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.
What level of public support is there for prohibiting the sale of tobacco products to people born after 2000?
‘The tobacco-free generation (TFG) proposal advocates prohibiting the sale of tobacco products to people born after the year 2000. In a world-first, the Tasmanian parliament is considering this proposed legislation’. Researchers based in Tasmania investigated levels of public support for the proposal among adults and adolescents. They conducted two cross-sectional studies in 2014: a telephone survey of 600 randomly sampled Tasmanians aged 18 years or over and a pencil and paper survey of 1,888 Tasmanian secondary school students aged 12–17 years. They found that ‘Support for the TFG proposal was 75% among Tasmanian adults. Majority support extends across all sociodemographic subgroups, including 72% of current smokers…Of those aged 12–17 years, 68% supported the TFG proposal, including 64% of those born after the year 2000, who would be directly affected by the TFG proposal. Support was higher among non-smokers and those born before the year 2000’. They concluded that ‘There is strong public support for the TFG proposal in Tasmania, even among smokers and people born after the year 2000’.
Trainer, E, Gall, S, Smith, A & Terry, K 2016, ‘Public perceptions of the tobacco-free generation in Tasmania: adults and adolescents
’, Tobacco Control
, online ahead of print.
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Is the smoking population hardening or softening as smoking prevalence falls - #1?
: The hardening hypothesis proposes that as smoking prevalence declines the proportion of ‘hardcore’ or ‘hardened’ smokers will increase. The possible constructs of hardening include reduced motivation to quit, increased levels of addiction, increased levels of disadvantage and reduced quit rates among continuing smokers. Most previous studies have investigated only a single facet of the hypothesis. Data from a national population monitor was used to test the hypothesis using measures across all four hardening constructs.
Data was analysed from a biennial population-based survey of New Zealand adults (aged 15 years+) from 2008 to 2014. Data were collected through face-to-face computer-assisted personal interviews.
: During a period of reducing smoking prevalence, there were no statistically significant changes in indicators of hardening including the proportion of smokers who were unmotivated to quit, unable to quit despite repeated attempts or receiving state benefits or on a low income. Quit rates did not change significantly over the study period…
: This study provides evidence that robust tobacco control strategies that result in substantial declines in smoking prevalence are not accompanied by the hypothesised increase in ‘hardcore’ or ‘hardened’ smokers who are more addicted and less motivated and able to quit. The findings suggest that there is no need for substantial change in approach to achieve New Zealand’s Smokefree 2025 goal on the grounds that the smoker population is becoming increasingly hardened.
Edwards, R, Tu, D, Newcombe, R, Holland, K & Walton, D 2016, ‘Achieving the tobacco endgame: evidence on the hardening hypothesis from repeated cross-sectional studies in New Zealand 2008–2014
’, Tobacco Control
, online ahead of print.
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Is the smoking population hardening or softening as smoking prevalence falls - #2?
: It has been argued that as smoking prevalence declines in countries, the smokers that remain include higher proportions of those who are unwilling or unable to quit (a process known as ‘hardening’). Smokeless tobacco and e-cigarettes have been promoted as a strategy to deal with such smokers. If hardening is occurring, there would be a positive association between smoking prevalence and quitting, with less quitting at lower prevalence. There would also be a neutral or negative association between prevalence and the number of cigarettes smoked.
: They examined US state-level associations using the Tobacco Use Supplement (1992/1993–2010/2011) and Eurobarometer surveys for 31 European countries (2006–2009–2012) using regressions of quit attempts, quit ratios, and number of cigarettes smoked on smoking prevalence over time.
For each 1% drop in smoking prevalence, quit attempts increase by 0.55%±.07…in the USA and remain stable in Europe…, US quit ratios increase by 1.13%±0.06…, and consumption drops by 0.32 cig/day±0.02…in the USA and 0.22 cig/day±0.05…in Europe. These associations remain stable over time …, with significantly lower consumption at any given prevalence level as time passed in the USA (−0.15 (cig/day)/year±0.06…).
