Not much to ask for, really! The introduction of standard drink labelling in Australia.

An account is provided of the processes leading up to the introduction of standard drink labelling on all alcoholic beverage containers in Australia. The roles of research and advocacy in recommending the introduction of such labelling are analysed as is the resistance of some parts of the alcohol beverage industry. It is concluded that the success of this policy initiative derived from the carefully orchestrated campaign in which researchers co-operated with health advocates. The prior existence of nationally endorsed guidelines for safe drinking expressed in terms of standard drinks, recommendations of the National Health Policy on Alcohol and an accumulation of relevant research were crucial elements for success. However, the role played by some fortuitous circumstances cannot be ruled out.

Protecting the interests of participants in research into illicit drug use: two case studies.

This paper addresses the conflict between the ethical and legal responsibilities of researchers engaged in illicit drug use research. Fundamentally, the primary ethical responsibility is to protect research subjects from any harm which may come to them as a consequence of having taken part in the research. Legal responsibilities, however, might lie in assisting police with their enquiries into the conduct of an individual who is a research subject, and allowing research data to be searched and possibly used in evidence against the individual. There is no Western Australian legislation which protects research, nor Australian legislation which can be applied to most studies. Using two case studies, we give examples of the conflict and suggest that legislation may be the most effective way to overcome it. However, we also raise a number of issues which would need to be considered before solutions are enacted.

The new public health: nanny in a new hat?

It has been suggested that the new public health is but nannyism in a different guise and that its advocates are the equivalents of health fascists. It will be argued that a form of paternalism (or maternalism) has always been inherent in public health and that to treat illness as if it was wholly a personal possession is to abdicate the government's responsibility for ensuring a healthy environment.

Unravelling the preventive paradox for acute alcohol problems.

Kreitman's discussion of the preventive paradox in relation to the prevention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued here that although Kreitman should be credited with the important observation that alcohol-related harm is not confined to a few dependent drinkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a commonplace truth underlies his apparently paradoxical findings. It is shown that the preventive paradox disappears when consideration is given to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute alcohol-related harm occurred. Episodic heavy consumption by people whose average alcohol intake can be classified as 'low' or 'medium' risk contributes to the bulk of such experiences of harm. It is suggested that the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education campaigns and prevention policy are only based on average rates of alcohol consumption. Advice regarding the low risk levels of consumption for different types of harm should form one component of a comprehensive harm reduction policy. Other elements of such a policy should include a variety of other measures of proven effectiveness in relation to reducing levels of intoxication and related problems.

Changes in drug use and HIV/AIDS risk-taking 1989-90.

The Australian National AIDS and Injecting Drug Use Study was designed to monitor the risk behaviour of Australian injecting drug users (IDUs) in a number of major cities, and to estimate the seroprevalence of those interviewed. Differences in risk behaviour found across 2 years in Perth are reported. One hundred and ninety-six Perth IDUs were interviewed in 1989, and 150 in 1990 using the same survey questionnaire, with a small cohort of 38 respondents being followed up across the 2 years.Significant injecting differences between 1989 and 1990 in both the cohort and independent samples were found. In general, these amounted to a greater likelihood that a new needle and syringe would be used on each injecting occasion, and a greater use of bleach in 1990 than in 1989. The most common response of respondents who said they had changed their drug use behaviour in 1990 was to report ceasing to share needles, while the most common response in 1989 was reduced sharing. There was an increased use of condoms for vaginal intercourse with all partners in both studies across the 2 years. Seropositivity for all new cases across the 2 years was 1.75%. It is apparent that there has been a significant shift in risky behaviour in the direction of greater safety across the 2 years. There is also objective corroborative evidence in increased demand for sterile injecting equipment sold through pharmacists, although there is no evidence that drug use increased significantly during the same period. It is concluded that the availability of sterile needles and syringes should be maintained and improved and that emphasis should be placed on encouraging safer sexual behaviour among IDUs.

Harm reduction in Australia: has it worked? A review.

The literature is reviewed with a view to determining what evidence exists for the success of Australia's policy of harm minimization in relation to drug use. While there are relatively few examples of strategies which can unequivocally be said to have succeeded, there are many more for which the evidence is suggestive. While there has been a considerable mushrooming of research since the advent of the National Campaign on Drug Abuse, it would appear that little of this has measured the extent to which harm has been reduced. The National Drug Strategy would benefit from more policy-orientated research which measures drug-related harm if it is to be, as claimed, research driven.

"Who is responsible for my health-is Nanny always right?".

Allegations of nannyism on the part of the State are examined in relation to alcohol and drug policies. It is argued that some form of protectionism is inherent in public health, and that the argument turns not so much on whether the State has a mandate for such protectionism but what limitations should be placed on the State's mandate.

AIDS and injecting drug use: very risky behaviour in a Perth sample of injecting drug users.

This research was carried out in 1990 to examine high-risk injecting and sexual behaviour in a sample of injecting drug users (IDUs) in Perth. The study was a cross-sectional survey with a convenience sample drawn from drug treatment (54%) and non-treatment (46%) populations. In the sample of 150 IDUs, there were 11 very risky drug behaviour (VRDB) and 63 very risky sex behaviour (VRSB) respondents. Four respondents fell into both categories. Independent comparisons were made between each risk group and the rest of the sample. The VRDB respondents were heterosexual men, most of whom were in long-term monogamous relationships, with heavier levels of drug use than the rest of the sample. The VRSB respondents were largely single and mainly heterosexual, with more sexual partners than the rest of the sample. It was concluded that there was little evidence that very risky behaviour was related to a general risk-taking dimension, to inadequate knowledge about AIDS or to a low assessment of personal vulnerability to AIDS. However, situational influences in association with heavy drug use appeared to be a major component of high-risk injecting behaviour, while high-risk sexual behaviour appeared more to be a reflection of community norms about heterosexual sexual behaviour. The study should be replicated with larger samples, particularly as the VRDB group was so small, but if the findings are reproduced in other studies, it suggests that serious attention should be paid to the promotion of safer sex among injecting drug users.

Response to the Distilled spirits Industry Council of Australia Inc. position paper 'Alcohol Availability'.

A critique is offered of the Distilled Spirits Industry Council position paper 'Alcohol Availability'. It is argued that this position paper presents a simple-minded analysis of the complex relationship between the availability of alcohol and its consumption which pays no attention to the importance of price in determining consumption. As a consequence, it misconstrues the lessons to be drawn from the Victorian experiment in liberalization and fails to consider its implications for the incidence of alcohol related problems.

Public support for the prevention of alcohol-related problems.

Support for a number of strategies and policies for the prevention of alcohol related harm was ascertained as part of a larger survey of public attitudes and behaviours in a representative sample of the Perth metropolitan area. Support for these policies varied, but was generally positive, with young male drinkers the least supportive. The greatest degree of support was found for a variety of training strategies for licensees and barstaff, while a number of restrictive practices, such as reduced trading hours and the banning of the sale of beer in jugs, were less popular. Those who had recently worked in the alcohol trade were less likely than the general population to be supportive of these policies. This effect could not be completely explained by their generally being younger and drinkers. It is concluded that governments generally have a mandate to introduce certain policies and practices into the licensed drinking environment, but that the resistance of the alcohol trade to such measures may need to be overcome if they are to be successfully introduced.