Martin O'Flaherty

Very young adolescents and alcohol : evidence of a unique susceptibility to peer alcohol use

AIM The aim of this study is to examine the susceptibility of very young adolescents (10-12 years of age) to peer alcohol-related influences, compared to older adolescents (13-14 years of age). METHODS The analysis sample consisted of 7064 adolescents in grade 6 (modal age 11) or grade 8 (modal age 13) from 231 schools in 30 communities across three Australian States. Key measures were adolescent reports of alcohol use (past 30 days) and the number of peers who consume alcohol without their parents awareness. Control variables included parent alcohol use, family relationship quality, pubertal advancement, school connectedness, sensation seeking, depression, length of time in high school, as well as age, gender, father/mother education, and language spoken at home. A multi-level model of alcohol use was used to account for school-level clustering on the dependent variable. RESULTS For both groups, the number of peers who consumed alcohol was associated with alcohol use, but Grade 6 students showed a unique susceptibility to peripheral involvement with peer drinking networks (having one friend who consumed alcohol). CONCLUSION The results point to the importance of monitoring and responding to comparatively minor shifts in the proportion of peers who use alcohol, particularly among very young adolescents.

Gender differences in the impact of families on alcohol use: a lagged longitudinal study of early adolescents.

AIMS From the pre-teen to the mid-teen years, rates of alcohol use and misuse increase rapidly. Cross-sectional research shows that positive family emotional climate (low conflict, high closeness) is protective, and there is emerging evidence that these protective mechanisms are different for girls versus boys. The aim of this study was to explore gender differences in the longitudinal impact of family emotional climate on adolescent alcohol use and exposure to peer drinking networks. DESIGN Three-wave two-level (individual, within-individual over time) ordinal logistic regression with alcohol use in the past year as the dependent measure and family variables lagged by 1 year. SETTING Adolescents completed surveys during school hours. PARTICIPANTS A total of 855 Australian students (modal age 10-11 years at baseline) participating in the International Youth Development Study (Victoria, Australia). MEASUREMENTS These included emotional closeness to mother/father, family conflict, parent disapproval of alcohol use and peer alcohol use. FINDINGS For girls, the effect of emotional closeness to mothers on alcohol use was mediated by exposure to high-risk peer networks. Parent disapproval of alcohol use was protective for both genders, but this effect was larger for boys versus girls, and there was no evidence that peer use mediated this effect. Peer drinking networks showed stronger direct risk effects than family variables. CONCLUSIONS Family factors unidirectionally impact on growth in adolescent alcohol use and effects vary with child gender.

The influence of parents, siblings and peers on pre- and early-teen smoking: A multilevel model

INTRODUCTION AND AIMS Despite considerable success in tobacco control, many teenagers in Australia and other industrialised countries still smoke tobacco. There is mixed evidence on the relative influence of proximal social networks (parents/siblings/peers) on pre- and early-teen smoking, and no research has examined how these influences compare after accounting for school- and community-level effects.The aim of this study was to compare the relative influences of parents, siblings and peers, after accounting for school- and community-level variation in smoking. DESIGN AND METHODS A cross-sectional fixed and random effects model of smoking prevalence was used, with individuals (n = 7314) nested within schools (n = 231) nested within communities (n = 30). Grade 6 and 8 students (modal ages 11 and 13 years) completed an on-line survey. Key variables included parent/sibling/peer use. Controls included alcohol involvement, sensation seeking, pro-social beliefs, laws/norms about substance use and school commitment. RESULTS There was significant variation in smoking at both the school and community levels, supporting the need for a multilevel model. Individual-level predictors accounted for much of the variance at higher levels. The strongest effects were for number of friends who smoke, sibling smoking and alcohol involvement. Smaller significant effects were found for parent smoking. At the community level, socioeconomic disadvantage was significant, but community-level variance in pro-social and drug-related laws/norms was not related to smoking. DISCUSSION AND CONCLUSIONS Cross-level interactions were generally non-significant. Early teenage smoking was best explained by sibling and peer smoking, and individual risks largely accounted for the substantial variation observed across schools and communities. In terms of future tobacco control, findings point to the utility of targeting families in disadvantaged communities.

Home Visits: Transnationalism among Australian migrants

Abstract As a perspective developed primarily in anthropology, ‘transnationalism’ has until recently been dominated by ethnographic and textual analyses. While not problematic for any particular study, the overwhelming dominance of these methodologies has created two major theoretical shortcomings; a tendency to inflate the prevalence of transnational models of living, and the attribution of an egalitarian or emancipatory character to transnationalism, generally in the absence of systematic evidence. In this article we attempt to remedy these problems by examining the frequency and determinants of one tangible indicator of transnational activity in migrants to Australia: visits home. Our results suggest three important conclusions: 1) not all migrants visit home at all, and only about 11 per cent do so on a regular basis; 2) there are major between-group differences in migrants’ capacity to visit home; and 3) the earlier concepts of assimilation and migration order are of substantial significance in understanding transnationalism.

How important is the context of an adolescent's first alcoholic drink? Evidence that parental provision may reduce later heavy episodic drinking.

