Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

Article

Milte, Catherine M., Parletta, Natalie, Buckley, Jonathan D., Coates, Alison M., Young, Ross M. and Howe, Peter R. C.. 2012. "Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: A randomized controlled trial." Nutrition. 28 (6), pp. 670-677. https://doi.org/10.1016/j.nut.2011.12.009
Article Title

Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

ERA Journal ID13728
Article CategoryArticle
AuthorsMilte, Catherine M. (Author), Parletta, Natalie (Author), Buckley, Jonathan D. (Author), Coates, Alison M. (Author), Young, Ross M. (Author) and Howe, Peter R. C. (Author)
Journal TitleNutrition
Journal Citation28 (6), pp. 670-677
Number of Pages8
Year2012
Place of PublicationUnited States
ISSN0899-9007
1873-1244
Digital Object Identifier (DOI)https://doi.org/10.1016/j.nut.2011.12.009
Web Address (URL)http://www.sciencedirect.com/science/article/pii/S0899900712000020
Abstract

Objective: To determine the effects of an eicosapentaenoic acid (EPA)-rich oil and a docosahexaenoic acid (DHA)-rich oil versus an ω-6 polyunsaturated fatty acid-rich safflower oil (control) on literacy and behavior in children with attention-deficit/hyperactivity disorder (ADHD) in a randomized controlled trial. Methods: Supplements rich in EPA, DHA, or safflower oil were randomly allocated for 4 mo to 90 Australian children 7 to 12 y old with ADHD symptoms higher than the 90th percentile on the Conners Rating Scales. The effect of supplementation on cognition, literacy, and parent-rated behavior was assessed by linear mixed modeling. Pearson correlations determined associations between the changes in outcome measurements and the erythrocyte fatty acid content (percentage of total) from baseline to 4 mo. Results: There were no significant differences between the supplement groups in the primary outcomes after 4 mo. However, the erythrocyte fatty acid profiles indicated that an increased proportion of DHA was associated with improved word reading (r = 0.394) and lower parent ratings of oppositional behavior (r = 0.392). These effects were more evident in a subgroup of 17 children with learning difficulties: an increased erythrocyte DHA was associated with improved word reading (r = 0.683), improved spelling (r = 0.556), an improved ability to divide attention (r = 0.676), and lower parent ratings of oppositional behavior (r = 0.777), hyperactivity (r = 0.702), restlessness (r = 0.705), and overall ADHD symptoms (r = 0.665). Conclusion: Increases in erythrocyte ω-3 polyunsaturated fatty acids, specifically DHA, may improve literacy and behavior in children with ADHD. The greatest benefit may be observed in children who have comorbid learning difficulties.

KeywordsAttention-deficit/hyperactivity disorder; Children; Docosahexaenoic acid; Eicosapentaenoic acid; Learning difficulties; ω-3 Fatty acids
ANZSRC Field of Research 2020321099. Nutrition and dietetics not elsewhere classified
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Byline AffiliationsUniversity of South Australia
Queensland University of Technology
Australian Technology Network Centre for Metabolic Fitness, Australia
Institution of OriginUniversity of Southern Queensland
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Lower energy intake following consumption of Hi-oleic and regular peanuts compared with iso-energetic consumption of potato crisps
Barbour, Jayne A., Howe, Peter R. C., Buckley, Jonathan D., Wright, Graeme C., Bryan, Janet and Coates, Alison M.. 2014. "Lower energy intake following consumption of Hi-oleic and regular peanuts compared with iso-energetic consumption of potato crisps." Appetite. 82, pp. 124-130. https://doi.org/10.1016/j.appet.2014.07.015
