Correction to: Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians.

After publication of the original article [1] it was noted that the name of author, Peter Jack, was erroneously typeset in both the PDF and online formats of the manuscript as Peter Jack GradDipIndigH.

Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians.

BACKGROUND: The challenges of assessing alcohol consumption can be greater in Indigenous communities where there may be culturally distinct approaches to communication, sharing of drinking containers and episodic patterns of drinking. This paper discusses the processes used to develop a tablet computer-based application ('App') to collect a detailed assessment of drinking patterns in Indigenous Australians. The key features of the resulting App are described. METHODS: An iterative consultation process was used (instead of one-off focus groups), with Indigenous cultural experts and clinical experts. Regular (weekly or more) advice was sought over a 12-month period from Indigenous community leaders and from a range of Indigenous and non-Indigenous health professionals and researchers. RESULTS: The underpinning principles, selected survey items, and key technical features of the App are described. Features include culturally appropriate questioning style and gender-specific voice and images; community-recognised events used as reference points to 'anchor' time periods; 'translation' to colloquial English and (for audio) to traditional language; interactive visual approaches to estimate quantity of drinking; images of specific brands of alcohol, rather than abstract description of alcohol type (e.g. 'spirits'); images of make-shift drinking containers; option to estimate consumption based on the individual's share of what the group drank. CONCLUSIONS: With any survey platform, helping participants to accurately reflect on and report their drinking presents a challenge. The availability of interactive, tablet-based technologies enables potential bridging of differences in culture and lifestyle and enhanced reporting.

The Alcohol Mandatory Treatment Act: evidence, ethics and the law.

The Northern Territory Alcohol Mandatory Treatment Act 2013 (AMT Act) permits mandatory residential alcohol rehabilitation for up to 3 months. International guidelines and human rights law confirm that mandatory rehabilitation should only be used for short periods. Evidence concerning the efficacy of long-term mandatory alcohol rehabilitation is lacking, and minimal data concerning the efficacy of the scheme have been released. Specific legal issues also arise concerning the AMT Act, including its potentially discriminatory application to Aboriginal and Torres Strait Islander peoples. The program only permits referral by police, despite the fact that it is ostensibly a medical intervention. Use of a treatment as a method of effectively solving a public intoxication problem is highly dubious, and should be of concern to the medical community. Given that more cost-effective and proven measures exist to combat alcohol dependence, the utility of the AMT Act is questionable.

Sexual behaviour, drug use and health service use by young Noongar people in Western Australia: a snapshot.

UNLABELLED: Background This study aimed to describe sexual health behaviour, alcohol and other drug use, and health service use among young Noongar people in the south-west of Western Australia. METHOD: A cross-sectional survey was undertaken among a sample of 244 Noongar people aged 16-30 years. RESULTS: The sample was more disadvantaged than the wider Noongar population. Sexual activity was initiated at a young age, 18% had two or more casual sex partners in the previous 12 months, with men more likely to have done so than women (23% vs 14%). Condoms were always or often carried by 57% of men and 37% of women, and 36% of men and 23% of women reported condom use at last sex with a casual partner. Lifetime sexually transmissible infection diagnosis was 14%. Forty percent currently smoked tobacco and 25% reported risky alcohol consumption on a weekly and 7% on an almost daily basis. Cannabis was used by 37%, 12% used drugs in addition to cannabis and 11% reported recently injecting drugs. In the previous 12 months, 66% had a health check and 31% were tested for HIV or sexually transmissible infections. Additionally, 25% sought advice or assistance for mental health or alcohol and other drug issues. DISCUSSION: Although some respondents engaged in risky sexual behaviour, alcohol and other drug use or both, most did not. Particularly encouraging was the engagement of respondents with the health care system, especially among those engaging in risky behaviours. The results confound negative stereotypes of Aboriginal people and demonstrate a level of resilience among respondents.

Barriers and enablers to the provision of alcohol treatment among Aboriginal Australians: a thematic review of five research projects.

