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PYB159 End of Sem > specific populations > Flashcards

specific populations Flashcards

1
Q

what can whole population strategies be very effective at?

A

reducing total harm and social impact

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2
Q

why study specific populations?

A

reduce risk of experiencing disproportionate harms seen in whole population studies/strategies

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3
Q

whole population strategies have a higher risk of experiencing disproportionate harms (direct and indirect)

what are some examples of specific populations effected?

A 
> injecting drug users
> women 
> aboriginal or Torres strait islander people
> LGBTI+
> young  people, older people
> people with mental illnes
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4
Q

what does IDRS stand for

A

illicit drug reporting system

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5
Q

what is the IDRS?

A

Australia’s central monitoring an dearly warning system

identified key and emerging trends among injecting drug users

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6
Q

how does the IDRS obtain their information

A
  • almost 1000 interviews with injecting drug users
  • interviews with key experts
  • incorporates analysis of other national data related to illicit drug use in Australia
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7
Q

according to 2017 IDRS

___ drug use was high, varying markedly across states.

A

poly drug use = high

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8
Q

according to 2017 IDRS

what was the average age of first time injection drug use

A

age = 20 yo

injecting drug users are getting older

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9
Q

according to 2017 IDRS

2/3 injection drug users in Australia injection some form of _____

A

Methamphetamine

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10
Q

according to 2017 IDRS

What was the most commonly used prescription opioid in 2017

A

morphine

majority obtained illicitly

recent oxycodone use = high

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11
Q

according to 2017 IDRS

what was the most commonly used drugs

A

methamphetamine, cannabis and heroin

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12
Q

according to 2017 IDRS

what is the unemployment rate of the 2017 IDRS sample

A

80% unemployment

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13
Q

according to 2017 IDRS

56% reported high or very high ____

A

psychological distress

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14
Q

according to 2017 IDRS

what percentage of survey participants are receiving ORT

A

50%

ORT = opioid replacement

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15
Q

according to 2017 IDRS

1/5 have _____ in the past year

A

overdosed

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16
Q

according to strathdee et al 2006

social factors that predict risky injecting practices include:

A

depression

suicide attempts

non-consensual sex

unstable housing

low education

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17
Q

injecting drug use is a behaviour strongly associated with other highly marginalised characteristics such as:

A
  • imprisonment
  • blod borne virus infections
  • homelessness
  • mental illness
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18
Q

multiple harms related to injection drugs include:

A
  • blood borne viruses
  • overdose
  • physical health (inc. vein care)
  • mental health
  • psychosocial (relationships, law, etc.)
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19
Q

what is HCV

A

Hepatitis C virus

  • causes infectious disease hepatitis C
  • primarily effects liver
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20
Q

what percentage of new hep C diagnoses is attributed to people to inject or have a history of injecting

A

90%

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21
Q

what percentage of existing hep C diagnoses is attributed to people to inject or have a history of injecting

A

80%

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22
Q

what does the
Australian NSP National Data Survey Report 2012-16
say about general prevalence of HCV

A

prevalence increases with longer duration of injecting drug use (male and female)
> 60% of NSP population
> 2% of general population

prevalence also higher among oder respondents

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23
Q

what does the
Australian NSP National Data Survey Report 2012-16
say about prevalence of HBV

A

prevalence higher for longterm injecting drug users

<0.5% prevalence with <5 year injecting drug history

14% of users with history of 10+ years

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24
Q

according to Australian NSP National Data Survey Report 2012-16

how does HCV prevalence differ among sexes

A

prevalence in females (48%) more frequent than males (23%)

particularly among those with < 3 year injecting history

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25
Q

what is HIV

A

Human immunodeficiency virus

once established in body, virus attacks immune system (specifically - CD4 cells [protective cells])

no cure - HIV positive for life

potentially lead to secondary AIDS related illnesses

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26
Q

how is HIV transmitted

A

in blood, semen, vaginal fluid

through unprotected sex, blood to blood (inc. sharing injecting equipment), mother to baby (via breast milk)

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27
Q

Australia 2016

prevalence of HIV diagnosis due to ….

