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Introduction: The complex and contentious nature of alcohol and other drug (AOD) clinical work affords the likelihood of significant ethical dimensions. However, little attention has been paid to clinicians' perspectives of ethics in their practice within AOD settings. This potentially neglects an important aspect of AOD clinical work. Methods: We used an insider empirical ethics methodology, where the first author (DS) concurrently worked as an AOD clinician in the research setting. Participants were 30 experienced AOD clinicians, working within a large specialist AOD service in Victoria, Australia. We used three qualitative data collection methods: moral conversation, involving semi‐structured interviews; moral participation, involving the first author reflecting on his own ethical practices; and participant‐observation, involving observation of clinical meetings. We used Applied Thematic Analysis to analyse the data. Results: Although participants rarely used explicitly ethical language to describe their work, they described four ethical goals: helping clients to access AOD care and treatment; facilitating change in clients' lives; challenging stigma; and keeping people safe. We argue that these clinical goals should also be conceptualised as ethical goals. Discussion and Conclusions: Ethics is an integral component of everyday AOD work. Our findings had some overlap with established ethical principles. Participants demonstrated expertise in engaging with ethical dimensions, without using ethical language. Given the limited attention paid to ethics in AOD clinical settings, increasing the focus on ethics in everyday clinical practice is an important contribution to future AOD clinical work. Its absence negates important aspects of care for clients. [ABSTRACT FROM AUTHOR]

This article seeks to understand Indigenous Australian young people's relationships and their experiences of sexual intimacy. A cohort of Indigenous 16–25-year-olds from urban, rural and remote communities were invited to participate in a collaborative method involving scenario-based body mapping. In these activities, young people discussed the range and complexity of their relationships and how constructions and interpretations of relationships contribute to both positive and negative experiences. These rich understandings provide important insights into adolescent sexuality as 'multidimensional, socially constructed and negotiated'. However, they also point to the continued gendered power inequalities that subordinate young women's lives to the desires and control of young men. [ABSTRACT FROM AUTHOR]

The migration literature has shown that immigrant parents face significant challenges with regard to parenting in a new culture, especially with the children in early adolescence, a period of significant physical, social and emotional change for human being. This article demonstrates that Bangladeshi mothers, who have spent a major part of their lives in Bangladeshi cultural contexts, face different socio-cultural contexts raising their young daughters in Australia. Using qualitative methods, this article discusses Bangladeshi mothers parenting experiences who have daughters' between the ages of 10 to 14 years. Thematic analysis of the data revealed two broad themes: perceived benefits of raising daughters in Australia and mothers' anxieties around daughters' rearing and promotion of mistrust; and two sub-themes: perceived cultural differences: Bangladeshi vs. Australian culture and perceived risk of shame, loss of family reputation and honour. The findings reveal how mothers' construct their daughters' identities as Bengali women as they follow cautionary parenting in a foreign culture through promotion of mistrust about interracial communications. [ABSTRACT FROM AUTHOR]

The small, decentralised communities, known as outstations which satellite larger Indigenous Australian remote communities have often been conceptualised as places that are beneficial to health and well-being. This paper provides an exploration of the meaning of an outstation for one family and the benefits that this connection brings to them, which are expressed in a deep connection to the land, continuing relationships with ancestors and a safe refuge from the stresses of the larger community. We argue that the outstation provides a place for people to be in control of their lives and form hopes and plans for the future. These benefits are positioned in a context where the future liveability and sustainability of the outstation is both fragile and vulnerable. [ABSTRACT FROM AUTHOR]

Stigma associated with alcoholism is common in Japan, and individuals who suffer from alcoholism often feel that it is a taboo to discuss their problems with alcohol in the general public. This paper describes the way in which the self-help group called Danshukai offers a model for recovery for people suffering from alcoholism in Japan. Since 2006, the authors have been involved in various meetings and conducted conversational and semi-structured interviews with leaders and rank-and-file members of Danshukai. In Danshukai, recovery is viewed as a spiritual process offering the potential for a new life compared to models offered by medical treatment that place little emphasis on the role of spirituality in recovery. While medical models seek to reduce alcohol-related stigma by viewing it as a treatable ‘disease’, rather than a personality weakness, Danshukai encourages members to embrace their identity as a Danshukai member and to engage with a ‘way of abstinence’ that includes a lifelong commitment to Danshukai activities and helping others with similar problems. [ABSTRACT FROM PUBLISHER]

