Unmasking Distorted Reflections: Exploring Body Image, Alcohol, and Drug Use in Nighttime Entertainment Districts

Background: Violence within nighttime entertainment districts (NEDs) has been blamed on problematic masculinity and has predominantly been attributed to excessive alcohol intake and steroid use in men. In this report we conducted two studies to: (1) ascertain whether researchers could act as third-party raters of body weight and muscle mass in NED patrons; and (2) to examine the relationship between body self-image, inebriation, alcohol preloading behaviors and drug use in the NEDs. Methods: Study 1 employed an observational approach to establish inter-rater reliability for ratings of muscle mass and weight. In Study 2 data (n = 2,745) were collected through breathalyzing and questionnaires to examine individuals' self-image and drinking and drug-taking behaviors. Results: Participants' self-ratings of muscle and weight significantly differed from researchers' ratings, with males perceiving themselves as less muscular and females perceiving themselves as heavier. Perceived weight and muscle size did not relate to alcohol levels, but an interaction was found for female steroid users who perceived themselves as less muscular. Conclusions: Findings indicated a distortion in participants' perceived body image, with a desire for muscularity among both males and females. These results underscore the complex interplay between self-perception, societal ideals, and drug use in young NED patrons.

Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects

Anabolic-androgenic steroids (AAS) encompass a broad group of natural and synthetic androgens. AAS misuse is highly prevalent on a global scale, with the lifetime prevalence of AAS misuse in males being estimated to be around 6%, with 15 to 25% of male gym attendees using it at any one time. AAS are associated with sudden cardiac death, neuropsychiatric manifestations, and infertility. The average AAS user is unlikely to voluntarily declare their usage to a physician, with around 1 in 10 actively engaging in unsafe injection techniques. The aim of this paper is to review the current evidence base on AAS with emphasis on mechanisms of action, adverse effects, and user profiles that are most likely to engage in AAS misuse. This paper also reviews terminologies and uses methods specific to the AAS user community.

Consumption in contrast: The politics of comparison in healthcare practitioners' accounts of men who inject performance and image-enhancing drugs

In recent years, Australian researchers' interest in the use of performance and image-enhancing drugs (PIEDs) has grown, in part because PIEDs use is thought to be on the rise. In much existing research, PIED consumers are described as a new and unique cohort of service users, with distinct needs, expectations and views regarding service provision, harm reduction and risk. There is some evidence that policymakers and service providers have been unsure of how best to support this seemingly distinct cohort. Are their needs different to those of people who use other illicit drugs, or the same? How so? And how might we design services with these similarities and/or differences in mind? As these questions suggest, understandings of PIED use and our efforts to address it are often heavily reliant on comparisons, including between people who consume different kinds of drugs. This article engages with the central role of these comparisons in shaping understandings of PIED-related service delivery and design, and considers what is at stake in the drawing of comparisons. We explore these issues through an analysis of 20 interviews with Australian healthcare professionals conducted for a major research project on PIEDs. As we explain, comparison was a tool commonly used by many of our participants - a way of thinking through who PIED consumers 'are' and what they need. Drawing on the work of philosopher of science Isabelle Stengers (2011) and an application in research on the politics of comparison in drug treatment (Fraser & Ekendahl, 2018), we argue that such comparisons can work to reproduce normalising ideals and flawed hierarchies, with PIED consumption positioned as less desirable than 'mainstream' ways of being and living, but more desirable than other forms of drug use. The comparisons we identify may also concretise or naturalise differences between consumers, positioning difference as somehow linked to the individual attributes or capacities of people who use different kinds of drugs, thus foreclosing questions about the political contexts in which comparisons are made and which give them their meaning. In concluding, we encourage other ways of thinking about difference, including whether the differences identified by our participants might be shaped by forces beyond those raised in their accounts, and what this means for both future policy responses to PIED consumption and future PIED research.

Alcohol-related risk from pre-loading and heavy episodic drinking (HED) among a cohort of young Australian women: a cross-sectional analysis

OBJECTIVE

To cross-sectionally examine heavy episodic drinking (HED) and pre-loading with alcohol among young Australian women in relation to the alcohol-induced adverse outcomes of memory loss, vomiting and injury.

METHODS

A total of 7,800 participants, aged 20-25 years, from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log-binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre-loading.

RESULTS

The majority of participants reported HED (83.4%) and/or pre-loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre-loading increased, so did the risk of an adverse outcome.

CONCLUSIONS

Both HED and pre-loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre-loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre-loading, a related, yet unique risky drinking behaviour.