A

male to male sex (70%)

heterosexual sex (21%)

both male to male sex and injection drug use (5%

injection drug use (1%)

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28
Q

According to Australian NSP National Data Survey Report 2012-16

how does the prevalence of HIV antibodies differ among gender/sexuality groups

A

higher among homosexual men compared to bisexual and heterosexual men

and higher compared to women

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29
Q

According to Australian NSP National Data Survey Report 2012-16

how does the prevalence of HIV antibodies differ among Aboriginal and Torres strait islanders compared to non-indigenous respondents

A

antibody prevalence higher in indigenous respondents (2.8%) compared to non-indigenous (1%)

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30
Q

describe the trend of HIV infection among Aboriginal and Torres strait islander respondents from 2012-2016

A

increase from 0.4% to 2.8%

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31
Q

what does IVDU stand for

A

intravenous drug use/er

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32
Q

what are the interventions utilised in Australia for IVDU

A

Psychoeducation

access to NSP (needle and syringe program)

Replacement programs (e.g. ORT)

regular testing - prevention and early treatment for IVDU related harms

general health

peer interventions

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33
Q

what does Psychoeducation as a intervention encompass

A

risk taking (injecting, sex, intoxication

safer injecting

vein care

overdose

community safety/disposal

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34
Q

American study comparing female substance abuse to males

women were more likely:

(than men)

A

more likely:

  • unemployed
  • to have a substance abusing spouse (if married)
  • shorter time periods. durations of substance use but more rapid development of substance problems
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35
Q

American study comparing female substance abuse to males

women were less likely:

(than men)

A

less likely

  • to have legal problems associated with substance misuse
  • to report lifetime use of inhalants or hallucinogens
  • to be cannabis-dependent
36
Q

American study comparing female substance abuse to males

on trends in treatment, women reported

A

fewer admissions for treatment

fewer treatment days (when admitted)

lower overall treatment costs
> implications regarding a “male-orientated” treatment system <

reduced treatment options/patterns

37
Q

overview of gender differences

biological differences - women

A

intoxication occurs with less alcohol intake

metabolise alcohol differently

develop cirrhosis of liver more rapidly

38
Q

overview of gender differences

social differences - women

A

increased stamina associated with use/misuse

more often caring for children

cultural differences regarding social status

39
Q

overview of gender differences

patterns of uses - women

A

develop problematic use more quickly

more use of prescription medications

more “private” use/misuse

40
Q

overview of gender differences

Limited research implications - women

A

lack research regarding women

conclusions drawn with men may not adequately generalise to women

impacts prevention and treatment development

41
Q

describe and give examples of stigma surrounding substance-using women

A

more stigma

highest among pregnant women

increase blame for difficulties

reluctant to seek treatment

feat negative attitudes of heal professionals (e.g. child safety)

stereotypes and cultural aspects

42
Q

barriers to treatment for substance-using women

A

lack of awareness of range of treatment options

stigma

childcare/ fear of them being removed from their care

perceived economic and time costs of residential treatment inc. const to family disruption

lack of support

concerns about type of treatment (especially confrontational approaches

43
Q

barriers to treatment for substance-using women that are related to male correspondence

A

male oriented programs may not address issues of importance to women

having to talk with men present

abusive relationships or history may make women feel unsafe in the company of men during treatment

may experience sexual harassment in mixed gender settings

may feel marginalised and less able to speak freely about issues

44
Q

what is known about pregnancy and alcohol consumption

A

safe threshold alcohol consumption is not yet known

risk of damage to baby increases with amount consumed during pregnancy

binge drinking is especially harmful

safest to abstain from drinking in planning or during pregnancy or breastfeeding

45
Q

what CALD populations have a higher rate of use or higher risk

A

migrants moving from culture of non alcohol use to high alcohol use

cultural specific substances brought to Australian context

46
Q

what are some stressors that could increase drug use and risk of drug use in CALD populations

A

PTSD/Trauma

family stressors

unemployment

language barriers

lack of understanding of available services

47
Q

Aboriginal and torres strait islander poeple make up ___% of the australian populaiton

A

2.8%

48
Q

why do Aboriginal and torres strait islander poeple have more ill health than other australians

A

socioeconomic disadvantage

- greater risk of exposer/vulnerability to health risk factors (i.e. smoking and alcohol misuse)

49
Q

____ play a major rile in disparities in health and life expectancy between indigenos and non-indigenous australians

A

drug related problems

50
Q

indigenous australian the life expectancy is __-__ years shorter than non indigenous australians

due to ___

A

10-12yrs

due to

  • chronic disease (diabetes, lung, heat, kidney disease)
  • lifestyle factors (smoking, lacking excersice, obesity)
  • higher rates of illness and hospitalisation
51
Q

trends in alcohol consumption in indigenous people

data in comparison to non-indigenous

A

31% abstain from alcohol

more drinking at risky levels on a single occasion at least monthly (35% comp. 25%) - leading to alc. related injury

2.8x as likely to drink more than 11+ standards drinks in single sitting once+ monthly (18.8% comp. 6.8%)

1/5 exceed lifetime risk guidelines

52
Q

trends in illicit drug intake in indigenous people in comparison to non-indigenous

