Meet us where we are: non-Indigenous young peoples' ideas on how to reduce alcohol-related harm in Mparntwe (Alice Springs).

OBJECTIVE: This research sought to understand the strategies young people in a remote central Australian town believed would reduce alcohol-related harms amongst their peers. METHODS: A total of 38 non-Indigenous residents of Mparntwe (Alice Springs), aged between 14 and 18 years, participated in focus groups at their school. Participants discussed strategies they thought would reduce alcohol-related harms among people their age. Data were analysed using thematic analysis. RESULTS: Participants suggested that young peoples' drinking behaviour developed with peers. Through social learning in peer groups, drinking alcohol was perceived as fun and normal. Participants indicated a willingness to learn about strategies to stay safe around alcohol. Their ideas for doing so reflected their existing social methods of learning about alcohol: having comfortable conversations and storytelling with a small group of peers and a relatable role model. CONCLUSIONS: Young residents of Mparntwe (Alice Springs) advised that alcohol-related harm reduction strategies would be most effective if focussed on safety, rather than abstinence, and applied social-learning strategies. IMPLICATIONS FOR PUBLIC HEALTH: Young people value their burgeoning self-determination. Youth health interventions must engage youth in intervention co-design and aim to assist young people to make safer decisions, rather than making decisions on their behalf.

Effectiveness of strategies to reduce risky alcohol consumption among youth living in rural or remote areas: a systematic review.

OBJECTIVE: This review aimed to evaluate the effectiveness of strategies to reduce risky alcohol consumption among youth living in rural and remote areas. INTRODUCTION: Youth living in rural and remote areas are more likely to drink alcohol and experience alcohol-related harm than youth living in urban locations. This review assessed the effectiveness of strategies to reduce young people's risky alcohol consumption in rural and remote areas. INCLUSION CRITERIA: We considered papers that included youth (aged 12 to 24 years; also referred to in this review as young people ) who were identified as living in rural or remote locations. Any intervention or strategy designed to reduce or prevent alcohol consumption among this population was included. The primary outcome was frequency of short-term risky alcohol consumption as measured by self-reported incidents of drinking 5 or more standard drinks in 1 session. METHODS: We conducted this systematic review in accordance with the JBI methodology for systematic reviews of effectiveness. We searched for published and unpublished English-language studies and gray literature from 1999 to December 2021. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data to identify studies that reported duplicate data (eg, due to progressive publication of longitudinal data sets) and, where multiple studies reported the same data set, the study with the measure most proximal to the primary outcome measure and/or with the longest follow-up was selected. Two authors then critically appraised the studies. There were no interventions that were assessed for impact on the primary outcome in more than 1 study; in turn, the feasibility and utility of statistical pooling and the Summary of Findings were limited. Instead, results and certainty of evidence is provided in narrative format. RESULTS: Twenty-eight articles reporting on 16 studies were included in the review: 10 randomized controlled trials, 4 quasi-experimental studies, and 2 cohort studies. All studies except 1 were conducted in the United States. Only 3 studies measured the primary outcome of short-term risky alcohol consumption and included a comparison group. A meta-analysis of 2 of these studies showed that interventions that included motivational interviewing had a small and non-significant effect on short-term risky alcohol consumption among Indigenous youth in the United States. Meta-analyses of the effect of a variety of interventions on secondary outcomes demonstrated that intervention was not more effective than control for reducing past month drunkenness; however, intervention was more effective for reducing past month alcohol use (odds radio 0.3; 95% CI 0.13 to 0.67; P =0.003). The heterogeneity of effects was evident within these meta-analyses as well as in the studies unable to be meta-analyzed. CONCLUSION: Based on this review, no interventions can be broadly recommended for reducing short-term risky alcohol consumption among youth in rural and remote areas. Further research to increase the robustness of available evidence in relation to the effectiveness of strategies to reduce short-term risky alcohol consumption among youth in rural and remote areas is urgently required. REVIEW REGISTRATION: PROSPERO CRD42020167834.

Association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities: a systematic review.

