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Climate change is the single biggest health threat facing humanity. The production, distribution and consumption of many fast-moving consumer goods contribute substantially to climate change, principally through releasing greenhouse gas emissions. Here we consider just some of the ways that alcohol-already a key contributor to an array of health, social and economic burdens-exacerbates environmental harms and climate change. We explore current evidence on alcohol production as a resource- and energy-intensive process, contributing to significant environmental degradation through water usage and other carbon emission costs. We argue that the impacts of alcohol production on climate change have been minimally explored by researchers. Yet the extent of the unfolding catastrophe beholds us to consider all available ways to mitigate unnecessary emissions, including from products such as alcohol. We then turn to suggestions for a research agenda on this topic, including investigations of commercial determinants, inequalities and product advice to help consumers choose lower-carbon options. We conclude by arguing that public health researchers already have an array of methodological expertise and experience that is well placed to produce the evidence needed to inform regulation and efforts by alcohol producers and consumers to minimize their contributions to environmental harms.
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Cambio Climático , Salud Pública , Humanos , CarbonoRESUMEN
INTRODUCTION: The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. OBJECTIVE: This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. DESIGN: This research utilised a case study approach. Data were collected through in-depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID-19 restrictions during 2020-2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID-19. FINDINGS: The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment-making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. DISCUSSION: The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. CONCLUSION: Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis.
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Acceso a Atención Primaria , Pueblos de Australasia , COVID-19 , Servicios de Salud del Indígena , Adulto , Humanos , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres , Atención Primaria de Salud/métodosRESUMEN
In this article, we investigate young people's involvement with residential alcohol and other drug (AOD) services as part of their broader engagement with hope. This study draws on qualitative interviews conducted with 20 young people aged 17-23 from Victoria, Australia, who were either in, or had recently left, residential AOD services. Interviews explored their experiences with AOD services and included questions about their hopes for the future. We found hope located in social relationships, productive discourses and AOD settings themselves. Hope also presented differently according to the external resources young people had available to them, giving some young people greater capacity to action their hoped-for futures than others. Given many young people seek reimagined futures as part of their use of residential AOD services, this creates a valuable opportunity for services to help shape achievable hopes and boost service engagement. We suggest that hope can materialise in a variety of ways but caution against relying on it as a motivational strategy without providing young people with other resources. A more sustainable narrative of hope may require a solid foundation of resources, allowing young people with AOD problems to gain a sense of control over their lives and their imagined futures.
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Trastornos Relacionados con Sustancias , Humanos , Adolescente , VictoriaRESUMEN
INTRODUCTION: Understanding how patterns of drinking are associated with risky gambling in Australia is needed to inform an effective approach to minimise harm. METHODS: This cross-sectional questionnaire study reports on 2,704 subsampled participants who completed survey questions about their patterns of drinking. With logistic regressions, we examined whether frequency of heavy episodic drinking (HED) and alcohol use while gambling were associated with risky gambling while controlling for sociodemographic variables. RESULTS: Occasional HED and monthly HED were associated with any gambling (versus no gambling), but frequent HED was not significantly associated with gambling. The opposite pattern was found when predicting risky gambling. Occasional HED (i.e. less than monthly) was not significantly associated, but a higher frequency of HED (at least weekly) was associated with a higher likelihood of risky gambling. Drinking alcohol while gambling was associated with risky gambling, over and above HED. The combination of HED and use of alcohol while gambling appeared to significantly increase the likelihood of risky gambling. CONCLUSIONS: The association of HED and alcohol use while gambling with risky gambling highlights the importance of preventing heavy alcohol use among gamblers. The links between these forms of drinking and risky gambling further suggests that individuals who engage in both activities are specifically prone to gambling harm. Policies should therefore discourage alcohol use while gambling for example by prohibiting serving alcohol at reduced prices or to gamblers who show signs of being affected by alcohol and informing individuals of the risks associated with alcohol use while gambling.
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Juego de Azar , Humanos , Juego de Azar/psicología , Consumo de Bebidas Alcohólicas , Estudios Transversales , Encuestas y Cuestionarios , EtanolRESUMEN
Australian national, state and territory school-based drug education policies advise that volatile substance use (VSU) should be excluded from general drug education curriculum for fear of alerting young people to the intoxicating properties of substances such as petrol, sprays and glues. We review evidence from the United States and United Kingdom on the effects of including volatile substances in school-based drug education, to argue that these policies are due for reconsideration. Nitrous oxide and nitrites are classified as volatile substances along with solvents such as those listed above, although their patterns of use, effects and harms are different. In an era of widespread social media access, more young people than in the past are likely to have heard about VSU. But because VSU is often short-term, parents and teachers may be unaware when young people in their care consume volatile substances. The general silence about VSU in schools, difficulty in detecting use and the varying sets of risks associated with inhaling different substances mean that young people may be unaware of toxicity or harm reduction strategies when they consume volatiles as drugs. We consider some implementation challenges to be negotiated if VSU education were introduced in Australian schools.
