We report on the feasibility and perceived acceptability of brief motivational interviewing for hazardous alcohol use in an urban Aboriginal health service. General practitioners (GPs) were trained in brief motivational interviewing, and health workers in other aspects of the intervention. Screening was initially carried out using the AUDIT, but subsequently reduced to two simple questions. Information was obtained through a combination of participant observation by the study team, ongoing ad hoc review and feedback from staff, periodic group meetings, and one-on-one interviews with health workers and GPs. The AUDIT was felt to be intrusive and some questions were poorly understood. Brief intervention seemed to be culturally appropriate, but barriers to wider administration included lack of time and the complexity of patients' presenting health problems. As a result of the research there was an increase in general awareness and acceptability of addressing alcohol issues at the health service. This study raises a number of issues that both support and threaten the wide implementation of brief intervention in urban Aboriginal primary care settings.
There are over 100 million girls and women who have undergone female genital mutilation (FGM). The World Health Organization (WHO) estimates that another 2 million are subject to it every year. FGM is practiced in many countries, especially Africa and parts of the Middle East. Various degrees of FGM are prevalent, the most mutilating one being infibulation (pharaonic). With infibulation there are numerous life-long health problems such as hemorrhage, infection, dyspareunia, genital ulcers, and gynecological and obstetrical complications. It has been postulated that FGM may also play a significant role in facilitating the transmission of HIV infection through numerous mechanisms. In this article several of the most common complications are discussed and helpful suggestions for management during pregnancy and delivery are explored. Included are the legal and ethical ramifications.
The ability of policy makers, practitioners and the broader public to respond appropriately in reducing the harms caused by alcohol misuse depends in large part on our understanding of the nature of the problem. In the case of consumption patterns and associated harms among indigenous minority peoples--in Australia and elsewhere--such an understanding is often difficult to achieve. There are a host of reasons for this including cultural differences between indigenous peoples and the broader populations within which they are located, cultural heterogeneity among indigenous peoples themselves, political and economic disadvantages which exacerbate misuse and its effects, methodological difficulties in the appropriate design of data collection instruments, sampling issues and the issues in the interpretation of data. All these difficulties mean that we need to subject any studies of substance misuse among indigenous peoples to a high level of scrutiny. This is particularly the case when such studies are conducted by organisations that are generally regarded as 'authoritative' sources of information. Chikritzhs & Brady have done this in the case of the National Aboriginal and Torres Strait Islander Social Survey 2002, conducted by the Australian Bureau of Statistics. In their review of this and other surveys, they demonstrate that to produce valid information about indigenous alcohol misuse, as well as having the skills to conduct broad population surveys, it is necessary to have an understanding of both methods of collecting data on alcohol consumption and Indigenous cultures themselves.
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.
The paper presents preliminary findings from a qualitative study of Australian Aboriginal men who have stopped drinking without the assistance of residential treatment, counselling or other programs. Main reasons advanced by interviewees for ceasing drinking were one or more of: medical condition and/or doctor's warning; family factors; trauma from accidents; conversion to Christianity. The author concludes that employment both helps and hinders abstention from drinking, and that social ties often pose major difficulties for those trying to give up drinking. The paper also discusses the importance of Aboriginal beliefs regarding personal autonomy.
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