What are the impacts of alcohol supply reduction measures on police-recorded adult domestic and family violence in the Northern Territory of Australia?

BACKGROUND

During 2017-18, the Northern Territory (NT) introduced a Banned Drinker Register (BDR) and Minimum Unit Price (MUP) NT-wide; Police Auxiliary Liquor Inspectors (PALIs) in three regional towns; and restrictions on daily purchases/opening hours (DPOH) in one regional town. The BDR is an individual-level alcohol ban; MUP is a pricing policy; and PALIs enforce bans on restricted areas at takeaway outlets. This study examines the impact of these policies on adult domestic and family violence (DFV).

METHODS

We examined DFV assaults and breaches of violence orders from January 2014 - February 2020 using interrupted time series models for NT, Greater Darwin, Katherine, Tennant Creek, and Alice Springs. To account for increasing numbers of individuals on the BDR we tested two timepoints (Sept 2017, March 2018).

FINDINGS

Following DPOH, assaults (78 %) and alcohol-involved assaults (92 %) decreased in Tennant Creek. After PALIs, assaults (79 %) in Tennant Creek, and breaches (39 %) and alcohol-involved breaches (58 %) in Katherine decreased. After MUP, assaults (11 %), alcohol-involved assaults (21 %) and alcohol-involved breaches (21%) decreased NT wide. After MUP/PALIs in Alice Springs, alcohol-involved assaults (33 %), breaches (42 %), and alcohol-involved breaches (57 %) decreased. BDR (Sept 2017) found increases in assaults (44 %) and alcohol-involved assaults (39 %) in Katherine and assaults (10%) and alcohol-involved assaults NT-wide (17 %). There were increases of 21 %-45 % in breaches NT-wide, in Darwin, Katherine, and Alice Springs. Following March 2018 found increases in assaults (33 %) and alcohol-involved assaults (48 %) in Katherine. There were increases - from 20 % to 56 % - in breaches in NT-wide, Katherine, and Alice Springs.

CONCLUSION

PALIs and DPOH were associated with some reductions in DFV; the BDR was associated with some increases. The upward trend commences prior to the BDR, so it is also plausible that the BDR had no effect on DFV outcomes. Although MUP was associated with reductions in the NT-wide model, there were no changes in sites without cooccurring PALIs.

'I mean, I wouldn't say I was sober': Exploring the psychosocial impact of e-scooter injuries and aligning a collaborative public health response

ISSUE ADDRESSED

E-scooters are sought after for their cost-effectiveness, sustainability, and efficiency in urban transportation. However, this popularity has been accompanied by a surge in injuries, prompting a deeper investigation into the factors influencing risk perceptions among e-scooter users.

METHODS

Using a qualitative approach, we conducted 19 interviews with those who attended an emergency department as a result of e-scooter injury. We aimed to understand the psychosocial effects of these incidents and employed thematic analysis to discern recurrent patterns in participants' experiences, focusing on alterations in daily life, community response, perception shifts, and avenues to enhance safety awareness.

RESULTS

The findings underscored significant disruptions to daily life due to injuries, demonstrating enduring impacts on lifestyle and wellbeing. Participants exhibited a perceptual shift, transitioning from perceiving e-scooters as enjoyable to viewing them as dangerous. Recommendations for enhancing safety awareness included accessible and clear safety education, pre-ride briefings, real-time safety guidance, temporal rental restrictions, and mandatory breathalysers before e-scooter use.

CONCLUSIONS

The study underscores the importance of considering not only the individual experiences and perceptions of e-scooter injuries but also the broader social context, including the night-time economy. Leveraging peer narratives and community engagement is vital to reshape risk perceptions and promote harm reduction messages. SO WHAT?: A comprehensive approach through proactive interventions and robust educational strategies is essential to foster responsible e-scooter usage and prioritise public safety.

Police-recorded adult sexual assault in the Northern Territory, Australia: Alcohol involvement and alcohol policy effects

INTRODUCTION

Between 2017 and 2018 three major alcohol policy changes were introduced in the Northern Territory (NT): the Banned Drinker Register, an individual-level ban enforced via ID scanners at takeaway outlets; a Minimum Unit Price on alcohol; and Police Auxiliary Liquor Inspectors, who monitor takeaway outlets to prevent purchase by people who do not have a legal place to consume alcohol. We aimed to: (i) describe alcohol-involved adult sexual assault in the NT; and (ii) estimate the impacts of these alcohol policies on police-recorded adult sexual assault.

METHODS

We used victim records for sexual assault where victims were aged 15 years and over. We undertook descriptive analyses for the NT from 2014 to 2020 and used interrupted time series analysis to assess policy impacts across the NT and in Greater Darwin.

RESULTS

In 2020, the NT adult victimisation rate was 105 per 100,000. A large minority (40%) of adult sexual assaults involved alcohol. Interrupted time series analyses showed no effect of the Banned Drinker Register or Minimum Unit Price on sexual assault across the NT or in Greater Darwin.

DISCUSSION AND CONCLUSIONS

The rate of adult sexual assaults in the NT is extremely high and many involve alcohol. Neither the Banned Drinker Register or Minimum Unit Price were associated with changes in police-recorded adult sexual assault in Greater Darwin or across the NT. Due to small counts, we were unable to assess policy impacts in three of the four main towns, highlighting the challenges of assessing impacts of policies on sexual assault in small population areas.

