More Canadian students drink but American students drink more: comparing college alcohol use in two countries.

AIMS: To compare alcohol use among US and Canadian college students. DESIGN: Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared. SETTING: One hundred and nineteen nationally representative US 4-year colleges and universities in 40 states and 16 nationally representative Canadian 4-year universities. PARTICIPANTS: Randomly selected students under 25 years (12 344 US and 6729 Canadian). MEASUREMENTS: Self-reports of alcohol use and heavy alcohol use. FINDINGS: The prevalence of life-time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past-year and past-week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries older [corrected] students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college. CONCLUSION: Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.

Multilevel analysis of situational drinking among Canadian undergraduates.

Using a multi-level approach, we examined the contribution of drinking setting characteristics and of individual characteristics on the alcohol intake per drinking occasion. The data are drawn from the Canadian Campus Survey, a national mail survey conducted in 1998 with a random sample of 8,864 students in 18 universities. For each student, up to five drinking occasions were investigated, resulting in 26,348 drinking occasions among 6,850 drinkers. At the individual level this study focused on the university life experience. At the situational level, information about alcohol intake was recorded relative to why, when, where and with whom drinking occurred. Our results show that drinking setting is as important as the individual characteristics in explaining the alcohol intake per occasion. Policies aimed at reducing students alcohol intake may be more beneficial if they address both situational and individual factors.

For all these reasons, I do...drink: a multilevel analysis of contextual reasons for drinking among Canadian undergraduates.

OBJECTIVE: Student drinking is largely related to the setting of the drinking occasion as well as to individual psychosocial characteristics. This article assesses the effect of the reasons for drinking on situational alcohol use above and beyond other environmental and individual factors. METHOD: The data were drawn from the Canadian Campus Survey, a national mail survey conducted in 1998 with a sample of 8,864 students in 18 universities. Each student provided information on up to five drinking occasions, resulting in 25,347 drinking occasions among 6,598 drinkers. At the individual level, this study focused on the university life experience. At the situational level, information about alcohol intake was recorded relative to why, when, where and with whom drinking occurred and the reasons for drinking. RESULTS: Our results show that the reasons for drinking explain 8.3% of the variance in individual alcohol intake per occasion at the individual level and 8.1% at the drinking occasion level. CONCLUSIONS: Reasons for drinking and the drinking setting together influence consumption. Moreover, reasons are context specific, because students drink for different reasons in different contexts. Thus, contextual motivational models may be more effective in helping one understand the various pathways to alcohol use and misuse.

Heavy drinking on Canadian campuses.

OBJECTIVE: To describe the prevalence and frequency of heavy drinking episodes among Canadian undergraduates. METHODS: Data are drawn from the Canadian Campus Survey, a national mail survey, conducted in the fall of 1998, with a random sample of 7,800 students from 16 universities. RESULTS: Overall, 62.7% and 34.8% of students reported consuming 5 or more drinks and 8 or more drinks, respectively, on a single occasion at least once during the fall semester. On average, drinkers reported having 5 or more drinks almost 5 times during the fall semester, and having 8 or more drinks almost twice during the same period. The groups reporting the highest rates of heavy drinking were males, those living in university residences, those with low academic orientation and those with high recreational orientation. INTERPRETATION: Generally, this study has shown that heavy drinking is highly engrained in Canadian undergraduates' drinking patterns, and is related to a number of factors. These factors can be used to develop targeted prevention efforts.

Cigarette use among Canadian undergraduates.

OBJECTIVE: To describe the prevalence of daily cigarette use among Canadian undergraduates. Estimates are also compared to earlier Ontario surveys. METHODS: Data are drawn from the Canadian Campus Survey, a national mail survey, conducted in the fall of 1998, with a random sample of 7,800 students from 16 universities. RESULTS: Overall, 17.1% reported daily cigarette smoking and 10.4% reported occasional smoking. Rates of daily smoking differed significantly by region (with rates above average among those attending university in the Atlantic and below average among those attending university in British Columbia and the Prairies), residence (those residing off campus without family reported the highest prevalence rate), and year of study (those in the final year typically reported lower rate of use). INTERPRETATION: University campuses represent an environment with potential gains to be made by tobacco control policies.

The effect of the Safer Bars programme on physical aggression in bars: results of a randomized controlled trial.

