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Biomedical subjects

John D Langley

Publications and source records attributed to John D Langley.

12 recordsLinked to original sources
PubMed2007

Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking.

CONTEXT: The concept that assessment of a person's health status without subsequent intervention has beneficial effects in itself has stimulated much interest in underlying psychological mechanisms, methodological implications and its public health potential. There have, however, been few experimental studies of assessment effects. AIM: To test the hypothesis that assessment in itself produces a reduction in hazardous drinking. DESIGN AND SETTING: Two conditions (group A, leaflet only and group B, leaflet and assessment but no intervention) of a four-arm randomized controlled trial with enrollment in March-April 2003. PARTICIPANTS: A total of 975 students (17-29 years) attending a primary health-care clinic completed a web-based Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Of 599 who scored >or= 8576 consented to follow-up and were included in the full four-arm trial, of whom 293 (153 women) were assigned to groups A and B. INTERVENTION: Group A received an information leaflet at baseline. Group B received the information leaflet and 10 minutes of web-based assessment 4 weeks later. MEASUREMENTS: Drinking frequency, typical quantity, heavy episode frequency, personal problems and academic problems. FINDINGS: Baseline mean AUDIT scores were 15.0 (SD = 5.4) and 14.9 (SD = 5.0) in groups A and B, respectively. Twelve months after baseline, relative to group A, group B reported lower overall consumption (geometric means ratio 0.82, 95% CI: 0.68-0.98), fewer heavy drinking episodes (0.66, 0.47-0.91), fewer problems (0.81, 0.67-0.99) and lower AUDIT scores (beta = -1.63, -0.62 to -2.65). CONCLUSIONS: Brief assessment appeared to reduce hazardous drinking. Controlled trials that rely on assessment may therefore underestimate treatment effects. Limitations include the possibility of measurement artefact due to social desirability bias.

Adolescent↗
PubMed2005

Minimum purchasing age for alcohol and traffic crash injuries among 15- to 19-year-olds in New Zealand.

OBJECTIVES: In 1999, New Zealand lowered the minimum purchasing age for alcohol from 20 to 18 years. We tested the hypothesis that this increased traffic crash injuries among 15- to 19-year-olds. METHODS: Poisson regression was used to compute incidence rate ratios for the after to before incidence of alcohol-involved crashes and hospitalized injuries among 18- to 19-year-olds and 15- to 17-year-olds (20- to 24-year-olds were the reference). RESULTS: Among young men, the ratio of the alcohol-involved crash rate after the law change to the period before was 12% larger (95% confidence interval [CI]=1.00, 1.25) for 18- to 19-year-olds and 14% larger (95% CI=1.01, 1.30) for 15- to 17-year-olds, relative to 20- to 24-year-olds. Among young women, the equivalent ratios were 51% larger (95% CI=1.17, 1.94) for 18- to 19-year-olds and 24% larger (95% CI=0.96, 1.59) for 15- to 17-year-olds. A similar pattern was observed for hospitalized injuries. CONCLUSIONS: Significantly more alcohol-involved crashes occurred among 15-to 19-year-olds than would have occurred had the purchase age not been reduced to 18 years. The effect size for 18- to 19-year-olds is remarkable given the legal exceptions to the pre-1999 law and its poor enforcement.

Accidents, Traffic↗
PubMed2004

Identifying predictors of persistent non-alcohol or drug-related risky driving behaviours among a cohort of young adults.

This study sought to identify adolescent risk factors that predicted persistent risky driving behaviours among young adults. It was part of a longitudinal study of a birth cohort (474 males and 459 females). The potential predictors were self-reported data obtained at ages 15, 18, 21 years (academic qualifications, personality, mental health, anti-social behaviour and driving behaviour). The risky driving behaviour outcomes were obtained at ages 21 and 26 years and included driving fast for thrills, taking deliberate risks for fun, excessive speed, dangerous overtaking, and close following (tailgating). Persistent risky drivers were defined as those who often, or fairly often engaged in a behaviour at both ages. A minority of males and very few females were classified as persistent risky drivers. Among the males, the factors that predicted at least one, or more of the outcomes were the personality trait of low constraint (i.e. low scores for control, harm avoidance, and traditionalism), aggressive behaviour, and cannabis dependence. These are characteristics to be borne in mind when developing programmes for young drivers that aim to deter the development of persistent risky driving behaviour.

Accidents, Traffic↗
PubMed2004

Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial.

