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Article Review

Sherman, S. S., Plitt,S., Salman ul Hassan, Cheng, Y., & S. Tariq Zafar, (2005). Drug
Use, Street Survival, and Risk Behaviors among Street Children in Lahore,
Pakistan. Journal of Urban Health: Bulletin of the New York Academy of
Medicine, Volume 82 (3). pp.iv113-iv124.

Summary

Three categories of drug-use status in street children (the former drug users, the
never drug users and the current drug user) as describe by Sherman et. al (2005) were
compared according to their drug use behaviors, coping mechanisms and a range of risky
behaviors through statistical methods and analyses; chi-sqaure tests, univariate and
multivariate analyses. Clearly, the drug utilization by street children in Lahore shown by
researchers is a main coping technique employed and it is related to various behaviors.

The current drug users who is categorize as having used drug in the month before
the present study was carried, is the predominant drug-use status followed by the former
drug users who is defined as had ever used one of the specified drugs in their lifetime but
not in the month before engaging in the study. The never drug user who is classified as
never having used any of the illicit drugs listed demonstrate the least group of street
children that use drug (Sherman et al., 2005, p.iv116).

Of the types of drug reported in this study, the pattern of drug utilization among
street children in Lahore was leading by charas smoking (hashish), sniffing glue, bhang
drinking (cannabis leaves drink), sniffing heroin, and heroin injection (Sherman et al.,
2005, p.iv119).

Sherman and colleagues reported that sustained drug use which is the main coping
mechanism taken by this street children were associated with various leading factors such
as a response to family violence, peer pressures and transactional sex (Sherman et al.,
2005, p.iv120). There are several risk behaviors which are linked with the drug use
including cutting oneself, exchanging sex for food, shelter, drugs and money and feeling
hatred from the public.
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Evaluation

This article represents a unique and in-depth examination of an aspect of drug use
among street children in Lahore, Pakistan, and has value. It is comprehensive in its
inferential statistics analyses and wealth of quantifiable data.

Due to such conditions, street children often take up avoidant and detrimental
coping strategies that often worsen poor health outcomes, such as using drugs to deal
with their situation (Kidd, 2007; Kombarakaran, 2004). In this regard, there are many
studies on street children across the world that has reported to have consensus in this
pattern of drugs abuse (Sherman et al, 2005; de Carvalho et al., 2006; Kombarakaran,
2004; Noto, 2006). Normally, the findings show that these street children use multiple
drugs that are cheap and easy access to their locale, including alcohol, inhalants, and
cigarettes. Besides, the findings from this current study as well as well several studies
(Olley, 2006; Goodwin, 2004). In order to get supplies like drugs, street children engaged
in transactional sex to pay for this need (Sherman et al, 2005). It is supported that drug
use among street children is closely related to other health issues and risk-taking behavior
such as prostitution, sexual exploitation and unsafe sex practices, all of which have
contributed to a growing incidence of AIDS/HIV among this particular group (glue
sniffing, cite). Although Pakistan has had very low HIV rates compared to nearest
countries such as India (Bokhari et al., 2007), an HIV/AIDS outbreak has lately emerged
as reported by Pandey et al. (2007). In this context, the latest UNAIDS estimates,
Pakistan has 85,000 HIV-infected individuals, or a prevalence of 0.1% among 15–49 year
olds (UNAIDS, 2006).

Drug use is harmful as it leads to many negative and destructive outcomes

especially to health, cognition, economic and social. As far the health problem is
concerned, drugs contribute to the human brain dysfunctional and have an impact on
behavior (UNODC, 2004). Sniffing glue for instance may cause the serious health
consequences. Unfortunately, in many cases, young people do not clearly aware about the
dangers yet they enjoy the inhale vapors for emotional escape (Baldivieso, 1995). A
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classic study by Barman et al., (1964) asserted that sniffing glue have impact on a
transitory visual motor disturbance. It is also potential to elevate spinal fluid pressure due
to intoxication with the inhaled substance.

