Acceptability and feasibility of a computer-based application to help Aboriginal and Torres Strait Islander Australians describe their alcohol consumption

We examined acceptability and feasibility of a tablet application (“App”) to record self-reported alcohol consumption among Aboriginal and Torres Strait Islander Australians. Four communities (1 urban; 3 regional/remote) tested the App, with 246 adult participants (132 males, 114 females). The App collected (a) completion time; (b) participant feedback; (c) staff observations. Three research assistants were interviewed. Only six (1.4%) participants reported that the App was “hard” to use. Participants appeared to be engaged and to require minimal assistance; nearly half verbally reflected on their drinking or drinking of others. The App has potential for surveys, screening, or health promotion

Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians : Modified AUDIT-C and a new approach

Background Alcohol consumption among Indigenous Australians can involve a stop-start pattern of drinking, with consumption well above recommended guidelines on each occasion. Such intermittent drinking patterns can make screening for risky drinking difficult. This study evaluates the ability of several short alcohol screening tools, contained in the Grog Survey Application, to detect short- or long-term risky drinking as defined by Australian guidelines. Tested tools include a modification of Alcohol Use Disorders Identification Test-Consumption (AUDIT-Cm). Methods Alcohol consumption was assessed in current drinkers in the past year (n = 184) using AUDIT-Cm and using the last four drinking occasions (Finnish method). Sensitivity and specificity were assessed relative to the Finnish method, for how AUDIT-Cm score (3 + for women, 4 + for men), and how subsets of AUDIT-Cm questions (AUDIT-1m and AUDIT-2m; and AUDIT-3mV alone) were able to determine short- or long-term risk from drinking. Responses to AUDIT-Cm were used to calculate the average standard drinks consumed per day, and the frequency at which more than four standard drinks were consumed on single occasions. Finally, shorter versions of the Finnish method (1, 2, or 3 occasions of drinking) were compared to the full Finnish method, by examining the percentage of variance retained by shorter versions. Results AUDIT-Cm has a high sensitivity in detecting at-risk drinking compared with the Finnish method (sensitivity = 99%, specificity = 67%). The combination of AUDIT-1m and AUDIT-2m was able to classify the drinking risk status for all but four individuals in the same way as the Finnish method did. For the Finnish method, two drinking sessions to calculate drinks per drinking occasion, and four to calculate frequency resulted in nearly identical estimates to data on all four of the most recent drinking occasions (r2 = 0.997). Conclusions The combination of AUDIT-1m and AUDIT-2m may offer advantages as a short screening tool, over AUDIT-3mV, in groups where intermittent and high per occasion drinking is common. As an alternative to the full Finnish method, the quantity consumed on the last two occasions and timing of the last four occasions may provide a practical short screening tool

Alcohol dependence in a community sample of Aboriginal and Torres Strait Islander Australians : Harms, getting help and awareness of local treatments

Background Few studies have examined links between current alcohol dependence and specific harms among Indigenous Australians. We investigated these associations as well as help seeking for drinking, awareness of local treatments and recommendations to help family or friends cut down or stop drinking in two Indigenous communities. Methods A representative sample of Indigenous Australians was surveyed in one urban and one remote community in South Australia. Data were collected via the Grog Survey App. Participants were dependent if they reported two or more symptoms of alcohol dependence (ICD-11). Pearson chi-square tests were used to describe relationships between employment by gender, and dependence by awareness of medicines and local treatment options. Multivariate logistic regressions were used to predict the odds of dependent drinkers experiencing harms and getting help for drinking, controlling for age, gender, schooling and income. Results A total of 775 Indigenous Australians took part in the study. After controlling for confounders, dependent drinkers were nearly eight times more likely to report a harm and nearly three times more likely to get help for their drinking—compared with non-dependent drinkers. Participants recommended accessing local support from an Aboriginal alcohol and other drugs worker, or a detoxification/ rehabilitation service. Discussion and conclusions More support and funding is needed for Indigenous Australians to ensure local treatment options for dependent drinkers are readily available, appropriate and accessible. Involvement of local Aboriginal or Torres Strait Islander health professionals in delivery of care can help ensure that it is appropriate to an individual’s culture and context

IMPROVING OUR UNDERSTANDING OF ALCOHOL DEPENDENCE AMONG INDIGENOUS PEOPLES: AN INTERNATIONAL SYSTEMATIC REVIEW AND QUANTITATIVE STUDY OF TWO AUSTRALIAN ABORIGINAL COMMUNITIES

Alcohol use is common globally and the health risks from drinking are recognised. However, Indigenous Peoples who have been impacted by colonisation, trauma and racism, could be at greater risk of developing alcohol-related harms. One of these harms could be alcohol dependence, the strong internal drive to use alcohol with an inability to control use, prioritising alcohol and also physiological characteristics. The way alcohol dependence is interpreted or identified can be different across cultures and for Indigenous Peoples. The overall aim of this thesis was to identify the prevalence of alcohol dependence among Indigenous Peoples globally, and the associations of dependence in an Indigenous Australian community sample. Chapter 2 is a systematic review of the prevalence of alcohol dependence among Indigenous Peoples globally and examines how dependence is identified. Chapter 3 estimates the prevalence and describes the correlates of alcohol dependence in a representative community sample of Indigenous Australians. Chapter 4 identifies the associations between alcohol dependence with harms and getting help for drinking in a representative community sample of Indigenous Australians. This research reports that the prevalence of current alcohol dependence among Indigenous Peoples globally from similarly colonised countries varies widely and shows few tools have been validated for Indigenous Peoples. The prevalence in the representative community sample of Indigenous Australians is similar to the general Australian population. Dependent drinkers were more likely to report harms and more likely to get help for their drinking. Researchers, health professionals and clinicians do well to use Indigenous-specific survey tools or operationalise existing tools when trying to identify alcohol dependence among Indigenous Peoples. Accurate prevalence data can better inform treatment needs and unmet needs. Indigenous Australians need support and treatment options that are readily available, accessible and culturally appropriate. Identifying these needs could help with funding and resource allocation

Erratum: Correction to: Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians

After publication of the original article [1] it was noted that the name of author, Peter Jack, was erroneously typeset in both the PDF and online formats of the manuscript as Peter Jack GradDipIndigH. This inclusion of his qualification as part of his surname was introduced during typesetting, thus the publisher apologises for this error. The original article has also been updated to reflect this correction

Realist evaluation for programs designed to reduce demand and harms of substance misuse at the community level in Australian remote Indigenous community settings

This thesis reviewed NHMRC-funded, community-level substance misuse interventions, documenting: outcomes; study designs; implicit program theory; and assumptions. Data from one intervention project, targeting cannabis misuse in Cape York, exemplified common evaluation constraints, and informed hypothetical context-mechanism-outcome clusters for a plausible program theory and proposed theory-driven evaluation