Developing Aboriginal and Torres Strait Islander cultural indicators: an overview from Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing.

BACKGROUND: For Aboriginal and Torres Strait Islander peoples, culture is foundational to health and wellbeing. However, its inherent conceptual complexity and diversity across and within different Aboriginal and Torres Strait Islander cultural groups means that it has rarely been explored in depth by epidemiological research. As a result, there are very few measures which adequately represent the heterogeneity and importance of Aboriginal and Torres Strait Islander cultures for health and wellbeing. Tools grounded in the social determinants of health are mostly based on European academic opinion about what constitutes culture and wellbeing, and the views of Indigenous peoples are rarely included. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, developed a new survey tool based on health and wellbeing as perceived by Aboriginal and Torres Strait Islander people. This paper describes several of the key processes used to identify cultural domains and develop questionnaire items for the survey tool, reflecting the importance of culture to Aboriginal and Torres Strait Islander peoples. METHODS: Focus groups were conducted at community organisations and conferences with Aboriginal and Torres Strait Islander people. These sessions were aimed at identifying key cultural domains to be addressed by the Mayi Kuwayu questionnaire and to field test drafts of the questionnaire, which were then modified according to focus group feedback and expert input. RESULTS: Extensive community consultations allowed us to identify key cultural domains, generate questionnaire items, and test initial content validity. The six overarching cultural domains identified during the development of the Mayi Kuwayu questionnaire were: Connection to Country; Beliefs and knowledge; Language; Family, kinship, and community; Cultural expression and continuity; and Self-determination and leadership. CONCLUSIONS: The processes used by Mayi Kuwayu have generated meaningful cultural items for use in Aboriginal and Torres Strait Islander health and wellbeing research. Further assessment of these processes, including a comparison with best practice guidelines and psychometric testing of the items and scales developed, will be conducted in a future program of work.

"We are not stray leaves blowing about in the wind": exploring the impact of Family Wellbeing empowerment research, 1998-2021.

BACKGROUND: An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of the program, over a 23 year period. The aim is to assess the long-term impact of FWB research and identify the key enablers of research impact and the limitations of the impact assessment exercise. This will inform more comprehensive monitoring of research impact into the future. METHODS: To assess impact, the study took an implementation science approach, incorporating theory of change and service utilisation frameworks, to create a logic model underpinned by Indigenous research principles. A research impact narrative was developed based on mixed methods analysis of publicly available data on: 1) FWB program participation; 2) research program funding; 3) program outcome evaluation (nine studies); and 4) accounts of research utilisation (seven studies). RESULTS: Starting from a need for research on empowerment identified by research users, an investment of $2.3 million in research activities over 23 years produced a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in the FWB program. Accounts of research utilisation confirmed the role of research outputs in educating participants about the program, and thus, facilitating more demand (and funding acquisition) for FWB. Overall research contributed to 5,405 recorded participants accessing the intervention. The key enablers of research impact were; 1) the research was user- and community-driven; 2) a long-term mutually beneficial partnership between research users and researchers; 3) the creation of a body of knowledge that demonstrated the impact of the FWB intervention via different research methods; 4) the universality of the FWB approach which led to widespread application. CONCLUSIONS: The FWB research impact exercise reinforced the view that assessing research impact is best approached as a "wicked problem" for which there are no easy fixes. It requires flexible, open-ended, collaborative learning-by-doing approaches to build the evidence base over time. Steps and approaches that research groups might take to build the research impact knowledge base within their disciplines are discussed.

Alcohol and Other Drug Service Availability, Capacity, and Diversity in Urban and Rural Australia: An Integrated Atlas.

