HealthBulletin 2(2)

This section of the Bulletin identifies recent journal articles. If you are aware of any journal articles that would be appropriate for inclusion in this section please contact us.

Bailie RS (2002)
In reply. Household infrastructure in Aboriginal communities and the implications for health improvement [letter]. Medical Journal of Australia;176:503.
View letter (HTML)
View letter (PDF)

Brady M (2002)
Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people.
Australian and New Zealand Journal of Public Health;26:120-124.

Tobacco smoking has been identified as a major contributor to the high morbidity and mortality rates of Aborigines and Torres Strait Islanders. After years of inattention, smoking cessation projects designed for Indigenous Australians are beginning to emerge. Dealing successfully with smoking cessation would be enhanced by an understanding of the long-standing historical, social and cultural antecedents to present-day usage of tobacco. This paper provides a brief account of the historical precursors to present-day patterns of tobacco use among Aboriginal and Torres Strait Islander people. Historical records and mission documents, together with ethnographic accounts, suggest that Indigenous tobacco use today demonstrates strong continuity with past patterns and styles of use. These sources also reveal that Europeans deliberately exploited Aboriginal addiction to nicotine.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health

Cass A, Lowell A, Christie M, et al. (2002)
Sharing the true stories: improving communication between Aboriginal patients and healthcare workers.
Medical Journal of Australia;176:466-470.
View full paper (HTML)
View full paper (PDF)
View ABC interview

Clough AR, Bailie R, Burns CB, Guyula T, Wunungmurra R, Wanybarrnga SR (2002)
Validity and utility of community health workers' estimation of kava use.
Australian and New Zealand Journal of Public Health;26:52-57.

Objective
Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure.

Methods
We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed.

Results
Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39).

Conclusions
Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health

Healey T, Olver I, and Selva-Nayagam S (2002)
Immunoproliferative small intestinal disease, two cases in the Northern Territory.
Internal Medicine Journal; 32:47-49.

This paper discusses the progression of immunoproliferative small intestinal disease (IPSID), and the consensus on management of the condition once notified. The article outlines the clinical management of two cases of IPSID within an Aboriginal community. After the administration of tetracycline, symptoms were reduced, and further treatment with antibiotics and chemotherapy was applied. Consideration of this diagnosis in appropriate clinical circumstances may allow diagnosis at a stage when antibiotic therapy could prevent progression to malignant disease.

Australian Indigenous HealthInfoNet Abstract

Henderson R, Simmons DS, Bourke L, Muir J (2002)
Development of guidelines for non-Indigenous people undertaking research among the Indigenous population of north-east Victoria.
Medical Journal of Australia;176:482-485.
View full paper (HTML)
View full paper (PDF)

Jamrozik K (2002)
Hard lessons from a randomised controlled trial [editorial].
Medical Journal of Australia;176:248-249.
View full paper (HTML)
View full paper (PDF)

Kearns T, Savage J, Peacock D (2001)
Northern Territory antibiotic resistant Neisseria gonorrhoeae sentinel surveillance sites.
The Northern Territory Disease Control Bulletin;8:5-9.
View full paper (PDF)

Laugharne J, Glennen M, Austin J (2002)
The 'Maga Barndi' mental health service for Aboriginal people in Western Australia.
Australasian Psychiatry;10:13-18.

The Maga Barndi (clear head) pilot project was implemented in Geraldton with the objective of pioneering a culturally sensitive psychiatric service for Aboriginal people in the Midwest. This article describes the implementation of the project and discusses some of the issues involved in successfully delivering mental health services to Aboriginal people.

The project was deemed a success, and the 'lessons learnt' and shared through this article may be of value to others seeking to improve accessibility and acceptability of mental health services to Indigenous Australians.

Australian Indigenous HealthInfoNet abstract

Leonard D, McDermott R, O'Dea K, et al. (2002)
Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people.
Australian and New Zealand Journal of Public Health;26:144-149.

Objective
To describe the lifestyle-related chronic disease and risk factor prevalence among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area Health Service District and to compare this information with that available for the general Australian population.

