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Abstract 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

Abstract Objective: Abuse of inhalants containing the volatile solvent toluene is a significant public health issue, especially for adolescent and Indigenous communities. Adolescent inhalant abuse can lead to chronic health issues and may initiate a trajectory towards further drug use. Identification of at‐risk individuals is difficult and diagnostic tools are limited primarily to measurement of serum toluene. Our objective was to identify the effects of adolescent inhalant abuse on subsequent drug use and growth parameters, and to test the predictive power of growth parameters as a diagnostic measure for inhalant abuse. Methods: We retrospectively analysed drug use and growth data from 118 Indigenous males; 86 chronically sniffed petrol as adolescents. Results: Petrol sniffing was the earliest drug used (mean 13 years) and increased the likelihood and earlier use of other drugs. Petrol sniffing significantly impaired height and weight and was associated with meeting ‘failure to thrive’ criteria; growth diagnostically out‐performed serum toluene. Conclusions: Adolescent inhalant abuse increases the risk for subsequent and earlier drug use. It also impairs growth such that individuals meet ‘failure to thrive’ criteria, representing an improved diagnostic model for inhalant abuse. Implications for Public Health: Improved diagnosis of adolescent inhalant abuse may lead to earlier detection and enhanced health outcomes.

Background: Abuse of inhalants containing the volatile solvent toluene is a significant public health issue, especially for adolescent and Indigenous communities. We previously demonstrated that inhalant abuse (petrol sniffing) during adolescence results in impairments to height and weight. The aim of this study was to understand whether these impairments resolve or persist into early adulthood, following sustained abstinence. Methods: Baseline data were collected from 118 Indigenous males; 86 chronically sniffed petrol during adolescence. Following 2 years sustained abstinence, data were again collected from a subset (n = 40) of this population; 30 sniffed petrol during adolescence. This study is a retrospective analysis of data collected after 2 years sustained abstinence. Results: After 2 years abstinence, inhalant-induced impairments to height persisted (p = 0.023) whereas weight impairments resolved (p = 0.796). Conclusions: Adolescent inhalant abuse alters growth trajectories, even after 2 years of sustained abstinence. Despite the fact that individuals continue to get taller, there is no catch-up growth in those who abused inhalants. The persistence of height impairments demonstrates that adolescent inhalant abuse can impact individuals into adulthood, despite sustained abstinence. In contrast, weight impairments associated with inhalant abuse resolved in abstinence, however, it is unknown if this represents a normalisation of weight or a rapid and unhealthy gain in weight. Further research is required to determine the health impacts of the observed weight changes. [ABSTRACT FROM AUTHOR]

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. [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]

Inhalation of petrol (gasoline) fumes has been prevalent in some Australian Indigenous communities since World War II, and has led to a continuing quest for an effective method of preventing the practice either by modifying the substance or by substituting nonharmful alternatives. This article traces the results of this search, beginning with the addition of ethyl mercaptan, then describing the substitution of aviation fuel for conventional vehicle fuel, and concluding with the staged introduction of Opal--a vehicle fuel containing low levels of aromatic hydrocarbons--throughout many communities from 2005. The article assesses the benefits and limitations of supply reduction methods. [ABSTRACT FROM AUTHOR]

The practice of petrol sniffing is a unique and poorly understood phenomenon that is associated with substantial morbidity, mortality and social devastation in affected remote Indigenous communities. For these groups and for the wider community, much mystery has surrounded the practice and its effects. Here we introduce the epidemiology of petrol sniffing among Indigenous groups internationally, review its impact on the brain, behaviour and social functions and summarise related interventions. [ABSTRACT FROM AUTHOR]