Consistent with prior research using different data and methods, these population-level results reject the hypothesis of hardening as smoking prevalence drops, instead supporting softening of the smoking population as prevalence declines.
Kulik, MC & Glantz, SA 2016, ‘The smoking population in the USA and EU is softening not hardening
’, Tobacco Control
, vol. 25, no. 4, pp. 470-5.
Comment: These and related studies provide guidance as to priority setting in tobacco control policies in low smoking prevalence jurisdictions such as the ACT. The absence of hardening and the possibility of softening mean that we need to maintain—indeed increase—implementing the existing strategies, as they have been shown to work well with the residual smokers. At the same time, we need to innovate to meet the needs of specific sub-populations of smokers, and adopt technological innovations, such as personal vaporisers containing nicotine, as adjuncts to standard approaches.
To what extent does the normalisation theory explain changes in adolescent drunkenness and smoking?
Israeli researchers applied a normalisation framework to examine changes in adolescent drunkenness and cigarette use in Israel between 1994 and 2010. They explained that ‘the normalisation theory predicts that when alcohol or cigarette use becomes normal…alcohol and cigarette use behaviours become more attractive to well-adjusted adolescents. In turn one would expect to see more low risk adolescents use cigarettes and alcohol when prevalence rates are relatively high’. They expected that ‘adolescents exposed to multiple risk factors to be at equal risk for drunkenness and cigarette use regardless of population level changes in alcohol and cigarette use’. They found that, ‘Between zero and two risk factors, the risk of drunkenness and smoking increases for each additional risk factor. When reaching two risk factors, added risk does not significantly increase the likelihood of smoking and drunkenness. Changes in population level drunkenness and smoking did not systematically relate to changes in the individual level relationship between risk factors and smoking and drunkenness’. This led to the conclusion that, ‘In a low prevalence country like Israel, the normalisation theory may not accurately explain changes in adolescent alcohol and cigarette use. In contrast, the multiple risk factor model explains the relation between risk factors and adolescent drunkenness and cigarette use well’.
Sznitman, SR, Zlotnick, C & Harel-Fisch, Y 2016, ‘Normalisation theory: Does it accurately describe temporal changes in adolescent drunkenness and smoking?
’, Drug and Alcohol Review
, vol. 35, no. 4, pp. 424-32.
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What is the relationship between the normalisation of drug use and the social supply of drugs?
Researchers described how the relative normalisation of recreational drug use in the UK has produced and fused with the relatively normalised and non-commercial social supply of recreational drugs. They conducted interviews with 60 social suppliers of recreational drugs in two studies: half students and half from the general population. They found that ‘Both samples provided strong evidence of the normalised supply of recreational drugs in micro-sites of friendship and close social networks. Many social suppliers described “drift” into social supply and normalised use was suggested to be productive of supply relationships that both suppliers and consumers regard as something less than “real” dealing in order to reinforce their preconceptions of themselves as relatively non-deviant’. They concluded that ‘The fairly recent context of relative normalisation of recreational drug use has coalesced with the social supply of recreational drugs in micro-sites of use and exchange whereby a range of “social” supply acts (sometimes even involving large amounts of drugs/money) have become accepted as something closer to gift-giving or friendship exchange dynamics within social networks rather than dealing proper. To some degree, there is increasing sensitivity to this within the criminal justice system’.
Coomber, R, Moyle, L & South, N 2016, ‘The normalisation of drug supply: the social supply of drugs as the “other side” of the history of normalisation
’, Drugs: education, prevention and policy
, vol. 23, no. 3, pp. 255-63, open access.
Comment: Research into social supply of illegal drugs in Canberra conducted by DPMP and local researchers, facilitated by ATODA and CAHMA, formed the basis of legislative changes to the thresholds of drug possession that differentiate possession for personal use from possession for the purpose of supply, a much more serious offence. The ACT Government’s policy response, fully supported by ATODA, reflected the reality of social supply. See Hughes, C & Ritter, A 2011, Legal thresholds for serious drug offences: expert advice to the ACT on determining amounts for trafficable, commercial and large commercial drug offences, National Drug and Alcohol Research Centre, Sydney, https://ndarc.med.unsw.edu.au/resource/DPMP-monograph-22-legal-thresholds-serious-drug-offences.
