Transcript Document

Centre for Public Health
Evidence Base for Drug Prevention
Service Gaps in Rural Areas
Professor Mark Bellis
Dr Harry Sumnall
Yuko McGrath
Karen Hughes
Centre for Public Health
Brief Overview
• Drug Use in England and Wales
– Recreational
– Problematic
• Some Rural Issues in Drug Use
• Rural Issues in Drug Prevention
• Evidence Base to date from the HDA
• Collaborating Centre for Drug Prevention
16-24
25-34
35-59
30%
% used in last year
25%
20%
15%
10%
5%
613
oi
n
ac
k
H
er
ca
in
e
Co
ca
in
e
Co
e
ph
et
am
in
Cr
A
m
Estimated
number of users
3,357
(16-59)
Thousands
Ec
sta
sy
0%
Ca
nn
ab
is
Centre for Public Health
Prevalence of Drug Use in the Last Year among the
General Population
486
642
63
45
• Over 1 in 4 (16-24) used drugs in last year
• Around 50% of population ever used illegal drugs
British Crime Survey 2003
Centre for Public Health
School use of Drugs
Comparison between UK and Europe
• Levels of lifetime use of any illegal drugs: UK vs Europe (36% vs 16%)
Source: ESPAD survey of 15-16 year olds(1999)
Centre for Public Health
Lifetime Drug Use among Young People
General Population, Club Goers and Techno-Club Goers
General Population (age 16-24)
Nightclubs
Techno clubs
100%
80%
60%
40%
20%
0%
Amphetamine
Cannabis
Ecstasy
Cocaine
Heroin
BCS 2000; Deehan and Saville 2004; O’Hagan 2000
Centre for Public Health
Estimated Prevalence of Problematic Drug Use
• Problematic drug use
– 0.6% Total population
– 0.9% 15-64 Year olds
• Injecting drug use
– 0.2% Total population
– 0.3% for 15- 64 Year olds
• Locality Estimates (Injecting, 15-44 Year olds)
– Brighton
2.0%
– Liverpool
1.5%
– London
1.2%
Frischer et al, 2004, Hickman et al, 2004
Centre for Public Health
Estimated rates and numbers of Problematic Drug Use
per 100,000 population for English DATs (2001)
Rates/100,000
Numbers
Estimates are generally based on urban studies and relatively
little is known about levels in rural communities
Frischer et al 2004
Drug Prevention is a mechanism for reducing Inequalities and Social Exclusion
The effects it has on these issues should help prioritise action
Centre for Public Health
Bundles of Rural Disadvantage
• Definition of Rurality
• Employment
unclear
– Access
• ~ 28% of UK population
– Quality
– Vulnerability
• Standards generally
– Low incomes
– Better health
• Environment
– Higher educational
– Housing unaffordable
qualifications
• Transport
– Incomes higher
– Poor
• Deprivation
– Expensive
– 1 in 4 living in low
income
– Dispersed
Centre for Public Health
Characteristics of Rural Drug Use
• National Surveys too small to measure local variation
• Research data:
– Use follows National trends
– Cannabis and amphetamine available and cheaper
– Access to magic (psilocybin) mushrooms and
veterinary drugs (e.g. ketamine)
• Increasing Nationally
– Varies between villages and proximity to urban
centres
– Dance Drugs availability depends upon cultural
participation
• Increased with mobility and youth culture
Centre for Public Health
Mean year of First Use of Crack
NW National Drug Treatment Monitoring System
1992
1993
1994
1995
McVeigh et al, 2003
Centre for Public Health
Drugs Use by Drug Treatment Clients by PCT
NW National Drug Treatment Monitoring System
Heroin only
Cocaine only
Heroin and Cocaine
Crack only
Heroin and Crack
Cocaine and Crack
All Three
McVeigh et al, 2003
Have a Party in the Country
“Imagine being shacked up in a remote setting, with all your
mates, a thumping sound system and a stash of stimulants.
The worst that can happen is that you tread in a freshly-laid
cow pat”
Tourism and Festivals
• Glastonbury
– Three days
– 140,000 people (official
only)
– Reported drug offences –
85
– 2C-i –65 (largest seizure)
– 4,000 tickets for locals
• BBC 15th August 2004
– Thousands at illegal parties
– Neighbours Complain
• Exposure to Drug Culture
– Festivals
– Tourism
– Holiday Work
70
UK
60
% of users
Centre for Public Health
Frequency of Ecstasy Use in UK and Ibiza
(1999 & 2002 Users only)
Ibiza
50
40
30
20
10
0
<1 day per
week
1 day per week
2-4 days
frequency of use
=>5 days
"I was on E for 2 weeks. On the way back I couldn't
find words for things I saw or type on my phone."
