The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement.

BACKGROUND: People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted. OBJECTIVE: The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions. METHODS: A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021. RESULTS: Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored. CONCLUSIONS: Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.

How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review.

BACKGROUND: Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia. METHOD: The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity. RESULTS: A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC. CONCLUSION: There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.

"Meth circles" and "pipe pirates": crystal methamphetamine smoking and identity management among a social network of young adults.

This article analyzes crystal methamphetamine smoking among a social network of young Australian adults. Ethnographic data were collected from 2005 to 2007 among 60 individuals, and semistructured in-depth interviews were conducted with a sub-set of 25 individuals. Fieldnotes and interview transcripts were entered into NVivo7 and thematically analyzed. We argue that although drug use may be considered "normal" among some social networks, the management of stigma associated with drug use is more complex and contested than portrayed in the literature. Policy implications are discussed. The study was supported by funds from Australia's National Health and Medical Research Council.

'Kiddie drugs' and controlled pleasure: recreational use of dexamphetamine in a social network of young Australians.

BACKGROUND: This article explores the recreational use of diverted dexamphetamine, a pharmaceutical stimulant, amongst a social network of young adults (aged 18-31 years) in Perth, Western Australia (WA). Prior epidemiological research indicates that there are high levels of dexamphetamine prescription, and use of diverted dexamphetamine, in this jurisdiction. Little research exists on the social contexts of diverted dexamphetamine use in Australia or overseas. METHODS: Ethnographic fieldwork was conducted over 18 months amongst a network of approximately 60 young adults who regularly used psychostimulants. Data collection involved participant observation conducted in natural settings including nightclubs and private parties. In-depth interviews were also conducted with 25 key contacts which explored drug use histories and themes emerging from fieldwork. RESULTS: The use of diverted dexamphetamine, or 'dexies', was prevalent amongst the social network and integrated into local drug practices. The paper explores the ways in which dexamphetamine use is rationalised, negotiated and represented in the context of the use of alcohol and other psychostimulants such as methamphetamine and ecstasy. Two key aspects are emphasised. First, dexamphetamine use is seen as insignificant by network members and is positioned as 'safer' in relation to the use of other drugs by virtue of its pharmaceutical status. Second, dexamphetamine plays an instrumental role in facilitating the pursuit of 'controlled pleasure' via the heavy consumption of alcohol and other drugs. CONCLUSION: The findings of the paper have implications for harm reduction policy. In particular, dexamphetamine use facilitates heavy drinking and polydrug use amongst young adults, which may increase the harms associated with such use. Further, current interventions targeting young psychostimulant users, which emphasise their adulterated and illegal nature, may inadvertently contribute to the cultural construction of dexamphetamine as a relatively 'safe' drug.