Monday, 10 December 2012

Why don't the ASSAD Surveys' results always match our personal experience?

The 2011 Australian Secondary School Alcohol and Drug (ASSAD) survey was released today and for the next few years these figures will be used by a wide variety of people to describe what is going on amongst high school students in terms of alcohol and other drug use. I use the ASSAD data all the time - it is a great piece of research that provides some really useful information - but the response I get from many people I speak to, whether it be teachers, parents or those who work with young people in other sectors, is that the results simply don't match their experience.

For the purposes of this post I'll be looking at just the illicit drug use, we'll leave the alcohol, tobacco and over-the-counter information for another day ...

Once again, the data shows quite clearly that the majority of Australian secondary school students do not use illicit drugs. Here are just a few of the key findings:
  • in terms of lifetime drug use, rates were either stable or decreasing for all illicit drug use (apart for cannabis) when compared to the 2008 ASSAD survey among 12-17 year old students
  • lifetime cannabis use had risen from 13.6% in 2008 to 14.8% in 2011
  • 15.6% of 12-17 year old students reported using any illicit drug, including cannabis, in their lifetime. Excluding cannabis use, just 6.5% of students reported using any illicit drug in their lifetime
Even cannabis, the most popular illicit drug, had not been used by 85.2% of the 2011 sample - for some people (e.g., the parent who has a teenage son recently expelled from his school for supplying cannabis to classmates, or the drug worker running programs for at-risk young people) this just doesn't ring true. In their experience, cannabis is a major issue and a significant proportion of the young people that they work with use the drug or are exposed to it on a regular basis. So why don't the results match their personal experience?

Before we try to work out why there is this disparity, let's take a look at the survey a little more closely. This is the tenth survey in the series (and sixth to include questions on the use of over-the-counter and illicit substances) with just under 25,000 students aged between 12 and 17 years taking part in 2011. Students from government, Catholic and independent schools took part in this study with 893 schools invited to participate, with the aim to survey students from 414 schools across the country. That makes it a pretty good study - it has a more than decent sample size, it's collected across the three main education sectors and it has a random sampling methodology.

So, back to the reasons for the difference ...

Firstly, and most importantly, this is a survey of school-based young people, not Australian teenagers. Many youth workers, as well as others who work in health and law enforcement who come in contact with young people, usually see those who are no longer 'connected' to school. Those teens are not represented in this survey. These young people are much more likely to have used, or be currently using, illicit drugs and because they are often much more visible and their behaviour more extreme, they attract much more attention.

In the school setting the so-called 'druggie' group is usually labelled that way by teachers and students alike due to the behaviour they exhibit. They often talk loudly about their exploits, whether they be true or not, and they fit all the usual stereotypes. Even though the group may be small in number it often seems as if there are a lot of them simply because they are so loud and obvious. I can't tell you how many times I have been told by a well-meaning teacher that a particular year group has a 'drug problem' and when asked what evidence they have to support this the only response is 'we hear talk'! I'm certainly not saying to ignore gut feelings, but if you're concerned about possible drug use, get good evidence before you jump to conclusions ...

Finally, always remember that you can use statistics selectively to tell the story you want to get across. I believe in telling a positive story - saying that 85.2% of the sample had not used cannabis sends an affirming prevention message to those young people who choose not to use drugs, letting them know that they are not alone in their decision not to use. If I wanted to tell a different story and see the problems, I could say that one in five 15 year old Australian males have ever used cannabis, and over a quarter of 16 year old and one third of 17 year old males also reported using the drug at some time in their lives. Pretty depressing stuff if I wanted it to be ...

Overall, this survey tells a very positive story, i.e., illicit drug use is not the norm amongst Australian secondary school students. This doesn't make sense to some people who work with young people or have family members who experience great problems with their drug use. Look at the report a little more closely however and you will see that those young people who do use illicit drugs are indeed represented, but they are in the minority in this sample. Even though the figures may not match your personal experience, try to have an open mind and, at the same time, acknowledge that school-based young people are a diverse group, many of whom are simply not interested in illict drug use at this time of their lives.

Sunday, 2 December 2012

'Sheesha' smoking: Why should we be worried?

In the week that the world-first initiative of the plain packaging of cigarettes has finally been introduced in Australia, we should be incredibly proud of our achievements in the tobacco area. We have one of the lowest rates of daily smoking in the world and data that we have available from the latest 2011 ASSAD Survey indicates that we continue to see an upward trend in the number of Australian high school students who have never smoked cigarettes. That said, I am seeing a very worrying trend across the country that may be removing some of the existing barriers around smoking - the increasing popularity of 'sheesha' smoking.

About six months ago I was at a school in Sydney's eastern suburbs when a Year 10 student asked me about the harms associated with smoking a 'hubbly bubbly'. He had gone to a friend's 15th birthday and the parents of the birthday boy had given their son and his friends a sheesha to use at the party! I was absolutely floored - I couldn't believe a parent would do such a thing but since that time I've travelled the country and found that sheesha smoking is becoming increasingly popular, across all age groups, and most worryingly some see it as a 'healthy' way of smoking!

A sheesha (also known as a 'hookah' or 'hubbly bubbly') is a waterpipe, usually used to smoke flavoured tobacco. The smoke travels through a water basin before it is inhaled and, as such, many believe that this makes it a 'safer' way of smoking. Certainly this is what I'm hearing from young (and not so young) people across the country who truly think the water, plus the flavouring added to the tobacco, somehow reduces the risks associated with smoking. I even had one Year 12 girl who told me "it must be good for you, it's got fruit in it!" - truly scary ...

It has only been in recent years that some of the most significant harms have been identified. The sheesha has been used in many cultures for centuries and it is for this reason that harms are often downplayed. A World Health Organisation (WHO) report was released in 2005 and reported that sheesha smoking posed a serious potential health hazard and was certainly not a safe alternative to cigarette smoking. One of the most concerning findings was that during a 'sheesha session' of about 30mins, a smoker could be smoking the equivalent of between 30-100 cigarettes!

As much as we should be concerned about the fact that young people are smoking, more worrying is the belief that there is such a thing as 'healthy smoking'. It has taken such a long time for us to change community attitudes towards tobacco smoking that it would be really sad to see all our efforts undermined by sheesha use. Where we have managed to make cigarette smoking an 'antisocial' activity (who would have believed 25 years ago that if you wanted to have a puff of a cigarette you would have to stand in the middle of a freeway to do it?), you couldn't get further from the truth for sheesha smoking. Most adults are usually introduced to it at Middle Eastern restaurants, others when they were travelling internationally (particularly as backpackers), and now teens are first trying sheesha at gatherings on Saturday nights, usually while drinking alcohol. It is a social activity and that is a worry ... 

I am currently looking at the many Australian websites that sell sheesha products and trying to establish whether any of them are breaking advertising regulations. Claims that the products are "tar free" (they are until you smoke them!) and that they provide a "healthy smoking experience" (is there such a thing?) do push the boundaries of truth and it'll be interesting to see whether we can prove they are breaking the law ... Watch this space ....