Calderdale JSNA 2015: Drugs*, Alcohol and Tobacco - Children and Young People

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1 Calderdale JSNA 2015: Drugs*, Alcohol and Tobacco - Children and Young People *Drugs in this context includes illegal drugs, new psychoactive substances (also known as legal highs ), volatile substances and over-the-counter or prescription drugs that are abused. What is the issue and why is it important? Effect on quality of life/future prospects Drugs, alcohol and tobacco misuse causes harm to an individual s health and wellbeing. Smoking causes one in five deaths in people aged over 35. It is the primary cause of preventable illness and premature death. Two thirds of smokers begin before they are 18 (HSCIC, 2012). Concern about levels of smoking among young people arises from awareness about the longer-term outcomes such as cancer, but also the shorter term negative effects such as respiratory illness and impact on physical fitness. Drug and alcohol misuse can also cause wider social problems within families and communities. In the worst cases, families are torn apart and loved ones are lost, communities are blighted by crime and communities live in fear. Drug and alcohol misuse can increase young people s risk of long-term addiction and all related problems, increase the risk of illnesses and long term conditions (for example COPD, cancer, psychosis, mental illness) and unplanned pregnancies. It also increases the risk of unemployment and involvement in crime. However, it is important to note that the majority of young people do not use substances and less use drugs than alcohol, but all young people are affected in some way by substances because they are available. Further complications arising from issue Puberty is in itself a risk factor for drug, alcohol and tobacco use due to changes in the brain and increasing independence. Smoking in the UK leaps up from a population prevalence of 1% at age 11 years to around 20% at 15 years. In fact, nearly 90% of lifetime smoking is initiated between the ages of 10 and 20 years in the UK. Similarly, approximately 80% of lifetime alcohol or

2 cannabis use is initiated <20 years, with the proportions initiating other illicit drugs in adolescence closer to 50%. Once initiated, these behaviours track strongly into adult life, highlighting the importance of intervention in adolescence to prevent health burden (1). But young people who misuse drugs and alcohol often have other areas of vulnerability in their lives, for example involvement in the criminal justice system, not being in education, employment or training (NEET) or at risk from sexual exploitation. Young people are at higher risk of smoking if their parents smoke. Calderdale has a number of factors present that can increase the risk of young people misusing drugs and alcohol and increase the risk of adult dependency. There are areas of deprivation; children living in poverty; parents that misuse substances. It is estimated that Some 1,000 children in Calderdale are at risk because of parental drug use and 9,000 because of parental alcohol consumption (2). In addition to this estimate we know that 31% of new adult drug treatment starts in Calderdale report being parents or having children residing with them (3). For those in contact with alcohol services, 49% had regular contact with children whilst 33% reported living with children. A further 16% were parents not living with their children (4). Parental attitudes can have a significant impact on their children s drug, alcohol and tobacco use. For example, where parents disapprove of or do not take drugs, drink regularly or to excess or smoke themselves their children are less likely to. The wider context is important too. The rise of new psychosocial substances, the use of the internet for buying drugs (over the counter, legal and illegal), enforcement regarding trafficking, community safety and planning regulations (for example, the sales of drugs via head shops) also have a role to play. In the context of alcohol and tobacco advertising, national policy around pricing and licensing, all have a role to play. Cost to public sector There is evidence that drug and alcohol misuse prevention and treatment reduces harm and saves public money. There is local evidence that young people who enter treatment stop or reduce their use of substances, reduce risk taking behaviours and decrease offending behaviour. Current Level of Need Local data on Prevalence of Drug, Alcohol and Tobacco Use Information on children and young people drug, alcohol and tobacco use is collected by the ehna (electronic Health Needs Assessment), the Specialist Substance Misuse Service (Drugs and Alcohol) for young people, the School Nursing Service and Chimat. ehna There is an annual school survey (electronic health needs assessment or ehna) in Calderdale of year seven (11 to 12-year-olds) and year ten (14 to 15-year-olds). Survey