A

aged 14+ = higher usage than general population

  • use of any illicit drug in past 12 months (1.8x)
  • use cannabis (1.9x)
  • use methamphetamine (2.2x)
  • misuse pharmaceuticals (2.3x)
53
Q

historical perspective and impact of substance abuse in indigenous australians

A

increased susceptibility to substance abuse stimulated by dispossession and human rights violations

helped form and maintain drug problems

evidence of controlled alcohol use prior to colonisation - lack of awareness increased vulnerability

control theory
- indigenous encouraged to be like ‘ white people’ - including participating in bringing/drinking

54
Q

what happened in 1837 in terms of alcohol laws in australis

A

legislation to ban alcohol among ATSI people

with exceptions of mixed decent and good hygiene

alcohol used for payment and for trade

55
Q

how did the 1837 legislation shape drinking patterns of ATSI people

A

illegal to drink in hotels&raquo_space; public drinking

quick drinking to avoid incarceration

resulted in increased public drunkenness and arrests

56
Q

what events resulted in the indigenous community to see drinking as a sign of equality and status

A

1957-1975 reform of prohibition laws, including the rights to drink

57
Q

Anthropological perspective of ATSI substance abuse

A

culturally determined responses to changes in history

peer influence is particularly important

  • ‘group-sharing’
  • belonging
  • non-confronting culture

“hunter gatherer” explanation

58
Q

Explain the hunter gatherer explanation in terms of anthropological perspective of ATSI

A

food shortage means food gathered rarely and shared among the community

extends to alcohol use

  • bought when money available and consumed quickly
  • shared amongst community
59
Q

Physiological disease perspective of ATSI substance use

A

racial interpretation

  • genetic predisposition to alcohol dependence
  • disease model - the idea that addiction is a disease and lives in the person

most treatment for ATSI have a goal of absinence

disease model is popular with ATSI community

60
Q

psycho social perspective of ATSI substance use

A

describes the learned behaviours that reinforce drinking

the impact of psychosocial stressors

social norms and cultural practices undermine resistance

61
Q

according to pearson (2002) what are the 5 elements for outbreak of substance misuse?

A

availability

money

spare time

examples o fothers in immediate environment

permissive social ideology

62
Q

what strategy is currently in place to address ATSI substance use

A

the 2014-2019 national aaboriginal and toress strait islander people’s drug strategy

63
Q

what are the 4 priority areas for action identified in the 2014-2019 ATSI drug strategy?

A
  1. build capacity and capability of AOD service system, particularly ATSI-controlled services/workforce
  2. increase access culturally responsive and appropriate programs
    - prevention/interventions aimed at local needs to address harmful AOD use
  3. strengthen partnerships based on respect within and between ATSI people, government and mainstream service providers
    - inc. law enforcement and health organisations, at all levels of planning, delivery and evaluation
  4. Establish meaningful performance measures wiht effective data systems that support community-led monitoring and evaluation
64
Q

what are all the priorities of the 2014-19 ATSI drug strategy directed at?

A

reducing:
- population of people consuming alcohol at risky levels
- levels of illicit and licit drug use
- AOD related offences and involvement in the criminal justice system
- proportion of people smoking tobacco
- blood-bourn viruses due to injecting drug use

65
Q

best practice approaches to addressing the needs of ATSI people include:

A
  • culturally responsive and appropriate mainstream programs
  • ATSI community controlled services leading the planning, implementation and delivery of progams
  • services delivered by specialist ATSI AOD services
    (who understand their physical , spiritual, cultural, emotional and social needs)
  • screening and brief intervention in primary care
    (Aboriginal medical services and other relevant heath services)
  • widely delivered services (urban, regional & remote locations - prison, hospital and mental health facility settings)
  • involvement of family and communities where appropriate
  • addressing the social determinants of alcohol, tobacco and other drugs
    (inc. homelessness, education, unemployment, grief/loss/trauma and violence)
  • interagency collaboration and data sharing
66
Q

treatment issues to consider for ATSI people

A

limited access to culturally sensitive treatment = major theme in research
- few aboriginal people choose to access treatment programs for general population

most successful strategies are often those designed and run by the community

need for more rigorous evaluation of what works

67
Q

what is the general trends of the AOD use for people in contact wiht the criminal justice system

A

high underlying rates of AOD use

68
Q

what does the AIHW (2015) say about the health of Australian prisoners in terms of AOD use

A

67% of prison entrants report using an illicit drug in 12 months prior to entering prison

recent illicit drug use was more common among younger entrants

  • 3/4 of 18-24yo entrants had taken illicit drugs in last 12 months
  • 1/2 of 45+ entrants had taken illicit drugs in last 12 months

half of all prisnon entrants report using methamphetamine

69
Q

what does the Drug Use Monitoring in Autralia (2013-14) say about AOD trends in those associated with the crim. justice system