Methods
Voluntary community-based screening for persons aged 15 years and older, including oral glucose tolerance test, anthropometry, health questionnaire, measurement of lipids and lipoprotein levels, blood pressure and urinary albumin to creatinine ratio.

Results
Nine communities participated in screening between 1993 and 1997. Five hundred and ninety-two participants (286 male and 306 female) identified as Torres Strait Islander. There were high prevalences of overweight (30%), obesity (51%), abdominal obesity (70%), diabetes (26%), hypercholesterolaemia (33%), albuminuria (28%), hypertension (32%) and tobacco smoking (45%). Only 8.5% of men and 6.5% of women were free of any cardiovascular risk factors (abdominal obesity, hypercholesterolaemia, hypertension, dyslipidaemia, smoking, diabetes, albuminuria). Comparisons of this information for Torres Strait Islander people with results from the AusDiab survey show rates of obesity three times higher and diabetes six times higher than for other Australians.

Conclusions
There is a very high prevalence of preventable chronic disease and associated risk factors among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area.

Implications
Effective interventions to prevent and manage obesity, diabetes and associated cardiovascular risk factors are essential if the health of the Torres Strait Islander people is to improve. Such interventions could inform initiatives to stem the burgeoning epidemic of obesity and diabetes among all Australians.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health

MacLean SJ, d'Abbs PHN (2002)
Petrol sniffing in Aboriginal communities: a review of interventions.
Drug and Alcohol Review;21:65-72.

Petrol sniffing (and other forms of inhalant misuse) occur within some Aboriginal communities across Australia. However, there is little documented information about the nature and combination of interventions that are most effective in addressing it. This article reviews published and unpublished literature relevant to petrol sniffing in Australian Aboriginal communities. A range of strategies which have been trialled previously are discussed under the categories of primary, secondary and tertiary intervention. We have adopted Zinberg's schema of 'drug', 'set' and 'setting' in theorising the mix of interventions most likely to reduce petrol sniffing. We argue that interventions should address as many as possible of these factors. Further, while no strategy is likely to succeed without strong support from local community members, governments also have an important role in addressing petrol sniffing. Consistent funding for strategies directly addressing petrol sniffing and coordinated government responses to the broader needs of Aboriginal young people and their communities are critical.

Abstract reproduced with permission of the Drug and Alcohol Review

Markey P, Barclay L, Krause V (2002)
NT Mantoux school screening 1991 - 2000.
The Northern Territory Disease Control Bulletin;9:6-9.
View full paper (PDF)

McCarthy JS, Garrow SC (2002)
Parasite elimination programs: at home and away [editorial].
Medical Journal of Australia;176:456-457.
View full paper (HTML)
View full paper (PDF)

Panaretto KS, Muller R, Patole S, Watson D, Whitehall JS (2002)
Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland?
Journal of Paediatrics and Child Health;38:16-22.

This article investigated neonatal outcomes for Indigenous and non-Indigenous infants born at a tertiary hospital in Townsville or admitted to the hospital's Neonatal Intensive Care Unit between January 1998 and June 1999. When compared with national and State reports, neonatal outcomes were better than expected among Aboriginal infants, but worse than expected among Torres Strait Islander infants. Study findings indicated that Indigenous women were less likely to attend antenatal care. The authors concluded that increased access to antenatal care services may improve neonatal outcomes for Indigenous infants.

Australian Indigenous HealthInfoNet abstract

Sibthorpe BM, Bailie RS, Brady MA, Ball SA, Sumner-Dodd P, Hall WD (2002)
The demise of a planned randomised controlled trial in an urban Aboriginal medical service.
Medical Journal of Australia;176:273-276.
View full paper (HTML)
View full paper (PDF)

Shannon C, Canuto C, Young E, et al. (2001)
Injury prevention in Indigenous communities: results of a two-year community development project.
Health Promotion Journal of Australia;12:233-237.

Issue addressed
This paper reports on the quantitative evaluation of a comprehensive injury prevention program in an Indigenous community in Australia.

Methods
The project involved the combination of a public health approach to injury control with community owned and directed partnership processes for Indigenous health promotion. It was conducted between April 1997 and April 1999. Bayesian change-point analysis was used to identify the month that immediately preceded a change in reported injuries over the course of the program. Evaluation of the program included quantitative comparisons before and after this change-point in the context of ongoing intervention activities.

