National Drug Strategy Household Survey Research Articles

Estimates and predictors of alcohol-related harm to intimate partners in Australia An analysis of a nationally representative survey

Aims: This study explores the prevalence and predictors reported in 2019 by men and women of alcohol-related intimate partner violence (ARIPV), that is, verbal abuse, physical abuse, and being put in fear by intimate partners, when partners were under the influence of alcohol. Methods: Secondary data analysis of the 2019 Australia’s cross-sectional National Drug Strategy Household Survey included 22,015 respondents aged 14 years or older (9,804 men, and 12,211 women). The prevalence of ARIPV and each type of ARIPV (verbal abuse, physical abuse, and being put in fear) in the past year is described, and the predictors of all are analysed using chi-square tests and logistic regressions, overall and separately for men and women. Results: An estimated 3.4% of the Australian adult population (4.7% women, 2.1% men) reported ARIPV in 2019. The prevalence of ARIPV was higher among the participants who were women, middle-aged (35-44 years), had a certificate or diploma, were less advantaged, were divorced, separated, or widowed, single with dependents, living in more regional, and remote areas, and undertook heavy episodic drinking (HED) weekly or less often. Age, marital status, household composition, and weekly, monthly, or ever HED predicted ARIPV for women, while higher education levels and weekly or monthly HED were significant for men. Discussion and conclusions: Women were twice as likely to report intimate partner violence (IPV) from their male partner when they were under the influence of alcohol, as were men. The findings underline that interventions are needed to address IPV from intoxicated partners.

Factors associated with very high-risk drinking in the Australian general population: How do men and women compare?

Despite vulnerability to alcohol-related harms, women have historically been under-represented in alcohol research. This study examined the prevalence and characteristics of women who drink at very high-risk levels (11+ standard drinks monthly), factors associated with this consumption and comparisons with men. Secondary analyses of 2019 National Drug Strategy Household Survey data were undertaken. Significant differences by sex in the distribution of demographic and alcohol-related variables were explored using chi-squared and Mann-Whitney U tests. Binary logistic regression examined factors associated with very high-risk drinking. Very high-risk drinking was reported by 10.4% of men and 3.1% of women. Compared to men, women were significantly younger with higher levels of psychological distress/mental health conditions, and were more likely to be unmarried. Both women and men engaged in a range of harm-minimisation strategies. Odds of very high-risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked and used illicit drugs. Interactions with sex indicated that very high-risk drinking declined after the age of 24 for men compared to 44 for women. Being married reduced the likelihood of very high-risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (and not women). Very high-risk drinking is not limited to Australian men, and the women who drink at these levels have distinct profiles and factors associated with consumption.

Participation in Australian drug treatment programs for individuals engaging in high-risk substance use: Data from a nationally representative sample.

Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.

Alcohol-Attributable Death and Burden of Illness among Aboriginal and Non-Aboriginal Populations in Remote Australia, 2014-2018.

Harmful use of alcohol is a problem in the Northern Territory (NT), Australia. The aim of this study was to assess and compare alcohol-attributable deaths and the contribution of alcohol to the burden of disease and injury (BOD) among the Aboriginal and non-Aboriginal populations in the NT between 2014 and 2018. The alcohol-use data for adults aged 15+ years old in the NT population was taken from the 2016 National Drug Strategy Household Survey. BOD was measured in disability-adjusted life years (DALY) as part of the NT BOD study. Population-attributable fractions were derived to analyse deaths and BOD. Between 2014 and 2018, 673 Aboriginal and 392 non-Aboriginal people died of harmful use of alcohol, accounting for 26.3% and 12.9% of the total deaths in the Aboriginal and non-Aboriginal population, respectively. Alcohol caused 38,596 and 15,433 DALY (19.9% and 10.2% of the total), respectively, in the NT Aboriginal and non-Aboriginal population for the same period. The alcohol-attributable DALY rate in the Aboriginal population was 10,444.6 per 100,000 persons, six times the non-Aboriginal rate. This study highlights the urgent need to reduce harmful alcohol use in the NT, which disproportionately affects Aboriginal peoples in rural and remote areas.

Shifts in the Australian public's opinions towards alcohol policies: 2004-2019.