Increased erythrocyte eicosapentaenoic acid and docosahexaenoic acid are associated with improved attention and behavior in children with adhd in a randomized controlled three-way crossover trial
Milte, Catherine M., Parletta, Natalie, Buckley, Jonathan D., Coates, Alison M., Young, Ross M. and Howe, Peter R. C.. 2015. "Increased erythrocyte eicosapentaenoic acid and docosahexaenoic acid are associated with improved attention and behavior in children with adhd in a randomized controlled three-way crossover trial." Journal of Attention Disorders. 19 (11), pp. 954-964. https://doi.org/10.1177/1087054713510562
Potential implications of dose and diet for the effects of eocoa flavanols on cardiometabolic function
Davison, Kade and Howe, Peter R C. 2015. "Potential implications of dose and diet for the effects of eocoa flavanols on cardiometabolic function." Journal of Agricultural and Food Chemistry. 63 (45), pp. 9942-9947. https://doi.org/10.1021/acs.jafc.5b01492
Vibration therapy is no more effective than the standard practice of massage and stretching for promoting recovery from muscle damage after eccentric exercise
Fuller, Joel T., Thomson, Rebecca L., Howe, Peter R. C. and Buckley, Jonathan D.. 2015. "Vibration therapy is no more effective than the standard practice of massage and stretching for promoting recovery from muscle damage after eccentric exercise." Clinical Journal of Sport Medicine. 25 (4), pp. 332-337. https://doi.org/10.1097/JSM.0000000000000149
Paucity of evidence for a relationship between long-chain omega-3 fatty acid intake and chronic obstructive pulmonary disease: a systematic review
Fulton, Ashley S., Hill, Alison M., Williams, Marie T., Howe, Peter R. C. and Coates, Alison M.. 2015. "Paucity of evidence for a relationship between long-chain omega-3 fatty acid intake and chronic obstructive pulmonary disease: a systematic review." Nutrition Reviews. 73 (9), pp. 612-623. https://doi.org/10.1093/nutrit/nuv017
Combination chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil causes trabecular bone loss, bone marrow cell depletion and marrow adiposity in female rats
Fan, Chiaming, Georgiou, Kristen R., McKinnon, Ross A., Keefe, Dorothy M. K., Howe, Peter R. C. and Xian, Cory J.. 2016. "Combination chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil causes trabecular bone loss, bone marrow cell depletion and marrow adiposity in female rats." Journal of Bone and Mineral Metabolism. 34 (3), pp. 277-290. https://doi.org/10.1007/s00774-015-0679-x
Improvement of major depression is associated with increased erythrocyte DHA
Meyer, Barbara J., Grenyer, Brin F. S., Crowe, Trevor, Owen, Alice J., Grigonis-Deane, Elizabeth M. and Howe, Peter R. C.. 2013. "Improvement of major depression is associated with increased erythrocyte DHA." Lipids. 48 (9), pp. 863-868. https://doi.org/10.1007/s11745-013-3801-7
A randomised trial comparing low-fat diets differing in carbohydrate and protein ratio, combined with regular moderate intensity exercise, on glycaemic control, cardiometabolic risk factors, food cravings, cognitive function and psychological wellbeing in adults with type 2 diabetes: study protocol
Watson, Nerylee Ann, Dyer, Kathryn Ann, Buckley, Jonathan David, Brinkworth, Grant David, Coates, Alison Mary, Parfitt, Gaynor, Howe, Peter Ranald Charles, Noakes, Manny, Dye, Louise, Chadwick, Helen and Murphy, Karen Joy. 2015. "A randomised trial comparing low-fat diets differing in carbohydrate and protein ratio, combined with regular moderate intensity exercise, on glycaemic control, cardiometabolic risk factors, food cravings, cognitive function and psychological wellbeing in adults with type 2 diabetes: study protocol." Contemporary Clinical Trials. 45, pp. 217-225. https://doi.org/10.1016/j.cct.2015.11.001
Obesity: the new childhood disability?
