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Introduction The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). Recommendations •Guideline 1: To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. •Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. •Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. Changes as result of the guideline The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously "per drinking occasion"). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

Introduction and Aims Liquor permits were once used throughout Scandinavia and North America for managing alcohol, but largely disappeared in the late 20th century. Today, they are used in some Indigenous communities in Nunavut, Canada and the Northern Territory, Australia. This paper examines the extent to which liquor permits: (i) contribute to reducing alcohol‐related harms in Indigenous communities; and (ii) offer a viable mechanism for managing alcohol in Indigenous communities. Design and Methods The study draws on published and unpublished international literature on liquor permit systems in Indigenous communities, and on field visits to northern territory (NT) communities. Results Apart from one anecdotal report, the study found no evidence that liquor permit systems in Nunavut communities have reduced alcohol‐related problems. In the NT, they have reduced alcohol‐related harms in some communities. However, management of liquor permit systems generates significant administrative demands in communities. Discussion and Conclusions Effectiveness of liquor permit systems is a product of five factors: permits themselves; agencies and procedures for issuing and managing permits; agencies and procedures for supplying liquor; enforcement of permit conditions, and the presence of other agencies—legal and illegal—affecting supply and consumption of liquor. Liquor permits continue to be valued by some Indigenous communities for managing alcohol. This study suggests that they can do so provided: (i) agencies administering permits have adequate support; (ii) controls over non‐legal purchasing and consumption of liquor are effective, and (iii) the permit system is viewed in the community as legitimate, equitable and transparent.

In recent decades a style of preparing and drinking tea modelled largely on gongfu tea associated with the Chaoshan region of north-eastern Guangdong Province, China, has been taken up as a contemp...

This paper examines attempts by members of a remote Aboriginal community in the Northern Territory (NT), Australia, to control alcohol use, and the impact of policy decisions taken by national, territory and local governments on those attempts between 2007 and 2017. The Australian Government's main policy instrument for reducing alcohol-related harms from 2010 was the Alcohol Management Plan (AMP), officially defined as a plan, negotiated at a local community level with a high level of community input, for the effective management of alcohol use by the local community. The paper shows that the policy as implemented had the unintended consequence of undermining rather than enhancing the capacity of the community to act collectively in managing alcohol, largely as a result of the interactions of four sets of factors: (1) the policies as formulated; (2) actions taken to implement the policies, (3) the responses of those affected by the policies, and (4) the socio-ecological context in which these events occurred. The paper seeks to identify the processes through which these consequences were generated, and the implications for future policy-making, policy implementation and community-level initiatives for managing alcohol in Aboriginal communities.

To examine the temporal association between the experience of different types of intimate partner violence (IPV) in early adulthood (21 years) and substance use disorders in young adulthood (30 years).Prospective birth cohort study using data from the Mater-University of Queensland Study of Pregnancy (MUSP).Brisbane, Australia.A total of 1353 people (822 females and 531 males).IPV was measured using the Composite Abuse Scale (CAS) and alcohol, substance and nicotine use disorders were assessed using the Composite International Diagnostic Interview (CIDI).In females, the experience of different forms of IPV at 21 years remained a robust risk factor for subsequent alcohol use disorder [adjusted odds ratios (aORs) ranged from 1.6 to 2.6 (all P 0.05)], substance use disorder [aORs ranged from 2.1 to 4.0 (all P 0.001)] and nicotine use disorder [aORs ranged from 2.0 to 2.4 (all P 0.05)] at 30 years, even after controlling for antecedent substance disorders. However, in males only physical and emotional abuse (but not harassment) were significant in predicting alcohol use disorder [aORs ranged from 1.4 to 1.8 (all P 0.05)] and drug use disorder [aORs ranged from 1.6 to 2.0 (all P 0.05)] in the fully adjusted model.Intimate partner violence (IPV) in early adulthood is robustly associated with alcohol, substance and nicotine use disorders in women, whereas in men the association is clear for only some forms of IPV and types of disorder.