"They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents

OBJECTIVE

Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents.

METHODS

We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data.

RESULTS

Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported.

CONCLUSIONS

Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents.

IMPLICATIONS FOR PUBLIC HEALTH

As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

Social and contextual factors associated with drinking before, during and after watching Australian Football League games: A pilot ecological momentary assessment study

INTRODUCTION

The aim of this study was to: (i) determine the feasibility of using ecological momentary assessment to collect data from Australian Football League (AFL) fans; (ii) explore pre-game, during-game and post-game consumption patterns of AFL fans; and (iii) explore the social and setting-related factors associated with risky single occasion drinking (5+ drinks) among AFL fans.

METHODS

Thirty-four participants completed up to 10 ecological momentary assessment surveys before, during and after 63 AFL games (n = 437 completed surveys). Surveys collected data about their drinking, and their social and environmental milieu (e.g., location, company). Binary logistic regression analyses clustered by participant identified which game-day characteristics were associated with higher odds of risky single occasion drinking. Significant differences between pre-game, during-game and post-game drinking on social and environmental factors were explored using pairwise comparisons.

RESULTS

Risky single occasion drinking was more likely when games began in the early-afternoon (1-3 pm) than late-afternoon (3-6 pm), when participants watched the game at a stadium or pub compared to home, and when participants watched the game with friends compared to family. Pre-drinking was more likely before night games and post-drinking was more likely after day games. Drinking during the game was heavier when watching the game at a pub and when watching with a combined group of friends and family.

DISCUSSION AND CONCLUSIONS

Preliminary findings suggest that social and contextual factors matter in the way alcohol is consumed while watching AFL games. These findings require further investigation in larger samples.

Identifying the Most Effective Recruitment Strategy Using Financial Reimbursements for a Web-Based Peer Network Study With Young People Aged 16-18 Years: Protocol for a Randomized Controlled Trial

BACKGROUND

Peers are an important determinant of health and well-being during late adolescence; however, there is limited quantitative research examining peer influence. Previous peer network research with adolescents faced methodological limitations and difficulties recruiting young people.

OBJECTIVE

This study aims to determine whether a web-based peer network survey is effective at recruiting adolescent peer networks by comparing 2 strategies for reimbursement.

METHODS

This study will use a 2-group randomized trial design to test the effectiveness of reimbursements for peer referral in a web-based cross-sectional peer network survey. Young people aged 16-18 years recruited through Instagram, Snapchat, and a survey panel will be randomized to receive either scaled group reimbursement (the experimental group) or fixed individual reimbursement (the control group). All participants will receive a reimbursement of Aus $5 (US $3.70) for their own survey completion. In the experimental group (scaled group reimbursement), all participants within a peer network will receive an additional Aus $5 (US $3.70) voucher for each referred participant who completes the study, up to a maximum total value of Aus $30 (US $22.20) per participant. In the control group (fixed individual reimbursement), participants will only be reimbursed for their own survey completion. Participants' peer networks are assessed during the survey by asking about their close friends. A unique survey link will be generated to share with the participant's nominated friends for the recruitment of secondary participants. Outcomes are the proportion of a participant's peer network and the number of referred peers who complete the survey. The required sample size is 306 primary participants. Using a multilevel logistic regression model, we will assess the effect of the reimbursement intervention on the proportion of primary participants' close friends who complete the survey. The secondary aim is to determine participant characteristics that are associated with successfully recruiting close friends. Young people aged 16-18 years were involved in the development of the study design through focus groups and interviews (n=26).

RESULTS

Participant recruitment commenced in 2022.

CONCLUSIONS

A longitudinal web-based social network study could provide important data on how social networks and their influence change over time. This trial aims to determine whether scaled group reimbursement can increase the number of peers referred. The outcomes of this trial will improve the recruitment of young people to web-based network studies of sensitive health issues.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44813.

Measurement of Transdermal Alcohol Concentration using a Wrist Worn Enzymatic Transdermal Monitor

BACKGROUND

New-generation transdermal monitors such as the ION Research Alpha Prototypes (ION RAP) hold promise for real-time alcohol measurement, with improvements in design features such as sampling frequency, size and comfort. This paper aims to provide the first comparisons of the wrist worn enzyme-based ION RAP and the fuel-cell based SCRAM-CAM against breath alcohol concentration (BrAC) readings.

METHODS

Participants (N=23) completed a total of 69 laboratory alcohol administration sessions, while wearing both a prototype of the ION RAP wristband and a SCRAM-CAM ankle monitor; they also gave breath samples each 10 minutes. Analyses focused on latencies of transdermal alcohol concentration (TAC) after alcohol ingestion, correlations, and cross-correlations between BrAC and TAC measurements.

