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Additionally, Rose Ragin et al. The authors suggested that the head-and-neck cancers are caused by secondary infections from hpv. They also suggest that oral hpv is often contracted through oral sex. However, Sok and Grandis 7 stated that some of the routes of oral hpv infection are unknown. Regardless, many people have suggested that a vaccine against oral hpv might be important in preventing oral hpv infections 8 — Given these considerations, there has been much debate on whether cannabis has been a causative agent of oral cancers.
As with hpv -linked cancers, studies have tried to find a relationship between cannabis smoking and a variety of types of cancers. For example, Almadori et al. Some authors have hypothesized that cannabis use might be a cause of transitional cell carcinoma, a type of bladder cancer typically associated with tobacco smokers 13 , Others have reviewed cannabis use and the probability of developing cancer In a more recent study, Aldington et al.
However, in all of the above-mentioned studies and reviews, hpv as a possible factor in the development of cancer was not discussed. The importance of understanding the role that cannabis smoking might play in hpv -related cancers is difficult to overstate. Indeed, a recent report by the World Health Organization notes that countries must begin to take action toward dealing with oral cancer prevention If cannabis use is indeed a major contributor to spreading oral hpv , steps should be taken by governments to educate their citizens to help mitigate oral cancer rates.
North America and Europe accounted for about 70 million of those users, both regions being above the global average. A report by Leatherdale et al. However, some countries have recognized the medicinal properties of this plant product and approved it for medical use, which may also contribute to the observed increase in use. The possibility that hpv can be passed among cannabis users is therefore significant. The human papilloma virus can be found on the surface of the lips, the lining of the mouth, on the tongue, and so on. Therefore, as an infected person places a cannabis cigarette or smoking device on their lips, they simultaneously deposit viral particles on the device.
The hpv remains there until another user places the same area of the smoking device onto their lips. This scenario could easily have continued for many years as a possible method of oral hpv transmission. Although partaking in cannabis smoking may be an individual process, cannabis smokers are also known to pass and share their cannabis freely. For instance, various studies have found that, although some cannabis users smoke alone, others share with close friends or at parties, making smoking a social activity 21 , Gillison and Lowy 24 discussed some ways in which people might contract hpv and postulated reasons that vaccines might be useful in controlling hpv -related cancers in later life.
They cited use of alcohol and tobacco because of the carcinogenic nature of those substances as additional contributors to the likelihood that these types of cancers may develop. The mention of tobacco is interesting, because it, too, may serve as an indirect route of transmission. For example, Knishkowy and Amitai 25 discuss tobacco smoking through water pipes, a practice that is very common in most Middle Eastern countries. Although they mention that sharing of these pipes can lead to a variety of diseases, hpv is not mentioned. Still, sharing tobacco-smoking devices could also serve as an additional route of oral hpv contraction.
To compound matters further, it not exactly known how easily oral hpv can be transmitted between individuals for example, through sharing water bottles in sports or through casual kissing. With such uncertainty, one would hope that a rapid assay for oral hpv would soon be available.
Such a test might prove useful in a clinical setting, for research purposes, or for personal knowledge. Even within these boundaries, we recognize that our theory is incomplete and may prove inadequate in some details when applied to some persons, some drugs, and some social contexts. The remainder of this article examines the social processes that facilitate the evolution of drug subcultures and employs our theory to provide insight into drug eras, drug generations, and the gateway phenomenon.
Drug use emerges from a dialectic of the prevailing culture and especially drug subcultures with individual identity development. Conversely, individual decisions to adopt, adapt or reject aspects of the prevailing drug subcultures cause the subcultures to evolve as well as lead to the emergence of new ones. Different groups across disciplines and over time have operationalized culture in assorted ways to organize their study of human behavior in context Schafer, ; Spillman, These conceptualizations range from the overarching to the minimalist. For our purposes, both perspectives are useful.
In , Sir Edward Burnett Tylor, an anthropologist, provided a concise statement of the monumental and comprehensive nature to culture that now represents a classical formulation cited in Schafer, , p. Culture or civilization, taken in its wide ethnographic sense, is that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society. According to this perspective, ideas, artifacts, behaviors and persons are intimately bound together within a single social structure, the culture.