BACKGROUND: Strong evidence exists for the efficacy of screening and brief intervention for reducing hazardous drinking. However, problems have been highlighted with respect to its implementation in health-care systems, not least of which is a reluctance of some doctors to discuss alcohol proactively with their patients. AIMS: To determine the efficacy of a novel web-based screening and brief intervention (e-SBI) to reduce hazardous drinking. DESIGN: A double-blind randomized controlled trial. SETTING: A university student health service. PARTICIPANTS: A total of 167 students (17-26 years) were recruited in the reception area and completed a 3-minute web-based screen including the Alcohol Use Disorder Identification Test (AUDIT) questionnaire. Of these, 112 tested positive, and 104 (52 females) who consented to follow-up were included in the trial. MEASUREMENTS: Drinking frequency, typical occasion quantity, total volume, heavy episode frequency (females > 80 g ethanol, males > 120 g ethanol), number of personal problems, an academic problems score. INTERVENTION: Participants were randomized to 10-15 minutes of web-based assessment and personalized feedback on their drinking (intervention, n = 51) or to a leaflet-only control group (n = 53). FINDINGS: Mean baseline AUDIT scores for control and intervention groups were 16.6 (SD = 6.0) and 16.6 (SD = 5.7). At 6 weeks, participants receiving e-SBI reported significantly lower total consumption (geometric mean ratio = 0.74; 95% confidence interval: 0.56-0.96), lower heavy episode frequency (0.63; 0.42-0.92) and fewer personal problems (0.70; 0.54-0.91). At 6 months personal problems remained lower (0.76; 0.60-0.97), although consumption did not differ significantly. At 6 months, academic problems were lower in the intervention group relative to controls (0.72; 0.51-1.02). CONCLUSIONS: e-SBI reduced hazardous drinking among university students, to an extent similar to that found for practitioner-delivered brief interventions in the general population. e-SBI offers promise as a strategy to reduce alcohol-related harm in a way that is non-intrusive, appealing to the target group, and capable of being incorporated into primary care. Research is required to replicate the findings, to determine the duration of intervention effects, and to investigate the mechanisms by which the intervention operates.

Adolescent↗
PubMed2003

Identifying factors that predict persistent driving after drinking, unsafe driving after drinking, and driving after using cannabis among young adults.

UNLABELLED: The main aim of this study was to identify adolescent/young adulthood factors that predicted persistent driving after drinking, persistent unsafe driving after drinking, and persistent cannabis use and driving among young adults. It was a longitudinal study of a birth cohort (n=933, 474 males and 459 females) and was based on data collected at ages 15, 18, 21 and 26 years. At each of these ages members of the cohort attended the research unit for a personal interview by a trained interviewer, using a standardised questionnaire. For this study, the data for the outcome measures (persistent driving after drinking, persistent unsafe driving after drinking, and persistent driving after using cannabis) were obtained at ages 21 and 26 years. The main explanatory measures were collected at ages 15, 18, 21 years and included demographic factors (academic qualifications, employment, parenting); personality measures; mental health measures (substance use, cannabis dependence, alcohol dependence, depression); anti-social behaviour (juvenile arrest, aggressive behaviour, court convictions); early driving behaviour and experiences (car and motorcycle licences, traffic crashes). The analyses were conducted by gender. The results showed that females who persisted in driving after drinking (13%, n=61) were more likely than the others to have a motorcycle licence at 18. The males who persisted in driving after drinking (28%, n=135) were more likely than the other males to have some school academic qualifications and to be employed at age 26. Compared to the other males, those who persisted in unsafe driving after drinking (4%, n=17) were more likely to be aggressive at 18 and alcohol dependent at 21. Only six (1%) females persisted in unsafe driving after drinking so regression analyses were not conducted for this group. For persistent driving after using cannabis, the univariate analyses showed that females who persisted with this behaviour tended to have high substance use at 18, cannabis dependence at 21, police contact as a juvenile, and to be a parent at 21. For this group, because of the small numbers (3%, n=13) multivariate analyses were not appropriate. For the males who persisted in driving after using cannabis (14%, n=68) a wide range of variables were significant at the univariate stage. The multivariate analysis showed that the most important factors were dependence on cannabis at 21, at least one traffic conviction before 21, a non traffic conviction before 18, and low constraint at 18. CONCLUSION: These results show different characteristics were associated with persistence in each of these outcome behaviours. This indicates that different approaches would be required if intervention programmes were to be developed to target these behaviours.

Adolescent↗
PubMed2003

The process and impact of implementing injury prevention projects in smaller communities in New Zealand.

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.

Accident Prevention↗
PubMed2003

Perceived social norms and their relation to university student drinking.

OBJECTIVE: The aims of this study were to compare university students' perceptions of drinking norms with actual student drinking norms, to examine the relationship between norm misperception and individual drinking status and to investigate the relative importance of three reference groups as potential determinants of individual drinking levels: young people in New Zealand of the same age and gender, local university students of the same age and gender and the closest friends of individual respondents. METHOD: In 2002 a randomly selected representative sample of 1,564 New Zealand university students aged 16-29 years completed an Internet-based survey of their alcohol use (response rate: 82%). Respondents were asked to estimate the incidence of heavy episodic drinking and vomiting in the three reference groups and to rate their own drinking in comparison. Estimates within +/- 10% of actual norms were rated as accurate; estimates above or below actual norms by more than 10% were rated, respectively, as overestimates and underestimates. RESULTS: The vast majority of women (80%) and men (73%) overestimated the incidence of heavy drinking among student peers. The incidence of vomiting was also overestimated, but to a lesser extent. The extents of overestimation for both heavy drinking and vomiting were strongly related to the individual's heavy drinking frequency (p < .001). Only 9% of drinkers believed they drank more than other students. Correlations of perceived norms and self-reported drinking increased with the proximity of the social grouping to the individual and were higher for women than for men. CONCLUSIONS: This New Zealand university sample showed strong evidence of norm misperceptions, consistent with the results of several U.S. studies. Perceived norms are strongly related to individual drinking levels. It is unclear whether norm misperceptions are a cause or effect of heavy drinking. Research in which norm misperceptions are corrected may assist in understanding their importance in the etiology and treatment of heavy drinking.