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BACKGROUND: Bingo is often understood as a low-harm form of gambling. This view has been challenged by a growing body of literature identifying gambling harm to bingo players in a range of countries. In this study, we aimed to identify which conditions enabled, facilitated, intensified or mitigated gambling harm for bingo players in three populations in Victoria in the context of corporate, technological and regulatory changes. METHODS: Our qualitative study investigated experiences of bingo-related gambling harm in three populations in Victoria, Australia where bingo was popular and structural disadvantage common: Indigenous people in the east, Pacific people in the state's north and older people on low or fixed incomes in the capital. Data was generated through interviews with 53 bingo players and 13 stakeholders as well as 12 participant observations of bingo sessions. RESULTS: We found that while bingo is overwhelmingly positive for many players, a minority of bingo players and their families experience notable harm. Harm was generated through traditional paper-based bingo games, new technologies such as tablet-based bingo and by the widespread tactic of placing bingo sessions in close proximity to harmful electronic gambling machines. Overall, the risk of harm to bingo players appears to be escalating due to commercial, technological and regulatory changes. CONCLUSIONS: These changes can be better managed by regulators: reforms are needed to safeguard bingo's distinct character as a lower-risk form of gambling at a time when it, and its players, are under threat. Significantly, we found that harm to bingo players is intensified by factors external to gambling such as racialised poverty and adverse life events. Strategies that recognise these factors and grapple with gambling harm to bingo players are needed.
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Juego de Azar , Anciano , Juego de Azar/epidemiología , Humanos , Renta , Investigación Cualitativa , Victoria/epidemiologíaRESUMEN
How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.
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Responsabilidad Parental , Padres , Adulto , Consumo de Bebidas Alcohólicas , Australia , Niño , HumanosRESUMEN
Young people's drinking has declined markedly in Australia over the past 15 years, and this may be linked to changing norms and values around health. We take the view that healthism-a discourse that privileges good health and renders people personally responsible for managing health-has become pervasive, creating new pressures influencing young people's alcohol practices. Through interviews with 50 young light drinkers and abstainers, we explored these notions of health and alcohol. Although health was not the only reason that participants abstained or drank lightly, many avoided drinking to minimise health risks and to pursue healthy lifestyles. Their understanding of health came from multiple sources such as the media, schools, parents-and often reinforced public health messages, and healthist discourse. This discourse influenced how participants perceived health norms, engaged with health in everyday life and managed their alcohol consumption. Because the need to be healthy incorporated bodily health, mental health and social wellbeing, it also created tensions around how young people could drink while maintaining their health. This highlights the importance of health as a key consideration in the alcohol practices of light drinking and abstaining young Australians, which could help explain broader declines in youth drinking.
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Consumo de Bebidas Alcohólicas , Padres , Adolescente , Australia , Estilo de Vida Saludable , Humanos , Salud MentalRESUMEN
Those who work with immigrants in detention centers may be at increased risk of secondary trauma. This study used Photovoice to capture reflections on how the lives of volunteers are affected by their work on behalf of immigrant family detainees. Participants were recruited over a two-month period in 2018 from amongst the volunteers of a non-governmental organization that provides legal services to the detainees at one immigration detention center. Participants submitted photos and captions that explored their experiences with their work. Thirteen volunteers consented to participate and submitted 44 photos with captions to the project. Major themes included emotional challenges of the work, frustrations with the U.S. government, comparison of their experiences to those of their clients', and finding uplifting moments. Our findings regarding the significant emotional challenges of this work are of particular importance given the increasing coverage of immigration detention in the media and the increased interest in volunteer opportunities to support this population.
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Emigrantes e Inmigrantes/legislación & jurisprudencia , Emigrantes e Inmigrantes/psicología , Emigración e Inmigración/legislación & jurisprudencia , Emociones , Fotograbar , Voluntarios/psicología , Humanos , Masculino , Estados UnidosRESUMEN
BACKGROUND: Alcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12 years and older drink alcohol but don't exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain. METHODS: Data from the 2013 National Drug Strategy Household Survey were used. In the past 12 months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk). RESULTS: Multivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers. CONCLUSIONS: The socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.