3 results tell us that Year 7 report Alcohol is the substance most frequently tried by young people. Over a quarter of pupils (27%) have tried alcohol a significantly higher proportion than in whereas only 1 in 40 pupils (2.4%) have tried smoking, most commonly boys. Nevertheless, the vast majority have tried neither. Very few pupils use alcohol (1.5%) or tobacco (0.5%) regularly (daily, weekly or monthly), boys more than girls. Very few pupils (0.4%) smoke daily. 1 in 8 (12.3%) of regular alcohol drinkers were worried by their use of alcohol and the same proportion reported that others were worried about their alcohol use. Half (50%) of those smoking regularly were worried by their use of cigarettes, and a quarter (25%) of regular smokers did so because they couldn t give up. A quarter of pupils (27.0%) lived with people who regularly smoked cigarettes. A high proportion of pupils report having had access to information about alcohol (62.6%), drugs (60.6%) and tobacco (52.5%); access to information about tobacco has reduced significantly since Around two-fifths of pupils reported wanted more information about drugs (41%), alcohol (38%) and tobacco (42%). Survey results for year 10 tell us that alcohol is the substance most frequently tried by young people: over half (54.8%) of pupils have tried alcohol at least once, a fifth (21%) of pupils has tried tobacco, and 11.1% have tried drugs (usually cannabis). The proportion of pupils that has never tried alcohol or drugs has reduced significantly since Nationally, 39% of pupils aged years had tried alcohol, 22% had tried tobacco and 16% had tried drugs at least once in 2013 (latest figures) 1. The proportion regularly using tobacco or drugs has increased significantly since Nevertheless, regular use of tobacco, alcohol and drugs in 2014 is still significantly less than in Around 1 in 20 (5.0%) of pupils use tobacco daily, with Year 10 girls the greatest daily users. The survey asked about use of e-cigarettes for the first time in More young people have tried e-cigarettes than tobacco: 1 in 6 (17.4%) had tried these-cigarettes compared with 13.3% having tried tobacco. The proportion using e-cigarettes regularly (5.9%) was almost as high as the proportion using tobacco regularly (7.7%). For each Year, boys were more likely than girls to use e-cigarettes. Half (51%) of regular tobacco users also use e-cigarettes at least monthly. 5% of pupils who have never even tried tobacco have tried e-cigarettes and a further 2% of those who have never tried tobacco used e- cigarettes regularly (at least monthly). Cannabis is the main substance used by regular drug users. Calderdale use of cannabis and solvents is significantly lower than found nationally in a similar survey 2 of similar age 1 HSCIC (2014) Smoking, Drinking and Drug Use Among Young People in England 2013, Health and Social Care Information Centre, July 2014: 2 HSCIC (2014) Smoking, Drinking and Drug Use Among Young People in England 2013, Health and Social Care Information Centre, July 2014:

4 groups whereas ecstasy use is significantly higher in Calderdale than nationally for the same overall age groups (although very low). Overall, the proportion using alcohol or drugs to excess has been reducing since 2010, but has risen significantly for excessive alcohol use since The pupils who drink or drug use to excess seem to be largely the same. Those who report using drink or drugs excessively in this way are more likely to report living with adults who also do the same. A high proportion of pupils have had access to information about alcohol, drugs and tobacco although this differs by school (71% to 98%). Around one-third wanted more information on substances, specifically on drugs (33.2%), alcohol (31.2%) and tobacco (31.3%). For years 12s the ehna survey results indicate that almost a fifth are smoking regularly and around half of students regularly drink alcohol (with half of these drinking so much they don t know what they are doing) Alcohol is the most commonly tried substance: only a fifth (19.8%) have never tried alcohol, compared with three-fifths (58.3%) of students who have never tried tobacco and three-quarters (73.7%) who have never tried drugs. Alcohol is the substance most frequently used regularly (monthly, weekly or daily) with 54.1% students regular users compared to tobacco (17.7%) or drugs (7.5%) or e- cigarettes (5.5%). Around 1 in 8 (12.5%) of students use tobacco daily, higher for males than females. This compares with 3.3% using e-cigarettes daily. 58.3% of students have never tried tobacco and 70.9% of students have never tried e-cigarettes. 7.5% of students are regular (at least monthly) users of drugs (similar to Year 10); three-quarters (73.7%) of students have never tried drugs. Cannabis is the main substance used regularly by regular drug users (89% of them). Other substances are used by up to a fifth of regular drug users to similar extents. The vast majority of students (around 95%) have had access to information about alcohol, drugs and tobacco. Around one-tenth of students wanted more information on substances (range 0-25% in schools/college). The main specific reason that students use tobacco is because they can t give up (34.6%). Very few (1.7%) regular users of alcohol are worried about their use, whereas almost a quarter (22.5%) of tobacco users is worried by their own use of the substance. When we look at ehna results by all age ranges together the results tell us:

