Alcohol, assault and licensed premises in inner-city areas

This report contains eight linked feasibility studies conducted in Cairns during 2010. These exploratory studies examine the complex challenges of compiling and sharing information about incidents of person-to-person violence in a late night entertainment precinct (LNEP). The challenges were methodological as well as logistical and ethical. The studies look at how information can be usefully shared, while preserving the confidentiality of those involved. They also examine how information can be compiled from routinely collected sources with little or no additional resources, and then shared by the agencies that are providing and using the information.Although the studies are linked, they are also stand-alone and so can be published in peer-reviewed literature. Some have already been published, or are ‘in press’ or have been submitted for review. Others require the NDLERF board’s permission to be published as they include data related more directly to policing, or they include information provided by police.The studies are incorporated into the document under section headings. In each section, they are introduced and then presented in their final draft form. The final published form of each paper, however, is likely to be different from the draft because of journal and reviewer requirements. The content, results and implications of each study are discussed in summaries included in each section.Funded by the National Drug Law Enforcement Research Fund, an initiative of the National Drug StrategyAlan R Clough (PhD) School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook UniversityCharmaine S Hayes-Jonkers (BPsy, BSocSci (Hon1)) James Cook University, Cairns.Edward S Pointing (BPsych) James Cook University, Cairns

"Need Everyone Helping to Keep Off Because Everyone Helping to Keep On" – reducing harms from cannabis use in remote Indigenous Australian communities involves more than just users

Background: Heavy cannabis use in remote Indigenous Australian communities potentially contributes to existing health disparities. Community members’ perceptions of cannabis harms will support harm-minimization in these settings. Objective: To describe perceived cannabis harms reported by a cohort of Indigenous Australians living in small, isolated communities as an indication of their existing resources for change. Method: Inductive thematic analysis of 407 semi-structured interviews with participants in a cohort study in three remote communities in Cape York in far north Queensland (Australia) revealed major areas of concern about cannabis. Three attitudinal categories were defined according to reported cannabis impacts and urgency for change: 1- “LOW CONCERN” said cannabis was a low priority community issue; 2- “SOME CONCERN” tolerated cannabis use but identified personal or community-level concerns; and 3- “HIGH CONCERN” expressed strong aversion to cannabis and identified serious personal or community-level harms. The characteristics and the patterns of concerns were summarized across the groups. Results: “Category 1- LOW CONCERN” (n¼107), mostly current users, emphasized personal “financial impacts” and “stress.” “Category 2 – SOME CONCERN” (n¼141) perceived community level impacts warranting systematic action, particularly on “employment”; and “Category 3 – HIGH CONCERN” (n¼159), most of the never users, emphasized concerns for families and youth. Irrespective of use history, the cohort reported financial and abstinence-related stress, overlapping alcohol issues and generally endorsed alleviating impacts on children and youth. Conclusion: Nearly ubiquitous experience with cannabis harms and impacts in this cohort suggests resources for harm reduction including family and cultural obligation, stress relief, financial management, and engagement are available across all community members, not just users

What Works for Aboriginal and Torres Strait Islander Men? A Systematic Review of the Literature

Aboriginal and Torres Strait Islander men experience significantly higher rates of suicide, trauma, alcohol related deaths and unemployment than other Australian men. Despite significant levels of government intervention, rates of family violence, unemployment and incarceration continue to increase in Aboriginal and Torres Strait Islander communities. As a subset of the Aboriginal and Torres Strait Islander population, there has been a lesser focus on how to meaningfully improve the wellbeing of Aboriginal and Torres Strait Islander men. This systematic review seeks to understand what interventions, programs and activities are successful in improving the wellbeing of Aboriginal and Torres Strait Islander men and thereby the wellbeing of their communities. A thorough search of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifteen studies met the inclusion criteria. Analysis of the programs, activities and interventions evaluated in these studies indicated two prominent themes that were successful in improving the wellbeing of Aboriginal and Torres Strait Islander men: strengthening identity and increasing social connection. The mechanisms contributing to these outcomes are discussed, as are implications for policy and future research

Which Way From Here? An Exploration of Local Perspectives on Strengths, Needs and Goals in the Aurukun Community