OBJECTIVE: Variation exists in the patterns of alcohol and other drug (AOD) use and related impacts across geographic locations and over time. Understanding the existing AOD service system and the local context that it operates within is fundamental to optimize service provision. This article describes and compares the availability, placement capacity, and diversity of AOD services in urban and rural regions in Australia. METHOD: The Description and Evaluation of Services and DirectoriEs (DESDE) tool was used to categorize the service delivery system for AOD care in selected urban and rural regions in Australia. RESULTS: This study found that although AOD services (303 main types of care) were available across all study regions, there was consistently very limited availability of services targeting young people (n = 39, 13%) or older adults (n = 1, <1%). There were also very limited services addressing comorbidities. Availability and diversity of services varied across study areas. Outpatient and residential care were the most available services, whereas day care services were absent in most areas. CONCLUSIONS: By describing the capacity of identified available services within the study regions, this study provides baseline information to inform changes to policy and practice and a foundation for monitoring and modeling service changes over time. This information provides evidence useful for optimal planning. However, it should be combined with local knowledge and stakeholder expertise to ensure that local area service needs are addressed.

Reliability, validity, and clinical utility of a culturally modified Kessler scale (MK-K5) in the Aboriginal and Torres Strait Islander population.

BACKGROUND: Aboriginal and Torres Strait Islander peoples are the first people of Australia. Consequences of historic and contemporary settler-colonialism including racism, trauma, grief and loss (of land, culture, spirituality, and freedoms) have led to substantial negative health and wellbeing impacts. The Kessler Psychological Distress Scales are population and individual-level tools designed to measure general psychological health status. There has been limited assessment of the psychometric properties and validity of the Kessler Psychological Distress Scale for use with the Aboriginal and Torres Strait Islander population in Australia, despite its widespread use. METHODS: A national sample of Aboriginal and Torres Strait Islander adults (n = 6988 ≥ 16 years) was used in the psychometric assessment of the MK-K5, which involved face validity, acceptability, internal consistency/reliability, construct validity, and convergent and divergent validity testing. Receiver Operator Characteristics (ROC) curves were produced to assess clinical utility for depression and anxiety screening. RESULTS: The MK-K5 demonstrated face validity for psychological distress in two focus groups, and had good acceptability, good internal consistency/reliability (α = 0.89), good construct validity (uni-dimensional; one underlying component explaining 70.1% of variance), and demonstrated convergent and divergent validity in the sample. The MK-K5 had good clinical utility at a cut-off score of 11 for detecting ever being diagnosed with depression or anxiety. CONCLUSIONS: The MK-K5 is a valid measure of psychological distress and has clinical utility in the Aboriginal and Torres Strait Islander population.

A latent class analysis of psychiatric symptom profiles associated with past-month methamphetamine use.

We explored latent psychiatric symptom profiles associated with methamphetamine use, and examined how these corresponded to diagnoses of schizophrenia (SZ) and methamphetamine-associated psychosis (MAP). We assessed psychiatric symptoms among 160 people who had used methamphetamine in the past month. Psychiatric symptoms were defined as a score of 4+ on Brief Psychiatric Rating Scale (BPRS) items. Diagnoses were made using the Composite International Diagnostic Interview (CIDI). Participants were defined as having MAP if they met symptom criteria for SZ, but symptoms were considered to be always the result of substance use. Latent class analysis identified three classes. Class one (44% of participants) had a low probability of most BPRS symptoms; 4% met criteria for SZ, 51% for MAP. Class two (31% of participants) had a higher probability hallucinations and suspiciousness (37-46%); 72% met criteria for MAP, and 7% for SZ. Class three (25% of participants) had the highest probability for all positive psychotic symptoms (hallucinations, suspiciousness, grandiosity, unusual thought content; 32-82%), and reported activation, conceptual disorganisation, and tension (35% met criteria for SZ and 17% for MAP). We found three distinct classes of psychiatric symptom profiles, two of which showed partial alignment with diagnostic constructs of SZ and MAP.

'We walked side by side through the whole thing': A mixed-methods study of key elements of community-based participatory research partnerships between rural Aboriginal communities and researchers.

