"They loved gambling more than me." Women's experiences of gambling-related harm as an affected other.

BACKGROUND: Gambling poses a global threat to public health due to its far-reaching impacts. Research has demonstrated a ripple effect of harmful gambling on social network members and broader communities. While researchers have documented extreme harms associated with an affected other, limited research has qualitatively investigated how women describe their concerns about the gambling of a social network member, and any subsequent negative impacts on their own lives. METHODS: An online panel survey was conducted with women aged 18 years and older, who gambled at least once in the last 12 months, and resided in the Australian states of Victoria and New South Wales. This paper focused on the open text responses of a subsection of the sample (n = 136) who reported being negatively impacted by someone else's gambling. The study utilised reflexive thematic analysis to interpret the data. RESULTS: Results indicated that women were concerned about the gambling behaviours of a broad range of social network members. Open text responses regarding the nature of these concerns mostly related to individualised paradigms of gambling behaviour - including whether the participant perceived their network member could afford to gamble, was being responsible with their gambling, or were gambling too frequently. Participants experienced a range of negative impacts including significant financial issues, relationship difficulties, poorer emotional wellbeing as a result of worrying about the gambler, and loss of trust. Some described the negative experiences associated with growing up with a parent who gambled. CONCLUSION: The research demonstrates the broad impacts of gambling on affected others. This study enhances our understanding of how women are harmed by gambling and considers the complexities of their experiences and relationships with the gambler. This extends knowledge beyond quantitative descriptors of harm among affected others and provides a critical reflection on the nuances of women's experiences with gambling and gambling harm.

Gambling-related suicide in Victoria, Australia: a population-based cross-sectional study.

Background: Gambling is associated with serious harms to health, including suicide. Yet public health systems for recording the role of gambling in suicide deaths are relatively underdeveloped. This study contributes to the understanding of this relationship. Methods: A population-based cross-sectional study of suicides reported to the Coroners Court of Victoria between 2009 and 2016 was performed to identify the incidence and characteristics of gambling-related suicides (GRS). Findings: From 2009 to 2016 there were 4788 suicide deaths in Victoria. Of these, 184 were identified as direct GRS and a further 17 were GRS by 'affected others'. Together, these GRS comprise 4.2% of all suicides in Victoria over this eight-year period. Direct GRS account for an annual average rate of 5.13 GRS per million Victorian adults. GRS were significantly more likely to be male (n = 153, 83%), than the Victorian population of total suicide deaths and significantly more likely to occur among those most disadvantaged. Family members and friends were more likely than clinicians to know about the deceased gambling. Interpretation: Given that gambling is not routinely investigated by coroners and may be hidden from family, friends, and health professionals, this is an underestimate of the true scale of the GRS in Victoria. A range of measures should be introduced to prevent, screen, support, and treat gambling harm. Family members and friends should also be provided with help services. Preventing gambling-related harm through public health measures could significantly reduce suicidality and suicide, both in Australia and globally. Funding: Federation University Australia, Coroners Court of Victoria, Suicide Prevention Australia.

Convenient consumption: a critical qualitative inquiry into the gambling practices of younger women in Australia.

There are a range of stereotypes and assumptions associated with women's gambling behaviours. While researchers have demonstrated that the practices associated with women's gambling are changing and becoming increasingly normalized, there is a limited understanding of how younger women ascribe meanings to these practices. This study explored the gambling practices of younger women. Forty-one women (20-40 years) participated in qualitative telephone interviews. Participants were asked open-ended questions about personal engagement in gambling, including experiences of gambling, gambling engagement, and experiences with different gambling products and environments. Data interpretation was guided by reflexive thematic analysis. Three themes were constructed from the data: (i) gambling infrastructures, including both products and the embedding of gambling in community environments, contributed to the convenient and regular consumption of gambling, with gambling easy to access and engage with; (ii) social networks and intergenerational gambling practices impacted the perceived social value and competencies related to gambling; and (iii) technology facilitated new gambling practices, routinizing gambling behaviours through automation and building perceived competencies with a range of gambling products. Gambling regulation and public health responses to gambling often focus on either individual behaviours or product characteristics. This study suggests that this focus is too narrow and excludes important influences on younger women's gambling practices, which include the infrastructure that supports the provision and consumption of gambling products. Public health research, policy and practice must consider the full range of determinants that may contribute to the initiation and continuation of gambling in younger women.

