Under the influence : identifying determinants of young adults' involvement in alcohol-influenced aquatic activity to improve drowning prevention efforts

BACKGROUND: Young adults are an at-risk group for experiencing an alcohol-related drowning incident. Investigations and drowning prevention efforts have aimed to address young adults’ prevalence in alcohol-related drownings and contribute to understanding their level of risk. Some explanations have concluded young adults’ need for autonomy and independence coincides with their exposure to alcohol and social norm pressures. However, gaps in knowledge remain, specifically young adults’: behaviours, knowledge and attitudes towards alcohol-influenced aquatic activity and the associated risks; and, their awareness and perceptions of alcohol-themed drowning prevention campaigns. METHODS: This PhD, completed with publications, aimed to address these gaps through four interlinked projects: (i) a systematic review of alcohol education programs to determine evidence-based quality criteria necessary for inclusion in programs to successfully change young adults’ alcohol-related behaviours, knowledge and attitudes; (ii) a program audit of alcohol-themed drowning prevention campaigns to establish current prevention efforts in high-income countries and areas for improvement; (iii) a survey among young adults from Australia and the United Kingdom to establish their knowledge, attitudes and predictors of intentions and involvement in alcohol-influenced aquatic activities; and, (iv) interviews to deepen understanding of young adults’ knowledge, attitudes and behaviours relating to alcohol-influenced aquatic activity, their awareness of alcohol-themed drowning prevention campaigns and their suggestions for improvement. Six publications resulted from this research. RESULTS: Friends influenced frequency of young adults’ involvement in alcohol-influenced aquatic activity, but involvement was dependent on the characteristics of the peer group, self-confidence and risk disassociation. Attitudes were neutral towards alcohol-influenced aquatic activity, but when participants perceived personal control over the risks it was deemed more acceptable. Alcohol-related safety strategies from other contexts (e.g., driving) were applied to aquatic settings, but specific water safety knowledge/education was low. Stronger swimmers, Australian young adults and those who had received alcohol-specific water safety education displayed more knowledge of alcohol and its effects in aquatic contexts. Participants lacked awareness of alcohol-themed drowning prevention campaigns, and used campaign logos and names to interpret key messages. Little information was available on the alcohol-themed drowning prevention campaigns identified in the program audit and only two had evidence of evaluation, limiting progress of future prevention efforts. Ten quality criteria identified from evidence-based literature were considered to be necessary for inclusion in alcohol education programs. Programs included in the systematic review which incorporated these criteria were more likely to report success in influencing behaviour changes among the participants. CONCLUSIONS: To decrease the incidence of alcohol-related drowning among young adults, the findings of the projects included within this thesis result in the following recommendations. For enhanced likelihood of successful outcomes, alcohol-themed drowning prevention campaigns should align campaign design, implementation and evaluation with best-practice literature. The identified influencers on young adults’ involvement in alcohol-influenced aquatic activity, such as their peers, should be incorporated into prevention efforts and appropriate information provided to encourage informed decision making. Alcohol education programs (e.g., drink driving education) should include information about alcohol use in aquatic settings to clarify the risks associated with transferring safety strategies between drinking contexts, and appropriate information should be provided about alcohol consumption in aquatic settings.Doctor of Philosoph

Alcohol_focused drowning prevention campaigns : what do we know and what should we do now?

Alcohol and drugs have been identified as key risk factors for youth (aged 15-24 years) and adult drownings in high-income countries (HIC). Whilst alcohol specific drowning prevention education programs have been developed and implemented, youth continue to be over-represented in drowning statistics, including those linked with alcohol. Therefore, this project aimed to: (i) review and assess all alcohol themed drowning prevention campaigns within HICs; (ii) determine whether the campaign had undergone evaluation for effectiveness; and (iii) provide recommendations to improve the effectiveness of future interventions. For each of the eighty-one HICs identified for the 2019 fiscal year, searches of peer-reviewed literature (through academic databases) and grey literature (through webpages and emails to organisations) were conducted. Twelve alcohol focused campaigns were identified, with only two providing limited information about program evaluation. For most campaigns identified, there was a dearth of information available and therefore assessment of campaign quality was unfeasible. This brief report highlights a lack of alcohol themed drowning prevention campaigns in HIC, and an absence of evaluations on their effectiveness. Implications associated with a lack of program evaluation are discussed and adoption of the recommendations from this brief report should enhance the quality of future research in this area. © 2020 Human Kinetics Publishers Inc.. All rights reserved

A systematic review of alcohol education programs for young people : do these programs change behavior?

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes. © The Author(s) 2020. Published by Oxford University Press. All rights reserved

Alcohol_Focused Drowning Prevention Campaigns: What Do We Know and What Should We Do Now?