The ongoing quest for effective ways of preventing and managing alcohol and other drug use-related problems among Indigenous Australians has spawned a variety of approaches, including AA-based treatment, population health-based preventive approaches, and various forms of cultural healing. This paper examines two inter-related sources of ideas and strategies: firstly, the emergence since the 1970s of evangelical Christianity in some Aboriginal communities as a response to profound changes, including increased access to alcohol. The second is the attempt to invoke Indigenous spirituality as an alternative to both western Christianity and western biomedical intervention models. We also discuss the representation of Australian Indigenous spirituality within New Age and related discourses. [ABSTRACT FROM AUTHOR]

This article describes the application and adaptation of body mapping as a tool for exploring sexual health and sexual decision making among young people aged 16-25. It argues that while body mapping engaged youth to discuss general health issues, young people were reluctant to engage with issues related to sexual health, due to feelings of shame and fear of stigma. Sexual health case scenarios were developed and used in conjunction with body-mapping exercises. The use of scenarios was an effective way to explore sensitive information, while protecting young people from revealing any specific identifiable information about themselves. In this article, we suggest that utilizing a combination of methodological approaches (the visual body maps and written case scenarios) in sexual health research with young people has the potential to enhance and enrich the quality of the data, and allow for a safe and enabling environment. This is particularly important where long-term fieldwork might be difficult or constrained. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities. Methods: Qualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author. Results: The findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment. Conclusion: This different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active 'on country' need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on 'traditional country' needs to be considered as imperative to health improvement. [ABSTRACT FROM AUTHOR]

This study investigated the quality of life (QoL) of clients in an Indigenous Australian residential alcohol and drug treatment center. Qualitative and quantitative data were collected from a random sample of Indigenous clients utilizing the Self Evaluated Individual Quality of Life–Direct Weight tool. The findings from this study provide support for the inclusion of QoL as important in understanding the recovery process from substance misuse. A discrepancy was found between the self-reported aspirations of clients and the focus of the treatment provided, and recommendations were provided for inclusion of new areas in the education provided to the clients of this service. [ABSTRACT FROM PUBLISHER]

The human ethics issues surrounding the conduct of health science research have been the subject of increasing debate among biomedical and social science researchers in recent years. Ethics procedures in health-science research are typically concerned with protecting anonymity and confidentiality, and are tailored to work that primarily uses quantitative methodologies. For qualitative research in the health social sciences, a different set of ethical issues often arises in the research process. This article examines three case studies of qualitative researchers working with Indigenous Australian communities, focusing on the researchers' experiences with ethics committees and how they approached a range of ethical issues arising in the course of their research. Key issues include: obtaining informed consent for participant observation; the evolving nature of qualitative research; the difficulties in foreseeing changes in approach; and the distinction between the research team and the researched in participatory action research. [ABSTRACT FROM AUTHOR]

The subject of mental health has been discussed for some time in the literature on Australian Aboriginal peoples, although the volume of this work has been relatively small. This literature can be separated into two main approaches. The first has been concerned with documenting and analyzing disorders that are culturally specific to a particular group. The second, more recent body of literature understands mental health issues as resulting from a combination of factors related to the effects of colonization, such as loss of land, poverty, and the destruction of families. This literature is often aimed at diagnosis and the provision of appropriate services for Indigenous people without a comprehensive ethnographic understanding of the cultural specificities of certain mental health disorders. Although mental health problems are discussed, such as suicide, depression, and anxiety, little analysis is undertaken of how such states are locally experienced and understood. This paper reports the complexities involved in understanding mental health from the perspective of youth in a remote Aboriginal community in northern Australia. We argue that it is necessary to understand mental health within the broader context of the lives of Indigenous youth and, in particular, the interaction between their marginalization from participating in the opportunities that globalization offers with issues related to poverty, substance misuse, and specific cultural beliefs. [ABSTRACT FROM AUTHOR]

Residential rehabilitation centres are a popular form of treatment for Indigenous Australians suffering from alcohol and drug misuse; however, there has been very little substantive research and evaluation in this area. Based on long-term ethnographic research, this study examines the informal aspects of a treatment programme in an Indigenous residential alcohol and drug rehabilitation service. Evaluation of such services often focuses on treatment length and/or treatment level obtained as key indicators of success. This study suggests that 'treatment' may be more complex and layered with multiple levels of meaning, which may not necessarily be captured in some evaluation designs. For the residential rehabilitation centre discussed in this paper, oscillating periods of mutual support and discipline have an important therapeutic function. Standard measures of treatment length and level obtained are meaningless without incorporating understanding of this process. This paper presents some of the ethnographic findings, alongside some of the evaluation implications of doing this kind of research. [ABSTRACT FROM AUTHOR]

