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Biomedical subjects

Jim McCambridge

Publications and source records attributed to Jim McCambridge.

At least 19 recordsLinked to original sources
PubMed2006

Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data.

BACKGROUND: Rates of mortality due to cirrhosis of the liver are an important indicator of population levels of alcohol harm. Total recorded alcohol consumption in Britain doubled between 1960 and 2002, giving rise to a need to examine and assess cirrhosis mortality trends. METHODS: Mortality rates were calculated for all ages and for specific age-groups (15-44 years and 45-64 years) for cirrhosis of the liver. Rates were directly age-standardised to the European standard population and compared with rates from 12 western European countries for the period 1955-2001. FINDINGS: Cirrhosis mortality rates increased steeply in Britain during the 1990s. Between the periods 1987-1991, and 1997-2001, cirrhosis mortality in men in Scotland more than doubled (104% increase) and in England and Wales rose by over two-thirds (69%). Mortality in women increased by almost half (46% in Scotland and 44% in England and Wales). These relative increases are the steepest in western Europe, and contrast with the declines apparent in most other countries examined, particularly those of southern Europe. Cirrhosis mortality rates in Scotland are now one of the highest in western Europe, in 2002 being 45.2 per 100,000 in men and 19.9 in women. INTERPRETATION: Current alcohol policies in Britain should be assessed by the extent to which they can successfully halt the adverse trends in liver cirrhosis mortality. The situation in Scotland warrants particular attention.

Adolescent↗
PubMed2006

The rise of Viagra among British illicit drug users: 5-year survey data.

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms.

Adult↗
PubMed2005

The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi-experimental pilot study.

AIM: To test whether a single session of Motivational Interviewing (MI) focussing on drinking alcohol, and cigarette and cannabis smoking, would successfully lead to reductions in use or problems. METHODS: Naturalistic quasi-experimental study, in 162 young people (mean age 17 years) who were daily cigarette smokers, weekly drinkers or weekly cannabis smokers, comparing 59 receiving MI with 103 non-intervention assessment-only controls. MI was delivered in a single session by youth workers or by the first author. Assessment was made of changes in self-reported cigarette, alcohol, cannabis use and related indicators of risk and problems between recruitment and after 3 months by self-completion questionnaire. RESULTS: 87% of subjects (141 of 162) were followed up. The most substantial evidence of benefit was achieved in relation to alcohol consumption, with those receiving MI drinking on average two days per month less than controls after 3 months. Weaker evidences of impact on cigarette smoking, and no evidence of impact on cannabis use, were obtained. CONCLUSIONS: Evidence of effectiveness for the delivery of MI by youth workers in routine conditions has been identified. However, the extent of benefit is much more modest than previously identified in efficacy studies.

Adolescent↗
PubMed2005

Are cannabis users exposed to other drug use opportunities? Investigation of high-risk drug exposure opportunities among young cannabis users in London.

In a study of young cannabis users attending further education colleges across London which specifically excluded young heroin users or injecting drug users, 35% were found to have been offered heroin, 36% had been present during heroin smoking, and 12% present at injecting. Factors associated with these exposure opportunities were investigated. The proportion of friends who use drugs other than cannabis was also considered, both as an indicator of risk in its own right and as a possible mechanism for high-risk drug exposure opportunities involving heroin and/or injecting. Alcohol variables and interactional problems perceived by the study subjects to be caused by their own drug use were found to be predictive of the involvement of friends in drug use other than cannabis and of exposure to heroin and injecting drug use. Non-cannabis illicit drug use among friends was also found to be associated with offers of heroin and with having been present during injecting drug use by others. Interpretations of these data are considered and the need for more detailed study with an area of increasing public policy significance is discussed.

Adolescent↗
PubMed2005

Age of first use and ongoing patterns of legal and illegal drug use in a sample of young Londoners.

