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DRUGNFOclearinghousewww.druginfo.adf.org.auPreventionResearchQuarterlycurrent evidence evaluatedJune 2007ISSN 1832-6013Culturally andlinguistically diversecommunities anddrug prevention

Prevention Research Quarterly: Current evidence evaluatedISSN 1832-6013This publication is copyright, but its contents may be freely photocopied or transmitted, providedthe authors are appropriately acknowledged. Copies of this publication must not be sold.The Issues Paper and the Reading and Resource List are part of the Druglnfo Clearinghouse’squarterly publications on drug prevention. Other publications and resources include the newsletterDrugInfo and a range of Fact Sheets tailored for specific audiences, such as professionals and othersworking in the drug prevention and related sectors, teachers, students, parents and others withan interest in drug prevention. The quarterly publications usually provide a range of perspectiveson current research and best practice relating to a central theme in drug prevention. All thesepublications are available for download.The Druglnfo Clearinghouse provides a first port of call for workers, professionals and others seekinginformation on drugs and drug prevention.You can sign up for free membership—at the DrugInfo website, or by visiting, telephoning orwriting to:Druglnfo ClearinghouseAustralian Drug Foundation409 King Street, West Melbourne, Victoria 3003 AustraliaTel. 1300 85 85 84 (Victoria only)Email: druginfo@adf.org.auWeb: www.druginfo.adf.org.auAny enquiries or comments on this publication should be directed to the Publishing Manager,Druglnfo Clearinghouse, at the above address.The research in this publication represents work done on behalf of the DrugInfo Clearinghouse bythe Centre for Youth Drug Studies (CYDS) at the Australian Drug Foundation. The work of CYDSin this research was supported by a Reference Group that included key stakeholders and advisorypartners:Premier’s Drug Prevention CouncilDepartment of Human Services, VictoriaDrugInfo ClearinghouseEthnic Communities Council of Victoria, Drugs Task ForceVicHealthNorth Richmond Community Health ServiceCutting Edge—UnitingCare SheppartonDrugInfo Clearinghouse is an initiative of the Australian Drug Foundation and the VictorianPremier’s Drug Prevention Council

ContentsCulturally and linguisticallydiverse communities anddrug preventionIssues Paper no. 1 1Reading and Resource List no. 20 13

Issues PaperNo. 1 • June 2007DRUGNFOclearinghousewww.druginfo.adf.org.auCulturally and linguisticallydiverse communities and drugpreventionby Vanessa Kennedy, Research Officer, andNetzach Goren, Senior Research Officer, Centre forYouth Drug Studies, Australian Drug FoundationIntroductionAustralia’s immigrant population has grown enormously in recent decades. Millions of peoplefrom more than 150 different countries, and from diverse backgrounds, have been integratedwith much success. In the year 2005–06, 119 564 immigrants from non-English speakingcountries settled permanently in Australia (Department of Immigration and Citizenship 2007).These immigrants are referred to as being “culturally and linguistically diverse” (CLD), a termgenerally understood to encompass both those born overseas in a non-English speaking country(first-generation immigrants), as well as those born in Australia but with one or both parents,or grandparents, born overseas in a non-English speaking country (second and third-generationimmigrants, respectively).While for the majority of arrivals immigrationmeans a significant improvement in quality of life,the immigrant experience is a very complex one.Migrants may encounter various stressors that havean impact on their general wellbeing, and thereforethe experience of immigrating has the capacity tonegatively influence all parts of their lives. From adrug prevention perspective, it is desirable to preventstressors related to the immigrant experience fromleading to the development of drug and/or alcoholproblems. Initiatives that aim to prevent or reducedrug and/or alcohol problems in CLD communitieshave thus been designed and implemented.In recent years, the Australian Drug Foundation’sDrugInfo Clearinghouse has produced two “suites” ofpublications (2003 and 2006) that explored a rangeof issues related to drug and/or alcohol preventionwork with CLD communities. The prevention researchevaluation papers included in these suites werebased on reviews of the evidence and interviews withpractitioners who worked in a prevention capacitywith CLD communities. The 2003 paper, entitled“Prevention issues for communities characterised bycultural and linguistic diversity” (Rowland, Tombourou& Stevens 2003), explored the broader issues facingpractitioners undertaking drug prevention workwith CLD communities. The 2006 paper, “Newlyarrived refugees and drug prevention” (Goren 2006),examined issues related specifically to emergingrefugee communities in Australia. Both the 2003and 2006 papers focused largely on identifying riskfactors for CLD communities. That is, they focusedon identifying factors specific to CLD communitiesthat may predispose them to developing drug and/oralcohol problems. The types of risk factors that werediscussed included:◗ family problems◗ low socioeconomic statusIssues Paper | No. 1 | June 2007

