specific populations Flashcards
what can whole population strategies be very effective at?
reducing total harm and social impact
why study specific populations?
reduce risk of experiencing disproportionate harms seen in whole population studies/strategies
whole population strategies have a higher risk of experiencing disproportionate harms (direct and indirect)
what are some examples of specific populations effected?
> injecting drug users > women > aboriginal or Torres strait islander people > LGBTI+ > young people, older people > people with mental illnes
what does IDRS stand for
illicit drug reporting system
what is the IDRS?
Australia’s central monitoring an dearly warning system
identified key and emerging trends among injecting drug users
how does the IDRS obtain their information
- almost 1000 interviews with injecting drug users
- interviews with key experts
- incorporates analysis of other national data related to illicit drug use in Australia
according to 2017 IDRS
___ drug use was high, varying markedly across states.
poly drug use = high
according to 2017 IDRS
what was the average age of first time injection drug use
age = 20 yo
injecting drug users are getting older
according to 2017 IDRS
2/3 injection drug users in Australia injection some form of _____
Methamphetamine
according to 2017 IDRS
What was the most commonly used prescription opioid in 2017
morphine
majority obtained illicitly
recent oxycodone use = high
according to 2017 IDRS
what was the most commonly used drugs
methamphetamine, cannabis and heroin
according to 2017 IDRS
what is the unemployment rate of the 2017 IDRS sample
80% unemployment
according to 2017 IDRS
56% reported high or very high ____
psychological distress
according to 2017 IDRS
what percentage of survey participants are receiving ORT
50%
ORT = opioid replacement
according to 2017 IDRS
1/5 have _____ in the past year
overdosed
according to strathdee et al 2006
social factors that predict risky injecting practices include:
depression
suicide attempts
non-consensual sex
unstable housing
low education
injecting drug use is a behaviour strongly associated with other highly marginalised characteristics such as:
- imprisonment
- blod borne virus infections
- homelessness
- mental illness
multiple harms related to injection drugs include:
- blood borne viruses
- overdose
- physical health (inc. vein care)
- mental health
- psychosocial (relationships, law, etc.)
what is HCV
Hepatitis C virus
- causes infectious disease hepatitis C
- primarily effects liver
what percentage of new hep C diagnoses is attributed to people to inject or have a history of injecting
90%
what percentage of existing hep C diagnoses is attributed to people to inject or have a history of injecting
80%
what does the
Australian NSP National Data Survey Report 2012-16
say about general prevalence of HCV
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
what does the
Australian NSP National Data Survey Report 2012-16
say about prevalence of HBV
prevalence higher for longterm injecting drug users
<0.5% prevalence with <5 year injecting drug history
14% of users with history of 10+ years
according to Australian NSP National Data Survey Report 2012-16
how does HCV prevalence differ among sexes
prevalence in females (48%) more frequent than males (23%)
particularly among those with < 3 year injecting history
what is HIV
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
how is HIV transmitted
in blood, semen, vaginal fluid
through unprotected sex, blood to blood (inc. sharing injecting equipment), mother to baby (via breast milk)
Australia 2016
prevalence of HIV diagnosis due to ….
male to male sex (70%)
heterosexual sex (21%)
both male to male sex and injection drug use (5%
injection drug use (1%)
According to Australian NSP National Data Survey Report 2012-16
how does the prevalence of HIV antibodies differ among gender/sexuality groups
higher among homosexual men compared to bisexual and heterosexual men
and higher compared to women
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
antibody prevalence higher in indigenous respondents (2.8%) compared to non-indigenous (1%)
describe the trend of HIV infection among Aboriginal and Torres strait islander respondents from 2012-2016
increase from 0.4% to 2.8%
what does IVDU stand for
intravenous drug use/er
what are the interventions utilised in Australia for IVDU
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
what does Psychoeducation as a intervention encompass
risk taking (injecting, sex, intoxication
safer injecting
vein care
overdose
community safety/disposal
American study comparing female substance abuse to males
women were more likely:
(than men)
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
American study comparing female substance abuse to males
women were less likely:
(than men)
less likely
- to have legal problems associated with substance misuse
- to report lifetime use of inhalants or hallucinogens
- to be cannabis-dependent
American study comparing female substance abuse to males
on trends in treatment, women reported
fewer admissions for treatment
fewer treatment days (when admitted)
lower overall treatment costs
> implications regarding a “male-orientated” treatment system <
reduced treatment options/patterns
overview of gender differences
biological differences - women
intoxication occurs with less alcohol intake
metabolise alcohol differently
develop cirrhosis of liver more rapidly
overview of gender differences
social differences - women
increased stamina associated with use/misuse
more often caring for children
cultural differences regarding social status
overview of gender differences
patterns of uses - women
develop problematic use more quickly
more use of prescription medications
more “private” use/misuse
overview of gender differences
Limited research implications - women
lack research regarding women
conclusions drawn with men may not adequately generalise to women
impacts prevention and treatment development
describe and give examples of stigma surrounding substance-using women
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
barriers to treatment for substance-using women
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
barriers to treatment for substance-using women that are related to male correspondence
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
what is known about pregnancy and alcohol consumption
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
what CALD populations have a higher rate of use or higher risk
migrants moving from culture of non alcohol use to high alcohol use
cultural specific substances brought to Australian context
what are some stressors that could increase drug use and risk of drug use in CALD populations
PTSD/Trauma
family stressors
unemployment
language barriers
