Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia

BACKGROUND: This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU) who report engaging in sex work for money or drugs and regular injecting drug users who do not. METHODS: Cross sectional data collected from regular IDU interviewed as part of the New South Wales (NSW) Illicit Drug Reporting System (IDRS) in 2003 were analysed. RESULTS: IDU who reported engaging in sex work were more likely to be female, and identify as being of Aboriginal and/or Torres Strait Islander descent. They initiated injecting drug use at a significantly younger age and were more likely to report injection related problems than IDU who had not engaged in sex work. There were no differences in the drug classes used, but findings suggested that the sex workers tended to be more frequent users of crystalline methamphetamine (ice) and benzodiazepines. CONCLUSION: The similarities between these groups were more striking than the differences. Further research, examining a larger sample is needed to clarify whether injecting drug users who are sex workers have heavier use patterns

Alcohol consumption and related harms in regional communities: exploring individual and community factors

Alcohol is a widely used and socially acceptable drug. Its misuse contributes to considerable individual and community level harm. This harm represents a major public health issue and is one of the leading causes of preventable mortality, morbidity and injury in many developed countries. Despite limited research in rural and regional areas there is evidence of disproportionate alcohol consumption and related harm. A postal survey was designed and implemented in twenty regional communities in NSW, Australia. Methods to improve response rates were incorporated. The results of a randomised controlled trial (Chapter 2) suggest a follow-up telephone call is not a cost- effective strategy to improve response rates when additional surveys have been sent to non-responders. The results of the large survey of regional residents on patterns of alcohol consumption (Chapter 3) provide evidence of higher levels of risky drinking in regional areas. Excessive drinking on a single occasion is disproportionately high. Data on the effect of alcohol on people other than the drinker indicate the „second-hand effects‟ of alcohol are significant. Differences between regional communities were examined (Chapter 4), providing one of the first examinations of individual and community factors associated with risky alcohol consumption. Being young, male, unmarried, Australian-born, and having a higher income were the individual characteristics associated with risky drinking. Communities with more GPs and less police had higher proportions of individuals at risk for harm in the long-term. Communities with more hotels and clubs had higher proportions of individuals reporting single occasion risky drinking. To complement the survey data, routinely collected data were used to ascertain a suitable measure for alcohol-related crime (Chapter 5). Differences between communities in alcohol-related crime, and associated community factors, were examined (Chapter 6). Communities with less disadvantage, more GPs and more hotels and clubs had more alcohol-related crime. These results, combined with the findings in Chapter 4, suggest strategies addressing the price and availability of alcohol may impact alcohol-related harm. The analyses in this thesis highlight the importance of tailoring alcohol-related policy and intervention strategies to individual communities, using population specific data on alcohol consumption and harms

The dependence of election coverage on political institutions: political competition and policy framing in Germany and the United Kingdom

Election coverage is often assumed to be different to everyday political coverage. We argue that this depends on political institutions. In majoritarian countries, where elections choose governments, election coverage should decisively move towards political competition and away from policy. In consensual countries, where coalitions are based on policy negotiations, there should be a less pronounced shift towards political competition and away from policy. To test this argument, we use an automatic coding system to study 0.9 billion words in Die Welt for 12 years and in the Financial Times for 30 years. The results support our institutional hypothesis

Daily judgement: political news and financial markets

Political economists disagree about the extent to which markets monitor politics in advanced economies. Some argue that investors are interested in a handful of macroeconomic indicators, while others say that markets also watch political competition closely. We argue that political competition drives variation in the government bond market more than information about economic policy. Using a new automatic classifier, we code the content of millions of newspaper paragraphs about the UK from 1986 to 2012. We then test the impact of news on government debt. We find that political news is correlated with bond prices and that macroeconomic policy news is not. Our results suggest that the market passes daily judgement on politics, not merely cleaving to seldom-released official statistics or focusing on occasional events like elections

Interdisciplinary Perspectives on Restraint Use in Aged Care.

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected 'Restraint' as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the 'last resort'. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly 'low-level' forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care

Acceptability and preliminary efficacy testing of a web-based coach development program addressing gender essentialism among coaches of adolescent girls

Gender essentialism in coaching discourses often goes unnoticed by coaches yet promotes gender stereotypes. Currently, no coach development program addresses gender essentialism. This study tested the acceptability and preliminary efficacy of a novel web-based coaching intervention comprising seven self-led modules, aimed at reducing gender essentialism among coaches. A pilot randomized controlled trial was conducted with 102 coaches of adolescent girls across multiple sports. Coaches were randomized into the intervention condition (n = 54) or a waitlist control condition (n = 48). Both intervention and control group participants completed a baseline self-assessment prior. Intervention group participants undertook Coaching HER Foundation modules over 2 weeks and completed a postintervention self-assessment. Control group coaches completed the postintervention assessment without completing the Coaching HER Foundation modules. Based on the data, coaches found the intervention easy to follow, relevant, applicable, and enjoyable. Efficacy analyses illustrated the intervention group reported lower levels of gender essentialism at postintervention compared with the control group. Study results must be considered in relation to the small sample size and high attrition rate (72%). Study findings will inform intervention optimizations based on participant feedback, after which Coaching HER Foundation will be made freely available within a wider coach education and training framework

Neonatal abstinence syndrome and high school performance

BACKGROUND AND OBJECTIVES: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS: Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS: Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1- 1.6), with all Ps < .001. CONCLUSIONS: A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes

Body confident coaching: A pilot randomized controlled trial evaluating the acceptability of a web-based body image intervention for coaches of adolescent girls

Coaches influence athletes’ body image, but often feel ill-equipped to address body image concerns and inadvertently perpetuate harmful body ideals. No evidence-based, empirically-tested body image intervention for coaches exists. This study evaluated the acceptability and preliminary efficacy of a novel web-based intervention (body confident coaching [BCC]), comprising five self-led 20-min modules. A pilot randomized controlled trial was conducted with 97 coaches of adolescent girls (Mage = 36.6yrs, SD = 10.4; 70% women). Coaches were randomized into the intervention (n = 52) or waitlist control condition (n = 45). Intervention condition participants completed baseline self-assessments (demographics, target outcomes), took part in BCC over two weeks, and completed post-intervention self-assessments (target outcomes, acceptability, adherence). Waitlist control participants completed baseline (demographics, target outcomes) and post-intervention self-assessments (target outcomes), after which they received unmonitored access to the intervention. Intervention condition participants who completed post-intervention assessments (n = 16) finished all five modules and 75% reported engaging with the additional resources. Coaches found the intervention easy to follow, appropriate, useful, and enjoyable. Preliminary efficacy analyses indicated that the intervention condition reported higher levels of self-efficacy toward body image (ηp2 = .19), and lower levels of fat phobia (ηp2 = .39) and gender essentialist beliefs (ηp2 = .20) at post-intervention, compared to the waitlist condition. A limitation of this study is the small sample size and high attrition rate (51%), which may bias results. Following modifications to the intervention and trial protocol, BCC will be evaluated in a large-scale randomized controlled effectiveness trial