5 Regular alcohol use increases with age, but at year 10 more females use alcohol regularly then males, by year 12 the inverse is true with more males using alcohol regularly. Regular tobacco use also increases with age, and again at year 10 more females use tobacco regularly then males, by year 12 the inverse is true with more males using tobacco regularly. 25% % students using tobacco at least monthly 20% 15% 10% Females Males 5% 0% Year 5 Year 6 Year 7 Year 10 Year 12 The use of e-cigs at least monthly increases with age, but more males than females use e-cigs.

6 12% 10% 8% 6% 4% Females Males 2% 0% Year 7 Year 10 Year 12 Drug use also increases with age but the percentage of males taking drugs at least monthly is more than females. 12% % students taking drugs at least monthly 10% 8% 6% 4% Females Males 2% 0% Year 7 Year 10 Year 12 We can see that overall there have been decreases since 2010 in alcohol, tobacco and drug use but in 2014 there has been some increase in years 7/10.

7 30% Trends in use of alcohol, tobacco and drugs by Years 7/10 students 25% 20% 15% 10% Tobacco Alcohol Drugs 5% 0% Local data on morbidity from alcohol and drug use In 2013/ young people under the age of 18 received treatment for drug and alcohol use in Calderdale at the specialist substance misuse treatment service for children and young people, a 2% increase on the previous year. 153 of these were new presentations. In addition to this 43 young people between the ages of 18 and 21 accessed young people s services. All young people accessing services wait less than 3 weeks in line with national objectives. In 2013/14, the primary substances used by young people under 18 accessing treatment are as follows; cannabis at 79%, alcohol at 75% and amphetamines 3 at 10%. Nationally, 85% of young people access treatment for cannabis, 55% for alcohol and 10% for cannabis. (NDTMS / Assurance Report Public Health England). However, it is important to note that the majority of young people in treatment are poly substance users and that this creates greater risk of harm. The referral activity data for children and young people indicates that the majority of young people accessing services in Calderdale is via education, followed by Youth Justice System and children and family services, there is further information below which shows Calderdale s position compared to national. Referral Source % Calderdale % National Children and family services Education Amphetamines include the new psychoactive substances, often referred to as legal highs

8 Health and mental health 3 7 Accident and emergency 0 1 Substance misuse services 1 3 Youth Justice system self, family and friends other 0 4 As can be seen Calderdale receives the majority of its referrals from education which is thought to be due to the good working relationships between schools and the specialist substance misuse service. While referrals from A&E to specialist substance misuse services are low this does not mean children and young people are not being followed up from A&E (or hospital admission). The pathway in Calderdale from hospital is to inform School Nursing Service who follow up young people, the majority of young people aged under 16 are followed up with a face to face intervention. For under 18s accessing treatment in 2013/14 the following information on vulnerabilities is known: Vulnerability Item % Calderdale % National Children Looked After 8 10 Child in Need 3 5 Domestic violence Mental health problems Sexual exploitation 2 4 Self ham Neet 7 17 Housing 0 2 Pregnancy 0 2 child protection plan 3 5 ASB / criminal act Affected by other use The majority of young people in Calderdale access specialist substance misuse services at age Further details are supplied below with comparisons to national data. Age % Calderdale % National Under Calderdale age profile is younger than the national which is believed to be due to the good working relationships between the specialist substance misuse service and schools and fit within Calderdale s approach to early intervention.

