Mob and country : a role for identity in alcohol screening for Indigenous Australians living in the ACT and region

Abstract

Risky alcohol consumption is responsible for seven per cent of all Indigenous deaths in Australia and is a precursor to many diseases. Despite high rates of risky consumption, screening is not routine practice in primary health care and the validity of screening instruments (other than the Indigenous Risk Impact Screen) have not been performed for Indigenous peoples. Enquiring about risky alcohol use can cause discomfort for health practitioners and clients. One way of overcoming this is to create an environment free from a number of social contexts. My first aim was to assess the reliability and validity of commonly used alcohol screening instruments. This then provided an opportunity to assess the level of risky alcohol use in the study population, my second aim. My third aim was to assess whether a culturally mediated alcohol screen could improve reporting of risky alcohol consumption. It involved starting the interview with questions about the participant's 'mob and country'. My fourth aim was to determine whether the socio-cultural factors or acculturation stress reflected determinants of drinking for the study population. My final aim was to examine facilitators and moderators of risky drinking. I conducted a computer-assisted cross-sectional survey of Indigenous people (n=121) in the primary survey and 45 participants completed a re-test survey (for test re-test reliability). The surveys were conducted among Aboriginal and Torres Strait Islander people living in the Australian Capital Territory (ACT) region from July 2010 to August 2011. Participants were randomised into a 'mob-ask' screening group (n=53) and a 'screening as usual' group (n=69). Five alcohol screening instruments were administered. A modified Vancouver Index of Acculturation (VIA) were used to examine how Indigenous people viewed their participation in heritage and dominant society cultures, the Drinking Motives Questionnaire (DMQ) to examine motives for drinking and the Kessler 10 (K10) to examine psychological distress. All alcohol screening instruments were reliable, but shorter screening instruments were as reliable and valid as existing instruments. Half the participants were drinking above recommended guideline limits and the mean age of initiation to alcohol was 14 years, 13 years for males and 15 years for females. Being male, living in a dependent household situation and being excluded from education were associated with risk-taking behaviour and risky alcohol consumption. Alcohol screening instrument mean scores were higher in the 'mob-ask' screen group compared to the control group. Participants were highly integrated (had a positive association with both heritage and dominant society culture) and, as anticipated, socio-cultural factors, rather than acculturation stress, predicted risky alcohol use. Health gains achieved through reducing consumption and drinking in specific situations (particularly around children and family members) moderated drinking. Family members were also identified by participants as facilitators to drinking and risk-taking behaviour. Screening approaches for risky drinking do not require major modification but do need to be focused on younger people (from 13 years) and screening needs to be routine. Show more