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Abstinencia de Alcohol/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Adolescente , Adulto , Anciano , Australia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Depression is a common mental disorder with a high social burden and significant impact on suicidality and quality of life. Treatment is often limited to drug therapies because of long waiting times to see psychological therapists face to face, despite several guidelines recommending that psychological treatments should be first-line interventions for mild to moderate depression. OBJECTIVE: We aimed to evaluate, among patients on a waitlist to receive secondary mental health care services for depression, how effective coach-guided web-based therapy (The Journal) is, compared with an information-only waitlist control group, in reducing depression symptoms after 12 weeks. METHODS: We conducted a randomized controlled trial with 2 parallel arms and a process evaluation, which included interviews with study participants. Participants assigned to the intervention group received 12 weeks of web-based therapy guided by a coach who had a background in social work. Patients in the control group receive a leaflet of mental health resources they could access. The primary outcome measure was a change in depression scores, as measured by the Patient-Health Questionnaire (PHQ-9). RESULTS: A total of 95 participants were enrolled (intervention, n=47; control, n=48). The mean change in PHQ-9 scores from baseline to week 12 was -3.6 (SD 6.6) in the intervention group and -3.1 (SD 6.2) in the control group, which was not a statistically significant difference with a two-sided alpha of .05 (t91=-0.37; P=.72, 95% CI -3.1 to 2.2). At 12 weeks, participants in the intervention group reported higher health-related quality of life (mean EuroQol 5 dimensions visual analogue scale [EQ-5D-VAS] score 66.8, SD 18.0) compared with the control group (mean EQ-5D VAS score 55.9, SD 19.2; t84=-2.73; P=.01). There were no statistically significant differences between the two groups in health service use following their initial consultation with a psychiatrist. The process evaluation showed that participants in the intervention group completed a mean of 5.0 (SD 2.3) lessons in The Journal and 8.8 (SD 3.1) sessions with the coach. Most participants (29/47, 62%) in the intervention group who completed the full dose of the intervention, by finishing 6 or more lessons in The Journal, were more likely to have a clinically important reduction in depressive symptoms at 12 weeks compared with the control group (Χ21=6.3; P=.01, Φ=0.37). Participants who completed the interviews reported that the role played by the coach was a major factor in adherence to the study intervention. CONCLUSIONS: The results demonstrate that the use of guided web-based therapy for the treatment of depression is not more effective than information-only waitlist control. However, it showed that the coach has the potential to increase adherence and engagement with web-based depression treatment protocols. Further research is needed on what makes the coach effective. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02423733; https://clinicaltrials.gov/ct2/show/NCT02423733.
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Depresión/terapia , Recursos en Salud/normas , Salud Mental/normas , Telemedicina/métodos , Adolescente , Adulto , Femenino , Humanos , Internet , Masculino , Calidad de Vida , Resultado del Tratamiento , Adulto JovenRESUMEN
AIMS: This paper examines: (a) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group. SHORT SUMMARY: Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia. METHODS: Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age. RESULTS: Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment. CONCLUSION: Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people.
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Abstinencia de Alcohol/tendencias , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/tendencias , Motivación , Adolescente , Adulto , Anciano , Abstinencia de Alcohol/psicología , Consumo de Bebidas Alcohólicas/psicología , Australia/epidemiología , Femenino , Encuestas Epidemiológicas/tendencias , Humanos , Masculino , Persona de Mediana Edad , Motivación/fisiología , Distribución Aleatoria , Adulto JovenRESUMEN
Reflecting international patterns, Aboriginal people in Victoria are more likely to gamble and to experience gambling harm than non-Indigenous Victorians. This paper describes experiences of gambling reported by 50 Aboriginal people interviewed in regional Victoria in 2016 and 2017 as part of studies initiated by two Aboriginal community-controlled organisations. Data were analysed using social practice theory (SPT) and coded to the elements of 'meaning', 'material', 'competence', and 'temporality'. Across each element we identified highly contradictory experiences. Gambling held meaning as an opportunity for community gatherings but was also regarded as a cause of domestic violence, conflict, isolation and shame. Materially, the venues that offered gambling were experienced by many Aboriginal people as safe and welcoming, but at the same time gambling produced a damaging affective sense of addiction for some. Gambling was a competency that some people valued and taught to children, but it was also seen as undermining cultural practices. While Aboriginal people were historically denied access to licensed venues offering commercial gambling, many participants now found opportunities to gamble inescapable. The intermingling of benefits and harms described above supports the need for a multi-faceted response to gambling in Aboriginal communities, which includes harm reduction as well as supply restriction and treatment. Some experiences of gambling related by our participants reflected those reported also by non-Indigenous Australians, while others were differently nuanced. Because SPT is used to understand collectively-shared practices, it facilitates the identification of gambling interventions at the level of the community, as recommended by our research participants.