Results
A change-point in the monthly incidence of injuries occurred at January 1998, which coincided with the timing of the introduction of prevention activities in the community. A mean 96 (SE = 4.8) injuries per month presented for medical attention during the nine months pre-intervention, while only 65 (SE = 3.8) injuries per month occurred during the remainder of the study period, resulting in a statistically significant mean difference attributable to the intervention (Student's t = 5.07, df = 21, P < 0.001). The reduction appeared to be across all ages and all injury types and not due to any specific injury event subgroup.

Conclusion
This paper demonstrates that effective injury prevention programs can be established by Indigenous communities in a manner consistent with contemporary best practice models of injury control. Replication of the methods used in this project in other Indigenous communities is needed to confirm the appropriateness of the model.

So what?
There would appear to be urgent need to encourage widespread implementation of such programs to reduce the excess injury rate now experienced by Aboriginal and Torres Strait Islander communities.

Key words
injury prevention, Indigenous health

Abstract reproduced with permission of the Health Promotion Journal of Australia

Stockwell T, Chikritzhs T, Hendrie D, et al. (2001)
The public health and safety benefits of the Northern Territory's Living with Alcohol Programme.
Drug And Alcohol Review;20:167-180.

An evaluation is presented of the impact of a comprehensive population-based alcohol harm reduction programme in the Northern Territory funded by a levy of 5 cents per standard drink which took effect from April 1992. The proceeds of the levy supported increased treatment, public education and other prevention activities. Towards the end of the study period (the first 4 years) other positive initiatives were introduced: the lowering of the legal limit for drivers to 0.05 mg/ml and a special levy on cask wine. Indicators of alcohol-related harm were tracked from 1980 to June 30 1996 and developed from hospital, mortality and road crash data. In each case appropriate control data from the same source was employed to control for other possible confounding effects. Alcohol aetiological fractions for major alcohol-related causes of death were estimated taking account of the level of high-risk alcohol use in the Northern Territory. Multiple linear regression and time-series analyses were employed to test for any effect coinciding with the introduction of LWA. There were reductions in estimated alcohol-caused deaths from acute conditions (road deaths 34.5%, other 23.4%) and in road crash injuries requiring hospital treatment (28.3%). In addition there were substantial reductions in per capita alcohol consumption and self-reported hazardous and harmful consumption via surveys. These reductions were evident immediately from the outset of the introduction of LWA and were largely sustained throughout the 4 years studied. The data reported here suggest that significant health and safety benefits accrued to the people of the Northern Territory during the first 4 years of the Living With Alcohol programme. This benefit is likely to be due to several factors: the effect of the levy on alcohol consumption, other factors depressing alcohol consumption and the effect of the LWA programme itself.

Abstract reproduced with permission of the Drug and Alcohol Review

Talbot N (2001)
Nunga IT is a hit.
Health Promotion Journal of Australia;12:269.

Torzillo PJ, Pholeros P (2002)
Household infrastructure in Aboriginal communities and the implications for health improvement [letter].
Medical Journal of Australia;176:502-503.
View letter (HTML)
View letter (PDF)

You J, Hoy W, Zhao Y, Beaver C, Eagar K (2002)
End-stage renal disease in the Northern Territory: current and future treatment costs.
Medical Journal of Australia;176:461-465.
View full paper (HTML)
View full paper (PDF)