◗◗◗◗unemployment / few desirable employmentopportunitiesdifficulties at school due to language difficultiesa desire to gain acceptancelack of information about drugs (both youngpeople and parents).The current studyIn this study we aimed to explore the types ofprevention programs that practitioners in theprevention sector believe are effective with CLDcommunities. Other areas of interest were theprevalence of substance use in CLD communities,obstacles to prevention work and the extent to whichthe evidence-base is used in the design of preventioninitiatives. A section of the report is devoted to eachof these areas of interest.The decision to focus on practitioners’ perspectiveswas made on the basis that the literature/researchavailable on the above-mentioned areas of interesthad already been extensively examined through the2003 and 2006 DrugInfo suites. The assumption wasthat a comprehensive exploration of practitioners’perspectives at the grassroots would complementthis work. Given that a literature review was notconducted in this study, in order to contextualisepractitioners’ opinions, findings from past reports(2003 and 2006) are referred to throughout thecurrent report where appropriate.In order to gain the perspectives of CLD drugprevention practitioners, a focus group wasconducted. A focus group methodology was chosenon the assumption that the social and interactivecontext of a focus group would be an effective meansof divulging practitioners’ different experiences andideas about prevention with CLD communities.A list of practitioners to approach for the focus groupwas arrived at through internal and external liaison.A total of eight practitioners agreed to participate.Cumulatively, they had experience in working with arange of cultures to prevent and reduce drug and/oralcohol problems, including Greek, Macedonian,Italian, Russian, Pacific Islander, Vietnamese,Cambodian and Spanish, as well as with newly arrivedimmigrants from Israel and the Jewish communityand from the Horn of Africa.We acknowledge that eight practitioners cannotrepresent the general population of drug and alcoholworkers in Victoria. However, the study did not setout to be representative of the sector as a whole.Rather, it is exploratory in nature and points to areasthat may require further investigation, research orattention.The focus group was held at the Australian DrugFoundation on 24 January, 2007. The duration ofthe session was restricted to 90 minutes, as researchsuggests that the quality of discussion in focus groupscan wane if they are too lengthy.Direct quotations from the 2007 focus group arescattered throughout the report to illustrate thepoints made, and for readers’ interest.1. The prevalence of drug and/oralcohol use in CLD communitiesPractitioners’ perspectives of the extent of drugand/or alcohol use in CLD communities were exploredin the 2007 focus group in order to provide acontext for the study. It was thought that having anunderstanding of practitioners’ ideas of the extent ofthe problem was important, as their opinions on thismatter would no doubt influence their opinions aboutthe sector as a whole and thus the study’s other areasof interest.Statistics from systematic data collection indicatethat CLD communities have lower rates of alcoholand drug use than the general population (AustralianInstitute of Health and Welfare 2001). The majorityof practitioners in the focus group had reservationsabout the validity of this finding. A number were ofthe opinion that certain drug use in certain cultureswould be equal to, if not higher than, usage rates inthe general population.Similarly, the accuracy of the above-mentioned finding(that the level of drug and/or alcohol use in CLDcommunities is lower than in the general community)was also questioned by practitioners interviewed forthe 2003 report. They also believed that the level ofdrug and/or alcohol use in CLD communities would beequal to, if not higher than, the level in the generalpopulations.Practitioners in the 2007 focus group discussedsome possibilities as to why statistics may be lowerCulturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.authan expected. One suggestion was that previousprevalence studies employed a narrow interpretationof CLD status. That is, they considered only firstgenerationimmigrants to be of CLD status, eventhough (as discussed in the Introduction) the termCLD is generally understood to encapsulate first,second and third-generation immigrants. The pointwas made that results of some studies, therefore,reflect only a small portion of the drug and/or alcoholuse that occurs in CLD communities.In a similar vein, the 2003 report highlighted that“CLD” is defined