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 Ward; Sophia Garlick Bock; Nicola Newton; Lexine Stapinski

doi:10.1016/j.pmedr.2020.101277

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

Prev Med Rep. 2020 Dec 1:21:101277. doi: 10.1016/j.pmedr.2020.101277. eCollection 2021 Mar.

Authors

Mieke Snijder¹, Briana Lees¹, Annalee Stearne², James Ward³, Sophia Garlick Bock¹, Nicola Newton¹, Lexine Stapinski¹

Affiliations

¹ 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.
² Curtin University, Perth, 6102 Western Australia, Australia.
³ The Poche Centre for Indigenous Health, University of Queensland, St Lucia, 4067 Queensland, Australia.

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.

Keywords: Aboriginal and Torres Strait Islander people; Alcohol; Cannabis; Drug; Indigenous; Prevention; Protective factors; Risk factors; Substance use; Tobacco.

Publication types

Review