The monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.

Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.

 

In the December 2015 issue


ACT Research Spotlight

Research Findings

New Reports
 

How could a harm reduction approach be applied to the use of drugs in sport?

Academics based in Melbourne argue that the current zero-tolerance policy towards drug use in sports has neither been successful in eliminating doping in sport, nor effective in protecting the health of athletes. They contend that ‘the primary principle of sound drug management in sport should be HR [harm reduction]. In the context of sport, the HR approach illuminates three principles. First, drug use is not just a sporting matter nor is it a criminal or legal matter. Instead, drug use in sport constitutes a serious social issue. Second, HR obviates the need for any form of moral certitude. Instead, it accepts that drug use exists in sport and will never be completely eliminated. Third, although HR does not condone the use of drugs in sport, it acknowledges that when it does occur, policy makers have an obligation to develop public health measures that reduce drug-related harm to all athletes, irrespective of their status or ambition. For example, policies that exclusively pursue the elimination of doping do not account for high or low risk use. Conversely, some evidence indicates that harm reduction polices providing education, private support, and rehabilitation, lower the social costs and cultural damage associated with substance use. The key issue for HR therefore has less to do with the short-term brand equity and credibility that might be tarnished by a drug use or drug trafficking incident, and more to do with the long-term best interests of sport participants’.

Smith, ACT & Stewart, B 2015, ‘Why the war on drugs in sport will never be won’, Harm Reduction Journal, vol. 12, no. 1, pp. 53, open access http://www.harmreductionjournal.com/content/12/1/53.

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To what extent has Scotland's National Naloxone Programme impacted on the incidence of opioid-related deaths among newly-released prisoners?

An evaluation of the effectiveness of Scotland’s National Naloxone Program (NNP) applied a before-after research design which compared the number of opioid-related deaths (ORDs) in 2006-10 (before the NNP was implemented) with 2011-13 (after NNP started in January 2011). The researchers found that the NNP ‘was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison’.
Specifically, ‘In 2006-2010, 9.8% of ORDs (193/1970) were in people released from prison within 4 weeks of death whereas only 6.3% of ORDs in 2011-2013 followed prison release (76/1212, p <0.001; this represented a reduction of 3.6% (95% CI: 1.6% to 5.4%)). This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs (95% CI: 19 to 65) during 2011-13, when 12,000 naloxone kits were issued at current prescription-cost of £225,000.’
The study assessed cost-effectiveness, concluding that the NNP is cost-effective, though the extent of this depends heavily on a set of assumptions underpinning the valuing of the outcomes (deaths averted). It also assessed patterns of causality, using the Bradford Hill criteria. The authors concluded that the NNP met the following criteria demonstrating that the NNP actually caused the observed fall in ORDs: strength, consistency, specificity, analogy, temporality (partially), biological gradient, plausibility, coherence, and experiment (partially).

Bird, SM, McAuley, A, Perry, S & Hunter, C 2015, ‘Effectiveness of Scotland’s national naloxone programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison’, Addiction, online ahead of print.

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In what direction, and to what extent, does banning adolescents' access to e-cigarettes change adolescent smoking?

Electronic cigarettes entered the US market around 2007, and individual states began enacting restrictions to limit access by minors to e-cigarette in 2010. By January 2014, 24 states had introduced bans. An analysis of state bans on e-cigarette sales to minors ‘…indicates that these restrictions on e-cigarette access increase adolescent smoking by 0.9 percentage points, with the impact only evident once the ban goes into effect, and only among those subject to the ban (i.e., under age 18)’. The researchers found that ‘…reducing e-cigarette access increases smoking among 12 to 17 year olds. The effect is large: over the 8 years preceding the first bans on e-cigarette sales to minors, states recent smoking rates for this age group fell an average of 1.3 percentage points every two years. The estimated 0.9 percentage point rise in smoking due to bans on e-cigarette sales to minors counters 70 percent of this downward trend for a given two-year period, in states that implemented such bans’.

Friedman, AS 2015, ‘How does electronic cigarette access affect adolescent smoking?’, Journal of Health Economics, vol. 44, pp. 300-8.

