Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1
Social determinants
United States
California
San Francisco
2
Acknowlegments
4
Inter-generational, life course roots of health and well-being, 1960s, 2004, 2016
5
Physical and behavioral health outcomes with 4 or more ACEs
Bucci et al. Toxic Stress in Children and Adolescents, Advances in Pediatrics. 2016;63:408
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Social determinants of toxic stress and behavioral health outcomes
Bucci et al. Toxic Stress in Children and Adolescents, Advances in Pediatrics. 2016;63:408
Behavioral health outcomes
• Alcoholism
• Anxiety
• Bipolar disorder
Social determinants
• Depression
1. Structural trauma, • Difficulty controlling anger
discrimination, racism • Hallucinations
• High stress
2. Inter-generational • Panic reactions
transmission • Post-traumatic stress disorder
• Smoking
3. Life course • Substance abuse
neurodevelopment • Suicide
• Bullying
4. Exploitation of
• Dating violence
neuro-vulnerabilities • Delinquent behavior
• Learning difficulties
• Physical fighting
• Weapon-carrying 7
United States
8
New York Times, June 2019: Teenage Drug and Alcohol Use Is Falling
Percent of 10th graders who have used various substances in the last year
10
Depression and anxiety in young adulthood according to cannabis use
Gobbi G et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and
Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Feb
13. doi: 10.1001/jamapsychiatry.2018.4500. PubMed PMID: 30758486. 11
Suicidal ideations and attempts according to cannabis use
Gobbi G et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and
Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Feb
13. doi: 10.1001/jamapsychiatry.2018.4500. PubMed PMID: 30758486. 12
Pain in the Nation: Building a National Resilience Strategy, June 2019
Alcohol and Drug Misuse and Suicide and the Millennial Generation—A Devastating Impact
http://paininthenation.org/
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Alcohol and Drug Misuse and Suicide and the Millennial Generation
Pain in the Nation: Building a National Resilience Strategy (http://paininthenation.org)
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Alcohol and Drug Misuse and Suicide and the Millennial Generation
Pain in the Nation: Building a National Resilience Strategy (http://paininthenation.org)
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Alcohol and Drug Misuse and Suicide and the Millennial Generation
Pain in the Nation: Building a National Resilience Strategy (http://paininthenation.org)
16
California
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California Opioid Overdose Surveillance Dashboard
URL: https://discovery.cdph.ca.gov/CDIC/ODdash
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San Francisco
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San Francisco overdose deaths, 2006–2017
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SF Community Health Needs Assessment, 2019 (http://www.sfhip.org/)
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Overdose deaths in San Francisco, 2011-2018
Erin Allday, San Francisco Chronicle, June 23, 2019
22
San Francisco Harm Reduction
OVERDOSE
ADVISORY
San Francisco’s fentanyl supply is
VERY STRONG right now, containing
more fentanyl than we’ve previously
seen in other samples we’ve tested!
In the last week, we’ve seen an increase in overdose, and
10 people have died in from suspected opioid overdose in
San Francisco, almost all inside and alone.
REMEMBER TO BE CAREFUL, USE LESS & SLOW TO
START, TRY NOT TO USE ALONE, AND MAKE SURE
Harm Reduction Center, SF AIDS Foundation EVERYONE HAS NARCAN!
Fentanyl is a strong synthetic opioid, meaning the margin of error when using is
(https://www.sfaf.org/locations/harm-reduction-center) small. With the supply currently containing MORE fentanyl, that means it’s even
harder to dose. People are overdosing while injecting and smoking, so always
SF DOPE Project, Harm Reduction Coalition use with caution!
Need Narcan?
(https://harmreduction.org/issues/overdose-prevention/dope-sf) Go to any syringe access site (6th Street, Glide, Drug User’s Union, HYA, St. James)
for as many free injectable naloxone kits as you need!
Charles Hawthorne, Trainer, email: hawthorne@harmreduction.org Go to the CBHS Pharmacy at 1380 Howard, Mon - Fri 9am - 3:30pm for a free
training and nasal naloxone kit!
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San Francisco Harm Reduction
Low Barrier Buprenorphine Pilot Program (Dr. Barry Zevin, Street Medicine)
Between Nov, 2016 and Oct, 2017, 95 patients were evaluated and received at least
one prescription for buprenorphine.
(a) 36% of urine toxicology tests were opioid negative
(b) 34% with any F/U has at least one opioid negative test
(c) 14% of those with any F/U had had abstinence from opioids on all tests
Safety First: Real Drug Education for Teens (Dr. Marsha Rosenbaum & DPA)
Honest and accurate information to empower teens to reduce drug-related harms.
50
Black/African American
Chinese
40 Filipino
Latino
Pacific Islander
30
Percent
White
20
10
0
2009−2011 2013−2015
Year
25
Cannabis age-adjusted rates (per 10,000), San Francisco, 2006-2015
Cannabis Legalization in San Francisco: A health impact assessment, SFDPH 2017
80 80
Black/African American
Latino
60 60 White
Black/African American
40 Latino 40
White
20 20
0 0
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