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BACKGROUND: Alcohol-related harm is a substantial burden on the community in Australia and internationally, particularly harm related to risky drinking practices of young people in the night-time economy. This protocol paper describes a study that will report on the changes in a wide range of health and justice outcome measures associated with major policy changes in the state of Queensland, Australia. A key element includes trading hours restrictions for licensed premises to 2 am for the state and 3 am in Safe Night Precincts (SNPs). Other measures introduced include drinks restrictions after midnight, increased patron banning measures for repeat offenders, mandatory ID scanning of patrons in late-night venues, and education campaigns. METHODS: The primary aim of the study is to evaluate change in the levels of harm due to these policy changes using administrative data (e.g., police, hospital, ambulance, and court data). Other study elements will investigate the impact of the Policy by measuring foot traffic volume in SNPs, using ID scanner data to quantify the volume of people entering venues and measure the effectiveness of banning notices, using patron interviews to quantify the levels of pre-drinking, intoxication and illicit drug use within night-time economy districts, and to explore the impacts of the Policy on business and live music, and costs to the community. DISCUSSION: The information gathered through this project aims to evaluate the effectiveness of the Policy and to draw on these findings to inform future prevention and enforcement approaches by policy makers, police, and venue staff.

Objective: This study investigates the prevalence and characteristics of first drink driving convictions among young Aboriginal and Torres Strait Islander (Indigenous) Australians (aged from 14 to 24) and considers some of the risk factors associated with recidivism. Methods: Convictions recorded between 2006 and 2013 were extracted from the Queensland Department of Justice and Attorney General database. Convictions were regrouped by gender, age, Accessibility/Remoteness Index of Australia classification, and sentence severity. Chi-square analyses and logistic regression were conducted to identify group differences in offense characteristics for gender and recidivism (recidivists versus nonrecidivists). Results: The sample consisted of 1,583 individuals (74.1% males) convicted in the 8-year period. Gender comparisons showed that there was no significant difference in age at time of first offense, blood alcohol concentration (BAC) level at apprehension, or type of penalty received between males and females. However, males received larger fines and longer periods of license disqualification. Comparisons for reoffending and non-reoffending revealed that males, drivers aged 14–17 years of age and 18 to 20 years of age, and inner regional drivers were more likely to reoffend. Conclusions: There were limited differences between females and males or recidivists and nonrecidivists at first conviction. Convictions for drink driving may provide an opportunity for early alcohol intervention with Indigenous young drivers (<20 years) because it is likely to be an individual’s first alcohol-related conviction.

Free to read The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970–2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03–0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth.

Background In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. Methods/Design The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. Discussion This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to com

BACKGROUND: In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. METHODS/DESIGN: The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. DISCUSSION: This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to

Drink driving contributes towards high injury rates for Indigenous populations in Canada and Australia, particularly in more isolated regions. At present there is limited research on the cultural and psychosocial factors that underpin Indigenous peoples’ drink driving. This study is part of a broader project aiming to inform a culturally sensitive program. Qualitative interviews with 29 convicted Indigenous drink drivers (aged 20-51 years) from a remote region of Queensland, Australia were used to explore their cognitions about, and underlying motivation for, drink driving as well as the factors that might facilitate or impede it. Although a number of themes were identified, this paper will focus on the first theme, respondents’ self-perceived rationale for their behaviour. Two subthemes were identified: ‘being the hero’ referred to situations where respondents were motivated by a bravado mentality to drive after drinking despite having, on some occasions, the opportunity to avoid this (e.g. another person offering to drive); and ‘family obligations’ which referred to situations where respondents described pressure from members of their extended families to drive after drinking. The underlying responsibility for transporting family members appeared to be difficult to avoid and related to cultural values. Findings indicate the social and individual characteristics for younger drink drivers are similar to mainstream populations. However, the reinforcers for Indigenous drink drivers may be different for this population, consistent with findings on other Indigenous populations outside Australia. Specific programs should contain a family-centred approach and explore the kinship value system to build strategies around these strong relationships.

In Australia and internationally, there is scant information about Indigenous repeat drink drivers. The aim was to identify the risk factors associated with repeat offending. De-identified data on drink driving convictions by offenders identifying as Indigenous in Queensland between 2006 and 2010 were examined. A range of univariate analyses were used to compare first time and repeat offenders on gender, age, court location and region (based on the accessibility/remoteness index of Australia), blood alcohol concentration and sentencing severity. Multivariate logistic regression adjusted for confounding variables. Convictions for repeat offenders were more likely from locations other than ‘major cities’ with the association strongest for courts in the ‘very remote’ region (OR=2.75, 2.06-3.76, p<.001). Indigenous offenders 40 years or older were found to be at reduced risk in comparison to offenders aged 15-24 years (OR=0.68, 0.54-0.86, p=0.01). After controlling for confounding factors, gender, sentencing severity and blood alcohol concentration levels were not significantly associated with recidivism. The association of recidivism and remoteness is consistent with higher rates of alcohol-related transport accidents involving Indigenous Australians in isolated areas. This study provides a platform for future research and allows for early attempts to address the need for intervention to reduce Indigenous drink driving recidivism.