Comment: The ACT Government recently announced that it plans to legislate to prohibit the sale of e-cigarettes to people aged under 18 years. This study suggests that such bans, in jurisdictions that permit the sale of nicotine-containing e-cigarettes, has the unintended consequence of increasing young people’s smoking of tobacco products.
 
How effective are e-cigarette ads in recruiting young people to the use of e-cigarettes and cigarettes?

A randomized controlled trial was conducted in the USA to assess the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on young adults’ perceptions, intention, and subsequent use of e-cigarettes and cigarettes. The findings were that ‘Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette…among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up…among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users’. The researchers concluded that ‘This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes’.

Villanti, AC et al. 2015, ‘Impact of exposure to electronic cigarette advertising on susceptibility and trial of electronic cigarettes and cigarettes in US young adults: a randomized controlled trial’, Nicotine and Tobacco Research, online ahead of print.
 
Comment: This study confirms that jurisdictions which permit the sale of e-cigarettes need to have clear, evidence-informed policies on the advertising of these products.

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To what extent can a human rights perspective on medicinal cannabis use facilitate a holistic understanding of public health?

A paper published in the journal Critical Public Health acknowledges that the concepts of public health and human rights are complex, but advances the notion that the regimes are, in fact, complementary, and demonstrates how ‘…a human rights lens can better inform public health policies relating to medicinal cannabis use and psychoactive substance use more generally’. The paper concludes that ‘The global prohibition of cannabis cultivation, supply and possession might be considered to present an insurmountable barrier to the full exploration of the therapeutic potential and public health benefits of medicinal cannabis consumption. Despite this, examples of innovative approaches have emerged around the world, although some jurisdictions, notably the UK, have provided less fertile ground for them to flourish in. We have argued in this paper that the lens of human rights provides a fruitful perspective for addressing the power dynamic between state and individual which underpins the medicinal cannabis issue, by recognising a broader idea of what constitutes “health”. Narrow and externalist conceptions of health…fail to acknowledge adequately the human right to health and undermine public health goals by taking a parochialist approach to the issue of medicinal cannabis use. A more expansive conception of health, in contrast, appreciating both internalist and externalist views, could lead to a public heath approach which more effectively balances individual and collective interests. Through employing a human rights perspective, the paper seeks to open a dialogue to rethink drug policies in a more thoroughgoing and potentially radical way, so that a more fully public health approach to the issue of the therapeutic use of cannabis can be developed which is not constricted by the drug prohibition paradigm’.

Bone, M & Seddon, T 2016, ‘Human rights, public health and medicinal cannabis use’, Critical Public Health, vol. 26, no. 1, pp. 51-61, open access http://www.tandfonline.com/doi/full/10.1080/09581596.2015.1038218

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What's the latest on the natural outcomes of the cannabis use disorder?

An analysis of data from the 2001 and 2004 waves of the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was undertaken to explore three-year outcomes for people diagnosed with the cannabis use disorder (CUD)—either cannabis dependence or cannabis abuse—at baseline. The outcomes assessed were abstinent remission (i.e. no longer using cannabis and no longer diagnosed with the CUD), non-abstinent remission (still using cannabis but no longer diagnosed with the CUD), and still diagnosed with the CUD.
 
‘Our results suggest that approximately 67% of individuals with a diagnosis of CUD remitted at a 3-year follow-up, compared to 33% who remained with a sustained diagnosis of CUD. Notably, approximately 37% of those who remitted at follow-up did so without terminating their use of cannabis, averaging nearly half the cannabis-use days in the 12 months prior to follow-up compared to those with sustained CUD. Individuals who used drugs other than cannabis and individuals who used cannabis daily at baseline had greater odds to achieve any type of remission from CUD at follow-up. Daily cannabis users were also significantly more prone to achieve non-abstinent rather than abstinent remission compared to individuals who used cannabis weekly or less than weekly. Additionally, individuals who achieved non-abstinent remission at follow-up had lower rates of baseline cannabis dependence (rather than abuse) compared to individuals who achieved abstinent remission or no remission. Analysis of socio-demographic correlates revealed that individuals with medical comorbidities compared to no medical comorbidities and individuals with Hispanic compared to Caucasian ethnicity had greater odds to achieve any type of remission from CUD at follow-up. Additionally, individuals who achieved abstinent remission were more likely than non-abstinent remitters and those with sustained CUD to start a first full-time job in the 3 years prior to wave.’ The authors argue that ‘…our findings are important, as they shed additional light on the natural outcome of CUDs and suggest that CUDs may be characterized by high remission rates over a shorter time-period than reported previously’.