After a period of stagnation, alcohol policy in Australia has received increased attention in the past decade, with Sydney's lockout laws and Queensland's restrictions on trading hours garnering media attention. This study will investigate any changing trends in support towards alcohol policy and identify any demographic-specific shifts. Respondents from the National Drug Strategy Household Survey (conducted every 3 years from 2004 to 2019) were asked to gauge their level of support for 16 alcohol policy items proposed to reduce the problems associated with excessive alcohol use. Mean levels of support for various policy options, as well as demographic predictors of support, were assessed. After an increase from 2004 to 2013, support for more evidence-based policies on alcohol (e.g., restricting the availability of alcohol) has decreased since 2013. Support for policy items that focus less on the restriction of the availability of alcohol and more on education remained relatively stable in comparison. While demographic groups continue to vary in their extent of support, shifts appear to be occurring fairly uniformly across sex, age, states and drinking groups. Support for public health-oriented alcohol policies has been decreasing since 2013. The introduction of high-profile policies and less of a media focus on alcohol may be contributing to decreases in support.

Dose-response relationship between alcohol consumption and workplace absenteeism in Australia.

Workplace absenteeism is a burden in Australia. The estimated productivity losses due to alcohol were around $4.0 billion in 2017, with absenteeism driving 90% of these costs. We aim to determine the dose-response relationship between average daily alcohol consumption and heavy episodic drinking (HED) frequency and workplace absenteeism amongst Australian workers. We used the 2019 National Drug Strategy Household Survey of Australian employed workers aged ≥20 years to 69 years old. Respondents' average daily alcohol consumption was categorised into four: abstainers, light to moderate (1-20 g of alcohol/day), risky (>20-40 g of alcohol/day) and high-risk (>40 g of alcohol/day). HED was classified into four frequency measures (never, less than monthly, monthly, weekly). The outcome variables came from dichotomised measures of: (i) absence due to alcohol consumption; and (ii) broader sickness absence-absence due to illness or injury in the previous 3 months. Risky (adjusted odds ratio 4.74 [95% CI 2.93-7.64]) and high-risk drinking (adjusted odds ratio 6.61 [95% CI 4.10-10.68]) were linked to increased odds of alcohol-related absence. Higher HED frequency was significantly associated with alcohol-related and broader sickness absenteeism. No significant associations exist between regular alcohol consumption and broader sickness absence in fully adjusted models. Findings suggest that only HED is linked to broader sickness absence. However, there is a strong dose-response association between alcohol consumption and alcohol-related absences for both consumption measures amongst Australian workers. Population-level policies that reduce alcohol consumption to moderate level and less frequent HED might address workplace absenteeism.

Is the association between psychological distress and risky alcohol consumption shifting over time? An age-period-cohort analysis of the Australian population

This study explored age, period, and cohort effects associated with trends in psychological distress and risky alcohol consumption. Data came from 108,536 Australians aged 14-79 years old from birth cohorts between 1925-2005, endorsing past year alcohol use in the 2004-2019 Australian National Drug Strategy Household Surveys. Risky alcohol consumption was split into exceeding weekly national drinking limits (>10 drinks per week) or daily limits (>4 drinks per day). An extended hierarchical age-period-cohort model was used to investigate differential effects on trends in psychological distress. Psychological distress showed an inverse U-shape throughout the lifespan with a peak in distress at age 60. Exceeding weekly alcohol limits was positively related to psychological distress prior to age 40 while exceeding daily alcohol limits remained positively related across the lifespan. There were relatively flat period effects, with no alcohol-related changes in psychological distress across years. Lastly, psychological distress gradually increased across birth cohorts until a notable spike among Australians born from 1980-2005 alongside weakening alcohol-related cohort effects. Overall, the recent increases in psychological distress did not appear to be meaningfully explained by risky alcohol consumption though risky alcohol consumption remained an important factor to consider alongside psychological distress.

Who supports drug-checking services in Australia? An analysis of 2019 National Drug Strategy Household Survey data.