lack of understanding of available services
Aboriginal and torres strait islander poeple make up ___% of the australian populaiton
2.8%
why do Aboriginal and torres strait islander poeple have more ill health than other australians
socioeconomic disadvantage
- greater risk of exposer/vulnerability to health risk factors (i.e. smoking and alcohol misuse)
____ play a major rile in disparities in health and life expectancy between indigenos and non-indigenous australians
drug related problems
indigenous australian the life expectancy is __-__ years shorter than non indigenous australians
due to ___
10-12yrs
due to
- chronic disease (diabetes, lung, heat, kidney disease)
- lifestyle factors (smoking, lacking excersice, obesity)
- higher rates of illness and hospitalisation
trends in alcohol consumption in indigenous people
data in comparison to non-indigenous
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
trends in illicit drug intake in indigenous people in comparison to non-indigenous
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)
historical perspective and impact of substance abuse in indigenous australians
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
what happened in 1837 in terms of alcohol laws in australis
legislation to ban alcohol among ATSI people
with exceptions of mixed decent and good hygiene
alcohol used for payment and for trade
how did the 1837 legislation shape drinking patterns of ATSI people
illegal to drink in hotels»_space; public drinking
quick drinking to avoid incarceration
resulted in increased public drunkenness and arrests
what events resulted in the indigenous community to see drinking as a sign of equality and status
1957-1975 reform of prohibition laws, including the rights to drink
Anthropological perspective of ATSI substance abuse
culturally determined responses to changes in history
peer influence is particularly important
- ‘group-sharing’
- belonging
- non-confronting culture
“hunter gatherer” explanation
Explain the hunter gatherer explanation in terms of anthropological perspective of ATSI
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
Physiological disease perspective of ATSI substance use
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
psycho social perspective of ATSI substance use
describes the learned behaviours that reinforce drinking
the impact of psychosocial stressors
social norms and cultural practices undermine resistance
according to pearson (2002) what are the 5 elements for outbreak of substance misuse?
availability
money
spare time
examples o fothers in immediate environment
permissive social ideology
what strategy is currently in place to address ATSI substance use
the 2014-2019 national aaboriginal and toress strait islander people’s drug strategy
what are the 4 priority areas for action identified in the 2014-2019 ATSI drug strategy?
- build capacity and capability of AOD service system, particularly ATSI-controlled services/workforce
- increase access culturally responsive and appropriate programs
- prevention/interventions aimed at local needs to address harmful AOD use - 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 - Establish meaningful performance measures wiht effective data systems that support community-led monitoring and evaluation
what are all the priorities of the 2014-19 ATSI drug strategy directed at?
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
best practice approaches to addressing the needs of ATSI people include:
- 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
treatment issues to consider for ATSI people
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
what is the general trends of the AOD use for people in contact wiht the criminal justice system
high underlying rates of AOD use
what does the AIHW (2015) say about the health of Australian prisoners in terms of AOD use
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
what does the Drug Use Monitoring in Autralia (2013-14) say about AOD trends in those associated with the crim. justice system
45% of adult detainees interviewed as part of the program reported that their AOD used contributed to their current detention by police
what are the most commonly used substances for non-medical perposes in the previous 12 mths. by prison entrants
methamphetamine (50%) cannabis (41%) analgesics/painkillers (13%) tranquillisers/ sleeping pills (11%) other analgesics (inc. opiates/opioids) (85)
gender differences in most commonl used drugs of prison entrants
women more likely to use analgesics/pain killers than men (27%, 11%)
women more likely to use tranquillisers/sleeping pills (26%, 9%)
hep C rates in prisoners
over 40% of male prisoners have hep C
over 70% of female prisoners have hep C
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?
31% prevelance of hep c
57% prevalence among people who inject
whats the trend of smoking in prison entrants?
75% are current smokers
70% are daily smokers
best approaches to adressing the needs of poeple in contact with the criminal justice system:
- 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
what are some harm reduction recommendations for poeple in contact with the criminal justice system:
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
AOD prevalence in LGBTI+ population of australia
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
Lea et al (2013) - trends in IVDU by gay/bisexual men in sydney
- 6% of men reported injecting drugs in the previous 6 months
- 3.4% reporte methamphetamine injetion
- 0.4% heroin
Lea et al (2013) concludes that
men who inject were:
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
difference in alcohol use and alcohol related problems between transgender and non transgender identified in young adults
(coulter et al 2015)
heavy episodic drinking is higher
higher risk of sexual assault after drinking
higher risk of suicidaity after drinking
what is the queensland chemsex study (2017)
the results from a ross sectional survey of gay and other homosexually active men in queensland substance use and sexual activity
accoridng to the queensland chemsex study
the most commonly reported drugs used were:
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%)
mental health trends of LGBTI+ populations
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%
how can AOD facilitate sexual encounters and unsafe sex?
variety of mechanisms
- state dependent learning
- tension reduction
- sensation seeking
- expectancies
- etc
what are some factors that motivate the use of AOD in LGBTI+ populaitons
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
possible practice approaches for LGBTI+ for substance use
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
interventions for LGBTI for substance abuse
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
