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Montemayor BN, Flores SA, Hassan A, Lockman A. Help-Seeking Intentions Among High-Risk College Student Drinkers: A Theory-Driven Examination of Social and Cognitive Influences. JOURNAL OF PREVENTION (2022) 2025:10.1007/s10935-025-00854-x. [PMID: 40317405 DOI: 10.1007/s10935-025-00854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2025] [Indexed: 05/07/2025]
Abstract
Alcohol use remains a prevalent issue on college campuses, with approximately 15% of students drinking at levels indicative of an Alcohol Use Disorder (AUD), yet help-seeking rates remain low. The Reasoned Action Approach (RAA) provides a framework for understanding psychosocial drivers of help-seeking intentions. This study assessed associations between college students' drinking behaviors, the RAA, and their intentions to seek professional help for alcohol use if they thought or knew they had an AUD. Cross-sectional survey data from 2,110 college students were analyzed to examine alcohol use, psychosocial risk factors, and help-seeking behaviors. Participants met inclusion criteria if they were 18 to 24 years old, enrolled full-time in a college or university, reported past-year alcohol consumption, and passed data quality checks. Measures included demographics, RAA constructs (attitudes toward, norms regarding, perceived control over, and intention to seek professional help), and alcohol use behaviors assessed via the Alcohol Use Disorder Identification Test (AUDIT). Descriptive statistics and multiple linear regression analyses were conducted to examine factors associated with help-seeking intentions. The average AUDIT score was 10.91, indicating hazardous alcohol use. Nearly one-third of participants had an AUDIT score ≥ 15, suggesting an increased likelihood of an AUD. Regression results showed that higher AUDIT scores (p < .001) were negatively associated with the intention to seek professional help for alcohol use. All RAA constructs were statistically significant predictors of intention to seek help (p < .001), with the full model explaining nearly 40% of the variance in help-seeking intentions. This study provides new insights into the complex interplay between personal beliefs and drinking behaviors in help-seeking intentions. Leveraging constructs of the RAA, specifically, positive attitudes toward professional help, greater social acceptance of help-seeking, and higher perceived autonomy over seeking help, was associated with stronger intentions to seek support. The psychosocial elements of these frameworks, combined with informing students of their risks, offer a nuanced approach to encouraging the shift from help-seeking hesitancy to help-seeking acceptance.
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Affiliation(s)
- Benjamin N Montemayor
- Department of Health Behavior, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA.
| | - Sara A Flores
- Department of Health Behavior, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Arham Hassan
- Department of Health Behavior, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Alee Lockman
- Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, USA
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Walmisley U, De Jong M, George A, Okeyo I, Späth C, Siegfried N, Harker N, Tomlinson M, Doherty T. Whole-of-community and intersectoral interventions that address alcohol-related harms: A scoping review. Glob Public Health 2024; 19:2357211. [PMID: 38916343 DOI: 10.1080/17441692.2024.2357211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/12/2024] [Indexed: 06/26/2024]
Abstract
Alcohol harms threaten global population health, with youth particularly vulnerable. Low - and middle-income countries (LMIC) are increasingly targeted by the alcohol industry. Intersectoral and whole-of-community actions are recommended to combat alcohol harms, but there is insufficient global evidence synthesis and research examining interventions in LMIC. This paper maps existing literature on whole-of - community and intersectoral alcohol harms reduction interventions in high-income countries (HIC) and LMIC. Systematic searching and screening produced 61 articles from an initial set of 1325: HIC (n = 53), LMIC (n = 8). Data were extracted on geographic location, intersectoral action, reported outcomes, barriers, and enablers. HIC interventions most often targeted adolescents and combined community action with other components. LMIC interventions did not target adolescents or use policy, schools, alcohol outlets, or enforcement components. Programme enablers were a clear intervention focus with high political support and local level leadership, locally appropriate plans, high community motivation, community action and specific strategies for parents. Challenges were sustainability, complexity of interventions, managing participant expectations and difficulty engaging multiple sectors. A learning agenda to pilot, scale and sustain whole-of-community approaches to address alcohol harms in settings is crucial, with consideration of local contexts and capacities, more standardised methods, and a focus on community-driven action.