The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. We found a temporal relationship between almost all forms of IPV at 21 years and females’ new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males’ subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Background This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization. Methods Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale. Results We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents. Conclusion Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

There is some limited evidence of an association between maternal intimate partner victimization (IPV) and children's experience of maltreatment. Using data from a longitudinal study, we examine whether this relationship is independent of range of potential confounders including socio-economic, familial and psychological factors. Data were taken from the 14 and 30-year follow-ups of the Mater-University of Queensland Study of Pregnancy (MUSP) in Australia. A subsample of 2064 mothers and children (59.0% female) whose data on maternal IPV and child maltreatment was available, were analysed. In families with maternal IPV, two in five children reported being maltreated, compared to one in five children maltreated in families without maternal IPV. Except for sexual maltreatment which was consistently higher in female offspring, there was no gender differences in experiencing different types of maltreatment in families manifesting maternal IPV. Although both males and females were at increased risk of child maltreatment in families where mothers were victimized by their male partners, male children were more likely to be emotionally maltreated. The main associations were substantially independent of measured confounders, except for father's history of mental health problems which attenuated the association of maternal IPV victimization and male offspring's physical abuse. Our findings confirm that there is a robust association between maternal IPV and child maltreatment. Both maternal IPV victimization and child maltreatment co-occur in a household characterized by conflict and violence. Consequences of IPV go beyond the incident and influence all family members. Efforts to reduce child maltreatment may need to address the greater level of IPV associated with the cycle of family violence.

Although much available research indicates that intimate partner violence (IPV) is male perpetrated, growing recent evidence suggests a gender symmetry model of family violence. This article examines gender differences in IPV in current and prior relationships reported by young adults. Data comprised 2,060 young adults (62.1% females) who participated in the 30-year follow-up of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Brisbane, Australia. The Composite Abuse Scale was used to measure IPV during the last 12 months in the respondents’ most recent relationship. Similar proportions of males and females reported leaving their prior relationships. Both males and females who were not currently in a relationship reported experiencing much higher rates of IPV than those who were in a relationship. There were no differences in the past experience of IPV between males and females who were not currently in a relationship, but males in a current relationship reported they experienced most forms of IPV more often than did females. IPV typically involves both male and female perpetrators and victims. It does appear that the majority of relationships involving higher rates of IPV were dissolved. IPV was more likely to have occurred in relationships that ended than in relationships that persisted. Males more often remain in an abusive relationship and report experiencing higher rates of IPV in their current relationships compared with females.

Alcohol policies and control measures are attempts to change what is deemed (by processes that are themselves open to analysis) to be problematic drinking behavior. Attempts to bring about behavioral or cultural shifts, however, typically generate resistance, which may take place as small local actions by individuals in their everyday lives, or evolve into broader social phenomena. This article argues that, while some alcohol researchers have recognized the presence of resistance to control measures, the nature and determinants of resistance remain poorly understood. The article draws on sociological approaches to resistance in order to redress this. Theoretically, I draw in particular on de Certeau’s conceptualization of resistance as a tactical practice of everyday life. Empirically, I illustrate some key aspects of resistance by referring to manifestations of power and resistance relating to drinking by indigenous people in Fourth World settings such as Australia, New Zealand, Canada, and the United States. The article concludes by arguing that a sociologically informed understanding of resistance is necessary to an adequate understanding of the role and place of alcohol control policies.

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

OBJECTIVES: To evaluate a 12-month trial of an evidence-based non-residential treatment program for Indigenous clients with alcohol problems, offering three streams of care: pharmacotherapy, psychological and social support. METHODS: Process evaluation of program implementation; outcome evaluation of client outcomes. RESULTS: Implementation: despite constraints of time and remoteness, the trial demonstrated the feasibility of implementing such a program. The medical stream generated fewer pharmacotherapy prescriptions than expected. The most active stream was the psychological therapy stream. Outcomes: between March 2008 and April 2009, 129 clients were referred to the program, of whom 49 consented to have de-identified data used for the evaluation. Of these, 19 clients received one or more streams of care, 15 of whom (78.9%) subsequently stopped or reduced drinking. However, among the remaining 30 consenting clients who had not received an intervention, 70.0% also reported stopping or reducing drinking. The evidence of program effectiveness is therefore equivocal and evaluation over a longer period is required. Conclusion and implications: The trial demonstrated the viability of, and demand for, evidence-based non-residential treatment for Indigenous clients with alcohol problems. Reasons behind an apparent reluctance among GPs to prescribe pharmacotherapy for Indigenous clients, and steps to overcome this, need further attention. Language: en

