Search

Background: Although previous quantitative studies have documented the association between exposure to alcohol portrayals and drinking attitudes in Western countries, few qualitative studies have explored this matter in Thailand. A better understanding of the association in young Thais is required for a more efficient alcohol policy development. This study aims to explore the information young Thais have learnt from exposure to alcohol portrayals in society and the media, examine how this exposure shapes their drinking attitudes, and investigate the alignment of policy-makers' views on drinking with those of young people. Methods: Two qualitative research methods were employed. Seventy-two university students (38 men, 34 women) aged 20-24 participated in focus groups conducted on campus. Semi-structured interviews were conducted with academia, civil society and representatives from government who were involved in alcohol policy. Recorded data were transcribed verbatim, systematically coded and analysed using content analysis. Results: Young Thais were regularly exposed to alcohol portrayals, particularly on social media and in their social environment. Being increasingly exposed to alcohol portrayals, particularly on social media, and the role of the alcohol industry emerged as concerning matters to the academia and civil society sectors. In response to the concerns, the government social media monitoring and alcohol censorship had become more challenging. Conclusions: This study reflects the growing concerns from academia and civil society sectors of the impacts of increased alcohol exposure and the role that the industry may have on young people's drinking attitudes. It highlights the need for response to significant policy challenges to reduce these impacts.

Introduction and Aims: The dominant Thai alcohol companies have strategically employed brand advertising and brand sharing (using a very similar branding for both alcoholic and non-alcoholic products) to circumvent restrictive alcohol advertising regulations. As empirical evidence confirms that exposure to alcohol advertisements increases youth drinking, young Thais could be at risk of constant and incidental exposure to alcohol advertising, hence leading to increased alcohol consumption. This study aims to explore young people's perceptions of these alcohol branding strategies and to examine how exposure to such advertising strategies affect their attitudes towards alcohol use. Design and Methods: Seventy-two university students aged 20-24 years participated in 1.5-h semi-structured focus groups conducted in Bangkok and a peripheral province. Logos of two domestic alcohol brands were also used as part of projective techniques to elicit information. Thematic content analysis was used to analyse data. Results: Despite a range of alcoholic and non-alcoholic products under the same branding, participants associated the logos primarily with beer-the flagship product. Branding strategies seemed to successfully increase young people's brand familiarity and affected their brand recognition and brand awareness. Participants had a high awareness of the alcohol companies' commercial activities but regarded alcohol advertisements to be indifferent to advertisements of other ordinary products. Discussion and Conclusions: Brand advertising is a dynamic tool that affects young people's attitudes towards the advertised brands and alcohol use. Due to early exposure to the brands, brand sharing increases brand familiarity and, among other factors, potentially affects drinking attitudes and purchase intentions.

Introduction and Aims: The recognition of the association between the use of alcohol and negative health outcomes have led to the endorsement of the World Health Organization's global strategy to reduce the harmful use of alcohol. Given the capacities, capabilities and sociocultural contexts of Thailand, this study aims to examine the Thai alcohol policy against the global strategy's recommended policy measures for marketing control and identify areas for further policy development. Design and Methods: Semi-structured interviews were conducted with the stakeholders from three sectors: the government, academia and civil society. Their perceptions of the Thai alcohol policy in regulating alcohol industry's commercial strategies and activities were discussed. Audio data were transcribed verbatim, systematically coded and thematically analysed. Results: Although the Thai Alcohol Control Act meticulously regulates the content of direct alcohol marketing, the volume of marketing and indirect alcohol marketing have become problematic and difficult for the government to address. The industry has worked to normalise the consumption of alcohol through repetitive brand exposure and their suggestion that drinking was integral for socialisation. The control of alcohol sponsorship was politically sensitive and legally ambiguous because alcohol sponsorship seemed to provide economic and social benefits and further reinforced the industry's positive image. Discussion and Conclusions: Despite the strict alcohol policy, gaps in the marketing regulations exist. Future policy development should place greater emphasis on alcohol sponsorship and branding through evidenced-based interventions. The interactions between the government and the industry should be monitored and restricted. Rigorous regulations, as seen for tobacco, are encouraged for alcohol marketing.