Background Road crashes contribute to high injury rates in Indigenous population in Aust, NZ, Canada and USA Alcohol one of the leading risk factors for road crashes: 31.5% Indigenous drivers in remote areas over 0.05mg/100ml, compared to 7.4 percent of non-Indigenous counterparts 17.5% Indigenous drivers in regional areas over 0.05mg/100ml compared to 3.8 percent of non-Indigenous counterparts Indigenous peoples are overrepresented in alcohol-related fatality rates, with this group 40% more likely to be killed

Objective To inform smoking interventions by clinicians, particularly doctors, in primary healthcare settings in remote Aboriginal communities, we describe the results of tobacco surveys in remote Northern Territory communities. Methods During 2008–09 in three remote communities in the Northern Territory, 400 people (aged ≥16 years) were asked about their tobacco use. Results Extremely high rates of smoking persist: 71%, 78% and 82% of those interviewed in the three communities. More than half the smokers were either thinking about or actively trying to quit, despite limited access to appropriate support. Among former smokers, the most common motivator for quitting was ‘health concerns’. Of those citing ‘health concerns’, 22% specifically mentioned receiving advice from a clinician, usually a ‘doctor’. Conclusion General practitioners, and their colleagues in similar primary healthcare settings, are well placed and are strongly encouraged to take every opportunity to make what could be a significant impact on reducing harms related to smoking and environmental smoke.

Objective To inform smoking interventions by clinicians, particularly doctors, in primary healthcare settings in remote Aboriginal communities, we describe the results of tobacco surveys in remote Northern Territory communities. Methods During 2008–09 in three remote communities in the Northern Territory, 400 people (aged ≥16 years) were asked about their tobacco use. Results Extremely high rates of smoking persist: 71%, 78% and 82% of those interviewed in the three communities. More than half the smokers were either thinking about or actively trying to quit, despite limited access to appropriate support. Among former smokers, the most common motivator for quitting was ‘health concerns’. Of those citing ‘health concerns’, 22% specifically mentioned receiving advice from a clinician, usually a ‘doctor’. Conclusion General practitioners, and their colleagues in similar primary healthcare settings, are well placed and are strongly encouraged to take every opportunity to make what could be a significant impact on reducing harms related to smoking and environmental smoke.

Background: In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results: The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions: These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Au

Background: In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results: The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions: These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Au

Background: In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results: The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions: These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Au

Background: In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results: The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions: These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Au

Objective: To review available literature addressing the issue of whether smoking status of Indigenous Health Workers (IHWs) impedes provision of health information about smoking tobacco to their communities. Method: Databases were searched for publications that examined IHWs' smoking status or quit support programs for IHWs. Studies were categorised as reviews and commentaries, intervention studies or descriptive research. Results: Fourteen studies met inclusion criteria. Overall, the literature suggests that IHWs' smoking status is a barrier. However, the poor quality of most studies weakens the evidence for this conclusion. The issue of IHWs smoking status as a barrier is peripheral to all but two of the studies. Literature cited and reviewed was often not exhaustive and relied on only a few preceding empirical studies. Most studies were unclear about whether IHWs' views were reported as distinct from views of health staff in general. Conclusions and implications: The recent COAG investment to Tackling Smoking is an important contribution to Closing the Gap in the health of Indigenous Australians. However, there remain potential barriers faced by IHWs that may undermine efforts to reduce Indigenous smoking. Overcoming these barriers and assisting IHWs to quit smoking may provide an opportunity to address high rates of smoking in Indigenous communities. Further research is required with a balance between descriptive research to assess the issue and intervention research to address it.

