'Joining the Dots: Linking Prenatal Drug Exposure to Childhood and Adolescence' - research protocol of a population cohort study.

INTRODUCTION: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The Joining the Dots cohort study uses linked population data to understand the relationship between services, therapeutic interventions and outcomes of children with PDE. METHODS AND ANALYSIS: Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal social demographics or social determinants of health, and maternal physical and mental health comorbidities. Key outcome measures will include child mortality, academic standardised testing results, rehospitalisation and maternal survival. Data analysis will be conducted using Stata V.18.0. ETHICS AND DISSEMINATION: Approvals were obtained from the NSW Population and Health Services Research Ethics Committee (29 June 2020; 2019/ETH12716) and the Australian Capital Territory Health Human Research Ethics Committee (11 October 2021; 2021-1231, 2021-1232, 2021-1233); and the Aboriginal Health and Medical Research Council (5 July 2022; 1824/21), and all Australian educational sectors: Board of Studies (government schools), Australian Independent Schools and Catholic Education Commission (D2014/120797). Data were released to researchers in September 2022. Results will be presented in peer-reviewed academic journals and at international conferences. Collaborative efforts from similar datasets in other countries are welcome.

Association of adolescent and young adult depression and anxiety with perinatal mental health in fathers: Findings from an Australian longitudinal study.

The current study examined associations between preconception diagnoses of major depressive disorder (MDD) and anxiety disorders in adolescence and young adulthood and perinatal depression and anxiety symptoms in early fatherhood. In an Australian community cohort study of health and development, earlier history of MDD and anxiety disorders (extending back to adolescence) were assessed retrospectively in the third trimester of pregnancy via the Composite International Diagnostic Interview. Paternal perinatal depression and anxiety were then assessed prospectively over three timepoints (third trimester of pregnancy, 8 weeks and 12 months postpartum), using established cut-points on the Edinburgh Postnatal Depression Scale and the Depression Anxiety Stress Scales (anxiety subscale). Mixed-effects regression models examined risk associations between preconception diagnoses of MDD and anxiety disorders, and perinatal depression and anxiety symptoms at each timepoint, adjusting for socio-demographic factors and concurrent maternal mental health difficulties. The odds of clinically concerning levels of paternal perinatal depression and anxiety were 6-fold and 4-fold higher, respectively, in men with a preconception history of MDD. The odds of perinatal depression were 3-fold higher in men with a preconception history of an anxiety disorder. Less evidence was found for an association between preconception diagnoses of an anxiety disorder and perinatal anxiety in fathers. Interventions aimed at improving mental health in men during adolescence and young adulthood may promote continued psychological health in men during early fatherhood.

The Role of Antenatal and Postnatal Maternal Bonding in Infant Development.

OBJECTIVE: The affectional bond experienced by a mother toward her developing fetus/infant has been theorized to be a critical factor in determining infant developmental outcomes; yet there remains a paucity of research in this area, and a lack of high-quality longitudinal studies. This study aimed to examine the extent to which mother-to-infant bonding predicted infant development in a multi-wave longitudinal pregnancy cohort study (N = 1,347). METHOD: Self-reported bonding was assessed using the Maternal Antenatal Attachment Scale at each trimester, and the Maternal Postnatal Attachment Scale at 8 weeks and 12 months postpartum. Infant development was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 12 months. RESULTS: Bonding predicted indicators of infant social-affective development, including social-emotional, behavioral, and temperamental outcomes. Effect sizes ranged from small to moderate, increasing over the perinatal period (ß = 0.11-0.27). Very small effects were also identified in the relationship between bonding and cognitive, language, and motor development (ß = 0.06-0.08). CONCLUSION: Findings suggest that a mother's perceived emotional connection with her child plays a role in predicting social-affective outcomes; prediction may not extend to other domains of infant development. Maternal bonding may therefore be a potentially modifiable predictor of infant social-affective outcomes, offering important considerations for preventive intervention.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.

OF RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).

Safety first: Beliefs of older peers supplying alcohol to underage friends.

