Australian Indigenous Communities Research Articles

Climatic and community sociodemographic factors associated with remote Indigenous Australian smoking rates: an ecological study of health audit data

Australian Indigenous smoking rates are highest in remote communities but likely vary between communities; few studies have assessed community features in relation to Indigenous smoking rates.Design and objectiveThis ecological study...

Smokefree leadership among the Yolŋu peoples of East Arnhem Land, Northern Territory: a qualitative study.

This qualitative study examined smokefree leadership among the Yolŋu people, Indigenous landowners of East Arnhem Land. Despite disproportionately high smoking prevalence, the study found that most people enacted smokefree leadership within families and communities. While there was broad concern about not impinging on the autonomy of others, Indigenous health workers regularly advised clients, family and community members to quit smoking. This followed a general belief that the issue of smoking was best raised by health workers, rather than traditional leaders. Protecting children from second-hand smoke and preventing smoking initiation was important to all participants irrespective of their smoking status. An enduring and highly valued cultural connection to ŋarali' (tobacco) remains an essential part of the sacred practices of the funeral ceremony, an important and unique social utility. The study found consensus among participants that this would not change. Navigating traditional connections to ŋarali' in a context where most people are still addicted to commercial tobacco is challenging and requires respectful and culturally compelling approaches. Tobacco control initiatives with the Yolŋu should therefore utilise existing smokefree leaders within the social context in which ŋarali' is valued and used, an approach that may resonate with other Indigenous Australian nations and communities.

Challenges of WASH in remote Australian Indigenous communities

Abstract Health and well-being are influenced by access and quality to safe drinking water, wastewater treatment, and hygiene practices and settings. This is recognised in the United Nations' Sustainable Development Goals for water and health. As a signatory to the UN Goals, Australia has a commitment to ensure the access and quality of these resources is attained for all, including Indigenous Australians living in remote communities. This research sought to identify the status of water, sanitation and hygiene services within remote communities on mainland Australia. Interviews were conducted with representatives of organisations providing water, sanitation and/or hygiene to communities. The quality and access of WASH services in remote Indigenous communities were revealed in this research as lacking at times in many communities. The qualitative results indicate that drinking water supplies can be contaminated by microbes or naturally occurring chemicals, wastewater treatment can be poorly maintained with irregular monitoring, and the health of residents is negatively impacted by crowding in houses, which affects residents' ability to maintain healthy hygiene levels of people, clothing, bedding and infrastructure. Effective responses require a collaborative and systemic approach by the respective government agencies responsible that effectively partner with – and adequately fund – Indigenous communities to provide options that are ‘fit for purpose, place and people’.

Associations between Community Environmental-Level Factors and Diet Quality in Geographically Isolated Australian Communities.

Remote Indigenous Australians experience disproportionately poor cardio-metabolic health, which is largely underpinned by adverse dietary intake related to social determinants. Little evidence exists about the community environmental-level factors that shape diet quality in this geographically isolated population group. This study aimed to explore the modifiable environmental-level factors associated with the features of dietary intake that underpin cardio-metabolic disease risk in this population group. Community-level dietary intake data were estimated from weekly store sales data collected throughout 2012 and linked with concurrent social, built, and physical environmental dimension data for 13 remote Indigenous Australian communities in the Northern Territory. Statistical analyses were performed to investigate associations. At the community level, store sales of discretionary foods were lower in communities with greater distance to a neighbouring store (r = −0.45 (p < 0.05)). Sales of sugar-sweetened beverages were lower in communities with higher levels of household crowding (r = −0.55 (p < 0.05)), higher levels of Indigenous unemployment (r = −0.62 (p = 0.02)), and greater distance to neighbouring stores (r = −0.61 (p = 0.004)). Modifiable environmental-level factors may be associated with adverse diet quality in remote Indigenous Australian communities and further investigations of these factors should be considered when developing policies to improve dietary intake quality in geographically isolated populations.