Feingold, D, Fox, J, Rehm, J, Lev & Ran, S 2015, ‘Natural outcome of cannabis use disorder: a 3-year longitudinal follow-up’, Addiction, vol. 110, no. 12, pp. 1963-74.
 
Comment: This quantification of the high rate of natural remission of problematic cannabis use over a relatively short time period—three years—highlights the inappropriateness of criminalising cannabis possession and use. The illegal status of the drug does not reflect the relatively low levels of harms that it causes, and cannabis law enforcement results in large numbers of young people becoming caught up, unnecessarily, in the criminal justice system.

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Is there a correlation between cannabis liberalisation and increased adolescent use of cannabis?

Data from over 170,000 adolescents in 38 European and American countries were assessed to ascertain whether and how types of cannabis control policies were correlated with ever use, past-year use, and regular use of cannabis. (Regular use was defined as adolescents reporting that they had used cannabis 40 times or more in their life time.) The researchers found that ‘substantial variation in the prevalence of cannabis use can be attributed to the country-level characteristics. Overall, cannabis liberalization was associated with higher likelihood of ever use, past-year use, and regular use of cannabis. Significant positive correlations were found between cannabis depenalization and past-year and regular use, and between partial prohibition and regular use…Those who ever used cannabis but did not use in past year or use regularly were primarily discontinued users or experimental users. The heterogeneities in the impacts of cannabis control policies highlighted the importance of making distinctions between different types of cannabis users…Our study findings were supported by the demand theory that less strict laws and enforcement induce more drug use…Boys had a considerable higher level of cannabis use compared to girls’.
The researchers concluded that ‘Cannabis control in many western countries has departed from the full prohibition regime towards liberalization, with various models adopted including depenalization, decriminalization, and partial prohibition…Our study showed that the liberalization policy in general was associated with higher levels of cannabis use, and depenalization and partial-prohibition policies were particularly correlated with regular use. The correlations were heterogeneous between genders and between short- and long-terms. Efforts to prevent cannabis use among adolescents are recommended in countries that have embraced liberalization policies, with particular attention to gender differences and policy dynamics’.

Shi, Y, Lenzi, M & An, R 2015, ‘Cannabis liberalization and adolescent cannabis use: a cross-national study in 38 countries’, PLoS One, vol. 10, no. 11, pp. e0143562, open access http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143562.
 
Comment: While this is a useful study, the authors caution that, in classifying nations’ legal approaches to cannabis, it 1) fails to differentiate between the laws on the books and the ways they are implemented and 2) the fact that, in many nations, cannabis legislation and law enforcement practices differ between sub-national jurisdictions, e.g. states and provinces. These and other, methodological limitations, mean that the results need to be used with caution, especially as the findings are inconsistent with those of a number other studies.

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How effective are psychological and psychosocial interventions for cannabis cessation in adults who use cannabis?

A systematic review of the clinical effectiveness of psychological and psychosocial interventions for cannabis cessation in adults who use cannabis regularly evaluated the use of a wide variety of psychological and psychosocial interventions. The authors summarised their findings as follows: ‘Regular users of cannabis risk become dependent on the drug. Treatments aiming to reduce cannabis use in regular users have focused on psychosocial and psychological interventions such as cognitive–behavioural therapy (CBT), which aims to manage cannabis use by managing negative behaviours through changing the way the participant thinks or behaves; motivational interviewing (MI), which helps people change behaviour by resolving ambivalence and improving motivation; and contingency management, voucher incentives for reductions in cannabis use. This systematic review assesses which treatment (or combination of treatments) is most effective at reducing cannabis use. Studies were of low quality and differed in the treatments they tested and the participants they recruited. We divided studies into those assessing “general” cannabis users and those assessing cannabis users who also had a psychiatric condition. In the “general” studies, CBT was more effective than no treatment in six studies, but this effect was assessed long term in only one study. Results were mixed when CBT was compared with brief MI and when brief MI was compared with no treatment. CBT with contingency management was more effective than CBT alone in the long term. In studies in people with psychiatric conditions, CBT showed limited benefit when compared with usual treatment; however, results were difficult to interpret owing to study design. Future research should focus on the number of treatment sessions required, effect of participant recruitment method on results (i.e. whether or not participants volunteered), selection of appropriate measures to assess changes in cannabis use, use of no-treatment control groups and long-term follow-up’.

