Adolescent Drinking Patterns Across Countries: Associations with Alcohol Policies

Early consumption of full servings of alcohol and early experience of drunkenness have been linked with alcohol-related harmful effects in adolescence, as well as adult health and social problems. On the basis of secondary analysis of county-level prevalence data, the present study explored the current pattern of drinking and drunkenness among 15- and 16-year-old adolescents in 40 European and North American countries. Data from the 2006 Health Behavior in School Children survey and the European School Survey Project on Alcohol and other Drugs were used. The potential role of alcohol control and policy measures in explaining variance in drinking patterns across countries was also examined. Policy measures and data on adult consumption patterns were taken from the WHO Global Information System on Alcohol and Health, Eurostat and the indicator of alcohol control policy strength developed by Brand DA, Saisana M, Rynn LA et al. [(2007) Comparative analysis of alcohol control policies in 30 countries. PLoS Med 4:e151.]. We found that a non-significant trend existed whereby higher prices and stronger alcohol controls were associated with a lower proportion of weekly drinking but a higher proportion of drunkenness. It is important that future research explores the causal relationships between alcohol policy measures and alcohol consumption patterns to determine whether strict policies do in fact have any beneficial effect on drinking patterns, or rather, lead to rebellion and an increased prevalence of binge drinkin

Do schools and alcohol mix? Australian parents\u27 perspectives

© 2020, Emerald Publishing Limited. Purpose: Alcohol use by adults at school events and alcohol promotion through school fundraising activities is common, but little is known about secondary school parents\u27 attitudes towards these practices. Parental attitudes may influence principals\u27 decision-making on this topic, particularly in jurisdictions where education department guidance is limited. This study explored parents\u27 attitudes towards the consumption or promotion of alcohol in schools or at school events. Design/methodology/approach: Parents (n = 298) from five non-government secondary schools in Western Australia completed an online survey and provided responses relating to the promotion and availability of alcohol through their child\u27s school. Findings: This sample of parents were evenly divided in support of alcohol consumption or support of schools as alcohol-free zones. Parents reporting higher alcohol consumption were more supportive of alcohol promotion and use through schools, and those with higher education supported use of alcohol for school fundraising. Almost 20% of parents were neutral on several measures indicating they could be swayed by social pressure. Engaging parents is an ongoing challenge for school principals and alcohol may play a part in engagement activities. The results from this small, exploratory study suggest even engaged parents may have very differing views on alcohol use in schools. Practical implications: Education departments are encouraged to explore these issues carefully and introduce changes incrementally to assist decision-making and minimise potential parent disengagement. Originality/value: This paper addresses a knowledge gap about parents\u27 attitudes towards alcohol in secondary schools. These findings can support those involved in the development of school alcohol policies

An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial

Objective: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women. Design: Randomised controlled trial. Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n= 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009. Intervention: A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman’s partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control (“usual care”) group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits. Main outcome measure: Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks’ gestation and delivery. Results: Participants in the intervention group (n = 148) and usual care group (n= 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86–1.08]; P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis. Conclusion: An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment

IntroductionDespite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments.MethodsA qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data.ResultsTwelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students’ perceptions of practice, and challenges in different learning environments.DiscussionThis study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice.

OBJECTIVE In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. METHODS Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. RESULTS The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. CONCLUSION This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. INNOVATION This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication

Mapping the Steroid Response to Major Trauma From Injury to Recovery : A Prospective Cohort Study

CONTEXT: Survival rates after severe injury are improving, but complication rates and outcomes are variable. OBJECTIVE: This cohort study addressed the lack of longitudinal data on the steroid response to major trauma and during recovery. DESIGN: We undertook a prospective, observational cohort study from time of injury to 6 months postinjury at a major UK trauma centre and a military rehabilitation unit, studying patients within 24 hours of major trauma (estimated New Injury Severity Score (NISS) > 15). MAIN OUTCOME MEASURES: We measured adrenal and gonadal steroids in serum and 24-hour urine by mass spectrometry, assessed muscle loss by ultrasound and nitrogen excretion, and recorded clinical outcomes (ventilator days, length of hospital stay, opioid use, incidence of organ dysfunction, and sepsis); results were analyzed by generalized mixed-effect linear models. FINDINGS: We screened 996 multiple injured adults, approached 106, and recruited 95 eligible patients; 87 survived. We analyzed all male survivors <50 years not treated with steroids (N = 60; median age 27 [interquartile range 24-31] years; median NISS 34 [29-44]). Urinary nitrogen excretion and muscle loss peaked after 1 and 6 weeks, respectively. Serum testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate decreased immediately after trauma and took 2, 4, and more than 6 months, respectively, to recover; opioid treatment delayed dehydroepiandrosterone recovery in a dose-dependent fashion. Androgens and precursors correlated with SOFA score and probability of sepsis. CONCLUSION: The catabolic response to severe injury was accompanied by acute and sustained androgen suppression. Whether androgen supplementation improves health outcomes after major trauma requires further investigation