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How does smoking rates among pregnant women compare with smoking rates in the female population as a whole?
A study of smoking rates among pregnant women and the general female population used data from Australia, Finland, Norway and Sweden. It found that, ‘In general, persistent smoking has decreased and late-pregnancy smoking rates are lower than daily smoking rates among all women. However, younger women are more likely to be persistent smokers regardless of pregnancy status. In Norway and Finland, persistent smoking was most common among young pregnant women and in Sweden there was an increased polarisation between age groups. In Australia, a steady decrease in smoking rates appears to have stalled in younger pregnant women’. The researchers concluded that ‘Although smoking has declined substantially in recent decades, there are groups lagging behind this general trend. Young pregnant women are of particular concern in this respect’.
Reitan, T & Callinan, S 2016, ‘Changes in smoking rates among pregnant women and the general female population in Australia, Finland, Norway and Sweden
’, Nicotine & Tobacco Research
, online ahead of print.
Comment: This trend towards higher smoking rates among younger pregnant women is consistent with ACT data (as reported in the ACT Chief Health Officer’s Report 2016). ACT Health is currently implementing a project targeting smoking during pregnancy among young women; the project includes a social marketing campaign and the provision of nicotine replacement therapy to young pregnant women.
Smoking rates are also known to be higher among a number of disadvantaged sub-populations in the ACT—e.g. Aboriginal and Torres Strait Islander people, people accessing alcohol and other drug services, people accessing mental health services, etc. Pregnant women in these sub-populations are likely to also require additional smoking cessation support, particularly if they are from younger age groups. ATODA has published a paper, ‘Reducing smoking in the ACT among Aboriginal and Torres Strait Islander women who are pregnant or who have young children’, that make s number of recommendations on promoting smoking cessation among this sub-population.
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How effective is the NSW Magistrates Early Referral Into Treatment (MERIT) diversion program in protecting against recidivism?
A Drug Policy Modelling Program study sought to assess the impact of the pre-sentence Magistrates Early Referral Into Treatment (MERIT) diversion program in NSW on offending in the 12 months following exposure to the intervention. The researchers state that ‘Our research has shown how MERIT participants were reconvicted within 12 months at a significantly higher rate than a comparison group identified as drug misusers following completion of an LSI-R assessment and sentence in non-MERIT NSW Local Courts and matched on relevant demographic and criminal history variables. Furthermore, when controlling for the influence of index penalty imposed, exposure to MERIT did not make a significant contribution to the prediction of reconviction at 12 months. The volume of known offending among those exiting the MERIT program was found to be significantly higher in the 12-month follow-up period (including when adjustments were made for time at reduced risk due to imprisonment). There were no associations observed between exposure to MERIT and changes in offence seriousness… Of those belonging to the MERIT group, program completion was found to have a significant protective effect against recidivism’.
McSweeney, T, Hughes, CE & Ritter, A 2016, ‘Tackling “drug-related” crime: are there merits in diverting drug-misusing defendants to treatment? Findings from an Australian case study’, Australian & New Zealand Journal of Criminology
, vol. 49, no. 2, pp. 198-220.
Comment: A key take-home message from this important Australian study is that diversion to treatment, although important, is not sufficient. What is also needed is high quality treatment and high treatment completion rates among the diverted offenders.http://anj.sagepub.com/content/early/2015/01/29/0004865814555773
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How significant is the association between traumatic brain injury and substance use?
: The literature has opposing views regarding the magnitude of the association between substance use and TBI [traumatic brain injury]. Most studies have examined clinical samples which are not representative of the entire head injured population. Clinical samples provide very limited insight into TBI patients whom (sic
) do not seek care.
