Aims
Children are an important group harmed by others' alcohol consumption. This study (1) compared the risk of occurrence of child maltreatment among children exposed versus not exposed to parents ...with an alcohol‐attributable hospitalization or service use for mental health/addiction and (2) conducted sensitivity analyses to estimate the cases of child maltreatment that could be attributable to alcohol under two different conditions in New Zealand.
Design
A cohort study conducted among children 0−17 years and their parents (years 2000–2017) using the Statistics New Zealand Integrated Data Infrastructure. The New Zealand Health Survey 2017 was also used.
Setting
New Zealand.
Participants
58 359 children aged 0–17 years and their parents.
Measurements
Survival analysis based on a Bayesian piecewise exponential model was used to estimate the risk of time to first substantiated child maltreatment event (identified from social service, hospital, mortality and police data) related to exposure to parents with an alcohol‐attributable hospitalization or who used a mental health/addiction service (versus no exposure). Potential confounders were included for parents and children. The sensitivity analyses (i) estimated an alcohol‐attributable admissions/service use fraction for maltreatment in 2017 and (ii) calculated a population‐attributable fraction using the relative risk from the cohort and prevalence of hazardous drinking (AUDIT 8+) among parents in 2017.
Findings
There was a 65.1% 1.65; 95% confidence interval (CI) = 1.46−1.86 increased risk of child maltreatment if a child was exposed to parents who had an alcohol‐attributable hospitalized or mental health/addictions service use. The sensitivity analyses estimated that in 2017 14.6% (CI = 14.0−15.3%) and 11.4% (95% CI = 8.4−14.3%) of the documented cases of child maltreatment in New Zealand could be attributable to parents with severe or hazardous consumption.
Conclusions
In New Zealand, exposure to parents with an alcohol‐attributable hospitalization or service use is a risk factor for substantiated child maltreatment.
Introduction
This paper aimed to assess purchasing and drinking behaviour during the first COVID‐19 pandemic restrictions in New Zealand.
Method
A convenience sample was collected via Facebook from ...2173 New Zealanders 18+ years during pandemic restrictions April/May 2020. Measures included: the quantity typically consumed during a drinking occasion and heavier drinking (6+ drinks on a typical occasion) in the past week; place of purchase including online alcohol delivery. Descriptive statistics were generated, logistic and linear regression models predicted heavier drinking and typical occasion quantity, respectively. Weighting was not applied.
Results
During pandemic restrictions, around 75% of respondents purchased from supermarkets, 40% used online alcohol delivery services (18% for the first time during COVID‐19). Purchasing online alcohol delivery during pandemic restrictions was associated with heavier drinking (75% higher odds) in the past week, while purchasing from supermarkets was not. About 58% of online purchasers under 25 reported no age checks. Sixteen percent of those purchasing online repeat ordered online to keep drinking after running out. Of respondents who had tried to buy alcohol and food online, 56% reported that alcohol was easier to get delivered than fresh food. Advertising for online alcohol delivery was seen by around 75% of the sample. Half of the sample reported drinking more alcohol during the restrictions.
Discussion and Conclusions
Online alcohol delivery during the COVID‐19 pandemic restrictions was associated with heavier drinking in the past week. The rapid expansion of online alcohol delivery coupled with a lack of regulatory control requires public health policy attention.
Introduction
Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence ...estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity.
Methods
FASD prevalence was estimated from self‐reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta‐analysis of case‐ascertainment or clinic‐based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation.
Results
We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval CI 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%.
Discussion and Conclusions
This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol‐free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.
Background: Little is known about daily vaping of different substances, particularly cannabis. Aim: To explore daily vaping of cannabis and nicotine products in a sample of people who use drugs in ...New Zealand. Method: The online New Zealand Drug Trends convenience survey (N = 23,500) was promoted to those aged 16+ via a targeted Facebook™ campaign, with 9,042 reporting vaping in the past six months. Multivariate logistic regression models were fitted to identify predictors of daily vaping of: (i) nicotine e-liquids, (ii) no-nicotine e-liquids, (iii) cannabis e-liquids/oils, (iv)cannabis herb. Results: Forty-two percent of past 6-month vapers used a vaporizing device "daily or near daily" (n = 3,508). Nicotine was most common substance used by daily vapers (96%), followed by dry herb cannabis (12%), no-nicotine e-liquids (10%) and cannabis e-liquid (6%). Daily vaping of no-nicotine e-liquids was associated with abstinence from tobacco use. Frequency of cannabis use was negatively correlated with daily vaping of nicotine liquids and positively correlated with daily vaping of no-nicotine and herbal cannabis. Younger age strongly predicted daily vaping of nicotine and no-nicotine liquids, but the reverse association was observed for daily vaping of herbal cannabis. Māori were less likely to daily vape cannabis herb than NZ Europeans. Daily vaping of both cannabis e-liquid and cannabis herb was associated with medicinal cannabis use. Conclusion: Daily vapers of nicotine and cannabis differed by several characteristics. Younger age group is at risk of daily vaping nicotine and non-nicotine, while herbal cannabis vaping is associated with older and medicinal use, suggesting a need for a nuanced vape policy response.