A

45% of adult detainees interviewed as part of the program reported that their AOD used contributed to their current detention by police

70
Q

what are the most commonly used substances for non-medical perposes in the previous 12 mths. by prison entrants

A 
methamphetamine (50%)
cannabis (41%)
analgesics/painkillers (13%)
tranquillisers/ sleeping pills (11%)
other analgesics (inc. opiates/opioids) (85)
71
Q

gender differences in most commonl used drugs of prison entrants

A

women more likely to use analgesics/pain killers than men (27%, 11%)

women more likely to use tranquillisers/sleeping pills (26%, 9%)

72
Q

hep C rates in prisoners

A

over 40% of male prisoners have hep C

over 70% of female prisoners have hep C

73
Q

according to the butler et al (2015 ) national prison entrant blood bourn virus and risk behaviour survey

whats the relationship between imprisonment, illicit an dinjective drug use and the prevalence of blood bourn viruses?

A

31% prevelance of hep c

57% prevalence among people who inject

74
Q

whats the trend of smoking in prison entrants?

A

75% are current smokers

70% are daily smokers

75
Q

best approaches to adressing the needs of poeple in contact with the criminal justice system:

A
  • impliment smoke free policies in correctional facilities
  • access to education , health promotion and treatment and support services while in prison and during their transition back to comminity
  • provisions of a range of treatments
    inc. detoxification and withdrawal management, pharmacotherapy, drug free units or theraputic communities
  • testing, education and treatment for blood bourn viruses
  • restorative justice conferencing
  • strengthen harm reduction efforts in prison setting
  • after care and support after release
  • drug deduction units and searching of offenders, staff, visitors and vehicles
76
Q

what are some harm reduction recommendations for poeple in contact with the criminal justice system:

A

provide equal AOD treatment to that available to general pop

provide education

intridice methadone treatment, NSPs

Use alternative sentencing . diversionary programs

provide prison staff with better training

provide voluntary testing for hep B and C

77
Q

AOD prevalence in LGBTI+ population of australia

A

australia and international research has found that rates of AOD use by LGB eopel is 2-4 times higher than AOD rates by heterosexual people

increased poly-drug use and higher use of amphetamines cannabis amyl and other party drugs

78
Q

Lea et al (2013) - trends in IVDU by gay/bisexual men in sydney

A
  1. 6% of men reported injecting drugs in the previous 6 months
    - 3.4% reporte methamphetamine injetion
    - 0.4% heroin
79
Q

Lea et al (2013) concludes that

men who inject were:

A

less likely to be employed full time

more likely to be HCV+, HIV+

more likely to have used party drugs for sex

have engaged in esoteric sexual practices

80
Q

difference in alcohol use and alcohol related problems between transgender and non transgender identified in young adults

(coulter et al 2015)

A

heavy episodic drinking is higher

higher risk of sexual assault after drinking

higher risk of suicidaity after drinking

81
Q

what is the queensland chemsex study (2017)

A

the results from a ross sectional survey of gay and other homosexually active men in queensland substance use and sexual activity

82
Q

accoridng to the queensland chemsex study

the most commonly reported drugs used were:

A 
amyl nitrate ((85.3%)
- 58% of users reported using often, very often or always

alcohol (74.4%)
- 37% used often, very often or always

crystal meth amphetamine (65.9%)
- 45% used often, very often or always

viagra (65.9%)

83
Q

mental health trends of LGBTI+ populations

A

41% had a mental disorder in the previous 12 months

attempted suicide raes between 3.5-14 times higher than heterosexual populations

among transgender people the prevalence of attempted suicide is 16-47%

84
Q

how can AOD facilitate sexual encounters and unsafe sex?

A

variety of mechanisms

  • state dependent learning
  • tension reduction
  • sensation seeking
  • expectancies
  • etc
85
Q

what are some factors that motivate the use of AOD in LGBTI+ populaitons

A

minority stress

homophobia (internalised and externalised)

using to cope wiht negative feelings

peer modelling of AOD - using is commonly linked to social and sexual contexts - other places to socialise are limited

many avoid mainstream services due to concerns of discrimination

86
Q

possible practice approaches for LGBTI+ for substance use

A

involve LGBTI cominity in health education and prevention programs

research health needs and service use by LGBTI consumers to better programs

workforce deveopmentand training for appropriate support for LGBTI people

87
Q

interventions for LGBTI for substance abuse

A

harm reduction strategies

improve social issues - stigma/discrimination

provide safe place for LGBTI apart jrom contexts for AOD use

promote appropriate and accessible treatment options for mental health and AOD issues

continue community based health promotion camaigns

PYB159 End of Sem (5 decks)

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