Estimated changes in hospital admissions for alcohol intoxication after partial bans on off-premises sales of alcoholic beverages in the canton of Vaud, Switzerland: an interrupted time-series analysis

AIMS

To estimate age-specific changes in hospital admissions for alcohol intoxication following two consecutive restrictions on off-premises alcohol sales introduced in the canton of Vaud, Switzerland.

DESIGN

Primary analyses used interrupted autoregressive integrated moving average (ARIMA) time-series analyses (repeated cross-sectional), with Lausanne and Vaud as experimental sites and the rest of Switzerland as the control. Secondary analyses used, for example, a different control site (other French-speaking cantons only) or a different statistical model.

SETTING

Switzerland between 2010 and 2016.

PARTICIPANTS

In-patients (i.e. patients assigned a bed overnight) hospitalized between 8 p.m. and 6 a.m. (n = 1 261 564), as documented in the Swiss Hospital Statistics.

INTERVENTIONS

Ban 1, only effective in the canton's capital, Lausanne, prohibited off-premises sales of all alcoholic beverages after 8 p.m. on Fridays and Saturdays from September 2013 to June 2015. In July 2015, Ban 2 replaced this, covered the whole canton and affected off-premises sales of beer and spirits (but not wine) after 9 p.m. (8 p.m. in Lausanne) every night of the week.

MEASUREMENTS

Proportions of monthly hospital admissions for alcohol intoxication (ICD-10 diagnoses F10.0/F10.1, T51.0) per 1000 monthly overall admissions.

FINDINGS

Proportions of overall hospitalizations for alcohol intoxication declined after both bans in Lausanne [ω_Ban1  = -0.017, 95% confidence interval (CI) = -0.025, -0.008; ω_Ban2  = -0.021, 95% CI = -0.030, -0.013] but only after Ban 2 in the remainder of the canton of Vaud (ω_Ban2  = -0.008, 95% CI = -0.014, -0.002). Estimated changes in % were largest among 16-19-year-olds. However, as admission rates for alcohol intoxication were more frequent in adulthood than adolescence, the estimated change in number of cases was also relevant to public health among 20-69-year-olds. Secondary analyses supported the findings of the primary analyses.

CONCLUSION

Even partial restrictions of off-premises sales of alcohol in Switzerland (only 2 days per week or only for beer and spirits) appeared to reduce hospital admissions for alcohol intoxication across a wide age range (ages 16-69 years).

Aggression in the Australian night time economy: A comparison of alcohol only versus alcohol and illicit drug consumption

INTRODUCTION AND AIMS

Associations between substance use and aggression may be amplified by simultaneous alcohol and illicit drug use. This study aims to compare differences in involvement in past aggression between people who use different substances while accounting for broader risk propensity.

DESIGN AND METHODS

Self-reported data on past three-month involvement in verbal and physical aggression (victim or perpetrator) were drawn from interviews conducted in night-time entertainment districts in seven Australian cities (n = 5078). Using inverse probability of treatment weighting techniques, participants who reported alcohol versus alcohol and illicit drug use on the night of interview (including ecstasy, cannabis and other illicit stimulant subgroups) were weighted on the basis of drug use risk covariates (e.g. alcohol consumed, gender) to determine differences in involvement in aggression involvement.

RESULTS

After weighting for covariates, individuals who reported consuming any illicit drug + alcohol and ecstasy + alcohol combinations were more likely to be involved in physical (33% and 105%, respectively) and verbal (36% and 116%, respectively) aggression in the previous 3-months when compared to those who consumed alcohol only. Cannabis + alcohol and other illicit stimulant + alcohol combinations were no more likely to be involved in either forms of aggression.

DISCUSSION AND CONCLUSIONS

The likelihood of having been involved in past aggressive incidents was higher among those who reported any illicit drug + alcohol and ecstasy + alcohol combinations than those who reported alcohol exclusively, after accounting for covariates. These findings highlight individuals that may benefit most from the development of tailored health promotion/preventative safety interventions in night-time settings.

The contexts of heavy drinking: A systematic review of the combinations of context-related factors associated with heavy drinking occasions

Background

The amount of alcohol consumed during an occasion can be influenced by physical and social attributes of the setting, characteristics and state of individuals, and the interactions of these components. This systematic review identifies and describes the specific combinations and sequences of context-related factors that are associated with heavy drinking occasions.