Aboriginal and Torres Strait Islander women: an examination of smoking during pregnancy

Research Doctorate - Doctor of Philosophy (PhD)After decades of discrimination and deprivation, Australia’s Aboriginal and Torres Strait Islander population faces social circumstances and health status which resemble that of a third world population group. With a wide range of health risk factors and morbidities among this population, a logical place to begin tackling the health problems is at the beginning of life. With increasing recognition of the influence of the intrauterine environment upon health, not only during infancy but into adulthood, improving health during pregnancy offers substantial benefit for present and future generations. The poor health of Aboriginal and Torres Strait Islander Australians is deeply ingrained in social deprivation, poor mental well-being, and an array of modifiable risk factors. Smoking is one risk factor at the centre of this complex web. Smoking is often accompanied by, or used as relief in, stressful situations associated with socioeconomic status, mental health, illness, and other addictions. In order to determine the most appropriate way to tackle the smoking issue among Aboriginal and Torres Strait Islander women, a series of studies were conducted. Initial literature reviews found limited evidence derived from methodologically rigorous studies in mainstream populations, and even less evidence for Aboriginal and Torres Strait Islander, or other Indigenous groups. Exploration of the knowledge and attitudes of these women in relation to antenatal smoking was conducted to identify the most appropriate targets for intervention. The findings from extensive background studies were drawn upon to design an intervention which aimed to be culturally appropriate for Aboriginal and Torres Strait Islander women, providing intensive support to assist these women to quit smoking during their pregnancy. Pilot data from the resulting intervention is presented in Chapter 8 of this Thesis. The social network among Aboriginal and Torres Strait Islander communities appears to play a central role in the behaviour of individuals. With an array of risk factors and influences found not only in the individuals surrounding women, but in their socioeconomic circumstances and overall environment, it may be that the most important approach for achieving health and behaviour change among this population is the mobilisation of social support and efforts to intervene with multiple elements of that environment

Parent attitudes, family dynamics and adolescent drinking: qualitative study of the Australian parenting guidelines for adolescent alcohol use

Background: Parents play a critical role in their children’s introduction to alcohol. A range of parenting factors have been associated with the progression to risky drinking among adolescents, and have recently formed the basis of the Australian ‘Parenting Guidelines for Adolescent Alcohol Use’ designed to help parents delay or reduce their adolescents’ alcohol use. Methods: This study aimed to explore the experiences and attitudes of parents of adolescents to gain insight into: (1) the extent to which the behaviours of parents follow the recommendations made in the guidelines; and (2) approaches to reduce hazardous drinking among adolescents. Thirty-two telephone and face-to-face interviews were conducted with parents, and the content of discussions was examined using thematic analysis. Results: Parents used approaches they thought would minimise harm and promote healthy development in their children. The guidelines address key areas of concern for parents but their adherence to these approaches is low in certain areas. Many parents provided some alcohol to their adolescents and often cited the social norm of drinking among their adolescents’ peers as a source of pressure to supply. Conclusions: Further dissemination of the guidelines may be the first step in a public health strategy, but it is likely that parents will require support to effectively adopt the recommendations. Understanding the influences on parents’ beliefs about their children’s drinking and the functions of social networks in the creation of behavioural norms relating to alcohol consumption and supply may be necessary to address adolescent risky drinking

Changing parental behaviour to reduce risky drinking among adolescents: current evidence and future directions

Aims: Risky drinking among young people is an issue of public concern globally. In Australia and elsewhere, there has been a steady increase in alcohol-related harms among young people in recent years. The aims of this study were to review the nature of parental supply of alcohol to adolescents aged 13–17 years, explore parental social networks as a potential avenue for intervention, and propose future directions for research with a view to informing public policy and the development of interventions to reduce risky drinking. Methods: Narrative review. Results: While a large literature exists concerning parental influence on children's drinking, exploration of the volume of alcohol and context of parental supply is lacking. Results from cross-sectional and longitudinal studies on the impact of parental factors such as monitoring, rule setting, alcohol supply and supervision of drinking present an unclear picture. Consequently, translation of research findings into advice for parents is problematic. Conclusion: We propose that future research seeks to (a) gain a better understanding of the volume and contexts of parental supply of alcohol, (b) explore the structure of social networks among adolescents and their parents, (c) determine the accuracy of parents' perceptions of other parents' behaviours and beliefs, (d) develop an analytic approach for quantifying aspects of parental networks and (e) evaluate low-intensity parental interventions including web programmes