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Disaster risk reduction is of prime importance in informal settlements in the Global South, where several forms of vulnerability coexist. Policy and official programmes, however, rarely respond to the needs and expectations of citizens and local leaders living in these settlements. Even though these agents constantly attempt to reduce risks in their own way, we know very little about their activities, motivations and effective impact on risk reduction. Here we seek to conceptualize bottom-up initiatives to better grasp their origins, limitations and success.

Through a four-year action-research project in Colombia, Cuba and Chile, we theorize about the production of change by local agents. Through detailed case studies we explored the activism of 17 local leaders. Through narrative analysis we studied their motivations and explanations. Finally, by documenting 22 initiatives, we revealed effective changes in space.

In the face of risk and disasters, residents and leaders in informal settings engaged in symbolic, physical and social spaces of interaction. Their actions were guided by trust, emotions, time cycles and activism. Local agency was justified by narratives about risk and climate change that differ from those of authorities and scholars.

There is still limited understanding of bottom-up initiatives in informal settings. It is crucial to conceptualize their origins, limitations and success. The focus on three specific countries necessitates further research for broader applicability and understanding.

A better comprehension of bottom-up actions is crucial for informing policies and programmes aimed at reducing risk in informal settings. Stakeholders must recognize the political, social and cultural roles of these actions for more impactful climate action.

We borrow Simon’s concept of “artefact” to introduce the notion of “Artefacts of Disaster Risk Reduction”, providing insights into the multifaceted nature of bottom-up initiatives. We also emphasize the simultaneous political and phenomenological character of these actions, contributing to a deeper understanding of their origins and impact.

Illicit drug use is a well-known global problem that has been noticed to be increased significantly among medical students. This study aims to assess the prevalence and consequences of illicit drug use among medical students in the country of Jordan using the validated Drug Abuse Screening Test-10 (DAST-10).

The authors used a cross-sectional, descriptive design to conduct this study. A total of 2,104 participants from six medical schools were included. A structured online-based English self-administered questionnaire was used for data collection.

Out of 2,104 included participants, 242 (11.5%) reported using illicit drugs in the past year. More than three-quarters (77%) of the drug users suffer from various degrees of problems related to drug use, ranging from risky (41%) to severe risk (6%). Drug use was found to be associated with gender, planned specialty and exposure to psychiatry training.

The cross-sectional design prevents from drawing cause-and-effect relationships and confirming how the tendency toward substance use is affected by the psychological state, sleep quality and exposure to psychiatry. Also, although it is important to measure the subjective observation of distress and sleep, objective estimates of psychological distress and sleep including actigraphy and sleep diary could be helpful to strengthen the findings. Also using an online survey with convenience sampling are some inevitable limitations with the present COVID-19 restrictions. Also, the nature of DAST-10 closed-ended questions precluded from accurately exploring the consequences of substance abuse.

Appropriate screening to identify medical students at risk for substance abuse and provide them with treatment referrals are strongly recommended in this study. In addition, medical schools should provide a comfortable environment that encourages a healthy lifestyle with a responsible attitude toward using drugs.

There is a dearth of information about illicit drug use among medical students, especially in the country of Jordan. The nature of their studies, the different stresses they experience and the impact imposed by other factors such as sociocultural all are likely to make medical students more susceptible to drug abuse. To the best of the authors’ knowledge, this is the first cross-national study of its kind in Jordan with a representative sample of 2,104 participants. We assessed the prevalence and consequences of self-reported illicit drug use and the sleep quality of medical students from all schools of medicine in Jordan.