Tsiros, M. D., Coates, A. M., Howe, P. R. C., Grimshaw, P. N. and Buckley, J. D.. 2011. "Obesity: the new childhood disability?" Obesity Reviews. 12 (1), pp. 26-36. https://doi.org/10.1111/j.1467-789X.2009.00706.x
Proximal correlates of metabolic phenotypes during 'at-risk' and 'case' stages of the metabolic disease continuum
Haren, M. T., Misan, G., Grant, J. F., Buckley, J. D., Howe, P. R. C., Taylor, A. W., Newbury, J. and McDermott, R. A.. 2012. "Proximal correlates of metabolic phenotypes during 'at-risk' and 'case' stages of the metabolic disease continuum." Nutrition and Diabetes. 2, pp. 1-11. https://doi.org/10.1038/nutd.2011.20
Erythrocyte polyunsaturated fatty acid status, memory, cognition and mood in older adults with mild cognitive impairment and healthy controls
Milte, Catherine M., Sinn, Natalie, Street, Steven J., Buckley, Jonathan D., Coates, Alison M. and Howe, Peter R. C.. 2011. "Erythrocyte polyunsaturated fatty acid status, memory, cognition and mood in older adults with mild cognitive impairment and healthy controls." Prostaglandins, Leukotrienes and Essential Fatty Acids. 84 (5-6), pp. 153-161. https://doi.org/10.1016/j.plefa.2011.02.002
Dairy consumption and cardiometabolic health: outcomes of a 12-month crossover trial
Crichton, Georgina E., Howe, Peter R. C., Buckley, Jonathan D., Coates, Alison M. and Murphy, Karen J.. 2012. "Dairy consumption and cardiometabolic health: outcomes of a 12-month crossover trial." Nutrition and Metabolism. 9 (19). https://doi.org/10.1186/1743-7075-9-19
Day-to-day physical functioning and disability in obese 10- to 13-year-olds
Tsiros, M. D., Buckley, J. D., Howe, P. R. C., Olds, T., Walkley, J., Taylor, L., Mallows, R., Hills, A. P., Kagawa, M. and Coates, A. M.. 2013. "Day-to-day physical functioning and disability in obese 10- to 13-year-olds." Pediatric Obesity. 8 (1), pp. 31-41. https://doi.org/10.1111/j.2047-6310.2012.00083.x
Fish oil in comparison to folinic acid for protection against adverse effects of methotrexate chemotherapy on bone
Raghu Nadhanan, Rethi, Fan, Chia Ming, Su, Yu Wen, Howe, Peter R. C. and Xian, Cory J.. 2014. "Fish oil in comparison to folinic acid for protection against adverse effects of methotrexate chemotherapy on bone." Journal of Orthopaedic Research. 32 (4), pp. 587-596. https://doi.org/10.1002/jor.22565
Interaction of erythrocyte eicosapentaenoic acid and physical activity predicts reduced risk of mild cognitive impairment
Street, Steven John, Parletta, Natalie, Milte, Catherine, Sullivan, Karen, Hills, Andrew P., Buckley, Jonathan and Howe, Peter. 2015. "Interaction of erythrocyte eicosapentaenoic acid and physical activity predicts reduced risk of mild cognitive impairment." Aging and Mental Health. 19 (10), pp. 885-891. https://doi.org/10.1080/13607863.2014.971705
Adiposity is related to decrements in cardiorespiratory fitness in obese and normal-weight children
Tsiros, M. D., Coates, A. M., Howe, P. R. C., Walkley, J., Hills, A. P., Wood, R. E. and Buckley, J. D.. 2016. "Adiposity is related to decrements in cardiorespiratory fitness in obese and normal-weight children." Pediatric Obesity. 11 (2), pp. 144-150. https://doi.org/10.1111/ijpo.12037
Telomere shortening in elderly individuals with mild cognitive impairment may be attenuated with ω-3 fatty acid supplementation: a randomized controlled pilot study
O'Callaghan, Nathan, Parletta, Natalie, Milte, Catherine M., Benassi-Evans, Bianca, Fenech, Michael and Howe, Peter R. C.. 2014. "Telomere shortening in elderly individuals with mild cognitive impairment may be attenuated with ω-3 fatty acid supplementation: a randomized controlled pilot study." Nutrition. 30 (4), pp. 489-491. https://doi.org/10.1016/j.nut.2013.09.013
Effects of low-fat diets differing in protein and carbohydrate content on cardiometabolic risk factors during weight loss and weight maintenance in obese adults with type 2 diabetes