This paper examines the associations between TBI and substance use/misuse. Its primary aim is to test whether or not individuals with a past-year TBI have higher rates of substance use/misuse than Canadians without a TBI or back and/or spine injury controls drawing on self-report population level data.
: Using the 2009-2010 Canadian Community Health Survey, a nationally representative cross-sectional survey of Canadians 12 years and older, this paper assessed substance use (i.e., illicit drug use; drinking and binge drinking; current smoking) among those with a TBI, as compared to two control groups: (1) individuals with a back or spinal injury (BSI); and (2) healthy noninjured controls. Multivariate regressions (logistic and multinomial), both unadjusted and adjusting for a range of injury and sociodemographic covariates, were used in hypothesis testing.
: Those with a past-year TBI demonstrated significantly elevated rates of illicit drug use relative to non-injured Canadians. Relative to the BSI group those with a TBI were less likely to drink alcohol, did not differ in binge drinking, cigarette smoking and illicit drug use.
: Health care professionals working with the TBI population should integrate screening, brief intervention, and referral programming as a means to reduce future harm related to substance misuse.
Allen, S, Stewart, SH, Cusimano, M & Asbridge, M 2016, ‘Examining the relationship between traumatic brain injury and substance use outcomes in the Canadian population
’, Substance Use and Misuse
, online ahead of print.
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What is known about the extent and effect of stigma on people who inject drugs?
: Perceived experiences of stigma have been found to be associated with poorer psychosocial outcomes and engagement in risk practices among people who inject drugs. Yet the extent to which people internalize or accept the stigma surrounding their injecting drug use, and whether this is associated with risky injecting practices, is not well known.
The aim of this study was to assess the extent of internalized stigma among a sample of people who inject drugs in Australia and identify socio-demographic, injecting risk, and mental health correlates.
People who inject drugs were recruited from a needle and syringe program located in Sydney, Australia to complete a brief survey. The survey included measures of internalized stigma, severity of drug dependence, self-esteem, depression, and shared use of injecting equipment.
: The sample comprised 102 people who inject drugs. Internalized stigma was higher among participants who reported being depressed in the past month, and was also associated with greater severity of drug dependence and diminished self-esteem. There was no relationship between internalized stigma and shared use of needles or other injecting equipment in the past month.
: Findings underscore the need for further investigation of internalized stigma among people who inject drugs. In particular, future research should assess the impact of implicit (i.e., subconscious) internalized stigma on mental health.
Cama, E, Brener, L, Wilson, H & von Hippel, C 2016, ‘Internalized stigma among people who inject drugs’, Substance Use and Misuse
, online ahead of print.
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How long after heroin overdose is it feasible to intervene to attempt resuscitation?
The presence of 6-monoacetyl morphine (6MAM), an active metabolite of heroin, in the blood is suggestive of survival times of less than 20–30 minutes following heroin administration. The study of 145 heroin-related deaths in Sydney over the two years 2013-2014 aimed to determine the proportions of cases in which 6MAM was present, and compare concentrations of secondary metabolites and circumstances of death by 6MAM status. The mean age was 40.5 years and 81% were male. Circumstances of death included bronchopneumonia, apparent sudden collapse, location and other central nervous system (CNS) depressants. The study found that 6MAM was detected in 43% of the deaths. The conclusion of the researchers was that ‘In heroin-related deaths in Sydney, Australia during 2013 and 2014, 6-monoacetyl morphine was present in the blood in less than half of cases, suggesting that a minority of cases had survival times after overdose of less than 20–30 minutes. The toxicology of heroin metabolites and the circumstances of death were consistent with 6-monoacetyl morphine as a proxy for a more rapid death…In the majority of cases, however, survival times appeared prolonged, with a substantial period of time in which resuscitation was feasible’.
Darke, S & Duflou, J 2016, ‘The toxicology of heroin-related death: estimating survival times
, vol. 111, no. 9, pp. 1607-13.
Comment: This study provides further evidence underpinning opioid overdose mortality prevention programs: in the majority of overdoses there is time available for bystanders to call an ambulance, administer naloxone and carry out other life-saving interventions.