Drug-checking services can minimise the potential harms from drug use and have received increased attention in recent policy debates in Australia. In this brief report, we aim to better understand the prevalence of support for drug-checking services among individuals of certain demographic groups, social status and social attitudes towards drug and alcohol policy. This report uses data from the 2019 National Drug Strategy Household Survey, a national population study of alcohol and other drug use conducted triennially in Australia. We examined support for drug-checking services descriptively, alongside associations between demographic, social and substance use variables and support of drug-checking using Generalised Linear Model analyses with a Poisson distribution and log link. Overall, 56% of the sample supported policies related to drug-checking services. Support was highest among those aged 25-34 years (62%), most socioeconomically advantaged (66%), with an income over $104,000 (64%), with a bachelor's degree or higher (65%), living in major cities (58%), recent consumers of commonly tested drugs (88%) and other drugs (77%),and risky drinkers (64%). In the multivariable model, those who were younger, women and had the highest level of education were more likely to support the policy compared to those who were aged 55+ years, men and had lower levels of education. This report highlights that, while there were different degrees of support based on demographic characteristics, substance use status and social attitudes towards drug and alcohol policy, the overall majority of the sample supported the provision of drug-checking services.

Examining the association between psychological distress and alcohol use in Australian adolescents over a period of declining consumption.

Youth drinking rates have declined over the past 15 years while self-reported psychological distress has increased, despite a well-recognised positive relationship between the two. The current study aimed to identify changes in the relationship between psychological distress and alcohol use in adolescents from 2007 to 2019. This study used survey responses from 6543 Australians aged 14-19 years who completed the National Drug Strategy Household Survey in 2007, 2010, 2013, 2016 or 2019. Logistic and multivariable linear regressions with interactions (psychological distress × survey wave) predicted any alcohol consumption, short-term risk and average quantity of standard drinks consumed per day. Psychological distress was a positive predictor of alcohol use and this association remained stable across survey waves as alcohol consumption decreased. The relationship between distress and alcohol consumption remained relatively steady, even as youth drinking declined and distress increased. The proportion of drinkers experiencing distress did not increase as consumption rates dropped, suggesting that the decline in youth drinking is occurring independently of the increase in self-reported and diagnosed mental health issues.

Cask wine: Describing drinking patterns associated with Australia's cheapest alcohol.

In Australia, cask wine is the cheapest alcoholic beverage available, offering the lowest price per standard drink. Despite this, there is little research on the contextual correlates of cask wine consumption. Therefore, the current study aims to describe how cask wine consumption has changed over the last decade. Then, through comparisons between cask and bottled wine, how prices, typical drinking locations, and patterns of consumption differ between the beverages. Cross-sectional data was drawn from two sources. Four waves of the National Drug Strategy Household Survey were used (2010, 2013, 2016 and 2019) in order to examine consumption trends over time. The International Alcohol Control study (2013) in Australia was additionally used to explore pricing and consumption trends in greater detail. Cask wine was considerably cheaper than other forms of wine at $0.54 per standard drink (95% confidence interval [CI] 0.45-0.62, p < 0.05). Consumption trends associated with cask wine differed from that of bottled wine, being consumed almost entirely at home and in significantly greater quantity (standard drinks per day 7.8, 95% CI 6.25-9.26, p < 0.05). Among the heaviest drinkers, 13% (95% CI 7.2-18.8, p < 0.05) consumed cask wine as their main drink, compared to 5% (95% CI 3.76-6.24, p < 0.05) consuming bottled wine. Cask wine drinkers are disproportionately more likely to consume higher amounts of alcohol, paying less per drink doing so compared to bottled wine drinkers. As all cask wine purchases were under $1.30, a minimum unit price may largely affect cask wine purchases, applying to a far smaller proportion of bottled wine.

Who are Australia’s young heavy drinkers? a cross-sectional population study

ObjectiveIn light of the recent declines in youth drinking, the socio-demographic correlates of (1) annual total alcohol consumption (volume) and (2) monthly single occasion risky drinking among underage young people (14–17-year-olds) and young adults (18–24-year-olds) were examined. MethodsCross-sectional data were drawn from the 2019 National Drug Strategy Household Survey (n=1,547). Multivariable negative binomial regression analyses identified the socio-demographic correlates of total annual volume and monthly risky drinking. ResultsThose who spoke English as first language reported higher total volume and rates of monthly risky drinking. Not being in school predicted total volume for 14–17-year-olds, as did having a certificate/diploma for 18–24-year-olds. Living in affluent areas predicted a greater total volume for both age groups, and risky drinking for 18–24-year-olds. Young men in regional areas and working in labour and logistics reported higher total volume than young women in the same groups. ConclusionsThere are important differences among young heavy drinkers related to gender, cultural background, socio-economic status, education, regionality and work industry. Implications for public healthPrevention strategies that are sensitively tailored towards high risk groups (e.g. young men in regional areas and working in trade and logistics) may be of public health benefit.