Watson, Nerylee, Dyer, Kathryn, Buckley, Jonathan, Brinkworth, Grant, Coates, Alison, Parfitt, Gaynor, Howe, Peter, Noakes, Manny and Murphy, Karen. 2016. "Effects of low-fat diets differing in protein and carbohydrate content on cardiometabolic risk factors during weight loss and weight maintenance in obese adults with type 2 diabetes." Nutrients. 8 (5). https://doi.org/10.3390/nu8050289
Effects of resveratrol supplementation on bone growth in young rats and microarchitecture and remodeling in ageing rats
Lee, Alice M. C., Shandala, Tetyana, Nguyen, Long, Muhlhausler, Beverly S., Chen, Ke Ming, Howe, Peter R. and Xian, Cory J.. 2014. "Effects of resveratrol supplementation on bone growth in young rats and microarchitecture and remodeling in ageing rats." Nutrients. 6 (12), pp. 5871-5887. https://doi.org/10.3390/nu6125871
Food groups and fatty acids associated with self-reported depression: An analysis from the Australian National Nutrition and Health Surveys
Meyer, Barbara J., Kolanu, Nithin, Griffiths, David A., Grounds, Ben, Howe, Peter R. C. and Kreis, Irene A.. 2013. "Food groups and fatty acids associated with self-reported depression: An analysis from the Australian National Nutrition and Health Surveys." Nutrition. 29 (7-8), pp. 1042-1047. https://doi.org/10.1016/j.nut.2013.02.006
Acute resveratrol supplementation improves flow-mediated dilatation in overweight/obese individuals with mildly elevated blood pressure
Wong, R. H. X., Howe, P. R. C., Buckley, J. D., Coates, A. M., Kunz, I. and Berry, N. M.. 2011. "Acute resveratrol supplementation improves flow-mediated dilatation in overweight/obese individuals with mildly elevated blood pressure." Nutrition Metabolism and Cardiovascular Diseases. 21 (11), pp. 851-856. https://doi.org/10.1016/j.numecd.2010.03.003
Chronic effects of a wild green oat extract supplementation on cognitive performance in older adults: a randomised, double-blind, placebo-controlled, crossover trial
Wong, Rachel H. X., Howe, Peter R. C., Bryan, Janet, Coates, Alison M., Buckley, Jonathan D. and Berry, Narelle M.. 2012. "Chronic effects of a wild green oat extract supplementation on cognitive performance in older adults: a randomised, double-blind, placebo-controlled, crossover trial." Nutrients. 4 (5), pp. 331-342. https://doi.org/10.3390/nu4050331
Effects of eating fresh lean pork on cardiometabolic health parameters
Murphy, Karen J., Thomson, Rebecca L., Coates, Alison M., Buckley, Jonathan D. and Howe, Peter R. C.. 2012. "Effects of eating fresh lean pork on cardiometabolic health parameters." Nutrients. 4 (7), pp. 711-723. https://doi.org/10.3390/nu4070711
Acknowledgment of reviewers
Howe, Peter. 2012. "Acknowledgment of reviewers." Nutrients. 4 (3), pp. 151-153. https://doi.org/10.3390/nu4030151
The Australian paradox
Howe, Peter. 2012. "The Australian paradox." Nutrients. 4 (4), p. 258. https://doi.org/10.3390/nu4040258
Dairy foods and dairy protein consumption is inversely related to markers of adiposity in obese men and women
Murphy, Karen J., Crichton, Georgina E., Dyer, Kathryn A., Coates, Alison M., Pettman, Tahna L., Milte, Catherine, Thorp, Alicia A., Berry, Narelle M., Buckley, Jonathan D., Noakes, Manny and Howe, Peter R. C.. 2013. "Dairy foods and dairy protein consumption is inversely related to markers of adiposity in obese men and women." Nutrients. 5 (11), pp. 4665-4684. https://doi.org/10.3390/nu5114665
Proceedings of the 2013 meeting of the Australasian Section of the American Oil Chemists Society (AAOCS)
Murphy, Karen and Howe, Peter. 2013. "Proceedings of the 2013 meeting of the Australasian Section of the American Oil Chemists Society (AAOCS)." Nutrients. 5 (12), pp. 5065-5096. https://doi.org/10.3390/nu5125065
A comparison of regular consumption of fresh lean pork, beef and chicken on body composition: A randomized cross-over trial
Murphy, Karen J., Parker, Barbara, Dyer, Kathryn A., Davis, Courtney R., Coates, Alison M., Buckley, Jonathan D. and Howe, Peter R. C.. 2014. "A comparison of regular consumption of fresh lean pork, beef and chicken on body composition: A randomized cross-over trial." Nutrients. 6 (2), pp. 682-696. https://doi.org/10.3390/nu6020682