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Affiliation(s)
- Ulla Walmisley
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Michelle De Jong
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Ida Okeyo
- School of Pharmacy, University of the Western Cape, Belville, South Africa
| | - Carmen Späth
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nandi Siegfried
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Mental Health and Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Nadine Harker
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Tanya Doherty
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Deutsch AR, Chau E, Motabar N, Jalali MS. Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States. SYSTEM DYNAMICS REVIEW 2023; 39:207-238. [PMID: 38107548 PMCID: PMC10723070 DOI: 10.1002/sdr.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 12/19/2023]
Abstract
The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | | | - Nikki Motabar
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Mohammad S Jalali
- University of California Santa Barbara, Santa Barbara, CA, USA
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
- Sloan School of Management, Massachusetts, Institute of Technology, Cambridge, MA, USA
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Okeyo I, Walmisley U, De Jong M, Späth C, Doherty T, Siegfried N, Harker N, Tomlinson M, George AS. Whole-of-community interventions that address alcohol-related harms: protocol for a scoping review. BMJ Open 2022; 12:e059332. [PMID: 35851004 PMCID: PMC9297215 DOI: 10.1136/bmjopen-2021-059332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Alcohol-related harm is a rising global concern particularly in low-income and middle-income countries where alcohol use fuels the high rates of violence, road traffic accidents and is a risk factor for communicable diseases such as HIV/AIDS and tuberculosis. Existing evidence to address alcohol-related harm recommends the use of intersectoral approaches, however, previous efforts have largely focused on addressing individual behaviour with limited attention to whole-of-community approaches. Whole-of-community approaches are defined as intersectoral interventions that are systematically coordinated and implemented across the whole community. The objective of this scoping review is to synthesise the existing literature on multisectoral, whole-of-community interventions which have been used to modify or prevent alcohol-related harms. METHODS AND ANALYSIS This scoping review will follow the six-step approach that involves; (1) identifying the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting the results and (6) expert consultation. Published literature from 2010 to 2021 will be accessed through PubMed, Web of Science, CINAHL Plus and Scopus databases. Search terms will focus on the concepts of 'interventions', 'community-based', 'harm reduction' and 'alcohol'. There will be no restrictions on the type of study methodology or country of origin. Title and abstract followed by full-text screening will be conducted by two reviewers to identify relevant articles based on the inclusion and exclusion criteria. Data from selected articles will be extracted and charted in Excel software. Findings will be analysed qualitatively and presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review. ETHICS AND DISSEMINATION This review makes use of published and publicly available data and no ethics approval is required. The results from this study will be disseminated via publication in peer-reviewed journals and presentations at relevant academic research fora and conferences.
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Affiliation(s)
- Ida Okeyo
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
| | - Ulla Walmisley
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
| | - Michelle De Jong
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
| | - Carmen Späth
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
- Division of Social and Behavioural Sciences, University of Cape Town, School of Public Health and Family Medicine, Cape Town, Western Cape, South Africa
| | - Tanya Doherty
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Nandi Siegfried
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Department of Mental Health and Psychiatry, University of Cape Town, Observatory, Western Cape, South Africa
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, University of Stellenbosch, Cape Town, Western Cape, South Africa
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Asha S George
- Community and Health Sciences, University of the Western Cape School of Public Health, Bellville, Western Cape, South Africa
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Koning IM, Van der Rijst VG, De Wit JBF, De Kock C. Pre-Intervention Effects of a Community-Based Intervention Targeting Alcohol Use (LEF); The Role of Participatory Research and Publicity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8823. [PMID: 34444571 PMCID: PMC8391560 DOI: 10.3390/ijerph18168823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
This study explores the impact of the 'pre-intervention effects' of a community-based intervention. This refers to participatory research processes and parallel publicity in the media on changes in alcohol use and relevant mechanisms (rules and norms about alcohol, accessibility of alcohol in a formal setting) among adolescents before any intervention is implemented. The aim was to investigate the contribution of these processes (i.e., pre-intervention effects) to changes in intervention-targeted factors before any actual intervention was implemented. In a quasi-experimental study, data were collected twice by means of self-report among adolescents living in two municipalities (control and experimental condition). A regression analysis showed negative pre-intervention main effects on adolescents' perceived accessibility of alcohol in a formal setting. Moreover, among adolescents aged 15 years and older, the normative decline in strictness of rules and norms was less steep in the experimental condition compared to the control condition. Additionally, adolescents aged 14 years and younger in the experimental condition reported more weekly drinking compared to their peers in the control condition. No differential effects across gender were found. To conclude, applying a co-creational approach in the development of an intervention not only contributes to more effective interventions in the end, but the involvement of and discussions in the community when planning the intervention contribute to changes in targeted factors. This implies that public discussions about the development of intervention strategies should be considered as an essential feature of co-creation in community-based interventions.
