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Mark A Bellis

Publications and source records attributed to Mark A Bellis.

14 recordsLinked to original sources
PubMed2007

Thai War on Drugs: measuring changes in methamphetamine and other substance use by school students through matched cross sectional surveys.

In 2003 the Thai government announced a radical shift in drug policy with the implementation of a War on Drugs. Although consequences of this controversial measure (e.g. drug dealer deaths) have received widespread attention relatively little work has evaluated changes in substance use. We used two anonymous representative samples of secondary school students to compare drug use in Northeast Thailand before (1998; n=4217) and after (2004/5; n=3489) the War on Drugs. Results indicate that reported levels of current illicit drug use reduced significantly between 1998 and 2004/5 (for methamphetamine from 4.2% to 0.9%). By examining trends in year of first methamphetamine use we identify that observed reductions in drug initiation are temporally consistent with the War on Drugs. However, while prevalence of alcohol use has also fallen, there was a three-fold increase in daily alcohol use. We suggest that this rise, combined with other negative impacts of 'wars' on drugs, means drug control requires a public health perspective that sees eliminating drug use as part of a wider strategy that has improvement in population health, not just drug prevention, as its core objective.

Adolescent↗
PubMed2007

Effects of backpacking holidays in Australia on alcohol, tobacco and drug use of UK residents.

BACKGROUND: Whilst alcohol and drug use among young people is known to escalate during short holidays and working breaks in international nightlife resorts, little empirical data are available on the impact of longer backpacking holidays on substance use. Here we examine changes in alcohol, tobacco and drug use when UK residents go backpacking in Australia. METHODS: Matched information on alcohol and drug use in Australia and the UK was collected through a cross sectional cohort study of 1008 UK nationals aged 18-35 years, holidaying in Sydney or Cairns, Australia, during 2005. RESULTS: The use of alcohol and other drugs by UK backpackers visiting Australia was common with use of illicit drugs being substantially higher than in peers of the same age in their home country. Individuals showed a significant increase in frequency of alcohol consumption in Australia compared to their behaviour in the UK with the proportion drinking five or more times per week rising from 20.7% (UK) to 40.3% (Australia). Relatively few individuals were recruited into drug use in Australia (3.0%, cannabis; 2.7% ecstasy; 0.7%, methamphetamine). However, over half of the sample (55.0%) used at least one illicit drug when backpacking. Risk factors for illicit drug use while backpacking were being regular club goers, being male, Sydney based, travelling without a partner or spouse, having been in Australia more than four weeks, Australia being the only destination on their vacation and drinking or smoking five or more days a week. CONCLUSION: As countries actively seek to attract more international backpacker tourists, interventions must be developed that target this population's risk behaviours. Developing messages on drunkenness and other drug use specifically for backpackers could help minimise their health risks directly (e.g. adverse drug reactions) and indirectly (e.g. accidents and violence) as well as negative impacts on the host country.

Adolescent↗
PubMed2006

Comparative views of the public, sex workers, businesses and residents on establishing managed zones for prostitution: analysis of a consultation in Liverpool.

Drug addiction, violence and anti-social behaviour are characteristics of street prostitution. An alternative approach to zero tolerance is establishing a managed zone where sex workers operate according to regulations and can access health services. Using a consultation with sex workers (n=50), businesses (n=51), residents (n=179) and the public (n=789) we examined where a zone might be established in a UK city (Liverpool) and characteristics of the zone required by these stakeholders. All groups believed a zone would improve sex workers' safety and reduce prostitution elsewhere. Sex workers (96%) agreed to work in a zone. Location criteria from all groups were used to identify two potential business areas to host a zone but businesses in or near these areas rejected plans through fear for staff safety and reduced business. We discuss the consultation process, difficulties in locating services for marginalised groups in cities and the implications for health and judicial policy relating to prostitution.

Adolescent↗
PubMed2006

Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England.

BACKGROUND: Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. METHODS: A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation. RESULTS: The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. CONCLUSION: Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.

Adolescent↗
PubMed2006

Sexual behaviour among casual workers in an international nightlife resort: a case control study.

BACKGROUND: Young holidaymakers report increased sexual risk-taking abroad, yet little is currently known about the sexual behaviour of those who extend time abroad through casual work. METHODS: Information on sexual behaviour was collected via an anonymous questionnaire administered to British bar and nightclub workers in Ibiza (cases, n = 92) and British people visiting Ibiza for holiday purposes only (controls, n = 868). RESULTS: Four in five (80.5%) cases who arrived in Ibiza without a partner had sex during their stay and of these two thirds (65.5%) had unprotected sex. Cases were more likely to report sexual risk-taking in Ibiza than controls and reported greater numbers of sexual partners prior to their visit. However, they had fewer sexual partners per week of stay. CONCLUSION: Casual workers in bars and nightclubs abroad are a key risk group for sexual health and a potential conduit for the international spread of sexually transmitted infections. While they are an important target group for sexual health promotion, appropriately trained they are also ideally placed to deliver sexual health interventions to other young travellers.