OBJECTIVE: The objective of this review was to examine the association between alcohol supply restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities. INTRODUCTION: Aboriginal and Torres Strait Islander peoples living in remote communities experience a higher rate of alcohol-related harms than other Australians. High rates of alcohol consumption are associated with a range of physical and social harms. Restricting the supply of alcoholic beverages in Aboriginal and Torres Strait Islander communities is often used by governments as a strategy to reduce these harms, but the current evidence is conflicting. INCLUSION CRITERIA: This review considered all quantitative studies with Aboriginal and Torres Strait Islander participants living in remote communities in Australia, where the participants were exposed to restrictions on the supply of alcoholic beverages. Harms of interest were i) physical injuries (whether secondary to assaults or accidents), measured as hospital admissions, Royal Flying Doctor Service attendance and transfers, and reported assaults, including intimate partner or family violence; ii) alcohol-related illnesses, measured as hospital admissions for conditions primarily attributed to alcohol consumption; and iii) rates of alcohol consumption, measured as alcohol sales per person or as self-reported consumption. METHODS: We searched a wide range of databases and gray literature resources for published and unpublished, English-language studies from 1998 to 2020. Two reviewers independently screened search results and selected citations for full-text retrieval. Two reviewers independently assessed each article for congruence to the inclusion criteria. Critical appraisal and data extraction were conducted by two reviewers working independently. Data were narratively synthesized because statistical pooling was not possible. RESULTS: We included 13 observational studies with more than 15,800 participants. Most included studies reported some harm reductions in association with a variety of alcohol supply restrictions; however, these reductions were sometimes short-lived. Studies reported on a variety of supply reduction strategies, ranging from small limitations on when alcohol could be sold to total prohibition of alcohol within the community. None of the interventions examined in the included studies reported consistent results. Total prohibition of alcohol was initially associated with large reductions in consumption but also led to unintended consequences, such as illicit substance use, alcohol consumption outside of the community, and illegal importation of alcohol into the community. We were unable to make any strong recommendations based on the included studies due to inherent bias in the study designs employed. CONCLUSIONS: Problematic use of alcohol by Aboriginal and Torres Strait Islander peoples is unlikely to be solved by a single strategy. Total alcohol prohibition does not stop people from seeking and accessing alcohol, and may in fact lead to a range of negative unintended consequences. Future studies should be more rigorously designed and reported to increase the strength of the evidence and certainty in the results.

Barriers to and facilitators of engagement with early-intervention services by pregnant people at risk of child removal: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize existing qualitative, quantitative, and mixed methods evidence in order to identify and examine the barriers to and facilitators of engagement with early-intervention services by pregnant people at risk of child removal. INTRODUCTION: Early intervention and prevention is key to reducing the risk of child abuse, neglect, and removal. Prenatal screening and referral to appropriate treatment and supports underpins best practice early-intervention responses. However, research suggests that pregnant people most in need of support services are often those least likely to engage with them. For early intervention to work, the barriers and facilitators of prenatal engagement must be identified and addressed within service and practice approaches with this group. INCLUSION CRITERIA: This mixed methods systematic review will consider qualitative, quantitative, and mixed methods studies of pregnant people at risk of child removal. Studies will be considered if they report on barriers to or facilitators of engagement in early-intervention services that address risk factors for child removal. METHODS: The systematic review will be conducted in accordance with JBI methodology for mixed methods systematic reviews. A range of databases will be searched, including Informit online, MEDLINE (Ovid), ProQuest Central and Social Sciences Premium, PsycINFO (Ovid), and Scopus (Elsevier). Critical appraisal and data extraction for studies meeting the inclusion criteria will be performed by two reviewers using standardized JBI tools. Data synthesis will follow the convergent integrated approach to mixed methods systematic reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021254794.

Effectiveness and appropriateness of culturally adapted approaches to treating alcohol use disorders in Indigenous people: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review is to investigate the effectiveness and appropriateness of culturally adapted approaches for treating alcohol use disorders in Indigenous peoples in Canada, New Zealand, Australia, and the USA. INTRODUCTION: Poor and disadvantaged people, particularly those who are Indigenous, suffer more health effects due to alcohol misuse and are therefore subject to more law enforcement actions. Analyses have identified strategies for improving health services for Indigenous people; chief among these is culturally safe care specifically tailored to the context. Alcohol addiction is a chronic relapsing condition that usually requires ongoing treatment, so it is vital that treatment therapies are appropriate, meaningful, and effective. Many evidence-based therapies for substance abuse have not been specifically designed for or tested in Indigenous and First Nations communities. This absence of cultural considerations may be a contributor to the failure of these programs to engage with clients and successfully influence their behavior. INCLUSION CRITERIA: This review will consider qualitative and quantitative studies of any methodology, published in any language after 1998. Studies including adult and/or adolescent participants in inpatient or outpatient alcohol treatment programs described as being adapted to meet cultural needs will be considered. METHODS: This review will use the convergent segregated approach to mixed methods reviews. A range of databases will be searched, including MEDLINE, CINAHL, Embase, and PsycINFO. Two reviewers will critically appraise and extract data from studies meeting the inclusion criteria. Qualitative research findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach, and quantitative studies will, where possible, be pooled in statistical meta-analysis using JBI SUMARI. The JBI convergent segregated approach to mixed methods reviews will be followed.