Cooper, K, Chatters, R, Kaltenthaler, E & Wong, R 2015, ‘Psychological and psychosocial interventions for cannabis cessation in adults: a systematic review short report’, Health Technology Assessment, vol. 19, no. 56.

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How cost effective is it to provide opioid substitution therapy to opioid dependent prison inmates on their release?

A cost-effectiveness analysis (CEA) of opioid substitution therapy (OST) immediately after prison release on reducing mortality in the first 6-months post-release was undertaken in NSW. It involved a cohort of over 16,000 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011. The researchers report that ‘The results from this CEA provide the first available evidence that immediate treatment with OST after release from prison is…cost-effective. There were three times as many deaths among those who were not released onto OST…Furthermore, the probability that OST post-release is cost-effective per life-year saved was estimated to be 96.7% at a willingness to pay of $500 and 99.4% cost-effective at a willingness to pay of $10 000…Our finding, that the majority of people (about 95%) who were receiving OST in prison immediately prior to release were also released onto OST, is encouraging. Given the well-known health and social benefits of OST treatment, particularly among those who are retained in treatment, ensuring treatment continuity in the transitional phase between leaving prison and re-entry into the community is necessary to optimize outcomes. Furthermore, pre-release OST has been associated with an increase in both treatment uptake and retention after release, and OST treatment while in prison has also been shown to have a protective effect on mortality’.

Gisev, N, Shanahan, M, Weatherburn, DJ, Mattick, RP, Larney, S, Burns, L & Degenhardt, L 2015, ‘A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence’, Addiction, vol. 110, no. 12, pp. 1975-84.

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How extensive are harm reduction and drug treatment services in custodial settings in Europe?

Abstract:
Aims: The aim of the study was to survey the availability, coverage and quality of harm reduction and drug treatment services delivered to drug users in prisons across Europe.
Methods: A survey was conducted between 2012 and 2013 among the 29 European countries. An electronic semistructured questionnaire was sent to the national institutions responsible for prison services, and 27 countries responded. In addition, good practice interventions for drug offenders have been collated by 15 national experts covering 15 European countries. The interventions were described and assessed as to their quality through using European monitoring centre for drugs and drug addiction (EMCDDA) standard tools for reporting and quality assessment.
Findings: Drug treatment including detoxification and opioid substitution treatment (OST) is available in prisons of most European countries. However, OST is unavailable in five countries. Almost all countries provide prison-based harm reduction measures to prevent and treat infectious diseases among prisoners. Especially, testing and treatment for HIV and tuberculosis are provided, while other measures, such as the distribution of condoms or bleach, and especially needle and syringe programmes are still rare.
Conclusions: Access to and coverage of OST in prisons is higher in countries with a long history of OST provision, while in countries that introduced OST more recently the scale of OST is usually lower. Access to hepatitis C treatment is often limited in prisons due to the lack of drug abstinence or a health insurance.

Zurhold, H & Stöver, H 2015, ‘Provision of harm reduction and drug treatment services in custodial settings–findings from the European ACCESS study’, Drugs: education, prevention and policy, online ahead of print.

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What is the effect of alcohol taxes and prices on alcohol-related morbidity and mortality?

A systematic review of international studies on the effects of alcohol taxes and prices on alcohol-related morbidity (illness & injury) and mortality (deaths) aimed to assess their public health impacts. The analysis ‘…showed clearly that beverage alcohol prices and taxes were significantly and inversely related to all outcome categories examined: alcohol-related morbidity and mortality, violence, traffic crash fatalities and drunk driving, rates of STDs and risky sexual behavior, other drug use, and crime, with the sole exception that the estimated inverse relation with suicide was not statistically significant’. The reviewers concluded that ‘Public policies affecting the price of alcoholic beverages have significant effects on alcohol-related disease and injury rates. Our results suggest that doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%’.

