Promoting health in the digital environment: health policy experts' responses to on-demand delivery in Aotearoa New Zealand.

Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes-the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities.

The association between alcohol use disorder and suicidal ideation in a New Zealand birth cohort.

BACKGROUND: Alcohol use disorder is associated with increased suicide risk; however, both alcohol use disorder and suicide share risk factors which must be accounted for in order to understand this relationship. This study aimed to explore the longitudinal relationship between alcohol use disorder and suicidal ideation in adulthood, while accounting for both child background and adult covariate factors. METHOD: Data were collected from the Christchurch Health and Development Study, a birth cohort of 1265 children born in Christchurch (New Zealand) in mid-1977. Alcohol use disorder (operationalised as alcohol abuse and alcohol dependence) was quantified between age 18 and 40 in five data waves. The outcome measure suicidal ideation was reported over the same time periods. Childhood confounding variables were controlled for, as well as time-dynamic covariates collected in adulthood, including internalising disorders, distress due to relationship dissolutions and other substance use disorders. RESULTS: The association between alcohol abuse and suicidal ideation was not statistically significant before or after adjusting for childhood confounding and adulthood covariate factors, when compared to no alcohol disorder. However, the association between alcohol dependence and suicidal ideation was significant both before and after adjustment (unadjusted odds ratio = 2.89, 95% confidence interval = [2.09, 3.99]; adjusted odds ratio = 1.52, 95% confidence interval = [1.04, 2.23]), when compared to no alcohol disorder. Furthermore, alcohol dependence remained significant when compared to alcohol abuse (unadjusted odds ratio = 2.33, 95% confidence interval = [1.61, 3.37]; adjusted odds ratio = 1.54, 95% confidence interval = [1.00, 2.37]). CONCLUSION: This analysis found an association between alcohol dependence and suicidal ideation within a New Zealand birth cohort, which persists even after adjustment for childhood confounding and adulthood covariate factors. Given the high rates of suicide and heavy drinking within the New Zealand population, any comprehensive national or regional suicide prevention plan should seek to reduce risky alcohol consumption at an individual and population level, as this represents a modifiable risk factor for suicide.

A systematic review of the effect of ovarian sex hormones on stimulant use in females.

Stimulant use disorder is associated with significant global health burden. Despite evidence for sex differences in the development and maintenance of stimulant use disorder, few studies have focused on mechanisms underpinning distinct trajectories in females versus males, including the effect of the ovarian sex hormones estrogen and progesterone. This review aimed to identify and synthesise the existing preclinical and clinical literature on the effect of ovarian sex hormones on stimulant consumption in females. A systematic search of peer-reviewed literature identified 1593 articles, screened using the following inclusion criteria: (1) adult female humans or animals, (2) using stimulant drugs, (3) ovarian sex hormones were administered exogenously OR were measured in a validated manner and (4) with stimulant consumption as an outcome measure. A total of 50 studies (3 clinical and 47 preclinical) met inclusion criteria. High-estrogen (low progesterone) phases of the menstrual/estrus cycle were associated with increased stimulant use in preclinical studies, while there were no clinical studies examining estrogen and stimulant consumption. Consistent preclinical evidence supported progesterone use reducing stimulant consumption, which was also identified in one clinical study. The review was limited by inconsistent data reporting across studies and different protocols across preclinical laboratory paradigms. Importantly, almost all studies examined cocaine use, with impact on methamphetamine use a significant gap in the existing evidence. Given the safety and tolerability profile of progesterone, further research is urgently needed to address this gap, to explore the potential therapeutic utility of progesterone as a treatment for stimulant use disorder.

Adolescent chronic intermittent toluene inhalation dynamically regulates the transcriptome and neuronal methylome within the rat medial prefrontal cortex.

Inhalants containing the volatile solvent toluene are misused to induce euphoria or intoxication. Inhalant abuse is most common during adolescence and can result in cognitive impairments during an important maturational period. Despite evidence suggesting that epigenetic modifications may underpin the cognitive effects of inhalants, no studies to date have thoroughly investigated toluene-induced regulation of the transcriptome or discrete epigenetic modifications within the brain. To address this, we investigated effects of adolescent chronic intermittent toluene (CIT) inhalation on gene expression and DNA methylation profiles within the rat medial prefrontal cortex (mPFC), which undergoes maturation throughout adolescence and has been implicated in toluene-induced cognitive deficits. Employing both RNA-seq and genome-wide Methyl CpG Binding Domain (MBD) Ultra-seq analysis, we demonstrate that adolescent CIT inhalation (10 000 ppm for 1 h/day, 3 days/week for 4 weeks) induces both transient and persistent changes to the transcriptome and DNA methylome within the rat mPFC for at least 2 weeks following toluene exposure. We demonstrate for the first time that adolescent CIT exposure results in dynamic regulation of the mPFC transcriptome likely relating to acute inflammatory responses and persistent deficits in synaptic plasticity. These adaptations may contribute to the cognitive deficits associated with chronic toluene exposure and provide novel molecular targets for preventing long-term neurophysiological abnormalities following chronic toluene inhalation.