Increases in plasma lutein through supplementation are correlated with increases in physical activity and reductions in sedentary time in older adults
Thomson, Rebecca L., Coates, Alison M., Howe, Peter R. C., Bryan, Janet, Matsumoto, Megumi and Buckley, Jonathan D.. 2014. "Increases in plasma lutein through supplementation are correlated with increases in physical activity and reductions in sedentary time in older adults." Nutrients. 6 (3), pp. 974-984. https://doi.org/10.3390/nu6030974
Relationship between erythrocyte omega-3 content and obesity is gender dependent
Howe, Peter R. C., Buckley, Jonathan D., Murphy, Karen J., Pettman, Tahna, Milte, Catherine and Coates, Alison M.. 2014. "Relationship between erythrocyte omega-3 content and obesity is gender dependent." Nutrients. 6 (5), pp. 1850-1860. https://doi.org/10.3390/nu6051850
Acute effects of a dietary non-starch polysaccharide supplement on cognitive performance in healthy middle-aged adults
Best, Talitha, Howe, Peter, Bryan, Janet, Buckley, Jonathan and Scholey, Andrew. 2015. "Acute effects of a dietary non-starch polysaccharide supplement on cognitive performance in healthy middle-aged adults." Nutritional Neuroscience. 18 (2), pp. 76-86. https://doi.org/10.1179/1476830513Y.0000000101
Effect of 12 weeks high oleic peanut consumption on cardio-metabolic risk factors and body composition
Barbour, Jayne A., Howe, Peter R. C., Buckley, Jonathan D., Bryan, Janet and Coates, Alison M.. 2015. "Effect of 12 weeks high oleic peanut consumption on cardio-metabolic risk factors and body composition." Nutrients. 7 (9), pp. 7381-7398. https://doi.org/10.3390/nu7095343
Improved heart rate recovery despite reduced exercise performance following heavy training: A within-subject analysis
Thomson, Rebecca L., Bellenger, Clint R., Howe, Peter R. C., Karavirta, Laura and Buckley, Jonathan D.. 2016. "Improved heart rate recovery despite reduced exercise performance following heavy training: A within-subject analysis." Journal of Science and Medicine in Sport. 19 (3), pp. 255-259. https://doi.org/10.1016/j.jsams.2015.02.010
Effect of acute exercise-induced fatigue on maximal rate of heart rate increase during submaximal cycling
Thomson, Rebecca L., Rogers, Daniel K., Howe, Peter R. C. and Buckley, Jonathan D.. 2016. "Effect of acute exercise-induced fatigue on maximal rate of heart rate increase during submaximal cycling." Research in Sports Medicine. 24 (1), pp. 1-15. https://doi.org/10.1080/15438627.2015.1076414
Monitoring athletic training status using the maximal rate of heart rate increase
Bellenger, Clint R., Thomson, Rebecca L., Howe, Peter R. C., Karavirta, Laura and Buckley, Jonathan D.. 2016. "Monitoring athletic training status using the maximal rate of heart rate increase." Journal of Science and Medicine in Sport. 19 (7), pp. 590-595. https://doi.org/10.1016/j.jsams.2015.07.006
Report on the Fifth International Conference on Natural Products for Health and Beauty (NATPRO 5) held in Thailand, 6–8th May, 2014
Voravuthikunchai, Supayang and Howe, Peter. 2014. "Report on the Fifth International Conference on Natural Products for Health and Beauty (NATPRO 5) held in Thailand, 6–8th May, 2014." Nutrients. 6 (10), pp. 4115-4164. https://doi.org/10.3390/nu6104115
Assessing premorbid cognitive ability in adults with Type 2 Diabetes Mellitus: a review with implications for future intervention studies
Wong, Rachel Heloise Xiwen, Scholey, Andrew and Howe, Peter Ranald Charles. 2014. "Assessing premorbid cognitive ability in adults with Type 2 Diabetes Mellitus: a review with implications for future intervention studies." Current Diabetes Reports. 14 (11). https://doi.org/10.1007/s11892-014-0547-4
Antihypertensive potential of combined extracts of olive leaf, green coffee bean and beetroot: a randomized, double-blind, placebo-controlled crossover trial
