Impact of an Aboriginal and Torres Strait Islander brief intervention training program on health staff participants' own health behaviours: Smoking, nutrition and physical activity.

ISSUES ADDRESSED: Little research has been conducted on the impact of Aboriginal and Torres Strait Islander brief intervention training programs on health staff participants' own health behaviours. Through the Queensland B.strong program (2017-2020), brief intervention training in smoking cessation, nutrition and physical activity was provided to the Aboriginal and Torres Strait Islander health workforce and other health and community professionals. This study examined the program's impact on participants' own health behaviours. METHODS: Data were collected through four surveys (pre- and post-training workshop, and 3-month and 6-month follow-up) of the 1131 participants in B.strong training workshops from June 2017 to August 2019. Surveys included items on participants' own health behaviours. Pre- and post-workshop surveys were paper-based, and follow-up surveys were completed online. For the analysis of data reported in this paper, paired-samples t tests were used to assess changes between pre-workshop and 3-month follow-up. RESULTS: Statistically significant improvements were found between pre-workshop and 3-month follow-up in the number of serves of vegetables or legumes/beans eaten per day, the number of serves of fruit eaten per day, and in time spent in physical activity. However, there was: no statistically significant change in smoking status, with baseline rates being relatively low; a statistically significant increase in consumption of sugary drinks, and of takeaway foods; a nonsignificant increase in consumption of snack foods; and no significant change in sedentary behaviour of participants. CONCLUSION: While some positive changes in participants' own health behaviours in nutrition and physical activity were associated with the B.strong program, there was no change in their smoking behaviour. SO WHAT?: This study found that some improvements in participants' own health behaviours were associated with the B.strong program. This research may inform future Indigenous brief intervention training programs and health services on how to promote healthy behaviours for health staff themselves.

Revision of the Australian guidelines to reduce health risks from drinking alcohol.

INTRODUCTION: The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). RECOMMENDATIONS: •Guideline 1: To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. •Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. •Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. CHANGES AS RESULT OF THE GUIDELINE: The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously "per drinking occasion"). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

Evaluation of the B.strong Queensland Indigenous Health Worker Brief Intervention Training Program for Multiple Health Risk Behaviours.

Queensland's B.strong brief intervention training program was a complex intervention developed for Aboriginal and Torres Strait Islander health workers to assist clients address multiple health risks of smoking, poor nutrition and physical inactivity. This study evaluates program effectiveness by applying the Kirkpatrick four-level evaluation model: (1) Reaction, participants' satisfaction; (2) Learning, changes in participants' knowledge, confidence, attitudes, skills and usual practice; (3) Behaviour, application of learning to practice; and (4) Results, outcomes resulting from training. A retrospective analysis was conducted on data for respondents completing pre-training, post-workshop and follow-up surveys. Changes in domains such as training participant knowledge, confidence, attitudes, and practices between survey times were assessed using paired-samples t-tests. From 2017-2019, B.strong trained 1150 health professionals, reaching targets for workshop and online training. Findings showed statistically significant improvements from baseline to follow-up in: participants' knowledge, confidence, and some attitudes to conducting brief interventions in each domain of smoking cessation, nutrition and physical activity; and in the frequency of participants providing client brief interventions in each of the three domains. There was a statistically significant improvement in frequency of participants providing brief interventions for multiple health behaviours at the same time from pre-workshop to follow-up. Indigenous Queenslander telephone counselling referrals for smoking cessation increased during the program period. B.strong improved practitioners' capacity to deliver brief interventions addressing multiple health risks with Indigenous clients.

Gender Differences in Intimate Partner Violence in Current and Prior Relationships.