9 83% of young people in Calderdale left treatment in a care planned way, compared to 70% nationally leaving in a care planned way. For the period 2008/09 to 10/11, the rate of admission to hospital with alcohol specific conditions (such as unintentional alcohol overdose) for young people in Calderdale (81.2 per 100,000 population aged 0 to 17 years) is higher than the national average and broadly similar to that of the 2007 to 10 period. Nevertheless, this hospital admission rate for under-18s for alcohol-specific conditions for Calderdale has been reducing from a peak during the period 2006/7 to 2008/9. There were 111 admissions of Calderdale under-18s during the period 2008/09 to 2010/11. The figure below shows Calderdale s position relative to the regional and national average (Chimat). Hospital admissions for substance misuse of 15 to 24 year olds in Calderdale are also significantly higher than the national rate. The most recent figure for the period 2008 to 11 shows an admission rate of per 100, to 24 year olds (Chimat). Comparisons with England Historically, children in England have been more likely to drink alcohol than children in many other European countries. While the latest international comparisons suggest some improvement in the prevalence of alcohol consumption, the proportion consuming alcohol remains well above the European average. Furthermore, the UK continues to rank amongst countries with the highest levels of alcohol consumption for those who do drink, and British children are more likely to have binge drunk or been drunk compared to children in most other European countries.

10 A 2012 national survey 4 found that 43% of pupils said that they had ever had an alcoholic drink, with boys and girls equally likely and the proportion increasing from 11- year-olds (12%) to 15-year-olds (74%) (compares to 31.3% 11 to 12 year olds and 72% 14 to 15 year olds in Calderdale at least trying alcohol). One-tenth (10%) of pupils said they had drunk alcohol in the last week (compares to 7.5% pupils using alcohol at least weekly in Calderdale). Half (50%) of pupils who had drunk alcohol in the previous four weeks said they had been drunk at least once during that time (compares with 41.1% of Calderdale year seven/ten regular drinkers having drunk so much they didn t know what they were doing). Pupils were more likely to drink alcohol if they lived with someone who does. The same national survey found that 17% of pupils had never taken drugs, again with boys and girls equally likely and prevalence increasing from 11-year-olds (7%) to 15- year-olds (31%) (compares with 2.1% 11 to 12-year-olds and 14.4% 14 to 15-year-olds in Calderdale). Nationally, 2% of pupils said that they usually took drugs at least once a month (compares with 3.3% in Calderdale). Drug use in the last year was strongly associated with other risky behaviours: smoking, drinking alcohol, truancy and exclusion from school. The Department of Health funded Smoking, Drinking and Drug Use surveys of year olds in England have shown that smoking is clearly related to age. There has been a long-term decline in the prevalence of smoking since the mid-1990s. In 2012, less than a quarter (23%) of pupils had tried smoking at least once. In 1996, nearly half (49%) of 11 to 15 year olds had done so. 4% of pupils said that they smoke at least one cigarette a week, the survey definition or regular smoking. In 2012, boys and girls were equally likely to smoke. The prevalence of regular smoking increased with age, from less than 0.5% of 11 year olds to 10% of 15 year olds. Being a regular smoker was associated with other risky behaviours, such as drinking alcohol, taking drugs and truancy. Two thirds (67%) of pupils reported that they had been exposed to second-hand smoke in the past year. 55% of pupils said that this had happened in someone else s home, 43% in their own home, 30% in someone else s car and 26% in their family s car. Smokers tended to know other people who smoke: almost all the pupils who said that they smoked had friends who did so, compared with about half of non-smokers. Regular smokers were also more likely than occasional smokers or non-smokers to have family members who smoked (82% of regular smokers, compared with 71% of occasional smokers and 68% of non-smokers). The number of smokers a pupil lives with is related to whether or not he or she smokes. 2% of pupils who didn t live with any smokers were regular smokers, compared with 5% who lived with one person who smoked and 16% of those who lived with three or more (HSCIC, 2012). 4 Health and Social Care Information Centre (2013) Smoking, drinking and drug use among young people in England in A survey carried out by NatCen Social Research and the National Foundation for Educational Research,