Aurukun is a small Aboriginal community located in remote Cape York, Far North Queensland. This study explores local perspectives on the goals, strengths and areas of need in the community, and perceptions of the role of a man in Aurukun. Seventeen individuals from the Aurukun community were informally interviewed. The sample comprised eight community elders (four female, four male) and nine community members (six male, three female). A reference group comprising local community members and elders guided the research project. Results indicated that the communities’ main strength was their connection to culture, the areas most needing improvement were violence, alcohol use, over incarceration, poor support for mental health and a lack of employment opportunities. Participants saw the best way forward as being through more employment and better communication. The interconnectedness of these themes as well as their implications for successful program development and evaluation are discussed

Cannabis Use Among Remote Indigenous Australians: Opportunities to Support Change Identified in Two Waves of Sampling

Background: Cannabis harms among Indigenous populations in Australia, New Zealand, Canada and the United States may be magnified by poorer health and heavy use. However, little direct evidence is available to evaluate cannabis' impacts. In communities in remote northern Queensland (Australia) where cannabis has become endemic, opportunities to support change were investigated.Methods: Opportunistically recruited participants (aged 15–49 years) discussed their cannabis use history in interviews in two waves of population sampling in Cape York (Queensland). Wave 1 included 429 people (235 males and 194 females); and wave 2 included 402 people (228 males and 174 females). Current users (used cannabis during the year before interview) described frequency of use, amount consumed, expenditure and dependence symptoms. Other substance use was recorded for 402 people at wave 2.Results: Wave 1: 69% reported lifetime use and 44% current use. Males (55%) were more likely than females (30%) to be current users (P < 0.001). Most (96%) current users described at least weekly use; nearly half (48%) were “heavy” users (≥6 cones/session at least once/week) and 77% met cannabis dependence criteria. Three communities spent up to $AUD14,200/week on cannabis, around$AUD2.0 million/year, or around 9% of community people's total income on cannabis. The majority (79%) of current users wanted to quit or reduce their cannabis use. Wave 2: no difference was observed in the proportion of lifetime (69%, |z| = 0.04, P = 0.968) or current cannabis users (39%, |z| = 1.39, P = 0.164); nor current use among males (71%, |z| = 0.91, P = 0.363) or females (62%, |z| = 0.36, P = 0.719). However, a significant reduction in current users by 15% (|z| = 2.36, P = 0.018) was observed in one community. Of 105 wave 1 current users re-assessed in 2, 29 (27%) had ceased use. These participants reported cost and family commitments as reasons to change and that social support and employment enabled abstinence. Current and lifetime cannabis use were closely associated with all other substance use, particularly tobacco and alcohol (both P > 0.001).Conclusions: High rates of heavy cannabis use in remote Australian Indigenous communities warrant action. Successful cessation among some individuals suggests that significant opportunities are available to support change even where cannabis use may be endemic

Interventions to encourage smoke-free homes in remote indigenous Australian communities: a study protocol to evaluate the effects of a community-inspired awareness-raising and motivational enhancement strategy

Introduction: Rates of secondhand smoke exposure are currently significantly higher among remote indigenous communities in the top end of Australia. By implementing a smoke-free home' rule, secondhand smoke exposure can be reduced. Smoke-free Ironies encourage quit attempts and improve the health of children. The prevalence of indigenous smoking rates in remote, discrete communities in Australia is elevated compared with their nonindigenous non indigenous counterparts. The primary aim of this project is to examine the feasibility of conducting a health-driven intervention to encourage community members to make their homes a smoke-free zone. Methods and analysis: This study uses mixed-methods exploratory evaluation design to obtain data from key informants and community householders to assess their willingness to implement a'smoke-free' rule in their Ironies. Initial focus groups will provide guidance on intervention content and deliver evaluation procedures and community requirements. A rapid survey will be conducted to ascertain interest from community members in having the project team visit to discuss study objectives further and to have a particle meter (with consent) placed in the house. Focus groups recordings will he transcribed and analysed thematically. Rapid surveys will he analysed using frequency distributions and tabulations of responses. Ethics and dissemination: The National Health and Medical Research Council guidelines on ethical research approaches to indigenous studies will be adhered to. The James Cook University Human Research Ethics Committee has provided ethics approval

Case-control study of the association between kava use and pneumonia in eastern Arnhem Land Aboriginal communities (Northern Territory, Australia)

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia\u27s Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case-control study (n=115 cases; n=415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia, vas not associated with kava use. Crude OR=1.26 (0.74-2.14, P=0.386), increased after controlling for confounders (OR=1.98, 0.63-6.23, P=0.237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1.19 (0.39-3.62, P=0.756). In communities with longer kava-using histories, adjusted OR was 2.19 (0.67-7.14, P=0.187). There was no kava dose-response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2.27, 1.18-4.37, P=0.014) and alcohol use (OR=1.95, 1.07-3.53, P=0.026) were statistically significant and approached significance for petrol sniffing (OR=1.98, 0.99-3.95, P=0.056)

