Snijder Mieke, Lees Briana, Stearne Annalee, Ward James, Garlick Bock Sophia, Newton Nicola, Stapinski Lexine
The Matilda Centre for Research in Mental Health and Substance Use, School of Medicine, Medicine and Health, The University of Sydney, Sydney, 2006 New South Wales, Australia.
Curtin University, Perth, 6102 Western Australia, Australia.
Prev Med Rep. 2020 Dec 1;21:101277. doi: 10.1016/j.pmedr.2020.101277. eCollection 2021 Mar.
Globally, Indigenous populations experience a disproportionately higher burden of disease related to substance use. Effective prevention of harm related to substance use is a key strategy for improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples in Australia. To inform preventative approaches, this review synthesised the evidence of risk and protective factors of substance use and related harms among Aboriginal and Torres Strait Islander peoples. Eight peer-reviewed and two grey literature databases were systematically searched for quantitative or qualitative studies assessing factors associated with substance use and related harms among Aboriginal and Torres Strait Islander peoples, published between 1 January 1990 and 30 April 2018. Study quality was assessed using validated instruments. Risk or odds ratios were extracted or calculated and factors were summarised in an ecological model into individual, relationship, community, societal or culturally-distinct levels. Thirty-eight relevant studies were identified and reviewed. Individual-level risk factors for substance use were identified including low socio-economic status, high psychological distress, poly drug use and being male. Relationship-level factors were peer pressure and partner/family substance use; protective factors were supportive environments and positive role models. Community-level risk factors included availability of substances. Culturally-distinct factors included cultural connection as a protective factor, but cultural obligations around sharing was a risk factor. Societal risk factors included intergenerational trauma caused by government policies. These findings highlight the importance of tailored preventative approaches for Aboriginal and Torres Strait Islander communities that address identified risk factors and promote protective factors across all ecological levels.
在全球范围内，原住民群体遭受与物质使用相关的疾病负担比例过高。有效预防与物质使用相关的危害是改善澳大利亚原住民和托雷斯海峡岛民健康与福祉的关键策略。为了为预防方法提供依据，本综述综合了原住民和托雷斯海峡岛民中物质使用及相关危害的风险和保护因素的证据。系统检索了八个同行评审数据库和两个灰色文献数据库，以查找1990年1月1日至2018年4月30日期间发表的评估原住民和托雷斯海峡岛民中与物质使用及相关危害相关因素的定量或定性研究。使用经过验证的工具评估研究质量。提取或计算风险或比值比，并将因素在生态模型中归纳为个体、关系、社区、社会或文化独特层面。共识别并审查了38项相关研究。确定了物质使用的个体层面风险因素，包括社会经济地位低、心理困扰高、多药使用和男性；关系层面因素为同伴压力和伴侣/家庭物质使用，保护因素为支持性环境和积极榜样；社区层面风险因素包括物质可得性；文化独特因素包括文化联系作为保护因素，但围绕分享的文化义务是风险因素；社会风险因素包括政府政策导致的代际创伤。这些发现凸显了为原住民和托雷斯海峡岛民社区量身定制预防方法的重要性，这些方法应解决已识别的风险因素，并在所有生态层面促进保护因素。