Wong, Rachel H. X., Garg, Manohar L., Wood, Lisa G. and Howe, Peter R. C.. 2014. "Antihypertensive potential of combined extracts of olive leaf, green coffee bean and beetroot: a randomized, double-blind, placebo-controlled crossover trial." Nutrients. 6 (11), pp. 4881-4894. https://doi.org/10.3390/nu6114881
Clinical evaluation of effects of chronic resveratrol supplementation on cerebrovascular function, cognition, mood, physical function and general well-being in postmenopausal women—rationale and study design
Evans, Hamish Michael, Howe, Peter Ranald Charles and Wong, Rachel Heloise Xiwen. 2016. "Clinical evaluation of effects of chronic resveratrol supplementation on cerebrovascular function, cognition, mood, physical function and general well-being in postmenopausal women—rationale and study design." Nutrients. 8 (3). https://doi.org/10.3390/nu8030150
Low dose resveratrol improves cerebrovascular function in type 2 diabetes mellitus
Wong, R. H. X., Nealon, R. S., Scholey, A. and Howe, P. R. C.. 2016. "Low dose resveratrol improves cerebrovascular function in type 2 diabetes mellitus." Nutrition Metabolism and Cardiovascular Diseases. 26 (5), pp. 393-399. https://doi.org/10.1016/j.numecd.2016.03.003
Acute resveratrol consumption improves neurovascular coupling capacity in adults with type 2 diabetes mellitus
Wong, Rachel H. X., Raederstorff, Daniel and Howe, Peter R. C.. 2016. "Acute resveratrol consumption improves neurovascular coupling capacity in adults with type 2 diabetes mellitus." Nutrients. 8 (7). https://doi.org/10.3390/nu8070425
Poor cerebrovascular function is an early marker of cognitive decline in healthy postmenopausal women
Wong, Rachel H. X., Evans, Hamish M. and Howe, Peter R. C.. 2016. "Poor cerebrovascular function is an early marker of cognitive decline in healthy postmenopausal women." Alzheimer's & Dementia: Translational Research & Clinical Interventions. 2 (3), pp. 162-168. https://doi.org/10.1016/j.trci.2016.07.003
Supplementation with fish oil and genistein, individually or in combination, protects bone against the adverse effects of methotrexate chemotherapy in rats
Nadhanan, Rethi Raghu, Skinner, Jayne, Chung, Rosa, Su, Yu-Wen, Howe, Peter R. and Xian, Cory J.. 2013. "Supplementation with fish oil and genistein, individually or in combination, protects bone against the adverse effects of methotrexate chemotherapy in rats." PLoS One. 8 (8). https://doi.org/10.1371/journal.pone.0071592
The amyl nitrite expectancy questionnaire for men who have sex with men (AEQ-MSM): a measure of substance related beliefs
Mullens, Amy B., Young, Ross, Dunne, Michael P. and Norton, Graham. 2011. "The amyl nitrite expectancy questionnaire for men who have sex with men (AEQ-MSM): a measure of substance related beliefs." Substance Use and Misuse. 46 (13), pp. 1642-1650. https://doi.org/10.3109/10826084.2011.599096
The drinking expectancy questionnaire for men who have sex with men (DEQ-MSM): a measure of substance-related beliefs
Mullens, Amy B., Young, Ross McD., Dunne, Michael P. and Norton, Graham. 2011. "The drinking expectancy questionnaire for men who have sex with men (DEQ-MSM): a measure of substance-related beliefs." Drug and Alcohol Review. 30 (4), pp. 372-380. https://doi.org/10.1111/j.1465-3362.2010.00225.x
The cannabis expectancy questionnaire for men who have sex with men (CEQ-MSM): a measure of substance-related beliefs
Mullens, A. B., Young, R. McD., Dunne, M. and Norton, G.. 2010. "The cannabis expectancy questionnaire for men who have sex with men (CEQ-MSM): a measure of substance-related beliefs." Addictive Behaviors. 35, pp. 616-619. https://doi.org/10.1016/j.addbeh.2010.01.006
The consequences of substance use among gay and bisexual men: a consensual qualitative research analysis
Mullens, Amy B., Young, Ross McD., Hamernik, Elisabeth and Dunne, Michael. 2009. "The consequences of substance use among gay and bisexual men: a consensual qualitative research analysis." Sexual Health. 6 (2), pp. 139-152. https://doi.org/10.1071/SH08061