Wagenaar, AC, Tobler, AL & Komro, KA 2010, ‘Effects of alcohol tax and price policies on morbidity and mortality: a systematic review’, American Journal of Public Health, vol. 100, no. 11, pp. 2270-8.
 
Comment: Over the years the Australian AOD community, including ATODA, has been calling on the Commonwealth Government to implement the recommendations of the Henry tax review to introduce volumetric taxation of alcoholic beverages, i.e. taxing them according to the amount of alcohol they contain. This study provides further strong evidence of the likely benefits of adopting a more evidence-informed approach to alcohol taxation in this nation.

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What is the evidence about the effectiveness of brief, single-session interventions to reduce alcohol use among heavy drinking college students?
 
American researchers undertook a meta-analysis that aimed to summarise the effectiveness of brief, single-session interventions to reduce alcohol use among heavy drinking college students. They conducted a literature search which identified 73 studies comparing the effects of single-session brief alcohol intervention with treatment-as-usual or no-treatment control conditions on alcohol use among heavy drinking college students. The meta-analysis showed that, ‘…on average, single-session brief alcohol interventions significantly reduced alcohol use among heavy drinking college students relative to comparison conditions. There was minimal variability in effects associated with study method and quality, general study characteristics, participant demographics, or outcome measure type. However, studies using motivational enhancement therapy/motivational interviewing (MET/MI) modalities reported larger effects than those using psychoeducational therapy (PET) interventions. Further investigation revealed that studies using MET/ MI and feedback-only interventions, but not those using cognitive-behavioral therapy or PET modalities, reported average effect sizes that differed significantly from zero. There was also evidence that long-term effects were weaker than short-term effects.’ This led the researchers to conclude that the existing literature suggests that ‘Single-session brief alcohol interventions show modest effects for reducing alcohol consumption among heavy drinking college students and may be particularly effective when they incorporate MET/MI principles. More research is needed to directly compare intervention modalities, to develop more potent interventions, and to explore the persistence of long-term effects.’

Samson, JE & Tanner-Smith, EE 2015, ‘Single-session alcohol interventions for heavy drinking college students: a systematic review and meta-analysis’, Journal on Studies of Alcohol and Drugs, vol. 76, no. 4, pp. 530-43.

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How could screening and brief interventions in primary health care be improved so as to increase their effectiveness in reducing heavy alcohol consumption?

Researchers noted that ‘Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused.’ They undertook a meta-analysis of controlled trials covering SBI delivered in primary health care settings that aim to decrease alcohol consumption among patients. The aim was to identify implementation strategies that focus on SBI uptake and measure SBI’s impacts on heavy drinking and delivery of SBI in PHC. Key outcomes measured included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. 29 studies were included in the analysis and all were judged to be of moderate methodological quality.
They found that the ‘Strategies had no overall impact on patients’ reported alcohol consumption…, despite improving screening…and brief intervention delivery…Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients’ alcohol consumption…Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact...Involving other staff besides physicians was beneficial for screening...
The researchers concluded that, ‘…in order to increase SBI delivery and decrease patients’ alcohol consumption, this study has shown that implementation should ideally include a combination of patient-, professional- and organizational-orientated implementation strategies and involvement of other staff working with physicians. To explain the lack of effect on alcohol consumption when SBI delivery was increased, the fidelity of SBI delivery to detect effects in patients’ alcohol consumption should be investigated. Furthermore, evidence for new and innovative combinations of multiple implementation approaches to increase alcohol-focused SBI uptake in PHC is required’.

Keurhorst, M et al. 2015, 'Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis’, Addiction, vol. 110, no. 12, pp. 1877-900.

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What is the association between alcohol-related injuries and the availability of alcohol?

