Drink driving among Aboriginal and Torres Strait Islander Australians: what has been done and where to next?

The Australian Government will set the direction for addressing road safety over the next decade with its 2021–2030 National Road Safety Strategy. This road map will detail objectives and goals agreed upon by all Australian states and territories. Similar to previous national strategies, Aboriginal and Torres Strait Islander (Indigenous) Australians are a high priority population. Indigenous Australians are over-represented in serious injury and fatal road crashes, with alcohol a leading factor. Therapeutic and educational programs are a major strategy among the suite of measures designed to reduce and prevent drink driving in Australia. The release of this new strategy provides a timely opportunity to reflect on what is known about drink driving among Indigenous Australians and to consider the suitability of existing therapeutic and educational drink driving programs for Indigenous Australian contexts. Here, we summarise factors that contribute to drink driving in this population and identify outstanding knowledge gaps. Then, we present an overview of drink driving programs available for Indigenous Australians along with suggestions for why tailored programs are needed to suit local contexts. The response to address drink driving among Indigenous Australians has been fragmented Australia-wide. A coordinated national response, with ongoing monitoring and evaluation, would improve policy effectiveness and inform more efficient allocation of resources. Together this information can help create suitable and effective drink driving programs for Indigenous drivers and communities Australia-wide

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

Bioenergy for climate change mitigation:Scale and sustainability

Many global climate change mitigation pathways presented in IPCC assessment reports rely heavily on the deployment of bioenergy, often used in conjunction with carbon capture and storage. We review the literature on bioenergy use for climate change mitigation, including studies that use top-down integrated assessment models or bottom-up modelling, and studies that do not rely on modelling. We summarize the state of knowledge concerning potential co-benefits and adverse side effects of bioenergy systems and discuss limitations of modelling studies used to analyse consequences of bioenergy expansion. The implications of bioenergy supply on mitigation and other sustainability criteria are context dependent and influenced by feedstock, management regime, climatic region, scale of deployment and how bioenergy alters energy systems and land use. Depending on previous land use, widespread deployment of monoculture plantations may contribute to mitigation but can cause negative impacts across a range of other sustainability criteria. Strategic integration of new biomass supply systems into existing agriculture and forest landscapes may result in less mitigation but can contribute positively to other sustainability objectives. There is considerable variation in evaluations of how sustainability challenges evolve as the scale of bioenergy deployment increases, due to limitations of existing models, and uncertainty over the future context with respect to the many variables that influence alternative uses of biomass and land. Integrative policies, coordinated institutions and improved governance mechanisms to enhance co-benefits and minimize adverse side effects can reduce the risks of large-scale deployment of bioenergy. Further, conservation and efficiency measures for energy, land and biomass can support greater flexibility in achieving climate change mitigation and adaptation.</p

Bioenergy for climate change mitigation: Scale and sustainability

Many global climate change mitigation pathways presented in IPCC assessment reports rely heavily on the deployment of bioenergy, often used in conjunction with carbon capture and storage. We review the literature on bioenergy use for climate change mitigation, including studies that use top-down integrated assessment models or bottom-up modelling, and studies that do not rely on modelling. We summarize the state of knowledge concerning potential co-benefits and adverse side effects of bioenergy systems and discuss limitations of modelling studies used to analyse consequences of bioenergy expansion. The implications of bioenergy supply on mitigation and other sustainability criteria are context dependent and influenced by feedstock, management regime, climatic region, scale of deployment and how bioenergy alters energy systems and land use. Depending on previous land use, widespread deployment of monoculture plantations may contribute to mitigation but can cause negative impacts across a range of other sustainability criteria. Strategic integration of new biomass supply systems into existing agriculture and forest landscapes may result in less mitigation but can contribute positively to other sustainability objectives. There is considerable variation in evaluations of how sustainability challenges evolve as the scale of bioenergy deployment increases, due to limitations of existing models, and uncertainty over the future context with respect to the many variables that influence alternative uses of biomass and land. Integrative policies, coordinated institutions and improved governance mechanisms to enhance co-benefits and minimize adverse side effects can reduce the risks of large-scale deployment of bioenergy. Further, conservation and efficiency measures for energy, land and biomass can support greater flexibility in achieving climate change mitigation and adaptation

Bioenergy for climate change mitigation: Scale and sustainability

Many global climate change mitigation pathways presented in IPCC assessment reports rely heavily on the deployment of bioenergy, often used in conjunction with carbon capture and storage. We review the literature on bioenergy use for climate change mitigation, including studies that use top-down integrated assessment models or bottom-up modelling, and studies that do not rely on modelling. We summarize the state of knowledge concerning potential co-benefits and adverse side effects of bioenergy systems and discuss limitations of modelling studies used to analyse consequences of bioenergy expansion. The implications of bioenergy supply on mitigation and other sustainability criteria are context dependent and influenced by feedstock, management regime, climatic region, scale of deployment and how bioenergy alters energy systems and land use. Depending on previous land use, widespread deployment of monoculture plantations may contribute to mitigation but can cause negative impacts across a range of other sustainability criteria. Strategic integration of new biomass supply systems into existing agriculture and forest landscapes may result in less mitigation but can contribute positively to other sustainability objectives. There is considerable variation in evaluations of how sustainability challenges evolve as the scale of bioenergy deployment increases, due to limitations of existing models, and uncertainty over the future context with respect to the many variables that influence alternative uses of biomass and land. Integrative policies, coordinated institutions and improved governance mechanisms to enhance co-benefits and minimize adverse side effects can reduce the risks of large-scale deployment of bioenergy. Further, conservation and efficiency measures for energy, land and biomass can support greater flexibility in achieving climate change mitigation and adaptation

