AnnouncementsExam infoThe exam is not cumulative. We just have to study what we have learned since the 2nd exam. The test is in 3 weeks.GoalsUnderstand what the public health perspective is and how health disparities exist and to become familiar with them.Prevention as a drug policyEffective supply reduction techniques (e.g. increase cost, limit availability) clearly reduces drug useBut as long as there is demand, there is supplyDrugs will never disappearSupply reduction has unintended consequencesPrevention and treatment programs can reduce demandFrom a public health perspective, we should look at the health of a city, health of a state, or health of a whole nation. Looking at it from those perspectives the stakeholders are different.The more drugs cost the less people will be able to afford them so then less people use them.Knowing that supply control will not be effective in total, we need to do other things. And one of these things is prevention and treatment programs.Prevention paradoxThe large number of people at small risk contribute more harm/costs than the smaller number of people who are individually at greater risk or the people who use drugs at a harmful and high-risk are more harmful than the people who have severe dependence or have substance use disorder. People with less severe problems contribute more to the cost of the nation than those with more severe problems.When we move away from the chronic disease perspective, that really concentrates on those with the highest problems, we start looking at what is the whole nation is like and what the consequences of use are.People who have the most severe problems, who are the most severely addicted, they contribute to the least amount of the nations suffering from the consequences of drugs and alcohol. This is because there are so few people who are addicted severely. This is the top of the pyramid; this is also where substance use disorder is located.The vast majority of people who use substances use them at low levels or at high or risky levels.The top of the pyramid has a small number of people at great risk.The middle part is a large amount of people who are individually at a smaller risk. There are far more aggregate costs, injuries, years of life lost, etc. If we really want to make a difference for the nation we have to change the middle part of the pyramid.The bottom of the pyramid is low risk and abstinence and this is not a problem area either.Drug and alcohol related injuriesSaturday night in a Dallas Emergency RoomMany people are in the hospital for drug or alcohol related reasons.Some of the people in this video could have been severely addicted, or at the top of the pyramid. But the video shows that it isn’t that someone has a chronic addiction, the most cost to society is that intoxication and the injuries that occur during that. You don’t have to be drinking everyday to experience the harms that can occur from being intoxicated.It really is a lot of life lost when you compare alcohol or drugs to young people when compared to older people and their diseases.Types of prevention in public healthPrimary PreventionPrevent use before it startsAimed primarily at younger people. This is because typically drug and alcohol use is among young people.Primary Prevention is trying to prevent it before it starts to be useful.Secondary PreventionCurtail further problematic or risky usePrevent addiction and disorderAimed at persons who have used substancesPeople who have experimented and tried but are not yet severely addicted. This could be college students or other people who started using but have not become severely addicted.Tertiary PreventionIntervention, treatment, recoveryAimed at people who have developed addiction problemsThis is aimed at people who are already addicted. These are treatment programs to reduce addiction, etc. This is trying to take care of the problem after it already happens.The younger you are the lower prevention you will probably receive.Defining goals and evaluating outcomesGoal of presenting negative information about drugs to youth = preventionPrograms should be evaluated according to rates of substance use among those who attended the programUntil recently, most drug prevention programs were not evaluatedSome are still not evaluated todayFor youth, primary prevention will send messages that have to do with the negative consequences of use; the programs will probably talk to people about beliefs about use and change attitudes about using drugs.To evaluate programs you have to think of what population are they targeting, and what outcomes are most useful to that population.An example would be DARE which made people feel good because they thought something was being done about drugs. But because it wasn’t evaluated there was no information about what was really going on. And once it was evaluated it seems like it doesn’t really work.Montana Meth Project“Large-scale exercise in prevention, aimed at significantly reducing Meth use in Montana…”View methamphetamine as a consumer products/marketing problemMeth is a readily available, affordably priced consumer product.Perceived as attractive with little risks. “This is the root of the problem.”Goal was to increase knowledge about meth so Montana youth could make a better informed decisionTo manufacture this drug it creates a lot of toxic waste and you need a lot of chemicals. Most people to make this drug would go to a rural area away from people and manufacture it.This state is a really rural state so meth is used frequently.These tactics were informed by people’s hypotheses of why people use meth.For this program they wanted to convince youth that the drug is really risky.They use scare tactics; they tried to scare kids to not use meth.Montana Meth Messaging CampaignHigh-impact advertising that graphically communicates risks of meth useTV, radio, billboards, newspapers, internetStatewide targeting youths age 12-17Reach 70-90% of the target audience 3x/weekSample advertisementsThese ads might not work for everyone. Because these ads are so extreme it might not be always convincing. Some people continue to use substances is because they don’t think there are risks.Many people who use these drugs, if these effects from the video did not happen to them, they might think they don’t need to stop because their use is not risky.Claims by Montana Meth Project developersDramatic shifts in perception of risks, more parent-child