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What resources are available for assessing overdose knowledge in people who use opioids?
: Opioid overdose is a public health crisis. This study describes efforts to develop and validate the Brief Opioid Overdose Knowledge (BOOK) questionnaire to assess patient knowledge gaps related to opioid overdose risks.
: Two samples of illicit opioid users and a third sample of patients receiving an opioid for the treatment of chronic pain (total N = 848) completed self-report items pertaining to opioid overdose risks.
: A 3-factor scale was established, representing Opioid Knowledge (4 items), Opioid Overdose Knowledge (4 items), and Opioid Overdose Response Knowledge (4 items). The scale had strong internal and face validity. Patients with chronic pain performed worse than illicit drug users in almost all items assessed, highlighting the need to increase knowledge of opioid overdose risk to this population.
: This study sought to develop a brief, internally valid method for quickly assessing deficits in opioid overdose risk areas within users of illicit and prescribed opioids, to provide an efficient metric for assessing and comparing educational interventions, facilitate conversations between physicians and patients about overdose risks, and help formally identify knowledge deficits in other patient populations.
Dunn, KE, Barrett, FS, Yepez-Laubach, C, Meyer, AC, Hruska, BJ, Sigmon, SC, Fingerhood, M & Bigelow, GE 2016, ‘Brief Opioid Overdose Knowledge (BOOK): a questionnaire to assess overdose knowledge in individuals who use illicit or prescribed opioids’, Journal of Addiction Medicine
, online ahead of print, open access
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To what extent is there a relationship between the timing of income support payments and increases in the rate of illicit drug overdose deaths? Could staggering the delivery of payments reduce spikes in overdose deaths?
A Canadian study assessed the temporal patterns and causal relation between population-level illicit drug overdose deaths and income assistance payments using daily mortality data for British Columbia over a period of five years. The study found that ‘1343 deaths due to illicit drug overdose were reported in BC during 2009–2013; 394 occurred during cheque weeks (n = 60) and 949 occurred during non-cheque weeks (n = 202). Average weekly mortality due to illicit drug overdose was 40% higher during weeks of income assistance payments compared to weeks without payments…Consistent increases in mortality appeared the day after cheque disbursement and were significantly higher for two days, and marginally higher after 3 days, even when controlling for other temporal trends’. The researchers concluded that ‘Our findings clarify the temporal relation and causal impact of income assistance payments on illicit drug deaths. We estimate 77 avoidable deaths were attributable to the synchronized disbursement of income assistance cheques over the five year period. An important consideration is whether varying the timing of payments among recipients could reduce this excess mortality and the related demands on health and social services…There is, therefore, a strong rationale for examining alternative disbursement schedules experimentally (e.g., varying the timing of cheque issuance among recipients, issuing smaller and more frequent cheques, etc.) in order to reduce this avoidable mortality and the demands on health and social services. Given the consistent increase in overdose deaths following cheque issue, there is a clear need for harm reduction and support services to be available during this time to mitigate adverse outcomes related to substance use and income assistance payments’.
Otterstatter, MC, Amlani, A, Guan, TH, Richardson, L & Buxton, JA 2016, ‘Illicit drug overdose deaths resulting from income assistance payments: analysis of the ‘check effect’ using daily mortality data’
, International Journal of Drug Policy
, online ahead of print.
Comment: So far as ATODA is aware, no studies have been conducted in Australia to determine if a relationship exists between the timing of financial support payments and drug overdose incidence. Such a study may have potential to guide overdose prevention programs. Note, however, that in British Columbia social welfare payments are made monthly whereas in Australia they are made fortnightly.
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In what ways can drug consumption rooms improve the well-being of drug users and reduce overdose?