Other sniffing glues (http://www.healthblurbs.com/sniffing/) retrieved on

November 13, 2010) like volatile solvents (i.e paint thinners or removers, gasoline, glue,
correction fluids), aerosol (i.e. spray paints, hair or deodorant sprays, fabric protector
sprays), gases (i.e. butane lighters and propane tanks, chloroform) and nitrites (i.e. video
head cleaner, room deodorizer, leather cleaner, and liquid aroma) are able to cause death.
It also gives rise to euphoria and may also induce delusions and hallucinations. The
rapidly absorption of the inhaled chemical through the lungs into the bloodstream is
quickly circulated to the brain and other organs. Therefore, the inhalant user will
experience lethargy, nausea and shaking. Because intoxication lasts only a few minutes to
a maximum of about 45 minutes, drug users normally seek to lengthen the high by
continuing to inhale repeatedly over the course of several hours. The users will
experience symptoms of severe headache, tired and drowsiness once this high wears off
(UNODC, 2004).

According to United Nations Office on Drugs and Crimes (UNODC) annual

report (2004) almost all abused inhalants except nitrites produce a pleasurable effect by
depressing the central nervous system (CNS). Toluene for example, a solvent found in
several commonly harmful inhalants including glue, paint as well as nail polish removers,
cause reaction to the brain’s dopamine system which serves a role of rewarding effects.
Nitrites, in contrast, widen and relax blood vessels rather than acting as high agents.
Despites these pleasurable outcomes, this should not be taken as an excuse by the risk-
people to use these things freely as a way to relieve their tense and to forget their burden
in life. Based on the abovementioned point, undoubtedly the severe health problem
caused is much more dangerous than the temporarily benefits.

On the other hand, the psychological effects of volatile substance abuse are
distinctive from one person to another. Yet, there is always a common effect of euphoria
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and of omnipotence associated with the process (UNODC, 2004). Constant users may
also have difficulty with socialization and communication, which can contribute to
pattern of antisocial behavior (Cairney, 2002; Jansen, Ritcher & Griesel, 1992).
Accidental death or injury may taken place particularly if users are in an risky
environment such as near a busy road. Becoming unconscious also carries with it the risk
of death through choking. In fact any method of use which hinders breathing (such as
sniffing with a plastic bag over the head) increases the likelihood of death from
asphyxiation (Bland & Taylor, 1998 ; Esmail et al., 1993 ; Bowen, Daniel, Blaster, 1999;
Shepherd, 1989; Anderson et al., 1982).

Having to discuss the harmful effects caused by drug use, therefore, the steps and
preventive program should be taken seriously to overcome this matter. It is better late
than never. I guessed the step initiates by the small pilot intervention study by Project
Smile as reported Sherman et al. (2005) is the starting point in answering this alarm. The
project carried is motivated by the increasing scientific evidences on peer education’s
effectiveness in the promoting risk reduction behaviors among drug-using populations.
Thus, the project aim to teach the target group for instance the street children; the peer
outreach skills, helpful techniques of reducing risks related to drug use and sexual
behaviors, and communication skills. The pilot is hoped to offer the access to investigate
a range of characteristics of successful peer educators from the target population.

In sum, this article is valuable as it manage to give a details information and data
of the drug use status of street children in Lahore, Pakistan. I supposed that study will
definitely benefit professionals and relevant authority to further explore the issue
particularly the role of drug use among street children. In fact, the researchers of this
article and her team are currently collected the baseline survey of the peer outreach
intervention study as mentioned before. As a matter a fact, this current study is one of the
first studies differentiate street children by drug utilization which is hope to point a
directions for future research and interventions.
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In short, I am very impressed with the way the researchers presented this study. I
believed it demands a lot on energy in term of money, time as well as personnel in order
to obtain the three classifications of drug use among street children, what is more to
examine the characteristics aforementioned. The effort and venture taken reflects ones
passion, dedication and enthusiasm in reaching to the findings yielded. There are lots
more to do and it is hope this good effort will be continued and supported. All in all, this
article was by far the third best of the five I reviewed for the reasons of clearly stated
goals of investigation, detailed analyses of pertaining issue and excellent discussion. I
would not hesitate to recommend it to anyone interested in the field or organizational
psychology field especially health psychologist, social psychologist, medical and clinical
officers and social workers.
References

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Sherman S.S., Plitt, S., Salman ul Hassan, Cheng, Y., & S.Tariq Zafar. (2005). Drug use
street survival, and risk behaviors among street children in Lahore, Pakistan.
Journal of Urban Health. Volume 82. pp. iv113–124.

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