Tobacco cessation experiences and needs: perspectives from Arabic-speaking communities.

Use of tobacco products is higher in Arabic-speaking communities in Australia, compared to other populations. 70 persons identifying as being from Arabic-speaking communities in Western Sydney participated in focus group discussions to explore experiences and needs relating to tobacco, alcohol and other drug treatment. Tobacco was rated as the substance of highest concern in this sample, however a pattern of change was observed. Widespread cigarette use supported by gendered norms that particularly encouraged smoking among men was shifting, with some decline in the social acceptability of cigarette smoking linked to experience of health impacts and the financial cost to families. In contrast, waterpipe tobacco smoking was described as a common and acceptable practice across age and gender cohorts, despite some participants challenging the cultural and health rationales of this practice. Preventing tobacco-related harm among younger populations was highly valued among study participants, drawing on strong support for families as key influencer of health behaviors. Cessation strategies viewed as effective among community members spoken with commonly centered upon the notion of individual willpower, and appreciated the disincentivising impacts of high taxation on cigarettes. This study prioritizes community-informed perspectives for reducing tobacco related harms amongst Arabic-speaking populations in Australia and offers direction to health promoters, public health workers and policymakers. Results indicate opportunities exist to improve tobacco control outcomes through strategies that align prevention and treatment options with relevant community beliefs and norms, and build on existing harm reduction behaviors and support seeking behaviors.

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).

What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes.

In Australia, one in three people are born overseas, and one in five households speak languages other than English. This study explores substance use prevalence, related harms, and attitudes among these large groups in the population. Analysis was conducted using cross-sectional data (N = 22, 696) from the 2013 National Drug Strategy Household Survey. General linear model and binary logistic regression were used to assess substance use and harms, using stabilized inverse propensity score weighting to control for potential confounding variables. Between culturally and linguistically diverse populations and the population born in Australia, United Kingdom, or New Zealand who speak only English at home, there is no statistically significant variation in the likelihood of current smoking; using analgesics, tranquilizers, or sleeping pills; or administering drugs via injection. Culturally diverse populations are less likely to drink alcohol or use cannabis or methamphetamines. No difference between these two major groups in the population is observed in substance-related abuse from strangers; but culturally diverse respondents are less likely to report substance-related abuse from known persons. Lower substance use prevalence is not observed among people from culturally diverse backgrounds who have mental health issues. Australian-, UK-, or New Zealand-born respondents who speak only English at home are more likely to oppose drug and tobacco policies, including a range of harm reduction policies. We discuss the practical and ethical limitations of this major Australian data set for examining the burden of drug-related harms experienced by specific migrant populations. Avenues for potential future research are outlined.

Developing a guide for community-based groups to reduce alcohol-related harm among African migrants.

Issue addressed Alcohol-related harm is an issue of concern for African migrant communities living in Australia. However, there has been little information available to guide workers in developing culturally sensitive health promotion strategies. Methods A three-step approach, comprising a literature review, community consultations and an external review, was undertaken to develop a guide to assist organisations and health promotion groups working with African migrant communities to address alcohol-related harms. Discussion There was a high level of agreement between the three steps. Addressing alcohol harms with African migrant communities requires approaches that are sensitive to the needs, structures and experiences of communities. The process should incorporate targeted approaches that enable communities to achieve their resettlement goals as well as strengthening mainstream health promotion efforts. Conclusions The resource produced guides alcohol harm prevention coalitions and workers from the first steps of understanding the influences of acculturation and resettlement on alcohol consumption, through to planning, developing and evaluating an intervention in partnership with communities. So what? This paper advances knowledge by providing a precise summary of Australian African migrant focused alcohol and other drug research to date. It also describes a three-step approach that aimed to incorporate a diversity of community views in the creation of a health promotion and community capacity-building resource.

Understanding cultural inclusion in alcohol and other drug services in New South Wales, Australia and assessing the acceptability of a cultural inclusion audit.

