Thursday, February 07, 2013

Films on VSA



Research takes many forms, and some is easier on the brain than others, so I thought that I’d take a break from number-crunching and do some ‘desk research’ on YouTube. It’s easy to get distracted in that corner of cyberspace, but I have heroically avoided ‘lol-cats’ and concentrated on searching out clips that deal with the topic of VSA. I’ve found personal stories, PSAs (public service announcements), studio discussions and educational material. Check out some of these the next time you have a coffee break (if that’s your substance of choice).

As you might expect, there are many individual and tragic stories, and most of the material is from the USA. For example, The dangers of inhalant abuse is a 60-second clip presented by an American policeman whose son, Kyle, died from VSA in 2005.

However, there is UK material; The Chantellle Bleau Memorial Fund (named after a girl who died from VSA) made a film called Volatile Substance Abuse – Ashling’s Story which presents a young woman talking about her previous VSA which she describes interestingly and clearly. The slogan ‘don’t waste your life for an experience’ might provide an interesting discussion point. The Fund also has a video about Chantelle’s death which has her mother talking about her.

Re-Solv has some film on its website. The Silent Killer is a moving eight-minute film focusing on a memorial walk held on the first anniversary of the death of Steven Blacker, a 14-year-old from Derbyshire who died in 2005, sniffing petrol. The walkers have t-shirts with the slogan, ‘sniff it and you may snuff it’. It includes interviews with his mother and younger brother. (It can be purchased as a DVD which is accompanied by a teacher’s booklet.)

The Re-Solv website also has a Loaded Gun, with parents talking about their dead children, information about VSA, and its impacts on family and friends. (It can be purchased as a 12-minute DVD, plus a teacher’s guide with lesson plans and class activities.)

Re-Solv has a link to Chris Cullington, a film about this 16-year-old who died in 1999 after inhaling butane cigarette light refill. His father, Paul, talks very honestly about what happened. In my view, this is the best of all the parent videos.

Another personal account from a parent is on Re-Solv’s training site for the Scottish social care workforce. Here, an Aberdeenshire parent (who is a teacher) describes very movingly the circumstances that led to the VSA death of her youngest son at the age of 15.

Back to the USA, and Inhalants is four minutes of a guy talking about his friend who died from sniffing nitrous oxide; from ‘sobriety television’. From the same outfit is What is Nitrous Oxide?, a man talking about his dependence: ‘Don’t keep whipped cream cans in your house ... I had to keep that stuff out of my fridge ‘cos that’s a trigger for me. ..If I had a bad day I’d just get the whipped cream can and start huffing it… I had a lot of fun doing it ... but … I killed so many brain cells…  I would just look at other ways of finding that rush ... go skydiving or something, something that will give you that really short intense rush’.

At this point, I did get a bit distracted by an American series called ‘My Strange Addiction’. My Strange Addiction- Huffing Gasoline is about a 44-year-old female gasoline sniffer, sniffing since she was 13. It is weird, because it doesn’t look like she is actually inhaling very much. This is one of a series of short films on strange addictions (such as the woman who eats rocks;‘…she was initially attracted to the earthy smell … now Theresa can’t go more than a few hours without eating rocks.’ ‘…it’s the grittiness of it and the earthy taste… ‘ ‘t it in my mouth nad get the earthy task .. as the woman who eats rockspolcieman  I canle'rents - this palce for this –Theresa’s favourite type of rock is a mixture of several minerals, including granite.’ ‘I’d just put it in my mouth and bite on it … and get the earthy taste off it.’ In other words, this series is about behavioural addictions.)

But there are some more educational and informative films on YouTube, such as the three-part ‘Drug Education Inhalants’, a 2004 ‘Schlessinger Media’ presentation describing the nature of VSA and its risks. The three parts of this presentation are rather boring, with talking heads and ominous music in the background there are some lip-synch problems. The first part (seven-and-a-half-minutes long) is Drug Education Inhalants Part 1 covering what inhalants are, the different categories of sniffable products, how inhalants work, why people use, the effects, the risks and the dangers. The clip ends suddenly in the middle of a sentence and you have to go to Drug Education Inhalants Part 2 for the next section (just over eight minutes) which covers the consequences, including sudden sniffing death syndrome and ‘many other ways to die’; it includes a real life story from a mother who has a schizophrenic son – the implication is that sniffing can do this to you. The remaining six minutes are at Drug Education Inhalants Part 3 which shows how inhalants can affect the body: ‘It can freeze the lungs out – I know that isn’t the medical term but that’s what happens.’ It includes some interviews with users; one says. ‘It’s such a short high and it immediately followed by stupidity … it kills the brain… there is a reason you feel dumb after you’ve done [it].’