Australian Indigenous HealthBulletin Vol.2 No.2 April 2002 - June 2002: ISSN 1445-7253 An electronic journal from the Australian Indigenous HealthInfoNet Journal articles This section of the Bulletin identifies recent journal articles. If you are aware of any journal articles that would be appropriate for inclusion in this section please contact us. Development of guidelines for non-Indigenous people undertaking research among the Indigenous population of north-east Victoria added 29 May 2002 End-stage renal disease in the Northern Territory: current and future treatment costs added 27 May 2002 Hard lessons from a randomised controlled trial [editorial] added 2 April 2002 Injury prevention in Indigenous communities: results of a two-year community development project added 24 April 2002 Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people added 2 May 2002 Household infrastructure in Aboriginal communities and the implications for health improvement [letter] added 6 June 2002 In reply. Household infrastructure in Aboriginal communities and the implications for health improvement [letter] added 12 June 2002 Immunoproliferative small intestinal disease, two cases in the Northern Territory added 21 June 2002 Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland? added 15 April 2002 Northern Territory antibiotic resistant Neisseria gonorrhoeae sentinel surveillance sites added 16 May 2002 NT Mantoux school screening 1991 - 2000 added 9 May 2002 Nunga IT is a hit added 13 May 2002 Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people added 6 May 2002 Parasite elimination programs: at home and away [editorial] added 22 May 2002 Petrol sniffing in Aboriginal communities: a review of interventions added 22 April 2002 Sharing the true stories: improving communication between Aboriginal patients and healthcare workers added 20 May 2002 The demise of a planned randomised controlled trial in an urban Aboriginal medical service added 2 April 2002 The 'Maga Barndi' mental health service for Aboriginal people in Western Australia added 3 June 2002 The public health and safety benefits of the Northern Territory's Living with Alcohol Programme added 30 April 2002 Validity and utility of community health workers' estimation of kava use added 9 April 2002 Bailie RS (2002) In reply. Household infrastructure in Aboriginal communities and the implications for health improvement [letter]. Medical Journal of Australia;176:503. View letter (HTML) View letter (PDF) Brady M (2002) Historical and cultural roots of tobacco use among Aboriginal and Torres Strait Islander people. Australian and New Zealand Journal of Public Health;26:120-124. Tobacco smoking has been identified as a major contributor to the high morbidity and mortality rates of Aborigines and Torres Strait Islanders. After years of inattention, smoking cessation projects designed for Indigenous Australians are beginning to emerge. Dealing successfully with smoking cessation would be enhanced by an understanding of the long-standing historical, social and cultural antecedents to present-day usage of tobacco. This paper provides a brief account of the historical precursors to present-day patterns of tobacco use among Aboriginal and Torres Strait Islander people. Historical records and mission documents, together with ethnographic accounts, suggest that Indigenous tobacco use today demonstrates strong continuity with past patterns and styles of use. These sources also reveal that Europeans deliberately exploited Aboriginal addiction to nicotine. Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health Cass A, Lowell A, Christie M, et al. (2002) Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia;176:466-470. View full paper (HTML) View full paper (PDF) View ABC interview Clough AR, Bailie R, Burns CB, Guyula T, Wunungmurra R, Wanybarrnga SR (2002) Validity and utility of community health workers' estimation of kava use. Australian and New Zealand Journal of Public Health;26:52-57. Objective Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure. Methods We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed. Results Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39). Conclusions Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use. Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health Healey T, Olver I, and Selva-Nayagam S (2002) Immunoproliferative small intestinal disease, two cases in the Northern Territory. Internal Medicine Journal; 32:47-49. This paper discusses the progression of immunoproliferative small intestinal disease (IPSID), and the consensus on management of the condition once notified. The article outlines the clinical management of two cases of IPSID within an Aboriginal community. After the administration of tetracycline, symptoms were reduced, and further treatment with antibiotics and chemotherapy was applied. Consideration of this diagnosis in appropriate clinical circumstances may allow diagnosis at a stage when antibiotic therapy could prevent progression to malignant disease. Australian Indigenous HealthInfoNet Abstract Henderson R, Simmons DS, Bourke L, Muir J (2002) Development of guidelines for non-Indigenous people undertaking research among the Indigenous population of north-east Victoria. Medical Journal of Australia;176:482-485. View full paper (HTML) View full paper (PDF) Jamrozik K (2002) Hard