INTRODUCTION: Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non-government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites. METHODS: The research adopted a mixed methods approach comprising of a pre-audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in-depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process. RESULTS: Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program. DISCUSSION AND CONCLUSIONS: The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes.

Understanding how neglected tropical diseases programs in five Asia-Pacific countries adjusted to the COVID-19 pandemic: A qualitative study.

BACKGROUND: Following the COVID-19 pandemic declaration, the World Health Organization recommended suspending neglected tropical diseases (NTD) control activities as part of sweeping strategies to minimise COVID-19 transmission. Understanding how NTD programs were impacted and resumed operations will inform contingency planning for future emergencies. This is the first study that documents how South-East Asian and Pacific NTD programs addressed challenges experienced during the COVID-19 pandemic. METHODOLOGY/PRINCIPAL FINDINGS: Data was collected through semi-structured interviews with 11 NTD Program Coordinators and related personnel from Fiji, Papua New Guinea, The Philippines, Timor-Leste, and Vanuatu. Constructivist grounded theory methods were drawn on to generate an explanation of factors that enabled or hindered NTD program operations during the COVID-19 pandemic. The COVID-19 pandemic disrupted NTD programs in all countries. Some programs implemented novel strategies by partnering with services deemed essential or used new communications technology to continue (albeit scaled-back) NTD activities. Strong relationships to initiate cross-program integration, sufficient resources to implement adapted activities, and dedicated administrative systems were key enabling factors for recommencement. As the COVID-19 pandemic continued, exacerbating health resources scarcity, programs faced funding shortages and participants needed to find efficiencies through greater integration and activity prioritisation within their NTD units. Emphasising community-led approaches to restore trust and engagement was critical after widespread social anxiety and disconnection. CONCLUSIONS/SIGNIFICANCE: Sustaining effective NTD programs during a global emergency goes beyond managing immediate activity disruptions and requires attention to how NTD programs can be better ensconced within wider health programs, administrative, and social systems. This study underscores the importance of pre-emergency planning that reinforces NTD control programs as a critical service at all health systems levels, accompanied by governance arrangements that increase NTD staff control over their operations and strategies to maintain strong community relationships. Ensuring NTD units are supported via appropriate funding, personnel, and bureaucratic resources is also required.

Initial arterial carbon dioxide tension is associated with neurological outcome after resuscitation from cardiac arrest.

STUDY OBJECTIVES: To determine the relationships between partial pressure of arterial carbon dioxide (PaCO2), prescribed minute ventilation (MV), and neurologic outcome in patients resuscitated from cardiac arrest. METHODS: This was a retrospective cohort study utilizing a multicenter database of adult patients with return of spontaneous circulation (ROSC) after cardiac arrest. The primary outcome was neurologic status at hospital discharge, defined by Cerebral Performance Category (CPC) score: CPC 1-2 was favorable, CPC 3-5 was poor. We compared rates of initial normocarbia (PaCO2 31-49mmHg) and mean sequential PaCO2 measurements obtained over the first 24h. We also assessed the influence of MV on the PaCO2 at initial, 6, 12, 18, and 24h after cardiac arrest using univariate linear regression. RESULTS: One hundred and fourteen patients from 3 institutions met inclusion criteria. Overall, 46/114 (40.4%, 95% CI: 31.4-49.4%) patients survived to hospital discharge, and 33/114 (28.9%, 20.6-37.2%) had CPC 1-2 at the time of discharge. A total of 38.9% (95% CI: 29.9-47.9%) of patients had initial normocarbia; 43.2% (28.6-57.8%) of these patients were discharged with CPC 1-2, compared with 20.3% (10.8-29.8%) of dyscarbic patients. By 6h, neurologic outcomes were not significantly associated with PaCO2. Prescribed MV was not associated with PaCO2 at any time point with the exception of a weak correlation at hour 18. CONCLUSION: Initial normocarbia was associated with favorable neurological outcome in patients resuscitated from cardiac arrest. This relationship was not seen at subsequent time points. There was no significant association between prescribed MV and PaCO2 or neurologic outcome.