RESULTS

A high failure rate of the ION RAP was observed (61.5% of the sessions were excluded due to the sessions not containing enough valid data). On average, the SCRAM-CAM and ION RAP detected alcohol 43 (SD=21) and 50 (SD=27) minutes after the first drink, with peak values reached after 138 (SD=47) and 154 (SD=56) minutes, respectively. SCRAM-CAM TAC peak (r=0.185,p=0.375) and area under the curve (AUC; r=0.320, p=0.118) showed small- and medium-sized correlations to BrAC. ION RAP TAC peak (r=-0.082, p=0.698) and AUC (r=0.040, p=0.852) correlations to BrAC were close to zero.

CONCLUSIONS

In this study, the new-generation ION RAP and the traditionally used SCRAM-CAM show similar delays in detection and similar TAC curves over time, despite using either enzyme or fuel-cell based technologies, respectively. Due to high failure rates of the ION RAP prototypes and close to zero correlations to BrAC, further developments and improvements of these TAC wristbands are required for reliable and valid use in real-time alcohol measurement.

YArnhem: Co-designing a model of social and emotional wellbeing stepped care for young people of the north east Arnhem region: A development study protocol

INTRODUCTION

More Aboriginal and Torres Strait Islander young people experience high or very high levels of psychological distress compared to their non-Indigenous counterparts. This may be partly attributed to systemic barriers resulting in lower rates of help-seeking, sub-optimal identification of psychological challenges, and undertreatment. Reducing these barriers within health systems is an important factor in reducing the Social and Emotional Wellbeing (SEWB) health burden on young Aboriginal and Torres Strait Islander people.

OBJECTIVES

In partnership with Miwatj Health Aboriginal Corporation (Miwatj), this project will co-design an integrated youth Social and Emotional Wellbeing (SEWB) and mental health stepped care model for remote Aboriginal communities in the north east Arnhem region of the Northern Territory.

DESIGN

A collaborative research approach using co-design methods will underpin a community-centric stepped care allocation method, to which culturally appropriate SEWB and mental health interventions and treatments are assigned. These components of the project will inform a digital platform which will facilitate access to SEWB care for young people in north east Arnhem land. This concept was co-developed in a partnership between researchers and Miwatj and builds on Miwatj's previous work to map the stepped needs of young people. The co-design of the content and features of these outputs will be facilitated through community participation and overseen by community, health, and cultural governance structures. This will ensure the solutions developed by the project are culturally responsive, fit for purpose, and will enhance self-determination while reducing systemic barriers to care.

Drink and drug driving education in the Northern Territory: a qualitative study illustrating issues of access and inequity

OBJECTIVE

In the Northern Territory, people who commit drink driving offences are required to undertake an approved course or treatment to be eligible for a driver's licence, however, course uptake is low. We investigated barriers to program uptake.

METHODS

We conducted semi-structured interviews with 24 program attendees, course providers and government stakeholders. We used a framework analysis.

RESULTS

Program coverage in remote areas was limited, leading to inequitable access. The course cost affected uptake and exacerbated existing financial hardship. There were mixed views among government stakeholders on the program. While some held a view that offenders should 'pay the price', some also saw the user-pays model and high program cost as a clear barrier to accessibility.

CONCLUSIONS

The data from this study demonstrate how the current delivery model for drink and drug driving education increases inequities for those in regional and remote areas, and Aboriginal and Torres Strait Islander people.

IMPLICATIONS FOR PUBLIC HEALTH

Moving away from the current user-pays model to a subsidised or free model may facilitate greater access. Online delivery may increase accessibility; however, consultation is required to ensure the program is delivered equitably with consideration of language, literacy, cultural factors and access to technology.

The Use of Social Media as a Persuasive Platform to Facilitate Nutrition and Health Behavior Change in Young Adults: Web-Based Conversation Study

Background

Globally, suboptimal dietary choices are a leading cause of noncommunicable diseases. Evidence for effective interventions to address these behaviors, particularly in young adults, is limited. Given the substantial time young adults spend in using social media, there is interest in understanding the current and potential role of these platforms in shaping dietary behavior.

Objective

This study aims to explore the influence of social media on young adults’ dietary behaviors.

Methods

We recruited 234 young adults aged 18-24 years and living in Australia, using market and social research panels. We applied a digital ethnography approach to collect data from web-based conversations in a series of forums, where participants responded to different health-themed questions related to health behavior change and persuasion on social media. We conducted a qualitative thematic analysis.

Results

Participants described how social media influenced their decisions to change their health behaviors. Access to social support and health information through web-based communities was juxtaposed with exposure to highly persuasive fast-food advertisements. Some participants expressed that exposure to web-based health-focused content induced feelings of guilt about their behavior, which was more prominent among women. Fast-food advertisements were discussed as a contributor to poor health behaviors and indicated as a major barrier to change.

Conclusions

Young adults reported that social media is highly persuasive toward dietary behavior through different pathways of social influence. This suggests that social norms on the web are an important aspect of changing young adults’ health behaviors. The commercialization of social media also encourages poor health behaviors, largely through fast-food advertisements. Future social media–delivered dietary interventions should acknowledge the social and environmental factors that challenge the ability of young adults to make individual health behavior improvements. Care should also be taken to ensure that future interventions do not further elicit guilt in a way that contributes to poor mental health within this community.