The purpose of this study was to evaluate the effectiveness of Safer Bars, an intervention to reduce aggression in bars. A total of 734 pre - post-intervention observations were conducted by trained observers on Friday and Saturday nights between midnight and 2 a.m. in 18 large capacity ( > 300) Toronto bars and clubs assigned randomly to receive the intervention (69% participation rate of the 26 assigned) and 12 control bars. As part of the intervention, owners/managers completed the risk assessment workbook to identify ways of reducing environmental risks, and 373 staff and owners/managers (84% participation rate) attended a 3-hour training session focused on preventing escalation of aggression, working as a team and resolving problem situations safely. The main outcome measures were rates of severe aggression (e.g. punching, kicking) and moderate physical aggression (e.g. shoving, grappling). Hierarchical linear modelling (HLM) comparing pre - post aggression for intervention versus control bars indicated a significant effect of the intervention in reducing severe and moderate aggression. This effect was moderated by turnover of managers and door/security staff with higher post-intervention aggression associated with higher turnover in the intervention bars. The findings indicate the potential for a stand-alone relatively brief intervention to reduce severe and moderate physical aggression in bars.

Illicit drug use among Canadian University undergraduates.

The purpose of this study was to examine rates and patterns of illicit drug use among Canadian university undergraduates, to compare these rates with those for non-university samples, and to describe drug-use trends among university undergaduates in the province of Ontario between 1988 and 1998. A national mail survey was carried out based on stratified 2-stage sample design. The sample comprised 7,800 Canadian undergraduates from 16 universities (52% of eligible respondents). Approximately 47.5% reported use of illicit drug durning their life, 29.6% in the previous 12 months, and 18.7% since the beginning of the academic year. Cannabis was by far the most widley used drug (47.0%, 28.7%, and18.2%, respectively). Many of the gender and regional associations were similar to those found in general-populations surveys. Comparisons to non-university peers did not indicate elevated rates among university students. Among Ontario university undergraduates the use of cannabis, hallucinogens, methamphetamines, crack, and herion remained stable between 1988 and 1998. The use of cocaine declined from 4.8% to 1.7%. Rates of illicit drug use were not appreciably higher than those among their non-university peers. Other public-health issues, such as heavy drinking and poor mental health, override those related to illicit drug use.

The basis for Canada's new low-risk drinking guidelines: a relative risk approach to estimating hazardous levels and patterns of alcohol use.

ISSUE: Low-risk drinking guidelines have been developed independently in a number of jurisdictions resulting in different sets of advice with different definitions of 'low risk'. This paper discusses some of the fundamental issues addressed by an expert advisory panel during the course of developing national guidelines for Canadians and summarises key sets of evidence that were influential. APPROACH: The underlying reasoning and connection between the evidence and the guidelines is discussed in relation to: (i) how to minimise risk of long-term illnesses; (ii) how to minimise risk of short-term harms, for example injury; and (iii) alcohol use during pregnancy. Both absolute and relative risks were considered in the development of the guidelines. FINDINGS: Meta-analyses of all-cause mortality were used to identify upper limits for usual drinking levels where potential benefits and risks were balanced for the average person in comparison with lifetime abstainers (10 standard drinks per week for women, 15 for men). Emergency room studies and situational risk factors were considered for advice on reducing short-term: (i) when not to drink at all; (ii) how to reduce intoxication; and (iii) upper limits for occasional daily consumption by adults aged 25 to 64 years (3 standard drinks for women, 4 for men). Shortcomings in the research data were highlighted. IMPLICATIONS: It was estimated that total compliance with these guidelines at a national level would result in substantially reduced per capita alcohol consumption and approximately 4600 fewer deaths per year.

Behavior and major barriers faced by non-injectable drug users with HBV/HCV seeking treatment for hepatitis and drug addiction in Rio de Janeiro, Brazil.

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, unemployed and/or living on less than $245 a month (minimun wage). In the last 6 months, 61.8% of interviewees snorted cocaine, 64.7% at least once a week. Half of the interviewees had a stable partner and 38.3% of those with occasional partners never/almost never using condoms. Addiction treatment seeking was found to be associated with: being white (OR:5.5), high-school degree (OR:8.7), and employment (OR:5.7). Hepatitis treatment seeking was high (80.9%), and access to low-threshold, user-friendly health services was key for treatment seeking behaviors (OR:3.6). Missed opportunities for hepatitis treatment seem to be associated with structural (uneven political/financial support to hepatitis programs) and patient-related barriers (severe addiction and non-adherence). Those most in need were less likely to access treatment, calling for renewed strategies, in order to curb hepatitis among impoverished drug users and their sexual partners.

Addiction Research Centres and the Nurturing of Creativity. Substance abuse research in a modern health care centre: the case of the Centre for Addiction and Mental Health.

The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre.

Aboriginal community alcohol harm reduction policy (ACAHRP) project: a vision for the future.

Four First Nation communities in Ontario, Canada, formulated alcohol management policies between 1992 and 1994. An alcohol management policy is a local control option to manage alcohol use in recreation and leisure areas. Survey results indicate that decreases in alcohol use-related problems related to intoxication, nuisance behaviors, criminal activity, liquor license violations, and personal harm were perceived to have occurred. Furthermore, having policy regulations in place did not have an adverse effect on facility rentals. Band administrators and facility staff in each community felt the policy had had a positive effect on events at which alcohol was sold or served.

