Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

OBJECTIVE: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. METHODS: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. RESULTS: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. CONCLUSIONS AND IMPLICATIONS: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

Assessment of alcohol consumption among hepatitis C-positive people receiving opioid maintenance treatment using direct ethanol metabolites and self-report: a pilot study.

This study was conducted to identify the alcohol consumption among hepatitis C-positive people receiving opioid maintenance therapy using self-report and biomarkers. A total of 49 people (28 male, 21 female) were hepatitis C virus (HCV) positive and were included. The alcohol use disorder identification test (AUDIT) and self-reported ethanol intake in the last 28 days were assessed. In addition to gamma-glutamyl-transferase (GGT) and mean corpuscular volume (MCV), ethyl glucuronide (EtG) and ethyl sulphate (EtS) were determined in serum and urine (UEtG, UEtS, SEtG) using liquid chromatography/tandem mass-spectroscopy (LC/MS-MS) with deuterated internal standards. Abstinence from alcohol was reported for the last 28 days by 13 participants and for the last 7 days by 22. AUDIT was > 8 in 27 cases. The maximum values were 34.8 mg/l for UEtG, 5.3 mg/l for UEtS and 0.15 for SEtG. Among the 19 UEtG positives, 8 had not reported any ethanol intake in the 7 days prior to the study. Six participants reported intake of up to 320 g of ethanol in the last 7 days, but were negative for SEtG, UEtG and UEtS. Self-reported ethanol intake in the last 28 days correlated with AUDIT score (r = 0.733, P < 0.001), with the direct ethanol metabolites and MCV. In this population, abstinence and episodic heavy drinking are more common than in the general population. Episodic heavy drinking is a significant cause of acute risk in this population. Results from biomarker testing could indicate cases of under- as well as over-reporting of alcohol consumption. Further research on the diagnostic accuracy of direct ethanol metabolites, including the use of phosphatidylethanol (PEth), in this setting is needed.

The role of television advertising in increasing pneumococcal vaccination coverage among the elderly, North Coast, New South Wales, 2006.

North Coast Area Health Service (NCAHS) conducted a seven week television advertising campaign to raise community awareness of the availability of free adult pneumococcal vaccination and to increase coverage among North Coast residents in high risk groups. Effectiveness of the campaign was evaluated by examining vaccine ordering patterns of North Coast vaccination providers from 2005/2006 as a proxy for vaccination coverage. In the months during and immediately following (June-September 2006) the advertising campaign, a significantly higher proportion of vaccines were despatched to North Coast immunisation service providers. The advertising campaign was an effective strategy to promote vaccination among NCAHS residents not immunised in the first year of the National Pneumococcal Program for Older Australians. This higher immunisation coverage is expected to contribute to the statewide trend of significant reductions in invasive pneumococcal disease (IPD) notifications.

Pregnant smokers are receptive to smoking cessation advice and use of nicotine replacement therapy.

Pregnant women who identified themselves as smokers were surveyed to ascertain their attitudes towards and likelihood of using nicotine replacement therapy (NRT) if it were to be provided free of charge at antenatal clinics. Smokers were asked to participate in a brief anonymous survey to identify current levels of smoking, nicotine dependence, attitudes towards cessation, use of cessation aids and whether they would use free NRT if it were provided with support at antenatal clinics. The majority of women were supportive of NRT being offered to pregnant smokers (87%), and 64% reported they would be very likely to use NRT if it were offered free from the antenatal clinic. These results provide strong support for a comprehensive cessation strategy implemented in antenatal clinics.

Lessons from a respiratory illness outbreak in an aged-care facility.

This report outlines practical lessons learnt from an influenza-like outbreak in an aged-care facility in NSW, which affected 26 residents, resulted in 14 hospital admissions and was associated with six deaths. No common causative agent was identified. Key recommendations include: encouraging aged-care facilities to establish mechanisms that improve the early identification of outbreaks and timely implementation of outbreak control strategies; identifying strategies to inform general practitioners of outbreaks if they have patients residing in aged-care facilities; and improving the vaccination coverage of the aged-care workforce.

Methadone in pregnancy: treatment retention and neonatal outcomes.

AIM: To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. DESIGN: Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. MEASUREMENTS: Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. FINDINGS: There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. CONCLUSION: Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented.

Substance use, psychological distress and violence among pregnant and breastfeeding Australian women.

OBJECTIVE: To identify the population prevalence and demographic characteristics of pregnant and/or breastfeeding Australian women who use licit and illicit substances and their experience of psychological distress and violence. METHODS: Data from the 2004 National Drug Strategy Household Survey were used to determine the prevalence of substance use, psychological distress and violence experienced by pregnant and/or breastfeeding women. RESULTS: A total of 976 pregnant and/or breastfeeding women were included. These women were significantly less likely than non-pregnant women to consume alcohol (47% vs. 85%) or any illicit drug (6% vs. 17%); however, there was no significant difference in tobacco smoking (20% vs. 25%). Self-reported psychological distress was significantly more frequent in the non-pregnant group (42%) than in the pregnant group, irrespective of substance use status. At a population level, pregnant and/or breastfeeding women were not at a heightened risk of psychological distress or violence. DISCUSSION: These findings highlight the importance of targeting older, tertiary-educated and relatively affluent mothers and those living in regional areas for drug and alcohol education campaigns and treatment. IMPLICATIONS: Simplifying the National Health and Medical Research Council pregnancy-specific alcohol guidelines, improving clinician training, and increasing the availability of treatment options in rural and regional areas may assist in the identification, referral and provision of assistance to substance using pregnant/breastfeeding women.

Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment.

Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study.

Bug breakfast in the bulletin: human papilloma virus.

The Bug Breakfast topic for October was Human Papilloma Virus (HPV). The presenters covered the epidemiology of HPV, the newly introduced HPV vaccine and social and psychological issues relating to HPV vaccination.

Australia's national Q fever vaccination program.

A nationally funded Q fever vaccination program was introduced in Australia in 2002. The evaluation of this unique program included measures of program uptake, safety, and notification and hospitalisation rates for Q fever pre- and post-program implementation. Program uptake ranged from close to 100% amongst abattoir workers to 43% in farmers. The most commonly reported adverse event was injection site reaction. Q fever notification rates declined by over 50% between 2002 and 2006, particularly in young adult males, consistent with the profile of the abattoir workforce. Hospitalisation data showed similar trends. Available evidence suggests a significant impact of Australia's Q fever vaccination program; such a program merits consideration in other countries with a comparable Q fever disease burden.

Methamphetamine use, dependence and treatment access in rural and regional North Coast of New South Wales, Australia.

INTRODUCTION AND AIMS: To identify the sociodemographic, health, drug use patterns, treatment coverage and barriers to treatment among regular methamphetamine users in rural and regional North Coast of New South Wales. DESIGN AND METHODS: A structured questionnaire was used to measure sociodemographic factors, health and well-being, drug use patterns, methamphetamine dependence, engagement in methamphetamine treatment and barriers to treatment. Participants were 140 regular methamphetamine users. Dependent and non-dependent participants were compared to identify factors associated with dependence. RESULTS: Participants were predominantly in their thirties, male and had low levels of education, high levels of unemployment and polydrug use. Participants who were dependent on methamphetamine (59%) were more likely to report impaired mental health and to have been diagnosed with depression, anxiety and drug-induced psychosis. One quarter of dependent methamphetamine users had received treatment in the last year and half had ever received treatment. The main barriers to receiving treatment were a lack of perceived need or motivation to seek treatment and concerns about confidentiality. DISCUSSION AND CONCLUSIONS: Methamphetamine users living on the North Coast of New South Wales require treatment options tailored to address a complex array of physical and psychological problems. The findings highlight the need for psychiatric support and improved coordination between mental health and drug and alcohol services in rural and regional areas.

Smoking patterns and outcomes in a population of pregnant women with other substance use disorders.

Using a retrospective cross-sectional study design, we examined smoking patterns and associated neonatal outcomes in infants born to women with a diagnosis of a substance use disorder in pregnancy. Antenatal and birth admissions were linked to midwives data on pregnancy care, services, and outcomes over a 5-year period (1998-2002). Birth admissions were flagged as positive for drug use where a birth admission or any pregnancy admission for that birth involved a cannabis-, opioid-, stimulant-, or alcohol-related ICD-10AM code. There were 4,346 live births to women with a substance-related diagnosis in pregnancy. Women with a substance-related diagnosis (the drug group) had an adjusted odds ratio for smoking during pregnancy of 10.8 (95% CI = 9.9-11.7) relative to women without a substance-related diagnosis (the non-drug group). Women in the drug group also were heavier smokers; 26% smoked 1-10 cigarettes/day and 56% smoked more than 10 cigarettes/day compared with 8% in both groups in the non-drug group. Relative to the drug group, the adjusted odds ratio for quitting smoking during pregnancy in the non-drug group was 3.1 (95% CI = 2.3-4.3). Among women in the drug group, any smoking significantly increased the risk of poor fetal growth, prematurity, and admission to the special care nursery. In conclusion, innovative and effective strategies for tobacco cessation should target pregnant women as a high priority. Further research should identify the models of tobacco cessation most suited to women who also use other substances during pregnancy.

Evaluation of a community-driven preventive youth initiative in Arnhem Land, Northern Territory, Australia.

INTRODUCTION AND AIMS: We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. DESIGN AND METHODS: Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. RESULTS: Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. DISCUSSION AND CONCLUSIONS: Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.

Effects of a web based decision aid on parental attitudes to MMR vaccination: a before and after study.

OBJECTIVE: To determine whether an evidence based decision aid on the measles, mumps, and rubella (MMR) vaccine changed parents' attitudes towards vaccination. DESIGN: Before and after study. SETTING: Website promoted through search engines and online parenting and health websites. PARTICIPANTS: 158 people completing online questions out of 1277 who accessed the website. INTERVENTION: Evidence based decision aid with text and graphical representation of the possible outcomes of measles, mumps, and rubella diseases compared with MMR vaccination. MAIN OUTCOME MEASURES: Attitudes towards MMR vaccination. RESULTS: Significantly more participants indicated they were "leaning towards" vaccination after using the decision aid (39% before v 55% after, P < 0.001). Compared with those who were undecided or "leaning away from" vaccination after using the decision aid, participants "leaning towards" it were more likely to strongly value its potential to protect their children from the serious side effects of disease (98% v 84%) and other children who could not be vaccinated for medical reasons (68% v 25%). Participants with an unfavourable attitude to vaccination were more likely to be very concerned about the rare side effects of vaccination (78% v 57%), have residual concerns about autism and bowel disease (78% v 27%), and anticipate guilt should their child have an adverse reaction (77% v 50%). Those with a positive attitude to vaccination after using the decision aid were also more likely to feel well informed (83% v 48%). CONCLUSIONS: A web based decision aid significantly improved parental attitudes to MMR vaccination. Residual concerns about autism and bowel disease and the rare chance of serious complications remained as attitudinal barriers to some parents.