Learning from alcohol (policy) reforms in the Northern Territory (LEARNT): protocol for a mixed-methods study examining the impacts of the banned drinker register

INTRODUCTION

The Banned Drinker Register (BDR) was reintroduced in the Northern Territory (NT) in September 2017. The BDR is a supply reduction measure and involves placing people who consume alcohol at harmful levels on a register prohibiting the purchase, possession and consumption of alcohol. The current study aims to evaluate the impacts of the reintroduction of the BDR, in the context of other major alcohol policy initiatives introduced across the NT such as Police Auxiliary Liquor Inspectors and a minimum unit price for alcohol of US$1.30 per standard drink.

METHODS AND ANALYSES

The Learning from Alcohol (policy) Reforms in the Northern Territory project will use a mixed-methods approach and contain four major components: epidemiological analysis of trends over time (outcomes include health, justice and social welfare data); individual-level data linkage including those on the BDR (outcomes include health and justice data); qualitative interviews with key stakeholders in the NT (n≥50); and qualitative interviews among people who are, or were previously, on the BDR, as well as the families and communities connected to those on the BDR (n=150). The impacts of the BDR on epidemiological data will be examined using time series analysis. Linked data will use generalised mixed models to analyse the relationship between outcomes and exposures, utilising appropriate distributions. Qualitative data will be analysed using thematic analysis.

ETHICS AND DISSEMINATION

Ethics approvals have been obtained from NT Department of Health and Menzies School of Health Research Human Research Ethics Committee (HREC), Central Australia HREC and Deakin University HREC. In addition to peer-reviewed publications, we will report our findings to key organisational, policy, government and community stakeholders via conferences, briefings and lay summaries.

The who and what of women's drinking: Examining risky drinking and associated socio-demographic factors among women aged 40-65 years in Australia

INTRODUCTION

Recent trends in Australian national survey data show an increase in alcohol use among middle-aged people, amidst declines in alcohol use among other population groups. There is limited research, however, on middle-aged women's alcohol use. This study aimed to examine patterns in alcohol use among Australian women aged 40-65 and the associated sociodemographic and contextual factors.

METHODS

Cross-sectional data from six waves of the National Drug Strategy Household Survey (2001-2019). We estimated the prevalence of long-term risky drinking (>2 Australian standard drinks per day) and risky-single occasion drinking (>5 Australian standard drinks on one occasion) among middle-aged women. Logistic regression models were estimated using 2019 data to examine demographic characteristics and contextual factors associated with alcohol use.

RESULTS

Since 2001, there has been a statistically significant increase in long-term risky drinking and risky-single occasion drinking amongst middle-aged women in Australia. Educational attainment, marital status and employment status were negatively associated with risky drinking, whereas rurality, age and location of use were positively associated with risky drinking. Beverage type was both positively and negatively associated with risky drinking.

DISCUSSION AND CONCLUSIONS

Given the significant increase in alcohol use amongst middle-aged women in Australia, prevention efforts are needed for this group, which may focus in particular on home drinking and the impact of rurality on alcohol use.

A historical overview of legislated alcohol policy in the Northern Territory of Australia: 1979-2021

BACKGROUND

The Northern Territory (NT) has the highest levels of alcohol consumption and harms in Australia. Since the creation of the NT Liquor Act 1978, which came into effect in 1979, numerous legislated alcohol policies have been introduced to attempt to address these harms. We present a narrative historical overview of alcohol policies implemented in the NT from 1979 to 2021.

METHODS

Using scoping review methodology, databases were searched from 1979 to 2021. Of 506 articles screened, 34 met inclusion criteria. Reference lists of all included articles were searched, resulting in the inclusion of another 41 articles and reports, totalling 75 final documents. Policies were organised using Babor and colleagues (2010) established framework: 1. pricing/ taxation; 2. regulating physical availability; 3. modifying drinking environments; 4. drink-driving countermeasures; 5. restrictions on marketing; 6. education/persuasion; 7. treatment/early intervention.

RESULTS

Two pricing/taxation policies have been implemented, Living With Alcohol (LWA) and Minimum Unit Price, both demonstrating evidence of positive effects on health and consumption outcomes. Eight policies approaches have focused on regulating physical availability, implemented at both individual and local area levels. Several of these policies have varied by location and been amended over time. There is some evidence demonstrating reduction in harms attributable to Liquor Supply Plans, localised restrictions, and General Restricted Areas, although these have been site specific. Of the three policies which targeted modifying the drinking environment; one was evaluated, finding a relocation of social harms, rather than a reduction. The literature outlines a range of controversies, particularly regarding policies in domain 2-3, including racial discrimination and a lack of policy stability. No policies relating to restricting marketing or education/persuasion programs were found. The only drink-driving legislated policy was considered to have contributed to the success of the LWA program. Three policies relating to treatment were described; two were not evaluated and evidence showed no ongoing benefits of Alcohol Mandatory Treatment.

DISCUSSION

The NT has implemented a large number of alcohol policies, several of which have evidence of positive effects. However, these policies have often existed in a context of clear politicisation of alcohol policy, frequently with an implicit focus on Aboriginal people's consumption.

Zero-alcohol beverages: Harm-minimisation tool or gateway drink?

