DRUG POLICY IN THE TIME OF AIDS:

In 1985, the National Institute on Drug Abuse (NIDA) funded an ethnographic research project in San Francisco to study the needle sharing behavior of injection drug users (IDUs). The goal of the research was to develop a strategy to slow the spread of HIV among this hidden and hard to reach population of drug users and their sexual partners. This small-scale project grew into a model intervention in which bleach, condoms, and street-based education by outreach workers were employed to inform IDUs of the risk of AIDS and of methods for protecting themselves. The "reach and teach bleach" model was adopted by NIDA and implemented in a number of American cities. This study describes the development of the model intervention, the adoption of the model by NIDA as part of its National AIDS Demonstration Research (NADR) project, and the political circumstances under which the city of San Francisco applied for the NADR grant. Drawing on Social Worlds/Arena theory, and based on extensive interviews and participant observation, a sociohistorical analysis examines the initial development, implementation, and disintegration of the model outreach project and the impact of the program on drug policy in the city of San Francisco.     

MOVING OUT OF THE HOUSE: AN ANALYSIS OF CONGRESSIONAL QUITS

Despite extensive study concerning involuntary departures by U.S. House members, little has been said about voluntary departures from the House–-quit behavior. This paper has three primary purposes: (1) to establish a theoretical framework that models the full range of choices a representative faces in any given term, (2) to measure the impact of different variables that affect representatives' quit behavior, and (3) to explain why Republicans have been more likely to pursue higher office than their Democratic colleagues.     

Dose-Response and Risk Assessment of Airborne Hexavalent Chromium and Lung Cancer Mortality

This study evaluates the dose-response relationship for inhalation exposure to hexavalent chromium [Cr(VI)] and lung cancer mortality for workers of a chromate production facility, and provides estimates of the carcinogenic potency. The data were analyzed using relative risk and additive risk dose-response models implemented with both Poisson and Cox regression. Potential confounding by birth cohort and smoking prevalence were also assessed. Lifetime cumulative exposure and highest monthly exposure were the dose metrics evaluated. The estimated lifetime additional risk of lung cancer mortality associated with 45 years of occupational exposure to 1 microg/m3 Cr(VI) (occupational exposure unit risk) was 0.00205 (90%CI: 0.00134, 0.00291) for the relative risk model and 0.00216 (90%CI: 0.00143, 0.00302) for the additive risk model assuming a linear dose response for cumulative exposure with a five-year lag. Extrapolating these findings to a continuous (e.g., environmental) exposure scenario yielded an environmental unit risk of 0.00978 (90%CI: 0.00640, 0.0138) for the relative risk model [e.g., a cancer slope factor of 34 (mg/kg-day)-1] and 0.0125 (90%CI: 0.00833, 0.0175) for the additive risk model. The relative risk model is preferred because it is more consistent with the expected trend for lung cancer risk with age. Based on statistical tests for exposure-related trend, there was no statistically significant increased lung cancer risk below lifetime cumulative occupational exposures of 1.0 mg-yr/m3, and no excess risk for workers whose highest average monthly exposure did not exceed the current Permissible Exposure Limit (52 microg/m3). It is acknowledged that this study had limited power to detect increases at these low exposure levels. These cancer potency estimates are comparable to those developed by U.S. regulatory agencies and should be useful for assessing the potential cancer hazard associated with inhaled Cr(VI).     

Community-based household waste management: Lessons learnt from EXNORA's ‘zero waste management’ scheme in two South Indian cities

This paper presents two case studies on the efforts by a community-based organisation to promote a sustainable integrated waste management system in Indian mega cities. This effort was initiated in 1989 by a local non-governmental organisation (NGO) called EXNORA and is based on a ‘zero waste management scheme’ set up, run and financed by the residents themselves. As this model has been widely quoted as successful, the study aims at learning from two communities implementing this model.Results are reported from a survey of the two schemes that used various tools to assess both their performance and sustainability in selected residential areas of two Indian cities, Chennai and Hyderabad. The results indicate limited success of the schemes both in saving a significant fraction of the generated waste from dumping, and in rehabilitating the local poor. However, they show that motivated individuals can successfully set up and manage waste collection systems that lead to overall environmental improvements. The differences in the two schemes reflect how the local assets and contexts impact on the success of the scheme. The scheme in a rich neighbourhood of Hyderabad was less ambitious in its overall objectives and focussed on the provision of a waste management service, using the opportunity to provide local employment to a socially deprived fraction of the population. The scheme in a middle-class area of Chennai, although pioneering in its approach, suffered from diseconomies of scale and lack of social integration, making it less viable in the medium to long term. Both schemes suffered from a lack of community involvement, motivation and political support, which threatens the long-term sustainability of the enterprise. The research concludes that the role that communities can realistically play in management of their own waste depends on the local context. The system advocated by EXNORA seems to require significant local resources, and political and technical support which are hard to find and sustain without strong local leaders. Another model set up in the city of Visakhapatnam is finally introduced as an alternative. This is based on triangular contracts between the municipality, the residents and micro-enterprises and may provide a good solution in dealing with the technical and commercial aspects which communities find difficult.     