Background With chronic alcohol abuse, cognitive studies suggest that progressive cognitive decline may precede more serious and irreversible neurological syndromes. The early detection of cognitive impairment may therefore aid in the prevention of permanent brain damage. Despite the devastating consequences of alcohol abuse among Aboriginal Australians, the effects on brain function have never been studied in this population and a lack of appropriate assessment tools has prevented the development of such research. Aims To determine the impact of long-term and heavy episodic alcohol use on cognitive function in Aboriginal people. Design Cross-sectional comparing heavy episodic alcohol users with non-alcohol users. Setting Two remote Aboriginal communities in north-east Arnhem Land, northern Australia. Subjects The control group consisted of 24 non-drinkers (15 males, nine female) and the heavy episodic group consisted of 20 people (19 males, one female) who had been drinking alcohol in a heavy episodic style (median 14 drinks per occasion) for a mean of 8.9 years (SD = 5.0). Measurements Interview to obtain demographic information, substance abuse history and symptoms of mental health and wellbeing, together with a computerized cognitive assessment battery (CogState Ltd). Findings Compared with non-drinkers, heavy episodic drinkers showed reduced psychomotor speed (P = 0.04) and reduced accuracy when performing tasks of attention (P = 0.045), working memory (P = 0.04), implicit memory (P = 0.03) and associate learning and memory (P = 0.001). Conclusions Specific cognitive abnormalities that suggest frontostriatal abnormalities and have been observed in association with chronic alcoholism in other populations were observed among Aboriginal Australians who were heavy episodic alcoholic users.

Background Few studies describe cannabis use in indigenous populations, and no longitudinal studies are available in Australia. We conducted 3-year follow-up interviews and assessments in Aboriginal communities in Arnhem Land (Northern Territory, NT). Methods A randomly selected sample (n = 161; 80 males, 81 females aged 13-36 years) was assessed in October 2001 and then reassessed in September 2004. An opportunistically recruited sample ( n = 104; 53 males, 51 females aged 13-36 years) was also interviewed in 2001 and followed-up in 2004. Cannabis and other substance use were determined by combining proxy assessments by local Aboriginal health workers, medical records and data from interviews. Changes in cannabis use and symptoms of misuse were assessed using McNemar's test for paired proportions and the Wilcoxon signed rank test. Logistic regression assessed associations between clinical presentations and cannabis use at both time-points. Results Those who used cannabis at both baseline and follow-up were at greater risk than those who never used it to have suffered: auditory hallucinations; suicidal ideation; and imprisonment. In the randomly selected cohort there were fewer cannabis users at follow-up than at baseline (P = 0.003). The reduction was evident in females generally (P = 0.008) and older males ( aged = 16 at baseline) (P = 0.007). In those interviewed at both baseline and follow-up we measured no statistically significant reduction in frequency and levels of use, although fewer cannabis users reported symptoms of misuse such as: fragmented thought processes; memory disruption; difficulties controlling use; and auditory and visual hallucinations. Conclusions Modest reductions in cannabis use and its consequences in this population were demonstrated. These may be the result of enhanced supply control and broader socio-political changes.

A recent rise in cannabis use in Indigenous communities in northern Australia may have compounded existing patterns of other substance use. This paper describes these patterns in Arnhem Land in the 'Top End' of the Northern Territory (NT). Economic impacts of the cannabis trade are also described. In a descriptive cross-sectional study, random samples included 336 people (169 males, 167 females) aged 13 - 36 years. Consensus classification of lifetime and current use of cannabis, alcohol, tobacco, kava, inhalants (petrol) and other drugs was derived based on health workers' proxy assessments. A sample (n = 180, aged 13 - 36) was recruited opportunistically for interview. Lifetime cannabis users among those interviewed (n = 131, 81 males, 50 females) described their current cannabis use, usual quantities purchased and consumed, frequency and duration of cannabis use and other substance use. In the random samples, 69% (63 - 75%) of males and 26% (20 - 31%) of females were lifetime cannabis users (OR = 7.4, 4.5 - 12.1, p < 0.001). The proportion of males currently using cannabis was 67% (60 - 73%) while the proportion of females currently using cannabis was 22% (16 - 27%) (OR = 7.9, 4.8 - 13.1, p < 0.001). Current cannabis users were more likely than non-users to be also using alcohol (OR = 10.4, 4.7 - 23.3, p < 0.001), tobacco (OR = 19.0, 7.9 - 45.8, p < 0.001) and to have sniffed petrol (OR = 9.1, 4.6 - 18.0, p < 0.001) but were less likely to be using kava (OR = 0.4, 0.2 - 0.9, p < 0.001). Among those interviewed, higher tobacco consumption in current users and greater alcohol use in lifetime users was associated with increased cannabis use. Action is required to reduce cannabis use, especially in combination with other substances.