Zero-alcohol beverages, classified as products containing ≤0.5% alcohol by volume, are becoming increasingly popular. These beverages may contribute to alcohol harm reduction efforts if drinkers switch to them from regular strength beverages. However, there is currently a lack of evidence to support a substitution hypothesis, particularly as alcohol companies frequently market zero-alcohol beverages as drinks to consume in new locations, such as in the workplace, or by previously non-drinking groups, such as pregnant women. Additionally, zero-alcohol beverages are currently available for sale in supermarkets by all consumers, including minors. This is problematic as there is a lack of evidence around what impact consumption of zero-alcohol beverages in youth might have on social norms and initiation of alcohol consumption. In this commentary, we explore the existing evidence on zero-alcohol beverages and their impact on drinking behaviours, concluding that a current paucity of knowledge makes developing evidence-based policy a challenge. As such, substantial research efforts are required to inform policies regulating the availability and marketing of zero-alcohol beverages in Australia.

A parallel test of the SCRAM-CAM transdermal monitors ensuring reliability

INTRODUCTION

Previous studies validating the transdermal alcohol concentration (TAC) as measured by the Secure Continuous Remote Alcohol Monitors Continuous Alcohol Monitoring (SCRAM-CAM) have tested the monitor against self-reports or breath alcohol concentration (BrAC). This study aims to provide further evidence of the reliability of the SCRAM-CAM testing two monitors in parallel.

METHODS

Participants (N = 21) received four standard drinks in a laboratory session while wearing SCRAM-CAMs simultaneously on their left and right ankles. The SCRAM-CAMs sampled TAC every 30 min and participants were monitored for at least 2-3 h after their BrAC levels reached zero. Weight and height measures were taken to calculate body mass index (BMI).

RESULTS

There was a positive correlation between the TAC measurements from the left and right SCRAM-CAM (r = 0.718), a cross-correlation model revealed that this correlation was not significantly different for sex or BMI. Area under the TAC curve (AUC) and peak TAC values as measured by the left and right SCRAM-CAM also show positive correlations (r = 0.554 and r = 0.579, respectively). Cross-correlation models show a significant effect of BMI on the relationship between left and right peak TAC values, which may be due to outlier effects. No further effects were significant for on both peak and AUC values.

DISCUSSION AND CONCLUSIONS

Results show that TAC measured by SCRAM-CAMs worn on the left and right showed a good correlation, with correlations between AUC and peak TAC values considered to be fair. TAC monitors show promise for use in research settings; however, work is needed testing the reliability of TAC as measured by two TAC monitors.

Purchasing, consumption, demographic and socioeconomic variables associated with shifts in alcohol consumption during the COVID-19 pandemic

INTRODUCTION AND AIMS

Restrictions introduced to reduce the spread of COVID-19 have had major impacts on the living circumstances of Australians. This paper aims to provide insight into shifts in alcohol consumption and associated factors during the epidemic.

DESIGN AND METHODS

A cross-sectional convenience sample of 2307 Australians aged 18 and over who drank at least monthly was recruited through social media. Respondents were asked about their alcohol consumption and purchasing in 2019 prior to the epidemic plus similar questions about their experiences in the month prior to being surveyed between 29 April and 16 May 2020.

RESULTS

Reports of average consumption before (3.53 drinks per day [3.36, 3.71 95% confidence interval]) and during (3.52 [3.34, 3.69]) the pandemic were stable. However, young men and those who drank more outside the home in 2019 reported decreased consumption during the pandemic, and people with high levels of stress and those who bulk-bought alcohol when restrictions were announced reported an increase in consumption relative to those who did not.

DISCUSSION AND CONCLUSIONS

A reported increase in consumption among those experiencing more stress suggests that some people may have been drinking to cope during the epidemic. Conversely, the reported decrease in consumption among those who drank more outside of their home in 2019 suggests that closing all on-trade sales did not result in complete substitution of on-premise drinking with home drinking in this group. Monitoring of relevant subgroups to assess long-term changes in consumption in the aftermath of the epidemic is recommended.

Non-consensual sharing of personal sexually explicit imagery among young people in Australia: results from an online survey

Consensual sharing of personal sexually explicit imagery (SEI) is part of young people's sexual practise; however, harms arise if content is shared without consent. Australians aged 15-29 years were recruited for an online survey. Participants indicated if they had ever sent SEI of themselves to someone else, received SEI directly from the person in the imagery and whether they thought it was illegal to forward SEI without consent. Participants reported whether anyone shared their SEI without permission, if they told people, made official reports or if there were consequences for perpetrator(s). Logistic regression was used to identify associations between victimisation, gender, age group, sexual identity and knowledge of SEI-related law. In total, 1007 participants (65% female, mean age 23 years, 67% heterosexual) were recruited; 63% sent personal SEI to another person, 71% received SEI from the person pictured and 77% correctly identified it is illegal to forward SEI without consent. Thirteen percent (n = 126) indicated another person forwarded personal SEI without consent. In univariate analysis, victimisation was associated with identifying as non-heterosexual (odds ratio = 1.51, confidence interval = 1.03-2.22), but was independent from age group, gender and knowledge. In multivariate analysis, sexual identity, age group, gender and knowledge were not significantly associated with victimisation. Among participants who experienced non-consensual sharing of personal SEI, 63% told friends, 10% told family, 93% made no official report and 94% reported no consequences for perpetrator(s). Initiatives are needed to promote legal rights and enable young people to seek support.