lessons from a randomised controlled trial [editorial]. Medical Journal of Australia;176:248-249. View full paper (HTML) View full paper (PDF) Kearns T, Savage J, Peacock D (2001) Northern Territory antibiotic resistant Neisseria gonorrhoeae sentinel surveillance sites. The Northern Territory Disease Control Bulletin;8:5-9. View full paper (PDF) Laugharne J, Glennen M, Austin J (2002) The 'Maga Barndi' mental health service for Aboriginal people in Western Australia. Australasian Psychiatry;10:13-18. The Maga Barndi (clear head) pilot project was implemented in Geraldton with the objective of pioneering a culturally sensitive psychiatric service for Aboriginal people in the Midwest. This article describes the implementation of the project and discusses some of the issues involved in successfully delivering mental health services to Aboriginal people. The project was deemed a success, and the 'lessons learnt' and shared through this article may be of value to others seeking to improve accessibility and acceptability of mental health services to Indigenous Australians. Australian Indigenous HealthInfoNet abstract Leonard D, McDermott R, O'Dea K, et al. (2002) Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people. Australian and New Zealand Journal of Public Health;26:144-149. Objective To describe the lifestyle-related chronic disease and risk factor prevalence among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area Health Service District and to compare this information with that available for the general Australian population. Methods Voluntary community-based screening for persons aged 15 years and older, including oral glucose tolerance test, anthropometry, health questionnaire, measurement of lipids and lipoprotein levels, blood pressure and urinary albumin to creatinine ratio. Results Nine communities participated in screening between 1993 and 1997. Five hundred and ninety-two participants (286 male and 306 female) identified as Torres Strait Islander. There were high prevalences of overweight (30%), obesity (51%), abdominal obesity (70%), diabetes (26%), hypercholesterolaemia (33%), albuminuria (28%), hypertension (32%) and tobacco smoking (45%). Only 8.5% of men and 6.5% of women were free of any cardiovascular risk factors (abdominal obesity, hypercholesterolaemia, hypertension, dyslipidaemia, smoking, diabetes, albuminuria). Comparisons of this information for Torres Strait Islander people with results from the AusDiab survey show rates of obesity three times higher and diabetes six times higher than for other Australians. Conclusions There is a very high prevalence of preventable chronic disease and associated risk factors among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area. Implications Effective interventions to prevent and manage obesity, diabetes and associated cardiovascular risk factors are essential if the health of the Torres Strait Islander people is to improve. Such interventions could inform initiatives to stem the burgeoning epidemic of obesity and diabetes among all Australians. Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health MacLean SJ, d'Abbs PHN (2002) Petrol sniffing in Aboriginal communities: a review of interventions. Drug and Alcohol Review;21:65-72. Petrol sniffing (and other forms of inhalant misuse) occur within some Aboriginal communities across Australia. However, there is little documented information about the nature and combination of interventions that are most effective in addressing it. This article reviews published and unpublished literature relevant to petrol sniffing in Australian Aboriginal communities. A range of strategies which have been trialled previously are discussed under the categories of primary, secondary and tertiary intervention. We have adopted Zinberg's schema of 'drug', 'set' and 'setting' in theorising the mix of interventions most likely to reduce petrol sniffing. We argue that interventions should address as many as possible of these factors. Further, while no strategy is likely to succeed without strong support from local community members, governments also have an important role in addressing petrol sniffing. Consistent funding for strategies directly addressing petrol sniffing and coordinated government responses to the broader needs of Aboriginal young people and their communities are critical. Abstract reproduced with permission of the Drug and Alcohol Review Markey P, Barclay L, Krause V (2002) NT Mantoux school screening 1991 - 2000. The Northern Territory Disease Control Bulletin;9:6-9. View full paper (PDF) McCarthy JS, Garrow SC (2002) Parasite elimination programs: at home and away [editorial]. Medical Journal of Australia;176:456-457. View full paper (HTML) View full paper (PDF) Panaretto KS, Muller R, Patole S, Watson D, Whitehall JS (2002) Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland? Journal of Paediatrics and Child Health;38:16-22. This article investigated neonatal outcomes for Indigenous and non-Indigenous infants born at a tertiary hospital in Townsville or admitted to the hospital's Neonatal Intensive Care Unit between January 1998 and June 1999. When compared with national and State reports, neonatal outcomes were better than expected among Aboriginal infants, but worse than expected among Torres Strait Islander infants. Study findings indicated that Indigenous women were