Bioenergy for climate change mitigation : scale and sustainability

Funding Information: The authors are grateful for comments from three reviewers and the editor. The views expressed in this article are those of the authors alone.Peer reviewedPublisher PD

Parental Home-Based Pulse Oximetry Monitoring For Adults With Intellectual Disabilities At Risk Of Serious Respiratory Problems Including Covid-19: A Brief Report

BackgroundPeople with intellectual disabilities (ID) are at high risk of developing respiratory health issues. The COVID-19 pandemic has compounded this, with serious consequences, and for some, death. Despite home-based oxygen saturation monitoring being recommended for people with ID, there is a stark lack of evidence in the literature on its feasibility.MethodWe conducted 3-day baseline home-based oxygen saturation monitoring, using pulse oximeters, with eight parents of nine adults with ID in Scotland. Two eligible parents also completed a further 2 weeks of monitoring, and returned an evaluation questionnaire on its feasibility.ResultsBaseline mean readings for eight adults with ID were within the normal range (%Sp02 ≥ 95), and for another one 94%. Fluctuations over the 3-day assessment period were experienced by six of these individuals. However, these variations were within limits which are not dangerous (lowest reading 92%), implying that parental home-based pulse oximetry monitoring is likely to be safe for adults with ID. The two parents who completed the evaluation found home-based pulse oximetry monitoring to be easy/very easy to do, and effective/very effective.ConclusionsThis is the first research study, albeit with a very small sample, to report on the potential feasibility of parental home-based pulse oximetry monitoring for adults with ID. Home-based pulse oximetry monitoring appears to be safe in adults with ID at risk of developing serious respiratory problems, and not difficult for their parents to do. There is an urgent need to replicate this work, using a larger sample, to promote home-based respiratory health monitoring more widely for people with ID

'The drug survey app' : a protocol for developing and validating an interactive population survey tool for drug use among Aboriginal and Torres Strait Islander Australians

Background: Disadvantage and transgenerational trauma contribute to Aboriginal and Torres Strait Islander (Indigenous) Australians being more likely to experience adverse health consequences from alcohol and other drug use than non-Indigenous peoples. Addressing these health inequities requires local monitoring of alcohol and other drug use. While culturally appropriate methods for measuring drinking patterns among Indigenous Australians have been established, no similar methods are available for measuring other drug use patterns (amount and frequency of consumption). This paper describes a protocol for creating and validating a tablet-based survey for alcohol and other drugs (“The Drug Survey App”). Methods: The Drug Survey App will be co-designed with stakeholders including Indigenous Australian health professionals, addiction specialists, community leaders, and researchers. The App will allow participants to describe their drug use fexibly with an interactive, visual interface. The validity of estimated consumption patterns, and risk assessments will be tested against those made in clinical interviews conducted by Indigenous Australian health professionals. We will then trial the App as a population survey tool by using the App to determine the prevalence of substance use in two Indigenous communities. Discussion: The App could empower Indigenous Australian communities to conduct independent research that informs local prevention and treatment efforts

Comorbidity: Trauma, substance use and mental health

Substance use and mental health disorders commonly co-occur and they are frequently underpinned by history of psychological trauma. This symposium presents new data on the clinical presentation and documentation of trauma exposure, trauma-related disorders, and their treatment among adults entering substance use treatment, the implementation of integrated trauma-focused therapy in substance use treatment, and presenting issues among adolescents seeking integrated treatment for substance use and traumatic stress

Parental Home-Based Pulse Oximetry Monitoring For Adults With Intellectual Disabilities At Risk Of Serious Respiratory Problems Including Covid-19: A Brief Report

BackgroundPeople with intellectual disabilities (ID) are at high risk of developing respiratory health issues. The COVID-19 pandemic has compounded this, with serious consequences, and for some, death. Despite home-based oxygen saturation monitoring being recommended for people with ID, there is a stark lack of evidence in the literature on its feasibility.MethodWe conducted 3-day baseline home-based oxygen saturation monitoring, using pulse oximeters, with eight parents of nine adults with ID in Scotland. Two eligible parents also completed a further 2 weeks of monitoring, and returned an evaluation questionnaire on its feasibility.ResultsBaseline mean readings for eight adults with ID were within the normal range (%Sp02 ≥ 95), and for another one 94%. Fluctuations over the 3-day assessment period were experienced by six of these individuals. However, these variations were within limits which are not dangerous (lowest reading 92%), implying that parental home-based pulse oximetry monitoring is likely to be safe for adults with ID. The two parents who completed the evaluation found home-based pulse oximetry monitoring to be easy/very easy to do, and effective/very effective.ConclusionsThis is the first research study, albeit with a very small sample, to report on the potential feasibility of parental home-based pulse oximetry monitoring for adults with ID. Home-based pulse oximetry monitoring appears to be safe in adults with ID at risk of developing serious respiratory problems, and not difficult for their parents to do. There is an urgent need to replicate this work, using a larger sample, to promote home-based respiratory health monitoring more widely for people with ID