Trends in cannabis use intention around the period of cannabis legalisation in Australia: An age-period-cohort model.

This study examines age, time period and birth cohort trends in cannabis use intention and weekly use in Australia over a period in which medicinal cannabis was legalised. Hierarchical age-period-cohort models were used to analyse the National Drug Strategy Household Survey between 2001 and 2019, including 158,395 participants aged 18-79 years. The hierarchical age-period-cohort model demonstrated a decrease in likelihood of intending to try cannabis as age increases. Similar age effects were found in intending to use cannabis as often or less often. There was broad-based shift in attitudes for people wanting to try cannabis (2007: b=-0.51 [-0.82, -0.21]; 2019: b=0.68 [0.38, 0.98]) or use cannabis more often (2007: b=-0.15 [-0.50, 0.20]; 2019: b=0.83 [0.49, 1.18]). The population trend of weekly cannabis use decreased in the earlier periods but increased since 2013 (b = -0.13 [-0.25, -0.02] vs 2019: b=0.06 [-0.09, 0.20]). This suggests that legalisation would increase uptake of cannabis and consumption among current consumers. There were distinctive inter-generation variations: people born between 1950s and 1960s had more liberal views towards cannabis use than people born before or after (p < 0.05). There were indications that young people born in the 1990 s are catching up with the baby boomers in using cannabis more often if it was legal. There has been a population-based shift in Australia in favourable attitudes towards cannabis use, more so among those born in the 1950s to 1960s than other generations. Liberal attitudes and more frequent cannabis use may put certain cohorts at higher risks of cannabis dependence and related harms.

Non-medical use of pharmaceutical opioids with and without other illicit substance use: Trends from two repeated nationally representative Australian surveys

BackgroundDue to concerns over the public health impact of increasing opioid use, Australia up-scheduled codeine in 2018, requiring codeine-containing pharmaceuticals to be prescription-only. We examined pre-post changes in the prevalence and correlates of non-medical use of pharmaceutical opioids (NMUPO) and other illicit substance use (ISU). MethodsWe conducted a cross-sectional analysis of 45,463 participants aged 14 or above in the Australian National Drug Strategy Household Surveys (NDSHS) 2016 and 2019. Participants were categorized based on their past 12 months NMUPO and ISU patterns. Correlates examined included socio-demographic, psychological (Kessler 10), health and behavioral variables. ResultsThe overall prevalence of any NMUPO decreased from 3.56% in 2016 to 2.65% in 2019, and the prevalence of codeine use from 2.98% to 1.49%. No significant changes were observed in the use of other types of painkillers (e.g. oxycodone and fentanyl) between 2016 and 2019. The overall decrease in NMUPO primarily occurred among people who used NMUPO only and did not use other illicit drugs. Older adults were more likely to report NMUPO only. Younger age, higher psychological distress, risky alcohol use, and daily smoking were associated with both NMUPO and illicit drug use. ConclusionsA comparison of cross-sectional data from two time-points showed that the prevalence of NMUPO use among people who used NMUPO exclusively was lower post-up-scheduling of codeine in Australia. However, NMUPO use did not reduce among people who used both NMUPO and other illicit drugs. Public health interventions are needed to reduce opioid-related harm in those who also used other illicit drugs.

Age, period and cohort effects on alcohol-related risky behaviours in Australia from 2001 to 2016.

The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol-related risky behaviour and to compare these trends between men and women. We used an age-period-cohort analysis of repeated cross-sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants were 121 281 people aged 14-80 years who reported consuming alcohol in the past 12 months. Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Controlling for age and cohort, cubic spline models showed that any alcohol-related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76-0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30-1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27-0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol-related risky behaviour (RR = 2.10, 95% CI = 1.84-2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81-2.43; 2002 PRR = 1.31, 95% CI = 1.03-1.68]. Alcohol-related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male-female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world-wide.

Age-period-cohort analysis of trends in tobacco smoking, cannabis use, and their co-use in the Australian population.

