文章基本信息

标题：US Public Health Agency Involvement in Youth-Focused Illicit Drug Policy, Planning, and Prevention at the Local Level, 1999–2003
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作者：Duane C. McBride ; Yvonne M. Terry-McElrath ; Curtis J. VanderWaal 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：2
页码：270-277
DOI：10.2105/AJPH.2007.112524
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined local public health agencies’ involvement in community illicit drug policy advocacy and provision related to youths to determine the extent to which public health agencies were involved in local drug policy activities and could potentially provide an infrastructure for policy alternatives. Methods. We conducted telephone interviews from 1999 to 2003 with 1793 US public health agencies in 804 communities surrounding schools participating in the Monitoring the Future study. Respondents reported public health agency planning, priorities, and involvement in alternative drug policy advocacy and prevention activities. We examined results for variance by site sociodemographic characteristics. Results. Most students lived where public health agencies provided resources for community- and school-based drug use prevention. More than one third resided where public health agencies advocated for drug policy alternatives and more than one quarter where public health agencies were involved in juvenile drug court programs. Such activities were significantly higher in urban communities, in the West, and in sites where the proportion of African Americans was above the national average. Conclusions. Although local public health agencies could increase participation levels in drug policy alternatives, current involvement suggests that agencies may provide a base for supporting the development of public health alternatives to deterrence-based drug policies. Such a base may be more likely in communities with the highest need for such policies and services. US illicit drug policy varies significantly by state and substance. 1 However, deterrence approaches predominate. Health researchers have called for a public health policy focus that uses prevention and treatment in lieu of incarceration. 2 ^– 4 Whether a public health approach would better address US drug use than would deterrence is the subject of other articles. However, when considering policy approaches involving public health–related components, it would be helpful to know what role US public health agencies already play in drug policy and practice. A 1988 Institute of Medicine (IOM) report seriously questioned the ability of state and local health agencies to address immediate crises and enduring public health problems, including substance abuse. 5 The IOM found that public health system capabilities were inadequate and called for public health “to serve as leader and catalyst of private efforts as well as performing those health functions that only government can perform.” 5 ^(p31) Twelve years later, in a 2000 editorial in the Journal, Des Jarlais 6 called for a public health approach to drug policy, including prevention, treatment alternatives to incarceration, and programs to reduce health consequences of drug abuse. Des Jarlais concluded that a major challenge for public health would be to incorporate scientific drug use research into public policies to reduce harms associated with use. Recent research has shown that state public health agencies are increasing participation in health policy formation and development 7 and are helping to bridge gaps between adolescent drug treatment service need and provision. 8 However, little is known about public health agency involvement in local-level alternative drug policy advocacy. Most drug arrests and policy applications occur at state and local levels. 1 ^, 9 Furthermore, federal drug control spending recently has moved away from treatment and prevention and toward supply reduction. From 2001 to 2007, federal drug control spending for treatment and prevention steadily decreased from 47% of the total budget to 37%, whereas proportional spending on supply reduction increased from 53% to 63%. 10 Thus, the understanding of local public health agency activity relative to drug policy and related local-level services would help provide greater knowledge of the ability to meet the public’s need for substance abuse services. The ideal—but highly costly—method of investigating public health agency drug policy–related activity participation would involve conducting a random sample of all state and local public health agencies. We were positioned to survey public health agencies surrounding a nationally representative sample of middle and high schools. Substance use etiology indicates that drug use initiation occurs primarily during the middle and high school years; thus, it may be important to examine public health agency policies in communities surrounding such schools. 11 ^, 12 secondary-school youths are affected by public health agency advocacy for alternative public health drug policies and prevention activities? (2) What percentage of youths are affected by actual public health agency involvement in such alternatives? (3) Is there evidence for site sociodemographic variance in reported advocacy and involvement?