This article traces the evolution of alcohol policy in the Northern Territory, Australia, over the past half century, from the removal of prohibition on the possession and consumption of alcohol by Aboriginal people, to the emergence of spatially-defined restrictions which, while not overtly referring to Aborigines, are designed primarily to contain consumption in public by Aboriginal drinkers. Aboriginal alcohol-related problems, which are serious and broad-ranging, continue to be defined for policy purposes primarily by non-Aboriginal people in terms of public drunkenness and perceived threats to urban amenity. Meanwhile, a non-Aboriginal, heavy-drinking culture is positively sanctioned discursively through the social construction of “the Territorian.” The article argues that discourse and policies combine to perpetuate Aboriginal marginality with respect to urban spaces, and to deny a voice to Aboriginal people and organizations in defining alcohol-related problems and identifying solutions.

In 2007, a report into the sexual abuse of children in Aboriginal communities in the Northern Territory, Australia, led to allegations that “rivers of grog [alcohol]” were destroying these communities. It also precipitated a dramatic shift in Aboriginal policy by the Australian government, in which principles of self-determination were discarded in favor of top-down measures designed to restrict Aboriginal access to alcohol. While not disputing the gravity of current levels of alcohol-related harm in some Indigenous settings, this article challenges the assumption that “rivers of grog” have swept away all capacities for local control, and argues that a more theoretically and empirically informed analysis of the nature, determinants, and outcomes of social control provides a basis for a more viable policy than the current so-called emergency response. The article traces the evolution of policies affecting Indigenous alcohol use, and of concerns expressed by both Indigenous and non-Indigenous commentators about problems in controlling drinking at a local level. It then examines sociological perspectives on social control. The article concludes by reviewing initiatives by Aboriginal organizations aimed at developing more effective local controls over alcohol.

Objective: To test an evaluation framework designed to evaluate implementation of the North Queensland Indigenous communities between August and December 2005. Setting: Both communities are located in Cape York, North Queensland. Community A has an estimated population of around 600 people; Community B has an enumerated population of 750, although health centre records indicate a higher number. Participants: Process evaluation involved health centre staff in both communities; clinical audits used random samples from the adult population (each sample n = 30); ethnographic fieldwork was conducted with resident population. Main outcome measures: Health centre scores and qualitative findings using a System Assessment Tool; clinical audits – extent to which scheduled services recorded; selected primary health performance indicators; qualitative ethnographic findings. Results: On almost all indicators, implementation of NQICDS had progressed further in Community A than in Community B; however, some common issues emerged, especially lack of linkages between health centres and other groups, and lack of support for client self-management. Conclusions: The evaluation framework is an effective and acceptable framework for monitoring implementation of the NQICDS at the primary health centre level.

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.

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities. Methods: The study consisted of a preand post-study of the effect of a multicomponent tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. Results: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t=-4.5, 95% Cl -33.6 –12.5, p 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. Conclusions: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.

Recent growing concern in Australia and elsewhere about harm associated with volatile substance misuse (VSM) in both urban and remote settings has prompted an openness to new policies, laws and programs for prevention and treatment. One measure under consideration is product modification of volatile substances (VSPM). This article reviews international literature documenting instances of three kinds of product modification: (1) replacement of particularly harmful or psychoactive components; (2) addition of deterrent chemicals; and (3) package modification. Although VSPM has received considerable attention, few initiatives have been implemented and, of these, even fewer evaluated. Where VSPM has occurred, success in reducing misuse of specific products appears to have occurred in relation to type (1) modifications, many of which have been driven by environmental rather than health concerns. The ready availability of a wide range of VSM products in most urban settings means that even where interventions red...

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.

Objective: To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia. Design: Follow-up study over 3 years. Setting: Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory. Participants: 137 Aboriginal people with type 2 diabetes. Intervention: Implementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback. Main outcome measures: Trends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA1c) were achieved; health staff perceptions of barriers to effective service delivery. Results: An initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA1c level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients’ acceptance of services. Conclusions: Multifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers

We evaluate a method to describe changing substance use patterns in northern Australia's remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 101 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-κ statistic) among health workers for a history of substance use and current use, varied from κ = 0.207 for petrol sniffing (P = 0.006) up to κ = 0.749 for cannabis use (P

