ABSTRACT
AIM: To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care. DESIGN: A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20). SETTING: A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated. PARTICIPANTS: A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized. INTERVENTION AND COMPARISON: ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406). MEASUREMENTS: Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up. FINDINGS: Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47). CONCLUSION: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.
Subject(s)
Primary Health Care/methods , Substance Abuse Detection/methods , Substance Abuse Detection/statistics & numerical data , Substance-Related Disorders/diagnosis , Adult , Alcohol-Related Disorders/diagnosis , Chile , Female , Humans , Male , Middle Aged , Referral and Consultation , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
El concepto de promoción de la salud surgió de forma simultánea al de igualdad y equidad. Estos conceptos implicaron un giro en la forma de explicar fenómenos de salud-enfermedad, incorporando la perspectiva psicosocial y contextual. No se ha desarrollado una reflexión crítica sobre cómo una universidad saludable debe incorporar la perspectiva de igualdad y equidad en salud. OBJETIVOS: describir la relación entre estos conceptos; identificar mecanismos explicativos de desigualdad; proponer pasos a seguir para promover la equidad e igualdad en una universidad. METODOLOGIA: búsqueda de literatura en bases de datos y reportes recomendados por expertos. Resultados: se presentan definiciones de determinantes sociales de salud, desigualdad, equidad y promoción de salud; se revisa la evidencia de desigualdad social y sus consecuencias en salud en la comunidad universitaria; se discuten posibles modelos explicativos de dichas desigualdades y se establecen algunos posibles pasos a seguir para reducir estas diferencias en salud en una universidad. CONCLUSIONES: un ambiente universitario más igualitario y equitativo podría contribuir de manera concreta a catalizar una vida sana en esta comunidad. Una universidad con estructura y cultura más igualitaria y equitativa, es un camino desafiante y complejo, pero seguro hacia el éxito.
The concept of health promotion emerged simultaneously with those of equality and equity. These concepts implied a change in the way in which the phenomena known as health and disease are explained, thus incorporating psychosocial and contextual perspectives. However, no critical reflection has been developed regarding how a healthy university should incorporate the perspectives of equality and equity in terms of health. OBJECTIVES: to describe the relationship between these concepts, identify the mechanisms that explain inequality, and propose steps to promote equity and equality at the university level. METHODOLOGY: a literature search using databases and reports recommended by experts (a total of 62 documents.). RESULTS: we present definitions for the social determinants of health, equality, equity, and health promotion. We also review the evidence of social inequality and its impact on health in the university community. Likewise we discuss possible models explaining these inequalities and establish some possible steps to follow in order to reduce the differences in terms of health at the university level. CONCLUSIONS: a more equal and equitable university environment could contribute specifically to bring about a healthy life in its community. Achieving a university with a more egalitarian and equitable structure and culture is a challenging and complex task, but it will surely lead to success.