Although much available research indicates that intimate partner violence (IPV) is male perpetrated, growing recent evidence suggests a gender symmetry model of family violence. This article examines gender differences in IPV in current and prior relationships reported by young adults. Data comprised 2,060 young adults (62.1% females) who participated in the 30-year follow-up of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Brisbane, Australia. The Composite Abuse Scale was used to measure IPV during the last 12 months in the respondents' most recent relationship. Similar proportions of males and females reported leaving their prior relationships. Both males and females who were not currently in a relationship reported experiencing much higher rates of IPV than those who were in a relationship. There were no differences in the past experience of IPV between males and females who were not currently in a relationship, but males in a current relationship reported they experienced most forms of IPV more often than did females. IPV typically involves both male and female perpetrators and victims. It does appear that the majority of relationships involving higher rates of IPV were dissolved. IPV was more likely to have occurred in relationships that ended than in relationships that persisted. Males more often remain in an abusive relationship and report experiencing higher rates of IPV in their current relationships compared with females.

Intimate partner violence and subsequent depression and anxiety disorders.

PURPOSE: The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). METHODS: Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. RESULTS: We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. CONCLUSION: Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Do individual liquor permit systems help Indigenous communities to manage alcohol?

INTRODUCTION AND AIMS: Liquor permits were once used throughout Scandinavia and North America for managing alcohol, but largely disappeared in the late 20th century. Today, they are used in some Indigenous communities in Nunavut, Canada and the Northern Territory, Australia. This paper examines the extent to which liquor permits: (i) contribute to reducing alcohol-related harms in Indigenous communities; and (ii) offer a viable mechanism for managing alcohol in Indigenous communities. DESIGN AND METHODS: The study draws on published and unpublished international literature on liquor permit systems in Indigenous communities, and on field visits to northern territory (NT) communities. RESULTS: Apart from one anecdotal report, the study found no evidence that liquor permit systems in Nunavut communities have reduced alcohol-related problems. In the NT, they have reduced alcohol-related harms in some communities. However, management of liquor permit systems generates significant administrative demands in communities. DISCUSSION AND CONCLUSIONS: Effectiveness of liquor permit systems is a product of five factors: permits themselves; agencies and procedures for issuing and managing permits; agencies and procedures for supplying liquor; enforcement of permit conditions, and the presence of other agencies-legal and illegal-affecting supply and consumption of liquor. Liquor permits continue to be valued by some Indigenous communities for managing alcohol. This study suggests that they can do so provided: (i) agencies administering permits have adequate support; (ii) controls over non-legal purchasing and consumption of liquor are effective, and (iii) the permit system is viewed in the community as legitimate, equitable and transparent.

Intimate partner violence in emerging adulthood and subsequent substance use disorders: findings from a longitudinal study.

AIMS: To examine the temporal association between the experience of different types of intimate partner violence (IPV) in early adulthood (21 years) and substance use disorders in young adulthood (30 years). DESIGN: Prospective birth cohort study using data from the Mater-University of Queensland Study of Pregnancy (MUSP). SETTING: Brisbane, Australia. PARTICIPANTS: A total of 1353 people (822 females and 531 males). MEASUREMENTS: IPV was measured using the Composite Abuse Scale (CAS) and alcohol, substance and nicotine use disorders were assessed using the Composite International Diagnostic Interview (CIDI). FINDINGS: In females, the experience of different forms of IPV at 21 years remained a robust risk factor for subsequent alcohol use disorder [adjusted odds ratios (aORs) ranged from 1.6 to 2.6 (all P < 0.05)], substance use disorder [aORs ranged from 2.1 to 4.0 (all P < 0.001)] and nicotine use disorder [aORs ranged from 2.0 to 2.4 (all P < 0.05)] at 30 years, even after controlling for antecedent substance disorders. However, in males only physical and emotional abuse (but not harassment) were significant in predicting alcohol use disorder [aORs ranged from 1.4 to 1.8 (all P < 0.05)] and drug use disorder [aORs ranged from 1.6 to 2.0 (all P < 0.05)] in the fully adjusted model. CONCLUSION: Intimate partner violence (IPV) in early adulthood is robustly associated with alcohol, substance and nicotine use disorders in women, whereas in men the association is clear for only some forms of IPV and types of disorder.