Adolescent↗
PubMed2006

Treatment and care of HIV positive asylum seekers.

BACKGROUND: Enhanced regional surveillance in north west England suggests that the proportion of HIV positive people who are asylum seekers (AS) is increasing. Nationally, there is no empirical evidence that HIV positive AS use HIV services to a greater or lesser extent than HIV positive non-AS. This report compares stage of disease and use of services between HIV positive non-AS and AS. METHODS: Data on those accessing HIV treatment and care (from hospitals and non-governmental organisations (NGOs)) in the north west of England for the first time January 2001-June 2004 (total 2204; AS 409) were extracted from the regional enhanced surveillance system. RESULTS: Compared with non-AS, AS did not differ in stage of HIV disease on first contact (p>0.05), were no more likely to stay overnight in hospital (p>0.05), but had an average of one extra outpatient appointment per year (median seven compared with six, p = 0.014). AS were much more likely to have accessed NGOs for support (43% compared with 27%: p<0.001). CONCLUSIONS: Use of specialist hospital services by HIV positive AS differs little from HIV positive persons who are not AS. However, HIV positive AS rely more on NGOs at a time when such voluntary services are under increasing financial pressures.

Adult↗
PubMed2005

Assessing and communicating the health and judicial impact of alcohol use.

BACKGROUND: Alcohol consumption places an increasing burden on health services, criminal justice agencies and private industry throughout the UK. Despite a national strategy to tackle alcohol-related harm, there remains a lack of epidemiology on alcohol use and related harms at local levels. Utilising national data sources and existing research studies, Regional Public Health Observatories are appropriately placed to calculate such measures and examine their relationship with deprivation. METHODS: For the North West of England, borough and health locality data were extracted from national sources. Alcohol consumption utilised lifestyle survey data and estimates of related harm were calculated by applying existing alcohol attributable fractions to deaths, hospital episodes and crime data. Contribution of alcohol to reduction in life expectancy was also calculated and all measures were correlated with deprivation. RESULTS: For the North West, the annual burden of alcohol was estimated at over 3700 deaths, 56,700 hospital episodes and 71,000 crimes. Annual alcohol-related death rates for men varied from 0.43 to 1.17 per 1000 between Local Authorities and there was a six-fold variation in alcohol-related crime rate between areas. For males, alcohol reduced life expectancy by more than five months in the area worst affected. For both sexes, more deprived areas had significantly higher levels of alcohol-related hospital episodes, crime, and contribution to reduced life expectancy. CONCLUSIONS: Alcohol-related harm requires urgent, multi-agency attention at local levels throughout the UK. Applying appropriate research methods to national data sources provides limited but valuable local measures of alcohol use and its impact on health and crime. Regional Public Health Observatories can facilitate partnership working through such provision of national intelligence tailored to support local and regional action. Application of these techniques also helps identify additional requirements for better local intelligence on health-related behaviours and the necessity for consistency across local health and behaviour surveys.

Adolescent↗
PubMed2005

Measuring paternal discrepancy and its public health consequences.

Paternal discrepancy (PD) occurs when a child is identified as being biologically fathered by someone other than the man who believes he is the father. This paper examines published evidence on levels of PD and its public health consequences. Rates vary between studies from 0.8% to 30% (median 3.7%, n = 17). Using information from genetic and behavioural studies, the article identifies those who conceive younger, live in deprivation, are in long term relationships (rather than marriages), or in certain cultural groups are at higher risk. Public health consequences of PD being exposed include family break up and violence. However, leaving PD undiagnosed means cases having incorrect information on their genetics and fathers continuing to suspect that children may not be theirs. Increasing paternity testing and use of DNA techniques in clinical and judicial procedures means more cases of PD will be identified. Given developing roles for individual's genetics in decisions made by health services, private services (for example, insurance), and even in personal lifestyle decisions, the dearth of intelligence on how and when PD should be exposed urgently needs addressing.

Child↗
PubMed2003

Re-emerging syphilis: a detrended correspondence analysis of the behaviour of HIV positive and negative gay men.