OBJECTIVES: To advance the rural practice in working with Aboriginal communities by (a) identifying the extent of community partners' participation in and (b) operationalising the key elements of three community-based participatory research partnerships between university-based researchers and Australian rural Aboriginal communities. DESIGN: A mixed-methods study. Quantitative survey and qualitative one-on-one interviews with local project implementation committee members and group interviews with other community partners and project documentation. SETTING: Three rural Aboriginal communities in New South Wales. PARTICIPANTS: Thirty-seven community partners in three community-based participatory research partnerships of which 22 were members of local project implementation committees and 15 were other community partners who implemented activities. INTERVENTION: Community-based participatory research partnerships to develop, implement and evaluate community-based responses to alcohol-related harms. MAIN OUTCOMES MEASURES: Community partners' extent of and experiences with participation in the community-based participatory research partnership and their involvement in the development and implementation processes. RESULTS: Community partners' participation varied between communities and between project phases within communities. Contributing to the community-based participatory research partnerships were four key elements of the participatory process: unique expertise of researchers and community-based partners, openness to learn from each other, trust and community leadership. CONCLUSION: To advance the research practice in rural Aboriginal communities, equitable partnerships between Aboriginal community and research partners are encouraged to embrace the unique expertise of the partners, encourage co-learning and implement community leadership to build trust.

Factors Associated with Alcohol-Related Injuries for Aboriginal and Non-Aboriginal Australians: An Observational Study.

Alcohol use and related injuries are a leading risk factor for deaths and disabilities in Australia, particularly for Aboriginal and Torres Strait Islander people. An improved understanding of individual and geographical community characteristics that are significantly associated with higher rates of alcohol-related injuries for specific populations can contribute to more effective efforts aimed at reducing alcohol-related injuries. For Aboriginal and non-Aboriginal Australians in New South Wales, this study used emergency department (ED) data to investigate rates of alcohol-related injuries, whether differences in rates vary between communities, and individual and community characteristics significantly associated with alcohol-related injuries. Differences in rates of alcohol-related injuries between Aboriginal and non-Aboriginal people varied significantly between communities. Being younger than 38 years old was significantly associated with increased risk of alcohol-related injuries, independent of Aboriginal status and gender. Increased disadvantage of the geographical community inhabited was associated with increased alcohol-related injuries for males. For Aboriginal males, living in a regional community was significantly associated with increased alcohol-related injuries, compared to living in major cities. Conversely, for non-Aboriginal people, living in regional communities was significantly associated with fewer alcohol-related injuries. It is therefore likely that an explanation for between-community differences can be found in regional communities.

Reducing drug and alcohol use and improving well-being for Indigenous and non-Indigenous Australians using the Community Reinforcement Approach: A feasibility and acceptability study.

There is a lack of evidence of effective and appropriate drug and alcohol treatment for Aboriginal and Torres Strait Islander peoples. This paper contributes to addressing the evidence gap by examining the feasibility and acceptability and conducting a pre/post-evaluation of the Aboriginal-adapted Community Reinforcement Approach (CRA) delivered in New South Wales, Australia. Aboriginal and non-Aboriginal clients (n = 55) received tailored CRA delivery between March and November 2013. Compared to the original US version, tailored CRA had reduced technical language, reduced number of treatment sessions, and the addition of group delivery option. An Australian training manual with local case studies was developed. Alcohol, Smoking and Substance Involvement Test (ASSIST), Kessler-5 (K-5) and the Growth Empowerment Measure were used. 58% of participants were followed-up at 3 months. Tailored CRA was feasible to deliver in a rural, community-based health setting, and rated by clients as highly effective and acceptable. CRA was associated with statistically significant reductions in the use of alcohol, tobacco, cannabis, amphetamine and over the counter medication, and levels of psychological distress, and an increase in levels of empowerment for Aboriginal and non-Aboriginal clients. This study provides evidence for the feasibility and acceptability of an Aboriginal-adapted psychological intervention addressing drug, alcohol and mental health outcomes.