ISSUE ADDRESSED: Underage drinkers most commonly source alcohol from older peers. However, few studies have examined older peers' supply-related beliefs and motivations. METHODS: A sample of 270 risky drinkers aged 18-19 years were interviewed in Australia where the legal purchase age is 18. They were asked about their provision to underage friends, awareness of secondary supply legislation (intended to prohibit such supply) and 24 psycho-legal beliefs around supply. RESULTS: Half (49%) provided alcohol to a 16- to 17-year-old friend to drink at a party they were both attending at least twice a year. Three-quarters reported provision was okay so long as the recipient(s) were in a safe environment, and 46% reported "everyone gives alcohol to teenagers if they are in a safe environment." There was significantly higher agreement that "my friends would think I was mean if I did not give alcohol to a friend under the age of 18" (37%), compared to "my friends would think I was uncool if I did not give alcohol to a friend under the age of 18" (26%). Two thirds (69%) felt more responsible for an underage friend's safety if they provided the alcohol. A multivariate logistic regression revealed supply was more likely if the supplier: was aged 18 compared to 19 (95% CI OR: 1.57, 4.84), male (1.06, 3.27), of a higher SES quintile (1.08, 1.80) and believed alcohol supply to minors was morally acceptable (1.01, 1.33) and normal (1.04, 1.38). Knowledge of regulatory strategies (68%) designed to prevent supply to minors, and their perceived deterrent value did not significantly impact supply. CONCLUSIONS: Supply of alcohol to underage peers was perceived as morally and socially acceptable in a group of 18- to 19-year-old risky drinkers. SO WHAT?: Opportunities include harm reduction initiatives that prioritise caring responsibilities towards friends, as opposed to relying on external enforcement measures alone.

Maternal bonding, negative affect, and infant social-emotional development: A prospective cohort study.

BACKGROUND: Theoretical perspectives and empirical evidence suggest that maternal bonding and negative affect play a role in supporting infant social-emotional development (Branjerdporn et al., 2017; Kingston et al., 2012; O'Donnell et al., 2014; Van den Bergh et al., 2017). However, the complex pathways likely to exist between these constructs remain unclear, with limited research examining the temporal and potentially bi-directional associations between maternal bonding and negative affect across pregnancy and infancy. METHODS: The interrelationships between maternal bonding, negative affect, and infant social-emotional development were examined using multi-wave perinatal data from an Australian cohort study (N = 1,579). Self-reported bonding and negative affect were assessed at each trimester, and 8 weeks and 12 months postpartum. The Bayley-III social-emotional scale was administered at age 12 months. RESULTS: Results revealed strong continuities in bonding and negative affect across pregnancy and postpartum. Small associations (ß = -.10 to -.20) existed between maternal negative affect during pregnancy and poor early bonding. Higher postnatal maternal bonding predicted infant social-emotional development (ß = .17). LIMITATIONS: Limitations include a somewhat advantaged and predominantly Anglo-Saxon sample of families, and the use of self-report measures (though with strong psychometric properties). These limitations should be considered when interpreting the study findings. CONCLUSIONS: Maternal bonding and negative affect are interrelated yet unique constructs, with suggested developmental interplay between mother-to-infant bonding and infant social-affective development.

Characteristics and causes of death in children with neonatal abstinence syndrome.

AIM: To determine characteristics of death in children with neonatal abstinence syndrome (NAS). METHODS: A population-based linkage study of children from birth to 13 years of age in New South Wales (NSW), Australia, born 1 July 2000 to 31 December 2011. Infants with an International Statistical Classification of Diseases and Related Problems, Australian modification coding of NAS (P96.1, n = 3842) were compared to infants (n = 1 018 421) without NAS by birth, hospitalisation and death records linkage. RESULTS: Forty-five (1.2%) children with NAS died, compared to 3665 (0.4%) other children. Most deaths (n = 30, 66%) in NAS children occurred between 1 month and 1 year. Risk of death was independently increased in full-term children (hazard ratio 2.34, 95% confidence interval 1.63-3.35; P < 0.001) from lower socio-economic groups (1.23, 1.12-1.35; P < 0.001), most commonly from ill-defined or external causes, including assault and accidents (P < 0.001). CONCLUSIONS: Children with NAS, especially those of term gestation and from lower socio-economic groups, are more likely to die, especially from external causes.

Social domains of discrimination against people who inject drugs: Links with health and wellbeing.

AIMS: People who inject drugs frequently experience discrimination. However, little is known about how discrimination experienced in different social domains is linked to health and wellbeing. DESIGN: We used data collected in 2016 from the Illicit Drug Reporting System (IDRS), an Australian survey of people who inject drugs. We used a modified version of the Discrimination Scale (DISC-12) to assess discriminatory behaviours in diverse social domains, including public institutions, neighbours, family and friends. We used the Kessler-10 scale, the Personal Wellbeing Index and specific items from the IDRS questionnaire to assess participants' health and wellbeing. FINDINGS: Sixty three percent of participants who responded to the discrimination module included in the IDRS 2016 (N = 796) reported ever having experienced discrimination due to their injecting drug use and 53% reported having experienced discrimination in the past month. Discrimination in all social domains analysed was linked with poor health and wellbeing, except for housing. Self-reported mental health problems and poorer general health were most frequently associated with discrimination. Participants who experienced discrimination from friends were three times more likely to report mental health problems (AOR=3.0, CI95=1.5-6.0). CONCLUSIONS: There are significant associations between the domains in which discrimination takes place and the health and wellbeing of people who inject drugs. Our findings highlighted the importance of assessing the social domains of discrimination in relation to mental health. Further research needs to assess not just whether a group or individual is discriminated against, but rather how they are likely to perceive this discrimination and how this experience can affect their life as a whole.

