RESUMEN
AIMS: To establish predictors of age 21 alcohol-related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. PARTICIPANTS: One thousand, five hundred and ninety-six students recruited from an initial sample of 3300 during their final year of high school in 1993. DESIGN: Longitudinal follow-up across five waves of data collection. SETTING: Post high school in Victoria, Australia. MEASUREMENTS: Self-administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. FINDINGS: Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol-related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post-high-school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. FINDINGS: revealed that over one quarter of males and females drank alcohol, but on a less-than-weekly basis. This pattern of alcohol use demonstrated considerable stability through the post-school transition and was associated with a low level of subsequent harm at age 21. CONCLUSIONS: Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less-than-weekly basis may be a practical intervention target for reducing alcohol-related harms.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Trastornos Relacionados con Alcohol/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Conducta del Adolescente/psicología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Distribución por Sexo , Estudiantes/psicología , Encuestas y Cuestionarios , Victoria/epidemiologíaRESUMEN
OBJECTIVES: To ascertain the urban/rural distribution of health personnel and the opinions of the medical fraternity in KwaZulu-Natal on compulsory rural service for medical practitioners. DESIGN: Cross-sectional analysis of geographical distribution of health personnel in KwaZulu-Natal based on 1991/92 South African Medical and Dental Council, South African Nursing Council and Pharmacy Council registration data. Opinion survey by administration of a structured questionnaire to a simple, random sample of private practitioners, academic consultants, postgraduate and undergraduate medical students and key informants in senior health service management in KwaZulu-Natal. RESULTS: Peripheral rural areas had health personnel/population ratios higher than or equivalent to those of urban areas, whereas the ratios were 15-40 times lower in deep rural areas. The key finding of the opinion survey was that the majority of all sectors except fifth-year medical students felt that rural service should be compulsory, either post-internship, prior to specialisation or prior to entry into private practice. However, respondents were significantly more likely to agree to rural service that would not affect them personally. The majority (54-87%) of all sectors felt that an option of 'buying out' of rural service should not be permitted. Respondents identified a range of financial, health service, academic, infrastructural and social incentives for rural practice. It is recommended that post-internship rural service be compulsory for a period of 6 months to 1 year provided that academic, health service and infrastructural deficiencies are ameliorated and appropriate financial incentives are provided.