Title Pending 9744

In Arnhem Land's remote Aboriginal communities [Northern Territory], very high smoking rates and overcrowding mean high exposure to Environmental Tobacco Smoke. This study compared smokers who restrict their smoking in these environments with those who do not. In 2008-2009, 258 smokers (137 males and 121 females) aged ≥ 16 years, provided information permitting categorisation of those who 'RESTRICT' their smoking in the house, car or workplace from those who do 'NOT RESTRICT'. Univariable and multivariable logistic regressions compared 'RESTRICT' and 'NOT RESTRICT' groups by gender, age group, daily use, tobacco consumption, time-to-first-cigarette and quit intentions. Those in the 'RESTRICT' group explained their motivations, summarised using qualitative data analysis. Men were almost twice as likely to 'NOT RESTRICT' their smoking (odds ratio = 1.88, 95% confidence interval = 1.14-3.08, P = 0.013). Time-to-first-cigarette was the strongest predictor to 'NOT RESTRICT' in women (odds ratio = 3.48, 95% confidence interval = 1.44-8.41, P = 0.006) with daily consumption the strongest predictor in men (odds ratio = 3.15, 95% confidence interval = 1.39-7.18, P = 0.006). Men and women shared similar motivations for restricting smoking. Smoke-free homes and workplaces are important opportunities to reduce exposure to Environmental Tobacco Smoke in remote Indigenous communities.

Whither the Aborigine

Editorial

To examine predictors of cannabis use at 5 year follow up in an Australian Aboriginal cohort. A longitudinal study consisting of two waves of data collection 5 years apart was conducted. Of the 100 Aboriginal residents (aged 13-36 years) interviewed about cannabis use in 2001, 83 were re-interviewed in 2005-2006 from three remote communities in Arnhem Land, Northern Territory, Australia. Self-reported cannabis use was categorised at each time point (none; former use, quit > or = 3 months; lighter use, < 6 cones, 2-3 times weekly; daily use, > or = 6 cones, daily) and summarised as any current use, heavy use, dependence or cessation. Other substance use, employment and involvement in school or training were also compiled. Most respondents who reported cannabis use at baseline again reported use at follow up. A history of petrol sniffing predicted later heavy cannabis use (P < 0.05). Trends were evident for men to have persisting cannabis use, and for employment and/or engagement in school or training to be associated with cannabis cessation. Ongoing heavy cannabis use is commonplace in this Aboriginal cohort and raises concerns for the physical, social and psychiatric burden on these already vulnerable communities. Prevention, treatment and intervention programs developed with communities are badly needed.

Specialist outreach to isolated and disadvantaged communities: a population-based study

To determine the extent to which depressive symptoms are associated with heavy cannabis use in an Aboriginal population in Arnhem Land, Northern Territory. Cross-sectional study involving interviews with 106 Indigenous participants (57 males, 49 females) aged 13-42 years in three remote Aboriginal communities in Arnhem Land, NT, Australia. Measures of depressive symptoms (a raw score of > or = 6 out of a possible 18 on a modified version of the Patient Health Questionnaire-9) and self-reported heavy cannabis use (six or more cones daily). After adjusting for other substance use (tobacco, alcohol and lifetime petrol sniffing), age and sex, heavy cannabis users were four times more likely than the remainder of the sample to report moderate to severe depressive symptoms (odds ratio, 4.1; 95% CI, 1.3-13.4). Given its high prevalence in Indigenous populations, the development of clinical and prevention strategies for cannabis misuse are warranted.

The Whole of Community Engagement (WCE) initiative sought to identify barriers and enablers in Aboriginal students’ pathways to post-compulsory education, in six remote communities in Arnhem Land and central Australia. It identified known factors like colonial history, low English literacy, job prospects and cultural difference. Responses often focus on “both-ways” curriculum and pedagogy, and teachers’ cultural competence. Another factor found was interculturality, the fact of living and working at the intersections of Aboriginal and other socio-cultural worlds. The initiative found that students’ engagement with school and with pathways into further education were troubled by both cultural difference and intersection. The Aboriginal researchers involved in the initiative, living at the intersections in their own lives, exemplified the challenges of, and the capabilities needed to negotiate, cultural intersection. The authors propose an intercultural perspective as a refinement to the both-ways approach to remote education.

How Air Ambulance Services Can Improve Care Delivered to Remote Indigenous Communities

Petrol sniffing and use of other drugs were examined among 48 males aged 13-32 years resident in a remote Aboriginal community in Arnhem Land. The study group consisted of 13 non-sniffers, 13 ex-sniffers and 22 current sniffers. Unemployment was highest among those with a history of petrol sniffing. Employment and family influence emerged as major reported reasons for individuals stopping petrol sniffing. The findings of the study suggest that strategies to reduce petrol sniffing should not only focus on education, employment, skills training and recreation, but should further encourage Aboriginal communities to utilize family relationships to dissuade young people from the practice. Unlike ex-sniffers and current sniffers, non-sniffers tended to be abstainers from tobacco, kava and alcohol. Of the selected study group, 52% smoked >or=25 cigarettes per day. On the basis of the research findings, the local community Council has implemented employment, skills training and recreation strategies to reduce petrol sniffing in this age group. A reduction in tobacco consumption in both adults and young people has also been targeted through health education programmes developed by the community health clinic and the school.