Effectiveness of strategies for reducing risky alcohol consumption among youth living in rural or remote areas: a systematic review protocol.

OBJECTIVE: The aim of this review is to evaluate the effectiveness of strategies for reducing risky alcohol consumption among youth living in rural and remote areas. INTRODUCTION: Youth living in rural and remote areas are more likely to drink alcohol and are at higher risk of experiencing alcohol-related harm than youth living in urban locations. However, a review has not yet been conducted evaluating the effectiveness of strategies for reducing young people's risky alcohol consumption in rural and remote locations. INCLUSION CRITERIA: This systematic review will consider papers that include youth (aged 12 to 24 years) who are identified as living in rural, remote, regional, non-urban or non-metropolitan locations. Any intervention or strategy with the purpose of reducing or preventing alcohol consumption or alcohol-related harms among this population will be considered. The primary outcome is frequency of short-term risky alcohol consumption, as measured by self-reported incidents of drinking five or more standard drinks. Secondary outcomes will also be included. METHODS: Sources of published studies, unpublished studies and gray literature will be searched. Only studies in English published from 1999 will be included. Titles and abstracts of all search results will be screened. The full text of potentially relevant studies will then be assessed in detail. Studies will be stratified by methodological quality. The data extracted will include specific details about the populations, study methods, interventions and outcomes. Studies will be pooled in statistical meta-analysis, where possible, and where statistical pooling is not possible, the findings will be presented in narrative form.

Cognitive bias modification for energy drink cues.

Energy drink consumption is increasing worldwide, especially among young adults, and has been associated with physical and mental health problems. In two experiments, we tested the prediction that energy drink consumption is in part driven by biased cognitive processing (attentional and approach biases), with a view to modifying these to reduce consumption. Young adults (18-25 years) who regularly consume energy drinks completed the dot probe (Exp.1; N = 116) or approach-avoidance task (Exp.2; N = 110) to measure attentional and approach bias for energy drink cues, respectively. They then underwent a cognitive bias modification protocol where they were trained to direct their attention away from pictures of energy drink cans (Exp.1), or to push a joystick away from themselves in response to these pictures (Exp.2). Following a post-training assessment of attentional (Exp.1) or approach bias (Exp.2), energy drink consumption was measured by an ostensible taste test. Regular energy drink consumers showed both an attentional and an approach bias for energy drink cues. Cognitive bias modification successfully reduced both biases. However, neither attentional nor approach bias modification significantly reduced energy drink intake. The results lend some support to incentive sensitisation theory which emphasises the role of biased decision-making processes related to addictive behaviours.

Association between restriction policies and rate of alcohol-related harm in Australian Aboriginal and Torres Strait Islander communities: a systematic review protocol.

OBJECTIVE: This review aims to examine the association between alcohol restriction policies and rates of alcohol-related harms in Australian Aboriginal and Torres Strait Islander communities. INTRODUCTION: A number of different strategies have been used to reduce the harms and costs associated with excessive alcohol consumption in Aboriginal and Torres Strait Islander communities. These strategies, implemented at federal and state government levels, as well as by individual communities, have aimed to promote reduced alcohol consumption or prohibit consumption entirely. Strategies to address the problems associated with alcohol misuse can be categorized into three types: harm, demand and supply reduction. INCLUSION CRITERIA: This review will consider any kind of quantitative research study that includes Australian Aboriginal and Torres Strait Islander peoples living in communities subject to alcohol control policies due to the imposition of alcohol management plans or other alcohol restriction policies. Included studies will measure physical alcohol-related harms. The secondary outcome of interest will be rates of alcohol consumption measured as alcohol sales per person or as self-reported consumption. Studies published in English from 1998 will be included. METHODS: The proposed systematic review will be conducted in accordance with the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise and extract data from studies meeting the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be constructed.

Treating bulimia nervosa in the context of gender dysphoria using 10-session cognitive behavior therapy.

OBJECTIVE: This case report describes the psychological treatment for bulimia nervosa of a 16-year old with co-occurring gender dysphoria. He reported restricting his food intake and purging for approximately 1 year prior to therapy commencing. METHOD: Ten sessions of cognitive behavioral therapy for eating disorders (CBT-T) were conducted with accommodations for gender-specific body dissatisfaction. RESULTS: The client eliminated binging and purging from the second treatment session and had maintained this at the 3-month follow-up. The quantity and variety of foods he was eating had increased and he no longer reported subjective binges. Improvements were also evident in his depression, anxiety and stress symptoms. DISCUSSION: This suggests that bulimia nervosa may be effectively treated with CBT-T in the context of gender dysphoria. Further research that investigates the generalizability of these outcomes would be beneficial.