY: Community-based alcohol brief interventions implemented by community-health workers accompanied by motivational talks by former drinkers were associated with reduced hazardous and harmful alcohol consumption in a rural setting in western Kenya.

Correlates of alcohol consumption in rural western Kenya: A cross-sectional study.

BACKGROUND: Studies on alcohol consumption in rural areas in sub-Saharan Africa are scarce. This study aimed to determine the prevalence and determinants of alcohol consumption in rural western Kenya. The study was conducted as a preliminary stage of a community-based intervention to reduce hazardous alcohol consumption. METHODS: A cross-sectional survey of 478 participants aged 18-65 years residing in Ikolomani Sub-county, Kakamega County was conducted in April 2015. Data were collected using an interviewer-administered questionnaire. We defined current drinkers as participants who consumed any alcoholic product in the preceding one month, and hazardous/high-risk drinkers as participants with an Alcohol Use Disorders Identification Test (AUDIT) score of 8 and above. We summarised data using descriptive statistics and used logistic regression to explore for the correlates of each of current alcohol consumption and hazardous/high-risk alcohol consumption. RESULTS: The sex-standardized prevalence of current alcohol drinkers was 31.7% (95% confidence interval (CI): 26.8%-37.2%). The prevalence was higher in men (54.6%) than in women (8.9%). The mean AUDIT score among current drinkers was 16.9 (SD 8.2) and the sex-standardized prevalence of hazardous/high-risk alcohol drinking was 28.7% (95% CI: 24.1%-34.0%). Traditional brews were the most commonly consumed types of alcohol and most drinkers took alcohol in the homes of alcohol sellers/brewers. In multivariate analyses, the number of drinkers in the family, the number of friends who are drinkers and the attitude towards alcohol intake were positively associated with current alcohol drinking status, and with hazardous/high-risk alcohol consumption. Women were less likely to be current drinkers and hazardous/high-risk drinkers than were men. Other socio-demographic factors were not significantly associated with alcohol consumption. CONCLUSIONS: The prevalence of alcohol consumption in the study area was higher than the national level estimate of 13.3%. The results suggest that the social environment is the main determinant of alcohol consumption in this setting. These findings imply that interventions to mitigate alcohol consumption in this area will have to target the social networks of the alcohol consumers, change the drinkers' attitude towards alcohol, and tackle the issue of availability of unlicensed homemade brews.

The Association Between Weapon Carrying and Health Risk Behaviors Among Adolescent Students in Bangkok, Thailand.

Carrying weapons is a significant social and public health problem worldwide, especially among adolescents. The present study examined the association between weapon carrying and related risk behaviors among Thai adolescents. A cross-sectional study of 2,588 high school and vocational school students aged 11 to 19 years from 26 schools in Bangkok, Thailand, was conducted in 2014. This study found that 7.8% of youth reported having carried a weapon in the past 12 months. The high prevalence of weapon carrying was reported by male students, and males were more likely to have reported carrying a weapon than females. The association between weapon carrying and the health risk behaviors like drinking, smoking, any drug use, and physical fighting were significant with higher odds of weapon carrying in all models. Among males, weapon carrying was related to drinking and smoking, any drug use, physical fighting, and school type. Among females, suicidal thoughts were significantly related along with drinking and smoking, any drug use, and physical fighting. Having a mother who used substances was significant only among females. These data could be used for further interventions about weapon carrying to reduce violence.

Examining the Sociocultural Context of HIV-related Risk Behaviors Among Kathoey (Male-to-female Transgender Women) Sex Workers in Bangkok, Thailand.

Kathoey (male-to-female transgender) sex workers (KSW) in Thailand are at high risk for sexually transmitted infections; however, few qualitative studies have been conducted to understand the sociocultural context of engaging in HIV risk behaviors. A total of 24 participants were purposively sampled in Bangkok based on KSW work venues and substance use. Results revealed the importance of participants' understanding of the self in relation to establishing economic independence through sex work, which could then be used to re-establish support from family, who often have not accepted a son's gender transition. Participants linked being kathoey to a belief in fate but did not view engagement in sex work in the same way. Different sex work venues exposed KSW to different risky situations. HIV prevention programs for kathoey must address the importance of economic security and its relation to social support and gender transition within a cultural- and work-environment-specific framework.

Sustainability of Tailored Goal Oriented Community Brief Intervention Model among risky drinkers in community in Thailand.