Pregabalin misuse-related ambulance attendances in Victoria, 2012-2017: characteristics of patients and attendances.

OBJECTIVE: To compare changes in pregabalin prescribing and misuse-related ambulance attendances; to characterise the patients attended by paramedics for pregabalin misuse-related harms; to assess the association of pregabalin misuse with use of other sedatives and with suicidal ideation and self-harm; to compare the characteristics of pregabalin misuse-related harms in people who misuse pregabalin according to whether or not they also used other sedatives. DESIGN, SETTING, PARTICIPANTS: Retrospective analysis of data on ambulance attendances in Victoria, January 2012 - December 2017, for which pregabalin misuse-related harms were a contributing factor. MAIN OUTCOME MEASURES: Rates of pregabalin misuse-related ambulance attendances, pregabalin prescription rates (each 6-monthly); patient characteristics, including age, sex, history of drug misuse or psychiatric problems, concurrent use of other sedatives, and current suicidal ideation and self-harm. RESULTS: There were 1201 pregabalin misuse-related attendances during the study period; the rate increased from 0.28 cases per 100 000 population in the first half of 2012 to 3.32 cases per 100 000 in the second half of 2017. The attendance rate was strongly correlated with prescription rates in Australia (r = 0.90; P = 0.001). 593 attendances (49%) were for people with a history that may have contraindicated prescribing pregabalin. Pregabalin was frequently misused with other sedatives (812 attendances, 68%), particularly benzodiazepines (440, 37%); 472 attendances (39%) were associated with suicide attempts. People who misused pregabalin with other sedatives more frequently presented with moderate to severe impairments of consciousness, but the frequency of suicide attempts was similar whether other sedatives were concurrently used or not. CONCLUSIONS: Rates of pregabalin misuse-related ambulance attendances in Victoria have increased markedly over the past 6 years. Caution is required when prescribing pregabalin for people taking other sedatives. Limiting the dispensing of this drug may reduce the risks associated with its misuse.

Adolescent Inhalant Abuse Results in Adrenal Dysfunction and a Hypermetabolic Phenotype with Persistent Growth Impairments.

BACKGROUND/AIMS: Abuse of toluene products (e.g., glue-sniffing) primarily occurs during adolescence and has been associated with appetite suppression and weight impairments. However, the metabolic phenotype arising from adolescent inhalant abuse has never been fully characterised, and its persistence during abstinence and underlying mechanisms remain unknown. METHODS: Adolescent male Wistar rats (post-natal day 27) were exposed to inhaled toluene (10,000 ppm) (n = 32) or air (n = 48) for 1 h/day, 3 days/week for 4 weeks, followed by 4 weeks of abstinence. Twenty air rats were pair-fed to the toluene group, to differentiate the direct effects of toluene from under-nutrition. Food intake, weight, and growth were monitored. Metabolic hormones were measured after exposure and abstinence periods. Energy expenditure was measured using indirect calorimetry. Adrenal function was assessed using adrenal histology and hormone testing. RESULTS: Inhalant abuse suppressed appetite and increased energy expenditure. Reduced weight gain and growth were observed in both the toluene and pair-fed groups. Compared to the pair-fed group, and despite normalisation of food intake, the suppression of weight and growth for toluene-exposed rats persisted during abstinence. After exposure, toluene-exposed rats had low fasting blood glucose and insulin compared to the air and pair-fed groups. Consistent with adrenal insufficiency, adrenal hypertrophy and increased basal adrenocorticotropic hormone were observed in the toluene-exposed rats, despite normal basal corticosterone levels. CONCLUSIONS: Inhalant abuse results in negative energy balance, persistent growth impairment, and endocrine changes suggestive of adrenal insufficiency. We conclude that adrenal insufficiency contributes to the negative energy balance phenotype, potentially presenting a significant additional health risk for inhalant users.

Presence of alcohol and other drug use within youth mental health presentations to the emergency department: A single-site retrospective observational study.