This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.

Background: Despite abundant alcohol control regulations and measures in Thailand, prevalence of alcohol consumption has been relatively steady for the past decade and alcohol-related harm remains high. This study aims to explore, through the perspectives of key public health stakeholders, the current performance of regulations controlling alcohol availability and access, and the future directions for the implementation of Thai alcohol policy. Methods: Semi-structured interviews were conducted with public health stakeholders from three sectors; the government, academia and civil society. Their perceptions about the current alcohol situation, gaps in the current policies, and future directions of alcohol policy were discussed. Audio data were transcribed verbatim, systematically coded and analysed. Results: The three key concerning issues were physical availability, economic availability and commercial access, which referred to outlet density, taxation and pricing, and compliance to stipulated regulations, respectively. First, Thailand failed to control the number of alcohol outlets. The availability problem was exacerbated by the increased numbers of liquor licences issued, without delineating the need for the outlets. Second, alcohol tax rates, albeit occasionally adjusted, are disproportionate to the economic dynamic, and there is yet a minimum pricing. Finally, compliance to age and time restrictions was challenging. Conclusions: The lack of robustness of enforcement and disintegration of government agencies in regulating availability and access hampers effectiveness of alcohol policy. Comprehensive regulations for the control of availability of and access to alcohol are required to strengthen alcohol policy. Consistent monitoring and surveillance of the compliances are recommended to prevent significant effects of the regulations diminish over time.

This article describes qualitative research undertaken to explore young people's understanding of sex and relationships that used a scenario-driven body-mapping technique. This art-based method was designed to allow young people to think deeply about the subject and build upon each other's ideas through the medium of decorating a life-sized human body. Although this method produced rich information the depictions of young people tended to be highly stigmatized. We further refined the method to encourage young people to empathize with the character that they created and the resultant research became the basis for the sexual health resource 'Life Happens'.

The small, decentralised communities, known as outstations which satellite larger Indigenous Australian remote communities have often been conceptualised as places that are beneficial to health and well-being. This paper provides an exploration of the meaning of their outstation for one family and the benefits that this connection brings to them, which are expressed in a deep connection to the land, continuing relationships with ancestors and a safe refuge from the stresses of the larger community. We argue that the outstation provides a place for people to be in control of their lives and form hopes and plans for the future. These benefits are position in a context where the future liveability and sustainability of the outstation is both fragile and vulnerable.

Drawn from a sample of 88 Indigenous young people in five locations in urban and remote Northern Australia, this research utilised a combination of qualitative approaches to encourage young people to discuss their ideas about sexual relationships and violence. Indigenous youth discussed highly public displays of violence, as well as violence within intimate settings and the interrelationships between these two arenas. A key finding of this research was that young people described violence as an accepted part of their sexual relationships and this normalisation led to significant tensions in their experiences and management of their everyday relationships. While violence around young people's relationships in remote communities was reported to some extent as being controlled through both the public and controlled form they take, we found that the increasing mobility of young people from remote to urban locations due to education opportunities and the impact of social media can lead to more serious forms of violence and tension in the maintenance of young people's sexual relationships. This contributes new findings to the literature on Indigenous young people's experiences in relationship forming and management, an area that has received little attention in the academic literature.

This paper examines the contribution that a community newspaper made to a remote aboriginal community in northern Australia. Instigated by the researchers as a way to engage young people in the project, the community newspaper became an important focus of activity and learning, providing young people with skills and education around the collection, management, and dissemination of news and supporting youth to gain empowerment in the community. At the time, the researchers did not acknowledge this impact. This article discusses the development of the community newspaper, and the authors (two academics and one community member) reflect on the importance of supporting community development activities in the research process.

This paper examines young people's perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young people's everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety.