In 2012, Danish politicians passed a law that allowed drug consumption rooms (DCRs) to operate; among the objectives of this intervention were to improve the well-being of vulnerable citizens and to reduce the number of overdoses. Five Danish DCRs are currently operating. A team of Danish researchers undertook a national investigation focused on assessing the impact of Danish drug consumption rooms on the health and well-being of DCR clients and factors facilitating the acceptance of DCR clients in order to improve their health and refer them to social and health service providers. They conducted 250 hours of participant observation in the DCRs, followed by in-depth qualitative interviews with 42 DCR clients and 25 staff members. They found that ‘DCR clients experienced a sense of social acceptance while inside DCRs. Members of staff conveyed a welcoming, non-judgemental attitude, and DCR clients were predominantly satisfied with the facilities. They prioritized forging relations with drug users so as to foster a sense of social acceptance within DCRs. The primary goal of staff members is to prevent overdoses by informing clients about strong drugs and by intervening in cases of intoxication. DCRs provide security to clients. In cases of health-related problems, DCR clients were referred to local health clinics. Members of the staff build bridges for DCR clients by guiding them towards drug treatment programmes and services in the social and the health sectors’. The researchers concluded that ‘The study reveals a consistency between DCR clients and staff members with respect to appraisal of the importance of DCRs. Both clients and staff agreed that DCRs provide a safe haven in the environment in which DCR clients often live and that staff members approach to clients with the intention of promoting acceptance clears the path for the prevention and treatment of overdoses and providing referrals to healthcare facilities, to drug treatment centres and to social services’.
Kappel, N, Toth, E, Tegner, J, & Lauridsen, S 2016, 'A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugs
’, Harm Reduction Journal
, vol. 13, no. 1, pp. 1-12.
Comment: In 1999, during the previous epidemic of opioid overdose morbidity and mortality, the Legislative Assembly for the ACT passed the Supervised Injecting Place Trial Act. The establishment of Canberra’s supervised injecting place was blocked by two independent members of the Assembly. Perhaps the time has come to re-visit the need for such a facility in Canberra, particularly in light of the demonstrated success of the Sydney Medically Supervised Injecting Centre and the continuing high rates of overdose in Canberra?
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How effective are managed alcohol programs in changing patterns of alcohol consumption and reducing related harm?
Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Canadian researchers investigated patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, in 2013. They found that, ‘Compared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time…87% fewer detox admissions…and 32 % fewer hospital admissions…There were reductions in nearly all available LFT [liver function test] scores after MAP entry. Compared with controls, MAP participants had 43% fewer police contacts, significantly fewer police contacts (-38%) that resulted in custody time…70% fewer detox admissions…and 47% fewer emergency room presentations. NBA [non-beverage alcohol] use was significantly less frequent for MAP participants versus controls…Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and withdrawal seizures. Qualitative interviews with staff and MAP participants provided additional insight into reductions of non-beverage alcohol use and reductions of police and health-care contacts. It was unclear if overall volume of alcohol consumption was reduced as a result of MAP participation.’ They concluded that ‘The quantitative and qualitative findings of this pilot study suggest that MAP participation was associated with a number of positive outcomes including fewer hospital admissions, detox episodes, and police contacts leading to custody, reduced NBA consumption, and decreases in some alcohol-related harms. These encouraging trends are being investigated in a larger national study’.
Vallance, K, Stockwell, T, Pauly, B, Chow, C, Gray, E, Krysowaty, B, Perkin, K & Zhao, J 2016, ‘Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study
’, Harm Reduction Journal
, vol. 13, no. 1, p. 13.
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How do rates of alcohol consumption in Australia differ between different age groups?
A study using data from the Australian National Drug Strategy Household Survey from 1995 to 2013 examined whether recent declines in overall consumption of alcohol have been influenced by reductions in drinking among young people. The researchers found that, ‘Controlling for age and period effects, there was significant variation in drinking participation and drinking volume by birth cohort. In particular, male cohorts born between the 1965 and 1974 and female cohorts born between 1955 and 1974 reported higher rates of drinking participation…while the most recent cohorts (born in the 1990s) had lower rates of participation…Among drinkers, the most recently born cohort also had sharply lower average consumption volumes than older cohorts for both men and women’. Their conclusion was that ‘Recent birth cohorts (born between 1995 and 1999) in Australia report significantly lower rates of both drinking participation and drinking volume than previous cohorts, controlling for their age distribution and overall changes in population drinking. These findings suggest that the recent decline in alcohol consumption in Australia has been driven by declines in drinking among these recently born cohorts. These trends are consistent with international shifts in youth drinking’.