We present a novel frailty model for modeling clustered survival data. In particular, we consider the Birnbaum–Saunders (BS) distribution for the frailty terms with a new directly parameterized on ...the variance of the frailty distribution. This allows, among other things, compare the estimated frailty terms among traditional models, such as the gamma frailty model. Some mathematical properties of the new model are studied including the conditional distribution of frailties among the survivors, the frailty of individuals dying at time
t
, and the Kendall’s
τ
measure. Furthermore, an explicit form to the derivatives of the Laplace transform for the BS distribution using the di Bruno’s formula is found. Parametric, non-parametric and semiparametric versions of the BS frailty model are studied. We use a simple Expectation-Maximization (EM) algorithm to estimate the model parameters and evaluate its performance under different censoring proportion by a Monte Carlo simulation study. We also show that the BS frailty model is competitive over the gamma and weighted Lindley frailty models under misspecification. We illustrate our methodology by using a real data sets.
Abstract Introduction To assesses the alcohol‐related burden of child maltreatment among Māori in Aotearoa New Zealand. We compared the risk of child maltreatment among Māori (0–17 years) exposed to ...parents with alcohol‐related hospitalisation or mental health/addiction service use. We also conducted a sensitivity analysis to estimate the number of cases of maltreatment that could be attributed to alcohol among Māori. Methods A cohort study of 16,617 Māori aged 0–17 and their parents from 2000 to 2017 was conducted using the Statistics New Zealand Integrated Data Infrastructure. A Bayesian piecewise exponential model estimated the risk of time to first child maltreatment event. This analysis used data from child protection, hospital, mortality and police records, and specifically focused on the risk associated with exposure to parents with an alcohol‐attributable hospitalisation or mental health/addiction service use event. Potential confounders for both parents and Māori (0–17 years) were included. We calculated a population‐attributable fraction to estimate the proportion of maltreatment cases that could be attributed to alcohol in 2017. Results Results showed a 65% increased risk for young Māori exposed to parents with heavy alcohol use. We estimated 17% of substantiated child maltreatment among Māori could be attributed to parental hazardous alcohol consumption. Discussion and Conclusions Severe or hazardous alcohol consumption among parents is a risk factor for child maltreatment among Māori. Māori alcohol consumption and harm are symptomatic of wider inequities related, among other things, to the ongoing effects of colonisation, as well as gaps in the regulation of alcohol sales.
Background and aims
Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol‘s harm to others (HTO), but ...it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability‐adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another‘s drinking.
Design
This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018.
Setting and participants
The study took place among the Aotearoa/New Zealand population in 2018.
Measurements
The involvement of others’ drinking was obtained from prevalence, alcohol‐attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta–Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers.
Findings
In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non‐Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174).
Conclusions
Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.
There are increasing reports of social media being used to buy and sell illegal drugs internationally. Studies of social media drug markets to date have largely involved general explorations of ...social media drug transactions in select countries. Social media drug markets may operate differently for different drug types and in different country contexts.
To identify predictors of the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA in New Zealand using a large-scale online survey sample.
The annual New Zealand Drug Trends Survey (NZDTS), an online convenience survey promoted via targeted Facebook™ campaign, was completed by 23,500 respondents aged 16+. Logistic regression models were fitted to identify demographic, drug use and drug market predictors of reporting the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA.