Objective: To examine marijuana use by youth in a remote Aboriginal community in Northern Australia over a 5-year period. Design: Participant observation, structured and unstructured interviews. Setting: Remote Indigenous Australian community. Participants: Young Aboriginal people and adult community members. Main outcome measure: Emergent themes of the attitudes towards marijuana use among remote Indigenous residents are reported. Results: Restrictions in the availability of alcohol and petrol have led to increased use of marijuana with serious social and community consequences. Conclusions: Efforts to control licit substances, such as alcohol, in remote communities need to be addressed in the context of understanding of the dynamics of alcohol and drug use in totality as well as interventions that address underlying structural and social inequalities. [ABSTRACT FROM AUTHOR]

This is an account of various unsuccessful efforts to combat petrol-sniffing in River Town, a remote Aboriginal settlement in north Australia. The paper provides insights into the dynamics of remote Aboriginal settlements, highlighting the dissonance between non-Aboriginal service providers and the Aboriginal residents. Attention is drawn to the need for more involvement of Aboriginal people in policy making and program implementation. The paper suggests also that there is a need for adequate resources to resolve the problems experienced in settlements such as River Town. [ABSTRACT FROM AUTHOR]

While petrol sniffing amonge Australian Aboriginal youth has received significant public and academic attention, the experience of petrol sniffing as articulated by sniffers themselves and community's perceptions of petrol sniffing have been underexplored. Through an ethnographic analysis of a remote Aboriginal community in the Northern Territory Australia, a range of perspectives on petrol sniffing are elucidated in order to understand both the experiences associated with sniffing and non-sniffers' perceptions of the activity. We argue that contextualizing sniffing within the community is essential to understanding petrol sniffing, and hence to providing appropriate health interventions. It would be incorrect to presume a causal connection between the introduction of a petrol sniffing intervention, described in this article, and the sudden cessation of all petrol sniffing activities in late 2005. Rather, a number of factors and occurrences within the community combined with the effects of the intervention were associated with a significant decrease in petrol sniffing. [ABSTRACT FROM AUTHOR]

The overrepresentation of Aboriginal and Torres Strait Islander (respectfully referred to hereafter as “Aboriginal”) children in the child protection system is a concern in Australia, with Aboriginal children placed in out-of-home care at a rate 11 times that of non-Aboriginal children. This study utilised linked administrative data to determine the longitudinal child protection pathways from birth to age 10 years for a cohort of 15,815 Aboriginal children born in Western Australia between 2000 and 2006. In total, 9,269 (59%) children did not have any contact with child protection between one year prior to birth and their 11th birthday. Conversely, 6,546 (41%) Aboriginal children were involved with child protection during the study period, with 1,405 (9%) children placed in out-of-home care. Infants who had a child protection notification were more likely than other age groups to have a substantiated notification of abuse and neglect and placed in out-of-home care. More than half (56%) of all children were predominantly placed in kinship care; however, only 22% had their first placement with kinship carers. Aboriginal-led strategies together with the support and commitment of all levels of government are required to reduce entry into care and improve outcomes for Aboriginal children in care.IMPLICATIONSAboriginal-led strategies and wholistic responses can reduce the overrepresentation of Aboriginal children reported to child protection systems, and support families and communities.Infancy stands out as a key point of system involvement. This stage offers an opportunity where early intervention and family support strategies may prevent first time involvement with the child protection services and promote kinship placement, reunification with parents, and community-led supportive care.Aboriginal-led strategies and wholistic responses can reduce the overrepresentation of Aboriginal children reported to child protection systems, and support families and communities.Infancy stands out as a key point of system involvement. This stage offers an opportunity where early intervention and family support strategies may prevent first time involvement with the child protection services and promote kinship placement, reunification with parents, and community-led supportive care. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Cardiovascular disease and cancers are the leading cause of mortality amongst people accessing treatment for alcohol and other drug use. The current study aimed to examine risk factors for chronic disease amongst people attending residential alcohol and other drug treatment services.Participants (N = 325) were attending residential alcohol and other drug treatment services across Australia. Diabetes and cardiovascular disease risk scores were calculated using established risk estimation algorithms. Differences in existing health conditions, risk factors for chronic diseases and risk algorithms were calculated for males and females.In addition to alcohol and other drug use (including tobacco use), 95% of the sample had at least one other risk factor for chronic disease. Of participants not already diagnosed, 36% were at a high risk of developing type 2 diabetes and 11% had a high risk of developing cardiovascular disease. The heart age of participants was 11 years older than actual age (Mage = 40.63, Mheart age = 52.41). Males had a higher cardiovascular disease risk than females.A large proportion of people accessing residential alcohol and other drug treatment were at risk of chronic disease. Future research is needed that uses objective indicators of physical health. Such research will help to develop our understanding of prevention and intervention initiatives that could be adopted by treatment providers to improve the physical health of their consumers. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the actions of the Human Research Ethics Committee (HREC) of the Australian Department of Health and Menzies School of Health Research.