A Health Education Website Developed to Meet Young People's Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study

BACKGROUND

Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population.

OBJECTIVE

This study aimed to test the usability of a resource about online pornography and sexting among young people.

METHODS

Semistructured interviews were conducted with 17 participants aged 15 to 29 years.

RESULTS

We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation.

CONCLUSIONS

Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space.

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.

Barriers and opportunities in the translation of mobile phone and social media interventions between research and health promotion practice in Australia: a qualitative study of expert perspectives

Background

Newer technologies, such as smartphones and social networking sites, offer new opportunities for health promotion interventions. There is evidence to show that these technologies can be effectively and acceptably used for health promotion activities. However, most interventions produced in research do not end up benefitting non-research populations, while the majority of technology-facilitated interventions which are available outside of research settings are either undocumented or have limited or no evidence to support any benefit. We therefore aimed to explore the perspectives of researchers and health promotion experts on efforts to translate technology-facilitated prevention initiatives into practice, and the barriers to achieving translation.

Methods

We utilised a qualitative study design, involving in-depth interviews with researchers experienced with technology-facilitated prevention interventions and prominent health promotion experts.

Results

Some barriers mirror the findings of other studies into health promotion practice, which have found that competing priorities, resource limitations and organisational capacity are important in determining use of evidence in programme planning, engagement in translation and evaluation practice. We add to this literature by describing barriers that are more specifically related to technology-facilitated prevention, such as the pace of developments in technology, and how this clashes with the time taken to develop and ready evidence for translation.

Conclusions

In order to maximise the vast potential of technology-facilitated prevention interventions to promote population health, it is essential that translation is at the forefront of consideration for both researchers and practitioners. We suggest actions that can be taken by both researchers and practitioners to improve translation of technology-facilitated prevention interventions, and also highlight how funding schemes can be modified to facilitate translation.

Personal and reported partner pornography viewing by Australian women, and association with mental health and body image

Background Personal and partner pornography viewing may affect health and wellbeing. This study aimed to improve understanding of the effects of pornography on mental health and body image, given emerging evidence of increasing use, particularly among young people.

METHODS

A cross-sectional survey was implemented, targeting people who had accessed health and fitness content via social media. Convenience sampling was used and participants were recruited via advertising on social media.

RESULTS

Overall, 76% (75/99) of women reported having ever viewed pornography, and 21% had viewed pornography frequently (monthly/weekly/daily) in the prior 12 months. The association between frequent viewing and higher-risk Kessler 10 Psychological Distress Scale scores lost significance once controlled for age (adjusted OR 2.30, 95%CI 0.82-6.49, P=0.11). There was an association with frequent reported partner pornography use (monthly/weekly/daily) and increased Drive for Muscularity scores (adjusted OR 2.20, 95%CI 1.01-4.80, P=0.048). There were no other associations found with pornography use (personal or partner) and body image or mental health, although this was limited by the small sample size. Most women (85%, 41/48) reported being happy with their partner's pornography use, and in qualitative responses, indicated that pornography had minimal effect on their lives. Nevertheless, multiple qualitative responses indicated a multiplicity of perceived effects of pornography, including negative effects on body image.

CONCLUSIONS

Pornography had a minor effect on mental health and body image in this study. Additional research is required to improve understanding of the effects of pornography on body image and mental health, particularly among vulnerable individuals.

"I aspire to look and feel healthy like the posts convey": engagement with fitness inspiration on social media and perceptions of its influence on health and wellbeing

Background

Fitspiration is a popular social media trend containing images, quotes and advice related to exercise and healthy eating. This study aimed to 1) describe the types of fitspiration content that users access and how they engage with content, 2) investigate the disordered eating and exercise behaviours and psychological distress of individuals who access fitspiration, and 3) understand the perceived influence of fitspiration on health and wellbeing.

Methods

Participants who access fitspiration content were recruited via social media to complete a cross-sectional online survey. Participants’ psychological distress was measured using the Kessler 10 Psychological Distress Scale (K10); disordered eating behaviours using the Eating Attitudes Test-26 (EAT-26); and compulsive exercise behaviours using the Exercise Addiction Inventory (EAI). Participants also answered a series of open-ended questions about their experiences with fitspiration. A descriptive statistical analysis was conducted for quantitative data. Responses to open-ended questions were analysed for key themes using an iterative process of open, axial and thematic coding.

Results

Participants (N = 180, 151 female, median age 23.0 years (IQR 19.0, 28.5)) most commonly accessed content posted by personal trainers and athletes (59.4%), posts tagged with the ‘fitspiration’ hashtag (53.9%) and posted by ‘everyday’ people (53.3%). Overall, 17.7% of participants were classified as high risk for an eating disorder, 17.4% reported very high levels of psychological distress, and 10.3% were at risk of addictive exercise behaviours. Participants described both positive and negative influences of engaging with fitspiration content. The influence on their health beliefs and behaviours was explained through four key themes: 1) Setting the ‘healthy ideal’, 2) Failure to achieve the ‘ideal’, 3) Being part of a community, and 4) Access to reliable health information.

