Ten-Year Trajectories of Alcohol Consumption in Older Adult New Zealanders.

OBJECTIVES: Older adults are often treated as a homogeneous drinking group, but research suggests that they engage with alcohol in various ways, ranging from abstention to heavy drinking. The study aimed to (i) identify subgroups of older adults based on changes in frequency and quantity of alcohol use over 10 years and (ii) examine co-occurring changes in mental and physical health. METHOD: Data were collected biennially between 2006 and 2016 from 2,632 New Zealanders (55-70 years old at baseline). Latent class growth analysis was performed to identify trajectories of alcohol use. Co-occurring changes in physical and mental health were examined using latent growth curve analysis. RESULTS: Five drinking profiles emerged: (i) infrequent, low-quantity consumers; (ii) highly frequent, low-quantity consumers; (iii) moderately frequent, high-quantity consumers; (iv) moderately frequent, low-quantity consumers; and (v) highly frequent, high-quantity consumers. Drinking trajectories demonstrated no change or slight declines in frequency and quantity over time. Frequent and moderately frequent, high-quantity drinking was more prevalent among men, younger participants, and active smokers. Moderately frequent, heavy drinkers were in very poor health. Frequent and moderately frequent, low-quantity drinking was associated with better health and economic well-being. Infrequent, low-quantity consumers were more likely to be women and in poor health. DISCUSSION: The five drinking profiles indicate that older adults engage with alcohol in diverse ways. Two of these patterns indicated potentially hazardous use, which highlights the need for screening and intervention in this age group.

Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET.

Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen's kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as "hazardous on the CARET only" consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

Ascending single dose pharmacokinetics of cytisine in healthy adult smokers.

1. Cytisine, a partial agonist for the α4ß2-nAChR, is used as a smoking cessation medication. Cytisine's current dosing is complex and involves taking 1.5 mg several times a day. The aim of this study was to explore the effect of dose on the pharmacokinetics and safety of cytisine after a single dose in healthy adult smokers. 2. Participants were assigned to one of three groups (n = 6 in each group) to receive a single oral dose of 1.5, 3 or 4.5 mg of cytisine. Blood samples were collected up to 24 h post dose. Pulse, blood pressure and respiratory rate were measured. Adverse effects were recorded. 3. Cytisine reached peak plasma concentration 1-2 h post dose in all participants irrespective of dose, with no dose-dependent changes in the elimination phase. Mean (SD) cytisine exposure (AUC0-24h) were 81.9 (15.8), 181.9 (40.8) and 254.5 (48.1) ng.h/mL following 1.5, 3 and 4.5 mg, respectively. 4. Cytisine appears to have predictable pharmacokinetics following a single dose of up to 4.5 mg and may be safe given as a single 4.5 mg dose, which is threefold greater than the recommended dose taken at one time. This study is registered in ClinicalTrials.gov (ID:NCT02585024).

Energy drink consumption among New Zealand adolescents: Associations with mental health, health risk behaviours and body size.

AIM: With the increase in popularity of energy drinks come multiple concerns about the associated health indicators of young people. The current study aims to describe the frequency of consumption of energy drinks in a nationally representative sample of adolescents and to explore the relationship between energy drink consumption and health risk behaviours, body size and mental health. METHODS: Data were collected as part of Youth'12, a nationally representative survey of high school students in New Zealand (2012). In total, 8500 students answered a comprehensive questionnaire about their health and well-being, including multiple measures of mental well-being, and were weighed and measured for height. RESULTS: More than one-third (35%) of young people consumed energy drinks in the past week, and 12% consumed energy drinks four or more times in the past week. Energy drink consumption was significantly associated with greater depressive symptoms, greater emotional difficulties and lower general subjective well-being. Frequent energy drink consumption was also associated with binge drinking, smoking, engagement in unsafe sex, violent behaviours, risky motor vehicle use and disordered eating behaviours. There was no association between consumption of energy drinks and student body size. CONCLUSIONS: Consumption of energy drinks is associated with a range of health risk behaviours for young people. Strategies to limit consumption of energy drinks by young people are warranted.

Plasma concentrations of cytisine, a commercially available plant-based alkaloid, in healthy adult smokers taking recommended doses for smoking cessation.