Adolescent↗
PubMed2002

Comparing measures of injury severity for use with large databases.

BACKGROUND: After recent debate about the best measure of anatomic injury severity, this study aimed to compare four measures based on Abbreviated Injury Scale scores derived using ICDMAP-90-the Modified Anatomic Profile (ICD/mAP), Anatomic Profile Score (ICD/APS), Injury Severity Score (ICD/ISS), and New Injury Severity Score (ICD/NISS)-with the International Classification of Diseases-based Injury Severity Score (ICISS). METHODS: Data were selected from New Zealand public hospital discharges from 1989 to 1998. There were 349,409 patients in the dataset, of whom 3,871 had died. Models were compared in terms of their discrimination and calibration using logistic regression. Age was included as a covariate. RESULTS: The ICISS and ICD/mAP were the best performing measures. Adding age significantly improved the discrimination and calibration of almost all the models. CONCLUSION: The ICISS is a viable alternative to ICDMAP-based measures for coding anatomic injury severity on large datasets.

Calibration↗
PubMedDate not supplied

High prevalence, persistent hazardous drinking among New Zealand tertiary students.

AIMS: To determine the prevalence of hazardous drinking and alcohol-related negative consequences in New Zealand tertiary students, and to identify predictors of hazardous drinking across a 6-month period. METHODS: A total of 1480 tertiary students living in halls of residence was surveyed at the start of the academic year, and a subsample of 967 students was followed up 6 months later. Questionnaire items included quantity and frequency of drinking, alcohol-related problems, use of other substances, and the Alcohol Use Disorders Identification Test (AUDIT). Drinking at follow-up was modelled using demographic characteristics, mental well-being, other substance use, alcohol-related problems, and hall drinking norms, measured at baseline. RESULTS: Among drinkers, mean (+/- SD) weekly consumption was 243 +/- 241 and 135 +/- 157 g of ethanol for males and females respectively. The majority of male (60.0%) and female (58.2%) drinkers typically consumed more than national safe drinking guidelines. Mean (+/- SD) AUDIT scores were 10.9 +/- 7.6 for males and 7.6 +/- 5.9 for females. After controlling for AUDIT scores at baseline, increased AUDIT scores at follow-up were higher with lower age, Maori ethnicity, smoking, cannabis use, high levels of alcohol-related negative consequences, and higher levels of drinking in the student's hall of residence. CONCLUSIONS: Hazardous drinking is widespread and persistent among students living in the halls of residence. There is a need for university alcohol policies and intervention approaches among New Zealand tertiary students.

Adolescent↗
PubMedDate not supplied

Interpretation of items in the AUDIT questionnaire.

AIMS: To test for the possibility that tertiary students misinterpret certain items on the Alcohol Use Disorders Identification Test (AUDIT). METHODS: Responses to alternative question wordings were compared with responses to standard items. RESULTS: Alterations to items 5 and 9, so that consequences of drinking epitomized in these items were more specifically defined, resulted in markedly different response distributions to the item, but the total AUDIT score was not changed. CONCLUSIONS: Caution is necessary before using individual AUDIT items as measures of consequences in population surveys, and the possibility of false positives in total scores should be borne in mind.

Adolescent↗
PubMedDate not supplied

Adolescent injury mortality in New Zealand and opportunities for prevention.

Injury is recognised internationally as the major threat to adolescent health. The purpose of this study was to describe the epidemiology of adolescent fatal injury in New Zealand, and to examine opportunities for prevention. National mortality data were searched to identify all 15-19 year-olds, who died from injuries in the period 1986-1995. Leading causes of injury were reviewed in light of known risk factors, injury mortality rates in other industrialised countries, and available prevention strategies. The results showed that injury accounted for 2,095 deaths (72.8 per 100,000 person years). Males comprised 77% of victims (110.6 per 100,000 person years), and there was a three-fold increase in mortality from age 15 (35.3 per 100,000 person years) to 19 years (106.4 per 100,000 person years). The leading causes of death were road traffic crashes (42.6 per 100,000 person years), suicide (16.4 per 100,000 person years), and unintentional drowning (3.6 per 100,000 person years). The Graduated Driver Licensing System addresses a range of risk factors for adolescent road traffic crashes. Despite inadequate enforcement, early indications are that it has yielded modest reductions in injury. Hazardous drinking is implicated in the high rates of road traffic crashes and drownings, and given recent liberalization of supply-side policies, proactive identification of hazardous drinkers followed by brief intervention holds promise as a prevention measure. Suicide accounts for an increasing rate of adolescent deaths in New Zealand. The effect of national policies to address a range of suicide risk factors remains to be fully evaluated.

Accidents, Traffic↗