Livingston, M, Raninen, J, Slade, T, Swift, W, Lloyd, B & Dietze, P 2016, ‘Understanding trends in Australian alcohol consumption—an age–period–cohort model
, vol. 111, no. 9, pp. 1590-8.
Comment: This population-wide reduction in alcohol use is a welcome trend, but at the same time we are seeing, in some parts of the nation including Canberra, increases in alcohol-related harms. This implies that we need to continue with population-focussed interventions to reduce overall levels of alcohol consumption (such as the ACT Government’s recently abandoned proposal to reduce the hours of late night trading) and strengthen targetted alcohol harm reduction interventions in at-risk population groups.
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Dolan, K 2016, Prisons need better drug treatment programs to control infectious diseases, The Conversation, 15 July, https://theconversation.com/prisons-need-better-drug-treatment-programs-to-control-infectious-diseases-62350.
European Monitoring Centre for Drugs and Drug Addiction 2016, Health responses to new psychoactive substances, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/ad-hoc/nps-responses.
Foundation for Alcohol Research and Education 2016, Risky business: the alcohol industry’s dependence on Australia’s heaviest drinkers, Foundation for Alcohol Research and Education, Canberra, http://www.fare.org.au/2016/01/risky-business-the-alcohol-industrys-dependence-on-australias-heaviest-drinkers/.
Harm Reduction Coalition 2016, Alternatives to public injecting, Harm Reduction Coalition, New York, http://harmreduction.org/blog/sif-report/.
Jones, L & Sumnall, H 2016, Understanding the relationship between poverty and alcohol misuse, Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK, http://www.cph.org.uk/publication/understanding-the-relationship-between-poverty-and-alcohol-misuse/.
Loughnan, A 2016, The drugs made me do it: can prescription side-effects be an excuse for crime?, The Conversation, 8 July, https://theconversation.com/the-drugs-made-me-do-it-can-prescription-side-effects-be-an-excuse-for-crime-45821.
McNeill, B 2016, Shedding light on a vaping trend: researchers study the use of e-cigarettes for illicit drugs, Virginia Commonwealth University, http://news.vcu.edu/article/Shedding_light_on_a_vaping_trend_Researchers_study_the_use_of.
Roxburgh, A & Breen, C 2016, Cocaine and methamphetamine induced deaths in Australia 2012, NIDIP Bulletin, National Drug and Alcohol Research Centre, Sydney, https://ndarc.med.unsw.edu.au/resource/cocaine-and-methamphetamine-related-drug-induced-deaths-australia-2012.
---- 2016, Drug-related hospital stays in Australia 1993–2014, National Drug and Alcohol Research Centre, Sydney, https://ndarc.med.unsw.edu.au/resource/drug-related-hospital-stays-australia-1993-2014.
Stewart, R & Altamore, T 2016, ‘Developing a pill testing program for music festivals’, ACT Population Health Bulletin, vol. 5, no. 2, pp. 16-8, http://www.health.act.gov.au/healthy-living/population-health#Bulletin.
Sutherland, R, Entwistle, G & Breen, C 2016, Stimulant and depressant overdose among a sample [of] regular psychostimulant users in Australia, 2007-2015, Ecstasy and Related Drug Trends Bulletin, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, https://ndarc.med.unsw.edu.au/resource/stimulant-and-depressant-overdose-among-sample-regular-psychostimulant-users-australia-2007.
Tay, J 2016, Naloxone training in General Practice, Royal College of General Practitioners, http://www.rcgp.org.uk/clinical-and-research/bright-ideas/naloxone-training-in-general-practice.aspx.
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