The significance of ages of first use of cigarettes, alcohol, cannabis, and stimulant drugs were investigated in a sample of young drug users entering an intervention study in London. Age of first cigarette smoking emerges as a robust predictor of age of first cannabis use, and age of first cannabis use in turn is predictive of age of first stimulant use, among those using both drugs. In this sample, ages of first use of cigarettes, alcohol, and cannabis are not predictive of whether stimulant drugs are used. In a series of regression models that take account of the influence of other factors, age of first use is found to have no relationship to levels of ongoing consumption of cigarettes, alcohol, and cannabis.

Adolescent↗
PubMed2005

Five-year trends in patterns of drug use among people who use stimulants in dance contexts in the United Kingdom.

AIMS: To describe and evaluate trends in the use of stimulant drugs over a 5-year period using an under-studied data collection method. DESIGN: Repeated-measures cross-sectional survey. SETTING AND PARTICIPANTS: Annual magazine-based survey targeting people who use stimulant drugs in dance contexts. MEASUREMENTS: Life-time use prevalence (ever used), age of first use, current use prevalence (any use within the last month) and extent of use within the last month (number of days used) for a range of stimulant drugs. Additional measures of quantity of ecstasy used were also collected. FINDINGS: Trends in life-time and current prevalence over time have been detected and comparisons made between different stimulant drugs. Evidence is obtained of broad stability in patterns of stimulant use in respect of age of first use and frequency of use among ongoing users. Despite an apparent reduction in the current prevalence of ecstasy use, the proportion of heavy users (usually >4 pills per session) has more than doubled between 1999 and 2003. CONCLUSIONS: This purposively sampled population study has yielded time trend data broadly consistent with other indicators, where they exist, and also has demonstrable potential to identify new drug trends. Further comparisons of purposive samples and randomly formed samples are needed.

Adolescent↗
PubMed2005

Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people.

AIM: To test whether beneficial effects of a single session of Motivational Interviewing (MI) on alcohol, tobacco and illicit drug use apparent after 3 months were maintained until 12 months. DESIGN: Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either MI (n = 105) or to an assessment-only control condition (n = 95). SETTING: Ten further education colleges across inner London. PARTICIPANTS: Two hundred young people who were current users of illegal drugs (age range 16-20 years) with whom contact was established through peers trained for the project. INTERVENTION: The intervention was adapted from MI in the form of a topic-based 1-hour single-session discussion. MEASUREMENTS: Changes in cigarette, alcohol, cannabis and other drug use and perceptions of risk and harm between the time of recruitment and follow-up interviews after 3 and 12 months. FINDINGS: A satisfactory follow-up rate (81%) was achieved. After 12 months, 3-month differences between MI and assessment-only groups have disappeared almost entirely. Unexpected improvements by the assessment-only control group on a number of outcomes suggest the possibility of reactivity to the research assessment at 3-month follow-up. CONCLUSION: In the terms of the original experiment, there is little evidence of enduring intervention effectiveness shown by between-group differences after 12 months. Deterioration of effect is the most probable explanation, although reactivity to 3-month assessment, a late Hawthorne effect, cannot be ruled out.

Adolescent↗
PubMed2005

When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour.

AIMS: In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. DESIGN: Experimental manipulation of levels of patient resistance in a role play. SETTING: The study was conducted at the start of a 2-day health behaviour change workshop. PARTICIPANTS: Thirty-two practitioners who had registered for the workshop. INTERVENTION: The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. MEASUREMENTS: Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. FINDINGS: Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. CONCLUSIONS: Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.

Adult↗
PubMed2004

Can the practitioner correctly predict outcome in motivational interviewing?