less likely to attend antenatal care. The authors concluded that increased access to antenatal care services may improve neonatal outcomes for Indigenous infants. Australian Indigenous HealthInfoNet abstract Sibthorpe BM, Bailie RS, Brady MA, Ball SA, Sumner-Dodd P, Hall WD (2002) The demise of a planned randomised controlled trial in an urban Aboriginal medical service. Medical Journal of Australia;176:273-276. View full paper (HTML) View full paper (PDF) Shannon C, Canuto C, Young E, et al. (2001) Injury prevention in Indigenous communities: results of a two-year community development project. Health Promotion Journal of Australia;12:233-237. Issue addressed This paper reports on the quantitative evaluation of a comprehensive injury prevention program in an Indigenous community in Australia. Methods The project involved the combination of a public health approach to injury control with community owned and directed partnership processes for Indigenous health promotion. It was conducted between April 1997 and April 1999. Bayesian change-point analysis was used to identify the month that immediately preceded a change in reported injuries over the course of the program. Evaluation of the program included quantitative comparisons before and after this change-point in the context of ongoing intervention activities. Results A change-point in the monthly incidence of injuries occurred at January 1998, which coincided with the timing of the introduction of prevention activities in the community. A mean 96 (SE = 4.8) injuries per month presented for medical attention during the nine months pre-intervention, while only 65 (SE = 3.8) injuries per month occurred during the remainder of the study period, resulting in a statistically significant mean difference attributable to the intervention (Student's t = 5.07, df = 21, P < 0.001). The reduction appeared to be across all ages and all injury types and not due to any specific injury event subgroup. Conclusion This paper demonstrates that effective injury prevention programs can be established by Indigenous communities in a manner consistent with contemporary best practice models of injury control. Replication of the methods used in this project in other Indigenous communities is needed to confirm the appropriateness of the model. So what? There would appear to be urgent need to encourage widespread implementation of such programs to reduce the excess injury rate now experienced by Aboriginal and Torres Strait Islander communities. Key words injury prevention, Indigenous health Abstract reproduced with permission of the Health Promotion Journal of Australia Stockwell T, Chikritzhs T, Hendrie D, et al. (2001) The public health and safety benefits of the Northern Territory's Living with Alcohol Programme. Drug And Alcohol Review;20:167-180. An evaluation is presented of the impact of a comprehensive population-based alcohol harm reduction programme in the Northern Territory funded by a levy of 5 cents per standard drink which took effect from April 1992. The proceeds of the levy supported increased treatment, public education and other prevention activities. Towards the end of the study period (the first 4 years) other positive initiatives were introduced: the lowering of the legal limit for drivers to 0.05 mg/ml and a special levy on cask wine. Indicators of alcohol-related harm were tracked from 1980 to June 30 1996 and developed from hospital, mortality and road crash data. In each case appropriate control data from the same source was employed to control for other possible confounding effects. Alcohol aetiological fractions for major alcohol-related causes of death were estimated taking account of the level of high-risk alcohol use in the Northern Territory. Multiple linear regression and time-series analyses were employed to test for any effect coinciding with the introduction of LWA. There were reductions in estimated alcohol-caused deaths from acute conditions (road deaths 34.5%, other 23.4%) and in road crash injuries requiring hospital treatment (28.3%). In addition there were substantial reductions in per capita alcohol consumption and self-reported hazardous and harmful consumption via surveys. These reductions were evident immediately from the outset of the introduction of LWA and were largely sustained throughout the 4 years studied. The data reported here suggest that significant health and safety benefits accrued to the people of the Northern Territory during the first 4 years of the Living With Alcohol programme. This benefit is likely to be due to several factors: the effect of the levy on alcohol consumption, other factors depressing alcohol consumption and the effect of the LWA programme itself. Abstract reproduced with permission of the Drug and Alcohol Review Talbot N (2001) Nunga IT is a hit. Health Promotion Journal of Australia;12:269. Torzillo PJ, Pholeros P (2002) Household infrastructure in Aboriginal communities and the implications for health improvement [letter]. Medical Journal of Australia;176:502-503. View letter (HTML) View letter (PDF) You J, Hoy W, Zhao Y, Beaver C, Eagar K (2002) End-stage renal disease in the Northern Territory: current and future treatment costs. Medical Journal of Australia;176:461-465. View full paper (HTML) View full paper (PDF)

Australian Indigenous

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