Objective: This study examined the extent to which a retrospective measure of parental provision of the first alcoholic beverage was related to current heavy episodic drinking and current responsible drinking practices. Sample: 608 14- to 17-year-olds from the 2007 Australian National Drug Strategy Household Survey. Measures: Source of first alcoholic beverage (friends/parents/others), source of current alcohol, age of onset of alcohol use, current responsible drinking practices, and proportion of current friends who drink. Results: Binary logistic and multiple regression procedures revealed that parental provision of an adolescent’s first alcoholic beverage predicted lower current heavy episodic drinking, and responsible drinking mediated this association. Discussion: The results suggested that for adolescents who become alcohol users, parental provision of the first drink may reduce subsequent alcohol-related risks compared to introduction to alcohol by friends and other sources. Alcohol-related risks remain significant for adolescents who consume alcohol, independent of who is the provider.

Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis

Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasi-experimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16-1.52; P<0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46-15.79; P=0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81-2.91; P=0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.

Health for all? Patterns and predictors of allied health service use in Australia

OBJECTIVE To examine patterns and predictors of allied health service use among the Australian population. METHODS Data from the 2007-08 longitudinal National Health Survey conducted by the Australian Bureau of Statistics in Australia were used to examine differences in use of allied health services among the population. The survey is based on 15779 adult respondents. Multivariate logistic regression models were used to model the probability of visiting an allied health service contingent on multiple factors of interest. RESULTS Men, less educated people and people from non-English speaking backgrounds were low users compared with other groups. Interestingly, people with type 2 diabetes were substantially higher users compared with people with other chronic diseases, or no reported chronic disease, and ancillary health insurance had a strong positive effect on use. DISCUSSION Further investigation of the social and economic circumstances surrounding allied health service use is required to determine areas of under use or unmet need. High use among people with diabetes might indicate the impact of policy incentives to enhance use. Yet, whether all those in need are able to access services is unknown. Further investigation of use among groups with different health needs and by type of financing will enhance policy. What is known about the topic? Inequities and variations in access to allied health services are commonplace. Effective policy initiatives to improve access, particularly among patients with chronic disease, will depend on improving the knowledge base about patterns of use of allied health services, and what determines use. What does this paper add? This paper reveals the high and low users of allied health services among the Australian population, those population groups who might be missing out and what might explain these patterns. This information will enable policy makers to target areas of potential unmet need. What are the implications for practitioners? Multidisciplinary team care is advocated in the management of chronic disease. Practitioners have a vital role in framing the benefits of allied health services to patients and in developing the evidence base about best practice in the management of chronic disease for diverse patient groups.

Gender differences in the impact of families on alcohol use

AIMS From the pre-teen to the mid-teen years, rates of alcohol use and misuse increase rapidly. Cross-sectional research shows that positive family emotional climate (low conflict, high closeness) is protective, and there is emerging evidence that these protective mechanisms are different for girls versus boys. The aim of this study was to explore gender differences in the longitudinal impact of family emotional climate on adolescent alcohol use and exposure to peer drinking networks. DESIGN Three-wave two-level (individual, within-individual over time) ordinal logistic regression with alcohol use in the past year as the dependent measure and family variables lagged by 1 year. SETTING Adolescents completed surveys during school hours. PARTICIPANTS A total of 855 Australian students (modal age 10-11 years at baseline) participating in the International Youth Development Study (Victoria, Australia). MEASUREMENTS These included emotional closeness to mother/father, family conflict, parent disapproval of alcohol use and peer alcohol use. FINDINGS For girls, the effect of emotional closeness to mothers on alcohol use was mediated by exposure to high-risk peer networks. Parent disapproval of alcohol use was protective for both genders, but this effect was larger for boys versus girls, and there was no evidence that peer use mediated this effect. Peer drinking networks showed stronger direct risk effects than family variables. CONCLUSIONS Family factors unidirectionally impact on growth in adolescent alcohol use and effects vary with child gender.

Gender differences in the impact of families on alcohol use: a lagged longitudinal study of early adolescents: Families and early adolescent alcohol use

AIMS From the pre-teen to the mid-teen years, rates of alcohol use and misuse increase rapidly. Cross-sectional research shows that positive family emotional climate (low conflict, high closeness) is protective, and there is emerging evidence that these protective mechanisms are different for girls versus boys. The aim of this study was to explore gender differences in the longitudinal impact of family emotional climate on adolescent alcohol use and exposure to peer drinking networks. DESIGN Three-wave two-level (individual, within-individual over time) ordinal logistic regression with alcohol use in the past year as the dependent measure and family variables lagged by 1 year. SETTING Adolescents completed surveys during school hours. PARTICIPANTS A total of 855 Australian students (modal age 10-11 years at baseline) participating in the International Youth Development Study (Victoria, Australia). MEASUREMENTS These included emotional closeness to mother/father, family conflict, parent disapproval of alcohol use and peer alcohol use. FINDINGS For girls, the effect of emotional closeness to mothers on alcohol use was mediated by exposure to high-risk peer networks. Parent disapproval of alcohol use was protective for both genders, but this effect was larger for boys versus girls, and there was no evidence that peer use mediated this effect. Peer drinking networks showed stronger direct risk effects than family variables. CONCLUSIONS Family factors unidirectionally impact on growth in adolescent alcohol use and effects vary with child gender.