Clough Alan R, Margolis Stephen A, Miller Adrian, Shakeshaft Anthony, Doran Christopher M, McDermott Robyn, Sanson-Fisher Robert, Ypinazar Valmae, Martin David, Robertson Jan A, Fitts Michelle S, Bird Katrina, Honorato Bronwyn, Towle Simon, West Caryn
Community-based Health Promotion and Prevention Studies Group, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, 4870, Australia.
School of Medicine, Griffith University, Nathan, QLD, 4111, Australia.
BMC Public Health. 2017 Jan 10;17(1):55. doi: 10.1186/s12889-016-3995-8.
In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities.
This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18-24, 25-44, 45-64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances.
Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity (ρ = 0.90). Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. 'Unfavourable' items were not reliably reflected in one group (ρ = 0.48) but in: i) alcohol availability and consumption not reduced and ii) criminalization and discrimination. In logistic regressions, longer-term (≥ 6 years) residents more likely agreed that violence against women had reduced and that personal safety had improved but also that criminalization and binge drinking had increased. Younger people disagreed that their community was a better place to live and strongly agreed about discrimination. Current drinkers' views differed little from the sample overall.
The present Government review provides an opportunity to reinforce 'favourable' outcomes while targeting: illicit alcohol, treatment and diversion services and reconciliation of criminalization and discrimination issues.
在澳大利亚，“酒精管理计划”（AMPs）为州政府和联邦政府解决原住民和托雷斯海峡岛民的酒精使用问题提供了政策框架。我们报告了昆士兰州15个偏远原住民社区中10个社区居民对酒精管理计划的体验。
这项横断面研究采用两阶段抽样策略：N = 1211；10个社区中年龄≥18岁的居民，其中588名（48%）为男性，623名（52%）为女性。通过半结构化访谈得出了关于“有利”影响的7个命题和关于“不利”影响的7个命题。对于每个命题，采用单样本比例检验来考察参与者的认同情况，并通过多变量二元逻辑回归评估性别、年龄（18 - 24岁、25 - 44岁、45 - 64岁、≥65岁）、居住时间（≥6年）、当前饮酒情况和原住民身份的影响。验证性因素分析估计量表的信度（ρ）、项目负荷和协方差。
微弱多数人认同：酒精管理计划减少了暴力行为（53%，p = 0.024）；社区成为更宜居之地（54%，0.012）；儿童更安全（56%，p < 0.001）。更多人认同：上学出勤率提高（66%，p < 0.001）；对酒精危害的认识增强（71%，p < 0.001）。参与者对个人安全改善（53%，p = 0.097）和减少针对女性的暴力行为（49%，p = 0.362）的看法模棱两可。这7个“有利”项目可靠地总结了参与者对暴力减少和社区环境改善的体验（ρ = 0.90）。对于6个“不利”项目，有更强的认同：酒精供应未减少（58%，p < 0.001）；饮酒未减少（56%，p < 0.001）；大麻使用增加（69%，p < 0.001）；更多酗酒行为（73%，p < 0.001）；遭受歧视（77%；p < 0.001）；因违反限制而增加罚款、定罪和犯罪记录（90%，p < 0.001）。参与者对警察能否有效执行限制措施看法模棱两可（51%认同，p = 0.365）。“不利”项目在一组中未能可靠体现（ρ = 0.48），但在以下方面有所体现：i）酒精供应和消费未减少；ii）刑事定罪和歧视。在逻辑回归中，长期（≥6年）居民更有可能认同针对女性的暴力行为减少、个人安全改善，但也认同刑事定罪和酗酒行为增加。年轻人不同意他们的社区是更宜居之地，并强烈认同存在歧视。当前饮酒者的观点与总体样本差异不大。
当前的政府审查提供了一个机会，在针对非法酒精、治疗和转介服务以及协调刑事定罪和歧视问题的同时，强化“有利”成果。