Conclusions

Many participants reported benefits of fitspiration content including increased social support and access to health information. However, participants also reported that fitspiration content could negatively influence their wellbeing and perception of healthy goals. Content posted by relatable individuals or qualified experts was perceived as most trustworthy. Future research is needed to determine the individual and content-related factors associated with negative and positive fitspiration experiences.

Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews

ISSUE ADDRESSED

Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people.

METHODS

We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews.

RESULTS

We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.

Reach, engagement, and effectiveness: a systematic review of evaluation methodologies used in health promotion via social networking sites

Issue addressed Social networking sites (SNS) are increasingly popular platforms for health promotion. Advancements in SNS health promotion require quality evidence; however, interventions are often not formally evaluated. This study aims to describe evaluation practices used in SNS health promotion. Methods A systematic review was undertaken of Medline, PsycINFO, Scopus, EMBASE, CINAHL Plus, Communication and Mass Media Complete, and Cochrane Library databases. Articles published between 2006 and 2013 describing any health promotion intervention delivered using SNS were included. Results Forty-seven studies were included. There were two main evaluation approaches: closed designs (n=23), which used traditional research designs and formal recruitment procedures; and open designs (n=19), which evaluated the intervention in a real-world setting, allowing unknown SNS users to interact with the content without enrolling in research. Closed designs were unable to assess reach and engagement beyond their research sample. Open designs often relied on weaker study designs with no use of objective outcome measures and yielded low response rates. Conclusions Barriers to evaluation included low participation rates, high attrition, unknown representativeness and lack of comparison groups. Acceptability was typically assessed among those engaged with the intervention, with limited population data available to accurately assess intervention reach. Few studies were able to assess uptake of the intervention in a real-life setting while simultaneously assessing effectiveness of interventions with research rigour. So what? Through use of quasi-experimental or well designed before-after evaluations, in combination with detailed engagement metrics, it is possible to balance assessment of effectiveness and reach to evaluate SNS health promotion.

Correlates of in-person and technology-facilitated sexual harassment from an online survey among young Australians

Background Technology-facilitated sexual harassment is an emerging phenomenon. This study investigates correlates of sexual harassment among young Australians. Methods: Participants aged 15-29 were recruited for an online survey. Participants reported how often in the past year they experienced sexual harassment in person, via phone, social media and dating apps. Correlates of in-person and technology-facilitated sexual harassment were identified using logistic regression. Results: Of all participants (n = 1272, 70% female), two-thirds reported sexual harassment in person, 34% through social media and 26% via phone. Of participants who used a dating app in the past year (n = 535), 57% experienced sexual harassment. Sexual harassment in person was correlated with being female (aOR = 9.2, CI = 6.9–12.2), trans and gender diverse (aOR = 2.6, CI = 1.2–5.7) and being aged 20–24 years (aOR = 1.5, CI = 1.1–2.1). Heterosexual identity reduced the odds of sexual harassment in person (aOR = 0.7, CI = 0.5–0.9). Technology-facilitated sexual harassment was correlated with female (aOR = 3.5, CI = 2.6–4.6) and trans and gender diverse identities (aOR = 3.0, CI = 1.4–6.5). Older age [25–29 years (aOR = 0.5, CI = 0.4–0.8)] and heterosexual identity (aOR = 0.7, CI = 0.5–0.9) significantly reduced the odds of technology-facilitated sexual harassment. Conclusion: Young people identifying as female, trans and gender diverse and non-heterosexual are at risk of in-person and technology-facilitated sexual harassment. Service and technology providers, academics, and policy makers must respond with innovative strategies.

Correlates of alcohol consumption on heavy drinking occasions of young risky drinkers: event versus personal characteristics

AIMS

Risky single-occasion drinking (RSOD) by young people is a serious public health issue, yet little is known about the specific circumstances of risky drinking occasions. This study examined the independent effects of event- and individual-specific variables on RSOD.

DESIGN

Longitudinal cohort study measuring self-reported RSOD and event- and individual-specific variables across two drinking occasions approximately 1 year apart.

SETTING

Metropolitan Melbourne, Australia.

PARTICIPANTS

A sample of 710 young risky drinkers aged between 18 and 25 years and defined as engaging in risky drinking practices (males: consumed alcohol in excess of 10 Australian Standard Drinks (ASD: 10 g ethanol) in a single occasion in the previous year; females: consumed alcohol in excess of seven ASD for females in a single occasion in the previous year).

MEASUREMENTS

Random digit-dial telephone landline survey of the most recent heavy drinking occasion and socio-demographic variables. The primary outcome was the log of the total drinks consumed in the most recent heavy drinking occasion. Event-specific (e.g. number of drinking locations) and time-varying (e.g. weekly income) and time-invariant (e.g. sex) individual-specific variables were examined as correlates of total drinks consumed.

FINDINGS

Changes in event-specific characteristics including the length of the drinking occasion (Likelihood Ratio χ² (2) = 24.4, P < 0.001), the number of drinking locations (Wald χ²₍₁₎  = 7.6, P = 0.006) and the number of different drink types (Wald χ²₍₁₎  = 13.6, P < 0.001) were associated with increases in total drinks consumed, after adjustment for time-invariant and time-variant individual-specific variables such as gender, income level and weekly consumption. Few other effects were noted.