Establishing smoke-free homes in the Indigenous populations of Australia, New Zealand, Canada and the United States: a systematic literature review

A smoke-free home can have multiple benefits by reducing exposure to secondhand smoke (SHS), supporting quit attempts among active smokers, and discouraging adolescents from taking up smoking. The aim of this review was to summarize the literature on the establishment of smoke-free homes in Indigenous populations and identify the supporting influences and barriers, using the Social Cognitive Theory lens. A search of the Medline, CINAHL, Cochrane Collaboration and PyscINFO databases and manual searches of relevant peer-reviewed literature was completed, focusing on Indigenous populations in developed economies of North America and Oceania. Of 2567 articles identified, 15 studies were included. Ten studies included Indigenous participants only, and of these just three focused entirely on SHS in the home. Knowledge of the harms associated with SHS was the most common theme represented in all the studies. This knowledge fueled parents' motivation to protect their children from SHS by establishing smoke-free homes. Individuals who approached implementation with confidence, coupled with clear communication about smoke-free home rules were more successful. Barriers included challenges for families with multiple smokers living in the same dwelling. There is limited research regarding managing smoking behaviors in the home among Indigenous populations, even though this approach is a successful catalyst for smoking prevention and cessation. Research to understand the influences that support the establishment of smoke-free homes is required for better-informed intervention studies

After the Left–Right (Dis)continuum: Globalization and the Remaking of Europe’s Ideological Geography

This article examines the status of globalization as a causal factor in political mobilization and proposes a research agenda for diagnosing the impact of global socio-economic dynamics on ideological orientation in national polities. Focusing on Europe’s established democracies, the article outlines recent shifts in Europe’s ideological landscape and explores the mechanisms generating a new pattern of political conflict and electoral competition. It advances the hypothesis that the knowledge economy of open borders has brought about a political cleavage inti- mately linked to citizens’ perceptions of the social impact of global eco- nomic integration. In this context, the polarization of life chances is determined by institutionally mediated exposure to both the economic opportunities and the hazards of globalization. Fostered by the increas- ing relevance of the international for state-bound publics, new fault-lines of social conflict are emerging, giving shape to a new, ‘‘opportunity- risk,’’ axis of political competition. As the novel political cleavage challenges the conventional left–right divide, it is likely to radically alter Europe’s ideological geography

What is the best way to keep walking and moving around for individuals with Machado-Joseph disease? A scoping review through the lens of Aboriginal families with Machado-Joseph disease in the Top End of Australia

Objectives: Machado-Joseph disease (MJD) is the most common spinocerebellar ataxia worldwide. Prevalence is highest in affected remote Aboriginal communities of the Top End of Australia. Aboriginal families with MJD from Groote Eylandt believe 'staying strong on the inside and outside' works best to keep them walking and moving around, in accordance with six key domains that form the 'Staying Strong' Framework. The aim of this current study was to review the literature to: (1) map the range of interventions/strategies that have been explored to promote walking and moving around (functional mobility) for individuals with MJD and; (2) align these interventions to the 'Staying Strong' Framework described by Aboriginal families with MJD. Design: Scoping review. Data sources: Searches were conducted in July 2018 in MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane Databases. Eligibility criteria for selecting studies: Peer-reviewed studies that (1) included adolescents/adults with MJD, (2) explored the effects of any intervention on mobility and (3) included a measure of mobility, function and/or ataxia were included in the review. Results: Thirty studies were included. Few studies involved participants with MJD alone (12/30). Most studies explored interventions that aligned with two 'Staying Strong' Framework domains, 'exercising your body' (n=13) and 'searching for good medicine' (n=17). Few studies aligned with the domains having 'something important to do' (n=2) or 'keeping yourself happy' (n=2). No studies aligned with the domains 'going country' or 'families helping each other'. Conclusions: Evidence for interventions to promote mobility that align with the 'Staying Strong' Framework were focused on staying strong on the outside (physically) with little reflection on staying strong on the inside (emotionally, mentally and spiritually). Findings suggest future research is required to investigate the benefits of lifestyle activity programmes that address both physical and psychosocial well-being for families with MJD