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Affiliation(s)
- Ina M. Koning
- Youth Studies, Interdisciplinary Social Science, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands;
| | - Vincent G. Van der Rijst
- Youth Studies, Interdisciplinary Social Science, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands;
| | - John B. F. De Wit
- Social Policy and Public Health, Interdisciplinary Social Science, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands;
| | - Charlotte De Kock
- Institute for Social Drug Research, Faculty of Law and Criminology, Ghent University, B-9000 Ghent, Belgium;
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Sanchez HF, Orr MF, Wang A, Cano MÁ, Vaughan EL, Harvey LM, Essa S, Torbati A, Clark US, Fagundes CP, de Dios MA. Racial and gender inequities in the implementation of a cannabis criminal justice diversion program in a large and diverse metropolitan county of the USA. Drug Alcohol Depend 2020; 216:108316. [PMID: 33017750 DOI: 10.1016/j.drugalcdep.2020.108316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diversion programs are considered alternatives to the arrest and incarceration of non-violent drug offenders, including those found in possession of smaller amounts of cannabis in states with prohibitive laws. Despite the progressive nature of such programs, the inability to complete diversion program requirements can often result in greater involvement with the criminal justice system than traditional case adjudication. Few studies have evaluated racial group differences in cannabis diversion program completion. METHODS The current study examined a sample of 8323 adult participants in Harris County, Texas' Marijuana Misdemeanor Diversion Program (MMDP) between March 2017 and July 2019. Gender, age, and race/ethnicity were examined as predictors of program completion and time to completion using Chi square, Kruskal Wallis tests, and Cox proportional hazard regression models. RESULTS Both males and African Americans were over-represented (80 % and 50 %, respectively) among participants of Harris County's MMDP. African American (HR = 0.782, 95 % CI [.735-.832], p < .001) and Latino American MMDP participants (HR = .822, 95 % CI [.720-.937], p = .003) had significantly lower odds of MMDP completion and a longer interval to program completion as compared to non-Latino White participants. CONCLUSIONS The current study identified racial/ethnic and gender disparities in a large county's cannabis diversion program. These findings may be related to law enforcement disparities which disproportionately target males and people of color. Findings may serve to inform the continued reform of the criminal justice system, particularly laws relating to cannabis.
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Affiliation(s)
- Helen F Sanchez
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States.
| | - Michael F Orr
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Houston, TX 77204, United States.
| | - Ann Wang
- Department of Neurology, University of Texas Health Science Center at Houston, 6431 Fannin, Street, Houston TX 77030, United States.
| | - Miguel Á Cano
- Department of Epidemiology, Florida International University, 11200 SW 8thSt AHC5, Miami, FL 33199, United States.
| | - Ellen L Vaughan
- Department of Counseling and Educational Psychology, Indiana University, 201 N Rose Ave, Bloomington, IN 47405, United States.
| | - Laura M Harvey
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States.
| | - Saman Essa
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States.
| | - Autena Torbati
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States.
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave New York, NY 10029, United States.
| | - Christopher P Fagundes
- Department of Psychology, Rice University, 6100 Main St, Houston, TX 77005, United States.
| | - Marcel A de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Houston, TX 77204, United States; HEALTH Research Institute, University of Houston, 4849 Calhoun Rd, Houston, TX 77204, United States.
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7
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Stockings E, Bartlem K, Hall A, Hodder R, Gilligan C, Wiggers J, Sherker S, Wolfenden L. Whole-of-community interventions to reduce population-level harms arising from alcohol and other drug use: a systematic review and meta-analysis. Addiction 2018; 113:1984-2018. [PMID: 29806876 DOI: 10.1111/add.14277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/08/2018] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Whole-of-community interventions aim to reduce alcohol and other drug (AOD) use and harms by mobilizing community leaders, organizations and policy-makers to respond effectively to AOD use. The aim of this review is to estimate the effectiveness of whole-of-community interventions in reducing population-level harms arising from AOD use. DESIGN A systematic review of electronic databases CENTRAL, Embase, Medline, Medline in Process and PsycINFO was conducted from database inception to August 2017. Eligible trials had a parallel comparison group, implemented interventions in two or more community settings, and reported data on AOD use or harms. SETTING Intervention settings included schools, sporting clubs, police and law enforcement agencies, community centres, local media and retail premises. PARTICIPANTS Twenty-four trials from 63 publications were included (n = 249 125 participants). MEASUREMENTS Outcomes from AOD consumption (quantity and frequency), AOD-related crime and AOD-related accidents, injuries and hospital admissions. Data were pooled using random-effects inverse variance meta-analysis in Review Manager version 5.3. FINDINGS Risk of bias was mostly high, due to lack of random allocation, selective reporting and significant attrition. Meta-analyses indicated significant reductions in risky drinking [Alcohol Use Disorders Identification Scale (AUDIT) > 8; three trials (7 data points), relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.62-0.99)], but found no impact on past-month alcohol use (five trials, RR = 0.95, 95% CI = 0.89-1.02), binge drinking (five trials, RR = 0.97, 95% CI = 0.89-1.06) or 12-month marijuana use (two trials, RR = 0.98, 95% CI = 0.86-1.11). Narrative synthesis indicated some reductions in AOD-related assault rates and arrests, but were equivocal for quantity of alcohol consumed, 12-month illicit drug use, assault or abuse, motor vehicle accidents and hospital admissions. CONCLUSIONS Interventions to reduce alcohol and other drug use and harms applied to whole communities have resulted so far in small reductions in risky alcohol consumption, but have had little impact upon past month alcohol use, binge drinking or 12-month marijuana use and the studies have been subject to high risk of bias.
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Affiliation(s)
- Emily Stockings
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
| | - Kate Bartlem
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Hall
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Rebecca Hodder
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Conor Gilligan
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - John Wiggers
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Shauna Sherker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Alcohol and Drug Foundation, North Melbourne, Victoria, Australia
| | - Luke Wolfenden
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
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