INTRODUCTION AND AIMS: To review the results of five research projects commissioned to enhance alcohol treatment among Aboriginal Australians, and to highlight arising from them. DESIGN AND METHODS: Drafts of the papers were workshopped by project representatives, final papers reviewed and results summarised. Lessons arising were identified and described. RESULTS: While the impact of the projects varied, they highlight the feasibility of adapting mainstream interventions in Aboriginal Australian contexts. Outcomes include greater potential to: screen for those at risk; increase community awareness; build capacity and partnerships between organisations; and co-ordinate comprehensive referral networks and service provision. DISCUSSION: Results show a small investment can produce sustainable change and positive outcomes. However, to optimise and maintain investment, cultural difference needs to be recognised in both planning and delivery of alcohol interventions; resources and funding must be responsive to and realistic about the capacities of organisations; partnerships need to be formed voluntarily based on respect, equality and trust; and practices and procedures within organisations need to be formalised. CONCLUSIONS: There is no simple way to reduce alcohol-related harm in Aboriginal communities. However, the papers reviewed show that with Aboriginal control, modest investment and respectful collaboration, service enhancements and improved outcomes can be achieved. Mainstream interventions need to be adapted to Aboriginal settings, not simply transferred. The lessons outlined provide important reflections for future research.

Managing alcohol-related problems among Indigenous Australians: what the literature tells us.

OBJECTIVE: To contextualise and provide an overview of two review papers--prepared as part of a larger research program--dealing with different aspects of the treatment of Indigenous Australians with alcohol-related problems. METHOD: The papers were reviewed thematically and compared to identify key issues raised in them. FINDINGS: Together, the papers highlight the paucity of the evidence base for the provision of treatment for Indigenous Australians with alcohol-related problems. Among the key issues identified are: the need to engage with clients in culturally safe ways; practitioner, organisational and client barriers to engagement; the contexts in which Indigenous drinking and treatment take place; the need to develop rigorous methods of evaluation more appropriate to Indigenous cultural and service provision settings; and the importance of effective partnerships in the provision of services. CONCLUSION: For those working in the field, the reviews direct attention to the need to review and interrogate our current practice. They also provide clear directions for future research.

Determinants of carotid intima-medial thickness in an urban Australian Aboriginal population.

INTRODUCTION: We studied the determinants of carotid atherosclerosis in urban-dwelling Australian Aboriginals at high risk of atherosclerotic mortality and morbidity. METHODS: Cross-sectional study of self-selected adult Australian Aboriginals. Participants (n=602) aged 18-74 years had risk factor assessment and carotid ultrasound to determine carotid intima-medial thickness (IMT) and the presence of plaque. The upper quartile (>0.71 mm in males and >0.62 mm in females) was used as a measure of increased carotid IMT. RESULTS: Over 80% of participants were overweight or obese; the prevalence of diabetes was 25%. Age was the major predictor of thick IMT, OR 3.0 (95% CI 2.0-4.5) per decade for males and OR 6.3 (3.3-12.0) for females. Waist circumference and blood glucose were independent predictors of IMT for men, with hypertension, pack-years of smoking, diabetes, and cholesterol ratio additional predictors for women. Plaque was highly prevalent (>40%) in this relatively young population and was predicted by increasing age, a history of smoking and total cholesterol/HDL ratio, but not sex. CONCLUSIONS: Urban-dwelling Aboriginal Australians are at increased risk for early atherosclerosis. In this study an excess of obesity-related cardiovascular risk factors were the important contributors to increased IMT carotid atherosclerosis, but not inflammatory markers or other novel risk factors.

Cardiovascular risk among urban Aboriginal people.

OBJECTIVE: To describe the results of a program for detecting high cardiovascular risk in an urban Aboriginal community. DESIGN: Cardiovascular risk assessment program conducted between January 1998 and October 1999. Participants completed a questionnaire and underwent a physical assessment and biochemical tests. PARTICIPANTS: 738 self-selected members of the Perth Aboriginal community (332 men, 406 women; age range, 18-79 years). RESULTS: The participants represented approximately a fifth of the Perth Aboriginal population aged 25-64 years (those aged 18-24 years comprised < 5% of Aboriginals aged 15-24 years in Perth). Eighty-four per cent fell within National Heart Foundation "high risk" or "highest risk" categories for cardiovascular disease; 15% of men and 6% of women had an absolute risk of a cardiovascular event of over 15% within 10 years. A high proportion of participants reported diabetes, hypertension, smoking, overweight and obesity. A fasting plasma glucose level indicative of diabetes or impaired fasting glucose was found in 8.6% (95% CI, 6.2%-11%) of people not previously known to have diabetes. Obesity and smoking were twice as prevalent in study participants as in the general population. Less than a third of subjects with hypertension and diabetes had attained recommended target levels for blood pressure reduction or glycaemic control, and only a third of those at high risk and one in six of those at highest risk had attained recommended lipid-level targets. CONCLUSIONS: A cardiovascular risk assessment program with strong community support in an urban Aboriginal population can identify a significant number of people with high cardiovascular risk who are candidates for intensive risk-factor reduction strategies.