We evaluate a method to describe changing substance use patterns in northern Australia's remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 10 1 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-kappa statistic) among health workers for a history of substance use and current use, varied from kappa=0.207 for petrol sniffing (P=0.006) up to kappa=0.749 for cannabis use (P<0.001), all better than would be expected by chance. In communities A and 13, agreement between health workers' consensus and self-reported substance use was weaker (0.103

Introduction. Hepatic toxicity from manufactured herbal remedies that contain kava lactones has been reported in Europe, North America, and Australia. There is no evidence for serious liver damage in kava-using populations in Pacific Island societies or in Indigenous Australians who have used aqueous kava extracts. This article presents evidence that liver function changes in users of aqueous kava extracts appear to be reversible. Data from one Arnhem Land community [Northern Territory (NT), Australia] with 340 indigenous people older than 15 years of age in 2000 are used. Methods. This study was a cross-sectional study with 98 participants, 36 of whom had never used kava. Among 62 kava users, 23 had discontinued kava at least 1 year before the study. Continuing users had not used kava for 1 to 2 months (n = 10) or 1 to 2 weeks previously (n = 15). Some (n = 14) had used kava within the previous 24 hr. Liver function tests were compared across these groups, taking into account differences due to age, sex, alcohol, and other substance use. Results. The average quantity of kava powder consumed was 118 g/week, and median duration of use was 12 years (range, 1-18 years). Kava usage levels were less than one-half of those found in previous studies. More recent kava use was independently associated with higher levels of liver enzymes gamma-glutamyl transferase (GGT) (p < 0.001) and alkaline phosphatase (ALP) (p < 0.001), but not with alanine aminotransferase or bilirubin, which were not elevated. In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers (p < 0.001), whereas higher ALP levels occurred only in those who last used kava 1 to 2 weeks (p = 0.015) and 24 hr previously (p = 0.005). Discussion. Liver function changes in users of aqueous kava extracts at these moderate levels of consumption appear to be reversible and begin to return to baseline after 1 to 2 weeks abstinence from ka

Background: Heavy kava use in Aboriginal commun­ities has been linked to various health effects, including anecdotes of sudden cardiac deaths.Aims: To examine associations between kava use and potential health effects.Methods: A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments.Results: Kava users more frequently showed a characteristic dermopathy (P < 0.001). They had increased levels of γ-glutamyl transferase and alkaline phosphatase (P < 0.001). Lymphocyte counts were significantly lower in kava users (P < 0.001). Fibrinogen, plasmin­ogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine.Conclusions: Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities. (Intern Med J 2003; 33: 336−340)

Kava is an extract from the Piper methysticum Forst. f. plant that has social and spiritual importance in Pacific islands societies. Herbal remedies that contain kava are used for the psychiatric treatment of anxiety and insomnia. Laboratory studies have found only subtle, if any, changes on cognitive or motor functions from the acute effects of consuming small clinical doses of kava products. Intoxication from recreational doses of kava has not been studied. The performance of individuals intoxicated from drinking kava (n = 11) was compared with a control group (n = 17) using saccade and cognitive tests. On average, intoxicated individuals had consumed 205 g of kava powder each (approximately 150 times clinical doses) in a group session that went for 14.4 h and ended 8 h prior to testing. Intoxicated kava drinkers showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP), together with saccadic dysmetria, saccadic slowing and reduced accuracy performing a visual search task that only became evident as the task complexity increased. Kava intoxication is characterized by specific abnormalities of movement coordination and visual attention but normal performance of complex cognitive functions. Saccade abnormalities suggest disruption of cerebellar and GABAergic functions.

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case-control study (n=115 cases; n=415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia, vas not associated with kava use. Crude OR=1.26 (0.74-2.14, P=0.386), increased after controlling for confounders (OR=1.98, 0.63-6.23, P=0.237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1.19 (0.39-3.62, P=0.756). In communities with longer kava-using histories, adjusted OR was 2.19 (0.67-7.14, P=0.187). There was no kava dose-response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2.27, 1.18-4.37, P=0.014) and alcohol use (OR=1.95, 1.07-3.53, P=0.026) were statistically significant and approached significance for petrol sniffing (OR=1.98, 0.99-3.95, P=0.056).

BACKGROUND: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. AIMS: To examine associations between kava use and potential health effects. METHODS: A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. RESULTS: Kava users more frequently showed a characteristic dermopathy (P<0.001). They had increased levels of gamma-glutamyl transferase and alkaline phosphatase (P<0.001). Lymphocyte counts were significantly lower in kava users (P<0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. CONCLUSIONS: Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.

BACKGROUND: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. AIMS: To examine associations between kava use and potential health effects. METHODS: A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. RESULTS: Kava users more frequently showed a characteristic dermopathy (P<0.001). They had increased levels of gamma-glutamyl transferase and alkaline phosphatase (P<0.001). Lymphocyte counts were significantly lower in kava users (P<0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. CONCLUSIONS: Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.

Objective: Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure. Methods: We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed. Results: Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36), Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39). Conclusions: Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.