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations.

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.

Is there a discrete negative symptom syndrome in people who use methamphetamine?

BACKGROUND: Positive psychotic symptoms have consistently been associated with methamphetamine use but the presence of a negative symptom cluster remains unclear. We used exploratory factor analysis to examine whether a discrete negative syndrome could be delineated among methamphetamine users, and to examine the clinical correlates of this syndrome. METHOD: Participants (N = 154) were people who used methamphetamine at least monthly and did not meet DSM-IV diagnostic criteria for lifetime schizophrenia. Scores on the Brief Psychiatric Rating Scale for the past month were subject to exploratory factor analysis. Latent class analysis was applied to resultant factor scores to determine whether negative and positive factors were experienced by the same participants. Past-month substance use measures were days of use for each drug type and methamphetamine dependence assessed using the Severity of Dependence Scale. RESULTS: We articulated a three-factor model including 'positive/activation symptoms' (e.g. suspiciousness, hallucinations, conceptual disorganisation, tension), 'affective symptoms' (e.g. depression, anxiety) and 'negative symptoms' (e.g. blunted affect, motor retardation). Positive-activation and affective symptoms (but not negative symptoms) were positively correlated with past month days of methamphetamine use (r = 0.16; r = 0.25) and severity of dependence (r = 0.24; r = 0.41). Negative symptoms were correlated with heroin (r = 0.24) and benzodiazepine use (r = 0.21). Latent class analysis revealed a three-class model comprising a positive-symptom class (44%, high positive-activation, low negative symptoms), a negative-symptom class (31%, low positive-activation, high negative symptoms), and a low-symptom class (38%, low on all factors). CONCLUSIONS: A negative symptom syndrome exists among people who use methamphetamine, but this appears related to polysubstance use rather than forming a part of the psychotic syndrome associated with methamphetamine use. Overlooking the role of polysubstance use on negative symptoms may conflate the profiles of methamphetamine-associated psychosis and schizophrenia.

A Systematic Review of the Symptom Profile and Course of Methamphetamine-Associated PsychosisSubstance Use and Misuse.

OBJECTIVES: The psychiatric symptom profile of methamphetamine-associated psychosis (MAP) has varied considerably across studies of different research designs. We performed a systematic review to examine the available evidence for specific psychotic symptoms associated with MAP, including the clinical course and longitudinal changes in this symptom profile. METHODS: Five key electronic databases were searched to identify studies that examined the symptom profile or clinical course of MAP in individuals identified as having MAP. The reporting of specific psychiatric symptoms, and duration of symptoms where available, was recorded for each study. RESULTS: Ninety-four articles were identified (n = 7387), including case-control (k = 29), cross-sectional (k = 20), experimental (k = 6), case report (k = 29), and longitudinal (k = 20) studies. Persecutory delusions, auditory and visual auditory hallucinations were by far the most commonly reported symptoms (reported in 65-84% of studies). Hostility, conceptual disorganization, and depression were reported in a large proportion of studies (31-53%). Negative symptoms were mostly absent (<20%). The median percentage of participants with persistent psychotic symptoms (>1 month duration) across studies was 25% (excluding case reports). CONCLUSION: Persecutory delusions, auditory and visual hallucinations, hostility, depression and conceptual disorganization are central to MAP, whereas negative psychotic symptoms are typically absent. An overrepresentation of institutionalized or male participants may have overemphasized negative symptoms and underreported affective symptoms in past research. Symptoms of MAP may persist beyond one month after drug cessation in some individuals. Clinicians are encouraged to manage affective symptoms in MAP individuals, and monitor for the development of chronic psychotic symptoms.

General practitioners' perspectives on the prevention of cardiovascular disease: systematic review and thematic synthesis of qualitative studies.

