Addressing alcohol and tobacco harms in remote Indigenous communities and rapid responses to mental health crises in regional centres

Alcohol Management Plans (AMPs) were initially designed as part of a wide range of innovative and significant Queensland Government reforms. As well as supply control, these promised to reduce alcohol and substance misuse and violence through demand reduction by addressing key social determinants: economic development; education and training, land and sustainable natural resource management, housing, and health 3, 4. The limited available evidence in the peer-reviewed published literature points to some favourable impacts of restrictions 5, 6, including a reduction in indicators of serious injury in some communities to historically low levels 7. These favourable findings were reflected in an internal Queensland Government review 4. However, the evidence that these initial positive effects were experienced in all communities, or that they have been sustained, particularly after the most recent round of restrictions in 2008, has become equivocal 8. This paper was the first in a unique evaluation research program designed to examine the health and social effects of Queensland�s AMPs 1, 9. It investigates issues surrounding implementation of the designed AMP intervention components, specifically their perceived impacts on alcohol supply and consumption, violence, injury and community health and well-being. Perceptions and experiences are reported of the community leaders, service providers and relevant organisations with a mandate or responsibility for alcohol-related matters in the affected AMP communities and nearby towns.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Study Protocol - Alcohol Management Plans (AMPs) in remote indigenous communities in Queensland: their impacts on injury, violence, health and social indicators and their cost-effectiveness

BACKGROUND: In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland’s AMPs. METHODS/DESIGN: The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland’s Indigenous communities affected by alcohol management plans. DISCUSSION: This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the best credible evidence to judge future policy and program requirements for themselves. The project will inform impending alcohol policy and program adjustments in Queensland and other Australian jurisdictions.The study was funded by the National Health and Medical Research Council of Australia (NHMRC, Project Grant #APP1042532), with additional support from the Australian Primary Health Care Research Institute-funded Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations at James Cook University & University Adelaide. Dr Caryn West is a National Health and Medical Research Council of Australia Early Career Research Post – Doctoral Fellow (NHMRC ECR, #APP1070931).Associate Professor Clough holds a NHMRC Career Development Award (#APP1046773)

Alcohol management plans in Aboriginal and Torres Strait Islander (Indigenous) Australian communities in Queensland: community residents have experienced favourable impacts but also suffered unfavourable ones

Background: In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities.\ud \ud Methods: This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances.\ud \ud Results: Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity (ρ = 0.90).\ud \ud Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. 'Unfavourable' items were not reliably reflected in one group (ρ = 0.48) but in: i) alcohol availability and consumption not reduced and ii) criminalization and discrimination.\ud \ud In logistic regressions, longer-term (≥ 6 years) residents more likely agreed that violence against women had reduced and that personal safety had improved but also that criminalization and binge drinking had increased. Younger people disagreed that their community was a better place to live and strongly agreed about discrimination. Current drinkers' views differed little from the sample overall.\ud \ud Conclusions: The present Government review provides an opportunity to reinforce 'favourable' outcomes while targeting: illicit alcohol, treatment and diversion services and reconciliation of criminalization and discrimination issues.\ud \u

Alcohol management plans in Aboriginal and Torres Strait Islander (Indigenous) Australian communities in Queensland: Community residents have experienced favourable impacts but also suffered unfavourable ones

Background: In Australia, ‘Alcohol Management Plans’ (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents’ experiences of AMPs in 10 of Queensland’s 15 remote Indigenous communities. Methods: This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about ‘favourable’ impacts and seven about ‘unfavourable’ impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18–24, 25–44, 45–64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances. Results: Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0. 001); and awareness of alcohol’s harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven ‘favourable’ items reliably summarized participants’ experiences of reduced violence and improved community amenity (ρ = 0.90). Stronger agreement was found for six ‘unfavourable’ items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. ‘Unfavourable’ items were not reliably reflected in one group (ρ = 0.48) but in: i) alcohol availability and consumption not reduced and ii) criminalization and discrimination. In logistic regressions, longer-term (≥ 6 years) residents more likely agreed that violence against women had reduced and that personal safety had improved but also that criminalization and binge drinking had increased. Younger people disagreed that their community was a better place to live and strongly agreed about discrimination. Current drinkers’ views differed little from the sample overall. Conclusions: The present Government review provides an opportunity to reinforce ‘favourable’ outcomes while targeting: illicit alcohol, treatment and diversion services and reconciliation of criminalization and discrimination issues. Keywords: Alcohol, Indigenous, Aboriginal and Torres Strait Islander, Australian, Legal intervention, EvaluationThe study was funded by the National Health and Medical Research Council of Australia (NHMRC, Project Grant #APP1042532) with additional support from the Australian Primary Health Care Research Institute-funded Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations at James Cook University & University Adelaide. Associate Professor Caryn West is a National Health and Medical Research Council of Australia Early Career Research Fellow (#APP1070931). Professor Clough holds a NHMRC Career Development Award (#APP1046773)