'We just don't talk about it': Aboriginal and Torres Strait Islander peoples' perceptions of cancer in regional Queensland.

Disparities in cancer outcomes between Indigenous and non-Indigenous people are well reported. Some Australian Indigenous communities' beliefs about cancer may influence health behaviours, support for those with cancer and ,ultimately, treatment outcomes. This project was instigated by request of a cultural adviser from a regional Queensland community and aims to make community perceptions of cancer visible, facilitate development of resources representing these perceptions and briefly evaluate the project from the community's perspective. The project was guided by qualitative, participatory and visual research methodology. Community participation was engaged by identifying community champions who helped recruit interested community members and continued project momentum. The project was defined and driven by community, and a consensus decision making approach was used to select resources or activities to represent community perceptions of cancer and raise cancer awareness. Qualitative data were collected from yarning groups at two community forums and subsequent group sessions to explore and define community perceptions of cancer. Informed consent was obtained prior to audio-taped yarning groups. Data were also included from publicly available interviews broadcast on radio and television. All data about community perceptions of cancer and of the project were thematically analysed. Photovoice using cameras was the visual method chosen to capture images and stories representing community cancer beliefs. Three main themes were derived from thematic analysis of data collected about community perceptions of cancer, identified by participants as important to improving cancer outcomes: (1) silence in the community, (2) support is important for survivorship and (3) awareness of cancer and the importance of sharing positive stories. A consensus decision-making approach resulted in the community choosing two resources to stimulate community discussion about cancer, raise awareness and reduce stigma. These were creating a community quilt, with each quilt square representing community perceptions of cancer, and producing a community calendar, with messages promoting healthy behaviours and cancer screening. The overall project was viewed as valuable for facilitating and improving the conversation about cancer with family, friends, the broader community and health professionals. Group sessions were considered important for providing a shared, safe space for support, for asking health related questions and as an instigator to share cancer related knowledge and stories with others. Silence around cancer may influence awareness and discussion about cancer, screening participation and help-seeking behaviour in this community. In this project, engaging with the community created a safe space for conversation around a previously taboo topic, which could lead to improved screening and help seeking behaviour. The role of primary health care in reducing health disparities by partnering with community to conduct awareness and prevention activities and by providing culturally appropriate care for Indigenous people is emphasised.

Felty syndrome. Case report

The Work It Out (WIO) program is a holistic chronic disease self-management and rehabilitation program in Queensland that is tailored for urban Aboriginal and Torres Strait Islander people with/at risk of chronic disease. This study aimed to examine the overall changes in participants’ exercise capacity and anthropometric measurements and to explore the correlations between these changes.Quasi-experimental prepost intervention study.A total of 406 participants self-identified as Aboriginal and Torres Strait Islander people, who had attended one or more cycles of the program from 2014 to 2017, were included. Health information from the last review assessment was compared with that of the initial assessment using paired t-tests. Multivariate regression models were applied to explore the associations between changes in 6-min walk distance (6MWD) and anthropometric measurements.An increase in 6MWD (77 m, 95% confidence interval [CI]: 65, 90), as well as small reductions in waist circumference (WC) (−1.79 cm, 95% CI: −2.76 to −0.82) and hip circumference (−1.11 cm, 95% CI: −2.13 to −0.08) were identified. Statistically significant reductions were observed across all anthropometric measures in the respective highest tertiles (body mass index: −0.71, 95% CI: −1.35 to −0.07; weight: −2.59 kg, 95% CI: −4.84 to −0.34; WC: −5.09 cm, 95% CI: −6.99 to −3.20; waist to hip ratio: −0.033, 95% CI: −0.047 to −0.02). The increments of 6MWD in returning participants (92 m, 95% CI: 75 to 109) was found to be greater than those in one-off participants (59 m, 95% CI: 40–78). In particular, the percentage of 6MWD change from baseline was significantly correlated to the percentage of WC change after adjusting for age, gender, the number of pre-existing chronic conditions, and the number of cycles attended (coefficient: −1.33, 95% CI: −2.42 to −0.24).Significant improvement in functional exercise capacity and modest changes in anthropometric measurements were identified in WIO participants. WC change could be used as an indicator of the change of participants’ six-minute walk distance. Findings may be useful for promoting and guiding similar health programs for improving chronic disease management in Australian Indigenous communities.