OBJECTIVE: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally, and prevention of CVD is a public health priority. This paper aims to describe the perspectives of general practitioners (GPs) on the prevention of CVD across different contexts. DESIGN: Systematic review and thematic synthesis of qualitative studies using the Enhancing Transparency of Reporting the Synthesis of Qualitative research (ENTREQ) framework. DATA SOURCES: MEDLINE, Embase, PsycINFO and CINAHL from database inception to April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included qualitative studies on the perspectives of GPs on CVD prevention. DATA EXTRACTION AND SYNTHESIS: We used HyperRESEARCH to code the primary papers and identified themes. RESULTS: We selected 34 studies involving 1223 participants across nine countries. We identified six themes: defining own primary role (duty to prescribe medication, refraining from risking patients' lives, mediating between patients and specialists, delegating responsibility to patients, providing holistic care); trusting external expertise (depending on credible evidence and opinion, entrusting care to other health professionals, integrating into patient context); motivating behavioural change for prevention (highlighting tangible improvements, negotiating patient acceptance, enabling autonomy and empowerment, harnessing the power of fear, disappointment with futility of advice); recognising and accepting patient capacities (ascertaining patient's drive for lifestyle change, conceding to ingrained habits, prioritising urgent comorbidities, tailoring to patient environment and literacy); avoiding overmedicalisation (averting long-term dependence on medications, preventing a false sense of security, minimising stress of sickness) and minimising economic burdens (avoiding unjustified costs to patients, delivering practice within budget, alleviating healthcare expenses). CONCLUSIONS: GPs sought to empower patients to prevent CVD, but consideration of patients' individual factors was challenging. Community-based strategies for assessing CVD risk involving other health professionals, and decision aids that address the individuality of the patient's health and environment, may support GPs in their decisions regarding CVD prevention.

'Telling our story... Creating our own history': caregivers' reasons for participating in an Australian longitudinal study of Indigenous children.

BACKGROUND: Improving the wellbeing of Indigenous populations is an international priority. Robust research conducted with Aboriginal and Torres Strait Islander peoples is key to developing programs and policies to improve health and wellbeing. This paper aims to quantify the extent of participation in a national longitudinal study of Aboriginal and Torres Strait Islander (Indigenous Australian) children, and to understand the reasons why caregivers participate in the study. METHODS: This mixed methods study uses data from Wave 6 of Footprints in Time, the Longitudinal Study of Indigenous Children. We conducted descriptive analysis of quantitative variables to characterise the sample and retention rates. We applied conventional content analysis to 160 caregivers' open-ended responses to the question, 'Why do you stay in the study?', identifying themes and overarching meta-themes. RESULTS: The study has maintained a high retention rate, with 70.4% (n = 1239/1671) of the baseline sample participating in the study's 6th wave. We identified seven themes related to why participants stay in the study: telling our story, community benefit, satisfaction, tracking Study Child's progress, study processes, receiving study gifts, and valuing what the study stands for. These related to two meta-themes: reciprocity, and trust and connection. Caregivers reported that participation was associated with benefits for their family and community as well as for the study. They identified specific features of the Footprints in Time study design that built and maintained trust and connection between participants and the study. CONCLUSIONS: Our findings support the assertion that Aboriginal and Torres Strait Islander people want to be involved in research when it is done 'the right way'. Footprints in Time has successfully recruited and retained the current-largest cohort of Aboriginal and Torres Strait Islander children in Australia through the use of participatory research methodologies, suggesting effective study implementation and processes. Participants indicated ongoing commitment to the study resulting from perceptions of reciprocity and development of trust in the study. Footprints in Time can serve as a successful model of Aboriginal and Torres Strait Islander health research, to promote good research practice and provides lessons for research with other Indigenous populations.

Socioeconomic variation in absolute cardiovascular disease risk and treatment in the Australian population.