OBJECTIVE: Youth mental health is a growing issue, which can be worsened by alcohol and other drug (AOD) use. The present study aimed to characterise the association of AOD use in youth presenting to an ED with a mental health crisis. METHODS: A retrospective observational study of paediatric patients presenting with mental health concerns to a tertiary ED in New Zealand in 2019-2020, with an examination of use of alcohol or other drugs before presentation. RESULTS: There were 842 ED presentations, made up of 491 unique individuals, examined from the 2-year period. Overdose (63.1%) was the most common reason for presentation, with 39.9% of overdoses involving prescription-only medications, 36.7% over-the-counter, and 20.0% a combination. Seventy-four (8.8%) presentations had documented use of alcohol or other drugs (excluding those taken in overdose) before arrival, with alcohol (51 presentations), followed by cannabis (19 presentations), being the most commonly recorded drugs used. Concurrent AOD use was not associated with any significant difference in triage, length of stay or admission status. CONCLUSION: In New Zealand, it is not legal to sell alcohol to persons under 18 years; however, this was the most commonly identified drug impacting on youth mental health presentations. There is a known association between alcohol use and adverse mental health symptoms; therefore, efforts to decrease access to alcohol in this age group must continue, and harm reduction interventions to reduce clinically significant overdoses recommended.

Quantifying access to on-demand alcohol in New Zealand.

INTRODUCTION: On-demand delivery (<2 h from ordering) of alcohol is relatively new to New Zealand. We aimed to quantify the number of services available and the number of outlets available to purchase from within on-demand services. We then tested whether access differed by neighbourhood demographics. METHODS: We identified six on-demand alcohol services and quantified access to these in Auckland, Wellington and Christchurch. Eighty-one addresses were sampled according to three variables: (i) density of physical alcohol outlet tertile; (ii) socio-economic deprivation tertile; and (iii) areas within the top 20th percentile of Maori within each city. RESULTS: The median number of alcohol outlets to purchase from across all on-demand delivery services was five, though this was higher in Christchurch. For all three cities combined, and for Wellington, the number of outlets available on-demand was highest in areas with the highest density of physical outlets. However, the number of outlets available virtually was not associated with physical outlet density in Auckland or Christchurch. There were no significant differences in access observed for neighbourhood socio-economic deprivation. DISCUSSION AND CONCLUSIONS: On-demand delivery services are changing local alcohol environments, and may be increasing overall access to alcohol at a neighbourhood level. On-demand access patterns do not consistently reflect the physical alcohol environment. The current legislative and policy environment in New Zealand pre-dates the emergence of on-demand alcohol services. Local councils need to consider 'virtual' access as well as physical access when developing Local Alcohol Policies.

Changes in alcohol-related emergency department presentations-a comparison of three waves in 2013, 2017 and 2022.

AIMS: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. METHODS: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November-December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. RESULTS: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. CONCLUSION: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.

Defining and measuring 'inhalant' use in population-based surveys.

BACKGROUND: The term 'inhalants' is commonly used to describe a group of drugs that are characterised by the route of administration. There are three main sub-groups of inhalants; volatile solvents, alkyl nitrites, and nitrous oxide. These drugs all have different pharmacological properties, use patterns, and potential harms; yet they are sometimes grouped together in survey instruments. This critical review aimed to present a comparative analysis of how these inhalant drugs are defined, and use measured, across a range of population-level drug use surveys. METHODS: Population-level drug use surveys of youth (n=5) and general population (n=6), which measured use of at least once type of inhalant drug, were analysed as case studies. The types of inhalants surveyed were extracted, as well as definitions of these drugs, from code books or survey methods. RESULTS: Differing definitions were used between surveys, and included differences between countries, and between surveys intended to measure youth and general population drug use. Of the six general population surveys; five reported nitrous oxide use, five reported volatile solvent use, and four reported alkyl nitrite use. Of the five youth-specific surveys; three reported volatile solvent use, whereas only one reported on alkyl nitrite use, and one reported nitrous oxide use. CONCLUSIONS: There is no consistent approach used to define or measure the use of inhalant drugs, which has implications for global comparisons and understanding drug use in different populations. We conclude that the term 'inhalants' should be discontinued, due to the limited value in continuing to group very different types of drugs solely on the basis of their route of administration. Improving the epidemiology of volatile solvents, alkyl nitrites, and nitrous oxide as distinct drug types will be of benefit to harm reduction, treatment, and prevention efforts, and ensure these are targeted appropriately to population groups and context of use.

A policy analysis of how alkyl nitrites (poppers) became prescription-only in Aotearoa New Zealand.