Alcohol and drugs have been identified as key risk factors for youth (aged 15-24 years) and adult drownings in high-income countries (HIC). Whilst alcohol specific drowning prevention education programs have been developed and implemented, youth continue to be over-represented in drowning statistics, including those linked with alcohol. Therefore, this project aimed to: (i) review and assess all alcohol themed drowning prevention campaigns within HICs; (ii) determine whether the campaign had undergone evaluation for effectiveness; and (iii) provide recommendations to improve the effectiveness of future interventions. For each of the eighty-one HICs identified for the 2019 fiscal year, searches of peer-reviewed literature (through academic databases) and grey literature (through webpages and emails to organisations) were conducted. Twelve alcohol focused campaigns were identified, with only two providing limited information about program evaluation. For most campaigns identified, there was a dearth of information available and therefore assessment of campaign quality was unfeasible. This brief report highlights a lack of alcohol themed drowning prevention campaigns in HIC, and an absence of evaluations on their effectiveness. Implications associated with a lack of program evaluation are discussed and adoption of the recommendations from this brief report should enhance the quality of future research in this area

Predicting young adults’ intentions and involvement in alcohol-influenced aquatic activity

Globally, alcohol consumption is a public health issue and a risk factor for drownings among young adults. While studies have identified a prominence of alcohol in youth drownings, little is known about the factors that influence young adults’ involvement in alcohol-influenced aquatic activity. The current study aimed to identify the predictors of young adults’ intention to participate, and past participation, in alcohol-influenced aquatic activity. A reliable and valid survey, informed by the Theory of Planned Behavior, was distributed to young adults (aged 18-24 years) educated in the UK and Australia. Cumulative odds ordinal logistic regressions with proportional odds were conducted to establish predictors. Overall, 182 participants completed the survey. Subjective norms (Wal

Examining Group Differences in Emotion Regulation Strategies and the State and Trait Anxiety of Lifeguards and Non-Lifeguards in a Real-World Precompetitive Situation

The purpose of this study was to investigate differences, between swimmer-lifeguards and swimmer-non-lifeguards, in trait and state anxiety and emotion regulation techniques in a real-life precompetitive situation with a secondary focus on gender differences. The Emotion Regulation Questionnaire, Sport Anxiety Scale – 2 and the Mental Readiness Form – 3 were distributed to 100 participants at university swimming competitions in the United Kingdom. Swimmer-lifeguards displayed significantly lower cognitive (p=.03) and somatic state (p=.05) anxiety and cognitive trait anxiety (p=.02) than swimmer-non-lifeguards. Males reported significantly lower levels of cognitive and somatic trait anxiety (ppp=.01); no other effects were observed. These results support previous research regarding lifeguard characteristics, however the nature of these qualities and how they originate require further exploration

Predicting Young Adults’ Intentions and Involvement in Alcohol-Influenced Aquatic Activity

Globally, alcohol consumption is a public health issue and a risk factor for drownings among young adults. While studies have identified a prominence of alcohol in youth drownings, little is known about the factors that influence young adults’ involvement in alcohol-influenced aquatic activity. The current study aimed to identify the predictors of young adults’ intention to participate, and past participation, in alcohol-influenced aquatic activity. A reliable and valid survey, informed by the Theory of Planned Behavior, was distributed to young adults (aged 18-24 years) educated in the UK and Australia. Cumulative odds ordinal logistic regressions with proportional odds were conducted to establish predictors. Overall, 182 participants completed the survey. Subjective norms (Wald χ2 (2) = 8.43, p = .015), cognitive attitudes (Wald χ2 (2) = 6.40, p = .041) and previous involvement (χ2 (1) = 8.98, p = .003) were significant predictors of intention, whilst the influence of friends (Wald χ2 (2) = 10.99, p = .004) and intention (Wald χ2 (2) = 10.80, p = .005) were significant predictors of behavior. Practitioners should enhance risk awareness and norm perceptions in prevention programs to encourage informed decision making in social aquatic situations

Assistance, Support and Monitoring? The Paradoxes of Mentoring Adults in the Criminal Justice System

Mentoring has recently taken centre stage as one of the primary criminal justice ‘interventions’ to reduce reoffending, having grown in popularity over the past fifteen years. Its rapid growth has been driven by claims of success within and outwith the criminal justice system, leading some to argue that it has been perceived as a silver bullet (Newburn and Shiner, 2005). This article challenges such claims on three fronts: first, mentoring is an ill-defined concept with weak theoretical foundations; second, the evidence base upon which claims of success are made is limited; and third, transferring mentoring into the coercive and punitive environment of the criminal justice system results in a departure from the very principles and values which are the basis of its usefulness elsewhere. The article utilises the findings from three empirical criminal justice research projects to question claims of widespread and effective mentoring activity with defendants and offenders, suggesting instead that ‘interventions’ described as mentoring serve as a vehicle to extend the reach of the criminal justice system. At the end of the article we suggest that desistance theory, specifically the Good Lives Model, provides a conceptual framework for taking mentoring in criminal justice forward

Overtreatment of COPD with Inhaled Corticosteroids - Implications for Safety and Costs: Cross-Sectional Observational Study

<div><p>Introduction</p><p>Combined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS) are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD). They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse. </p> <p>Methods</p><p>Data were extracted from the electronic and paper records of 41 London general practices (population 310,775) including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision.</p> <p>Results</p><p>3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%). 709(29%) did not meet GOLD criteria. 1749(49%) with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38%) and in GOLD III or IV without exacerbations (n=231, 33.6%) was common. An estimated 12 cases (95%CI 7-19) annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03). Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22) in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7) in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS. </p> <p>Conclusion</p><p>Over-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits of treatment and the costs where the benefits are unproven. </p> </div