Tailored Goal Oriented Community Brief Intervention Model (TGCBI), first implemented as culturally secure and acceptable to communities in Thailand, is designed in 2 stages or levels: community level, a culturally secure approach to motivate participants to reconsider their drinking behavior; individual level, involved in the key messages received from the community level together with additional input focused towards individuals. TGCBI's effectiveness was measured by the number of abstinent drinkers and number of alcohol-free months among those who continued to drink at followup in two communities that originally had high prevalence of risky drinking. Multivariate Poisson regression was used to investigate the intervention effect. Results indicated that the number of participants who stopped drinking 6 months later and the number of alcohol-free months during followup were significantly greater (P < 0.05) for 47 participants in the intervention group compared to the control group (n = 50). TGCBI results in sustainable drinking cessation.

Effectiveness of a Tailored Goal Oriented Community Brief Intervention (TGCBI) in reducing alcohol consumption among risky drinkers in Thailand: a quasi-experimental study.

OBJECTIVE: An intervention to reduce the average alcohol intake and the number of drinking days in risky drinkers was conducted in a quasi-experimental study in two communities (intervention and control communities) in Lop Buri Province, Thailand. METHOD: The participants were risky drinkers (with scores ranging from 8 through 19 on the World Health Organization's Alcohol Use and Disorders Identification Test) ages 19-65 years. In the intervention community, individual participants set their own drinking-reduction goals, and each participant received a Tailored Goal Oriented Community Brief Intervention (TGCBI) administered in four sessions over 2 months. The number of drinking days and the average alcohol intake during the past 30 days were measured before the intervention and at 1, 3, and 6 months after it. Complete data were available from 47 intervention and 50 control participants. Intervention effects at each post-intervention time were assessed with linear mixed models. RESULTS: Baseline sociodemographic characteristics showed no statistically significant differences between the two groups (p > .05). At baseline, M (SD) days of drinking and average daily alcohol intake were 12.9 days (10.5) and 20.4 g (19.2), respectively. The intervention was associated with a substantial reduction in both measures at each post-intervention time, and magnitudes of reduction increased with increasing time. Modeled intervention-related reductions in drinking days at successive post-intervention times were 5.1 (p = .031), 7.4 (p = .001), and 9.0 days (p < .001). Corresponding reductions in daily alcohol intake were 16.5, 17.4, and 25.0 g (p < .001 at 1 month, 3 months, and 6 months, respectively, after the intervention). Adjustment for potential confounders and inclusion in the analysis of participants with missing data made little difference in modeled intervention effects. CONCLUSIONS: TGCBI was associated with a substantial and significant reduction in drinking days and average alcohol intake through 6 months after the intervention. TGCBI could well prove beneficial for risky drinkers both inside and outside Thailand.

Social and cultural contexts of HIV risk behaviors among Thai female sex workers in Bangkok, Thailand.

Recently, the number of indirect female sex workers (FSWs) who work at bars/clubs and massage parlors is substantially increasing in Thailand; however, there are huge gaps in knowledge about HIV risk behaviors among indirect FSWs. This study aimed to describe and understand HIV risk behaviors among Thai FSWs in Bangkok in relation to sociocultural factors and work environment (e.g., bars/clubs, massage parlors, brothels, and street). Based on venue-based purposive sampling methods, Thai FSWs were recruited for qualitative interviews (n=50) and survey interviews (n=205). Based on mixed methods, the study revealed that HIV risk and substance use behaviors among FSWs significantly differed depending on work venues, although there were no significant differences between work venues on some key risk behaviors (e.g., inconsistent condom use with primary partners and customers; willingness to engage in unsafe sex with customers). A multiple linear regression analysis revealed that FSWs who had used illicit drugs, were young, had low levels of self-esteem, or reported STIs had frequently engaged in unprotected vaginal sex with customers. Also, FSWs who worked at bars/clubs, were young, had higher income, or reported STIs had frequently engaged in sex with customers under the influence of alcohol. Qualitative interviews illustrated FSWs' alcohol and drug use due to their stressful life (e.g., long working hours and a large number of customers) and easy access to alcohol and drugs. FSWs had shown inaccurate knowledge about HIV prevention methods and engaged in risky behaviors, such as washing vagina with water or toothpaste after having had sex with customers. The HIV prevention strategies in Thailand need to be re-structured through implementing evidence-based HIV prevention intervention programs for FSWs, which must address sociocultural factors (e.g., self-esteem) and alcohol and drug use specific to work venues.

HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand.