BACKGROUND: Alkyl nitrites ('poppers') are a group of drugs that includes amyl nitrite, butyl nitrite, and isopropyl nitrite. Their use is prevalent among men who have sex with men (MSM), to enhance sexual comfort and pleasure. In Aotearoa New Zealand, all alkyl nitrites became prescription-only from March 2020. With alkyl nitrites no longer sold locally in stores, and no availability via pharmacies (even with a prescription), access has been significantly reduced. This decision was opposed by advocacy groups and people who use alkyl nitrites. This policy case study explores how this decision was made and impacts on MSM. METHODS: We use policy formation theory; both policy framing and Multiple Streams Framework, to analyse factors that contributed to this regulatory decision. Analysis of issue framing by policy coalitions was undertaken through review of documents including submissions and committee minutes. RESULTS: Two policy coalitions emerged, which differed in their issue framing. The Medicines Classification Committee conveyed concerns about evidence limitations, and recommended reclassification. NGOs and people who use alkyl nitrites communicated that there was no evidence of harm from alkyl nitrite use in New Zealand, and thus, given that there was evidence of benefit, the status quo should be maintained and further regulatory responses were unnecessary. Pre-existing processes created a situation where alkyl nitrite scheduling came unexpectedly onto the New Zealand policy agenda, and set the issue onto a somewhat pre-determined pathway with limited policy choices available. CONCLUSIONS: As a drug policy case study, it appears that reclassification was initiated due to a policy process that did not enable or support plausible alternatives. While the purpose of the reclassification was to improve safety, there was no evidence of harm prior to reclassification, and the reduction in access is likely to have increased harm for MSM.

Online on-demand delivery services of food and alcohol: A scoping review of public health impacts.

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy.

The New Zealand drug harms ranking study: A multi-criteria decision analysis.

AIMS: The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth. METHODS: Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software. RESULTS: When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others. CONCLUSIONS: The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Measuring drug harm in New Zealand: a stocktake of current data sources.

AIMS: The availability of legal and illegal drugs is widespread across New Zealand. All drugs have the potential to cause harm to those who use them, and to others. Understanding the nature and extent of these harms depends upon the ongoing and systematic collection of relevant data, which is crucial in achieving the current national policy goal of minimising drug harm. Thus, we aim to describe how information on drug harm is currently collected and measured in New Zealand. METHODS: This article maps and evaluates harm data within New Zealand, explores data collection methods and timing, and identifies the substances and types of harm assessed to date. We review large and predominantly administrative datasets that provide a measure of harm, which are collected more than once and/or are updated periodically. RESULTS: We highlight a number of key gaps and limitations that exist within the current data landscape, and outline barriers to ensuring greater utilisation. We recommend more frequent data collection, including improved data on harms to others, and inclusion of a wider range of drugs. CONCLUSIONS: Implementation of these recommendations will improve the understanding of comprehensive drug harm in New Zealand, to guide effective local harm reduction policies and interventions.

Describing and characterising on-demand delivery of unhealthy commodities in New Zealand.

OBJECTIVE: To determine the geographical location and characteristics of on-demand delivery services operating in New Zealand. METHODS: We systematically searched the web and application (app) stores for on-demand services offering rapid delivery of food, alcohol, cigarettes or vaping products in New Zealand and mapped their geographic location as of May 2021. Using desktop review, data on service characteristics were collected and stratified including: types of commodities available, promotion strategies, and the legal aspects of access to age-restricted items. RESULTS: On-demand services for food, alcohol and nicotine products operate across urban and rural New Zealand. All services offered personal memberships and 97% used promotions. All services offering restricted items had an age verification process, however, only 87% had birth date entry and 73% had an 18+ message pop-up on website entry. Only 60% of services appeared to have number limits on restricted items. CONCLUSIONS: Much of New Zealand is serviced by on-demand delivery services. IMPLICATIONS FOR PUBLIC HEALTH: The trend towards on-demand delivery services may increase unhealthy food, alcohol and nicotine-related harms and it undermines current government actions, e.g. the Smokefree 2025 goal. This research informs policy to reduce the future health burden.

Acute alcohol use and suicide deaths: an analysis of New Zealand coronial data from 2007-2020.

AIMS: Acute alcohol use is a proximal risk factor for suicide. However, the proportion of suicide deaths involving acute alcohol use has not been quantified in New Zealand. We sought to quantify and characterise the association between acute alcohol use and suicide. METHODS: Data for all suicides (≥15 years) between July 2007 and December 2020 were drawn from the National Coronial Information System. Acute alcohol use was defined as blood alcohol concentration (BAC) >50mg/100mL. Logistic regression was used to compare characteristics between suicide deaths with and without acute alcohol use. RESULTS: Twenty-six point six percent of suicide deaths involved acute alcohol use. No difference in the association was found by sex (male AOR: 0.87 (95%CI: 0.74,1.02)). Ethnicity differences were identified (Maori AOR: 1.20 (95%CI: 1.01,1.42), Pacific AOR: 1.46 (95%CI: 1.10,2.00)). Those aged 15-54 years had similar risks of suicide involving acute alcohol use, with a lower association in older age groups. CONCLUSIONS: Acute alcohol use was identified in approximately one quarter of suicides, with stronger associations in those of Maori and Pasifika ethnicity, and those aged <55 years. Acute alcohol use is a significant but modifiable risk factor for suicide in New Zealand.

