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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A discussion of adolescent high-risk behavior and associated stigma is presented from the perspective of teenagers confined in juvenile detention. Data contributing to this discussion originate from a qualitative research study designed to discover the meaning detained adolescents associate with substance use/abuse and to describe how they make substance-related decisions while in juvenile detention. This pilot study was part of a program of ongoing ethnographic research in the setting of a large metropolitan juvenile detention facility (JDF). Twenty teenagers participated in the study during interviews and focus group discussions. A major theme among all six focus groups involved resolutions to quit drugs and alcohol after release. The trajectory of substance abuse interwoven in these discussions most frequently began with problems at home, progressed to substance abuse and other high-risk behaviors, and culminated in detention. All of the groups gave suggestions for the kind of help teenagers need most: someone to listen and to care.
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PMID:Resolutions and risk-taking in juvenile detention. 770 65

Despite the growing national concern about the effect of the use of alcohol and other drugs on the health and productivity of men and women, relatively little is know about alcohol and other drug (AOD) problems in women. Because of this lack of research and the stigma associated with women who are alcoholic or drug addicted, AOD problems among women are less likely to be recognized and addressed. This article reviews patterns and consequences of AOD use among a number of special populations of women. Information about risk factors and assessment and screening are included to assist the nurse in the identification, counseling, and referral of women with AOD-related problems.
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PMID:Patterns of alcohol and drug use among women: focus on special populations. 824 41

The mental and physical health care issues of medical students are increasingly recognized as both prevalent and complex. Emotional distress, symptoms of mental illness, and maladaptive substance use are widespread and may often be driven by training-related stressors. The data suggest that nearly all medical students identify physical health concerns as well. The care of medical students as patients is complex because of problems associated with the stigma of various illnesses and the dual role of trainee and patient in medical school. A written confidential survey assessed students longitudinally near the end of their first and third years of training regarding their perceived health care needs, health concerns, attitudes toward care, access to services, and care-seeking practices (161 items). A subset of students (n = 33) were reassessed 1 month after the second survey to measure reliability. McNemar's chi-square (chi2) tests, repeated-measures multivariate analysis of variance (MANOVA), and K and Pearson correlations were used to evaluate outcomes. Almost all students reported health care needs during both training phases, and their mental and physical health concerns were stable over time. However, the preference for obtaining health care at a site other than their training institution and concerns about confidentiality increased, although students were marginally more likely to obtain care at their medical school during clinical versus preclinical training. The students' tendency to seek informal care from colleagues remained consistent, as did their high level of concern about professional jeopardy relating to personal health issues. Their tendency to accept the dual patient-student role depended on the particular health care issue; they expressed a strong tendency to protect other students' confidentiality, even in cases of potential significant impairment. Responses were reliable across a 1-month retest interval. We conclude that medical students' perspectives on their mental and physical health care across the transition from preclinical to clinical training reveal the importance of pursuing, not neglecting, a number of clinical and educational initiatives. Through their specialized expertise, psychiatrists may help to ensure sound mental and physical health care for the more than 69,000 medical students in training in this country.
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PMID:Medical students' evolving perspectives on their personal health care: clinical and educational implications of a longitudinal study. 1092

Models of program development have primarily focused on the internal organizational processes needed to plan, implement, and evaluate new service programs. However, creating an external demand for new programs by policy makers, administrative bureaucracies, public health officials, and funders is critical to establishing new programs. A series of deaths of seropositive youth and an absence of local service settings with staff trained to address the needs of youth living with HIV provided the impetus for Larkin Street Youth Center. In particular, the agency had to overcome stigma associated with having both substance use and mental health disorders to establish service programs to recruit and mobilize staff within the agency and the local community and to establish a comprehensive housing program for symptomatic HIV-infected adolescents. This article examines how a residential assisted care facility for HIV-seropositive adolescents was established using organizational strategic planning processes, problem solving, and social marketing frameworks.
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PMID:Developing services for substance-abusing HIV-positive youth with mental health disorders. 1107 Jun 32

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N= 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.
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PMID:Interest in and obstacles to pursuing work among unemployed dually diagnosed individuals. 1186 73