Cardiovascular disease (CVD), preventable through appropriate management of absolute CVD risk, disproportionately affects socioeconomically disadvantaged individuals. The aim of this study was to estimate absolute and relative socioeconomic inequalities in absolute CVD risk and treatment in the Australian population using cross-sectional representative data on 4751 people aged 45-74 from the 2011-12 Australian Health Survey. Poisson regression was used to calculate prevalence differences (PD) and ratios (PR) for prior CVD, high 5-year absolute risk of a primary CVD event and guideline-recommended medication use, in relation to socioeconomic position (SEP, measured by education). After adjusting for age and sex, the prevalence of high absolute risk of a primary CVD event among those of low, intermediate and high SEP was 12.6%, 10.9% and 7.7% (PD, low vs. high = 5.0 [95% CI: 2.3, 7.7], PR = 1.6 [1.2, 2.2]) and for prior CVD was 10.7%, 9.1% and 6.7% (PD = 4.0 [1.4, 6.6], PR = 1.6 [1.1, 2.2]). The proportions using preventive medication use among those with high primary risk were 21.3%, 19.5% and 29.4% for low, intermediate and high SEP and for prior CVD, were 37.8%, 35.7% and 17.7% (PD = 20.1 [9.7, 30.5], PR = 2.1 [1.3, 3.5]). Proportions at high primary risk and not using medications among those of low, intermediate and high SEP were 10.6%, 8.8% and 4.7% and with prior CVD and not using medications were 8.5%, 6.3% and 4.1%. Findings indicate substantial potential to prevent CVD and reduce inequalities through appropriate management of high absolute risk in the population.

Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians.

OBJECTIVE: To quantify absolute cardiovascular disease (CVD) risk in Aboriginal and Torres Strait Islander people and their use of lipid-lowering therapies. DESIGN, PARTICIPANTS: Cross-sectional analysis of nationally representative data from 2820 participants aged 18-74 years who provided biomedical data for the National Aboriginal and Torres Strait Islander Health Measures Survey component of the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey. MAIN OUTCOME MEASURES: Prior CVD and use of lipid-lowering medications were ascertained at interview. 5-year absolute risk of a primary CVD event was calculated with the Australian National Vascular Disease Prevention Alliance algorithm, with categories low (< 10%), moderate (10-15%) and high risk (> 15%). RESULTS: Among participants aged 35-74 years, 9.6% (95% CI, 7.2-12.0%) had prior CVD; 15.7% (95% CI, 13.0-18.3%) were at high, 4.9% (95% CI, 3.3-6.6%) at moderate, and 69.8% (95% CI, 66.8-72.8%) at low absolute primary CVD risk. 82.6% of those at high primary risk were identified on the basis of clinical criteria. High primary absolute risk affected 1.1% (95% CI, 0.0-2.5%) of 18-24-year-olds, 4.7% (95% CI, 2.0-7.5%) of 25-34-year-olds, and 44.2% (95% CI, 33.1-55.3%) of 65-74-year-olds. Lipid-lowering therapy was being used by 52.9% (95% CI, 38.2-67.6%) of people aged 35-74 years with prior CVD and by 42.2% (95% CI, 30.5-53.8%) of those at high primary CVD risk. CONCLUSION: Absolute CVD risk is high among Aboriginal and Torres Strait Islander people, and most of those at high risk are undertreated. Substantial proportions of people under 35 years of age are at high risk, but are not targeted by current guidelines for absolute CVD risk assessment, compromising CVD prevention in this population.

A Need for Tailored Programs and Policies to Reduce Rates of Alcohol-related Crimes for Vulnerable Communities and Young People: An Analysis of Routinely Collected Police Data.

