2. Capítulo 2: Estereotipos raciales
2.2. Elementos transculturales y de hibridación en el K-pop
Space limitations preclude detailed reporting of all comments, perspectives, and suggestions panelists provided during this study. Only major themes and responses to each survey will be briefly summarized and interpreted, followed by a discussion. Detailed memoranda are located in the appendices.
Expert Panel problem domain survey
Six (of 8) panelists considered the cannabis problem domains/variables that were specified to be “comprehensive” and “inclusive”. Five suggested further variables (e.g., consumption methods, tolerance, increased cannabis expenditure, reason for use, family drug use). Measuring cannabis consumption (section A) was universally identified as the key domain. While ‘frequency of use’ was unanimously endorsed as a problem indicator, ‘quantity’ was judged problematic (five panelists), and ‘binge’ use inappropriate (four panelists), for cannabis. All panelists endorsed the criteria/variables representing cardinal DSM/ICD constructs, ‘Using behaviour’ and ‘dependence’ and ‘Psychological reactions’ (sections B, C). Cultural issues were perceived in some terms (e.g., feeling ‘shame’ and ‘guilt’ after using cannabis, inappropriate for Pacific Peoples, was replaced with ‘felt bad or regretted using cannabis’). ‘Health problems’ (section D) such as loss of motivation, energy, memory, and concentration, and use in hazardous situations received universal support, although specificity issues (a cannabis attribution) were acknowledged. Perspectives on ‘Social consequences’ (DSM-IV) indicators (section E) varied. While concern from others, interpersonal, financial, and legal problems were endorsed, items for these variables required careful development. Consensus around the adjunct items (section F) indicated their perceived utility and importance in generalist health settings. (For more detail see Appendix 4).
Expert Panel item pool survey
Panelists’ evaluation of the provisional item pool with response categories was universally positive, supporting initial retention of a broad range of problem indicators. Panelists indicated their preferred versions where alternatively-worded sample items were provided, suggested additional or alternative categories in response options, and
alternative terminology where they saw potential for ambiguity/confusion or evoking resistance (e.g., respondent reluctance to report ‘committed a crime’, ‘needing cannabis’, ‘$ made off cannabis’). Further consideration of cultural appropriateness of some terminology (e.g. ‘hallucinations’, local terms for cannabis products) was emphasized. There was strong agreement that the proposed Likert-type response format of (most) items would enhance discriminatory power. Panelists favoured 5-point rather than 7-point options, for reasons of simplification and the (questionable) ability of cannabis users to differentiate meaningfully to that level of precision. Consensus supported the existing ordering of item pool sections as being the “most logical” administration sequence. Guided by these recommendations, the item pool was further refined before submission for Māori and Pacific Peoples perspectives.
Cultural review
Consultants for appropriateness/sensitivity of the item pool for administration among Māori and Pacific Peoples reported no apparent problems or reservations. Reviewers evaluated the provisional screen as “very comprehensive”, “inclusive”, and “impressive”. Targeting at risk users, as well as cannabis dependent, was applauded. Feedback confirmed the need for language and format simplicity, for cultural references wherever possible such as ‘family/whānau/aiga’, and familial participation in the process (see Appendix 9 for review dialogue).
IEP review of the item pool
Responses were diverse in terms of perspective, detail, issues raised, advice and suggestions. Overall support for the “very methodological approach taken to this research” (which) “pretty well covers the waterfront” was considerable, and the item pool “ready to go now”. From one expert viewpoint, “Ideally you would retain all or most of these items and sort out which ones are most useful empirically from here”. Panelists noted their preferred version for alternatively worded items, varied opinions about redundant or inappropriate items, and suggested changes to language or response categories. Item omissions identified were ‘quantity consumed’ and ‘respiratory problems’ measures. Interestingly, while noting its controversial status among local EP, five panelists explicitly opined that the ‘time spent stoned’ variable was an important
cannabis problem indicator, thus should be measured. While most (9; 90%) endorsed the utility of the two multi-response items (‘reasons for use’, ‘use in risky situations’), six (60%) indicated both required further refinement. There was almost universal (9; 90%) support for the Likert-type response categories, with the majority (7; 70%) recommending the options be truncated (from 7 to 5) and standardized, where appropriate, to reduce response burden and enhance reliability. One sole critic, who “strongly advised against using” the “unanchored and abstract Likert-type response categories notorious for low reliability”, preferred the binary ‘Yes/No’ option. Opinion was equally divided on the non-specificity to cannabis of items on loss of energy, concentration and memory, some recommending the items be cannabis-referenced, while others endorsed the non-specific versions. Two experts signaled problems inherent in interpreting responses to the ‘amount spent on’ or ‘amount made off’ cannabis. One expert identified a potential issue for predictive ability of items inherent in the 12-month (DSM/ICD) diagnostic timeframe (c/f a shorter window).