11 Trend information In Calderdale, there has been a statistically significant reduction in substance tobacco, alcohol, illegal drugs from 2010 to However, the proportion of pupils that have never tried alcohol or drugs reduced significantly since 2013 and drinking amongst Year 10 girls has significantly increased since 2013 and they are now the highest regular drinkers (ehna). Numbers of young people accessing specialist drug and alcohol treatment services has increased since 2006/07 (NDTMS). The numbers of under 18s admitting to hospital for alcohol has been decreasing since 2006/7 2008/9 (chimat). Emerging trends are the rise in usage of new psychoactive substances (NPS) and the drug markets themselves. New forms of NPS are coming onto the market weekly, the immediate and long-term effects of use of which are unknown, meaning that emergency services are dealing with unknowns when individuals enter hospital as a result of their misuse. This means that immediate harm is highly likely (local data). Sales of drugs over the internet are also having major impact. The availability of drugs is becoming easier and more confusion is arising as some substances enter the market as legal. Impact of changing demographics The biggest impact in terms of substance use is the changing availability of drugs, in terms of substances and access to them rather than the demographics of the population. For example, self reporting drug use data from those entering treatment has shown a rise in stimulant use, possibly due to the new psychoactive substances. However, other predictions based on demographics are hard to make. For example, there may be an increase in heroin use in younger people due to immigration from some eastern European countries (where the drug laws are more liberal when compared to the UK). There may be a rise in both alcohol and drug use due to the effects of living in poverty or due to a lack of training and employment opportunities. If there are increasing numbers of young people experiencing damaging environments, for example, living in a family where there is substance misuse, or housing problems or where there is some form of abuse, substance use may increase in the population. Treatment data indicates that the treatment population is getting younger. This would suggest that prevention work with children needs to take place at primary school age. Local and national data suggests that new recruits to heroin use are decreasing. The national drugs strategy makes the point that drug use is within all population groups, including those with jobs and stable homes but while drug dependence can affect anyone, we know that those with a background of childhood abuse, neglect, trauma or poverty are disproportionately likely to be affected. In turn, the children of those

12 dependent on drugs have to cope with the impact on their own lives and some may end up in state care. There are expected rises in the younger age group, this may have an impact on substance misuse as the 15 to 24 years old age range is the biggest consumer of substances. Inequalities Age Data from the drug and alcohol treatment service indicates that Calderdale has higher numbers of younger people accessing treatment than comparable areas. This has been a continuing trend since 2007/8 although the % of 14 to 17 year olds accessing treatment has been fairly static since 2009/10. In 20013/14 the numbers of under 13s reduced (NDTMS / Children and Young People s Drug, Alcohol and Tobacco Needs Assessment) Ethnicity The majority of young people accessing drug and alcohol treatment services are identified as White British. Sex More males than females access treatment locally. Religion and belief There is no information on substance, drug or alcohol misuse by religion or belief from the local and national surveys, or treatment activity. Sexual orientation and gender reassignment National research (King, et al; 2008) found that lesbian, gay and bisexual (LGB) people aged below 25 are 1.5 times more likely to misuse substances than heterosexual people. Stonewall s lesbian health survey (in Galyic 2008) also found higher levels of alcohol and drug misuse amongst lesbian and bisexual women and especially amongst younger women. The British crime survey (self-reported illicit drug use) suggests that when compared with heterosexual adults, gay or bisexual adults were more likely to have taken any drug or any class A drug. Deprivation National studies indicate that some young people have added vulnerabilities which will increase their risk to substance misuse and adult dependency. These vulnerabilities include: living in a deprived area; living in poverty; loss of a parent/s (through death, divorce or being taken into care); being a perpetrator of crime; having parents who themselves have vulnerabilities (for example victims/perpetrators of crime, domestic abuse, substance misusers, physical or mental illness). Other risk groups include having mental health problems.

13 Young people who use substances increase their vulnerabilities to unemployment, poverty, poor relationships, criminality, poor physical health, poor mental health and adult substance dependency. Other vulnerable groups Children of problematic substance misusers are at increased risk of harm. Problem drug use in the UK is characterised by the use of multiple drugs and is strongly associated with socio-economic deprivation and other factors that may affect parenting capacity. It is typically chaotic and unpredictable. These include: poverty; physical and emotional abuse or neglect; dangerously inadequate supervision; other inappropriate parenting practices; intermittent or permanent separation; inadequate accommodation and frequent changes in residence; toxic substances in the home; interrupted or otherwise unsatisfactory education and socialisation; exposure to criminal or other inappropriate adult behaviour, and social isolation. They often interact with and exacerbate other parental difficulties such as educational under-attainment and mental health problems. User and public s views There have not been any large local consultations with young people in the last two years about drug and alcohol use. For those young people accessing treatment, their feedback is gathered continually throughout the year via a feedback box in reception areas of the service and questionnaires, however Branching Out (the specialist substance misuse service for children and young people in Calderdale) generate most of their feedback via their Facebook page and conduct a yearly feedback week where young people anonymously complete a questionnaire. This exercise has found that 66% of young people returned after their first visit because they were keen to get help, and 56% because of staff friendliness and 86% felt the service had really helped them. Are current needs being met? Service use and met need In Calderdale, there is a specialist substance misuse service that delivers interventions that prevent drug and alcohol use via information, education, harm-reduction and treatment. Overall, there is evidence that treatment of drug and alcohol in young people is working well in Calderdale and that treatment interventions produce better outcomes. The impact of the Calderdale children and young people s partnership s efforts to date include: Increased referrals to drug and alcohol services Improvements in the range of referring agencies and indications that we are providing early interventions and help Improved outcomes for individuals who enter drug and alcohol treatment Improved workforce development