Consistencies and Inconsistencies: Mental Health, Compulsory Treatment and Community Capacity Building in England, Wales and Australia

In relation to mental health, it is clear that medicalized underpinnings,the provision of a clinically orientated evidence base for practiceand the need to contain ‘risk’ continue to be prioritized,particularly when compulsory intervention is considered. Thisis despite the increasing influence of a citizenship and socialjustice agenda which is being promoted by psychiatrists involvedin the development of ‘postpsychiatry’, as wellas by service users/survivors. These drivers are not mutuallyexclusive, but in the context of compulsory treatment, thereare clear tensions. In this article, the policy surroundingmental health and compulsory intervention in Australia and inEngland and Wales is explored. In the context of this discussion,three ways in which current government policy can be interpretedare examined and links made between these interpretations anddifferent ways of viewing the relationship between mental healthand community capacity building. With regard to social workpractice, it is argued that a response to mental ill healthwhich concentrates on an individualized ‘diagnose andtreat’ approach, which particularly comes to the foreat times of compulsory intervention, has limited capacity tofacilitate community engagement, foster social inclusion andgenerate reciprocal dynamics between positive mental healthand community capacity building.     

Adult Drug Treatment Courts: A Review

Drug treatment courts (DTCs), an alternative to traditional criminal courts, provide an innovative way to legally process some drug offenders. The origin and recent growth of the drug court system in the USA can be explained as an unintended consequence of a failing 'war on drugs'. In this article, we discuss the spread of adult DTCs throughout the USA, the main components of drug courts, controversies surrounding DTCs, and some criticisms of drug courts. We summarize the recent evaluations of adult DTCs, and highlight various DTC factors that have been found to reduce individual drug use and criminal activity. We also offer suggestions for future research on DTCs and conclude with policy recommendations.     

POTENTIAL COMPETITION AND POSSIBLE COLLUSION IN FOREST SERVICE TIMBER AUCTIONS

Potential competition significantly affects the size of winning bids in Forest Service sealed-bid timber auctions and has little effect on winning bids in oral auctions. Winning sealed bids depend even more, however, on actual competition, a result suggesting collusion. This explanation is supported using an index representing the likelihood an auction was rigged. Preclusive bidding (a type of collusion) in oral auctions is indicated by a positive relationship between hauling distances and the size of winning sealed bids. Comparisons of winning-bid variances, overbids, and numbers of bidders across auction type support this explanation of oral auction prices.     

Utilizing a game for both needs assessment and learning in adolescent sexuality education

A fact-gathering, experimental game proved to be an effective instrument in the needs assessment phase of an adolescent sexuality educational program aimed at low-income females. The game ("Family Few"), which covered the topics of menstruation and reproduction, was played by 35 Black, Hispanic, and white females aged 13-16 years recruited from medical and psychiatric clinics in Miami, Florida. The goals of the game were to elicit terminology used by participants, identify and correct misconceptions and misinformation, and determine if learning could occur. Although 57% of participants reported prior exposure to formal sex education, misinformation about the need for activity curtailment during menstruation and the importance of early pregnancy detection was widespread. Group members believed they needed to restrict activities involving physical exercise, sexual relations, water, and cold during menses and were not likely to seek medical or family consultation regarding a missed period until the end of the 1st trimester of pregnancy. Also evident was a need for accurate information on the side effects, risk factors, benefits, and effectiveness of contraceptive methods. The group responses enabled the sex educators to prepare a culturally responsive, developmentally oriented curriculum for further work with disadvantaged female adolescents. The group process was ranked highly on the Likert Scale by these teenagers as an enjoyable, useful means of information dissemination and problem solving.