Use of alcohol swabs to clean injecting sites among people who regularly inject drugs in Australia.

INTRODUCTION AND AIMS: Cleaning drug injection sites with alcohol swabs prior to injecting reduces risk of abscesses and other skin and soft tissue infections (SSTI). Better understanding of swabbing behaviours can inform interventions to improve injecting hygiene. We aimed to determine the socio-demographic, drug use and injecting risk exposure correlates of swabbing prior to injecting and reasons for not swabbing. DESIGN AND METHODS: The Illicit Drug Reporting System recruited participants who had injected drugs at least monthly in the past six months in June-July 2017 from all Australian capital cities via needle and syringe programs and word-of-mouth. A structured interview was used to collect information on drug use and related behaviour, as well as swabbing practices. Logistic regression was used to identify factors associated with not swabbing at last injection. RESULTS: Of 853 respondents, one-quarter (26%) reported that they did not swab prior to their last injection. In adjusted analyses, crystal methamphetamine as the last drug injected, past month receptive or distributive syringe sharing, and past month re-use of one's own needle were significantly associated with not swabbing at last injection. Among participants who did not swab at last injection, swabbing was frequently considered unnecessary and a small number disliked using alcohol swabs. DISCUSSION AND CONCLUSIONS: Efforts are needed to increase awareness of the importance of injecting hygiene in preventing SSTI. Interventions to increase swabbing should be included as part of a wider package of injecting hygiene education, particularly in light of associations with receptive and/or distributive syringe sharing.

From eye rolls to punches: experiences of harm from others' drinking among risky-drinking adolescents across Australia.

OBJECTIVES: Exploration of experience of harms due to another person's drinking within a demographic particularly vulnerable to these consequences. Importance of study: Largest sampling of young Australian risky drinkers, who are underrepresented in general population surveys. The range of harms due to others' drinking reported here is more comprehensive than documented elsewhere. STUDY TYPE: Cross-sectional self-report survey. METHODS: Participants were 14-19 years old and screened as being within the riskiest-drinking 25% for their age cohort. The convenience sample of 3465 was recruited primarily by social media advertising. Face-to-face interviews were conducted in all eight Australian capital cities (n = 596), supplemented by online surveys (n = 2869). Past 12-month experience of 13 harms due to others' drinking was assessed by age, gender and perpetrator. RESULTS: Females were more likely to experience seven harms, mainly characterised by fear and harassment, including being harassed or bothered at a party or some other private setting (41% vs 34% of males, p < 0.001), being given unwanted sexual attention (71% vs 47%, p < 0.001) and being put in fear (33% vs 20%, p < 0.001). Males were more likely to experience three harms, characterised by aggression: being yelled at, criticised or verbally abused (38% vs 33% of females, p = 0.002), being pushed or shoved (42% vs 28%, p < 0.001) and being physically hurt (17% vs 11%, p < 0.001). Teenagers of a legal alcohol-purchase age were more likely to experience harassment in public settings (49% vs 32-34%, p < 0.001) and unwanted sexual attention (66% vs 51-59%, p < 0.001) compared with younger teenagers. Seven of the harms studied were more likely (p < 0.01) to be perpetrated by people the respondents knew, and five (those associated with fear and aggression) were more likely to be perpetrated by strangers. CONCLUSION: Young people who are risky drinkers commonly experience multiple harms from others' drinking. Many of these alcohol harms to others are reported here for the first time, as previous studies of adolescent drinking have focused almost exclusively on the harms young people have experienced from their own drinking. This refocusing on the harms caused by the drinking of others may prompt greater community concern and concomitant calls for better alcohol regulation.

Prevalence of self-reported movement dysfunction among young adults with a history of ecstasy and methamphetamine use.

