title: Alcohol management plans in Aboriginal and Torres Strait Islander (Indigenous) Australian communities in Queensland: community residents have experienced favourable impacts but also suffered unfavourable ones.
abstract: In Australia, 'Alcohol Management Plans' (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents' experiences of AMPs in 10 of Queensland's 15 remote Indigenous communities.
  
  
  
  This cross-sectional study used a two-stage sampling strategy: N = 1211; 588 (48%) males, 623 (52%) females aged ≥18 years in 10 communities. Seven propositions about 'favourable' impacts and seven about 'unfavourable' impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18-24, 25-44, 45-64, ≥65 years), residence (≥6 years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability (ρ), item loadings and covariances.
  
  
  
  Slim majorities agreed that: AMPs reduced violence (53%, p = 0.024); community a better place to live (54%, 0.012); and children were safer (56%, p < 0.001). More agreed that: school attendance improved (66%, p < 0.001); and awareness of alcohol's harms increased (71%, p < 0.001). Participants were equivocal about improved personal safety (53%, p = 0.097) and reduced violence against women (49%, p = 0.362). The seven 'favourable' items reliably summarized participants' experiences of reduced violence and improved community amenity (ρ = 0.90). Stronger agreement was found for six 'unfavourable' items: alcohol availability not reduced (58%, p < 0.001); drinking not reduced (56%, p < 0.001)); cannabis use increased (69%, p < 0.001); more binge drinking (73%, p < 0.001); discrimination experienced (77%, p < 0.001); increased fines, convictions and criminal records for breaching restrictions (90%, p < 0.001). Participants were equivocal (51% agreed, p = 0.365) that police could enforce restrictions effectively. 'Unfavourable' items were not reliably reflected in one group (ρ = 0.48) but in: i) alcohol availability and consumption not reduced and ii) criminalization and discrimination. In logistic regressions, longer-term (≥ 6 years) residents more likely agreed that violence against women had reduced and that personal safety had improved but also that criminalization and binge drinking had increased. Younger people disagreed that their community was a better place to live and strongly agreed about discrimination. Current drinkers' views differed little from the sample overall.
  
  
  
  The present Government review provides an opportunity to reinforce 'favourable' outcomes while targeting: illicit alcohol, treatment and diversion services and reconciliation of criminalization and discrimination issues.
authors.affiliation: Community-based Health Promotion and Prevention Studies Group, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, 4870, Australia. alan.clough@jcu.edu.au.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
authors.affiliation: School of Medicine, Griffith University, Nathan, QLD, 4111, Australia.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Margolis
authors.affiliation: Indigenous Research Unit, Griffith University, Nathan, QLD, 4111, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Miller
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Shakeshaft
authors.affiliation: Health Economics, Central Queensland University, Brisbane, 4000, QLD, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Doran
authors.affiliation: Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4870, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: McDermott
authors.affiliation: School of Medicine and Public Health (Public Health), University of Newcastle, Sydney, NSW, 2000, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Sanson-Fisher
authors.affiliation: School of Medicine, Griffith University, Nathan, QLD, 4111, Australia.
authors.forename: Valmae
authors.initials: V
authors.lastname: Ypinazar
authors.affiliation: College of Arts and Social Sciences, Australian National University, Canberra, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: Division of Tropical Health and Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Robertson
authors.affiliation: Division of Tropical Health and Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Fitts
authors.affiliation: Division of Tropical Health and Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Bird
authors.affiliation: Division of Tropical Health and Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Honorato
authors.affiliation: Division of Tropical Health and Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Towle
authors.affiliation: Division of Tropical Health and Medicine, College of Healthcare Sciences, James Cook University, Cairns, QLD, Australia.
authors.forename: Caryn
authors.initials: C
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011793:Queensland / Q000453:epidemiology; D015203:Reproducibility of Results; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander; Alcohol; Australian; Evaluation; Indigenous; Legal intervention