Drug and Alcohol Prevention among Culturally Diverse Northern Australian Adolescents: An Investigation of a School Drug and Alcohol Prevention Program for Year 8 Students

This dissertation explored a number of themes associated with adolescent drug and alcohol prevention among culturally diverse Northern Australian adolescents. It was undertaken because important differences are often associated with specific cultural groups and local knowledge is often needed as a means of informing effective prevention programs. Five studies are presented, each, with its own hypotheses, results and conclusions that examine influences on the common dependent variable of adolescent substance use. In consultation with teachers a new universal school-based drug and alcohol prevention program was developed addressing the four most commonly used substances among Australian adolescents, namely alcohol, cigarettes, cannabis and inhalants. The program was predicated on the social influence and alcohol harm minimisation models and was successful in reducing alcohol initiation and increasing cannabis and inhalant refusal self-efficacy among non-initiates. Program delivery is equally as important and program content and prevention programs utilising interactive teaching have been found to be more effective in preventing adolescent substance use than those delivered in a didactic or non-interactive style. The implementation evaluation found that teachers delivered less of the interactive program contents (49%) compared with the non-interactive components (84%). Quality of program delivery may have explained the limited efficacy of the school program to reduce cigarette use and to deter use among those who had already initiated substance use. Additionally three descriptive studies explored variables representing risk and protection for adolescent substance use. Key finding were that cultural identity was observed to be protective of both Indigenous and Non-Indigenous alcohol initiation but was associated with risk for Indigenous youth who had any number of drinking friends; that drinking parents had a strong direct effect on adolescent drinking independent of friends’ use; and a lack of school connectedness was associated with increased adolescent smoking and drinking. This dissertation demonstrated that a school drug education program in its self cannot effectively prevent adolescent drug use. While improvements can be made to current teaching practices, school curricula need to be supplemented with multi-modal programs that aim to selectively reduce parental substance use and improve the school experience for all students

Cultural identity and peer influence as predictors of substance use among culturally diverse Australian adolescents

This study investigated cultural identity and peer influence on tobacco, alcohol, and cannabis use in a culturally diverse sample of Northern Australian adolescents. Middle school students (n = 274) completed the Multigroup Ethnic Identity Measure (MEIM) and measures of their own and perceived friends' substance use. Higher scores on the full scale MEIM indicating stronger cultural identity were found to be independently protective of Indigenous and Non-Indigenous alcohol initiation. More friends using substances was associated with increased substance use risk for both cultural groups. A factor analysis of the MEIM identified a two-factor structure, consisting of Affirmation/Belonging and Participation/Exploration. Few significant associations were found between the MEIM factors and cultural group substance use. Interactions between the MEIM factors and friends' substance use indicated the two factors acted in the same way and decreased Non-Indigenous alcohol initiation for up to four drinking friends but were associated with risk for Indigenous alcohol initiation with any number of drinking friends. Copyright © 2011 by SAGE Publication

CONCEPTT : Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol

Women with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy. A multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0 % to ≤10.0 % (53 to ≤ 86 mmol/mol) or are in early pregnancy (<13 weeks 6 days) with an HbA1c of 6.5 % to ≤10.0 % (48 to ≤ 86 mmol/mol). Participants will be randomized to either RT-CGM alongside conventional intermittent home glucose monitoring (HGM), or HGM alone. Eligible women will wear a CGM which does not display the glucose result for 6 days during the run-in phase. To be eligible for randomization, a minimum of 4 HGM measurements per day and a minimum of 96 hours total with 24 hours overnight (11 pm-7 am) of CGM glucose values are required. Those meeting these criteria are randomized to RT- CGM or HGM. A total of 324 women will be recruited (110 planning pregnancy, 214 pregnant). This takes into account 15 and 20 % attrition rates for the planning pregnancy and pregnant cohorts and will detect a clinically relevant 0.5 % difference between groups at 90 % power with 5 % significance. Randomization will stratify for type of insulin treatment (pump or multiple daily injections) and baseline HbA1c. Analyses will be performed according to intention to treat. The primary outcome is the change in glycemic control as measured by HbA1c from baseline to 24 weeks or conception in women planning pregnancy, and from baseline to 34 weeks gestation during pregnancy. Secondary outcomes include maternal hypoglycemia, CGM time in, above and below target (3.5-7.8 mmol/l), glucose variability measures, maternal and neonatal outcomes. This will be the first international multicenter randomized controlled trial to evaluate the impact of RT- CGM before and during pregnancy in women with type 1 diabetes. NCT01788527 December 19, 2012

Erratum : CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center, multi-national, randomized controlled trial - Study protocol [BMC Pregnancy Childbirth., 16, (2016) (167)] doi: 10.1186/s12884-016-0961-5

After publication of the original article [1], it came to the authors' attention that an incorrect affiliation was inadvertently added in the Acknowledgements section for the CONCEPTT Collaborative Group. The authors would like to amend the following statement in the CONCEPTT Collaborative Group section as follows: The correct affiliation for Julia Lowe and Anna Rogowsky should read Sunnybrook Health Sciences Centre, Toronto