BACKGROUND: Illicit stimulant use is associated with long-lasting changes in movement and movement-related brain regions. The aim of our study was to investigate the prevalence of movement dysfunction in this population. We hypothesized that prevalence of self-reported movement dysfunction is higher among stimulant users than non-stimulant users. METHODS: Three groups of adults completed a survey containing questions about demographics, health, drug use, and movement. The groups consisted of ecstasy users with no history of methamphetamine use (ecstasy group, n = 190, 20 ±â€¯3 yrs.), methamphetamine users (methamphetamine group, n = 331, 23 ±â€¯5 yrs.), and non-stimulant users (control group, n = 228, 25 ±â€¯8 yrs.). Movement data was analyzed with logistic regression. RESULTS: In the unadjusted logistic regression model, group had a significant effect on fine hand control, tremor, and voice/speech questions, but not on other movement domain questions. The prevalence of tremor and abnormal fine hand control was significantly higher in the ecstasy and methamphetamine groups than in the control group (p < 0.018), and changes in voice/speech was more prevalent in the ecstasy group than in the control group (p = 0.015). Age and use of cannabis and hallucinogens were confounding variables. However, inspection of chi-square tables suggests that the effect of these parameters on the movement data is likely to be minor. CONCLUSIONS: The prevalence of self-reported tremor and changes in fine hand control and voice/speech is significantly higher in stimulant users than in non-stimulant users. Inclusion of these common and noticeable changes in body function may aid public health campaigns that target prevention or harm minimization.

Mother-Infant Bonding and Emotional Availability at 12-Months of Age: The Role of Early Postnatal Bonding, Maternal Substance Use and Mental Health.

INTRODUCTION: The quality of the mother-child relationship in the first year of life has far reaching implications across the life course (Bornstein in Annu Rev Psychol 65:121-158, 2014). Yet little is known about predictors of maternal bonding and emotional availability in early infancy. In this study we examined the extent to which postnatal bonding, maternal mental health, and substance use at 8-weeks postpartum predicted mother-infant bonding (self-report) and mother emotional availability (observational) at 12-months of age. METHODS: Data were obtained from an Australian longitudinal cohort study of pregnancy (n = 308). Data were collected during pregnancy, at birth, and postnatally at 8-weeks and 12-months. RESULTS: The results show strong continuity between postnatal bonding at 8-weeks and 12-months. Early postpartum stress and depression were associated with bonding at 12-months; however, the effect did not persist after adjustment for bonding at 8-weeks. Tobacco use at 8-weeks, but no other indicators of mental health, predicted lower emotional availability scores at 12-months. DISCUSSION: Results suggest that the mother's felt bond to her child is stable across the first year of life and that early bonding is a more robust indicator of bonding at 12-months than a mother's mental health or substance use. These findings point to the importance of clinical and public health investments in establishing a strong bond between mother and child in the early postpartum period.

Correction to: Prenatal alcohol exposure and infant gross motor development: a prospective cohort study.

Following publication of the original article [1], the authors opted to revise the first paragraph of the section "Characteristics associated with maternal drinking in pregnancy". Below is the updated version.

Prenatal alcohol exposure and infant gross motor development: a prospective cohort study.

BACKGROUND: Maternal alcohol consumption in pregnancy may have adverse effects on child gross motor (GM) development. There have been few human studies on this topic, particularly ones examining low exposure. This study examined the association between prenatal alcohol exposure (PAE) and infant GM development at 12-months of age. METHODS: Participants were 1324 women recruited from antenatal clinics in Sydney and Perth, Australia. Maternal and paternal alcohol use was assessed in pregnancy via interview; offspring GM development was measured at 12-months with the Bayley Scales of Infant Development (BSID-III). RESULTS: Any alcohol use in pregnancy was common: 56.1%, of pregnant women drank early in Trimester one (0-6 weeks), however this reduced to 27.9% on average thereafter and at predominantly low levels. However, infant BSID GM scale scores were not found to differ significantly as a function of PAE in the first 6-weeks (low, moderate, binge or heavy PAE), nor with low PAE across pregnancy. CONCLUSIONS: We found no evidence to suggest that low PAE is associated with measurable impairment in infant GM development at 12-months. Further research is needed to examine potential PAE impacts on GM development in heavier exposure groups and through the childhood years when subtle GM deficits may be more detectable.

The association between experiencing discrimination and physical and mental health among people who inject drugs.

BACKGROUND: Discrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear. METHODS: Data focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates. FINDINGS: PWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI95 = 1.5-3.6) and mental health problems (ARRR = 1.4, CI95 = 1.2-1.7). The mental functioning (ARRR = 1.3, CI95 = 1.1-1.4) and physical functioning (ARRR = 1.1, CI95 = 1.1-1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores. CONCLUSION: Self-reported experience of discrimination was associated with poor mental and physical health amongst PWID.

Uptake of direct acting antiviral therapies for the treatment of hepatitis C virus among people who inject drugs in a universal health-care system.