Better is Understanding Inhalants, a ‘Coalition of Anti-drug Communities of America’ TV studio panel discussion – it’s an hour long, but is a thoughtful discussion (and it has my old friend Harvey Weiss in it) and about ten minutes in they refer to the UK deaths figures. It then cuts to the policeman whose son, Kyle, died (you can also view this clip in The dangers of inhalant abuse). About 18 minutes in, the Panel discusses the problems of communicating to young people – in particular, the risks of raising awareness and making the behaviour seem attractive. Twenty-five minutes in, the story of Michael Moran who ‘choose to use computer duster’ while driving, crashed and killed three people; he got nine years. Forty minutes in, there is an example of a Partnership for a Drug–free America PSA (public service announcement) aimed at parents.
Harvey Weiss also features in Parents Whose Child Died by Inhalant Abuse Educational Video which is an extract from a conference where parents tell tragic and moving stories about their dead children.

Vimeo is an alternative to YouTube, and has some interesting films about VSA. One is 10 minutes of a guy called Andre describing reasons for misuse, as well as treatment and prevention among New Zealand’s young people, at http://vimeo.com/48277706; there is a lot of good sense here, for example, ‘messages need to be context-specific… being responsive to the needs and history of each community’. Another ‘talking head’ film has Nick Baker talking (mainly) about prevention and treatment of VSA (http://vimeo.com/49133048). From the same up-loader, an account by Anne of her son who died from sniffing LPG is at http://vimeo.com/48931608, and a film of Kitty talking about Nathan, who died sniffing; at http://vimeo.com/49134165.

My own YouTube contribution is a four-minute extract from an animated film on VSA that I created in 1995 as part of a training package for the then ISDD (now DrugScope). Problems with Solutions explores the lives of (fictional) VS abusers.

Then there are the more sensational news stories, like Huffing – a TV item about inhalants, with dodgy YouTube extracts, which suggests that wood-stain can be sniffed – are not worth watching, but others are interesting just for their sensationalism: Teens huffing Freon is about the misuse of air-conditioner gas, ‘a frightening trend that is sweeping across the country … what seems like a harmless way to keep us cool can be misused.’

The Dangers of Inhalants, produced by the Alliance for Consumer Education, starts with the mother of Ricky who died a sudden sniffing death after sniffing freon from the air-conditioning unit. It’s mainly a rather hysterical news report, and about four minutes in reports on a Texas education programme with a clip from an animation about sniffing (showing the sniffing of a marker pen!).

Then there is the confessional genre. Our very own Jeremy Kyle is a skilled exponent of this exploitative genre, and he is seen in fine action on A Mum Hooked On Butane Gas (PART 1), an eight-and-a quarter-minute extract from the Jeremy Kyle Show ‘Mum why won’t you stop using butane gas?’ (uploaded in 2010). The 39-year-old Cindy interviewed is using 12 cans of butane a day and has been sniffing for 20 years. She says ‘It just chills you out. … I get lumps inside my head … one day they might just explode’. She is rather matter-of-fact about her habit in the face of Jeremy Kyle’s insensitive onslaught; until she breaks down and cries. Jeremy then interviews her son in the studio, who although sympathetic, and says he has tried to help her, ‘…but everyone’s given up on her now.’ His sister Stacy, interviewed next, is very emotional, and we learn more about the horrors of her mother’s life.

The second part, ‘after the break’, A Mum Hooked On Butane Gas (PART 2) brings Cindy onto the show to talk with her two adult children. It last nine-and-three-quarter minutes: and it’s hard to watch – especially as the sound disappears at about 6 minutes in. She starts her day at three a.m. with butane, and drinks beer as well. She is harangued about her dependence and it is argued that her misuse is ‘not physical’.

Also hard to watch, but for different reasons, are films about children living on the street. Children living on the street sometimes misuse volatile substances; a well-filmed drama about street children in Cambodia is GHOST IN A CAN (GLUE MADE ME A GHOST). Uploaded in 2007 and lasting eight minutes, it is the story of a twelve-year-old boy, Set, a glue-sniffer, who dies in a road accident. It has strong images of children sniffing from plastic bags. Set says ‘Inhaling the glue makes me sick inside. It hurts my head. I want to quit doing it but I can’t. I’m very addicted to it.’

