title: Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed.
abstract: OBJECTIVE
  To describe and critique methodological aspects of interventions targeting reductions in smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) among Indigenous Australians.
  
  
  METHODS
  An electronic search of eight databases and a manual search of reference lists of literature reviews and reference libraries for Indigenous-specific intervention studies published in peer-reviewed journals (January 1990 to August 2007) were undertaken. Alcohol, smoking, nutrition or physical activity needed to be the primary focus of the study and the intervention needed to specifically target Indigenous Australians.
  
  
  RESULTS
  Twenty studies were selected for inclusion in the review. Methodologically, few studies employed randomisation or a control group, most omitted important details (e.g. costs), some did not report process measures (e.g. attrition rates), and some did not use validated measures. Two-thirds of interventions were implemented at the community level and employed multiple strategies.
  
  
  CONCLUSIONS
  There is a need for more rigorous evaluations of interventions targeting reductions in SNAP risk factors among Indigenous Australians, and to establish the reliability and validity of measures to quantify their effect.
  
  
  CONCLUSIONS
  It may be beneficial for future Indigenous-specific intervention research to focus on the evaluation of secondary prevention to complement the current concentration of effort targeting primary prevention. Community-wide interventions, combining strategies of greater intensity for high risk individuals with those of less intensity targeting lower risk individuals, might also offer considerable promise.
authors.affiliation: National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales. a.clifford@unsw.edu.au
authors.forename: Anton
authors.initials: A
authors.lastname: Clifford
authors.forename: Lisa Jackson
authors.initials: LJ
authors.lastname: Pulver
authors.forename: Robyn
authors.initials: R
authors.lastname: Richmond
authors.forename: Anthony
authors.initials: A
authors.lastname: Shakeshaft
authors.forename: Rowena
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D001291:Attitude of Health Personnel; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003469:Culture; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012307:Risk Factors; D016540:Smoking Cessation / Q000208:ethnology* / Q000379:methods; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000208:ethnology*; D055815:Young Adult