Biomedical subjects

Shaun Stephenson

Publications and source records attributed to Shaun Stephenson.

10 recordsLinked to original sources

PubMed2005

Computerised screening for hazardous drinking in primary care.

INTRODUCTION: Brief interventions undertaken in primary care settings have been shown consistently to reduce hazardous drinking, but they are not commonly offered in practice. The aims were to determine the uptake by young people of an offer of screening in a primary care setting; to identify patients' drinking risk levels; and to estimate the proportion who would consent to computerised brief intervention and follow-up. METHODS: Participants were 1120 patients attending a university student health service that were invited for screening while in the waiting room. Participants were also asked for their consent to be contacted for follow-up assessment 1, 6, and 12 months later. RESULTS: 1,010 patients (90%) accepted the invitation for screening. Of these, 35 (4%) failed to complete screening, thus leaving 975 with complete Alcohol Use Disorders Identification Test (AUDIT) data. Sixty percent of women and 73% of men screened positive. Twenty-three patients (4%) eligible for intervention declined follow-up assessments. DISCUSSION: The study demonstrates that the primary care setting can be used to facilitate access via computer to a large number of individuals whose drinking is hazardous. Limitations of the study include the use of an educated segment of the population who may be more receptive to computerised screening than other groups. Strengths of the study include the high rate of participation and the naturalistic setting in which the data were collected.

Adolescent↗

PubMed2005

Episode-centred analysis of drinking to intoxication in university students.

AIMS: To demonstrate the use of an internet-based retrospective diary to measure intoxication and to describe the epidemiology of intoxication in a university community. METHODS: A probability sample of 1564 New Zealand university students completed an Internet-based survey (82% response), including a retrospective diary in which the volume consumed on each of the preceding seven days and the duration of each episode were recorded, along with the respondent's gender, weight, and their typical quantity/frequency of consumption, as a measure of tolerance. These parameters were used to compute an estimated blood alcohol concentration (EBAC) for each episode. RESULTS: Using an EBAC of 0.08 g/100 ml as a criterion for intoxication produced lower estimates of incidence than binge drinking guidelines (>40 g for women, >60 g for men), or subjective reports. EBACs of 0.08 g per cent were exceeded at least weekly by 37% of women and 39% of men. Teenage females had higher EBACs than teenage males, despite lower consumption. Intoxication was positively associated with lower age, European or Maori ethnicity relative to Asian, Pacific, or other ethnicities, and with residential halls relative to other living arrangements. Faculty of study was inconsistently related to intoxication. DISCUSSION: Frequent drinking to intoxication is normative behaviour in this population group. Of particular concern are intoxication levels in females aged 16-21 years and in males throughout their 20s. The web-based retrospective diary is a useful means of measuring intoxication by self-report. Where time permits it can be enhanced by specification of drinking locations and beverage-specific questions.

Adolescent↗

PubMed2005

Effects of service delivery versus changes in incidence on trends in injury: a demonstration using hospitalised traumatic brain injury.

Though injury incidence and hospitalisations are likely to be correlated, a range of factors other than incidence of injury in a population may influence trends in hospitalised injuries. These include technical changes in the hospital data's coverage, and real changes in the incidence of hospitalisations independent of the population incidence. This paper addresses the latter using the example of traumatic brain injury (TBI) hospitalisations in New Zealand. Data were New Zealand public hospitals inpatient discharges. Five measures of TBI severity were used. The relative rate of minor to serious TBI hospitalisations declined by approximately 2-6% per year from 1988 to 1998. This decline is observed across different mechanisms and the two severity measures used in the detailed analysis. The relative decline in minor to serious TBI is likely to be related to a change in the probability of admission rather than a change in the population TBI incidence. As most TBI hospitalisations are minor this suggests the trend in TBI hospitalisations was significantly influenced by factors other than changes in population incidence. Any analysis of routinely collected secondary injury data needs to consider case selection carefully, especially if trends are being examined. Applying a severity threshold should give more reliable trends.

Adolescent↗

PubMed2005

Drink-driving and perceptions of legally permissible alcohol use.