1. Cytisine is a plant alkaloid that is a partial agonist for the α4ß2 -nAChRs and is used as an aid to smoking cessation. To date, there are no published data on cytisine concentrations in humans following multiple dosing. The aim of this study was to determine cytisine plasma concentrations after taking recommended doses for smoking cessation and to report on adverse effects. 2. Subjects (n=10) were instructed to follow the 25-day standard dosing regimen of cytisine. Blood was collected at 0, 2, 4, 8 and 10 hours on day 1 then on subsequent visits (days 2, 3, 4, 6, 13, 14, 17, 18, 21, 22, 25 and 26) to measure plasma cytisine concentrations. Plasma concentrations were determined using a validated LC-MS method. 3. Accumulation of cytisine was observed with repeated dosing of cytisine on day 1. Mean ± SEM plasma cytisine concentration measured at 10 hours was 50.8 ± 4.7 ng/mL. Due to dose tapering, there was an overall decrease in plasma cytisine concentration over the whole treatment period. 4. Overall, cytisine was well-tolerated and adverse effects reported were minor, indicating that cytisine is safe at concentrations measured in this study. This study is registered in the Australia and New Zealand Clinical Trials Registry (ACTRN12613000002785).

The association between socioeconomic deprivation and secondary school students' health: findings from a latent class analysis of a national adolescent health survey.

BACKGROUND: The aims of this study were to examine indicators of socioeconomic deprivation among secondary school students and to determine associations between household poverty, neighbourhood deprivation and health indicators. METHODS: Data were from a nationally representative sample of 8500 secondary school students in New Zealand who participated in a health survey in 2012. Latent class analyses were used to group students by household poverty based on nine indicators of household socioeconomic deprivation: no car; no phone; no computer; their parent/s worry about not having enough money for food; more than two people sharing a bedroom; no holidays with their families; moving home more than twice that year; garages or living rooms used as bedrooms; and, no parent at home with employment. Multilevel generalized linear models were used to estimate the cross-level interaction between household poverty and neighbourhood deprivation with depressive symptoms, cigarette smoking and overweight/ obesity. RESULTS: Three groups of students were identified: 80 % of students had low levels of household poverty across all indicators; 15 % experienced moderate poverty; and 5 % experienced high levels of poverty. Depressive symptoms and cigarette smoking were 2-3 times higher in the poverty groups compared to student's not experiencing poverty. There were also higher rates of overweight/ obesity among students in the poverty groups compared to students not experiencing poverty, but once covariates were accounted for the relationship was less clear. Of note, students experiencing poverty and living in affluent neighbourhoods reported higher levels of depressive symptoms and higher rates of cigarette smoking than students experiencing poverty and living in low socioeconomic neighbourhoods. This cross-level interaction was not seen for overweight/ obesity. CONCLUSIONS: Measures of household socioeconomic deprivation among young people should not be combined with neighbourhood measures of socioeconomic deprivation due to non-linear relationships with health and behaviour indicators. Policies are needed that address household poverty alongside efforts to reduce socioeconomic inequalities in neighbourhoods.

Pharmacokinetics of cytisine, an α4 ß2 nicotinic receptor partial agonist, in healthy smokers following a single dose.

Cytisine, an α4 ß2 nicotinic receptor partial agonist, is a plant alkaloid that is commercially extracted for use as a smoking cessation medication. Despite its long history of use, there is very little understanding of the pharmacokinetics of cytisine. To date, no previous studies have reported cytisine concentrations in humans following its use as a smoking cessation agent. A high performance liquid chromatography-ultraviolet (HPLC-UV) method was developed and validated for analysis of Tabex® and nicotine-free oral strips, two commercial products containing cytisine. A sensitive liquid chromatography-mass spectrometry (LC-MS) method was developed and validated for the quantification of cytisine in human plasma and for the detection of cytisine in urine. Single-dose pharmacokinetics of cytisine was studied in healthy smokers. Subjects received a single 3 mg oral dose administration of cytisine. Cytisine was detected in all plasma samples collected after administration, including 15 min post-dose and at 24 h. Cytisine was renally excreted and detected as an unchanged drug. No metabolites were detected in plasma or urine collected in the study. No adverse reactions were reported.

Could community pharmacies help to improve youth health? Service availability and views of pharmacy personnel in New Zealand.