The Northern Territory Living With Alcohol Programme (LWAP), implemented in Australia from 1991 to 2000, has been hailed as a successful example of a comprehensive public health alcohol policy, especially in its first 4 years--1991/92 to 1995/96. This paper draws upon a policy analysis of the LWAP currently in progress to identify and describe the factors that made implementation possible at this time. I argue that programme implementation was shaped by a remarkable alignment of agencies and actors in the political, fiscal, administrative and industrial domains. This alignment of forces, however, owed as much to contingency as to planning and did not endure. Although the policy itself remained unchanged and continued to generate significant achievements, the alignment of forces sustaining it began to fragment from late 1995 onwards. The paper concludes by exploring the implications of the analysis for alcohol policy in other domains, and for the relationship between evidence regarding effectiveness and other components of the policy process.

Issue addressed: Although it is well known that there is a very high prevalence of Type 2 diabetes in the Torres Strait Islands and Northern Peninsula Area (NPA), little has been published on the personal perspectives and situations that the people with diabetes face in daily life, which includes managing their disease. This study provides a baseline of qualitative information so that supportive action from health services and communities can be better tailored to help people meet their needs for self-management. Methods: In-depth interviews and focus groups were conducted involving a total of 26 men and 41 women living with diabetes in eight communities of the Torres Strait and Northern Peninsula Area. The data are presented as case studies and thematic analysis illustrating a range of perspectives and experiences in coming to terms with the disease and in efforts to make lifestyle change, specifically related to eating well and moving more. Results: Broad recommendations are provided on ways to better support people with diabetes that are based on both the data collected and the experience of the Indigenous researchers as health workers and community members.

Objective: to assess use of free nicotine patches by Indigenous people when offered a brief intervention for smoking cessation, and to assess changes in smoking behaviour at six months. Methods: we conducted a pre and post study in three Indigenous communities in the Northern Territory. Results: forty Indigenous smokers self-selected to receive free nicotine patches and a brief intervention for smoking cessation, and 71 chose the brief intervention only. Eighty-four per cent of participants were followed up; 14% of participants could not be located. Fifteen per cent of the nicotine patches group (10% with CO validation) and 1% (CO validated) of the brief intervention only group reported that they had quit at six months. Seventy-six per cent of the nicotine patches group and 51% of the brief intervention only group had reduced their consumption of tobacco. No participant completed a full course of patches. One possible side effect—the experience of bad dreams—was attributed in one community to the person concerned having been 'sung' or cursed. Conclusions: free nicotine patches might benefit a small number of Indigenous smokers. Cessation rates for the use of both nicotine patches and brief intervention alone were lower than those in other populations, possibly because the study was conducted in a primary care setting and because of barriers to cessation such as widespread use of tobacco in these communities and the perception of tobacco use as non-problematic.

In Australia, as in other countries, recent initiatives aimed at reducing alcohol-related harm have focused on the local community as the site of interventions, and in many cases have included local controls on alcohol availability as a key component. In this process, liquor licensing authorities – as the statutory agency primarily responsible for regulating alcohol availability – have been called upon to act as instruments of public health. Historically, however, their primary function has not been to promote public health, but rather to maintain orderly markets. Moreover, their power to intervene in market processes has in many instances been curtailed under deregulatory policies accompanying globalisation. Taken together, these trends generate a need for a theoretically-informed understanding of the role of liquor licensing bodies and other regulatory agencies in a context of locally-based initiatives aimed at reducing alcohol-related problems. This paper proposes a conceptual framework for meeting this need. Liquor regulatory systems are seen as agencies of social control mandated by the state. Three key components of these systems are identified: 1) laws and regulations governing the activities of liquor licensing authorities; 2) the structure and resourcing of agencies established to uphold the laws and regulations, and 3) practices through which decisions are reached by the licensing authorities. Each of these has influence independently of, but also in interaction with, each other. The initiation of local action focusing on alcohol problems generates a complex social field within which economic and political agencies, some operating at a purely local level, others at a national or even global level, compete to promote and defend their interests, and in which culturally ascribed beliefs and practices associated with drinking alcohol at the micro-social level are endorsed, challenged and/or defended. Within this field, liquor licensing authorities become agencies upon which competing claims are made. The processes involved can be analysed in terms of four phases: 1) agenda setting and problem definition; 2) specification of alternatives; 3) decision-making; 4) implementation. The components and processes outlined in the paper are illustrated with reference to instances of local action in northern Australia. The model proposed will serve, it is argued here, as a framework for more systematic comparative analysis of such local actions.

