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The Universal Prevention Curriculum (UPC) for Substance Use Training Series
Curriculum 1
Introduction to Prevention Science
MODULE 2—EPIDEMIOLOGY OF
SUBSTANCE USE AND THE ROLE OF
PREVENTION
2.1
Introduction
2.2
Training Goals
2.4
Why Prevention Is Important
2.5
Why is Prevention of Health and Social
Problems Important for Any Nation?
2.6
Health, Safety and Well-being Are Related
to National Economic Growth
(Source: World Bank (2008), Population Health and Economic Growth) 2.7
Non-Communicable Diseases Constitute
More than 60% of Deaths Worldwide
2.10
Substance Use: Impact on
Health
2.11
Alcohol Use and Health: Alcohol Use
Disorders
2.12
Prevalence of alcohol use disorders by
sex, WHO region and the world, 2004a
Neuropsychiatric disorders
Gastrointestinal diseases
Cancer
Intentional injuries
Unintentional injuries
Cardiovascular diseases
Fetal alcohol syndrome and pre-term birth
complications
Diabetes mellitus
2.14
Global Alcohol-Attributable Deaths as a Percentage*
of Total Deaths By Disease of Injury, 2004
2.16
Alcohol-Attributable Burden of Disease,
2004
Alcohol-attributable Distribution of alcohol- Population-attributable
DALY's ('000s) attributable DALYs (%) fractions (%)
Disorder or injury Total Male Female Total Male Female Total Male Female
Alcohol use disorders 23738 21154 2584 34.2 35.7 25.5 100 100 100
Road traffic accidents 8046 7123 923 11.6 12 9.1 19.5 24.4 7.7
Cirrhosis of the liver 6632 5271 1361 9.6 8.9 13.4 48.6 59.4 28.5
Other unintentional
injuries 6208 5043 1165 8.9 8.5 11.5 12.2 16.4 5.8
Violence 5443 4814 630 7.8 8.1 6.2 25.1 26.9 16.5
Liver Cancer 2210 1860 350 3.2 3.1 3.5 32.9 39.4 17.6
Epilepsy 2150 1451 699 3.1 2.5 6.9 27.4 34.3 19.3
Self-inflicted injuries 2083 1712 372 3 2.9 3.7 10.6 14.6 4.7
Ischemic heart disease 1807 1917 -110 2.6 3.2 -1.1 2.9 5.1 -0.4
Cerebrovascular
disease 1579 1598 -19 2.3 2.7 -0.2 3.4 6.6 -0.1
Esophagus cancer 1563 1300 263 2.3 2.2 2.6 32.8 41.7 16
Poisonings 1449 1170 278 2.1 2 2.7 19.5 23.9 10.9
Drownings 1378 1129 249 2 1.9 2.5 12.8 15.4 7.4
Hypertensive heart
disease 1203 954 249 1.7 1.6 2.5 15 23.4 6.3
Falls 1152 977 175 1.7 1.6 1.7 6.7 9.4 2.6
Unipolar depressive
disorder 1023 794 229 1.5 1.3 2.3 1.6 3.3 0.6
Mouth and Oro-
pharynx cancers 973 862 112 1.4 1.5 1.1 25.7 30.9 11.2
Breast cancer 546 0 547 0.8 0 5.4 8.2 0 8.3
Colon/rectum cancer 221 183 37 0.3 0.3 0.4 3.8 5.7 1.4
Other neoplasms 128 84 43 0.2 0.1 0.4 6.5 8.3 4.6
Prematurity and low
birth weight 120 645 55 0.2 0.1 0.5 0.3 0.3 0.3
Diabetes mellitus -280 -225 -56 -0.4 -0.4 -0.5 -1.4 -2.5 -0.5
Net alcohol DALYs 69375 59237 10137 100 100 100 4.5 7.4 1.4
2.17
Global Distribution of All Alcohol-Attributable
DALYs by Disease or Injury, 2004
2.18
Alcohol-Attributable DALYs as a Percentage of
Total DALYs by WHO Sub-region, 2004
2.19
Economic Wealth and Alcohol-Attributable Mortality,
and Burden of Disease and Injury by WHO
Sub-regions, 2004
WHO DALYs Deaths DALYs per Deaths per litre GDP-PPP in US$
Subregion (‘000s) (‘000s) litre per 1000 per per capita
inhabitants 10,000
inhabitants
AFR D 2591 90 1.83 1.00 1879
AFR E 5324 179 3.47 1.80 1615
AMR A 3400 55 1.34 0.24 37765
AMR B 8767 264 3.23 1.04 8480
AMR D 1161 28 3.24 0.96 4297
EMR B 258 8 2.58 0.78 11607
EMR D 517 15 3.74 1.19 2528
EUR A 2988 25 0.70 0.08 28880
EUR B 2744 110 2.17 0.92 7803
EUR C 11893 484 4,00 1.75 9211
SEAR B 2945 80 5.76 1.86 3523
SEAR D 9193 275 5.32 1.92 1768
WPR A 791 31 0.63 0.29 29653
WPR B 18338 611 2.53 0.95 4017
World 70910 2255 2.9 1.0 10930
2.20
Smoking and Health
2.21
Prevalence of Daily Smoking Among
Population Aged 15+ by Country
2.23
Health Outcomes: Exposure to Second-
Hand Smoke and Strength of the Evidence
Children-Parental Exposure