Materials and methods

We conducted a systematic literature search of MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Eligible articles were event-level and event-based studies that quantitatively analysed associations of sequences or combinations of context-related factors with event-level alcohol consumption. We extracted information on study design, sample, variables, effect estimates and analytical methods. We compiled a list of combinations and sequences associated with heavier drinking (i.e., ‘risky contexts’) and with lighter drinking (‘protective contexts’). The review protocol was registered with PROSPERO (registration number: CRD42018089500).

Results

We screened 1902 retrieved records and identified a final sample of 65 eligible studies. Daily mood, day of week, location and drinking group characteristics are important drivers of whether an individual engages in a heavy drinking occasion. The direction and magnitude of some associations differed by gender, age, personality and motives, such that in particular social or physical contexts, some people may feel compelled to drink more while others are compelled to drink less. Very few sequences of factors were reported as being associated with event-level alcohol consumption.

Conclusions

Contexts or factors are experienced in specific sequences that shape the broader drinking context and influence drinking behaviours and consequences but are under-studied. Event-level studies such as those using ecological momentary assessment can harness new technologies for data collection and analysis to improve understandings of why people engage in heavy drinking. Continued event-level research will facilitate public health interventions and policies that reduce heavy drinking and alcohol-related harms.

Identifying a typology of men who use anabolic androgenic steroids (AAS)

BACKGROUND

Despite recognition that the Anabolic Androgenic Steroid (AAS) using population is diverse, empirical studies to develop theories to conceptualise this variance in use have been limited.

METHODS

In this study, using cluster analysis and multinomial logistic regression, we identify typologies of people who use AAS and examine variations in motivations for AAS use across types in a sample of 611 men who use AAS.

RESULTS

The cluster analysis identified four groups in the data with different risk profiles. These groups largely reflect the ideal types of people who use AAS proposed by Christiansen et al. (2016): Cluster 1 (You Only Live Once (YOLO) type, n = 68, 11.1%) were younger and motivated by fat loss; Cluster 2 (Well-being type, n = 236, 38.6%) were concerned with getting fit; Cluster 3 (Athlete type, n = 155, 25.4%) were motivated by muscle and strength gains; Cluster 4 (Expert type, n = 152, 24.9%) were focused on specific goals (i.e. not 'getting fit').

CONCLUSION

The results of this study demonstrate the need to make information about AAS accessible to the general population and to inform health service providers about variations in motivations and associated risk behaviours. Attention should also be given to ensuring existing harm minimisation services are equipped to disseminate information about safe intra-muscular injecting and ensuring needle disposal sites are accessible to the different types.

An intercept study to measure the extent to which New Zealand university students pre-game

OBJECTIVE

We aimed to quantify the degree to which students pre-gamed in New Zealand, using self-report and breathalysers.

METHODS

A total of 569 New Zealand undergraduate students were interviewed (men = 45.2%; first year = 81.4%) entering three university-run concerts. We asked participants to report how many drinks they had consumed, their self-reported intoxication and the duration of their pre-gaming session. We then recorded participants' Breath Alcohol Concentration (BrAC; µg/L) and the time they arrived at the event.

RESULTS

The number of participants who reported consuming alcohol before the event was 504 (88.6%) and the number of standard drinks consumed was high (M=6.9; median=6.0). A total of 237 (41.7%) participants could not have their BrAC recorded due to having consumed alcohol ≤10 minutes before the interview. The remaining 332 participants (57.3%) recorded a mean BrAC of 288.8µg/L (median=280.0 µg/L). Gender, off-campus accommodation, length of pre-gaming drinking session, and time of arrival at the event were all associated with increased pre-gaming. Conclusion and implications for public health: Pre-gaming was the norm for students. Universities must take pre-gaming into account; policy implications include earlier start times of events and limiting students' access to alcohol prior to events.

The need for accuracy and validity in research on nightlife and drinking: A commentary on Devilly et al. and recommendations for future research

Research on nightlife and drinking faces many unique challenges, and validity in research is an important concern. A recent publication by Devilly et al. entitled "SmartStart: Results of a large point of entry study into preloading alcohol and associated behaviours" contains definitions and assumptions about prior work that require more careful consideration. Important issues include: using a definition of pre-drinking which is the same as previous work so that valid comparison can be made, reporting of blood alcohol concentration (BAC) levels that comply with other work, accurate reporting of response rates, and careful consideration of sampling approaches to maximise ethical integrity. Ensuring consistency of definition and accurate representation of previous literature regarding BAC, pre-drinking and energy drink use, is important for supplying the broader community with reliable information on which policy decisions can be made.