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Juego de Azar/etnología , Juego de Azar/psicología , Nativos de Hawái y Otras Islas del Pacífico/psicología , Valores Sociales/etnología , Adulto , Actitud Frente a la Salud/etnología , Australia , Conducta de Elección , Femenino , Reducción del Daño , Humanos , Control Interno-ExternoRESUMEN
Bingo playing in Australian Indigenous communities has received little academic attention. We report here on an exploratory study designed to understand the complex benefits and harms associated with bingo playing for Aboriginal people in Sunraysia, a regional community in Victoria, Australia. The research was strongly participatory, and conducted in collaboration with staff of an Aboriginal community-controlled organisation. Twenty-six members of the Sunraysia Aboriginal community were interviewed, with interviews primarily conducted by workers from the Aboriginal organisation. Echoing research from other countries, but with a unique focus on the experience of bingo for Aboriginal people in Australia, this study demonstrates compelling reasons why Aboriginal people in Sunraysia play bingo, and how bingo playing both exposes players to risk and mitigates against a wide range of harms. We found that, for many people in the study, bingo was variously a site that reinforces social connectedness, a source of fun and excitement and a strategy to find solace or respite in the face of personal pain and structural injustice. In contrast with other forms of gambling, bingo presents risks that can generally be managed, largely because of the smaller financial spend involved. However, people also described harms including exhausting the family budget, family conflict and encouragement to commence other forms of gambling. We argue for enhanced regulation of commercial bingo and suggest that not-for-profit bingo be implemented as a harm reduction strategy to enable people to experience some of the pleasures associated with gambling, with reduced risk of financial and social harms.
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Juego de Azar/psicología , Reducción del Daño , Nativos de Hawái y Otras Islas del Pacífico/psicología , Placer , Adulto , Familia/psicología , Femenino , Juego de Azar/prevención & control , Humanos , Masculino , Investigación Cualitativa , Red Social , VictoriaRESUMEN
Climate and land-use changes are thought to be the greatest threats to biodiversity, but few studies have directly measured their simultaneous impacts on species distributions. We used a unique historic resource-early 20th-century bird surveys conducted by Joseph Grinnell and colleagues-paired with contemporary resurveys a century later to examine changes in bird distributions in California's Central Valley, one of the most intensively modified agricultural zones in the world and a region of heterogeneous climate change. We analyzed species- and community-level occupancy using multispecies occupancy models that explicitly accounted for imperfect detection probability, and developed a novel, simulation-based method to compare the relative influences of climate and land-use covariates on site-level species richness and beta diversity (measured by Jaccard similarity). Surprisingly, we show that mean occupancy, species richness and between-site similarity have remained remarkably stable over the past century. Stability in community-level metrics masked substantial changes in species composition; occupancy declines of some species were equally matched by increases in others, predominantly species with generalist or human-associated habitat preferences. Bird occupancy, richness and diversity within each era were driven most strongly by water availability (precipitation and percent water cover), indicating that both climate and land-use are important drivers of species distributions. Water availability had much stronger effects than temperature, urbanization and agricultural cover, which are typically thought to drive biodiversity decline.
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Biodiversidad , Cambio Climático , Agricultura , Animales , Aves , California , Ecosistema , Humanos , UrbanizaciónRESUMEN
Individuals have a wide range of resources when searching for health topics. The aim of this research was twofold: (1) to identify and assess the resources college students use when exercising health information seeking behavior (HISB); and (2) to examine perceptions and behaviors regarding adoption of online tools. A questionnaire was developed to assess HISB in a sample of college students. Items pertaining to HISB were adapted from a Health Information National Trends Survey with permission from the National Cancer Institute at the National Institutes of Health. During Spring 2018, 258 students in 9 sections of a personal health class at a public university in NJ completed the questionnaire. Students were most likely to often or always use the Internet for health information (n = 74%) over other sources. Females were more likely to use the Internet for health information (p = .030), to consult a health or medical professional (p = .042) and to confirm the health information they find with a health or medical professional (p = .028). Females also reported spending significantly more time on social media (mean 4.96 h/day) compared to males (4.00 h/day, p = .041). Non-white students were significantly more likely to often use the Internet to find health information (p = .039), while white students reported spending significantly less time on the Internet (p < .001) and on social media (p < .001). Future research is needed to understand motivating factors for HISB, and to tailor interventions accordingly to assure that college students who exhibit HISB have appropriate levels of e-health literacy.