From another continent, Glue-Sniffing Epidemic Among Kenyan Street Children is a three-and-a-half-minute news report about this topic uploaded in December 2008. It has graphic images of children sniffing. One interviewee says: ‘There are some things you cannot do when you are sober, like eat garbage. You need to sniff glue so that you have the courage to eat garbage and do other work in the streets.’

A film called ‘Glue boys’ is about the street children in Kenya but I couldn’t find it on the web (it can be purchased on DVD and there is a trailer at www.glueboys.com).

A similar name but a different film is Glue kids. Lasting about eight minutes, it was filmed in New York with Spanish-speaking participants; so if you speak Spanish, it might be worth watching.

A rather different sort of ‘glue boy’ and a rather different sort of glue misuse is this one-minute film, Glue Boy, about a boy who has flooring glue poured over his head.

That’s a jokey approach to a serious subject, but in our multi-opinionated world there are many sides to any topic, so of course you can find many films on YouTube that celebrate, demonstrate and joke about sniffing. I’ll leave you to find those for yourselves if that interests you (it is sometimes entertaining in a horrified, fixed-to-the seat-what-will-happen-next kind of way). But just one link: How to get high from deodorant is a joke film about getting high on roll-on deodorant.

And what’s my favourite YouTube film of the moment? It’s not about VSA, but right now, my favourite risk education film is about safety on the railways – it’s from the Melbourne Metro and you can watch it (with lyrics) here.

Richard Ives
7th February 2013

Tuesday, December 11, 2012

A thorough piece of research



I’m working with Re-Solv on a ‘Big Lottery’-funded project which aims to help the charity make better use of research evidence, generate its own research and increase its capacity to engage with, make use of, and undertake research. That’s partly why I’m writing these blogs. And right now I can report some exciting results from this work.

A paper based on research funded through this Project has just been published. It uses data collected by the long-running research project on VS-related deaths at St George’s (see my previous blog). It’s an excellent piece of work (carried out primarily by Barbara Butland, a statistician at St George’s, University of London), although I can’t say that the paper is easy reading! You can probably access at least the abstract here. (By the way, Addiction, the Journal in which the paper is published, is one of the oldest (est. 1884), and one of the most prestigious, substance misuse journals in the world.)

One of the questions that we were interested in when we applied for the Big Lottery money was why VS-related deaths had been falling since the early 1990s. What had happened that might have led to the fall in deaths?

Two laws had been introduced to try to curb the sales of volatile substances to young people. As early as 1985, the Intoxicating Substances Supply Act had made it an offence to supply volatile substances to under-18s if there was reason to believe they were going to use them to achieve intoxication, but this law had little effect – not surprisingly, since it was hard to say whether or not someone was going to misuse a consumer product.

In 1999, in response to the worrying rise in deaths associated with butane cigarette lighter refills, a regulation made it illegal in any circumstances to sell these canisters to under-18s. Was it possible that this was a factor in the continuing decline, into the twenty-first century, in the numbers of deaths?

It seems not. Butland’s thorough statistical analysis shows that there was no evidence of a ‘step change’ in the VSA-related deaths of under-18s following the 1999 regulation. 

Keen readers of this blog might recall the entry Reaching Parents: A case of successful advertising?which discussed the apparently positive effects of a prevention campaign aimed at parents. This major government campaign was well-thought-out and targeted, big, sustained, evaluated – unlike most prevention campaigns, then – and seemed to show positive results – even a reduction in VS-related deaths. But the evidence for this wasn’t very robust. We thought that some clever statistical analysis could wring more meaning from the data, and confirm (hopefully) or reject (we’d accept that, we’re doing research) this finding.

Butland’s paper provides support for the earlier finding. She writes: ‘Coincident with the 1992 Department of Health Advertising Campaign, VSA deaths in boys and girls (<18 years of age) fell by an estimated 56% (95% CI: 36%–70%) and 64% (20%–84%), respectively, from the underlying trend’.

That’s massive! And because the DH campaign was aimed at influencing parents, one wouldn’t expect it to have had an effect on deaths of over-18s. It didn’t: adult deaths didn’t fall in this way.

A brief statistical digression: the abbreviation, ‘CI’, is the ‘Confidence Interval’. This range gives us an idea of how reliable the estimate is. For example, in the quotation above, the estimated fall in deaths of under-18-year-old males is a whopping 56 per cent. But this has been worked out using those fancy statistics, so the estimate is only that – it has an element of uncertainty about it. The CI tells us <<how>> uncertain – and in this case it tells us that it could range from 36 per cent up to 70 per cent – but we can be very certain (although not 100% certain, of course) that the fall in young male deaths was at least a third, and might have been as much as seven-tenths. And note that the fall in girls’ deaths was possibly even bigger.