Background: Although previous quantitative studies have documented the association between exposure to alcohol portrayals and drinking attitudes in Western countries, few qualitative studies have explored this matter in Thailand. A better understanding of the association in young Thais is required for a more efficient alcohol policy development. This study aims to explore the information young Thais have learnt from exposure to alcohol portrayals in society and the media, examine how this exposure shapes their drinking attitudes, and investigate the alignment of policy-makers' views on drinking with those of young people. Methods: Two qualitative research methods were employed. Seventy-two university students (38 men, 34 women) aged 20–24 participated in focus groups conducted on campus. Semi-structured interviews were conducted with academia, civil society and representatives from government who were involved in alcohol policy. Recorded data were transcribed verbatim, systematically coded and analysed using content analysis. Results: Young Thais were regularly exposed to alcohol portrayals, particularly on social media and in their social environment. Being increasingly exposed to alcohol portrayals, particularly on social media, and the role of the alcohol industry emerged as concerning matters to the academia and civil society sectors. In response to the concerns, the government social media monitoring and alcohol censorship had become more challenging. Conclusions: This study reflects the growing concerns from academia and civil society sectors of the impacts of increased alcohol exposure and the role that the industry may have on young people's drinking attitudes. It highlights the need for response to significant policy challenges to reduce these impacts. [ABSTRACT FROM AUTHOR]

Aims This study aims to measure the prevalence rates and patterns of help-seeking behavior as a consequence of being harmed by drinkers in five Asian countries (India, Sri Lanka, Vietnam, Lao PDR and Thailand). Methods A total of 9832 respondents aged 18–65 years from the WHO/ThaiHealth Collaborative Project were surveyed between 2012 and 2014 about their experiences of being negatively affected due to another's drinking, and whether and where they sought help, focusing on four adverse aspects of harms from others' drinking. Results The prevalence of seeking help from any source in the past year due to harm from others' drinking ranged from 7% to 20%. The most common service used by those who were affected by other people's drinking was asking for help from friends, followed by calling the police and using health-related services. The largest proportion of help-seeking was among those reporting property harm, followed by those being harmed physically and sexually by drinkers. Conclusion Given a wide range of harms from others' drinking in the general population and different needs of those affected, prevalence rates for help-seeking behavior due to others' drinking in South and South East Asian countries were low and the help sought was often informal. There is a large knowledge gap in our understanding of the mechanisms of help-seeking behavior and the pathways for access to help among those affected. Further studies are important for enhancing the social response services available and making these more accessible to those who need help. [ABSTRACT FROM AUTHOR]

Background: Despite abundant alcohol control regulations and measures in Thailand, prevalence of alcohol consumption has been relatively steady for the past decade and alcohol-related harm remains high. This study aims to explore, through the perspectives of key public health stakeholders, the current performance of regulations controlling alcohol availability and access, and the future directions for the implementation of Thai alcohol policy.Methods: Semi-structured interviews were conducted with public health stakeholders from three sectors; the government, academia and civil society. Their perceptions about the current alcohol situation, gaps in the current policies, and future directions of alcohol policy were discussed. Audio data were transcribed verbatim, systematically coded and analysed.Results: The three key concerning issues were physical availability, economic availability and commercial access, which referred to outlet density, taxation and pricing, and compliance to stipulated regulations, respectively. First, Thailand failed to control the number of alcohol outlets. The availability problem was exacerbated by the increased numbers of liquor licences issued, without delineating the need for the outlets. Second, alcohol tax rates, albeit occasionally adjusted, are disproportionate to the economic dynamic, and there is yet a minimum pricing. Finally, compliance to age and time restrictions was challenging.Conclusions: The lack of robustness of enforcement and disintegration of government agencies in regulating availability and access hampers effectiveness of alcohol policy. Comprehensive regulations for the control of availability of and access to alcohol are required to strengthen alcohol policy. Consistent monitoring and surveillance of the compliances are recommended to prevent significant effects of the regulations diminish over time. [ABSTRACT FROM AUTHOR]

The article presents an obituary for David McKnight, Emeritus Professor of Anthropology at the London School of Economics.