Background: Chronic petrol inhalation can be associated with significant cognitive impairment. While rehabilitation programs can rely on such skills to educate clients and achieve treatment outcomes, cognitive function is rarely assessed on admission. This is particularly true for Indigenous populations where standard assessments are not appropriate. This paper describes a process for assessing cognition in Indigenous Australians. Two studies investigate firstly the demographic factors impacting on cognition for healthy Indigenous Australians and secondly the utility of the assessment process for detecting petrol sniffing related cognitive impairments. Methods: Study One assessed a naturalistic sample of healthy Indigenous Australians from the Northern Territory ( N = 206; mean age = 28.03) on computerised tests of psychomotor speed, visual attention, memory, learning, spatial awareness and executive functions. Multiple regression analyses determined the unique contributions of six factors (age, education, gender, familiarity with computers, regular long term cannabis use and locality) to the variance in performance for this group. Study Two examined group differences in cognitive performance on the same tests between healthy Indigenous Australians ( N = 96) and Indigenous petrol sniffers ( N = 50; both age restricted to < 26 years) while controlling those factors found to impact on performance from Study One. Results: Age, computer familiarity, and education significantly contributed to the variance in performance measures. While controlling these factors, petrol abuse was associated with poorer performance on complex tasks of psychomotor, visual attention, memory, learning, spatial awareness and executive function. Conclusions: This assessment process is useful for detecting substance abuse related impairments in Indigenous Australians and when using this assessment process, age and computer familiarity in particular should be controlled for. [ABSTRACT FROM AUTHOR]

Introduction and Aims. To examine predictors of cannabis use at 5 year follow up in an Australian Aboriginal cohort. Design and Methods. A longitudinal study consisting of two waves of data collection 5 years apart was conducted. Of the 100 Aboriginal residents (aged 13–36 years) interviewed about cannabis use in 2001, 83 were re-interviewed in 2005–2006 from three remote communities in Arnhem Land, Northern Territory, Australia. Self-reported cannabis use was categorised at each time point (none; former use, quit≥ 3 months; lighter use, < 6 cones, 2–3 times weekly; daily use,≥ 6 cones, daily) and summarised as any current use, heavy use, dependence or cessation. Other substance use, employment and involvement in school or training were also compiled. Results. Most respondents who reported cannabis use at baseline again reported use at follow up. A history of petrol sniffing predicted later heavy cannabis use (P < 0.05). Trends were evident for men to have persisting cannabis use, and for employment and/or engagement in school or training to be associated with cannabis cessation. Discussion and Conclusions. Ongoing heavy cannabis use is commonplace in this Aboriginal cohort and raises concerns for the physical, social and psychiatric burden on these already vulnerable communities. Prevention, treatment and intervention programs developed with communities are badly needed.[Lee KSK, Conigrave KM, Clough AR, Dobbins TA, Jaragba MJ, Patton GC. Five-year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

While petrol sniffing amonge Australian Aboriginal youth has received significant public and academic attention, the experience of petrol sniffing as articulated by sniffers themselves and community's perceptions of petrol sniffing have been underexplored. Through an ethnographic analysis of a remote Aboriginal community in the Northern Territory Australia, a range of perspectives on petrol sniffing are elucidated in order to understand both the experiences associated with sniffing and non-sniffers' perceptions of the activity. We argue that contextualizing sniffing within the community is essential to understanding petrol sniffing, and hence to providing appropriate health interventions. It would be incorrect to presume a causal connection between the introduction of a petrol sniffing intervention, described in this article, and the sudden cessation of all petrol sniffing activities in late 2005. Rather, a number of factors and occurrences within the community combined with the effects of the intervention were associated with a significant decrease in petrol sniffing. [ABSTRACT FROM AUTHOR]