We have examined whether practitioner ratings (immediately post-intervention) or other recorded characteristics of a single-session 1-hour motivational intervention were predictive of 3-month cannabis use outcome. In the context of a cluster randomized trial involving 200 non help-seeking illegal drug users (age range 16-20), 105 were randomized to the intervention, of whom 97 (92%) were interviewed for followup at 3 months, 96 of whom were current cannabis users at study entry. Six intervention characteristics and seven practitioner ratings as well as patterns of self-motivational statements were investigated in relation to substantial change in use, (which was defined as cessation or reduction by more than 50%). Both practitioner ratings post-session, and also the subject's own elicited self-motivational statements, were found to be predictive of outcome 3 months later. The strongest predictor of substantial change, however, was simply whether change had been discussed during the session. On the basis of the above findings, it does indeed appear possible for outcome to be predicted by the motivational interviewing practitioner immediately following delivery of the intervention, on the basis of simple observations and ratings. This area warrants more specific study.

Adolescent↗
PubMed2004

Engaging the reluctant GP in care of the opiate misuser: Pilot study of change-orientated reflective listening (CORL).

BACKGROUND: The GP is central to plans for improved general health care and increased availability and delivery of addiction treatment to drug misusers in the UK. Attention to the actual quality of overall primary care, rather than just the treatment of dependence, has, however, been limited. OBJECTIVES: The purpose of this study was to test the feasibility of delivery and potential value of a brief motivational enhancement intervention targeting the quality of primary care given to opiate misusers by GPs. METHOD: This study had an observational 'before and after' design with follow-up assessment after 2-3 months. The target population was all GPs in two Primary Care Groups who had neither attended training events nor were involved in the treatment of drug dependence (n = 66), who were then approached via a telephone-administered change-orientated reflective listening intervention, based on principles of motivational interviewing, with informational adjunct. Outcome measures for the study sample (n = 29) were overall therapeutic commitment and motivation to follow up and actual clinical activity and willingness to deliver specified general health care interventions for drug misusers. RESULTS: Across the study sample, therapeutic commitment improved over time, whilst motivation did not. Change among individual practitioners in receipt of the intervention was observed in both positive and negative directions, and in four of the positive changers, this was judged attributable to the intervention. Positive changes were more than twice as frequent as negative changes. CONCLUSIONS: The direction and extent of change detected were encouraging. Further initiatives are needed to influence practitioner motivation, based on improved understanding of GPs' views on the delivery of primary care for drug misusers.

Adult↗
PubMed2004

The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial.

AIM: To test whether a single session of motivational interviewing (discussing alcohol, tobacco and illicit drug use) would lead successfully to reduction in use of these drugs or in perceptions of drug-related risk and harm among young people. DESIGN: Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing (n=105) or non-intervention education-as-usual control condition (n=95). SETTING: Ten further education colleges across inner London. PARTICIPANTS: Two hundred young people (age range 16-20 years) currently using illegal drugs, with whom contact was established through peers trained for the project. INTERVENTION: The intervention was adapted from the literature on motivational interviewing in the form of a 1-hour single-session face-to-face interview structured by a series of topics. MEASUREMENTS: Changes in self-reported cigarette, alcohol, cannabis and other drug use and in a range of drug-specific perceptions and other indicators of risk and harm. Measurement at recruitment and follow-up interview 3 months later. FINDINGS: A good follow-up rate (89.5%; 179 of 200) was achieved. In comparison to the control group, those randomized to motivational interviewing reduced their of use of cigarettes, alcohol and cannabis, mainly through moderation of ongoing drug use rather than cessation. Effect sizes were 0.37 (0.15-0.6), 0.34 (0.09-0.59) and 0.75 (0.45-1.0) for reductions in the use of cigarettes, alcohol and cannabis, respectively. For both alcohol and cannabis, the effect was greater among heavier users of these drugs and among heavier cigarette smokers. The reduced cannabis use effect was also greater among youth usually considered vulnerable or high-risk according to other criteria. Change was also evident in various indicators of risk and harm, but not as widely as the changes in drug consumption. CONCLUSIONS: This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing. The targeting of multiple drug use in a generic fashion among young people has also been supported.

Adolescent↗