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

Mieke Snijder · Briana Lees · Annalee Stearne · James S Ward · Sophia Garlick Bock · Nicola C. Newton +1 more

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Indigenous Health, Education, and Rights Substance Abuse Treatment and Outcomes HIV, Drug Use, Sexual Risk

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.

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References

2012Interrater reliability: the kappa statistic 2013Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 2015Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data 1933A Handbook of Child Psychology.2009Indigenous health part 2: the underlying causes of the health gap 2017The need for a complex systems model of evidence for public health 2019Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement 1999The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, 1999

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