Reporting on key nutrition indicators as a decision support tool to improve diet quality in remote Indigenous Australian communities

Reporting on key nutrition indicators as a decision support tool to improve diet quality in remote Indigenous Australian communities

Burden of skin disease in two remote primary healthcare centres in northern and central Australia.

The burden of skin infections across all age groups in remote Australian Indigenous communities is currently unknown. In a retrospective audit of 439 residents from two remote communities presenting to health clinics, skin conditions were the most common reason for presentation (1603/7392, 22%) and 330/439 (75%) residents presented at least once with a skin infection. Skin infections are an under-appreciated and dominant reason for presentation to primary healthcare centres in these indigenous communities and public health campaigns to address this should incorporate all age groups.

“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” (n = 107), mostly current users, emphasized personal “financial impacts” and “stress.” “Category 2 – SOME CONCERN” (n = 141) perceived community level impacts warranting systematic action, particularly on “employment”; and “Category 3 – HIGH CONCERN” (n = 159), 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.

Review of principles governing dog health education in remote Aboriginal communities.

Conducting effective and culturally sensitive dog health education programs in Aboriginal communities requires an understanding of appropriate adult education and community development principles. Finding relevant material can be difficult, given that many of the available resources are in the 'grey literature'. To critically review publications addressing the principles governing dog health education in remote Aboriginal communities. A critical review was performed by searching English language peer-reviewed and grey literature databases for papers published between 2010 and 2018. Besides a small number of peer-reviewed papers, there was an extensive list of reports, educational material, guidelines and posters and pamphlets that illustrated the principles. Only a small amount of this grey literature was selected for the review. Selection was based on the publication illustrating a specific principle of dog health education. The material was organised around educational themes highlighting the strengths and weaknesses of these publications. Findings suggested that although relevant literature is scattered, there are clear processes for conducting culturally appropriate and effective dog health programs in Australian Indigenous communities. Two major principles were identified: acknowledging the effect on education of the ambiguity around the status of dogs in Aboriginal communities, and embedding programs within a social determinant of health framework or community development approach. These two principles provide guidance on negotiating educational sessions, the preparation of culturally appropriate materials, teaching sessions and what learning styles to foster and the use of a health promotion approach. Some contradictions exist within the literature, particularly around the use of images, and consistent with the first principle, a hesitancy to engage with Aboriginal people around the issue of dog health.

Contemporary Australian Profile of Rheumatic Fever: Results From Multiple Jurisdictions

Introduction: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) rates among Indigenous Australian communities are among the highest globally, yet no national reliable data exist on the burden. We aim to provide the first quasi-national description of ARF in Australia. Methods: Northern Territory (NT), Queensland, Western Australia and South Australia residents (NSW data forthcoming) with a diagnosis of ARF were identified from person-linked jurisdiction-specific in-patient hospital (ICD codes I00–I02) and ARF register data 2015–2017. ARF records were categorised into 3-month episodes. First-ever ARF was determined through interrogation of register/hospitalisation ARF/RHD dates and by applying a 13.5-year look-back period to hospital data. Age-specific (10-year age groups, 0–54 years), age-standardised first-ever and total ARF incidence rates were calculated by Indigenous status, and sex, with incident rate ratios (IRR) used for comparison across sub-populations. Recurrences per person-years were calculated for first-ever cases. Results: 1401 episodes (91% Indigenous, 55% female, 82% first-ever) pertaining to 1297 people were identified, predominantly from NT (56%) and Queensland (28%). First-ever incidence rates peaked at 5–14 years (46/100,000) and 15–24 years (19/100,000). Compared with non-Indigenous, Indigenous age-standardised first-ever rates (0–54 years) were significantly higher (IRR(all) = 113.7; IRR(females) = 137.7; IRR(males) = 90.8). Total IRRs were even higher. Recurrence rates were highest among females, people aged 5–14 years and NT residents. Conclusion: These findings confirm the unacceptably high risk of ARF among Indigenous Australians. The study provides the first incidence data using integrated/linked data from registers and hospitals, providing a comprehensive baseline from which to assess much-needed multi-sectoral policies to end ARF/RHD in Australia.