Of course, as statisticians say, ‘association does not mean causation’ – we can’t be certain that the fall in under-18-year-old deaths was <<caused by>> the DH Campaign. But it is a striking finding based on solid, thorough research, and Re-Solv (and the Big Lottery) can be proud to have enabled it to happen.

And let’s have more prevention campaigns like that! Maybe with the new arrangements for public health coming in next April, this is not such a pipedream. Within the new organisation, ‘Public Health England’ (Scotland, Wales and Northern Ireland will have different arrangements) the job of its ‘Health Improvement and Population Health Directorate’ will be to ‘lead… high-impact national health improvement social marketing campaigns to achieve behaviour change’  (see the Department of Health website). Let’s hope they’ll take heed of this research.

Richard Ives

New report on VSA deaths



Well, better late than never. The research on deaths associated with volatile substance abuse in 2009 has just been published (and there is a brief summary on Re-Solv’s news blog). Why so long? An annual report on deaths has been produced since the 1980s. But normally it doesn’t take quite as long as this after the year end and the report emerging. The problem is that the funding for the data collection was cut and the researchers are perhaps producing this report in their spare time. While I’m very grateful to them for their efforts, this doesn’t seem like a sustainable approach to a dataset that’s unique in the world and has been of great significance in keeping VSA on the policy agenda for more than 25 years.

To be fair, it does always take a while to collate all the data – collected mainly from coroners – and check its accuracy. There are also definitional problems: VSs are a disparate group of products and it isn’t always clear if a person has died from using a particular product or (say) from using some other substance at the same time. What counts as a VS-related death? One difficulty is that there isn’t an appropriate code under the International Classification of Diseases.

The excellent thing about this research, though, is that it has, over a very long time, used consistent methods of data collection and reporting, so that we can see trends and patterns emerging. 

However, we have to be careful in our interpretations. For example, the Report says that deaths in the UK from VSA rose from 38 in 2008 to 46 in 2009. That seems like quite a lot: eight more deaths – about a fifth more. But with small numbers there will be annual fluctuations due to chance – they don’t actually mean anything. To help us understand this, the Report gives a chart of deaths that is ‘smoothed’ by plotting a ‘three-year moving average’ (see Figure 2 in the Report). This shows, in the past twenty years, a gentle downward slope which has more recently tended to plateau. In other words, after a steep decline in deaths in the early 1990s, deaths continued to decline, but more slowly, through the 1990s and into the twenty-first century, but that decline seems to have levelled off.

So there were 46 individual tragedies in 2009, and we shouldn’t let up in our efforts to accelerate the decline in deaths. There have been some successes: for example, see my previous post, ‘Reaching Parents: A case of successful advertising?’ which discussed the apparently positive effects of prevention efforts aimed at parents. And one well-established recent downward trend in the deaths data is the smaller proportions of young people who are dying VS-related deaths. The proportion of females dying has increased and in 2009 a quarter of those dying were female (compare with the period 1971-1999, when the proportion was 13 per cent) – of course, this still means that three-quarters of the deaths are male – even though, as other surveys show girls report misusing volatile substances as much, or even more than, boys. The cause of this remains a puzzle.

Different parts of the UK have different rates of deaths (calculated by making a comparison with their populations) – Scotland has always had proportionately high levels of VS-related deaths, and 2009 saw a big jump in the recorded deaths – from four to 17. London and the South-East, along with other parts of England, have had lower death rates. In 2009, it was Northern Ireland that had the highest proportions of deaths – but as ever, we must be careful not to read too much into small numbers: there were three deaths in Northern Ireland in 2009 compared to two in 2008. There was only one death in Wales in 2009; while Wales has had slightly lower-than-average proportions of deaths, there have been a range of efforts to tackle the problem, including commissioning Re-Solv to conduct staff training, and the production, of a section of Wales’s Substance Misuse Treatment Framework especially focused on VSA. But this only came out in 2011, so could not have had an impact on the 2009 deaths figures.

You’ll find more fascinating detail in the Report, including information on the substances misused at time of death. We can only hope that this valuable data source will somehow continue to be published and provide us with information-rich time series data that help us to address this damaging social problem.

Richard Ives

Tuesday, July 03, 2012

Inhalants in the ESPAD Survey – part 3: Visualising the data

One of the difficulties with describing research findings is that, often, the results are multiply-dimensioned, complex and hard to explain. Finding the right words to describe this complexity, entering the caveats and the reporting the nuances is challenging. And it’s even more of a challenge for the reader. 