OBJECTIVE: The leading cause of death for young people in developed countries is road traffic crashes, a large proportion of which are attributable to drink-driving. The aims of the study were to estimate the prevalence of drink-driving and drink-riding in a sample of New Zealand university students, and to identify potential risk factors, in particular, students' perceptions of legally permissible consumption before driving. METHODS: Participants were 1,564 survey respondents (82% response, mean age = 20.5 years) who were asked to indicate whether they had driven after having "perhaps too much to drink to be able to drive safely," if they had been a passenger in a vehicle "where the driver had perhaps too much to drink to be able to drive safely," and how many standard drinks they could consume in one hour and legally drive a car. An estimated blood alcohol concentration was computed and compared with legal limits. RESULTS: Drink-driving (past four weeks) was reported by 3.4% of women and 8.4% of men. Drink-riding (past four weeks) was reported by 7.0% of women and 11.5% of men. Estimated blood alcohol concentrations from students' reports of how much they could drink in one hour and be below the legal limit of 0.08 g/ml, showed that most respondents dramatically underestimated permissible consumption; only 5.8% overestimated it. CONCLUSIONS: This may be a case where misperception of a public health message serves the public good. Further reductions in drink-driving/riding will require attention to transport needs, more visible enforcement of existing legislation, and modification of youth drinking behavior.

Accidents, Traffic↗

PubMed2004

Motor vehicle traffic crashes involving Maori.

AIMS: To provide a descriptive epidemiology of fatal and non-fatal motor vehicle traffic (MVT) crashes involving Maori (1980-1994 inclusive) and to describe factors associated with those crashes. METHODS: A data set for 1980-1994 was created by linking: (1) the New Zealand Police traffic crash reports (providing crash details), and (2) the New Zealand Health Information Services (NZHIS) hospital inpatient and mortality files (providing ethnicity, other demographic and injury details). RESULTS: The linked data set contained 8178 MVT crash events involving 8273 vehicles/drivers in which there were 9288 Maori casualties. Findings showed 82% of Maori casualties were aged less than 34 years and 70% were male. Nearly 30% were car drivers, 32% passengers, 15% motorcyclists and 12% pedestrians. Most crashes occurred in fine weather (82%), on a sealed (98%), two-way (97%) road, in or near an urban area (62%). The largest proportion (44%) of crashes occurred between 5 pm and midnight and the most common days of the week on which they occurred were Saturday (21%) and Friday (19%). The most common type of crash was 'loss of control' on a corner (27%) or a straight road (13%). CONCLUSIONS: Motor vehicle traffic crashes are a major cause of mortality and morbidity for Maori. Future research, and the development of strategies to prevent traffic-related injury among Maori, would be facilitated by the inclusion of an ethnicity indicator on the traffic crash reports, and the collection of more comprehensive crash data on safety measures, such as occupant protection and driver-licence status.

Accidents, Traffic↗

PubMed2004

Assessment of nonresponse bias in an internet survey of alcohol use.

BACKGROUND: Decreasing survey response rates are a growing concern in epidemiological research, principally because prevalence estimates may be biased by selective nonresponse. Internet-based methods have the potential to yield higher-quality data with lower nonresponse rates and at a lower cost than traditional methods. Little research exists on nonresponse bias in Internet surveys of alcohol use. This investigation draws on a study of the implementation of an Internet-based alcohol survey involving a random sample of 1910 university students with a response rate of 82% (n = 1564). Our aim was to identify nonresponse bias and to quantify its effects on estimates of alcohol consumption, the incidence of alcohol-related problems, and the prevalence of hazardous drinking. METHODS: Survey nonresponse has been characterized in terms of a continuum of resistance model, in which the propensity of individuals to respond is inferred from the level of effort required to elicit a response. Two methods were used to test this model: comparison of the demographic characteristics of the target sample with those of the respondents and comparison of alcohol variables for those who responded late with those who responded early. RESULTS: The results attained with method 1 showed that bias varied as a function of gender, age, ethnicity, and living arrangement. The results attained with method 2 showed that the incidence of alcohol-related problems and hazardous drinking prevalence varied as a function of response latency. If only the early and intermediate respondents had participated, the incidence of alcohol-related problems and the prevalence of hazardous drinking would each have been underestimated by 3%. CONCLUSIONS: The findings reported here are consistent with the continuum of resistance model but show that the bias resulting from nonresponse is arguably too small to be of concern with respect to estimating consumption levels, the incidence of alcohol-related problems, and the prevalence of hazardous drinking.