Final review/revision of the item pool
After protracted synthesis, further consultation and deliberation on all EP/IEP comments, advice, and suggestions, 14 items were deleted from the pool (listed in IEP Memo, Appendix 8). These included 3 adjunct items (readiness to change) that were not indicative of problem severity and therefore, conceptually anomalous. The ‘amount spent on’ and ‘amount made off’ cannabis items were discarded. Other items were reworded and refined as recommended, and Likert-type response categories truncated and standardized, or replaced with ‘yes/no’, where appropriate. Following IEP recommendations, two new items (quantity used, respiratory/cough or sore chest) were created, and the controversial (‘time spent stoned’) item was reinstated. Further clinical (AK) and supervisory (JC) input informed the decision to include an item ‘use frequency past 90 days’ to help attenuate the DSM/ICD predictive validity issue identified. One adjunct item representing two concepts (attitude/knowledge) was separated into two items. Although questioned as being conceptually contentious in a problems screen (i.e., risk factors, rather than severity indicators), the ‘reasons for use’ (one expert) and ‘family drug use/problems’ (three experts) items were retained, given overall EP/IEP opinion about their potential predictive and clinical utility. Perceived as
non-confrontational and thus ideal for an initial item, the ‘reasons for use’ item was re- ordered to become the first question. The end product of this systematic development process was the 43-item draft Cannabis Use Problems Identification Test (CUPIT). These items, together with the DSM-IV/ICD-10 criteria or problem domains they reflect, and the parent instrument sources where relevant, are presented in Table 5.1. The research version appears in Appendix 10.
Table 5.1: Pool of candidate questions for the CUPIT
Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument Source (if any) A Cannabis Consumption Quality/Potency Preference
a). What cannabis products do you prefer to use?
(OR)
b). What type of cannabis do you prefer to use?
Most Often / Usually Use
a). What cannabis products do you use most often?
(OR)
b). What type of cannabis do you use most often?
Frequency of Use
Days used
a). On how many days have you used cannabis during the past 12 months?
AUDIT; CUDIT; DUDIT
b). On how many days have you used cannabis over the past 3 months (90 days)?
Time Stoned
c). How much of the average day do you spend/feel stoned?
Times Used
d). How many times would you use cannabis on a typical day when you were using?
Quantity a). On average, how much would
you smoke when you use?
Joints ….………….
Cones ……….
Spots. ……….
Increased Use a). Are you using more or less
cannabis now than you were 12 months ago?
Table 5.1 continued … Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument Source (if any) B Using Behaviour / Dependence Experimental/Social vs. Problem Use
a). I use cannabis because ……….
(Tick EVERYTHING that applies to you)
CRAFFT; SMAQ; ASMA; MSI-X
Genetic / Environment a). Have any members of your family / whānau / aiga (including grandparents and other relatives) ever been heavy users of, or had problems with, alcohol, cannabis, or any other drugs?
SSI-AOD
Start Day With Joint a). Do you like to get stoned in the morning?
CASST; MSI-X
withdrawal avoidance b). How often have you used cannabis first thing in the morning?
Thomas, 1996
Tolerance tolerance a). Do you need to use more cannabis now to get stoned than you did 12 months ago?
AUDIT; CUDIT; DUDIT; DUSI; MSI-X; SMAQ; ASMA;SSI-AOD
Withdrawal withdrawal a). Have you had cravings or felt agitated if you tried to cut down or stop using cannabis?
CASST; DUSI; MSI-X; SMAQ/ASMA withdrawal b). Did you feel restless, irritable,
grumpy, anxious or depressed when you could not use cannabis?
DAST-20; MSI-X; SMAQ; ASMA; SDS
Loss Of Control Inability to abstain a). Have you been able to stop using cannabis when you wanted to?
AUDIT; CUDIT; DUDIT; DAST-20; DAST-A; Thomas, 1996
b). Have you felt that you needed cannabis?
desire to cut down/stop
c). How often did you wish you could stop using cannabis?
SDS
Longest Period Of Abstinence Inability to abstain a). What was the longest time that you went without using cannabis?
Table 5.1 continued … Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument
Source (if any)
Failed Attempts To Cut Down/Unsuccessful Efforts To Control Use
failed attempts to cut down
a). How often did you try to cut down on your cannabisuse, but found you couldn’t?
ASSIST V.3; CASST; DUSI; MSI-X; Thomas, 1996
failed attempts to cut down
b). Have you found it difficult to get through a day without using cannabis?
CASST
c). How difficult do you think you would find it to stop using or go without cannabis altogether?
SDS
Inability to abstain d). Did you ever use cannabis after you had decided not to?
DUSI
Preoccupation / Salience a great deal of time spent obtaining, using, recovering
a). Have you spent time thinking about cannabis or trying to get cannabis?
SMAQ
b). Did you ever find yourself thinking about when you would next be able to get stoned?