Striped bodypainting protects against horseflies.

Bodypainting is widespread in African, Australian and Papua New Guinean indigenous communities. Many bodypaintings use white or bright yellow/grey/beige stripes on brown skin. Where the majority of people using bodypainting presently live, blood-sucking horseflies are abundant, and they frequently attack the naked brown regions of the human body surface with the risk of transmitting the pathogens of dangerous diseases. Since horseflies are deterred by the black and white stripes of zebras, we hypothesized that white-striped paintings on dark brown human bodies have a similar effect. In a field experiment in Hungary, we tested this hypothesis. We show that the attractiveness to horseflies of a dark brown human body model significantly decreases, if it is painted with the white stripes that are used in bodypaintings. Our brown human model was 10 times more attractive to horseflies than the white-striped brown model, and a beige model, which was used as a control, attracted two times more horseflies than the striped brown model. Thus, white-striped bodypaintings, such as those used by African and Australian people, may serve to deter horseflies, which is an advantageous byproduct of these bodypaintings that could lead to reduced irritation and disease transmission by these blood-sucking insects.

Energy security, transnational politics, and renewable electricity exports in Australia and Southeast Asia

This paper seeks to identify potential energy security risks and opportunities of new renewable energy (RE) export projects such as transnational solar generated electricity. An energy security framework/index is sought, to facilitate analysis; and which shows promise for application to other electricity/RE export projects. A review of energy security literature identifies Sovacool and Mukherjee's (2011) [1] comprehensive index as most suitable to apply to a case study project (in its early feasibility stage). The project proposes to export solar-generated electricity from the Pilbara, Western Australia to Java, Indonesia. Additions to the chosen index are proposed, strengthening its scope regarding human security, geopolitical/foreign policy, and materials risks. Analysis identifies key potential risks and opportunities, and gaps in the project’s currently scarce analysis. The project’s primary risks may arise in the regulation and governance dimension. These include Australia’s stalled energy politics; required new business and regulatory frameworks; and the under-developed Australia-Indonesia trade relationship, partly due to historical cultural differences. Questions arise regarding price stability, affordability, access and equity for Indonesians; reliability and resilience risks; and environmental impacts. While potentially positive outcomes may arise for local (Indigenous) Australian communities, more analysis is needed on whether Australian investment in exports should prioritize (or equalize) large-scale electricity grid infrastructure and/or distributed energy systems, when considering impacts on Indonesian communities. Ultimately, the expanded index can inform development of new transnational renewable energy and electricity projects, and improve forward-thinking on risk management.

The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community.

Traditional Elders are integral to the social structure of Australian Indigenous communities. Due to progressive loss of traditional way of life, however, the role of Elders has been eroding. This study aims to develop a conceptual model of the role of Elders in an Australian Indigenous community, with the goal of attaining strategies to strengthen the role of Elders. The study, conducted in a regional Indigenous community in Australia, adopted a community-based participatory approach. Design and focus of the project were informed by a community forum (Yarning Circle). One-on-one semistructured interviews and focus groups with community members were conducted by Indigenous researchers. Group concept mapping (GCM) was applied to elicit major themes in qualitative data, from the point of view of community members, and to derive a conceptual model of the role of Elders. Fifty members of the Indigenous community took part in interviews and focus groups. The participants' median age was 45 years (range 18-76 years); 31 (62%) were female. An additional 24 Indigenous community members took part in the data sorting task of GCM. GCM identified seven major aspects of the role of Elders, including Community relations, Passing down the knowledge, Dealing with racism and oppression, Building a better resourced community, Intergenerational connectedness, Safeguarding our identity, and Caring for our youth. Elders fulfill many important roles in contemporary Indigenous communities. Our results can be used to assist the community to codesign a program to increase community wellbeing.