Background: Harm from alcohol-attributable aggression and violence is linked to diminished personal safety and reduced physical and mental health and wellbeing in many countries. But there has been limited evidence on these harms in low- and middle-income countries (LMICs). This study measured harm from others' drinking-related aggression, violence and misconduct in five Asian LMICs (Thailand, Sri Lanka, India, Vietnam, and Lao PDR), aiming to compare the magnitude and pattern of harm across countries by gender, age group, educational level, rurality, and country-level indicators.Methods: Data from 9832 respondents from the WHO/Thai Health International Collaborative Research Project on the Harm from Others' Drinking undertaken between 2012 and 2014 were analysed.Findings: 50-73% of respondents from five countries reported being harmed at least once in the past year. Public disorder and feeling unsafe due to someone else's drinking was frequently reported, followed by harassment, assaults and threats, traffic harm, and property damage. In most countries, men were more likely than women to report traffic harms, property harm, and assaults, whereas women were more likely to report feeling unsafe in public. Being young, less educated, living in urban areas, and one's own drinking were significant predictors of more harm from others' drinking for both genders.Conclusions: This study revealed a consistently high prevalence of alcohol-related aggression and violence in the five Asian countries. Patterns of harm within countries and populations at most risk for different forms of harms were identified. Alongside services for those affected, efforts to strengthen alcohol policies are needed in each society. [ABSTRACT FROM AUTHOR]

Clinical work in Alcohol and Other Drugs has not generally been an area of focus for ethicists. Likewise, ethics is not usually part of Alcohol and Other Drugs training or practice. This means that resources available to Alcohol and Other Drugs clinicians navigating ethical challenges are not widely available. This paper describes a systematic review of literature at the intersection of ethics and clinical practice in Alcohol and Other Drugs. The review will potentially benefit Alcohol and Other Drug practitioners by outlining what resources currently available and will also highlight potential directions for future research. The review searched for all published work in ethics at the intersection with Alcohol and Other Drugs. Searches within academic databases, the World Wide Web, and within journal Tables of Contents identified 18 relevant papers from 1985 onwards. An inductive process of categorisation produced two categories of this literature. The first was codes of ethics, further divided into rule-based codes (n = 4) and principle-based codes (n = 10). The second category was of empirical ethics (n = 4). Rule-based codes are not considered useful to practitioners. They can discourage reflection and potential irrelevance of rules. Principle-based codes are more useful, and principles specific to Alcohol and Other Drugs were identified in some literature. Empirical ethics enable the identification of ethics in everyday clinical work, rather than categorising ethics as a special case in particularly challenging circumstances. The four empirical ethics papers describe highly specific situations, guiding practitioners in these areas. This small body of work demonstrates that future research in empirical ethics is of potential benefit to research in ethics and to clinical practice in Alcohol and Other Drugs. [ABSTRACT FROM AUTHOR]

Rare disease patient organisations (RDPOs) provide funding, logistic support and ideas for biomedical research. The literature, however, largely consists of case studies of successful RDPOs, and theoretical analyses of their potential influence on biomedical science. RDPOs’ involvement is portrayed as an example of patient empowerment and democratisation of research that allows some societal groups to challenge researchers’ traditional control of research agendas. Little is known about whether this optimistic view reflects common experiences of RDPOs or how research involvement impacts on RDPOs themselves. In our mixed methods study of a broad group of Australian RDPOs, organisational leaders identified psychological and practical benefits of supporting research but, in contrast with prevailing accounts, often struggled to uphold organisational and personal interests when engaging with researchers. Leaders reported difficulty fundraising for research and allocating funds in ways likely to support the RDPOs’ goals. They had concerns about promoting ‘false hope’ and noted conflicts between researchers’ and patients’ interests. Some were disillusioned with research and frustrated by lack of opportunities for genuine involvement in decision-making. These insights have important implications for how patient group alliances, researchers and policymakers could strengthen the engagement and contributions of RDPOs, which have become vital stakeholder groups in research. [ABSTRACT FROM AUTHOR]