Younger women's engagement with gambling is changing. While there has been a significant focus on the gambling behaviours of men, very little research has investigated how women engage in different forms of gambling. We conducted in-depth telephone interviews with n = 41 women (20­40 years) in Australia about their personal engagement in gambling, their experiences of gambling, their motivations to gamble, and their engagement with different gambling products and environments. First, we found that the embedding of gambling in community environments (e.g. lotteries at shopping centres) meant that gambling was easy to access and engage with. This led to the convenient and regular consumption of some gambling products. Second, existing social practices among participants' social networks (including friends and family members) contributed to women feeling that gambling had social value, and that they had the skills to successfully participate in different forms of gambling. Finally, new technologies created routine gambling behaviours. For example, women automated the purchase of lottery tickets or used apps to help to build complex bets on activities such as sports. We conclude that public health and health promotion research, policy and practice must consider the unique factors that may influence the gambling behaviours of younger women.

Regulatory Resistance? Narratives and Uses of Evidence around "Black Market" Provision of Gambling during the British Gambling Act Review.

Commercial gambling is increasingly viewed as being part of the unhealthy commodities industries, in which products contribute to preventable ill-health globally. Britain has one of the world's most liberal gambling markets, meaning that the regulatory changes there have implications for developments elsewhere. A review of the British Gambling Act 2005 is underway. This has generated a range of actions by the industry, including mobilising arguments around the threat of the "black market". We critically explore industry's framing of these issues as part of their strategy to resist regulatory change during the Gambling Act review. We used a predefined review protocol to explore industry narratives about the "black market" in media reports published between 8 December 2020 and 26 May 2021. Fifty-five articles were identified and reviewed, and themes were narratively synthesised to examine industry framing of the "black market". The black market was framed in terms of economic threat and loss, and a direct connection was made between its growth and increased regulation. The articles mainly presented gambling industry perspectives uncritically, citing industry-generated evidence (n = 40). Industry narratives around the "black market" speak to economically and emotionally salient concerns: fear, safety, consumer freedom and economic growth. This dominant framing in political, mainstream and industry media may influence political and public opinion to support the current status quo: "protecting" the existing regulated market rather than "protecting" people. Debates should be reframed to consider all policy options, especially those designed to protect public health.

The Ottawa model for nursing curriculum renewal: An integrative review.

BACKGROUND: High-quality and relevant nursing education is needed to ensure graduates meet entry to practice competencies. Despite the important role of curricula in the development of nurses and the nursing profession, there does not appear to be a consistent or widely accepted approach to nursing curriculum renewal. OBJECTIVE: To identify and synthesize existing curriculum renewal/redesign practices, create an aggregated logic model depicting an evidence-informed process for nursing curriculum renewal, and stimulate dialogue about how to keep nursing curricula relevant in an ever-changing healthcare context. DESIGN: An integrative review, modeled on the Joanna Briggs Methodology of Systematic Reviews, of the available published articles, including empirical research and discussion articles. DATA SOURCES: We searched for quantitative, qualitative, and non-research literature (English and French) on full nursing programs or curriculum revisions for pre-licensure nursing students enrolled in an undergraduate or associate degree program. Databases included CINAHL, Nursing and Allied Health, and Medline from January 2010 to January 2017. We then did a hand search for articles from January 2017 to April 2019. SYNTHESIS: Extracted data were synthesized into an aggregated logic model based on Yin's method of cross-case analysis. Data included information about the internal context, the external context, drivers, the preparatory phase, the active phase, outcomes, and evaluation methods of the described curriculum renewal process. RESULTS: Twenty articles were included, which were published between 2010 and 2018. The resulting logic model, The Ottawa Model for Nursing Curriculum Renewal, includes information on the context, process and outcomes of the renewal process, and how and when to evaluate curricula. CONCLUSION: This synthesis aids in defining the process of curriculum renewal for undergraduate nursing education. It stimulates systems level thinking and reveals gaps, such as the need for further research into curriculum evaluation. The Ottawa Model for Nursing Curriculum Renewal is a usable template to aid educators undertaking their own process of curriculum renewal.