Indigenous Women's Sporting Experiences: Agency, Resistance and Nostalgia

Australian sports historiography, in privileging Western, reconstructionist approaches to narrating histories of Aboriginal sport, has overlooked Indigenous research methodologies that privilege Aboriginal voices. This paper adopts the Indigenous research methodology of yarning in a collaborative project with former sportswomen from the Cherbourg Aboriginal Settlement in Queensland. Yarning, as a culturally respectful way of eliciting memories and valuing expression of Indigenous voices, was used to explore their experiences, memories and meanings of competitive marching, a popular sport for young women in mid‐twentieth century Australia. The yarning sessions revealed insights into sport that are missing from the empirical, archival record, and allowed the exploration of agency and autonomy, acts of resistance, and complex intersections of nostalgia and trauma. This paper offers specific and broader insights on sport in Australian Indigenous communities and on the entanglement of the sporting past with the histories and politics of race and gender in Queensland. In repositioning researcher and researched in Aboriginal sport history, this paper demonstrates the potential of transformative narratives about the experiences of Indigenous Australians.

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.

Zoonotic Helminth Diseases in Dogs and Dingoes Utilising Shared Resources in an Australian Aboriginal Community

The impacts of free-roaming canids (domestic and wild) on public health have long been a concern in Australian Indigenous communities. We investigated the prevalence of zoonotic helminth diseases in dogs and sympatric dingoes, and used radio telemetry to measure their spatial overlap, in an Aboriginal community in the Wet Tropics of Australia. Samples collected from dingoes and dogs showed high levels of infection with the zoonotic hookworm, Ancylostoma caninum. Dingoes were also positive for A. ceylanicum infection (11.4%), but dogs were infection free. Whipworm, Trichuris vulpis, infection was far more prevalent in necropsies of domestic dogs (78.6%) than dingoes (3.7%). Dogs were free from Dirofilaria immitis infection, while dingoes recorded 46.2% infection. Eleven dingoes and seven free-roaming domestic dogs were fitted with Global Positioning System collars and tracked over an extended period. Dingo home-ranges almost completely overlapped those of the domestic dogs. However, dingoes and dogs did not utilise the same area at the same time, and dogs may have avoided dingoes. This spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of parasites between dogs and dingoes. Tracking and camera traps showed that the community rubbish tip and animal carcasses were areas of concentrated activity for dogs and dingoes.

Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial

Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16-29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory-based sexually transmissible infection testing for 12 months followed by 12 months of intervention with molecular point-of-care testing, or the reverse sequence. The primary outcome was the proportion of people (aged 16-29 years) found to have C trachomatis or N gonorrhoeae who had a positive result at retesting 3 weeks to 3 months after treatment, and a secondary outcome was treatment within 7 days, both in those aged 16-29 years and at the cluster level. We did these analyses using data from all participants who had a positive result at testing, by point-of-care of laboratory testing (ie, the intention-to-treat population). The trial is registered with Australian and New Zealand Clinical Trials Registry (ACTRN12613000808741). Between June 1, 2013, and Feb 29, 2016, 12 health services were enrolled and randomly assigned to standard care followed by intervention (six) and the reverse sequence (six). After randomisation, one health service that was initially assigned to standard care was excluded because it no longer met the inclusion criteria. 455 individuals tested positive for C trachomatis or N gonorrhoeae infection in the intervention group, and 405 tested positive in the standard care group. In the intervention group, 12 (19%) of 63 individuals retested had a positive test result, compared with nine (13%) of 67 with positive retests in the standard care group (relative ratio [RR] 1·42, 95% CI 0·64-3·13; p=0·405), and 347 (76%) were treated within 7 days in the intervention group, compared with 191 (47%) in the standard care group (RR 1·66, 1·41-1·93; p<0·0001). Retesting rates were too low to draw conclusions on the effect of the intervention on repeat infections. Further research will be needed to determine whether point-of-care tests have an effect on reinfection rates, and the sustainability of using this technology. However, our findings show that time to treatment of C trachomatis or N gonorrhoeae infections in primary care clinics in remote areas in Australia with a high prevalence of sexually transmissible infections could be substantially reduced by the use of molecular point-of-care tests. The National Health and Medical Research Council, Australia.