That’s why there is so much interest in visual representation of data. It really is true that a picture can be worth a thousand words. But until recently, it has been time-consuming to create charts, maps, and other forms of visual representation. With new web apps, this has become easier. I thought I’d try out one of these apps, Tableau Public, to see what it could do.

I took one of the ESPAD tables which I’d created in Excel as part of my work of reporting on ESPAD findings (see previous three blogs), and imported it into Tableau Public (which I downloaded for free from http://www.tableausoftware.com/public), manipulated it, then uploaded it – you can view the results here


It shows the reported prevalence of VSM use ‘once or more‘ (I’ve labelled this ‘ever’) in the ESPAD countries. It’s nice that the shade of the colour gives an immediate indication of the countries with higher, or lower, levels of misuse. You can ‘mouse-over’ the countries to read the actual values. Not only can you view the results, but you can download the worksheet and manipulate it.


This was an experimental upload, so please excuse any errors. I aim to make more use of this technique in future.

Wednesday, June 06, 2012

Inhalants in the ESPAD Survey – part 2: Some Findings


The 2011 ESPAD Survey was published last week. My previous blog entry (5-6-12) described the background to the Report and explored some of the methodological issues as they relate to VSM. In this blog, I’ll consider some of the substantive findings on ‘inhalants’, as they call them (I’ll follow their terminology here).

The question that students were asked about inhalants was: “On how many occasions (if any) have you used inhalants (x, y) to get high?” The national ESPAD teams used nationally relevant examples in place of ‘x’ and ‘y’ in the brackets.

The 2011 ESPAD average is nine per cent reporting ‘ever use’ of inhalants. There were large differences between countries; 28 per cent of students in Croatia reported trying inhalants (the highest) with Latvia (23%) and Slovenia (20%) also reporting high levels of experimentation, while in the two to three per cent range were Albania, Iceland, Italy, Ukraine and Moldova. So there doesn’t seem to be any geographical pattern to this.

What’s changed over the years? There has been a slight increase since 2007: 

 ‘In nearly half of the countries (15 out of 32) with comparable data in 2007 and 2011, a significant increase in the lifetime prevalence of inhalants can be seen… Croatia ... increase[d] from 11% to 28%, and … Latvia… went from 13% to 23%, making these two the top countries in 2011.’ (page 14)

However a decrease occurred in seven countries; for example, in Cyprus (a former ‘top country’) the proportion of students having tried inhalants decreased by half between 2007 (16%) and 2011 (8%).
 
Having had the highest rate of VSM in the 1995 survey (when it was a startling 20 per cent), the UK rate declined to 12 per cent (and was exceeded by nine countries) in the 2003 survey; the rate continued its decline in 2007 survey: nine per cent, which was the same as the average; but in 2011 the UK figure was ten per cent (9% boys; 11% girls), just slightly above the European average. (see footnote)

Across many countries there is now greater equality between the sexes: in most countries, lifetime prevalence was similar for boys and for girls, although in Croatia and France – as well as in the UK – more girls than boys used inhalants, and in six other countries boys’ use was higher. 

More than half of those who’ve tried inhalants have used them only once or twice.  In other words, four per cent of the sample have used inhalants on three or more occasions. Five per cent have used inhalants within the previous 12 months; two per cent reported use during the previous month. The figures for the UK are slightly higher, with seven per cent reporting using within the previous 12 months, and three per cent within the last 30 days.

Inhalants remain one of the first substances tried by young adolescents. On average across Europe, four per cent of boys and three per cent of girls report trying inhalants before the age of 13, the highest proportions being in Croatia (12 per cent for boys and 18 per cent for girls). In the UK, the figures are three per cent for boys and four per cent for girls. This compares with the figure for under-13 cannabis use in the UK, which – at seven per cent – is much higher than the average of three per cent (for both sexes combined) in the other 35 countries.

As regards VSM, the UK has become a more ‘normal’ European country over the years of the ESPAD Surveys. In this period, VSM-related deaths have declined in the UK – especially among teenagers.

Given the significant proportions of young people who try inhalant misuse, it is surprising that there has not been more research and prevention on VSM across Europe. Re-Solv’s recent application to the European Commission to undertake a European project on VSM aims to rectify that.

Footnote: some of the figures in this paragraph vary slightly (1%) from those quoted in the text of the ESPAD Report – mine are taken from the Report’s tables 37 and 38 a & b, while it seems that the Report’s figures are derived from lifetime abstinence tables (41 a & b). The differences are small and probably within the margin of error.