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Background: Indigenous young people have significantly higher suicide rates than their non-indigenous counterparts. There is a need for culturally appropriate and effective suicide prevention programs for this demographic., Aims: This review assesses suicide prevention programs that have been evaluated for indigenous youth in Australia, Canada, New Zealand, and the United States., Method: The databases MEDLINE and PsycINFO were searched for publications on suicide prevention programs targeting indigenous youth that include reports on evaluations and outcomes. Program content, indigenous involvement, evaluation design, program implementation, and outcomes were assessed for each article., Results: The search yielded 229 articles; 90 abstracts were assessed, and 11 articles describing nine programs were reviewed. Two Australian programs and seven American programs were included. Programs were culturally tailored, flexible, and incorporated multiple-levels of prevention. No randomized controlled trials were found, and many programs employed ad hoc evaluations, poor program description, and no process evaluation., Conclusion: Despite culturally appropriate content, the results of the review indicate that more controlled study designs using planned evaluations and valid outcome measures are needed in research on indigenous youth suicide prevention. Such changes may positively influence the future of research on indigenous youth suicide prevention as the outcomes and efficacy will be more reliable.

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.

Head and neck cancer (HNC) consists of a group of malignancies affecting closely related anatomical regions of the upper aerodigestive tract (UADT), including the oral cavity, salivary glands, upper and lower jaw bones and facial skin; the nasal cavity, paranasal sinuses, pharynx, larynx and thyroid gland (although the latter is often excluded and considered as part of endocrine neoplasms). Of these, 90% of HNCs are histologically squamous cell carcinomas originating from the mucosal lining. These malignancies are strongly associated with certain environmental and life-style risk factors, principally tobacco in both smoked and smokeless forms, excessive alcohol consumption, diets poor in antioxidants and essential micronutrients, UV light, chemicals used in certain workplaces, and viruses, principally certain strains of human papillomavirus (HPV) and Epstein-Barr virus (EBV). These cancers are frequently aggressive in their biological behaviour with local invasion and metastasis to lymph nodes in the neck. Since most patients are already at late stages of disease at the time of diagnosis, the desirable practice of early diagnosis (first sign of the malignant lesion at an initial stage) and early treatment, a critical priority to save lives and retain quality of life, is difficult to implement. Thus, primary prevention has been set as a key goal. This article aims to reinforce the basic knowledge of aetiology, key risk factors related to the development of head and neck cancer, basic features of clinical appearance of this group of cancers, and strategies for prevention and early detection.We also suggest basic research strategies on the basis of current knowledge, which should ultimately lead to the improvement of clinical management.

Introduction and Aims: Anecdotal reports suggest that high rates of cannabis use and dependence are significant issues in Indigenous communities in north Queensland; however, there is little scientific evidence to support or refute this. The Cape York Cannabis Project seeks to investigate cannabis use rates, cannabis dependence and mental health impacts for the first time in three Cape York Indigenous communities., Design and Methods: The current study reports preliminary findings, resulting from interviews with 133 Indigenous participants aged 14-47 years from one Cape York community. Quantitative data were gathered on rates of cannabis use, cannabis dependence as measured by a score of ≥ 3 the Severity of Dependence Scale. Qualitative self-report data were gathered concerning mental health impacts of cannabis and reasons for quitting., Results and Conclusions: Very high rates of cannabis use were identified, with 66.2% of males and 30.5% of females interviewed being current users. An additional 12.2% of males and 30.5% of females were former users, and 21.6% of males and 39% of females had never used cannabis. High rates of cannabis dependence were also observed. Of those current users who used cannabis at least weekly, 67.7% reported cannabis dependence. A range of mental health impacts due to cannabis were reported. In total, 76.1% of current users were considering quitting or cutting down. Rates of use and dependence were much higher than national rates, and indicate significant mental health harms due to cannabis. Further investigation of mental health impacts of cannabis is required, as is intervention to reduce these impacts., (© 2011 Australasian Professional Society on Alcohol and other Drugs.)

Closed circuit television (CCTV) systems which incorporate real-time communication links between camera room operators and on-the-ground security may limit injuries resulting from alcohol-related assault. This pilot study examined CCTV footage and operator records of security responses for two periods totalling 22 days in 2010-2011 when 30 alcohol-related assaults were recorded. Semistructured discussions were conducted with camera room operators during 18 h of observation. Camera operators were proactive, efficiently directing street security to assault incidents. The system intervened in 40% (n=12) of alcohol-related assaults, limiting possible injury. This included three incidents judged as potentially preventable. A further five (17%) assault incidents were also judged as potentially preventable, while 43% (n=13) happened too quickly for intervention. Case studies describe security intervention in each category. Further research is recommended, particularly to evaluate the effects on preventing injuries through targeted awareness training to improve responsiveness and enhance the preventative capacity of similar CCTV systems.