Problematic and unhealthy personality characteristics have typically been the focus of researchers interested in the possible causes of substance use/abuse. Recent research has begun to identify differences between individuals based upon frequency of use, with indications that moderate users may have "healthier" characteristics than either abstainers or regular users. The present study was conducted in a rural setting and compared personality structure (based on the California Psychological Inventory) among three groups of college students: abstainers, experimenters, and regular users. The comparisons were conducted as a function of all illicit substance use (excluding alcohol) and for alcohol use only. Minimal support was obtained for the above hypothesis when comparing the three groups on illicit substance use. When comparing the three groups on alcohol use only, support for the theory was identified, with fewer differences found between the experimenters and the abstainers than between the experimenters and the regular users. It is suggested that rural use of psychoactive substances may be more limited to alcohol due to easier availability and less stigma. Data supporting the "healthier" personality structure of moderate users of alcohol would thus be more likely in rural settings even though such use would still be "risky" behavior given its illegality for individuals under age 21. The need for adaptations to current treatment approaches is suggested.
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PMID:Personality characteristics as a function of frequency and type of substance use. 1256 24

Despite increasing need for HIV prevention research and intervention programs, the voices and stories of Asian and Pacific Islander men who have sex with men (API MSM) have remained absent from HIV prevention literature. Five focus groups with API MSM (N = 38) were conducted to identify psychological, social, and cultural factors related to HIV risk and protection. Six themes were identified based on focus group discussion: (a) dual-identity status, (b) coming out and disclosure issues, (c) relationships and dating, (d) substance use, (e) sexual risk reduction strategies, and (f) health and social services. Narrative data indicate that multilevel HIV prevention intervention strategies are necessary for addressing the unique psychosocial and behavioral HIV risk factors among API MSM, such as dual stigma stemming from homophobia and racism, discomfort with sexuality, power dynamics and stereotypes in relationships with White men, substance use, and low utilization of health and social services.
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PMID:HIV risk and prevention among Asian/Pacific Islander men who have sex with men: listen to our stories. 1263 May 96

Palliative care for patients infected with human immunodeficiency virus (HIV) includes components of pain and symptom management, advance care planning, prioritization of life goals, and the support of individuals and families throughout the entire continuum of the disease. There are numerous social stressors such as stigma, infected family members and caregivers, loss of housing and independent living, and the increasing influence of substance use in all communities. Because many barriers prevent those with advanced disease from getting comprehensive pain and symptom management as well as option planning, it is important for all HIV care providers to improve their knowledge, sensitivity, and competence regarding this aspect of care. This article provides an overview of critical issues in palliative care and information on how best to improve HIV primary care.
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PMID:Integration of palliative care into primary care for human immunodeficiency virus-infected patients. 1525 40

The World Health Organization (WHO) report on the Neuroscience of Psychoactive Substance Use and Dependence represents a summary of the latest scientific knowledge on the role of the brain in substance dependence. The findings of the report have important applications to both interventions and public health policy. Specifically, the report notes that psychoactive substances have physical and symbolic effects that are rewarding to the user. It notes that adverse consequences of psychoactive substance use are related to the level, pattern, mode, and context of use. Dependence is seen as a complex disorder involving brain mechanisms rather than a failure of will. The report notes that psychoactive substance use often coexists with other mental health problems, and that stigma associated with substance misuse inhibits treatment seeking. There is growing evidence for the efficacy and effectiveness of interventions, including advances in pharmacotherapy. However, these advances raise ethical issues that need to be addressed.
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PMID:From basic research to public health policy: WHO report on the neuroscience of substance dependence. 1534 78

People living with HIV/AIDS who have both a co-occurring mental health diagnosis and a substance use disorder (individuals with triple diagnoses) frequently do not receive adequate treatment for one or more of their illnesses. Poverty, risky behaviours, vacillating motivation, and cognitive impairments are additional problems facing many individuals with triple diagnoses. In many communities the service system is inadequately prepared to serve this population. Treatment barriers include stigma associated with the three illnesses, separate funding streams, and lack of co-ordination between medical, mental health, and substance abuse treatment facilities. This paper discusses strategies for recruiting, engaging, and retaining individuals with triple diagnoses in both treatment and research. Recruitment strategies should be directed at both professionals and individuals with triple diagnoses themselves. Recruiting and engaging these individuals in treatment requires that comprehensive services be provided on a 24-hour basis in a flexible and culturally competent manner. A team approach is often the most effective way of providing such services. Retaining individuals with triple diagnoses in a longitudinal research study requires multiple strategies including the collection of detailed tracking information, outreach workers, and financial incentives for completing the interviews.
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PMID:Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders. 1573 22


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