Postcolonial, decolonial research dilemmas: fieldwork in Australian Indigenous contexts

We come to this article as non-Indigenous teacher educators working as qualitative researchers in postcolonial/decolonial (Mignolo, 2000) times. We explore matters related to schooling in remote Australian Indigenous communities. In this article, we respond to Delamont’s invitation for qualitative researchers to revisit (Delamont and Hamilton, 1984) and think reflexively (Delamont, 2009) about our field work research methods. In doing so, attention is drawn to research processes involved with observing, narrating and writing lives and experiences. We highlight matters related to sequencing dilemmas (Delamont, 2009), the need to locate the self-as-researcher in the social (Delamont, 2007), and calling out ethical tensions associated with the ‘catch 22’ of confidentiality and acknowledgement (Delamont, 2007). Two separate researcher recounts of field notes are used to render visible our reflexive thinking as we attempt to negotiate Western educational research ethics policies and procedures and ways of knowing and being in Indigenous contexts.

A longitudinal observation study assessing changes in indicators of serious injury and violence with alcohol controls in four remote indigenous Australian communities in far north Queensland (2000\u20132015)

BackgroundLegal restrictions on alcohol availability have been used to address violence and injury in the world’s remote Indigenous communities. In Australia, alcohol management plans (AMPs) were implemented by the Queensland Government in 2002. This study reports changes in indicators of alcohol-related violence and injury in selected communities.MethodsDesign and setting: A longitudinal observational study was conducted in four Aboriginal and Torres Strait Islander (Indigenous) communities in Cape York, far north Queensland. All communities are similarly-isolated from population centres where alcohol is available.Data: For 2000 to 2015 inclusive: 1019 Royal Flying Doctor Service aeromedical trauma retrievals; 5641 Queensland Police Service records of unique assault occurrences, including 2936 involving alcohol; and records for 2741 unique assault victims were examined.Data analysis:Rates (per 1000 population) of trauma retrievals, assault occurrences and assault victims (per 1000 population) were compared across three policy phases.Phase 1: 2000 to 2008. Initial restrictions on possession and consumption of alcohol in ‘restricted areas’ were implemented during 2002–2003.Phase 2: 2009 to 2012. All alcohol was prohibited in three study communities and its legal availability limited in the fourth from 2009.Phase 3: 2013 to 2015. Government reviews of AMP policies in light of legal challenges and community responses characterise this phase.ResultsCompared with Phase 1, in Phase 2 retrieval rates declined by − 29.4%, assault occurrences by − 34.1% with less than one-third involving alcohol, and assault victims by − 21.1%, reaching historically low levels in 2010–2012. These reductions did not continue consistently. Compared with Phase 1, in Phase 3 retrieval rates, assault occurrence rates and assault victim rates declined by somewhat lesser amounts, − 13.9%, − 15.0% and − 13.4%, respectively. In Phase 3, the proportion of assault occurrences involving alcohol in communities 2, 3 and 4 rose towards pre-2008 levels.ConclusionsEarly successes of these controversial alcohol restrictions are jeopardised. Indicators of violence and injury appear to be rising once more in some AMP communities. Importantly, rates have not generally exceeded the highest levels seen in Phase 1. Fresh policy action is required with rigorous monitoring to prevent erosion of initial important successes.