Behavior and major barriers faced by non-injectable drug users with HBV/HCV seeking treatment for hepatitis and drug addiction in Rio de Janeiro, Brazil / Comportamentos e barreiras relacionados à busca ao tratamento para a hepatite e dependência química entre usuários de drogas não injetáveis com hepatite crônica do Rio de Janeiro, Brasil

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, unemployed and/or living on less than $245 a month (minimun wage). In the last 6 months, 61.8 percent of interviewees snorted cocaine, 64.7 percent at least once a week. Half of the interviewees had a stable partner and 38.3 percent of those with occasional partners never/almost never using condoms. Addiction treatment seeking was found to be associated with: being white (OR:5.5), high-school degree (OR:8.7), and employment (OR:5.7). Hepatitis treatment seeking was high (80.9 percent), and access to low-threshold, user-friendly health services was key for treatment seeking behaviors (OR:3.6). Missed opportunities for hepatitis treatment seem to be associated with structural (uneven political/financial support to hepatitis programs) and patient-related barriers (severe addiction and non-adherence). Those most in need were less likely to access treatment, calling for renewed strategies, in order to curb hepatitis among impoverished drug users and their sexual partners.

Usuários de drogas (UD) são uma população marginalizada e sob risco para hepatites virais que raramente acessam tratamento. Foi utilizado inquérito com 110 UD com Hepatite crônica e 15 entrevistas em profundidade com profissionais e gestores de saúde. A maioria dos entrevistados é homem, não branco, com baixa escolaridade, desempregado e com renda < salário mínimo. Nos últimos 6 meses, 61,8 por cento usaram cocaína inalada e 64,7 por cento uma vez por semana ou mais. Dos participantes, 50 por cento tiveram relações sexuais com parceiros estáveis e 38,3 por cento com parceiros ocasionais nunca/quase nunca usando preservativos. Preditores de busca por tratamento para dependência química incluem: raça/cor branca (OR:5.5), ter ensino médio (OR:8.7) e estar empregado (OR:5.7). 80,9 por cento dos participantes buscou tratamento para hepatite, o acesso a serviços mais acolhedores é determinante para esse comportamento (OR:3.6). Oportunidades perdidas para tratamento de hepatite estão associadas a barreiras estruturais (inadequado apoio político/financeiro aos programas) e barreiras individuais (dependência química severa e baixa aderência). Aqueles que mais precisam de tratamento possuem menor chance de obtê-lo, salientando a importância de renovar estratégias para responder à epidemia de hepatite entre usuários de drogas empobrecidos e seus parceiros sexuais.

Methadone treatment in Ontario after the 1996 regulation reforms. Results of a physician survey.

Over two decades of rather restrictive regulations have kept the availability of methadone treatment (MT) at low levels in the province of Ontario, Canada. Regulatory changes in the Province of Ontario in the mid-1990s relaxed relevant authorization and treatment practice guidelines. Subsequently, the number of physicians authorized for methadone treatment and treatment spots increased substantially. A large number of the newly authorized physicians are general/local medical practitioners. This study reports on the results of a survey conducted with the majority of MT prescribing physicians in Ontario authorized at the time of study. Physicians were surveyed on their attitudes and practices with regards to the MT authorization system, treatment approaches, requirements and workload, patient 'stability', additional opiate substitution treatment needs, and with regards to general issues and concerns about the new MT governance system. The article also discusses patterns and differences that were found between physicians when comparing their geographic location, whether they see themselves practicing under a 'harm reduction' or an 'abstinence' approach, and whether they received MT authorization under the old or the new guidelines. It is concluded that the liberalized regulations and the increased incorporation of local physicians seems to provide for an overall more desirable system of governance of MT. However, some relevant concerns about the current system exist and are discussed.

Drug treatment courts--a viable option for Canada? Sentencing issues and preliminary findings from the Toronto court.

The first drug treatment court in Canada began operation in Toronto in December of 1998. This paper describes some aspects of the evolution, structure, and operation of this court. In addition, the federally-funded evaluation of the new program has produced data from the first 18 months of its full operation when 198 drug-dependent individuals were admitted. These preliminary results are described and compared to the findings of an Australian study and to select American studies. Important differences in sentencing practices and options for drug offenses between Canada and the United States are highlighted. Even at this early stage of development, it is suggested that the types of clients retained and more successful in this Canadian experiment may be quite different from the more typical American drug treatment court clientele. The need for careful monitoring and more complete, long-term information is emphasized before the viability of this approach is established for Canada.