Important Activities Given Up Or Reduced
social, recreational, occupational activities reduced
a). Have you given up things you used to enjoy or were important because of cannabis? (e.g., work; school; sports; hobbies; being with family or friends; etc)
C Psychological Reactions / Problems
Guilt, Remorse, Shame psychological problems a). How often have you felt ashamed or guilty about using cannabis?
AUDIT; CUDIT; DUDIT; DAST-20; SSI-AOD; Thomas, 1996
psychological problems b). How often have you regretted using cannabis?
MSI-X
Worry About Use psychological problems a). How often have you felt worried about your cannabis use?
CASST; SDS
Paranoia / Anxiety psychological problems a). How often did you feel paranoid (suspicious) or anxious after using cannabis?
CASST; MSI-X
Table 5.1 continued … Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument
Source (if any)
D Health Effects
Composite Item physical/psychological harm
a). Cannabis has made my health ………
Nausea / Passed Out physical/psychological
harm
b). Have you felt sick or passed out (had a “whitey”) after using cannabis?
DAST-20; Thomas, 1996
physical/psychological harm
c). Have you had a cough, sore chest, or breathing problems for any length of time?
CPQ
Fatigue / Motivation or Energy Loss
physical/psychological harm
d). Have you lacked the energy to get things done in the way you used to?
CASST
Memory / Cognitive,
Concentration, and Distractibility
physical/psychological harm
e). Have you had problems concentrating and remembering things? CASST; AUDIT; CUDIT; DUDIT; CRAFT; DUSI; MSI-X physical/psychological harm
f). How often have you started to do something, and then forgotten what you were going to do?
physical/psychological harm
g). Have you ever found it difficult to understand new information or to study?
CASST
Cannabis Use In Risky/ Hazardous Situations
Use in risky/hazardous situations
a). Have you done any of the following things/activities after using cannabis?
(Tick EVERY ACTIVITY that applies to you)
DUSI
Injuries / Accidents physical/psychological harm
b). Have you or anybody else been injured after you used cannabis? AUDIT; CUDIT; DUDIT; DUSI; MSI-X E Social Consequences Neglect Commitments, Responsibilities When Stoned
role interference a). Has anything you had planned, or were expected to do, not happened after using cannabis?
(examples: a family outing; chores; take care of children; training; an assignment; appointment; school or work; etc)
AUDIT; CUDIT; DUDIT; MSI-X; ASSIST V.3; Thomas, 1996
role interference b). Did your use of cannabis ever interfere with (get in the way of) your work at school, your job, or home life?
DAST-20; MSI-X
Table 5.1 continued … Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument
Source (if any)
Concern From Others Advice To Cut Down
social & interpersonal problems caused or exacerbated by use
a). Has a partner, relative, friend, a doctor, or any other health worker been concerned about your cannabis use or suggested you cut down?
ASSIST 3.0; AUDIT; CUDIT; DUDIT; CRAFFT; Thomas, 1996
social & interpersonal problems caused or exacerbated by use
b). Has your cannabis use ever created problems between you and your partner, parents, other close relative, or friend?
CASST; DAST-20; DUSI; MSI-X; SSI- AOD
Friends/Peer Group a). Have you spent more time with friends who use cannabis than non-using friends?
b). Have you tended to smoke cannabis on your own more than you used to?
SMAQ
social & interpersonal problems caused or exacerbated by use
c). Have you lost any friends or partners (boyfriend or girlfriend) because you use/d cannabis?
DAST-20; DUSI; MSI-X; Thomas, 1996
Financial/Cost Of Drug a). How much did you spend on average on cannabis per week? b). On average how much did you
make off (how much money have you earned from selling) cannabis per week?
Financial Problems social & interpersonal problems caused or exacerbated by use
c). Did you ever spend more than you could afford or get into serious money problems because of cannabis?
CPQ; DUSI; Thomas, 1996
Legal/Criminal social & interpersonal problems caused or exacerbated by use
a). Have you been arrested, even for a few hours, because of your cannabis use? (examples: something you did when stoned, or to get money to buy cannabis; cannabis possession; cannabis supply; etc)
SAST-20; MSI-X; SSI-AOD
F Adjunct Items
Insight / Acknowledgement Of A Cannabis Use Problem
a). Do you think that you use too much cannabis?
SSI-AOD; Thomas, 1996
b). Do you think that your cannabis use is ever a problem?
SSI-AOD
c). Is cannabis use affecting you in ways you do not like?
CASST; Thomas, 1996
Table 5.1 continued … Domain / Variable DSM-IV & ICD-10 Diagnostic Criteria: Cannabis Dependence/Abuse Question
“Over the past 12 months…”
Parent Instrument
Source (if any)
Risk Perception; Attitude a). Do you think that cannabis is addictive or harmful?
Readiness To Change; Help- Seeking
a). Do you wish you could stop using cannabis?
SDS
b). Do you want to cut down or
quit your cannabis use? c). Would you like some
assistance to help you reduce or quit your cannabis use?
KEY
New Questions and items
Items considered but not used