differently by different organisations/studies. It referred to a study conducted by theAustralian Bureau of Statistics (1999) that suggestedthat a broad definition of CLD (one that considersfactors such as father’s and mother’s country of birth)is desirable for large-scale studies.Some practitioners suggested that CLD communitiesmay under report their drug and/or alcohol use, thusmasking its extent. Reasons provided by practitionersas to why they may do this included that:◗◗◗The stigma attached to drug use is particularlyhigh in some cultures.Reporting problems goes against the religion andbeliefs of some cultures:“Religions and beliefs may have a role inrestricting family members asking for help …[Some CLD communities] believe in sortingout conflicts and issues in the familiesthrough internal mediation rather thanservices offered by private or governmentagencies.”They already feel discriminated against andthey do not want another reason to add to thisdiscrimination.It was suggested that the openness of the term“CLD” makes broad discussion of the prevalence ofdrug and/or alcohol use in CLD communities verydifficult. The point was made that, contained withinthe umbrella term “CLD” is a heterogeneous group ofcultures. The implication was that blanket statementsare therefore not appropriate (or possible).“The CLD expression is very broad … It coversdiverse people with diverse experience in termsof drugs and other life experience.”Practitioners in the 2007 focus group acknowledgedthat they may have an inflated sense of the prevalenceof drug and/or alcohol use in CLD communities, andthat the lower-than-expected prevalence statisticsmay in fact be accurate. That is, they acknowledgedthat their perception of prevalence may be a result of“Clinician’s Illusion”, in the sense that encountering anumber of individuals from a certain CLD group withdrug and/or alcohol problems may have led them tothe assumption that that CLD group as a whole hassignificant drug and/or alcohol problems.Indeed, the 2003 DrugInfo report concluded thatpractitioners who work in the CLD drug preventionsector may have an exaggerated sense of the level ofdrug and/or alcohol use in CLD communities.One practitioner in the 2007 focus group made theinteresting point, however, that Clinician’s Illusion canwork in the reverse. That is, if service providers do notencounter individuals from a certain CLD group, theymay assume that the group as a whole has few drugand/or alcohol problems (when, in fact, members ofthat particular CLD group in another location mighthave significant problems). The argument was thatmainstream service providers can have a skewedperception of prevalence, which can be dangerousif prevalence information is based upon theirexperiences.“We may work with a number of Timoreseyoung people in Fitzroy and … they may beusing heroin. But if you went and talked to theTimorese youth worker … in North Richmond,they’ll be seeing hundreds more kids and havemore of a broad view. So … if you’re talkingto mainstream [service providers], they mayhave certain views but it’s not actually thecommunity view, depending on what theircontact with the community is.”Other reservations were aired about basing ideas ofprevalence on information from service providers.It was suggested that such statistics are highlydependent on the quality and suitability of theservices offered. Two of the practitioners in the 2007focus group stressed that, unless a service is designedspecifically for a specific CLD group, and unless theservice has good links with the group, members ofthat CLD group are unlikely to approach the service.Their point was that service providers (that are notIssues Paper | No. 1 | June 2007

culturally sensitive) can underestimate the extent ofdrug and/or alcohol use in CLD communities if theybase their assumptions on the number of CLD clientsthat contact their service.“When you’re looking at CLD communitiesfrom a mainstream perspective, it can be underrepresented based on, ‘Well we don’t see thosecommunities; it’s not happening’. And that’sabout service provision, not about if there’sdrug issues in that community.”In addition, another practitioner suggested thatservice providers may deliberately under report theextent of drug and/or alcohol use in particular CLDgroups because they lack the resources to fullyprovide for these groups (translators, translatedmaterials etc).