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Conductas Relacionadas con la Salud , Alfabetización en Salud/métodos , Conducta en la Búsqueda de Información , Internet/estadística & datos numéricos , Estudiantes/psicología , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades , Adulto JovenRESUMEN
Gloves can serve as barriers to decrease the transfer of microorganisms from hands to food. Glove changing by food vendors is particularly important when handling paper currency, as bills can carry and transmit microbes from person to person. The purpose of this study was two-fold: (1) To ascertain the extent to which gloves are changed after monetary transactions in food vendors at a major mall in New Jersey; and (2) to document the level of bacterial contamination and the presence of coliform bacteria on paper currency handled by these vendors. This study was conducted with two phases: Phase 1, in which 10 min of observation of food workers was completed followed by a monetary sample collection and testing, and Phase 2, in which 1 h of observations were conducted. During Phase 1, gloves were changed after 4 (2.3%) of the 174 transactions. All the dollar bills collected from all 17 vendors during Phase 1 exhibited bacterial contamination. The number of CFUs ranged from 1.18 × 107 to 1.13 × 1010, and bills collected from 6 of the 17 vendors (35.3%) tested positive for coliform bacteria. In Phase 2, gloves were changed after 3.35% of the 1193 transactions observed. This study makes the critical connection between the lack of compliance by food workers with the health code, and the contaminated money they may be handling while dispensing food.
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Microbiología Ambiental , Contaminación de Alimentos , Servicios de Alimentación/normas , Guantes Protectores/microbiología , Restaurantes/normas , Estudios Transversales , Contaminación de Alimentos/prevención & control , Contaminación de Alimentos/estadística & datos numéricos , Humanos , New JerseyRESUMEN
BACKGROUND: Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. OBJECTIVE: To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. METHODS: In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. RESULTS: Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. CONCLUSIONS: Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.
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Consumo de Bebidas Alcohólicas/psicología , Trabajadores Sexuales/psicología , Conducta Sexual/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Malaui , Asunción de Riesgos , Sexo Inseguro/psicología , Adulto JovenRESUMEN
ISSUE ADDRESSED: Hello Sunday Morning (HSM) is an online program that encourages people to commit to a period of non-drinking and blog about their experiences. Among a sample of Victorian HSM users, we aimed to explore the barriers faced and the strategies adopted to maximise potential for achieving temporary abstinence. METHODS: A content analysis of blog data from 154 HSM users (a total of 2844 blog posts) was undertaken by three researchers. Participants were predominantly women aged 30-50 years. RESULTS: The most common barriers to achieving temporary alcohol abstinence reported by participants were stress and tiredness, pervasiveness of drinking in social life, negative effects from not drinking and negative reactions from others. The strategies most commonly implemented included drawing on HSM and other non-drinking networks, self-talk, engaging in non-alcohol-related activities and substituting alcohol with other drinks. CONCLUSIONS: Although significant individual and systemic barriers to abstaining from alcohol were identified by HSM users, multiple strategies were identified and effectively utilised to overcome these barriers. SO WHAT?: We suggest that the virtual support from an online community with a shared interest in reducing their alcohol use appears to be a useful health promotion strategy for temporarily reducing consumption, particularly for women.
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Abstinencia de Alcohol/psicología , Consumo de Bebidas Alcohólicas/prevención & control , Consumo de Bebidas Alcohólicas/psicología , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Adulto , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Medios de Comunicación Sociales , Red Social , VictoriaRESUMEN
A growing body of literature seeks to explain variation in range shifts using species' ecological and life-history traits, with expectations that shifts should be greater in species with greater dispersal ability, reproductive potential, and ecological generalization. Despite strong theoretical support for species' traits as predictors of range shifts, empirical evidence from contemporary range shift studies remains limited in extent and consensus. We conducted the first comprehensive review of species' traits as predictors of range shifts, collecting results from 51 studies across multiple taxa encompassing over 11,000 species' responses for 54 assemblages of taxonomically related species occurring together in space. We used studies of assemblages that directly compared geographic distributions sampled in the 20th century prior to climate change with resurveys of distributions after contemporary climate change and then tested whether species traits accounted for heterogeneity in range shifts. We performed a formal meta-analysis on study-level effects of body size, fecundity, diet breadth, habitat breadth, and historic range limit as predictors of range shifts for a subset of 21 studies of 26 assemblages with sufficient data. Range shifts were consistent with predictions based on habitat breadth and historic range limit. However, body size, fecundity, and diet breadth showed no significant effect on range shifts across studies, and multiple studies reported significant relationships that contradicted predictions. Current understanding of species' traits as predictors of range shifts is limited, and standardized study is needed for traits to be valid indicators of vulnerability in assessments of climate change impacts.