The growing importance of local communities as sites for preventive alcohol-related initiatives has generated interest in the role of research associated with community action. To date, however, this has not led to a theoretically informed account because of a failure to account reflexively for researchers' own practices and the use of conceptually inadequate models of “community.” This paper proposes an analytical framework, derived from the author's association with alcohol initiatives in several northern Australian towns and drawing on Bourdieu's concept of the social field. It is argued that the initiation of local action generates a complex social field in which stakeholders pursue their interests by mobilizing forms of capital: economic, social, political, and symbolic. Research, as well as the conveyance of valued information, is imbued with symbolic and political capital. The analysis concludes with four propositions relating to how, by whom, and with what consequences research is likely to be utilized in these settings.

Objective: To identify barriers faced by Aboriginal people from remote communities in the Northern Territory (NT) when accessing hospital-based specialist medical services, and to evaluate the impact of the Specialist Outreach Service (SOS) on these barriers. Design: Combined quantitative and qualitative study. Setting: Remote Aboriginal communities in the Top End of the NT, 1993-1999 (spanning the introduction of the SOS in 1997). Participants: 25 remote health practitioners, patients and SOS specialists. Main outcome measures: Numbers of consultations with specialists; average cost per consultation; perceived barriers to accessing hospital-based outpatient care; and perceived impact of specialist outreach on these barriers. Results: Perceived barriers included geographic remoteness, poor doctor-patient communication, poverty, cultural differences, and the structure of the health service. Between 1993 and 1999, there were 5184 SOS and non-SOS outreach consultations in surgical specialties. Intensive outreach practice (as in gynaecology and ophthalmology) increased total consultations by up to 441% and significantly reduced the number of transfers to hospital outpatient clinics (P< 0.001). Average cost per consultation was $277 for SOS consultations, compared with $450 at Royal Darwin Hospital and $357 at the closest regional hospital. Outreach has reduced barriers relating to distance, communication and cultural differences, and potentially bolsters existing primary healthcare services. Conclusions: When compared with hospital-based outpatient services alone, outreach is a more accessible, appropriate and efficient method of providing specialist medical services to remote Aboriginal communities in the NT.

The author examines the conceptual underpinning of the new public health approach. He examines existing attempts to explain Indigenous Australian alcohol use, most of which have been written by non- Indigenous observers, and Indigenous critiques of these explanations. He outlines a sociologically informed model of the use, effects and management of alcohol at a local level. This model is intended, not as an alternative to the public health framework, but as a basis for addressing theoretical lacunae in the latter lacunae that have implications for policy and program development. (author abstract)

OBJECTIVE: To review the effectiveness of community-based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and to assess their implications for other communities or towns contemplating similar measures. METHODS: Findings from evaluations of community initiatives in Tennant Creek (NT), Derby (WA), Halls Creek (WA), Elliott (NT) and Curtin Springs (NT) are compared with respect to impact on alcohol consumption, and on indicators of alcohol-related harm relating to public order, health and well-being, and economic activities. The extent of community support for these initiatives is also examined. RESULTS: Restrictions were found to have a modest but real impact on alcohol consumption, and a significant impact on indicators of alcohol-related harm, especially violence. Restrictions were also found to have widespread community support, often qualified by a belief that other measures were also required. CONCLUSIONS: Restrictions on availability are an effective means of reducing alcohol-related harm at a local level and, depending upon the processes involved in their introduction, are likely to have strong community support, provided that other measures are also pursued. IMPLICATIONS: Five issues are identified that are likely to arise in other settings where restrictions are contemplated. These are: the issue of representativeness ('who speaks for the community?'); selection of particular kinds of restrictions on availability; selection of most appropriate additional measures; universal vs. selective restrictions; and the role of liquor licensing authorities in imposing or facilitating restrictions. Language: en

When originally published this was the first book to offer a collective history of all the arts – Art, Drama, Dance, Music, Literature and Film – in the curriculum. It also offers a coherent framework for the teaching of arts which is in line with the best current trends since the Gulbenkian Report of 1982. It insists that the arts, seen together should be an essential part of the national curriculum.