“They say ‘No, we don’t see them’. And partof why that’s happening is because they don’thave the resources to concentrate on anothercommunity or another group.”Dissatisfaction with, and scepticism about, theaccuracy and validity of research into the prevalenceof substance use in different CLD communities wasnot new or surprising, given that a recommendationwas made in the 2006 DrugInfo report for morecomprehensive quantitative research of this kind. Itwas suggested in the 2006 report that most studiesthat have investigated drug and/or alcohol use inCLD communities have employed qualitative ratherthan quantitative methodology and that, accordingly,the prevalence of drug and/or alcohol use in CLDcommunities is still largely unknown.In summaryAnalysis of practitioners’ views suggests that theextent of drug and/or alcohol use in CLD communitieshas not been accurately gauged. The need for moreprevalence research was highlighted, particularly theneed for culturally specific prevalence research thatexplores the situations of individual CLD groups. Thisis in line with recommendations made in previousDrugInfo reports. While it would be undesirable toconduct research that appears to single-out and“shame” certain CLD groups, if the effectiveness ofCLD prevention services rests on them being culturallyappropriate (as will be discussed in the followingsection), it is of value and interest to have anunderstanding of the types of initiatives required, andthe CLD groups that require them.Practitioners made suggestions as to why prevalenceresearch conducted thus far may have underestimatedthe extent of substance use in CLD communities.Taking account of these factors may help futureprevalence research projects to gain a more accurateportrayal.Given that there is some reason to believe that drugand/or alcohol use may be more prevalent within CLDgroups than research indicates, it seems importantto explore the types of prevention efforts that CLDprevention workers believe are effective with CLDgroups. This is the focus of the following section.2. Drug and/or alcohol preventioninitiatives that practitioners deemedeffective with CLD communitiesIt is desirable to learn more about the types ofinitiatives that practitioners believe are effectiveat preventing/reducing drug and/or alcohol use inCLD communities. This sort of information can haveimplications for further research and hence the typesof projects that receive funding and eventuate in thefuture.The types of prevention initiatives discussed ranged intype from the provision of information regarding therisks that can be associated with drug and/or alcoholuse, to broader types of initiatives that target factorsoutside of the drug prevention sector per se. In termsof broader initiatives, a couple of the practitionershighlighted that they believed focusing on the socialdeterminants of drug and/or alcohol use to be aparticularly effective means.“I think drug prevention is about harmreduction and looking at lowering risk of druguse, but so it is outside of the drug sector. It’slooking at what are the underlying reasons whya person uses a drug … So drug preventionactually steps outside the drug services sector.”Practitioners also discussed the importance ofinitiatives being culturally sensitive, and outlined waysof achieving this.Culturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.auProvision of drug and/or alcohol informationA number of practitioners highlighted the importanceof CLD groups being educated specifically about drugand/or alcohol issues. It was suggested that not onlyyoung people need to be informed but older people,namely parents, as well. One practitioner gave anexample to demonstrate that CLD parents can bedangerously ill-informed about drugs:“A pretty tragic incident happened in theAfrican community … last year. A daughter …[had] used drugs. She went home and her mumwas worried—she could see [her daughter] wasnot normal. But the daughter went to bed,the mum went to bed, and the next morning[the mum] found [her daughter] dead. So thatshows you the mum having no idea about whatthe symptoms of drugs are.”In accordance with this view, the 2003 and 2006reports also concluded that it was important toinform CLD children and parents about drug and/oralcohol issues. The 2003 report suggested that oldermembers of CLD groups should be better educatedabout the harms associated with legal drugs such astobacco and over-the-counter medications.Talking about drug and/or alcohol issues oncommunity radio stations, setting up informationstalls at CLD festivals/events, and publishing articlesin community newspapers were identified as effectiveways of dispensing information and generatingdiscussion. Having prizes and giveaways weresuggested as successful ways to stimulate interest indrug prevention topics.Broad initiatives that target socialdeterminants of drug useAs mentioned above, it was suggested that significantprevention outcomes can be achieved throughinitiatives that do not have a prevention focus perse. That is, through work outside of the drug sectorthat addresses the social determinants of, or riskfactors for, drug and/or alcohol use. Two significantrisk factors identified by the focus group were lackof connectedness to the community, and strainedrelationships within families. Practitioners in the 2007focus group discussed the practicalities of addressingeach of these areas.A large body of research supports the idea thatfeeling isolated from society can lead people to drugand/or alcohol use, and that initiatives that improvepeoples’ sense of connectedness to society can beeffective means of preventing