Schafer noted that a culture holds a shared cosmology, a worldview, a myth of origin, and visions of how things are supposed to be and why. The classical perspective identifies a larger gestalt to social context that compels individuals to engage in various behaviors and attach significance to them. On the negative side, this older viewpoint clearly downplays diversity within a society and the potential of personal autonomy.
A postmodern sensibility emphasizes the multiplicity of prevailing cultural frameworks, the interacting of themes, and the centrality of individual agency. Accordingly, the postmodern outlook holds a more fractionated and tenuous view for the influence of various cultural elements. We contend that the conditions of postmodernity apply less well to American inner-city residents than to wealthier populations. We maintain that the prevailing culture can loom large within these socially isolated conditions, in a manner suggested by the classical definition for culture.
On the other hand, inner-city life has not remained culturally stable.
There have been massive popular culture shifts since the s in the drug of choice among American inner-city populations from heroin especially when injected , to crack, and then blunts, inexpensive cigars in which the tobacco filler has been replaced with marijuana. For our purposes, we view culture as simultaneously encompassing multiple subcultures or toolkits that include constellations of connected values, symbols, norms, and behavior patterns. These subcultures can be based around drug use, ethnicity, religion, region, or a variety of other affiliations.
We operationalize the term drug subculture as an inter-related cluster of cultural elements associated with the consumption of an illicit drug in social settings. For example, youths may insist on smoking their marijuana in a blunt, drink ounce bottles of malt liquor, listen to rap music, wear baggy pants, define marijuana as not a drug, and socialize mainly with other blunt smokers.
Drug subcultures differ regarding the extent to which they represent an occasional leisure activity versus a lifestyle, an amusement versus a worldview, and an interest occasionally shared with others versus a group affiliation demanding limited association with nonmembers. Individuals will differ as to the extent to which they become involved with a drug subculture. Furthermore, individuals may act completely differently in different social contexts.
Anderson described how many inner-city youths code-switch or shift their behaviors depending on whether an occasion calls for street and drug using or decent subcultural behavior. Individuals may engage in more than one drug subculture. Individuals may end their involvement with a drug subculture.
Drug subcultures can differ across locations and across the groups that instantiate them. Moreover, drug subcultures can evolve or even disappear over time. Ecological studies have similarly observed this type of subcultural relativism and multiple affiliations in secondary schools. Youths easily identified crowd members by their appearance, attitude, and behavior patterns.
Crowds often insisted that members conform to group substance use norms. However, youths in these studies still displayed much personal autonomy. Moreover, crowd membership was ultimately voluntary. Not all youths were involved with a crowd; and some youths were positioned as partially belonging to two or more crowds. Our theory holds that culture and individual identity engage in a dialectic of coproduction.
In this manner, culture and identity are constructed from the same source material.
However, culture and drug subcultures depend on individuals as much as individuals base their experiences within the prevailing culture. People are not passive victims of culture.
Each person has three basic choices regarding their reaction to a drug subculture: We contend this process represents a symbolic interaction that often occurs subliminally in the course of daily activity as described by Blumer , p. Accordingly, interpretation should not be regarded as a mere automatic application of established meanings but as a formative process in which meanings are used and revised as instruments for the guidance and formation of action. Thus, the future of any drug subculture and its place within the larger culture depends on the extent that people continually adopt it and perpetuate its conduct norms.
Drug subcultures can die out as people reject them. New subcultures emerge through the process of persons adapting existing cultural elements to their circumstances. In adolescence, a wider range of influences some that parents and conventional society may disapprove of come to affect identity development including school, peers, mass media, and broader trends in clothes and music.
Interestingly, the literature also documented that very few persons first get involved with illicit drug use after their mid-twenties. Drug use tends to change over the life course. Young adults often conceive of illicit drug use as incompatible with the cultural expectations associated with their new social roles as employees, adult members of the community, and parents. However, desistence depends upon the drug involved and the subpopulation under consideration. Persons often continue use of licit substances alcohol, caffeine, and tobacco throughout much of adulthood.
Some also continue illicit drug use well into adulthood — especially adults with relatively limited attachment to conventional societal roles.