Dutch Person returning from Spain (IREFREA)
Drug use among British Casual workers in Bars and Clubs in Ibiza
%
Workers
100
Holidaymakers
80
60
40
20
B
G
H
e
et
am
in
K
A
m
ph
et
am
in
e
oc
ai
ne
C
sy
Ec
st
a
an
n
ab
is
0
C
Centre for Public Health
Seasonal staff in Holiday Resorts
Drug
• Seasonal workers Abroad see increased drug and sexual activity
• Seasonal workers in UK holiday centres see significant increases
in sexual activity whilst at holiday centre
• Initiation into Drug Use
Hughes et al, 2004; Hennink et al 1999
Centre for Public Health
Ecstasy use - Casual Workers vs. Holidaymakers
Holiday
Work
No. of tablets taken in a usual
night
3.0
4.75
Greatest no. of tablets ever
taken in one night
4.0
8.0
No. of tablets safe to take in
one night
2.0
5.0
No. of tablets safe to take in
one week
5.0
18.5
• Casual Workers are ideally placed to influence holidaymakers
• Health messages should target Casual Workers
Centre for Public Health
Drug Prevention
“Speak to someone you
trust, who knows about
drugs, whenever you feel
you need to speak to
them”
Rural
Goldfish Bowl
• Access to Services
– High Visibility
– Low Confidentiality
– Low Confidence – High Self
Reliance
• Community Involvement
– Everyone Knows
• Distant Services
– Difficult to Access
• Deprivation Dispersed
• Generation Gap Bubble
– Schools
– Media
– Community
Centre for Public Health
Rural Drug Use – Added Impact
• Urban schools
– Higher deprivation, lower achievement but
– Not reflected in life-time drug use
• Rural heroin users
– Higher injecting
• Health Service
– Non Specialist – Limited Options
(Stimulants)
– Staff recruitment poor but wide skills
required
– Isolated Services and Workers (Progress)
– Variation in Services (Syringe Exchange)
(Forsyth & Barnard, 1999)
Major Review
Centre for Public Health
Evidence Base for School Based Prevention
• School based drugs education
accounts for 0.14% of the variance in
drug use
– i.e. 3.7% of young people who would
use drugs delay onset or never use
• Methodologically strongest
– alcohol, tobacco and cannabis
• Targeting hard to reach
– Poorly evaluated
– Need peer recruitment and outreach (Rural
Issue)
(Category 1 White & Pitts, 1998)
Centre for Public Health
Best Evidence for Drug Prevention
• Interactive Teaching Techniques
– Facilitators- training/support from programme developers
• Rural – initial support difficult
• Positive effects Short Lived
– Decline with time without booster sessions
• Rural - continued support stretched
• Multiple Joined up components for health education
– Involve schools, communities, health initiatives, media,
and take into account cultural sensitivities
• Rural - may be better as community often better
integrated?
• Parish councils, local business involvement, District
councils, Countryside Agency
• Generational Bubble and Communications Issues
Health Development Agency - Canning et al., 2004
FRANK
BT exchanges ADSL
enabled, August 2004
Internet Access
• Availability of affordable
rural broadband (2003):
– Urban population: 95%
– Rural villages: 7%
– Remote rural areas: 1%
• Regular personal internet
use:
– Urban areas: 47%
– Rural areas: 45%
– Deprivation Gradient
• Television Coverage
Countryside Agency, 2003
Centre for Public Health
Qualities of Best Programmes
• Young People’s Perspective
– Including the most marginalized - Dispersed
– Ways back when off track – Special Support
• Planned, focused and persistent
– Early intervention, intensive, sustained
– Long term management difficult
• Understanding risk and protective factors
– Why start, What stops some, How some exit
– Poor Local Research
• Use data and local knowledge
– Target action and monitor their success
– University Support
Coomber et al., in press
Quarterly Report
April to September 2004 rapid summary report on
effective drug prevention evidence
Yuko McGrath
Dr Harry Sumnall
Professor Mark Bellis
Contact
NCCDP,
Centre for Public Health,
Liverpool JMU,
8 Marybone,
Liverpool,
L3 2AP
[email protected]
0151 231 5818
Technical Updates
Generic Communications
Collaborating Centre
for Drug Prevention
• Information Service
– Provides answers to questions
on drug prevention evidence
base
– Frequently Asked Questions
System
– National 2005
• Effective Action Briefing
– Evidence into Action
– May 2005
Centre for Public Health
Summary
• Missing
– Scale and Nature of Rural Drug Use
• Very Large and Dispersed
• Could glean some picture from National Data
– Likely to be changing rapidly
• Internet, Parties, Tourism
• May even lead in some recreational areas
• Problematic
– Tendency to follow urban but little use made
– NDTMS routinely examine this
• Goldfish Bowl
– Kept out – Generic National messages?
– Isolated within
• Drug Users
• Service Access & Confidentiality
• Movement to distant services difficult
Centre for Public Health
Summary
• Prevention Issues
– School Services
• Specialist Support – Training, Availability and
Sustainability
• Generation Difference – Better understood
– Other Prevention
• Stimulant services poor even in urban areas
• Syringe Exchange needed and cost effective
• Long Term Management an issue with individuals
multi-tasking
• Rural Possibilities
– Good Community Development
– Link Media, School, Police, Council, Parish, DAAT
– Peer-led and social/familial work effective and suited
to rural setting
– Mobile Services and Support needs examining
Professor Mark Bellis
National Collaborating Centre for Drug Prevention
Centre for Public Health
Marybone 8,
Liverpool JMU,
Liverpool
L3 2AP
UK
www.cph.org.uk/nccdp
[email protected]