A study undertaken by researchers from Curtin University in Perth analysed data from presentations to the emergency departments of Perth metropolitan hospitals over the period 2002 to 2010, and data on licensed outlets operating in the region during the study period. The analysis revealed that ‘Higher alcohol sales among off-premises outlets were associated with increased risk of alcohol-related injury. This association may be due to the effect that off-outlets have on economic availability or “affordability”. Larger outlets (often warehouse-style chain stores), with greater capacity, are able to offer sizeable discounts and other incentives, enabling drinkers to purchase more alcohol for the same price, such that the “real price” of alcohol falls and the economic availability of alcohol increases. Conversely, greater numbers of off-premises outlets appeared to reduce injury risk. This unexpected finding may be partly due to liquor outlets being situated closer to drinker residences (or work-places), thereby reducing travel time to and from outlets and lowering risk of transport injury. Alternatively, the closer proximity of off-premises outlets may reduce the number of occasions that drinkers frequent on-premises outlets; that is, readily available low-cost alcohol may encourage drinking in the home rather than at hotels where alcohol is more expensive’.
The researchers stated that ‘These findings provide further evidence to support limiting the granting of liquor licences and extended trading hours to reduce alcohol-related harm. They also indicate that the granting of on- and off-premises outlet licences may require different management strategies in order to reduce alcohol-related harms. The use of licence conditions to limit the size and capacity of off-premises outlets, rather than merely controlling the number of off-premises licences, may be important or regulating retail prices and economic availability’.
The researchers concluded that ‘This research provides evidence of associations between alcohol-related injury and the number of alcohol outlets, sales per outlet and trading hours. The associations between on- and off-premises outlets and injury appear to be underpinned by different mechanisms and will require tailored policy in order to reduce alcohol-related harms. On-premises outlets with extended trading hours present a specific challenge in addressing alcohol-related injury.

Hobday, M, Chikritzhs, T, Liang, W & Meuleners, L 2015, ‘The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010’, Addiction, vol. 110, no. 12, pp. 1901-9.

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What can be done to reduce the amount of alcohol that adults provide to minors?

The Foundation for Alcohol Research and Education (FARE) has published the results of a study which explored why Australian adults continue to provide alcohol to adolescents (secondary supply) despite being aware that this behaviour is illegal, and also examined similarities and differences in perceptions of secondary supply, speeding, and drink driving offences. A survey of over 400 NSW residents revealed that ‘Secondary supply appears to be a behaviour that is generally unacceptable, and that is strongly associated with Personal Morality and Social Norms. In response to the hypothetical scenario of a parent providing alcohol to someone else’s adolescent children, as with the scenario relating to speeding, few respondents focused on the behaviour itself when considering what the hypothetical individuals would be thinking about, instead generally focusing on other aspects of the scenario, such as relief that the evening went well or enjoyment of the social activity. Conversely, the illegal behaviour (and the risk of being caught) was the focus of the majority of the responses to the drink driving scenario’. The report makes several recommendations including ‘Communication and social marketing campaigns should focus on reinforcing people’s underlying attitudes that secondary supply is inappropriate, and denormalising the provision of alcohol to underage drinkers’ and ‘Given the demonstrated role of Deterrence in reducing speeding and drink driving, policy initiatives that facilitate enforcement of secondary supply laws are likely to have a substantial impact on reducing secondary supply’.

Jones, SC, Berends, L., Wyatt, A., Francis, K., Barrie, L. & Robinson, L. 2015, Why don’t friends and relatives of underage drinkers comply with secondary supply laws in NSW?, Foundation for Alcohol Research and Education, Canberra, http://www.fare.org.au/2015/11/why-dont-friends-and-relatives-of-underage-drinkers-comply-with-secondary-supply-laws-in-nsw/.

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What is the association between the density of tobacco outlets around secondary schools and the risk of young smoking?

Researchers in New Zealand examined the density of tobacco outlets around secondary schools in that country and current smoking, experimental smoking, susceptibility to smoking, and attempted and successful tobacco purchasing. They found ‘Of the 27 238 [Year 10] students surveyed, 3.5%...were current smokers, 4.1%...were experimental smokers, and 39.8%...of nonsmokers were susceptible to smoking. An inverse relationship was found between the density of tobacco retail outlets and current smoking. Current smokers were significantly more likely to attempt to purchase tobacco if the density of tobacco retail outlets around their school was high. Non-smoking students were more likely to be susceptible to smoking if the density of tobacco outlets around their school was high. There was no statistically significant association between density of tobacco outlets and successful purchasing, nor experimental smoking’. They concluded ‘Restricting the permitted density of tobacco retail outlets around schools should be part of comprehensive tobacco control. In this regard, both smokers and non-smokers support the introduction of increased regulation of the tobacco retail environment to achieve our national smoke-free 2025 goal’.