Based on combined methods, this study investigated substance use and HIV risk behaviors among kathoey sex workers (KSWs) in Bangkok, Thailand. The study found that only half of the KSW participants reported having been tested for HIV, and that except for one participant, all others had not seen health care providers in the past 12 months. About one third of the participants reported having engaged in unprotected anal sex with customers in the past six months. Almost all participants reported alcohol use, as well as having had sex with customers under the influence of alcohol. The prevalence of marijuana and ecstasy use in the past 12 months was high (32 and 36%, respectively); as was for ketamine (20%) and non-injecting methamphetamine (yaba) use (10%). A multiple regression analysis showed that the participants who were post-operative status, had used illicit drugs, or had been abused by their father and brothers were less likely to use condoms for anal sex with customers. Three quarters of the participants sent money to their families and 35% of the participants expressed their willingness to engage in unsafe sex when customers offer extra money. The qualitative interviews revealed that many identified as girl or kathoey in early age and had been exposed to transphobia and violence from father and brothers. Some reported support for gender transition from their mothers. More than half of the participants currently had difficulties in living as kathoey, such as challenges in the job market and relationship with family members. Family obligation for sending money and the Buddhist concept of karma were discussed in relation to risk behaviors among KSWs. The study provided implications for facilitating HIV testing and developing future HIV prevention intervention programs for KSWs in Thailand.

Methamphetamine dependence treatment rehabilitation in Thailand: a model assessment.

OBJECTIVE: Assess the process and outcome of the treatment rehabilitation program in Thailand by comparing out-patients and in-patients from drug dependent treatment centers (DDTCs) under Matrix and FAST Models. MATERIAL AND METHOD: In the DDTCs, male in-patient and out-patient volunteers aged 15-35 years were randomly selected to assess demographic characteristics, socio-economic status, history of substance use, and other behavior related to their health. Observations of the process of therapy and assessment of patients' improvement were made. After completing the rehabilitation, which lasted four months, trained field workers visited the patients at 1-, 3- and 6-month intervals. Analyses of rehabilitation focused on cognitive and behavioral changes at one and three months. Regarding the follow-up outcomes, comparison of Matrix and FAST Models relapse was analyzed by survival graph and Cox-regression of the days since stopping illegal substance use. RESULTS: Ninety-two in-patients and forty-three out-patients were recruited. No significant difference was found in the characteristics of the patients between the two models or in the treatment centers. After assessing patients at 1-, 3-, and 6-month, more improvement was noted among those in the FAST model than in the Matrix model. CONCLUSION: This research confirmed improvement in attendees at the in-patient treatment model and the effectiveness of rehabilitation.

Effect of "tailored goal oriented community brief intervention model" on AUDIT reduction in Thai communities.

OBJECTIVE: The present study aimed to test the result of Tailored Goal oriented Community Brief Intervention Model (TGCBI) the change of Alcohol Use Disorder Identification Test (AUDIT) scores. MATERIAL AND METHOD: A quasi-experimental research comparing between two high drinking prevalence communities in Lop Buri Province, Thailand, an intervention group with TGCBI Model, and a control group without TGCBI. The TGCBI is a treatment that lies on three components. Firstly the TGCBI based on FRAMES consisting of Feedback, Responsibility, Advice, Menu of Option, Empathy, and Self-Efficacy Secondly, drinkers must voluntarily set-up their goal and drinking reduction design suitable for them and their community. Lastly, key informants such as monks, health personnel, family, and friends can be a source to complete the FRAMES. MEASUREMENT: Measurements are done using AUDIT scores. RESULTS: Fifty subjects in control and forty-seven in intervention drinkers completing 1, 3, and 6 monthly intervals were followed-up. The follow-up of the change of AUDIT score after 1, 3, and 6 months of TGCBI in the two communities showed that intervention community, with TGCBI had a decrease in AUDIT score when compared within its community and with a controlled community. CONCLUSION: The results proved TGCBI model is effective in AUDIT reduction.

Drug and alcohol services in middle-income countries.

PURPOSE OF REVIEW: The present review summarizes current research in middle-income countries on drug and alcohol services for prevention, screening, treatment, care and rehabilitation between June 2006 and December 2007. RECENT FINDINGS: There is a dearth of scientific literature on prevention, treatment and rehabilitation in middle-income countries and no novel effective approaches reported during the review period. The Lancet Series on Global Mental Health showed only 0.7% of all papers reviewed were on low-income and middle-income countries. Several studies in these countries confirmed the effectiveness of brief interventions in treating alcohol use disorders at a primary care level. One study on alcohol screening in Brazil produced a promising screening tool. Other studies reported the availability of pharmacological and nonpharmacological treatments for alcohol and drug use disorders. Overall, poor accessibility to services and delayed onset of treatment persist. Political and cultural environments play a crucial role in providing services to fulfill treatment needs. SUMMARY: During the review period, reports from middle-income countries on alcohol and drug services were very limited. A few studies in some countries confirm the effectiveness of brief interventions in primary care settings. There is an obvious need for more research on alcohol and drug treatment services in middle-income countries.