OBJECTIVES: To investigate the availability of youth-relevant community pharmacy services in New Zealand (NZ), and the opinions of pharmacy personnel on the appropriateness of these services for young people aged 12-24. METHODS: Pharmacist and pharmacy support staff (PSS) questionnaires were developed collaboratively with a Youth Advisory Group (YAG) and were mailed to 500 randomly selected community pharmacies in NZ. RESULTS: Response rates for questionnaires were 50.5 % for pharmacists and 37.0 % for PSS. The majority of community pharmacies in NZ offer public health services relevant to youth health including emergency contraception, condoms, smoking cessation, weight management and harm reduction services for drug use. Not all pharmacy personnel believed these services are appropriate for youth, particularly for those aged 16 or under. PSS appeared less likely than pharmacists to feel services were appropriate. CONCLUSIONS: Community pharmacies are offering an increasing range of youth-relevant health services, and may, therefore, be able to improve youth healthcare access. More research is required to investigate the barriers to young people accessing services from pharmacies, and also the challenges for pharmacy personnel in providing services to this age group.

Filling the gaps: opportunities for community pharmacies to help increase healthcare access for young people in New Zealand.

OBJECTIVES: To investigate whether there is potential for community pharmacies to help increase healthcare access and address unmet health needs of young people in New Zealand. METHODS: A descriptive secondary analysis of the Youth'07 health and wellbeing survey data was undertaken alongside discussion meetings with a youth advisory group. KEY FINDINGS: Seventeen per cent (n = 1485) of all students had been unable to access care when required in the previous 12 months. Of these students, 86.0% cited barriers to accessing health care that are unlikely to be barriers in a community pharmacy setting (e.g. not being able to get an appointment). Thirty per cent (n = 2475) of students had experienced difficulty accessing health care in the past 12 months for various health issues, with over half of these (n = 1326) citing a health issue for which community pharmacies could provide services (e.g. minor health issues, smoking cessation). CONCLUSIONS: Although young people are generally considered to be fit and healthy, many have health needs that are currently unmet by traditional health services. Community pharmacies offer services that are relevant to youth health and are readily accessible to young people, indicating potential to help address unmet health needs and improve healthcare access. Further research is needed to explore how community pharmacy models of care might be provided in an appropriate and acceptable manner for youth.

Factors associated with consistent contraception and condom use among Maori secondary school students in New Zealand.

AIMS: The aims of this study are to provide a profile of sexual health behaviours of Maori youth and to identify factors associated with consistent condom and contraception use. METHODS: Multivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Maori participants in the 2007 New Zealand youth health and well-being survey of secondary school students. RESULTS: Forty per cent of Maori students were currently sexually active; of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio (OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females (OR 0.52, P = 0.02). Risk factors for not using condoms were 13- to 15-year-old females (OR 1.95, P < 0.01) and females who enjoyed sex (OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males (OR 1.07, P < 0.01). CONCLUSIONS: Reducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Maori youth.

Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012.

AIM: To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates. METHODS: Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data. RESULTS: Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve. CONCLUSIONS: There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

Predictors of cigarette use amongst Pacific youth in New Zealand.

BACKGROUND: Despite progressive population health policies to reduce tobacco harm, smoking prevalence continues to be inequitable amongst key ethnic groups in New Zealand. The purpose of this study is to describe the predictors of cigarette use amongst Pacific youth in New Zealand. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand adolescents. The study sample comprised 5471 students and this includes 1,178 were Pacific youth. RESULTS: The smoking prevalence rate for Pacific youth was twice that of New Zealand European youth. Pacific girls and older age groups, ages 16-17, smoked more than Pacific boys and younger adolescents. Pacific youth from higher and mid-deprivation neighbourhoods smoked at twice the rate of youth from low deprivation areas. Local neighbourhood stores (dairies) were the most used location for purchasing cigarettes, and only 12.7% of under-aged adolescents were asked "most of the time" for age identification. Pacific adolescent smoking was associated with parental smoking, peer-group smoking and binge drinking. Parents not knowing the whereabouts of adolescents during after-school hours and night-times were also associated with adolescent smoking. A majority of Pacific adolescent smokers (70.2%) had tried to quit smoking. CONCLUSION: The strategies for addressing ethically the issue of equal health for all is to allocate increased public health investments towards targeted quit-smoking treatment programmes for Pacific youth in New Zealand. Further qualitative studies with Pacific youth to inform the development of culturally-appropriate youth-focused quit-substance interventions is recommended.

Forgone health care among secondary school students in New Zealand.

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services.

Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions.

INTRODUCTION AND AIMS: To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). DESIGN AND METHODS: Cross-sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self-completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)-C using a cut-off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. RESULTS: 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut-off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT-C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT-C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT-C screen. DISCUSSION AND CONCLUSIONS: This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting.

Importation of prescription medicines into New Zealand: a snapshot of intercepted products.