Trachoma in remote Indigenous Australia: a review and public health perspective

Access to and use of modern communication services in remote Indigenous communities in Australia lags considerably behind that in the rest of Australia because of inadequate supply arrangements and prevalent economic and social conditions. This article presents some findings of research on the availability and use of telephone and internet services in remote Indigenous communities in central Australia. The research involved the collection of community-wide data on the availability of telephone and internet services as well as details of individual user experience in the use of those services. In evaluating the findings, the article suggests potential improvements to programs for the delivery of better communication services in remote communities.

In June 2008, 10 pre-service teachers and 2 teacher educators from Edith Cowan University (ECU) participated in an existing community education program in rural and remote Indigenous communities in central Australia. From an intrepid start with a mountain of overloaded baggage and camping cutlery; setting off the scanning machine at the airport, these educational risk takers trekked off into the desert. Our explorers joined 60 pre-service teachers and several teacher educators from the Victoria University (VU) Story Writing in Rural Locations (SWIRL) project. This project has been operating annually for 14 years in communities around Alice Springs, some up to 400 km of dirt track away. This paper reports the powerful effect of a short lived experience on pre-service teachers' attitudes and experience of living and teaching in a remote community. The experience described here represents the beginning of an authentic approach to giving experiences to pre-service teachers which may support them to consider teaching in remote Indigenous communities as part of their teaching career.

BackgroundIn Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes.ResultsThe 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention.ConclusionsThese results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Australian communities, local and operational-level participants' views point to an 'implementation gap'. Their views should be heard because they are in a position to provide practical recommendations for effective policy implementation faithful to its design, thereby translating sound policy into meaningful action. Some recommendations may also find a place in culturally diverse low- and middle-income countries. Key words: tobacco policy implementation, challenges, opportunities, remote Indigenous Australian communities.

In remote Indigenous Australian communities measuring individual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory). In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged ≥16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (<10 cigarettes per day) and 'heavier smokers' (≥10 cigarettes per day) in men and women were compared. Of 400 Indigenous study participants, 305 (76%) used tobacco; four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information; a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio=2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day; very similar to self-reported levels. Sixty per cent (=6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%). Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores.

The aim of this study was to explore the association of psychological health problems and heavy alcohol use in a remote Indigenous community. Remote Indigenous communities have been found to be heavily polarised between abstinence and heavy drinking, with approximately half of people falling into one category or the other.1 There is also other evidence of poor psychological health in remote communities. Most data come from gross measures of morbidity and mortality (such as suicide, death from injuries and violence).1 Because of limitations in existing Indigenous mental health databases,1 less is known about self-reported depression and anxiety in non-medical settings and community samples. There is limited information on the association of alcohol problems with psychological ill-health. The research received ethics approval, approval from the Chairperson of the Community Council, and was conducted during 2001. The population of this community was approximately 280 people living in 60 residences. Although the community is a dry community, alcohol typically is obtained through ‘sly groggers’. The survey interviews were conducted in English because the vast majority of community members were reported by the community council to have sufficient English, and 87% of Indigenous people have few difficulties with everyday English.2 People included in the study were individuals who either were in a couple relationship (e.g. married) or had separated in the past six months. The sample consisted of 31 Indigenous people (16 men, 15 women) with a mean age of 37 years (standard deviation (SD) = 10). Potential participants were approached in the main street of the community and invited to complete the survey. House-to-house interviews based on random selection of households were considered too invasive. All participants received an information sheet and completed a consent form. The questions were drawn from standard questionnaires, including the Alcohol Use Disorders Identification Test,3 CAGE4 and the General Health Questionnaire (GHQ-30).5 Abstinence was reported by 32% of the sample and a chi-squared test (by sex) was not significant. Men and women consumed alcohol on an average of 2.75 (SD = 1.73) and 1.40 (SD = 1.55) days per week, respectively, F30 = 5.21, P < 0.05. Men and women reported consuming an average of 44 (SD = 41) and 15 (SD = 19) standard drinks per day on days that alcohol consumption occurred, F30 = 6.37, P < 0.05. Men reported more significant alcohol problems than women, F30 = 9.21, P < 0.01. GHQ scores were unrelated to the frequency or quantity of alcohol consumption or alcohol problems. Between 29% and 71% of the sample had GHQ totals indicating clinically significant psychological ill health (using conservative vs more liberal cut-offs). The high rates of psychological ill-health are consistent with previous reviews of Indigenous mental health.6 However, the prevalence of psychological health problems in the community appeared of greater magnitude than prior investigations of psychological health in other Indigenous groups.1 It is possible that any association between psychological ill-health and alcohol consumption is masked by highly prevalent and potent antecedents to both problems, such as poverty, unemployment, boredom and marginalisation.6 There is a great need to address the high rates of depression and anxiety that may exist across this community and perhaps other similar remote communities. The opportunistic sampling method, relatively small sample size and voluntary nature of this study may limit generalisability to the whole community and to other remote Indigenous communities. Special thanks to Marusia Kowalyszyn for conducting the surveys. Sincere thanks to the community council and community members for their openness and willingness to participate in this study. This manuscript was completed during a National Health and Medical Research Council Career Development Fellowship.