Marsh, L, Ajmal, A, McGee, R, Robertson, L, Cameron, C & Doscher, C 2015, ‘Tobacco retail outlet density and risk of youth smoking in New Zealand’, Tobacco Control, online ahead of print.

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How serious a problem is thirdhand smoke in paediatric hospitals?

Abstract
Background: Tobacco has regained the status of the world’s number two killer behind heart/vascular disease. Thirdhand smoke (THS) residue and particles from secondhand smoke (SHS) are suspected health hazards (eg, DNA damage) that are likely to contribute to morbidity and mortality, especially in vulnerable children. THS is easily transported and deposited indoors, where it persists and exposes individuals for months, creating potential health consequences in seemingly nicotine-free environments, particularly for vulnerable patients. We collected THS data to estimate infant exposure in the neonatal ICU (NICU) after visits from household smokers. Infant exposure to nicotine, potentially from THS, was assessed via assays of infant urine.
Methods: Participants were mothers who smoked and had an infant in the NICU (N=5). Participants provided surface nicotine samples from their fingers, infants’ crib/incubator and hospital-provided furniture. Infant urine was analysed for cotinine, cotinine’s major metabolite: trans-3′-hydroxycotinine (3HC) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the nicotine-derived and tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).
Results: Incubators/cribs and other furniture had detectable surface nicotine. Detectable levels of cotinine, 3HC and NNAL were found in the infants’ urine.
Discussion: THS appears to be ubiquitous, even in closely guarded healthcare settings. Future research will address potential health consequences and THS-reduction policies. Ultimately, hospital policies and interventions to reduce THS transport and exposure may prove necessary, especially for immunocompromised children.

Northrup, TF et al. 2015, ‘Thirdhand smoke contamination in hospital settings: assessing exposure risk for vulnerable paediatric patients’, Tobacco Control, online ahead of print.
 

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New Reports

ACT Government, Justice and Community Safety Directorate quarterly, Statistical profile, ACT criminal justice, September 2015 quarter, ACT Government, Justice and Community Safety, http://www.justice.act.gov.au/criminal_and_civil_justice/criminal_justice_statistical_profiles.
 
Armenta, A & Jelsma, M 2015, The UN drug control conventions: a primer, Transnational Institute (TNI), https://www.tni.org/en/publication/the-un-drug-control-conventions.
 
Australian Bureau of Statistics 2015, National Health Survey: first results 2014-15, cat no. 4364.0.55.001, ABS, Canberra, www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001.
 
Australian Institute of Health & Welfare 2015, The health of Australia’s prisoners 2015, AIHW cat. no. PHE207, Australian Institute of Health & Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129553527.
 
Commonwealth of Australia, Department of the Prime Minister and Cabinet 2015, Final report of the National Ice Taskforce, Canberra, https://www.dpmc.gov.au/pmc/publication/final-report-national-ice-taskforce  large file warning: 6.2 & 3.1 MB.
 
Gray, D, Stearne, A, Bonson, M, Wilkes, E, Butt, J & Wilson, M 2014 (released Dec. 2015), Review of the Aboriginal and  Torres  Strait  Islander  alcohol,  tobacco  and  other  drugs  treatment  service  sector:  Harnessing Good Intentions (revised version), National Drug Research Institute, Curtin University, Perth, WA, http://ndri.curtin.edu.au/local/docs/pdf/publications/T231.pdf.
 
Iversen, J & Maher, L 2014, Australian NSP Survey: prevalence of HIV, HCV and injecting and sexual behaviour among Needle and Syringe Program attendees. 20 year national data report 1995 – 2014, The Kirby Institute, UNSW, Sydney, http://kirby.unsw.edu.au/surveillance/australian-nsp-survey-national-data-report-1995-2014.
 
McConnell, B & McConnell, M 2015, The drug law wars: twenty years of families fighting at the front, Families and Friends for Drug Law Reform, Canberra, http://www.ffdlr.org.au/.
 
Ritter, A, Berends, L, Chalmers, J, Hull, P, Lancaster, K & Gomez, M 2014 (released Nov. 2015), New Horizons: the review of alcohol and other drug treatment services in Australia. Final Report, Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, http://www.health.gov.au/internet/main/publishing.nsf/Content/drugtreat-fund.
 
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