Perspectives on barriers to employment for job seekers with mental illness and additional substance-use problems.

This paper examines the barriers to employment faced by job seekers (JS) with mental illness and additional substance-use issues. Semi-structured interviews concerning barriers to employment for JS with mental illness and substance-use problems and strategies to improve employment outcomes were conducted with stakeholders associated with an employment service provider specialising in mental illness (n = 17). Stakeholders were JS, family members who provide significant support to JS [support persons (SP)] and staff [employment staff (ES)]. Data were collected between May and August 2009 at the premises of the employment service provider in metropolitan Sydney. Thematic analysis of transcribed interview data was conducted to develop a meaningful data framework. The expectations of JS and SP regarding employment outcomes were higher than those of ES. Length of time unemployed was perceived as the most important barrier to future employment associated with mental illness, and substance-use problems were associated with lower, more variable motivation, restrictions on the environments where JS could work and more negative community and employer perceptions. The findings are consistent with studies from non-vocational settings and provide direction for meeting the needs of clients with mental illness and additional substance-use problems. Ensuring alignment between JS and ES concerning service goals and expected timeframes may improve JS motivation, satisfaction with service delivery and ultimately, employment outcomes.

Function, health and psychosocial needs in job-seekers with anxiety, mood, and psychotic disorders who access disability employment services.

BACKGROUND: Labour force participation of people with mental disorders varies according to the nature of their disorder. Research that compares function and psychosocial need in job-seekers with different mental disorders, however, is scant especially in the Australian setting. Identifying rehabilitation needs of job-seekers with mental disorders receiving employment services is of interest to providers of disability employment services in Australia. OBJECTIVE: This study sought to identify differences in health, social needs and function in people with anxiety, mood, or psychotic disorders accessing disability employment services to inform disability service providers of vocational rehabilitation interventions. PARTICIPANTS: 106 adult job-seekers with anxiety (29%), mood (51%), and psychotic (20%) disorders receiving job placement services from a disability employment service provider consented to participate in this study. METHODS: Self-report measures and the Executive Interview (EXIT) were used to document function. Differences between disorders were determined using one-way analysis of variance. RESULTS: Significantly better estimates of social functioning as measured by the Behaviour and Symptom Identification Scale (BASIS-32) were reported by job-seekers with psychotic disorders compared to those with anxiety or mood disorders. However, job-seekers with psychotic disorders reported longer periods of unemployment compared to those with mood disorders and longer estimates of the time it would take to obtain work compared to both the other groups. CONCLUSIONS: Perceived psychosocial problems, such as poor social function in job-seekers with anxiety and mood disorders and perceptions of poor employability in those with psychotic disorders, should be considered when developing vocational rehabilitation interventions, or where additional support may be required once employment is obtained.

Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services.

PURPOSE: This study identified functioning, health, and social needs in jobseekers with mental disorders independently assessed as having capacity to work and referred to disability employment services. Differences in function between jobseekers with mental illness alone and with additional drug and alcohol problems were examined with view to identifying interventions for vocational rehabilitation. METHOD: A convenience sample of 116 jobseekers completed BASIS-32, CANSAS, AUDIT, DAST-10 and 6 items from the EXIT interview and were divided into two groups: mental illness only, and additional drug and alcohol issues (AUDIT total score >8 and/or DAST total score >3). Analysis of variance was used to determine group differences. RESULTS: Jobseekers reported low-moderate problems with function. Over 40% of the sample reported unresolved psychological distress, physical health needs, and social/daytime activity needs. Thirty-five jobseekers (30%) had additional drug and alcohol problems and reported significantly greater difficulty with impulsive/addictive behavior and poorer memory and executive function than the mental illness only group. No significant differences were identified in past work functioning. CONCLUSIONS: Screening all job seekers for psychological, physical, and social needs to identify suitable treatment and rehabilitation strategies and providing interventions that improve emotional regulation and executive function for job seekers with additional drug and alcohol problems may improve employability of job seekers accessing disability employment services.