Recent increase in detection of alprazolam in Victorian heroin-related deaths.

OBJECTIVES: To examine the rate of detection of alprazolam among cases of heroin-related death (HRD) in Victoria, including the relationship between alprazolam supply and HRDs. DESIGN AND SETTING: Population-based study of community alprazolam supply in Victoria and HRDs reported to the Victorian coroner from January 1990 to December 2010. MAIN OUTCOME MEASURES: Number of prescriptions for alprazolam supplied; defined daily dose (DDD) per 1000 population per 04 of alprazolam; number of cases of HRD in which alprazolam was detected through postmortem toxicological testing. RESULTS: Alprazolam supply increased by 1426%, from 0.42 DDD/1000/04 in 1990, to 6.41 in 2010. For every 1 unit increase in DDD/1000/04, the proportion of cases of HRD in which alprazolam was detected increased at an incidence rate ratio of 2.4 (95% CI, 2.1-2.8; P < 0.001). Alprazolam was detected among increasing proportions of HRDs, from 5.3% in 2005 to a peak of 35.3% in 2009. CONCLUSION: The increase in detection of alprazolam among cases of HRD, particularly since 2005, and the disproportionate increase in prescribing of the high-dose 2 mg formulation compared with other formulations suggest a need to examine alprazolam prescribing and to identify inappropriate prescribing and the circumstances of diversion from licit to illicit use.

Increasing deaths involving oxycodone, Victoria, Australia, 2000-09.

OBJECTIVE: In light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic disadvantage of the deceased. STUDY DESIGN: Population-based observational study in Victoria, Australia. POPULATION: Decedents whose death was reported to the Victorian Coroner between 2000 and 2009 and where oxycodone was detected. MAIN OUTCOME MEASURES: Association between supply of oxycodone and deaths. Demographic characteristics of decedents. Rate ratios of the rural or metropolitan location and socioeconomic indicators of disadvantage of the deceased. RESULTS: Supply to Victoria has increased nine-fold from 7.5 mg per capita in 2000 to 67.5 mg per capita in 2009. Detection of oxycodone in deaths reported to the Victorian Coroner has increased from 4 (0.08/100,000 population) in 2000 to 97 (1.78/100,000 population) in 2009-a 21-fold increase in deaths. Of the 320 cases described, 53.8% (172) were the result of drug toxicity. Of these, 52.3% were unintentional and 19.8% intentional self-harm; the remaining 27.9% are either still under investigation by the coroner or intent is unknown. Drug toxicity deaths were overrepresented in both rural areas and areas indexed with high levels of disadvantage. CONCLUSIONS: The substantial increase in the number of deaths involving oxycodone is strongly and significantly associated with the increase in supply. Most drug toxicity deaths involving oxycodone were unintentional. This newly identified trend in fatalities in Victoria supports concerns that a pattern of increasing deaths involving oxycodone is emerging globally.

Killing time with enjoyment: a qualitative study of initiation into injecting drug use in north-east India.

Manipur and Nagaland are north-east Indian states characterized by a high prevalence of injecting drug use and HIV in a context of socio-economic underdevelopment and political instability. This qualitative study aims to increase understanding of the contextual factors associated with initiation into injecting drug use in these two states. Forty semi-structured in-depth interviews were conducted among injecting drug users (10 women, 30 men) aged 18-28 years in mid-2006. The interview transcripts were thematically analyzed. All participants were initiated into injecting by another person, most commonly a friend and often in the context of well-established social networks. Most were poly-drug users and unsafe injecting practices were frequently associated with the initiation experience. The subjective reasons for deciding to inject were pleasure-seeking, influence of peers, and economic reasons. We hypothesize that initiation into injecting in this part of the world is also linked to ideas of masculinity, and that young men engage in drug use in order to fill a social vacuum created by limited opportunities to meaningfully engage in adult roles within the community. The findings from this study suggest that harm reduction programs need to target (noninjecting) drug users, and that existing social networks could be creatively used to extend the reach of these programs.