BACKGROUND AND AIMS: Given ongoing community concern about high rates of alcohol-related crimes (ARCs) experienced by disadvantaged populations, a more specific and nuanced understanding of factors associated with ARCs would help inform the development of more sophisticated programs and policies aimed at reducing ARCs. This study estimates rates of ARCs across all communities in New South Wales (NSW), Australia, using routinely collected police data; investigates whether there are differences between communities; and identifies individual and community characteristics that are significantly associated with higher rates of ARCs. SHORT SUMMARY: This study analysed routinely collected police data in New South Wales, Australia, to identify individual and community characteristics associated with alcohol-related crimes. Young people, Aboriginal Australians, socio-economically disadvantaged communities, remote and regional communities and communities with higher per capita rate of on-venue liquor licenses are at risk of alcohol-related crimes. METHODS: Age standardized rates of ARCs were calculated. A multi-level Poisson regression analysis was conducted to investigate the individual and community factors that were statistically significantly associated with higher rates of ARC, separately for Aboriginal and non-Aboriginal Australians. RESULTS: Rates of ARCs were statistically significantly higher for Aboriginal Australians, young people (aged 13-37 years) and on weekends. ARCs varied significantly across communities, and were significantly higher in remote or regional communities, in communities with a higher per capita rate of on-venue licences, and for socio-economically disadvantaged communities for non-Aboriginal Australians, but not for Aboriginal females. CONCLUSION: This analysis shows that the impact of national-level and jurisdictional-level legislation and policies is uneven across communities and defined populations, leaving young people, socio-economically disadvantaged communities and Aboriginal Australians at increased risk of ARCs. To more equitably reduce the exposure of all Australians to ARC, mechanisms that effectively engage vulnerable communities and defined populations, need to be developed in consultation with them, implemented and evaluated.

The relationship between illicit amphetamine use and psychiatric symptom profiles in schizophrenia and affective psychoses.

This study examines whether illicit amphetamine use is associated with differences in the prevalence of specific psychiatric symptoms in a community sample of individuals diagnosed with schizophrenia or affective psychotic disorders. Data was drawn from the Australian Survey of High Impact Psychosis. The Diagnostic Interview for Psychosis was used to measure substance use and psychiatric symptoms. Participants had used amphetamine within their lifetime and had an ICD-10 diagnosis of schizophrenia (n = 347) or an affective psychotic disorder (n = 289). The past year prevalence of psychiatric symptoms was compared among those who had used amphetamine in the past year (past-year use, 32%) with those who had not (former use, 68%). Univariate logistic regression analysis indicated that past-year users with schizophrenia had a significantly higher past year prevalence of hallucinations, persecutory delusions, racing thoughts, dysphoria, and anhedonia relative to former amphetamine users with schizophrenia. There were no significant differences in symptoms between past-year and former users with affective psychotic disorders. The relationship between amphetamine use and specific psychiatric symptoms varies across different psychotic disorders. Amphetamine use may hinder prognosis by exacerbating symptoms of schizophrenia through dopaminergic dysfunctions or depressive vulnerabilities, however, this needs to be confirmed by prospective longitudinal research.

Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence.

OBJECTIVE: Indigenous Australians experience a disproportionately higher burden of disease compared to non-Indigenous Australians. High-quality evaluation of Indigenous health programs is required to inform health and health services improvement. We aimed to quantify methodological and other characteristics of Australian Indigenous health program evaluations published in the peer-reviewed literature. METHODS: Systematic review of peer-reviewed literature (November 2009-2014) on Indigenous health program evaluation. RESULTS: We identified 118 papers describing evaluations of 109 interventions; 72.0% were university/research institution-led. 82.2% of evaluations included a quantitative component; 49.2% utilised quantitative data only and 33.1% used both quantitative and qualitative data. The most common design was a before/after comparison (30.5%, n=36/118). 7.6% of studies (n=9/118) used an experimental design: six individual-level and three cluster-randomised controlled trials. 56.8% (67/118) reported on service delivery/process outcomes (versus health or health risk factor outcomes) only. CONCLUSIONS: Given the number of Indigenous health programs that are implemented, few evaluations overall are published in the peer-reviewed literature and, of these, few use optimal methodologies such as mixed methods and experimental design. Implications for public health: Multiple strategies are required to increase high-quality, accessible evaluation in Indigenous health, including supporting stronger research-policy-practice partnerships and capacity building for evaluation by health services and government.