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The Australian Government will set the direction for addressing road safety over the next decade with its 2021–2030 National Road Safety Strategy. This road map will detail objectives and goals agreed upon by all Australian states and territories. Similar to previous national strategies, Aboriginal and Torres Strait Islander (Indigenous) Australians are a high priority population. Indigenous Australians are over‐represented in serious injury and fatal road crashes, with alcohol a leading factor. Therapeutic and educational programs are a major strategy among the suite of measures designed to reduce and prevent drink driving in Australia. The release of this new strategy provides a timely opportunity to reflect on what is known about drink driving among Indigenous Australians and to consider the suitability of existing therapeutic and educational drink driving programs for Indigenous Australian contexts. Here, we summarise factors that contribute to drink driving in this population and identify outstanding knowledge gaps. Then, we present an overview of drink driving programs available for Indigenous Australians along with suggestions for why tailored programs are needed to suit local contexts. The response to address drink driving among Indigenous Australians has been fragmented Australia‐wide. A coordinated national response, with ongoing monitoring and evaluation, would improve policy effectiveness and inform more efficient allocation of resources. Together this information can help create suitable and effective drink driving programs for Indigenous drivers and communities Australia‐wide. [ABSTRACT FROM AUTHOR]

Objective: A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced. Methods and Procedure: Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis. Results: Five major themes were identified within the data. These were labelled 'hospital experiences', 'engaging with medical and community-based supports', 'health and wellbeing impacts from the injury', 'everyday living' and 'family adjustments post-injury'. Conclusions: While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is a leading cause of disability in Australia. Evidence shows that multidisciplinary rehabilitation and support in the six months following TBI is important for successful independent living and social re-integration. Despite this, access to services and supports during this period is often limited by environmental, socio-economic, geographic and cultural factors. Australian studies on outcomes after brain injury have reported primarily on non-Indigenous people. This study will investigate key sentinel events during the transition from hospital to home after a TBI in the first longitudinal study with Indigenous Australians. Method: Indigenous Australians admitted to one of three major trauma hospitals in northern Australia with a TBI, and their care givers, will be recruited. Clinical and brain injury risk factor information, along with measures of cognitive function, transition events, mental health and community re-integration will be collected at three time points prior to hospital discharge, and at three and six months post-discharge. Qualitative interviews will also be conducted. Data will be analysed using regression methods for the quantitative component, and situational analysis for the qualitative component. Annual rates of brain injury will be calculated for patients admitted to tertiary hospital facilities in the study region with a diagnosis of TBI. Discussion: Understanding the experience and events which shape the transition period is critical to determining the services and supports that may enhance transition outcomes, and ensure that such services are culturally appropriate and endorsed by Indigenous families and communities. [ABSTRACT FROM AUTHOR]

In 2002/2003, the Queensland Government released a decision that Alcohol Management Plans (AMPs) were to be introduced to most Indigenous communities in Cape York, Australia, in an effort to address violence generally and specifically violence against women and children. By 2008, increased restrictions brought total prohibition in some communities and tightened restrictions in others. This project provides a pre-/postprohibition comparison and analysis of injuries, injuries that involved alcohol and verified police reported assaults. Supporting this are rich community survey data which together aim to elicit the effect restricting alcohol had on violent activity in the communities, particularly for women. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to gauge whether, and to what extent, population flow occurred as a result of the implementation of alcohol management plans in Indigenous communities. Background Alcohol management plans involving carriage limits and dry places were introduced into 15 Queensland Indigenous communities between 2002-2004. Controls on alcohol availability were further tightened between 2008-2010, seeing the closure of eight mainly remote community taverns/canteens. Design A retrospective observational study was undertaken using data from the Queensland Injury Surveillance Unit. Methods Population flow was measured by changing patterns of alcohol-related injuries in a mining region near dry Indigenous communities following the introduction of alcohol management plans and a control mining region distant from Indigenous communities with alcohol management plans. Data were analysed using descriptive and inferential statistics. Logistic regression was used for the comparison of the characteristics between the emergency department presentations. The rates of alcohol-related injury presentations per 1000/population were calculated and age-standardised to the Australian population. Results Between the five-year periods 2003-2007 and 2008-2012, alcohol-related injury presentations to the Mount Isa emergency department trebled from an age-adjusted average annual rate of 9·5/1000 in the region's population to 27·1/1000 population. In the control region, alcohol-related emergency department injury presentations did not increase to the same degree with age-adjusted average annual rates of 1·42/1000 and 2·21/1000, respectively. Conclusions The 10-year pattern of emergency department presentations for alcohol-related injuries increased significantly in the Mount Isa region compared with the control region. Further research should investigate the impacts of population flow related to Indigenous community alcohol management plans. Relevance to clinical practice Although initiatives such as alcohol management plans have been implemented to reduce alcohol use and related consequences in Indigenous communities, there needs to be a greater consideration of the impact of these policies in nearby towns in the future. [ABSTRACT FROM AUTHOR]