BACKGROUND: Recent syphilis outbreaks in the UK have raised serious concerns about the sexual health of the population. Moreover, syphilis appears more likely to facilitate HIV transmission than any other sexually transmitted infection (STI). METHODS: The sexual and other risk behaviour of a sample of HIV positive and negative gay men with and without syphilis was subjected to a detrended correspondence analysis (DCA). RESULTS: A DCA plot was used to illustrate similarity of individuals in terms of their behaviours, regardless of their infection status. The majority of those with syphilis (78%; 18/23) fell into a high-risk group with more partners, and use of anonymous sex venues and drugs during sex. However, 16% of uninfected controls (8/49) and 62% of HIV positive individuals without syphilis (8/13) also fell into this high-risk group. CONCLUSIONS: Using a statistical technique that is novel for this type of investigation, we demonstrate behavioural overlaps between syphilis-infected individuals in an ongoing UK outbreak and uninfected HIV positive and negative controls. Given the high-risk behaviour of a significant proportion of uninfected individuals, ongoing transmission of syphilis and HIV in this population seems likely.

Adult↗
PubMed2003

The role of an international nightlife resort in the proliferation of recreational drugs.

AIMS: The study compares types, frequencies and quantities of substances used by young people while holidaying in the international dance resort of Ibiza (Spain) with their patterns of use in the United Kingdom. It measures changes in substance use at both locations between 1999 and 2002 and examines the role of dance resorts in recruiting individuals into using new substances. DESIGN: Data were collected from visitors to Ibiza in 1999 (n = 846) and 2002 (n = 868). Information on drug use was surveyed through a short anonymous questionnaire. SETTING: Individuals were sampled at Ibiza airport just prior to returning to the UK. FINDINGS: Most individuals visiting Ibiza used illicit drugs in the United Kingdom (57.4% in 2002), with nearly all users continuing to use in Ibiza. Use of most drugs in Ibiza was characterized by binge behaviour, with many individuals using drugs 5 or more nights per week. Proportions using cocaine, ecstasy and GHB have risen significantly (1999-2002) in both locations, as have numbers of ecstasy tablets taken on a usual night. Substance use was associated positively with number of previous visits to Ibiza and new users were recruited into use while abroad (17.4 and 33.1 per 1000 people were introduced to cocaine and ecstasy use, respectively, in Ibiza). CONCLUSIONS: The emergence of international nightlife resorts increasingly links drug use abroad with that in individuals' countries of origin. Our results indicate that resorts such as Ibiza offer tourists the opportunity to increase levels of drug consumption and try different substances in an atmosphere conducive to experimentation. Patterns of recreational drug use in leading international resorts may help predict developments in drug use elsewhere and as such be an important tool in planning appropriate interventions.

Adolescent↗
PubMed2003

Hidden diabetes in the UK: use of capture-recapture methods to estimate total prevalence of diabetes mellitus in an urban population.

An early requirement of the UK's Diabetes National Service Framework is enumeration of the total affected population. Existing estimates tend to be based on incomplete lists. In a study conducted over one year in North Liverpool, we compared crude prevalence rates for type 1 and type 2 diabetes with estimates obtained by capture-recapture (CR) analysis of multiple incomplete patient lists, to assess the extent of unascertained but diagnosed cases. Patient databases were constructed from six sources-a hospital diabetes centre; general practitioner registers; hospital admissions with a diagnosis of diabetes; a hospital diabetic retinal clinic; a research list of patients with diabetes admitted with stroke; and a local children's hospital. Log linear modelling was used to estimate missing cases, hence total prevalence. The crude prevalence of diabetes was 1.5% (95% confidence interval [CI] 1.41, 1.52), compared with a CR-adjusted rate of 3.1% (CI 3.03, 3.19). Age-banded CR-adjusted prevalence was always higher in males than in females and the difference became more pronounced with increasing age. Among males, CR-adjusted prevalence rose from 0.4% at age 10-19 years to 18.3% at 80+ years; in females the corresponding figures were 0.4% and 9.3%. The gap between crude and CR-estimated prevalence points to a rate of 'hidden diabetes' that has substantial implications for future diabetes care.

Adolescent↗
PubMedDate not supplied

Healthy nightclubs and recreational substance use. From a harm minimisation to a healthy settings approach.

Recent trends identify a global rise in the use of drugs such as ecstasy as part of nightlife behaviour. In order to protect young people's health, a variety of harm reduction interventions have been implemented, often focusing on the direct effects of substance use. However, the risk to health posed by substances is also related to the nightlife environmental in which they are used. A healthy settings approach to nightclubs allows environmental issues and substance use to be tackled together. Consequently, a wider range of individuals and organisations feel capable of participating in the risk reduction process. Some countries have already developed integrated approaches to nightlife health. However, growth in international travel associated with nightlife and the additional risks posed by nightclubbing in an unfamiliar country mean that both interventions and basic health and safety measures are now required on an international basis.

Adolescent↗