14 Reduction in hospital admissions for alcohol Increased support for parents The local school survey (ehna) found that a high proportion of pupils have had access to information about alcohol, drugs and tobacco although this differs by school and is higher in secondary than primary schools. Gaps in meeting young people s needs While the needs of some children, young people and families are met and are having a positive impact in Calderdale there needs to be increased activity in some areas. There is not yet evidence of industrial scale tier one interventions from partner agencies taking place with young people in Calderdale Some services are not referring in the numbers expected to drug and alcohol services Our prevention approach to tobacco could be improved significantly as could interventions to assist young people quit smoking (although its accepted that the evidence base is poor in these areas) Evidence of what works There are a number of key documents that are helpful in terms of evidence of what works; these cover the areas of prevention and treatment specific to substance misuse, alcohol pricing, licensing and the wider context of childhood. Substance misuse among young people 2011 to 2012 (National Treatment Agency) i School-based interventions on alcohol (PH7) (NICE) ii Alcohol-use disorders: preventing harmful drinking (NICE) iii Drug misuse declared: findings from the 2011 to 2012 Crime Survey for England and Wales (CSEW) (second edition) National Statistics iv DRUG STRATEGY 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug-free Life v Modelling to assess the effectiveness and cost-effectiveness of public healthrelated strategies and interventions to reduce alcohol attributable harm in England using the Sheffield Alcohol Policy Model version 2.0. Report to the NICE Public Health Programme Development Group,31 July 2009 vi Alcohol Strategy 2012 (includes minimum alcohol pricing) Plain Tobacco Packaging: A Systematic Review 2011 Crawford Moodiea,d, Martine Steada,d, Linda Baulda,d, Ann McNeillc,d, Kathryn Angusa,d, Kate Hindsb, Irene Kwanb, James Thomasb, Gerard Hastingsa,d, Alison O Mara- Evesb Univeristy of Stirling Children and Families Bill 2013 (Banning smoking in cars where children are present)

15 Recommendations/implications In summary, the JSNA indicates that young people are at risk of drugs, alcohol and tobacco because adolescence is a time of experimentation and increasing independence and because substances are becoming more accessible. Some young people are more at risk than others of harm and adult dependency on substances. Prevention work within Calderdale is having an impact with a decrease in alcohol hospital admissions and data from the ehna. For those that do use drugs and alcohol, treatment has a positive outcome for the majority. While the needs of some children, young people and families are met and are having a positive impact in Calderdale there needs to be increased activity in some areas, for example: Improvements in prevention of smoking in children and young people Partners who work with children and young people in universal and targeting settings could improve their engagement on the issues of drugs, alcohol and tobacco. The increased use of screening tools for drugs and alcohol The changing use of substances is increasing the demand for training and information to professionals in the field who work with young people Young people in schools are asking for more information about drugs, alcohol and tobacco. While all schools have some engagement with the specialist substance misuse service in Calderdale some are better than others. There is a need to improve engagement with all secondary schools in Calderdale and also a need to deliver age appropriate prevention strategies with children of primary school age for both drugs, alcohol and tobacco. Bibliography 1. Cited in Chief Medical Officers Report 2012, Degenhardt L, Chiu WT, Sampson N, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Med 2008; 5(7): e141). 2. Adult Substance Misuse Needs Assessment p NDTMS Full year 2013/14 and also YTD figure Q1 2013/ NDTMS 2012/13 i ii iii iv crime-survey-for-england-and-wales-csew-second-edition v

16 vi

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