CONCLUSIONS

Event-specific characteristics are important predictors of the number of drinks consumed during risky single occasion drinking (RSOD) and illustrate the importance of event contexts when considering interventions targeting RSOD. The total number of drinks consumed in a RSOD session appears to rise independently with the duration of the drinking event, the number of drinking locations and the number of different types of beverage consumed.

"Just not all ice users do that": investigating perceptions and potential harms of Australia's Ice Destroys Lives campaign in two studies

Background

In 2015, the Australian government launched the media campaign Ice Destroys Lives targeting crystal methamphetamine use. Previous research indicates mass media campaigns may have harmful effects for people engaged in drug use. This study investigated perceptions and harms of Ice Destroys Lives among adults with a history of injecting drugs and young people.

Methods

This analysis includes data from two studies: an online questionnaire with young people and in-depth interviews with adults who use crystal methamphetamine. Young people from Victoria, Australia, were recruited through Facebook. We collected data on drug use, campaign recognition and behaviours. Participants who recognised the campaign indicated whether they agreed with five statements related to Ice Destroys Lives. We compared campaign perceptions between young people who reported ever using crystal methamphetamine and those who did not. Adults who use crystal methamphetamine were sampled from the Melbourne injecting drug user cohort study. We asked participants if they recognised the campaign and whether it represented their experiences.

Results

One thousand twenty-nine young people completed the questionnaire; 71% were female, 4% had used crystal methamphetamine and 69% recognised Ice Destroys Lives. Three quarters agreed the campaign made them not want to use ice. Ever using crystal methamphetamine was associated with disagreeing with three statements including this campaign makes you not want to use ice (adjusted odds ratio (AOR) = 4.3, confidence interval (CI) = 1.8–10.0), this campaign accurately portrays the risks of ice use (AOR = 3.2, CI = 1.4–7.6) and this campaign makes you think that people who use ice are dangerous (AOR = 6.6, CI = 2.2–19.8). We interviewed 14 people who used crystal methamphetamine; most were male, aged 29–39 years, and most recognised the campaign. Participants believed Ice Destroys Lives misrepresented their experiences and exaggerated “the nasty side” of drug use. Participants felt the campaign exacerbated negative labels and portrayed people who use crystal methamphetamine as “violent” and “crazy”.

Conclusion

In our study, Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign also reinforced negative stereotypes and did not encourage help seeking. Alternative evidence-based strategies are required to reduce crystal methamphetamine-related harms.

Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events

BACKGROUND

Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events.

OBJECTIVE

The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events.

METHODS

A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically.

RESULTS

Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already.

CONCLUSIONS

Findings from this study offer insights into young adults' drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people's preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style.

Challenges to translating new media interventions in community practice: a sexual health SMS program case study

Issue addressed Herein we discuss translational challenges for new media interventions, using the Sexual Health & Youth (SHY) short message service (SMS) project to illustrate particular challenges relating to recruitment and evaluation. Methods Following the delivery of an SMS sexual health program, available documents (progress reports, communications with project staff, ethics submissions and reporting) were analysed thematically to elucidate the barriers to recruitment, implementation and evaluation. Results Despite being framed by evidence-based research, the project had little impact on the intended population. Only 119 of an expected 5100 young people (2%) enrolled to receive SMS messages. Program documents highlighted the difficulty of recruiting participants for new media interventions. Key issues identified in recruitment included under-resourcing, delays waiting to receive ethics approval and challenges of school-based recruitment. Conclusion The minimal impact of the SHY program illustrates the need for improved research translation in the field of new media interventions. It is important that recruitment procedures align with the convenience and appeal of mobile phone-based interventions. So what? New media research is not always easily translated into community settings. Large-scale recruitment requires adequate resourcing and careful planning, even for low-cost mobile interventions. Stronger formative research, documentation and use of partnerships are essential for successful implementation. Researchers must also consider translation in planning and disseminating their work.

'A Drink That Makes You Feel Happier, Relaxed and Loving': Young People's Perceptions of Alcohol Advertising on Facebook

AIMS

To explore young people's perceptions of alcohol advertising on Facebook and investigate perceived compliance with the Alcohol Beverages Advertising Code (ABAC).

METHODS

An online cross-sectional survey with 172 Australians aged 16-29 years recruited from a market research website and via Facebook. We compiled advertisements from six popular alcohol brands' Australian Facebook pages and asked respondents for their perceptions and interpretations in open and closed-ended questions.

RESULTS

Open-ended responses most commonly indicated that the main messages of the advertisements related to social success. In closed-ended questions, respondents perceived advertisements implied that alcohol facilitated relaxation (67%), improved mood (65%), social success (57%) and confidence (49%).

CONCLUSION

Young people identified the main themes of alcohol advertising on Facebook as related to social success and significant improvement in mood. Young people's interpretations of Facebook alcohol advertising suggest breaches of ABAC guidelines. Strengthening the enforcement and application of the ABAC and social media alcohol advertising policies is justified.