Adolescent↗

PubMed2003

Upward trends in the incidence of neck of femur fractures in the elderly.

AIM: A recent paper by Fielden and colleagues suggested the incidence of neck of femur fractures among those aged 65 years and older underwent a much smaller increase during the 1990s than had previously been predicted. Given the importance of neck of femur fractures in New Zealand we sought to re-examine the conclusions of Fielden and colleagues, paying close attention to case selection. METHODS: Cases were selected from patients discharged by New Zealand public hospitals, with close attention paid to the inclusion criteria. Readmissions and day patients were excluded. RESULTS: Twenty eight per cent of the cases we identified were excluded as either readmissions or day patients. The resulting yearly incidence estimates were generally lower than those reported by Fielden and colleagues but the upward trends in incidence were stronger. Similarly, our estimates of the trends in age-specific rates for women showed the decline in these rates to be much less significant than that reported by Fielden and colleagues. CONCLUSIONS: Age-group-specific rates of neck of femur fracture have not declined as much as Fielden and colleagues suggested. Case selection can have a significant effect on estimated incidence and trends derived from hospital data.

Aged↗

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

Graduated driver licensing: the New Zealand experience.

In New Zealand, on 1 August 1987, a three-stage graduated driver licensing (GDL) system that applied to all new drivers aged 15-24 years was introduced. The essential elements of GDL were a 6-month learner license (supervised driving) and an 18-month restricted license stage (with restrictions on night driving and carrying passengers). A blood alcohol limit of 0.03 mg% applied at both stages. EVALUATION STUDIES: Early studies indicated that young people were reasonably accepting of the restrictions, with the passenger restriction being the least acceptable. Problems of compliance with the restricted license driving restrictions were reported. Evaluations of the impact of the graduated driver licensing (GDL) on serious traffic-related injury showed that up until 1991-1992, an 8% reduction could be attributed to GDL. At this time, it was considered that reduced exposure was the main reason for this reduction. However, the number of fatalities and hospital admissions among young people continued to decline, as did the population rate and the rate per number of licensed drivers among the young driver age group. A further evaluation study showed that drivers with a restricted license had a smaller proportion of crashes at night, and with passengers, compared with drivers licensed before GDL. IMPACT OF GDL: These results suggested that GDL restrictions had contributed to the reduction in crashes among young people and that it was not simply a case of reduced exposure to risk. An update of the most recent crash statistics indicated that, compared with older age groups, the fatal and serious injury crash rate among young people has remained substantially below the pre-GDL level. This suggests that the impact of GDL has not diminished over time.

Accidents, Traffic↗

PubMed2003

Measuring road traffic safety performance: monitoring trends in nonfatal injury.

Traditional indicators used to monitor trends in nonfatal injury are influenced by a range of factors other than the incidence of injury. Indicators based on threat-to-life scales offer a means of addressing this problem. The aim of the research described in this article was to compare trends in the official indicators with trends in selected threat-to-life indicators. We compared indicators based on the New Injury Severity Score and the International Classification of Diseases-based Injury Severity Score with the official New Zealand indicators; namely, (1) reported injuries, (2) reported injuries per 10,000 vehicles, (3) reported injuries per 100,000 people, and (4) number hospitalized (discharges). All the official indicators suggest that there has been a substantive decline in nonfatal Motor Vehicle Traffic Crashes (MVTCs) for the period 1988-2000, but a notable increase in 2001. The latter appear to be artifactual increases due to changes in patterns of data collection and do not reflect any real changes in incidence. Further support for this is provided by the results for the two threat-to-life indicators, which suggest that the decline observed for 1988-98 may have been attributable to a decline in the ascertainment or occurrence of minor injuries since those injuries, which represent a significant threat to life, have not declined to the same degree. Given the prominence of motor vehicle crashes as a cause of unnecessary morbidity, more thought needs to be given to deriving valid indicators for measuring trends in serious nonfatal injury.

Accidents, Traffic↗