Food Outlet Access and the Healthiness of Food Available 'On-Demand' via Meal Delivery Apps in New Zealand.

Access to unhealthy commodities is a key factor determining consumption, and therefore influences the prevalence of non-communicable diseases. Recently, there has been an increase in the availability of food 'on-demand' via meal delivery apps (MDAs). However, the public health and equity impacts of this shift are not yet well understood. This study focused on three MDAs in New Zealand and aimed to answer (1) what is the health profile of the foods being offered on-demand, (2) how many food outlets are available and does this differ by physical access or neighbourhood demographics and (3) does the health profile of foods offered differ by physical access or neighbourhood demographics? A dataset was created by sampling a set of street addresses across a range of demographic variables, and recording the menu items and number of available outlets offered to each address. Machine learning was utilised to evaluate the healthiness of menu items, and we examined if healthiness and the number of available outlets varied by neighbourhood demographics. Over 75% of menu items offered by all MDAs were unhealthy and approximately 30% of all menu items across the three MDAs scored at the lowest level of healthiness. Statistically significant differences by demographics were identified in one of the three MDAs in this study, which suggested that the proportion of unhealthy foods offered was highest in areas with the greatest socioeconomic deprivation and those with a higher proportion of Maori population. Policy and regulatory approaches need to adapt to this novel mode of access to unhealthy foods, to mitigate public health consequences and the effects on population groups already more vulnerable to non-communicable diseases.

Exploring the link between adolescent inhalant misuse and suicidal behaviour: a behavioural toxicology perspective.

Adolescent inhalant misuse has a known association with suicidal thoughts and behaviour. This association persists even after inhalant misuse has ceased. Previous studies have hypothesised that this association may derive from socioeconomic disadvantage or vulnerability, and potentially mediated by impulsivity. This association may also be due to the central nervous system depressant effects of inhalants. This review takes a behavioural toxicology perspective, focussed particularly on the serotonergic system and the Hypothalamic-Pituitary-Adrenal (HPA) axis, as potential links between adolescent inhalant misuse and suicidal behaviour. The challenges of bridging the pre-clinical and clinical literature in this area are discussed, along with promising avenues for future research; ultimately aimed at reducing suicide risk in a vulnerable adolescent population group.

Nutritional and metabolic alterations arising from stimulant use: A targeted review of an emerging field.

People with stimulant use disorders are usually underweight. Current accepted knowledge is that they are skinny because stimulants suppress appetite - they eat less. But is it that simple? Here we review the relationship between stimulant use, food intake, metabolism and body weight, and highlight key points that may challenge current knowledge: 1) Stimulants interact with the hormonal signals that regulate appetite including ghrelin and leptin, and can produce long-term alterations in the ability to monitor and compensate energy deficits. 2) The diet of people with stimulant use disorders might be characterised by altered nutritional geometry, rather than overall reduction of food intake. 3) Long-term changes in homeostatic signals and nutrient intake can produce metabolic deficits that contribute to unhealthy low weight. Based on this knowledge we advocate for increasing awareness about the nuances of stimulant-related nutritional and metabolic deficits among addiction clinicians, and increased research on the interaction between stimulant use, appetite signaling, and metabolic deficits.

Access to primary care services using public transport in Otautahi Christchurch.

AIMS: Lack of transport is a contributor to poor access to healthcare and missed appointments. This research aimed to understand the accessibility of primary care for patients using public transport in Otautahi Christchurch, and to describe spatial and social distribution. METHODS: We measured access to primary care using geospatial analysis based on the time taken to reach the nearest general practice, the number of practices accessible within given time thresholds and the frequency of public transport services. Results are disaggregated by ethnicity, age, socioeconomic deprivation and car ownership. RESULTS: The poorest levels of access were in areas with the least deprivation and a greater NZ European population. Children aged 5-14 had low levels of access. Only 58.4% of the population in the most deprived areas had access to high-frequency bus services. CONCLUSIONS: This study highlights connectivity gaps between public transport and primary healthcare for key groups known to have a greater dependence upon public transport and poorer health outcomes. From an equity perspective, it highlights the need for further investigation into transport and health solutions to improve access to primary care for lower socioeconomic groups.