Anti-tobacco messages and interventions should relate to Aboriginal women's experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management. Focus group participants recommended individual, group and family approaches, and access to cessation services and nicotine replacement therapy for Aboriginal pregnant women who smoke.

This review gives strength to evidence from individual studies across diverse Indigenous cultures. Pregnant Aboriginal and Torres Strait Islander smokers require comprehensive approaches, which consider the environmental context, increase knowledge of smoking harms and cessation methods, and provide culturally targeted support. Long term, broad strategies should de-normalize smoking in Aboriginal and Torres Strait Islander communities. Further research needs to examine causes of resistance to antitobacco messages, clarify contributing roles of stress and depression, and attitudes to pharmacotherapy.

Preoperative comorbidity and smoking were risk factors for respiratory complications, whereas neoadjuvant treatment was not. MIE and the use of thoracic epidural analgesia decreased the risk of respiratory failure. Respiratory failure and ARDS were the only independent factors associated with an increased risk of in-hospital death, whereas anastomotic leakage was not.

Objective To summarise published empirical research on culturally targeted anti-tobacco media messages for Indigenous or First Nations people and examine the evidence for the effectiveness of targeted and nontargeted campaigns. Methods Studies were sought describing mass media and new media interventions for tobacco control or smoking cessation in Indigenous or First Nations populations. Studies of any design were included reporting outcomes of media-based interventions including: cognitions, awareness, recall, intention to quit and quit rates. Then, 2 reviewers independently applied inclusion criteria, which were met by 21 (5

Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.

A recent rise in cannabis use in Indigenous communities in northern Australia may have compounded existing patterns of other substance use. This paper describes these patterns in Arnhem Land in the 'Top End' of the Northern Territory (NT). Economic impacts of the cannabis trade are also described. In a descriptive cross-sectional study, random samples included 336 people (169 males, 167 females) aged 13 - 36 years. Consensus classification of lifetime and current use of cannabis, alcohol, tobacco, kava, inhalants (petrol) and other drugs was derived based on health workers' proxy assessments. A sample (n = 180, aged 13 - 36) was recruited opportunistically for interview. Lifetime cannabis users among those interviewed (n = 131, 81 males, 50 females) described their current cannabis use, usual quantities purchased and consumed, frequency and duration of cannabis use and other substance use. In the random samples, 69% (63 - 75%) of males and 26% (20 - 31%) of females were lifetime cannabis users (OR = 7.4, 4.5 - 12.1, p < 0.001). The proportion of males currently using cannabis was 67% (60 - 73%) while the proportion of females currently using cannabis was 22% (16 - 27%) (OR = 7.9, 4.8 - 13.1, p < 0.001). Current cannabis users were more likely than non-users to be also using alcohol (OR = 10.4, 4.7 - 23.3, p < 0.001), tobacco (OR = 19.0, 7.9 - 45.8, p < 0.001) and to have sniffed petrol (OR = 9.1, 4.6 - 18.0, p < 0.001) but were less likely to be using kava (OR = 0.4, 0.2 - 0.9, p < 0.001). Among those interviewed, higher tobacco consumption in current users and greater alcohol use in lifetime users was associated with increased cannabis use. Action is required to reduce cannabis use, especially in combination with other substances.

Background: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. Aims: To examine associations between kava use and potential health effects. Methods: A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. Results: Kava users more frequently showed a characteristic dermopathy (P < 0.001). They had increased levels of γ-glutamyl transferase and alkaline phosphatase (P < 0.001). Lymphocyte counts were significantly lower in kava users (P < 0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. Conclusions: Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities. (Intern Med J 2003; 33: 336-340)

The objective of this study was to describe patterns of substance use among remote Aboriginal community populations. The setting was the eastern Arnhem Land ('Miwatj') region of the Northern Territory's (NT) 'Top End', with a population of 4217 Aboriginal people over 15 years of age using a cross-sectional description and comparison. Sample 1 (n = 689) from the region used data from health-worker consensus classification of kava, alcohol, tobacco, petrol and cannabis use. Sample 2 (n = 101) from one community used self-reported use, age at commencement, duration, amounts consumed and expenditure. In 1999 (sample 1), 46% of males and 18% of females were kava users, alcohol: 53% males, 12% females, tobacco: 68% males, 65% females, and cannabis: 31% males, 8% females. Less than 5% sniffed petrol. In one community in 2000, 39% males and 20% females reported using cannabis during the previous month. In this community between 1999 and 2000, the proportion of current kava users among men declined (77-52%, p = 0.015) with a tendency in women for a decrease in the proportion of tobacco users (87-69%, p = 0.096). The increase in the proportion of cannabis users in men (21-39%, p = 0.068) was not statistically significant. However, in women the increase was significant (0-20%, p = 0.013). Gross expenditure on tobacco and kava were similar in 2000: both greater than cannabis and alcohol. Median years used ranged from 4 years for cannabis and 20 years for tobacco. The data supported anecdotes of a recent rise in cannabis use, especially in women. Kava use declined in men. Tobacco use patterns in women may have been changing. Average per capita consumption of alcohol was low compared with other 'Top End' areas. Such varied and dynamic substance use patterns pose challenges for research and policy.