Petrol sniffing is a major form of substance misuse in Aboriginal communities across Australia. This practice has detrimental effects on the health and wellbeing of individual sniffers, their families, communities and wider society. There are few examples of programmes that have successfully stopped petrol sniffing. This paper looks at the Mt Theo Program, regularly cited as ‘the success story’ in petrol sniffing interventions. The aim of this paper is to demonstrate key elements that have contributed towards Mt Theo Program's rare achievement: (1) initially, a multi-faceted approach including an outstation and youth programme, (2) community-initiated, operated, owned basis of the organisation, which incorporates (3) strong partnership between Indigenous and non-Indigenous team members and (4) an ability to operate beyond crisis intervention. [Preuss K, Napanangka Brown J. Stopping petrol sniffing in remote Aboriginal Australia: key elements of the Mt Theo Program. Drug Alcohol Rev 2006;25:189 – 193] [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective : We investigated adverse mental health effects and their associations with levels of cannabis use among indigenous Australian cannabis users in remote communities in the Northern Territory. Method : Local indigenous health workers and key informants assisted in developing 28 criteria describing mental health symptoms. Five symptom clusters were identified using cluster analysis of data compiled from interviews with 103 cannabis users. Agreement was assessed (method comparison approach, κ-statistic) with a clinician's classification of the 28 criteria into five groups labelled: ‘anxiety’, ‘dependency’, ‘mood’, ‘vegetative’ and ‘psychosis’. Participants were described as showing ‘anxiety’, ‘dependency’ etc., if they reported half or more of the symptoms comprising the cluster. Associations between participants' self-reported cannabis use and each symptom cluster were assessed (logistic regression adjusting for age, sex, other substance use). Results : Agreement between two classifications of 28 criteria into five groups was ‘moderate’ (64%, κ = 0.55, p < 0.001). When five clusters were combined into three, ‘anxiety-dependency’, ‘mood-vegetative’ and ‘psychosis’, agreement rose to 71% (κ = 0.56, p < 0.001). ‘Anxiety-dependency’ was positively associated with number of ‘cones’ usually smoked per week and this remained significant when adjusted for confounders (p = 0.020) and tended to remain significant in those who had never sniffed petrol (p = 0.052). Users of more than five cones per week were more likely to display ‘anxiety-dependency’ symptoms than those who used one cone per week (OR = 15.8, 1.8–141.2, p = 0.013). A crude association between the ‘mood-vegetative’ symptom cluster and number of cones usually smoked per week (p = 0.014) also remained statistically significant when adjusted for confounders (p = 0.012) but was modified by interactions with petrol sniffing (p = 0.116) and alcohol use (p = 0.276). There were no associations between cannabis use and ‘psychosis’. Conclusions : Risks for ‘anxiety-dependency’ symptoms in cannabis users increased as their level of use increased. Other plausible mental health effects of cannabis in this population of comparatively new users were probably masked by alcohol use and a history of petrol sniffing. Australian and New Zealand Journal of Psychiatry 2005; 39:612–620 [ABSTRACT FROM AUTHOR]

This paper examines the policy response of Australian governments to petrol sniffing in Indigenous communities from the 1980s until the present. During this period, despite the formation of numerous inquiries, working parties and intergovernmental committees, there has been little accumulation of knowledge about the nature and causes of sniffing, or about the effectiveness of interventions. Policies are fragmentary; programmes are rarely evaluated, and most rely on short-term funding. The paper sets out to explain why this should be so. It draws upon a conceptual framework known as 'analytics of government' to examine the ways in which petrol sniffing comes to the attention of government agencies and is perceived as an issue; the mechanisms deployed by governments to address petrol sniffing; ways in which knowledge about sniffing is generated; and the underlying assumptions about people that inform policy-making. Drawing upon case studies of policy responses, the paper argues that a number of structural factors combine to marginalize petrol sniffing as an issue, and to encourage reliance on short-term, one-off interventions in place of a sustained policy commitment. Four recommendations are advanced to help overcome these factors: (1) agreements should be reached within and between levels of government on steps to be taken to reduce risk factors before the eruption of petrol-sniffing crises; (2) the evidence base relevant to petrol sniffing (and other inhalants) should be improved by funding and directing one or more existing national drug research centres to collate data on inhalant-caused mortality and morbidity, and to conduct or commission research into prevalence patterns, effectiveness of interventions and other gaps in knowledge; (3) the current pattern of short-term, pilot and project funding should be replaced with longer-term, evidence-based interventions that address the multiple risk and protective factors present in communities; and (4) insistence by governments that communities must take 'ownership' of the problem should be replaced by a commitment to genuine partnerships involving governments, non-government and community sectors. [d'Abbs P, Brady M. Other people, other drugs: the policy response to petrol sniffing among Indigenous Australians. Drug Alcohol Rev 2004;23:253-260] [ABSTRACT FROM AUTHOR]

Petrol sniffing (and other forms of inhalant misuse) occur within some Aboriginal communities across Australia. However, there is little documented information about the nature and combination of interventions that are most effective in addressing it. This article reviews published and unpublished literature relevant to petrol sniffing in Australian Aboriginal communities. A range of strategies which have been trialled previously are discussed under the categories of primary, secondary and tertiary intervention.We have adopted Zinberg's schema of 'drug', 'set' and 'setting' in theorizing the mix of interventions most likely to reduce petrol sniffing. We argue that interventions should address as many as possible of these factors. Further, while no strategy is likely to succeed without strong support from local community members, governments also have an important role in addressing petrol sniffing. Consistent funding for strategies directly addressing petrol sniffing and co-ordinated government responses to the broader needs of Aboriginal young people and their communities are critical. [ABSTRACT FROM AUTHOR]