BackgroundThe burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities. MethodsQualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author. ResultsThe findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment. ConclusionThis different construction of physical activity in remote Indigenous communities highlights th

Purpose - The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context of treatment in this modified TC context. The aim of the research is to present an analysis of the key features of treatment associated with four Indigenous Australian alcohol and drug treatment centres, as expressed by staff working in these centres. Design/methodology/approach - Ethnographic observations were made at each site between 2008 and 2009 with the first author attending treatment groups, education sessions, staff meetings and other events. The first author conducted informal conversational discussions with all programme staff and board members. In addition, 23 staff and 15 board members participated in a semi-structured interview with an emphasis on gaining views on the essential elements of residential alcohol and drug treatment, potential barriers to effective treatment delivery and "what works" in residential treatment. Findings - A number of key themes emerged, including the importance of the flexibility of programmes to include a wide variety of treatment approaches, the importance of culture (although defined differently) in the delivery of appropriate service, provision of safe spaces that allow for clients and staff interaction, the potential for improvement in the provision of effective client case management, the need to reduce job-related stress through staff professional development and organisational culture change and the need to address the difficulties experienced in the provision of effective aftercare. Originality/value - Currently, there is very little evidence related to Indigenous Australian approaches to the treatment of alcohol and drug misuse. The paper contributes to the understanding of the key features of treatment delivery, as identified by staff employed in drug and alcohol residential treatment. This understanding is vital so that government agenci

Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision-making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub-questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness.

This article describes the application and adaptation of body mapping as a tool for exploring sexual health and sexual decision making among young people aged 16-25. It argues that while body mapping engaged youth to discuss general health issues, young people were reluctant to engage with issues related to sexual health, due to feelings of shame and fear of stigma. Sexual health case scenarios were developed and used in conjunction with body-mapping exercises. The use of scenarios was an effective way to explore sensitive information, while protecting young people from revealing any specific identifiable information about themselves. In this article, we suggest that utilizing a combination of methodological approaches (the visual body maps and written case scenarios) in sexual health research with young people has the potential to enhance and enrich the quality of the data, and allow for a safe and enabling environment. This is particularly important where long-term fieldwork might be difficult or constrained.

The Indigenous community of Wadeye in the Northern Territory, Australia has been described as a community 'under siege from continual gang violence' (Rioting flares again at Wadeye. The Australian 7 August; Gang violence plagues Wadeye. ABC News 1 December; Wadeye worst in 50 years. NT News 2 November). The gangs appear to have emerged in the early 1980s and are generally defined through youth aligning themselves along cultural, clan and family affiliations into groups with contemporary Americanised gang characteristics, symbolic links with heavy metal music and clearly defined turf boundaries. Although they do engage in some relatively minor drug (predominately cannabis) distribution for profit, the rationale for these groups appears to be either as a provocative and offensive structure, or at other times as a defence mechanism. Despite the portrayal of gangs as the focus of criminal activity in the community, there has been little research to explore the relationship between the gangs and the criminal profile of the community. Nor has there been research that examines gang activity from the perspective of the members or within a broader community context. Without this level of understanding, it is very difficult to design interventions that meet the needs of youth in the community. This paper presents data from a survey of young people who were involved in gangs in Wadeye and interviews with gang members who were incarcerated in Darwin Correctional Centre.

This report explores the experiences and aspirations of youth in Wadeye, a remote Aboriginal community in the Northern Territory which has become synonymous with the deviant behaviours of its young people. The research was undertaken over a three year period, and builds upon a previous ten year period of community based research. As such it forms a unique longitudinal study of young people during a period of extreme change in their lives. The research applied a mixed methods approach, utilising ethnography, interviews and the application of a community wide survey. Although young community based people were the primary focus of the study, the research also included the wider community perspectives, service provide rs and a sample of imprisoned community members. The proliferation of gangs in the Wadeye community has become a primary focus for outsiders' interpretation of social issues in the community. These gangs have been defined by their violent and oppositional cultures. This period of research and the research which preceded it, emphasise the complexity of gang cultures and gang dynamics in this community. The report also emphasises that a primary focus on gangs serves to obscure other factors influencing young people's lives and behaviours. This includes those youth who do not engage in deviant behaviour, who attend school and progress to employment. It also includes youth who engage in non-gang related violent and anti-social behaviour. The report argues that effective service delivery and the development of appropriate diversion activities for young people must recognise the diversity and complexity of the youth experience in the community and recognise and develop their current strengths. Feedback from elders, young people and long-term community workers, advocates that more partnership approaches to further research and program evaluation must become an integral part of the process. Involving young people themselves as part of this research process will pr

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life-Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service.