Background: In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities.Methods: This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18-24, 25-44, 45-64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances.Results: Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity (ρ = 0.90). Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. 'Unfavourable' items were not reliably reflected in one group (ρ = 0.48) but in: i) alcohol availability and consumption not reduced and ii) criminalization and discrimination. In logistic regressions, longer-term (≥ 6 years) residents more likely agreed that violence against women had reduced and that personal safety had improved but also that criminalization and binge drinking had increased. Younger people disagreed that their community was a better place to live and strongly agreed about discrimination. Current drinkers' views differed little from the sample overall.Conclusions: The present Government review provides an opportunity to reinforce 'favourable' outcomes while targeting: illicit alcohol, treatment and diversion services and reconciliation of criminalization and discrimination issues. [ABSTRACT FROM AUTHOR]

Introduction and Aims. While petrol sniffing afflicts several isolated Indigenous groups internationally, few studies have examined the factors contributing to continued sniffing following treatment. This study aims to describe those factors in a group of Aboriginal Australian users. Design and Methods. During residential treatment, 56 petrol sniffers completed baseline demographic and substance use questionnaires and cognitive and psychological assessments. Eighty per cent were reassessed and interviewed an average of 9 months (SD = 4) later. Cognitive, psychological, substance use and sociocultural factors were compared between those who relapsed at follow up and those who maintained abstinence. Results. More males (n = 44) than females (n = 12) were studied. Of the 45 individuals followed up, 58% (n = 26) relapsed. Significant risk factors for relapse included the ready availability of petrol, living in urban centres, being unmarried and living with fewer people (P < 0.05). Other potential risk factors, indicated by P -values < 0.10, included younger age of first petrol use, having sniffed within 14 days prior to treatment, poly substance use, sniffing in response to negative emotions, and feeling lonely at baseline and having sleep problems at follow up. Discussion and Conclusion. This study identified psychosocial factors that may be associated with continued petrol sniffing among Aboriginal Australians post treatment. Future research, interventions and policy relating to petrol sniffing should consider these factors. [Dingwall KM, Maruff P, Clough AR, Cairney S. Factors associated with continued solvent use in Indigenous petrol sniffers following treatment. Drug Alcohol Rev 2012;31:40-46] [ABSTRACT FROM AUTHOR]

Introduction and Aims. In remote Indigenous Australian communities measuring individual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory). Design and Methods. In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged≥ 16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (< 10 cigarettes per day) and 'heavier smokers' (≥ 10 cigarettes per day) in men and women were compared. Results. Of 400 Indigenous study participants, 305 (76%) used tobacco; four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information; a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio = 2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day; very similar to self-reported levels. Sixty per cent (= 6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%). Discussion and Conclusions. Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores. [Clough AR, MacLaren DJ, Robertson JA, Ivers RG, Conigrave KM. Can we measure daily tobacco consumption in remote Indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Diversion from court and prison has been recommended for Indigenous Australian youth who commit offences. As no evaluations of such programmes have been published, we describe processes and early outcomes of a diversion programme in the Northern Territory. Design and Methods. From 2003 to 2006, among 1700 remote Indigenous community residents, 35 young people (aged 11-18 years, median 15 years) committed offences. They were diverted from criminal justice and referred to a community-based diversion initiative. Client assessment records and staff interviews furnished data to examine clients' diversion pathways and early programme results. Results. Eighteen clients were reportedly using a substance at the time of their offence; cannabis (n = 9), petrol (n = 5), alcohol (n = 4). The remaining 17 had histories of using one or more of these. Two clients could not complete local diversion programs because they moved to other regions; one case was not pursued for legal reasons, leaving 32 clients exposed to the local programme. By July 2006, four clients were continuing in their programmes, three had breached them, but 25 had completed them in periods ranging from 2 to 60 weeks (median = 26 weeks), a completion rate of 89% (25/28). Just one client re-offended after completing diversion. Discussion and Conclusions. A high completion rate was achieved despite: a dearth of locally available drug and alcohol treatment services and diversion options; shifts in police approaches; heavy administrative burdens to meet legal requirements; and difficulties communicating across cultural barriers. [Clough AR, Lee KK San, Conigrave, KM. Promising performance of a juvenile justice diversion programme in remote Aboriginal communities, Northern Territory, Australia. Drug Alcohol Rev 2008;27:433 - 438] [ABSTRACT FROM AUTHOR]