Background and aimThe prevalence of tobacco smoking has declined in most high‐income countries, while cannabis use has been rising. Moreover, cannabis use has been found to have increased among cigarette smokers in recent years in jurisdictions where it has been either decriminalized or legalized. This study measured trends in cannabis, tobacco and the co‐use of cannabis and tobacco in Australia.DesignAge–period–cohort analysis.Setting and participantsParticipants were n = 143 344 individuals aged 18–80 years who participated in Australia's National Drug Strategy Household Surveys (NDSHS) between 2001 and 2019.MeasurementsRegular (weekly/more frequently): (1) tobacco smoking only, (2) cannabis use only and (3) the co‐use of cannabis and tobacco.FindingsPrevalence of only smoking tobacco decreased in all age groups (P < 0.001) and birth cohorts between 2001 and 2019, but the co‐use of cannabis and tobacco did not. Younger cohorts were much less likely to co‐use tobacco and cannabis (P = 0.02). Period trends showed that both cannabis use only and the co‐use of cannabis and tobacco have increased since 2013.ConclusionThere has been a consistent decrease in exclusive tobacco smoking across age, period and birth cohorts between 2001 and 2019 in Australia, although there is a recent increasing period trend in cannabis use with or without tobacco. The non‐decreasing trend of co‐use may reflect the strong tobacco control policies introduced over the period and changing attitudes towards cannabis use in Australia.

Prevalence and correlates of cannabis use for medicinal reasons – An Australian cross-sectional study

ObjectiveIt is important to know the prevalence and source of medicinal cannabis use in the population because non-prescribed medicinal use of cannabis products places individuals at higher risk of harms. We estimated the prevalence and correlates of the use of cannabis for medicinal purposes in Australia, three years after Australians were given legal access. DesignCross-sectional. SettingThe 2019 Australian National Drug Strategy Household Survey. ParticipantsParticipants were 22,015 Australians aged 14 or above. Outcome measureSelf-reported cannabis use in the last 12 months for medicinal purposes only, both medicinal/recreational reasons, or recreationally only. Those who reported medicinal use were asked if it had been prescribed by a doctor. Prevalence estimates were weighted to the population and multinomial logistic regression examined the correlates. ResultsThe prevalence of any medicinal cannabis use in the past year was 2.6%. Only 0.8% of the sample reported using cannabis solely for medicinal reasons, 95.9% of whom did not have a prescription. A self-reported diagnosis of cancer was associated with medicinal use only. Self-reported chronic pain was associated with both medicinal only and medicinal/recreational use. Medicinal cannabis use was associated with opioids use. ConclusionsIn 2019, the prevalence of cannabis use solely for medicinal reasons remains under 1%, was more common among people with specific medical conditions, but most individuals do not have a prescription. The prevalence of self-reported medicinal cannabis use in Australia is low and there is limited use of the legal pathway for medicinal cannabis.

Effect of vaping on past-year smoking cessation success of Australians in 2019-evidence from a national survey.

Background and aimsPrevious analyses of the effect of e‐cigarettes on real world smoking cessation success have mainly been based on surveys undertaken in the United States and United Kingdom, where nicotine e‐cigarettes can be readily obtained. In Australia, regulations have made obtaining e‐cigarettes containing nicotine difficult. The effectiveness of e‐cigarette use as a smoking cessation aid in Australia might therefore be lower than survey‐based estimates published to date. This study aimed to estimate the effect of using e‐cigarettes for a smoking cessation attempt on past‐year smoking cessation success in Australia.DesignMultivariable logistic regression models for past‐year smoking cessation success.Setting and participantsRespondents to the 2019 wave of Australia's National Drug Strategy Household Survey who made a smoking cessation attempt in the 12 months leading up to the survey.MeasurementsPast‐year smoking cessation success was assumed if a smoking cessation attempt resulted in abstinence of more than a month at the time of the survey.FindingsIn 2019, Australians who attempted to quit smoking using e‐cigarettes achieved greater success than smokers attempting to quit without e‐cigarettes [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.09–2.60]. If people who only tried e‐cigarettes once or twice are considered not to have used e‐cigarettes, the estimated effect was slightly stronger (aOR = 1.98; 95% CI = 1.27–3.10). Also, the estimated odds ratio was higher among vapers who acquired their e‐cigarettes from overseas websites (aOR = 2.24; 95% CI = 1.02–4.93).ConclusionsUse of e‐cigarettes for a smoking cessation attempt appears to be associated with greater success among Australians who attempted to quit tobacco in 2019 compared with Australians attempting to quit without e‐cigarettes, after adjusting for confounding effects.