Objectives: To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities., Methods: Participatory Action Research (PAR) approach that enabled communities and researchers to work together to develop understanding and take action to reduce risk., Results: The H1N109 pandemic raised deep concerns and serious issues in all of the Aboriginal and Torres Strait Islander communities involved in this project. The participants expressed distrust and scepticism in relation to current Australian health policies on containment and told the researchers that specific plans for Aboriginal and Torres Strait Islander peoples were needed. Respondents indicated that policies and plans had been developed without respectful engagement with communities. The strong and recurring themes that emerged from the PAR cycles were: the importance of family; ways of life and realities of living in response to influenza; and key messages to government and health services to focus on communication, understanding and respect., Conclusion: The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

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., (© 2010 Australasian Professional Society on Alcohol and other Drugs.)

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., (© 2011 The Authors. ANZJPH © 2010 Public Health Association of Australia.)

Objective: To describe and discuss challenges and opportunities encountered when estimating tobacco consumption in six remote Aboriginal communities using tobacco sales data from retail outlets., Approach: We consider tobacco sales data collected from retail outlets selling tobacco to six Aboriginal communities in two similar but separate studies. Despite challenges--including: not all outlets provided data; data not uniform across outlets (sales and invoice data); change in format of data; personnel change or management restructures; and anomalies in data and changes in community populations--tobacco consumption was estimated and returned through project newsletters and community feedback sessions. Amounts of tobacco sold were returned using graphs in newsletters and pictures of items common to the community in community feedback sessions., Conclusions: Despite inherent limitations of estimating tobacco consumption using tobacco sales data, returning the amount of tobacco sold to communities provided an opportunity to discuss tobacco consumption and provide a focal point for individual and community action. Using this method, however, may require large and sustained changes be observed over time to evaluate whether initiatives to reduce tobacco consumption have been effective., Implications: Estimating tobacco consumption in remote Aboriginal communities using tobacco sales data from retail outlets requires careful consideration of many logistical, social, cultural and geographic challenges.

Introduction and Aims: This study examined prevalence and predictors of alcohol consumption and alcohol problems in a sample of medical students in Vietnam., Design and Methods: A cross-sectional survey using a multi-stage cluster sampling approach was conducted in 2007 in two universities in Vietnam. The students (n = 619, 100% response rate) completed questionnaires based on the Alcohol Use Disorder Identification Test. A score of >or=8 defined presence of alcohol problems. Data analyses adjusted for the cluster sampling approach., Results: Overall 65.5% of students had drunk alcohol during the previous year while alcohol problems were detected in 12.5%. Male students, students who reported that their family members drank and students who reported that their flat mates were drinking were more likely to be current drinkers. Male students were 14.3 times more likely to have an Alcohol Use Disorder Identification Test score of >or=8 compared with female students (P = 0.005)., Discussion and Conclusions: Intervention programs focusing on male students and their social environment are warranted. As Vietnamese society rapidly modernises prevention programs for female students may also be needed.

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.

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, kappa-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%, kappa = 0.55, p < 0.001). When five clusters were combined into three, 'anxiety-dependency', 'mood-vegetative' and 'psychosis', agreement rose to 71% (kappa = 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.

Aims: To assess whether cannabis use, recently taken up by many indigenous Australians in remote communities, has reinforced tobacco use., Design: Cross-sectional study., Setting: Three eastern Arnhem Land communities (Northern Territory, NT); total population = 3384, in 2001., Participants: From 1247 people aged 17-36 years, 190 (120 males, 70 females) were opportunistically recruited., Measurements: Self-reported life-time and current tobacco, cannabis and other substance use were confirmed by local health workers and using clinic records. Participants reported level of substance use, frequency and duration (years used). Associations with tobacco use were calculated (odds ratios: OR) using logistic regression with age, sex, alcohol use and a history of petrol sniffing as confounders., Findings: In univariate analyses current tobacco users were more likely than non-users to be using cannabis (OR = 3.1, 1.5-6.2, P = 0.002) and this association remained in multivariate analyses (OR = 3.0, 1.4-6.8, P = 0.006). Tobacco use was associated with the number of years of cannabis use (P = 0.035). The likelihood that tobacco users were also cannabis users increased as quantity of cannabis used increased (P = 0.008). Current tobacco use was no more likely in those who initiated cannabis from 1998 onwards than in those who initiated cannabis before 1998 (OR = 1.1, 0.4-3.2, P = 0.881). One-third of life-time users of both tobacco and cannabis initiated their use at or near the same time, and very few of these (12%) had discontinued either cannabis or tobacco., Conclusions: Cannabis appears to have influenced the continued use of tobacco in these populations with possible additional burdens for cardiovascular and respiratory diseases and challenges for interventions.

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 kava. No evidence for irreversible liver damage has been found.

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.