INTRODUCTION AND AIMS: Direct acting antiviral (DAA) treatment can reduce hepatitis C virus (HCV) infection incidence and mortality, although large scale uptake of these treatments is necessary to achieve those reductions. Targeting people who inject drugs (PWID) will be crucial to achieve the necessary reductions. Previously, treatment uptake has been very low (1-2%) among PWID, but these new DAAs have been subsidised in Australia since March 2016. This study describes treatment uptake among a sample of PWID in Australia and examines sociodemographic and drug use variables associated with treatment uptake. DESIGN AND METHODS: An Australian national cross-sectional sample (n = 817) of regular PWID drawn from a convenience sentinel sample aged ≥18 years. Information on demographics, drug use, HCV antibody testing, RNA testing, recent DAA treatment initiation and DAA prescriber settings was collected via an interviewer-administered survey. RESULTS: There were 291 HCV RNA positive participants, of who one-third reported initiating DAA treatment since the introduction of subsidised DAA medications. Current opioid substitution treatment was significantly associated with increased treatment uptake (adjusted odds ratio 2.20, 95% confidence interval 1.31, 3.68) while those with unstable housing were less likely to initiate treatment (adjusted odds ratio 0.42, 95% confidence interval 0.22, 0.82). DISCUSSION AND CONCLUSIONS: This study found that DAA treatment uptake has increased among current PWID, a priority population for treatment. Efforts to maintain this uptake through linking current PWID with treatment providers through harm reduction services such as opioid substitution therapy, needle and syringe programs, and outreach services are required to meet incidence and mortality reduction targets.

Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers.

STUDY OBJECTIVES: We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia. METHODS: Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales. RESULTS: More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 (P < .001) and 1.7 (P = .02) times more likely to report clinical insomnia, respectively. CONCLUSIONS: Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues.

Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing.

BACKGROUND: Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing. METHODS: Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors. RESULTS: Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes. CONCLUSIONS: Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.

Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities.

INTRODUCTION AND AIMS: Take-home naloxone (THN) programs targeting people who inject drugs (PWID) have been running in some Australian states and territories since 2012. In this study, we aimed to determine the extent to which PWID in the capital cities of all Australian states and territories are aware of naloxone and THN programs, whether awareness of these programs has changed over time. DESIGN AND METHODS: Data were obtained from cross-sectional surveys of a total of 2088 PWID conducted annually as part of the Illicit Drug Reporting System from 2013 to 2015. Specific questions about THN added to the survey in 2013 allowed assessment of the extent to which sampled PWID were aware of naloxone and its function and THN programs in Australia and whether they had participated in a THN program. These main outcomes were examined over time and across states and territories using a mix of descriptive statistics and logistic regression. RESULTS: Over 80% of the sample reported having heard of naloxone across survey years. Less than half of the participants reported having heard of THN programs in 2013 (35%), but this increased to just over (52%) half in 2015 (P < 0.01). Changes over time differed across cities with increases in reports of having heard of THN occurring over time most clearly in those cities with operational THN programs. DISCUSSION AND CONCLUSIONS: Around half of the PWID sampled for this study are aware of THN programs. Further work is needed to ensure widespread awareness of THN programs which should include implementing THN in all Australian states and territories.

Typology of new psychoactive substance use among the general Australian population.

AIM: The aim of this study was to examine the typology of Australian illicit drug consumers to determine whether those who use new psychoactive substances (NPS) differ from those using other illicit substances. METHODS: Data were from the 2013 National Drug Strategy Household Survey, a representative population study; analyses were limited to participants reporting past year illicit drug use (including NPS; n = 3309). Latent class analysis identified groups based on past year substance use, and a weighted multivariable, multinomial regression model was used to examine characteristics associated with group membership. RESULTS: Six consumer typologies were identified: cannabis consumers (46%), pharmaceutical consumers (21%), ecstasy and cocaine consumers (19%), amphetamine and cannabis consumers (7%), polysubstance consumers (6%), and inhalant consumers (2%). Sixteen participants (total sample: 0.07%; NPS consumers: 5.7%) reported exclusive NPS use. Synthetic cannabinoid receptor agonist use was highest among amphetamine and cannabis consumers and polysubstance consumers; other NPS use was highest among polysubstance consumers. Polysubstance consumers were younger than all other groups, and more likely to engage in dangerous activities while under the influence of substances, inject drugs and report hazardous alcohol consumption. Amphetamine and cannabis consumers were more likely to report trouble ceasing their drug use. CONCLUSION: We found no distinct profile of NPS-only consumers; however, NPS use was a marker for more problematic patterns of use. Our findings suggest that specialised NPS interventions or harm reduction messages may not be required in the Australian context; rather, they could be based upon existing responses to drug use.