An ecological model of drug and alcohol use and related harms among Aboriginal and Torres Strait Islander Australians: A systematic review of the literature

Abstract

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.

Strong and Deadly Futures: Co-Development of a Web-Based Wellbeing and Substance Use Prevention Program for Aboriginal and Torres Strait Islander and Non-Aboriginal Adolescents

“…To complement the recommendations derived from these formative consultations, we reviewed the academic and grey literature to determine the modifiable risk and protective factors for substance use among Aboriginal and Torres Strait Islander people, and the effective substance use prevention components identified internationally for Indigenous youth. A full description of the methods, search terms and findings of these systematic reviews are provided in the published review protocols [ 31 , 32 ] and results [ 19 , 33 ]. Table 3 summarises the implications for effective program development arising from these systematic reviews, and reviews of mainstream substance use prevention literature [ 16 , 29 ].…”

“…Taking together, findings from our consultation and literature review in the information gathering phase indicated four key considerations in developing a culturally appropriate school-based prevention approach for Aboriginal and Torres Strait Islander adolescents: Adopt a comprehensive prevention strategy (beyond information provision) that is empowering, incorporates skills training and explores the impact of social influence and psychological distress on substance use; Combine core effective elements of mainstream programs with cultural elements, given the target factors for Aboriginal and Torres Strait Islander and non-Aboriginal adolescents are well aligned [ 33 ], and international evidence suggests that mainstream programs that are adapted to align with cultural identity and practices are effective in preventing substance-related harms among Indigenous adolescents [ 19 ]; Avoid stigma by developing a program for both Aboriginal and Torres Strait Islander and non-Aboriginal students that is inclusive, empowering and celebrates the cultural diversity within Australian classrooms; Align with the Australian schools’ curriculum and make use of technology for program delivery to capitalise on advantages of this delivery method, including student engagement, scalability and ease of implementation. …”

“…Combine core effective elements of mainstream programs with cultural elements, given the target factors for Aboriginal and Torres Strait Islander and non-Aboriginal adolescents are well aligned [ 33 ], and international evidence suggests that mainstream programs that are adapted to align with cultural identity and practices are effective in preventing substance-related harms among Indigenous adolescents [ 19 ];…”

“…Third, the program incorporates many of the desirable and effective components identified through our information gathering stage (outlined in Table 3 ). It incorporates skills training and substance use knowledge acquisition which were identified as effective components of prevention for Indigenous youth internationally [ 19 ], and addresses factors identified in the risk and protective factors review, including truancy, peer use and ability to resist peer pressure and normalisation of substance use [ 33 ]. Fourth, the web-based delivery of Climate Schools provides an interactive approach that aligns with teacher and student preferences to use digital technology to enhance learning [ 46 ].…”

“… Sources : 1 Snijder, Stapinski [ 19 ]; 2 Newton, Deady [ 29 ]; 3 Lee, Cameron [ 16 ] 4 Snijder, Lees [ 33 ]. Key: P = Protective factors; R = Risk factors.…”