Fifty-one percent of the sample had purchased cannabis, methamphetamine, ecstasy/MDMA or LSD in the past six months, of which 22% had done so via social media (n = 2,650). Cannabis was the drug type most purchased from social media among drug purchasers (24%), followed by ecstasy/MDMA (13%). Sixty percent of social media purchasers had used Facebook™, 48% Snapchat™, and 20% Instagram™. The leading advantages of social media purchasing were “high convenience” (74%), and “fast transaction speed” (43%). Younger age was a significant predictor of social media purchasing for all drug types (particularly among 16–17 year olds). Purchasing from someone identified as a “drug dealer” was a predictor of social media purchasing among respondents for all drug types.
Social media drug markets may have significant implications for drug purchasing by youth through providing greater access to supply and breaking down age-related barriers between social supply and commercial drug markets. Our findings highlight the importance of incorporating social media platforms into youth drug prevention and harm minimisation strategies.
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been associated with worse outcomes after transcatheter aortic valve replacement (TAVR). With TAVR indications extending to a ...wider range of patient populations, it is important to understand the current implications of chronic renal insufficiency on clinical outcomes. We aim to determine the impact of CKD and ESRD on in-hospital outcomes after TAVR.
We queried the National Inpatient Sample for TAVR performed between 2016 and 2020 using International Classification of Diseases-10th Revision codes. We compared in-hospital mortality and clinical outcomes between three groups: normal renal function, CKD and ESRD. The association between CKD/ESRD and outcomes was tested with multivariable logistic regression analyses, using normal renal function as baseline.
In the five-year study period, 279,195 patients underwent TAVR (mean age 78.9 ± 8.5 years, 44.4% female). Of all patients, 67.1% had normal renal function, 29.2% had CKD, and 3.7% had ESRD. There were significant differences in age, sex, and prevalence of comorbidities across groups. In-hospital mortality was 1.3%. Compared to patients with normal renal function, patients with renal insufficiency had higher in-hospital mortality, with the highest risk found in patients with ESRD (adjusted odds ratio: 1.4 95% confidence interval: 1.2-1.7 for CKD; adjusted odds ratio: 2.4 95% confidence interval: 1.8-3.3 for ESRD). Patients with CKD or ESRD had a higher risk of cardiogenic shock, need for mechanical circulatory support, and vascular access complications, compared to those with normal renal function. In addition, patients with ESRD had a higher risk of cardiac arrest and periprocedural acute myocardial infarction. The incidence of conversion to open heart surgery was 0.3% and did not differ between groups. Post-procedural infectious and respiratory complications were more common among patients with CKD or ESRD.
Patients with CKD and ESRD are at higher risk of in-hospital mortality, cardiovascular, and non-cardiovascular complications after TAVR. The risk of complications is highest in patients with ESRD and does not result in more frequent conversion to open heart surgery. These results emphasize the importance of individualized patient selection for TAVR and procedural planning among patients with chronic renal insufficiency.
Small towns in New Zealand have reported high availability of methamphetamine, and conversely a shortage of cannabis. Stakeholders have suggested drug dealers are purposely promoting methamphetamine ...rather than cannabis.
(1) To compare the availability of methamphetamine and cannabis in different size communities; (2) Identify determinants of the high availability of methamphetamine, including low availability of cannabis.
An online drug survey was promoted via a broadly targeted Facebook™ campaign. Participants were asked if they lived in a “city”, “small town” or “rural area”, their drug use patterns, and local drug market characteristics, including current availability. A total of 6311 people completed the survey. Logistic regression models were constructed to identify independent predictors of reporting high availability of methamphetamine, cannabis, ecstasy and LSD respectively, with low availability of cannabis included as a predictor in the non-cannabis markets.
Methamphetamine was reported to be more available than cannabis in all regions. Methamphetamine was more available in towns/rural areas than in cities. Significant predictors of high availability of methamphetamine were living in a town/rural area (OR = 1.38), purchasing from a gang member (OR = 1.88), daily methamphetamine use (OR = 2.41), Maori ethnicity (OR = 1.36) and reporting low availability of cannabis (OR = 1.89). Low availability of cannabis was not a predictor of high availability of ecstasy or LSD. Living in a town/rural area was not a predictor of high availability of cannabis, LSD or ecstasy. Purchasing from a gang member was a predictor of high availability of cannabis (OR = 1.80) and LSD (OR = 4.61).
Further research is required to identify what causal relationships, if any, there are between the statistical associations of high methamphetamine availability, living in a small town, purchasing from a gang, and low cannabis availability. It may be the case that small towns offer an environment where a gang can control the local drugs market.
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