Background: The burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities.Methods: Qualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author.Results: The findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment.Conclusion: This different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active 'on country' need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on 'traditional country' needs to be considered as imperative to health improvement. [ABSTRACT FROM AUTHOR]

Drawn from a sample of 88 Indigenous young people in five locations in urban and remote Northern Australia, this research utilised a combination of qualitative approaches to encourage young people to discuss their ideas about sexual relationships and violence. Indigenous youth discussed highly public displays of violence, as well as violence within intimate settings and the interrelationships between these two arenas. A key finding of this research was that young people described violence as an accepted part of their sexual relationships and this normalisation led to significant tensions in their experiences and management of their everyday relationships. While violence around young people's relationships in remote communities was reported to some extent as being controlled through both the public and controlled form they take, we found that the increasing mobility of young people from remote to urban locations due to education opportunities and the impact of social media can lead to more serious forms of violence and tension in the maintenance of young people's sexual relationships. This contributes new findings to the literature on Indigenous young people's experiences in relationship forming and management, an area that has received little attention in the academic literature. [ABSTRACT FROM AUTHOR]

Background: We report here selected findings from a mixed-methods study investigating the role of Australian rare disease patient organisations (RDPOs) in research. Despite there being many examples of RDPOs that have initiated and supported significant scientific advances, there is little information - and none at all in Australia - about RDPOs generally, and their research-related goals, activities, and experiences. This information is a pre-requisite for understanding what RDPOs bring to research and how their involvement could be strengthened.Methods: We reviewed 112 RDPO websites, conducted an online survey completed by 61 organisational leaders, and interviewed ten leaders and two key informants. Quantitative and qualitative data were analysed using basic descriptive statistics and content analysis, respectively.Results: Although most are small volunteer-based groups, more than 90% of the surveyed RDPOs had a goal to promote or support research on the diseases affecting their members. Nearly all (95 %) had undertaken at least one research-related activity - such as providing funding or other support to researchers - in the previous five years. However, RDPO leaders reported considerable challenges in meeting their research goals. Difficulties most frequently identified were insufficient RDPO resources, and a perceived lack of researchers interested in studying their diseases. Other concerns included inadequate RDPO expertise in governing research "investments", and difficulty engaging researchers in the organisation's knowledge and ideas. We discuss these perceived challenges in the light of two systemic issues: the proliferation of and lack of collaboration between RDPOs, and the lack of specific governmental policies and resources supporting rare disease research and patient advocacy in Australia.Conclusion: This study provides unique information about the experiences of RDPOs generally, rather than experiences retrospectively reported by RDPOs associated with successful research. We describe RDPOs' valuable contributions to research, while also providing insights into the difficulties for small organisations trying to promote research. The study is relevant internationally because of what it tells us about RDPOs; however, we draw attention to specific opportunities in Australia to support RDPOs' involvement in research, for the benefit of current and future generations affected by rare diseases. [ABSTRACT FROM AUTHOR]

This paper examines young people's perceived vulnerability to sexually transmitted infections (STIs) and their efforts to create a sense of personal safety within an environment in which risks may be high and where STIs are highly stigmatised. The paper reports on findings from research involving both Indigenous and non-Indigenous 16- to 25-year-olds from remote, rural and regional Australia, including communities in the Northern Territory, Western Australia and South Australia. The study used qualitative methods, including body mapping and scenario based interviewing, to explore how young people made decisions about potential sexual partners and how STIs were understood within the context of young people's everyday social worlds. The paper has important implications for the design and implementation of sexual-health education programmes by documenting the stigmatisation of young people with STIs and the protective mechanisms peer groups employ to create perceptions of personal safety. [ABSTRACT FROM AUTHOR]

This paper describes how spatial understandings of the internet (i.e. the internet is a 'space') enable the persistence of marginalised medical practices. By tracing different accounts of the internet as space among practitioners and followers of diện chẩn - an emergent Vietnamese unregulated therapeutic method - we show how the logic of space circumscribes an alternative techno-social site for marginalised medical practices, transforms the private experience of being alone with technology into being-in-space, spiritualises the internet as a conduit of healing power, and mediates transnational health mobility among the Vietnamese diaspora. Drawing on interviews and ethnographic participation in Vietnam and the US, we demonstrate how the internet can be understood as non-biomedical milieu - a field of determination that conjoins heterogenous interventions on health-related eventualities outside of structured and institutionalised biomedical practices. This in vivo conceptualisation of the internet as space offers a point of convergence against the bifurcation of information as abstract and technology as concrete. A spatial conceptualisation highlights the embeddedness of health knowledge on the internet and shows how techno-social interrelations produce different spaces of multiplicity, which constitute a favourable milieu for medical practices outside of the biomedical institution to persist. [ABSTRACT FROM AUTHOR]