This paper explores the aspirations of a group of young women in a remote Aboriginal community in the Northern Territory of Australia. It examines how their hopes and expectations are influenced by the reality of their everyday lives and the extent to which they are able to influence the course of their lives and become agents for change in their own communities. As with adolescents in lower socio-economic groups, the majority of young women in River Town have not developed life goals or clear strategies of how to achieve these goals. The choices that young women have are constrained by their narrow range of experience, which is characterized by early pregnancies and the potential threat of male violence. However, young women have articulated specific domains where they are able to control and structure their lives. This paper discusses the experiences of young women in this remote Aboriginal community.

Background: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in betteridentification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community.Methods: Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants’ CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events.Results: Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events.Conclusions: Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, a

This report explores school-­‐parent engagement in three town-­‐based schools in the Northern Territory of Australia. Undertaken over a three year period between 2008 and 2010, the research team worked in partnership with The Smith Family and participating schools— Karama Primary School in Darwin; Moulden Park Primary School in Palmerston; and MacFarlane Primary School in Katherine-to explore what parents have to say about the schools that their Indigenous children attend and about education more broadly. The research applied an exploratory case study approach using a mix of ethnographic and interview techniques. We observed children, parents and school environments; interviewed parents, teachers, policy personnel and school based staff; and conducted focus group sessions with key stakeholders. In-depth interviews were conducted with 48 parents and/or carers, 9 policy officers and 26 educators. The questions we asked all participants in this study probed three key questions: What does engagement mean? Why is it important? How is it achieved? Our research revealed a dissonance between what parents expect their level of engagement with school should be and what the policy community assumes about the importance of engagement. Suffice to say, parents’ visible engagement with schools and the importance they place on education are different matters. The parents who were most visible were not necessarily engaging for reasons of academic advancement or schooling success but over concerns about bullying or truancy or social trauma. And the parents who were least visible were not necessarily marginalised from the school but believed that the school was addressing the education of their children, and that the leadership of educators could be depended upon to get the job done, rendering forthright ‘engagement’ unnecessary. In short, non-visibility is an exaggerated problem. Non-visibility does not equate with lack of interest or lack of participation in schooling. The key messa

The human ethics issues surrounding the conduct of health science research have been the subject of increasing debate among biomedical and social science researchers in recent years. Ethics procedures in health-science research are typically concerned with protecting anonymity and confidentiality, and are tailored to work that primarily uses quantitative methodologies. For qualitative research in the health social sciences, a different set of ethical issues often arises in the research process. This article examines three case studies of qualitative researchers working with Indigenous Australian communities, focusing on the researchers' experiences with ethics committees and how they approached a range of ethical issues arising in the course of their research. Key issues include: obtaining informed consent for participant observation; the evolving nature of qualitative research; the difficulties in foreseeing changes in approach; and the distinction between the research team and the researched in participatory action research.

This paper reports the findings from a pilot study in which the Schedule for Individual Quality of Life (SEIQoL-DW) was used to determine how 15 at-risk Indigenous Australian male youths aged between 14 and 19 conceptualised their quality of life. The youths, who were referred with problems associated with drug and alcohol misuse and criminal activity, were attending a diversionary program run by an Indigenous organisation in the Northern Territory, Australia. Quality of life was measured before and at the end of the nine-day programme in order to evaluate outcomes. Program staff found the SEIQoL-DW to be particularly useful in identifying culturally specific quality of life domains, allowing interventions to focus on improving the life areas that were of particular value to individuals as well as recognizing any deficits in their understanding the options available to them. While a control group was not used, mean SEIQoL-DW scores increased significantly over the course of the program.