OBJECTIVE: The aim of this research was to describe the types of prescription medicines being imported into New Zealand. SETTING: Imported medicines intercepted at the international mail centre in Auckland and referred to the New Zealand Medicines and Medical Devices Safety Authority (Medsafe) between July and December 2007 were studied. METHOD: During the study 3,918 prescription medicine imports were intercepted and entered into a database by Medsafe. These were categorised according to the country the medicines were posted from and medicine related details such as brand, active ingredient(s), route of administration, strength and quantity imported. Researchers systematically categorised medicines by therapeutic indications, dosage form, whether these medicines were available in New Zealand and if they were subsidised by the New Zealand government. MAIN OUTCOME MEASURE: Types of medicines imported into New Zealand and whether or not they were legally available and subsidised by the government. RESULTS: Medicines were most commonly imported from India and China. Seventy eight percent of the total medicines imported were already available in New Zealand, and of these almost half were subsidised by the government. Antibiotics contributed to a significant proportion of the total subsidised medicines imported, the most common being amoxicillin. Four of the five most commonly imported medicines could be considered 'lifestyle' medicines (sildenafil, tadalafil, finasteride and sibutramine). 'High risk' medicines were identified--for example medicines used in the treatment of tuberculosis, malignant diseases and mental health disorders. CONCLUSION: This study is the first of its kind in New Zealand to explore the types of prescription medicines imported into the country. The majority of imported medicines were classified as 'lifestyle' medicines. The study findings also identified possible negative public health implications associated with some of the imported prescription medicines, for example resistance associated with the importation of antibiotics.

Determining the subjective effects of TFMPP in human males.

RATIONALE: Trifluoromethylphenyl piperazine (TFMPP) is an active constituent of a relatively new group of recreational drugs known as 'party pills'. TFMPP has been anecdotally reported to induce mild psychedelic effects similar to lysergic acid diethylamide and psilocybin. There has been no research about the subjective effects of TFMPP in humans. OBJECTIVES: This study aimed to investigate the subjective effects of TFMPP in human males. METHODS: A randomised, double-blind, placebo-controlled trial design was used to investigate the subjective effects of TFMPP in 30 healthy, non-smoking male volunteers (mean age 24 +/- 4 years). Participants were randomised into two groups and given either TFMPP 60 mg (n = 15) or placebo (n = 15). Each participant completed three rating scales, the Addiction Research Centre Inventory (ARCI), the Profile of Mood States (POMS) and the Visual Analogue Scales (VAS), both before and 120 min after drug administration. RESULTS: Results from the ARCI indicated that TFMPP produced increases in 'dysphoria' and 'dexamphetamine-like effects'. TFMPP also increased ratings of 'tension/anxiety' and 'confusion/bewilderment' as rated on the POMS. Results from the VAS indicated increases in 'drug liking', 'high' and 'stimulated' ratings relevant to placebo. CONCLUSIONS: Increased ratings of 'dexamphetamine-like effects', 'tension/anxiety', 'stimulated' and 'high' following TFMPP administration resemble the subjective effects of common amphetamine-type stimulants. However, increases in 'dysphoria' and 'confusion/bewilderment' ratings following TFMPP are more commonly associated with drugs that have greater effects on serotonin release, binding and reuptake such as 1-[3-chlorophenyl]-piperazine, fenfluramine and lysergic acid diethylamide.

National survey of HIV and hepatitis testing and vaccination services provided by drug and alcohol agencies in Australia.

OBJECTIVES: To identify the prevalence of blood-borne viruses (BBVs) testing, counselling and vaccination services by drug and alcohol services for injecting drug users in Australia. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of drug and alcohol agencies throughout Australia. OUTCOME MEASURES: Current availability of testing, counselling and vaccination services for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV; availability of medical coverage; and barriers to greater provision of services. RESULTS: Survey responses were provided by 222 agencies nationally (61% response rate). About three-quarters of agencies provided some access to HIV, HBV, and HCV testing and HBV vaccinations, but only a third offered these services routinely on site. HBV vaccination availability differed depending on the primary function of the agency, with drug dependence units and needle and syringe programs more likely to provide vaccination on site. The major barriers preventing agencies from providing routine on-site BBV services are lack of access to medical staff and trained personnel; the cost of providing these services; and a lack of facilities. CONCLUSIONS: The restricted provision of BBV services represents missed opportunities to reduce individual and community morbidity and to maximise the potential savings from preventable disease in relation to HBV infection. To address key barriers and patient retention issues, it is necessary to expand the role of non-medical staff, increase the use of shorter HBV vaccination schedules, and identify and maintain local clinical partnerships between public and private service providers.