The goal of this article is to explain the concept of double perspective and the impact this may be having on the health of Indigenous people. In inter-cultural communication, there are sets of meanings that are discernible to anyone, and an extra set of underlying meanings that are only accessible for people who have the cultural knowledge to discern them. These different sets of meanings embody a double perspective. We will discuss the double perspective involved in the interactions between public healthcare institutions, the clinicians and staff of these institutions, and Indigenous people. By realising the potential for improved resilience that a double perspective brings to Indigenous people, an awareness of the inclusion and exclusion of Indigenous persons, cultures and histories should become established in healthcare institutions and health research. A double perspective carries resilience, and as such it should be understood as a key to support individual health and the collective well-being of Indigenous people. [ABSTRACT FROM AUTHOR]

Introduction: Clown doctors are a feature in paediatric hospitals, visiting children and families, providing a welcome escape from the reality of hospitalisation. Whilst the use of humour to improve health and wellbeing has been widely researched, limited exploration of the role of clown doctors has occurred. This research aims to elucidate the role of clown doctors within a paediatric hospital. Theory/Methods: In this ethnographic study, participants included the clown doctors and every person with whom they had a meaningful encounter. The narrative of the clown doctors was captured through 1,500 hours of participant observation documented over one year. Interviews and visual methods were utilised, with key informants drawing and explaining their experience of the clown doctors. A constructivist framework was used to analyse emergent themes. Results: Whilst almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. Themes that arose during observation that related to the function of clown doctors included: distraction, anxiety reduction and procedural assistance; entertainment and making people laugh; emotional support and providing comfort; and communication, including translating clinical information to families. These functional elements of the clown doctors are the result of a more complex, intimate human connection that arose due to the nature of the clown being low-status, open, and vulnerable, and in particular existing as an outsider within the medical establishment. These interconnected relationships drove engagement and resulted in clown doctors becoming privy to information, emotions, complaints, jokes, disclosures etc., often not revealed by patients and their families to staff members, or even vice versa. Discussion: While almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. The role of the clown doctors transcends traditional labels, but in crude terms it can be characterised as thus: role leads to function, which in turn leads to outcome. In terms of a joke analogy, function is the punch line of being a clown doctor. Conclusion: The results of this study provide a comprehensive understanding of clown doctors and the complexity of human relationships within a major paediatric hospital, uncovering a profound, nuanced culture cheerfully highlighting the need for a more person-centred approach to healthcare. Lessons Learned: This study has advanced understanding regarding clown doctors' unique contribution to healthcare delivery within a tertiary paediatric health service, highlighting their expertise in role-modelling person-centred interactions. Limitations: This study was conducted within one paediatric health service. The researchers believe however that the novel understandings regarding the role of the clown doctors generated through this study would likely transfer easily to other healthcare settings. Suggestions for Future Research: This study will inform future qualitative and quantitate research studies that aim to describe and measure the role of the clown doctors, as distinct from their activities, and the contribution this has to the experience of patients within health care services. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The dominant Thai alcohol companies have strategically employed brand advertising and brand sharing (using a very similar branding for both alcoholic and non-alcoholic products) to circumvent restrictive alcohol advertising regulations. As empirical evidence confirms that exposure to alcohol advertisements increases youth drinking, young Thais could be at risk of constant and incidental exposure to alcohol advertising, hence leading to increased alcohol consumption. This study aims to explore young people's perceptions of these alcohol branding strategies and to examine how exposure to such advertising strategies affect their attitudes towards alcohol use.Design and Methods: Seventy-two university students aged 20-24 years participated in 1.5-h semi-structured focus groups conducted in Bangkok and a peripheral province. Logos of two domestic alcohol brands were also used as part of projective techniques to elicit information. Thematic content analysis was used to analyse data.Results: Despite a range of alcoholic and non-alcoholic products under the same branding, participants associated the logos primarily with beer-the flagship product. Branding strategies seemed to successfully increase young people's brand familiarity and affected their brand recognition and brand awareness. Participants had a high awareness of the alcohol companies' commercial activities but regarded alcohol advertisements to be indifferent to advertisements of other ordinary products.Discussion and Conclusions: Brand advertising is a dynamic tool that affects young people's attitudes towards the advertised brands and alcohol use. Due to early exposure to the brands, brand sharing increases brand familiarity and, among other factors, potentially affects drinking attitudes and purchase intentions. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The recognition of the association between the use of alcohol and negative health outcomes have led to the endorsement of the World Health Organization's global strategy to reduce the harmful use of alcohol. Given the capacities, capabilities and sociocultural contexts of Thailand, this study aims to examine the Thai alcohol policy against the global strategy's recommended policy measures for marketing control and identify areas for further policy development.Design and Methods: Semi-structured interviews were conducted with the stakeholders from three sectors: the government, academia and civil society. Their perceptions of the Thai alcohol policy in regulating alcohol industry's commercial strategies and activities were discussed. Audio data were transcribed verbatim, systematically coded and thematically analysed.Results: Although the Thai Alcohol Control Act meticulously regulates the content of direct alcohol marketing, the volume of marketing and indirect alcohol marketing have become problematic and difficult for the government to address. The industry has worked to normalise the consumption of alcohol through repetitive brand exposure and their suggestion that drinking was integral for socialisation. The control of alcohol sponsorship was politically sensitive and legally ambiguous because alcohol sponsorship seemed to provide economic and social benefits and further reinforced the industry's positive image.Discussion and Conclusions: Despite the strict alcohol policy, gaps in the marketing regulations exist. Future policy development should place greater emphasis on alcohol sponsorship and branding through evidenced-based interventions. The interactions between the government and the industry should be monitored and restricted. Rigorous regulations, as seen for tobacco, are encouraged for alcohol marketing. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC), results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. Methods: Interrupted time series study over six years in a remote primary health care (PHC) service involving Aboriginal adults identified with elevated CVD risk (N = 64). Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention) and three years following: (i) the proportion of guideline scheduled CVD preventive care services delivered, (ii) mean CVD medications prescribed and dispensed, (iii) mean PHC consultations, (iv) changes in participants' CVD risk factors and estimated absolute CVD risk and (v) mean number of CVD events and iatrogenic events. Results: Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%), and prescription of CVD related medications (28% to 89%) (P < 0.001). Amongst participants there was a 20% relative reduction in estimated absolute CVD risk (P = 0.004) following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. Conclusions: Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on strategies to reorient and restructure PHC services to the care of chronic illness for Aboriginal peoples in remote areas for there to be substantial progress in decreasing excess CVD related mortality. [ABSTRACT FROM AUTHOR]