This is our life, this is our child: mothers dancing in the margins of disability

This study examines the narratives of 15 mothers who each have (or had) a child who is medically, educationally and socio-culturally constituted as having a disability. This research interrogates the mothers’ narratives to consider motherhood from the discursive multiple position/ings of the society in which they live. The central research questions are: What are the lived experiences of these women who have a child who does not fit the dominant socio-cultural expectation of a 'normal' child? What subject positions are available for these women? How do they position themselves and how are they positioned in multiple discursive sites such as medicine and education? By drawing on multiple methodological frames, the study explores the lived experiences and meanings as these mothers (re)construct the discourse of motherhood. Qualitative methods were used to design the research and gather data. Poststructural and feminist perspectives are added to provide additional methods of data analysis. Poststructuralist theorisings are considered new to the field of disability studies and hence provide an opportunity to re-examine subjectivity, power/knowledge and agency in fresh ways, as various mothers in this study reject, (re)construct and even rupture dominant nondisabled assumptions not only of disability, but also of motherhood. The women’s narratives transverse multiple discursive sites but particular attention is paid to medical and educational discourses and the complex interplay of relations of power constituted with/in these sites. The outcome of analysis suggests many women with a child with a disability actively take up the subject position of 'good mother' in keeping with the dominant discourse and ideology of motherhood available in Western society and (re)construct their lives as 'normal', while simultaneously encountering societal and attitudinal barriers which continue to marginalise their child named with a disability and by association, their families. Professionals can do much to dismantle barriers encountered by these mothers and work collaboratively to ensure inclusive life experiences are available. This thesis adds to the body of literature in disability studies by adding new forms of analysis of the interaction between the lived experiences of mothers and society, serving to challenge Western socio-cultural ways of ‘knowing’ about the intersection of motherhood and disability

Seeking inclusive education: Disrupting boundaries of 'special' and 'regular' education

The present paper is part of a larger study carried out in North Queensland, Australia, between 1999 and 2001. The original study focused on the perceptions of 15 women who each have (or had) a child who was medically, educationally and socio-culturally constituted as having a disability. Qualitative methods were used for research design and to gather data. Poststructural and feminist perspectives were added to provide additional methods of data analysis. The primary focus in this paper is the spatiality of inclusive education with/in the discursive site of (special) education. It also considers the binary of regular/special education in relation to the spaces of educational discourse through the perspectives of the mothers, covering a temporal frame of 40 years. The mothers' perceptions provide a historical lens on the changes that occurred in special education in North Queensland over this time, while at the same time offer an insight into the spaces disability occupies in education discourse

Awareness of risks of overweight among rural Australians

Abstract: INTRODUCTION: Overweight and obesity are highly prevalent in rural areas and pose significant risks to health. The aim of this study was to investigate whether the rural public in central Queensland are aware of the health risks of overweight and to determine whether their perceptions of weight status and methods used to assess weight status correspond with those of health professionals. METHODS: Adults were randomly selected from shoppers in shopping centres in Central Queensland, Australia, to self-complete a questionnaire that assessed participants' understanding of the health risks of overweight, perception of current weight, methods used to assess current weight and understanding of the concepts of body mass index (BMI) and waist-to-hip ratio (WHR). Participants were also asked to provide demographic details and self-report their height and weight. RESULTS: The majority of participants were appropriately aware that, regardless of their degree of physical activity, overweight is associated with increased risk of heart disease (92%), type 2 diabetes (83%) and stroke (83%). A large proportion were also aware of the association of overweight with sleep apnoea (69%), fertility problems (68%) and arthritis (57%) but few were aware of the link with asthma (35%) and various types of cancer (14-32%). Knowledge of the health risks of overweight did not differ greatly across the BMI spectrum, with similar beliefs expressed by those who were classified overweight or obese (based on self-reported data) and those who were not. Women were more aware of the health risks of overweight for type 2 diabetes and fertility problems, less likely to be overweight, and to more accurately perceive their weight status compared with men. The majority of participants used subjective measures to assess weight status and few used or understood BMI or WHR. CONCLUSIONS: Rural people in central Queensland appear to be well aware of the health risks of overweight but many are unable to identify overweight in themselves and few understand how to accurately gauge their weight status. This exploratory study highlights the need to educate people in these communities about accurate and objective measures to assess overweight and obesity. Further studies are needed to assess how common misperception of weight status is among rural populations in Australia and to determine whether this contributes to a higher prevalence of overweight and obesity in rural communities compared with urban areas