Aboriginal alcohol policy and practice in Australia: A case study of unintended consequences.

This paper examines attempts by members of a remote Aboriginal community in the Northern Territory (NT), Australia, to control alcohol use, and the impact of policy decisions taken by national, territory and local governments on those attempts between 2007 and 2017. The Australian Government's main policy instrument for reducing alcohol-related harms from 2010 was the Alcohol Management Plan (AMP), officially defined as a plan, negotiated at a local community level with a high level of community input, for the effective management of alcohol use by the local community. The paper shows that the policy as implemented had the unintended consequence of undermining rather than enhancing the capacity of the community to act collectively in managing alcohol, largely as a result of the interactions of four sets of factors: (1) the policies as formulated; (2) actions taken to implement the policies, (3) the responses of those affected by the policies, and (4) the socio-ecological context in which these events occurred. The paper seeks to identify the processes through which these consequences were generated, and the implications for future policy-making, policy implementation and community-level initiatives for managing alcohol in Aboriginal communities.

Maternal intimate partner violence victimization and child maltreatment.

There is some limited evidence of an association between maternal intimate partner victimization (IPV) and children's experience of maltreatment. Using data from a longitudinal study, we examine whether this relationship is independent of range of potential confounders including socio-economic, familial and psychological factors. Data were taken from the 14 and 30-year follow-ups of the Mater-University of Queensland Study of Pregnancy (MUSP) in Australia. A subsample of 2064 mothers and children (59.0% female) whose data on maternal IPV and child maltreatment was available, were analysed. In families with maternal IPV, two in five children reported being maltreated, compared to one in five children maltreated in families without maternal IPV. Except for sexual maltreatment which was consistently higher in female offspring, there was no gender differences in experiencing different types of maltreatment in families manifesting maternal IPV. Although both males and females were at increased risk of child maltreatment in families where mothers were victimized by their male partners, male children were more likely to be emotionally maltreated. The main associations were substantially independent of measured confounders, except for father's history of mental health problems which attenuated the association of maternal IPV victimization and male offspring's physical abuse. Our findings confirm that there is a robust association between maternal IPV and child maltreatment. Both maternal IPV victimization and child maltreatment co-occur in a household characterized by conflict and violence. Consequences of IPV go beyond the incident and influence all family members. Efforts to reduce child maltreatment may need to address the greater level of IPV associated with the cycle of family violence.

Does leaving an abusive partner lead to a decline in victimization?

BACKGROUND: This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization. METHODS: Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale. RESULTS: We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents. CONCLUSION: Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

The impact of subsidized low aromatic fuel (LAF) on petrol (gasoline) sniffing in remote Australian indigenous communities.

BACKGROUND: Since 2005, the Australian Government has subsidized the production and distribution of Low Aromatic Fuel (LAF) as a deterrent against petrol (gasoline) sniffing in remote Indigenous communities. LAF is used in place of unleaded petrol as a fuel for vehicles and other engines. This paper reports findings from an independent evaluation of the LAF rollout. METHODS: Forty one Indigenous communities were surveyed between 2010 and 2014, with each community being visited twice at a two yearly interval. Quantitative data on prevalence of petrol sniffing were collected, as well as qualitative data on the acceptability of LAF, evidence of substitution for inhaled petrol with other drugs, and programs such as recreational, training and employment opportunities. Prevalence rates of sniffing per 1000 population for each survey year and community were calculated by dividing the total number of sniffers by the population aged 5-39 years and multiplying by 1000. RESULTS: Between 2011-12 and 2013-14, the total estimated number of people sniffing petrol declined from 289 to 204, a fall of 29.4%. At both times, the median petrol sniffing prevalence rate was lower in communities with LAF than in communities without LAF. In 17 of the 41 communities, comparable data were available over a longer period, commencing in 2005-06. Fifteen of these communities stocked LAF over the entire period. In these communities, the median rate of petrol sniffing declined by 96%, from 141.6 per 1000 population in 2005-06 to 5.5 in 2013-14 (p < 0.05). LAF was widely accepted, although acceptance was often qualified by a belief that LAF harmed engines. Anecdotal reports suggest that the fall in petrol sniffing may have been offset by increased use of cannabis and other drugs, but the relationship is not one of simple cause-and-effect, with evidence that an increase in cannabis use in communities commenced before the LAF rollout began. Provision of services in communities has improved in recent years, but many programs continue to be inadequately resourced. CONCLUSIONS: The rollout of LAF appears to have contributed to reducing petrol sniffing and associated harms in Australian Indigenous communities.