Urinalysis tests consistently identified the majority of arrestees across the U. This persistence may result from physical dependence, a commitment to a subcultural identity, barriers to conventional roles, or a combination of factors. The epidemic metaphor suggests drug use is a disease, drug use causes great suffering, drug users infect others through social contact, and that consequently drug users must be quarantined. We contend that drug eras represent a social and not a pharmacological phenomenon. Zinberg described how three exhaustive classes of factors influence a drug use experience: Drug and set would seem to have a very limited role, if any, in explaining the rise and fall of different drugs in the United States since During this time, drug and set have been relatively constant.
In particular, the various drug eras have mostly involved illicit drugs that have been known for years. Crack was a modest exception. It represented an innovative technique for packaging, selling and consuming a previously available drug, namely cocaine. Regarding set, the genetic and ethnic composition of the U.
Hence, a panoramic view of the data suggests that rapid changes in drug use prevalence are primarily a sociocultural or setting phenomenon. Accordingly, we prefer the term drug era to drug epidemic because it emphasizes the cultural aspect of the phenomena; it places drug use within a larger gestalt; it suggests that mass media in addition to personal contact can play a central role in the diffusion and acceptance of drug use; and it holds a relatively neutral connotation, eras can be good or bad and typically have both positive and negative qualities.
Based on empirical and theoretical research, we conceptualize four distinct phases to drug eras: A drug era typically starts among a highly limited subpopulation participating in a specific social context. Sometimes, the pioneering drug users successfully introduce the practice to wider subgroups of users and to the broader population.
In a very broad review of the literature, Rogers identified that when ideas spread they tend to spread with increasing rapidity whether it involves a new consumer product, fashion, teaching method, or agricultural technique. The primary difference between social diffusions and disease epidemics is what is being spread — an idea or behavior as opposed to a bacteria or virus.
Persons have agency regarding whether they adopt a behavior such as use of a new drug. Consequently, individual susceptibility to use varies greatly according to friendship networks, social position, and personal identity. Eventually, everyone most at risk of the new drug practice typically users of other illicit drugs has either initiated use or at least had the opportunity to do so. For a time, widespread use prevails. During this period, youths first coming of age typically initiate use of the currently popular drug s , if any. These users form the core of a drug generation for whom the drug has particularly symbolic significance based in their social activities and relationships.
Eventually, the use of an illicit drug tends to go out of favor. This leads to a gradual decline phase of a drug era. We conceptualize that new clusters of conduct norms emerge that hold that the use of a drug is bad or old-fashioned. The subsequent diffusion of innovation process then competes with the prevailing pro-use norms. During the decline phase, a decreasing proportion of youths coming of age develop into users. However, the overall use of the drug endures for many years as some members of a drug generation continue their habits.
Such shared experiences often distinguish a cohort from its predecessors leading to the emergence of generational identities. In an extensive review, Alwin and McCammon reported that researchers have employed this approach to explain a wide range of social changes including among others liberal versus conservative outlooks, racial prejudice, church attendance, sex roles beliefs, pre-marital co-habitation, and watching television. However, the most central factor was often age at the time an event occurred.
Youth coming of age during a historical period can form a generation readily distinguished by their behaviors and attitudes from persons that reached adulthood before the defining event and from persons born subsequently that did not fully experience the event or were more influenced by subsequent events. We maintain that major drug eras potentially impact lives in a similar manner, especially those that become users. Accordingly, we define a drug generation as the birth years most affected by a drug era.
In this manner, birth year represents a powerful risk factor or more accurately a proxy indicator of changes in prevailing social conditions that increase risk for use of a trendy drug. Many other locations in the U. During the late s, youths could choose to smoke crack or avoid its use. Not everyone born during —69 became a crack user, but many did, especially in inner-city New York.
Persons coming of age during the s did not have the opportunity to use crack in their youth. Persons coming of age since the mids overwhelmingly chose not to use crack and supported each others decisions to not use.
During the Heroin Injection Era, users maintained that heroin provided the greatest high. Crack users maintained that smoking crack yields the greatest high. Crack users went on runs or missions, jargon derived from Star Trek, a popular television show and series of movies.
These runs involved continuously hustling money, obtaining crack, and using it without sleep or much food, until extremely exhausted. Users would spend all their money on crack. Purchase small amounts of crack as soon as money was available. Trade labor or skills including sex for small amounts of crack. Abandon friends and family for crack use.