Under two years of age=Incidence of acute lower respiratory infections and
hospital admissions-WHO=A; Cal-EPA=A; US Surgeon General=A
Under 14 years of age=Incidence of new cases of asthma-Cal-EPS=A; US
Surgeon General=B
Under 8 years of age=incidence of acute otitis media-Cal-EPA=A; US
Surgeon General=A
Adult Non-Smokers-At Home or At Work Exposure
Over 20 years of age=adult onset of asthma-Cal-EPA=A; US Surgeon
General=B
Over 15 years of age=Incidence of lung cancer-Cal-EPA=A; US Surgeon
General=A; IARC=A
Over 15 years of age=Incidence of any ischaemic heart disease-Cal-
EPA=A; US Surgeon General=A
Evidence: WHO; California Environmental Protection Agency (CAL-EPA); US Surgeon General;
International Agency for Research and Cancer (IARC) 2.24
A=Supportive; B=Suggestive-Number represents the number of sources that rate the level of evidence.
Distribution of Total Deaths and DALYs
Attributable to Second-Hand Smoke, 2004
Study included
Amphetamines
Cannabis
Cocaine
Opioids
20.0 million DALYs of all disease related DALYs (0.8%)
Opioid dependence largest contributor (9.2 million DALYs)
Injecting drug use contributed 2.1 million DALYs related to HIV and
502,000 DALYs related to Hepatitis C
Suicide as a risk of
Amphetamine dependence=854,000 DALYs
Opioid dependence=329,000 DALYs
Cocaine dependence=324,000 DALYs
2.26
World Extent of Psychoactive Substance
Use
http://www.who.int/substance_abuse/facts/global_burden/en/ 2.27
Disability Adjusted Life Years (DALY)
http://www.who.int/substance_abuse/facts/global_burden/en/ 2.28
Costs to Society of Ignoring Prevention
2.32
Evidence-Based Prevention Interventions
2.34
Large-Group Exercise: What is
Epidemiology?
2.37
Epidemiology and Prevention
Various
methods can be used to carry out
epidemiological investigations:
Surveillance and descriptive studies can be used to
study distributions of a health issue
Analytical studies are used to study determinants of
the health issue (etiologic studies)
Forms the foundation for developing prevention
and treatment strategies
Forms the basis for planning and evaluation of
prevention and treatment service delivery
2.39
Prevalence of Substance Use (18-29 Year
Olds)
2.45
Vulnerability to Substance
Use and Progression to
Addiction
2.46
Etiology of Substance Use
2.48
Risk and Protective Factors: Background
(1/2)
2.56
Etiology Model: How the Interactions of Personal
Characteristics and the Micro- and Macro-Level
Environments Work (1/2)
Macro-Level
Environments
Beliefs
Personal
Attitudes
Characteristi
Behaviors
cs
Micro-Level
Environments
• Genetics
• Temperamen
t
• Physiology
1
Macro-Level
Environments
Beliefs
Personal
Attitudes
3 Characteristi
Behaviors
cs
Micro-Level
Environments 2
• Genetics
• Temperamen
t
• Physiology
High Risk
1 2
4
Low Risk
2.59
Micro-Level Influence: Parents and Family
General
Social and cultural environment
Poverty
Physical environment
Environmental Prevention
Restricts access to substances, especially for
youth
Modifies the context of use
Promotes non-substance use norms
©UNODC 2013 2.63
Macro-Level Influences of the Social and
Cultural Environment
2.69
Small-Group Exercise: Following Up with
Interventions
2.72
The Need for
Comprehensive Integrated
Substance Use Services
2.73
Substance Users Represent a Range of
Use Patterns
2.74
Natural History of Substance Use/Abuse
2 Discontinue Use
4 Develop Problems
• Health
- Dependency
- Infections
1 Initiate Use - Chronic problems
- Mortality
• Emotional, psychological
• Social
Influential
Factors
3 Continue Use
=Personal
Characteristics - Frequency
- Multiple Substances 5 No Problems
=Environment
al Factors - Varied Administration
=Pharmacologic
al Factors
2.77
Epidemiology and
Prevention Review
2.78
Epidemiology and Substance Use
Prevention