The objective of this study was to describe some costs and challenges for conducting follow-up interviews about substance use in Indigenous groups in northern Australia. In a remote region in the Northern Territory in 2001, 131 Indigenous people (aged 13 – 36 years) were approached for interview regarding their substance use. Of these, 108 (54 males, 54 females) were interviewed successfully. Follow-up interviews were attempted in 2004. Study records traced progress and costs. In 2001, the response rate was 82% (108/131). In 2004, 22 participants could not be found after four attempts although they were known by health workers to still reside in the region. Fifteen were not residing in the region during 2004 and were lost to follow-up, four were in prison and three were deceased. Fourteen contacted either refused directly ( n = 1) or repeatedly postponed interview ( n = 13). Fifty follow-up interviews were completed, a response rate of 78% among 64 participants contacted. The overall response rate in those approached was 64% (0.82 * 0.78). Costs for 108 interviews were 45 person-days and $A19 000 (32% = travel/associated costs). Costs for 50 follow-up interviews were 60 person-days and $A25 500 (39% = travel/associated costs). Such follow-up studies in these settings could be complemented by retrospective case – control approaches and by using proxy respondents to increase study efficiency. [Clough AR. Some costs and challenges of conducting follow-up studies of substance use in remote Aboriginal communities: an example from the Northern Territory . Drug Alcohol Rev 2006;25:455 – 458] [ABSTRACT FROM AUTHOR]

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. [Clough AR, d'Abbs P, Cairney S, Gray D, Maruff P, Parker R, O'Reilly B. Emerging patterns of cannabis and other substance use in Aboriginal communities in Arnhem Land, Northern Territory: a study of two communities. Drug Alcohol Rev 2004;23:381-390] [ABSTRACT FROM AUTHOR]

Background: 'Alcohol Management Plans' (AMPs) with a focus on alcohol restrictions were implemented in 19 discrete Indigenous communities, in 15 Local Government Areas, by the Queensland Government from 2002. Community residents' perceptions and experiences of the impacts of AMPs on local alcohol and drug use are documented.Methods: A cross-sectional study used quantitative and qualitative survey data collected during 2014-2015 in 10 affected communities. Five had some alcohol available. Five had total prohibition. Participant responses were assessed and compared by prohibition status.Results: Overall, less than 50% of 1098 participants agreed that: i) the restrictions had reduced alcohol availability in their community and ii) that people were drinking less. Nearly three quarters agreed that binge-drinking had increased, attributed to increased availability of illicit alcohol. There were no statistically significant differences between communities with prohibition and those with some access to alcohol. Participants agreed overall that cannabis use had increased but were more equivocal that new drugs were being used. These views were less frequently reported in prohibition communities.Conclusions: Contrary to what was intended, Queensland's alcohol restrictions in Indigenous communities were viewed by community residents as not significantly reducing the availability and use of alcohol. Furthermore, this was compounded by perceived increases in binge drinking and cannabis use; also unintended. There is a need to strengthen resolve at all levels to reduce the supply of illicit alcohol in restricted areas. [ABSTRACT FROM AUTHOR]

As efforts to shorten the duration of untreated psychosis increase, there is a need for short screening instruments to identify those at-risk. It is feared that remote Indigenous populations, manifesting many of the risk factors associated with schizophrenia and often lacking access to adequate mental health services, may be overlooked as the general population effort shifts towards early detection. This article aimed to review studies investigating psychotic symptoms in Indigenous communities in Australia, New Zealand, Canada and United States of America and aimed to evaluate the usefulness of the instruments. Eleven relevant studies were identified using seven unique instruments. The available instruments assessed psychotic symptoms to varying degrees, although no screener for early detection was found thus supporting concerns that these disadvantaged populations do not have access to suitable support enabling early detection of psychosis. We recommend that a rapid screening tool for detecting at-risk individuals be developed and validated for community use in Indigenous populations living in remote areas. [ABSTRACT FROM AUTHOR]