Background: Although long-term alcohol and tobacco use have widely been recognised as important risk factors for cancer, the impacts of alcohol and tobacco health policies on cancer mortality have not been examined in previous studies. This study aims to estimate the association of key alcohol and tobacco policy or events in Australia with changes in overall and five specific types of cancer mortality between the 1950s and 2013.Methods: Annual population-based time-series data between 1911 and 2013 on per capita alcohol and tobacco consumption and head and neck (lip, oral cavity, pharynx, larynx and oesophagus), lung, breast, colorectum and anus, liver and total cancer mortality data from the 1950s to 2013 were collected from the Australian Bureau of Statistics and Cancer Council Victoria, the WHO Cancer Mortality Database and the Australian Institute of Health and Welfare. The policies with significant relations to changes in alcohol and tobacco consumption were identified in an initial model. Intervention dummies with estimated lags were then developed based on these key alcohol and tobacco policies and events and inserted into time-series models to estimate the relation of the particular policy changes with cancer mortality.Results: Liquor licence liberalisation in the 1960s was significantly associated with increases in the level of population drinking and thereafter of male cancer mortality. The introduction of random breath testing programs in Australia after 1976 was associated with a reduction in population drinking and thereafter in cancer mortality for both men and women. Meanwhile, the release of UK and US public health reports on tobacco in 1962 and 1964 and the ban on cigarette ads on TV and radio in 1976 were found to have been associated with a reduction in Australian tobacco consumption and thereafter a reduction in mortality from all cancer types except liver cancer. Policy changes on alcohol and tobacco during the 1960s-1980s were associated with greater changes for men than for women, particularly for head and neck, lung and colorectum cancer sites.Conclusion: This study provides evidence that some changes to public health policies in Australia in the twentieth century were related to the changes in the population consumption of alcohol and tobacco, and in subsequent mortality from various cancers over the following 20 years. [ABSTRACT FROM AUTHOR]

Objective: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. Conclusions: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need. [ABSTRACT FROM AUTHOR]