The Grog Mob: lessons from an evaluation of a multi-disciplinary alcohol intervention for Aboriginal clients.

OBJECTIVES: To evaluate a 12-month trial of an evidence-based non-residential treatment program for Indigenous clients with alcohol problems, offering three streams of care: pharmacotherapy, psychological and social support. METHODS: Process evaluation of program implementation; outcome evaluation of client outcomes. IMPLEMENTATION: despite constraints of time and remoteness, the trial demonstrated the feasibility of implementing such a program. The medical stream generated fewer pharmacotherapy prescriptions than expected. The most active stream was the psychological therapy stream. OUTCOMES: between March 2008 and April 2009, 129 clients were referred to the program, of whom 49 consented to have de-identified data used for the evaluation. Of these, 19 clients received one or more streams of care, 15 of whom (78.9%) subsequently stopped or reduced drinking. However, among the remaining 30 consenting clients who had not received an intervention, 70.0% also reported stopping or reducing drinking. The evidence of program effectiveness is therefore equivocal and evaluation over a longer period is required. CONCLUSION AND IMPLICATIONS: The trial demonstrated the viability of, and demand for, evidence-based non-residential treatment for Indigenous clients with alcohol problems. Reasons behind an apparent reluctance among GPs to prescribe pharmacotherapy for Indigenous clients, and steps to overcome this, need further attention.

Spirituality and religion in response to substance misuse among indigenous Australians.

The ongoing quest for effective ways of preventing and managing alcohol and other drug use-related problems among Indigenous Australians has spawned a variety of approaches, including AA-based treatment, population health-based preventive approaches, and various forms of cultural healing. This paper examines two inter-related sources of ideas and strategies: firstly, the emergence since the 1970s of evangelical Christianity in some Aboriginal communities as a response to profound changes, including increased access to alcohol. The second is the attempt to invoke Indigenous spirituality as an alternative to both western Christianity and western biomedical intervention models. We also discuss the representation of Australian Indigenous spirituality within New Age and related discourses.

Prevention of Alcohol-Related Crime and Trauma (PACT): brief interventions in routine care pathway - a study protocol.

BACKGROUND: Globally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes. METHODS: Establishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG).Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral. IMPLEMENTATION: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback. EVALUATION: File audits, post workshop questionnaires and semi-structured interviews are administered. DISCUSSION: This project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies.

Study protocol: Screening and Treatment of Alcohol-Related Trauma (START) - a randomised controlled trial.

BACKGROUND: The incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma. METHODS AND DESIGN: The study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up. DISCUSSION: This project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma. TRIAL REGISTRATION: The trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) and Trial Registration: ACTRN12611000135910.

High risk alcohol-related trauma among the Aboriginal and Torres Strait Islanders in the Northern Territory.

High risk drinking is linked with high rates of physical harm. The reported incidence of alcohol - related trauma among Aboriginal and Torres Strait Islander people in the Northern Territory is the highest in the world. Facial fractures are common among young Aboriginal and Torres Strait Islanders. They are often linked with misuse of alcohol in the Northern Territory and are frequently secondary to assault. This review focuses on alcohol-related trauma in the Territory and draws attention to an urgent need for preventative health approach to address this critical issue.