Monitoring changes in smoking and quitting behaviours among Australians with and without mental illness over 15 years

ObjectiveThis study examines smoking prevalence and quitting behaviours among Australians with and without mental illness. MethodsAnalysis of data from Australia's triennial National Drug Strategy Household Surveys 2004–2019. The prevalence of regular smokers, never smokers, the quit proportion, cigarette consumption, and use of cessation aids were examined for those with and without mental illness. ResultsAmong Australians with mental illness, there was a significant decrease in regular smokers and significant increases in never smokers and in the proportion of ever smokers who had quit between 2004 and 2019. Smokers with mental illness were generally as likely to attempt to quit and more likely to use cessation support; however, they were also more likely to report unsuccessful quit attempts. Smokers with mental illness who had quit reported lower levels of psychological distress than those still smoking. ConclusionSince 2004, there have been some encouraging trends in reducing tobacco use among people with mental illness; however, smoking rates remain substantially higher than among those without mental illness. Implications for public healthFindings highlight the importance of routinely identifying smokers with mental illness and improving access and adherence to best practice smoking cessation treatment.

Alcohol consumption, heavy episodic drinking and the perpetration of antisocial behaviours in Australia

AimsThis study aims to understand the dose-response relationship of the volume and patterns of alcohol consumption with alcohol-related antisocial behaviours (ASB) in the general population and assess whether these relationships are consistent across various sociodemographic subgroups. MethodsWe used data from 30,275 respondents aged (14−69) from two waves (2013 and 2016) of the National Drug Strategy Household Survey (NDSHS). Average daily alcohol consumption and heavy episodic drinking (HED) frequencies were treated as the main independent variables and self-reported ASB perpetration as the dependent variable. Bivariable and multivariable logistic regression models predicting ASB with interaction terms between alcohol consumption and various sociodemographic variables were estimated. FindingsCompared with low-risk drinking (0.01–20 g of alcohol/day), respondents drinking at risky (20.01–40 g of alcohol/day) and high risk (>40 g of alcohol per day) levels had an increased prevalence of ASB perpetration with adjusted odds ratios of 3.63 (95% CI 2.98–4.42) and 8.07 (6.72–9.71). Increasing frequency of HED was also linked to increased self-report of ASB perpetration in bivariable and multivariable models. In our interaction models, we found higher probabilities of ASB perpetration among younger and unmarried respondents for a given level of drinking. Discussion and conclusionsBoth average daily alcohol consumption and frequency of HED predict the probability of perpetrating alcohol-related ASB. Unsurprisingly, the risk of alcohol-specific ASB increased more quickly with consumption levels for younger and single respondents, suggesting interventions to reduce consumption among younger and unmarried persons will significantly impact ASB.

Increasing cocaine use amongst employed Australians: who is most at-risk?

Australian's cocaine use is at record levels. Large increases occurred between 2016-2019, with significant increases predominately found among employed Australians. Patterns, and prevalence of workers' cocaine use were examined using the 2016 and 2019 National Drug Strategy Household Survey data via frequency analyses. Logistic regression modelling identified predictors of employed Australian's: cocaine use (2019); and increased use over time (2016-2019). Workers' cocaine use increased 63% between 2016-2019 (3.8%-6.2%). Predictors of use, and increased use, were age, marital status, state, remoteness, smoking status, alcohol use, and cocaine approval level. Income and psychological distress predicted cocaine use in 2019 only. Highest prevalence in 2019 occurred among workers who approved of regular cocaine use (47.9%), currently smoked (14.9%), were very highly distressed (14.0%), risky alcohol consumers (13.7%), and aged 18-24 years (13.9%). Numerous individual-level characteristics influence workers' cocaine use. Workplace cultural norms and substance use climates may facilitate increased cocaine use. The workplace is a powerful setting for cocaine prevention and intervention efforts. Potential strategies include targeting social norms, shifting positive drug use workplace cultures, and providing health and safety training focussing on the risk of use to self and co-workers whilst also examining demographic subgroups' motivations for use.