and reducing such use.Improving access to recreational facilities was thoughtto be a particularly effective and feasible means forimproving connectedness. The suggestion was thatrecreational facilities can be places where friendshipsare formed and homework is done, as well as placesthat offer jobs. Social networks and employmentoptions can thus be opened up. It was noted that notonly those involved in the activities themselves enjoythe benefits; the parents of children involved in theactivities have the opportunity to meet other familiesand thus increase their contentedness with life inAustralia and their confidence.A couple of the practitioners indicated the importanceof working closely with recreational organisations.It was highlighted that mainstream recreationalorganisations can be oblivious to the demand amongCLD groups for the sport/s they facilitate or manage,and thus they may need to be notified that membersof CLD groups would like to become involved in thesport/s they offer. Moreover, these organisations mayneed to be encouraged to make minor adjustments orallowances such that financial and other such barriersfor CLD groups can be broken down.“The sporting clubs have to listen to thecommunity. They have to find out, what are thebarriers … what do we need to change. Not,how do you need to change to fit our rules andthe way we operate, but how can we changeto fit what your needs are and what you wouldfind attractive and safe about our club.”One practitioner provided the interesting andinnovative example of how they worked with abadminton club to ensure that children from a CLDgroup had access to their facilities. Through liaisonwith the organisation, arrangements were made forchildren who could not afford a badminton racketto access to one for a fee of 20 cents per week. Atthe end of the year the children essentially ownedthe racket. It gave children the incentive to go backto the club each week, and the club increased itsmembership—“it was ‘win win’ all round’.Issues Paper | No. 1 | June 2007

Likewise, both the 2003 and 2006 DrugInfo reportssuggested that integrating CLD adolescents in existingsports and recreational programs can be a significantprotective factor against the development of drugand/or alcohol problems. The 2006 study based thissuggestion on a study conducted by Turning Point(2005).As mentioned in the Introduction, adjusting to life inAustralia can be very difficult for CLD families. SomeCLD parents struggle when their children behave in amanner that would have been inappropriate in theirhome country, but which is deemed acceptable andnormal in Australia. Parents can find it difficult if theirchildren expect greater freedom than they would havebeen allowed in their home country, and if they feelthey have lost some authority over them. They canbe overprotective and anxious about their children’ssafety, and moreover they can place unrealisticexpectations on their children to succeed at school.It was noted that these types of factors can causesignificant stress within CLD families.“[It can be difficult for] families that comefrom a particular culture where parents havean authoritarian role … They come to Australiawhere it’s more democratic and the childrenhave rights. So the parents’ influence isn’t thesame kind of influence. And I’ve seen parentsget totally overwhelmed.”“A lot of parents [in African communities] …their anxiety levels are so high with what theysee their kids doing with other young people …They travel a lot out of the city, so the parentsfeel like they’re physically losing control. Andthe kids are coming home being outspoken,and the [parents] are just beside themselveswith how to deal with this.”The concern, as expressed in the 2007 focus group,is that adolescents may turn to drug and/or alcoholuse as a means of dealing with this stress. A numberof practitioners noted, therefore, that initiatives thataim to improve family dynamics can be effectivemeans of preventing or reducing drug and/or alcoholuse in CLD communities. Based on their experience,practitioners suggested that family dynamics canbe improved through the provision of advice andinformation on:◗◗◗◗◗stressors for adolescents (specific to the Australiancontext)what to expect from adolescents in Australia—what is acceptable behaviourwhere to set boundariesways to communicate effectively with children andadolescentshow to support and encourage children’seducation without putting excessive pressure onthem to perform academically.“One of the things that we have to do is to helpthe parents to understand, or think about adifferent way of communicating with their kids.They won’t lose respect or their authority, butthey’ll actually talk about things in a differentway and it might help keep that bond betweenthe parents and kids.”The idea that family connectedness and satisfactionwith parental relationships are significant protectivefactors against the development of drug and/oralcohol problems in CLD communities is in accordancewith literature examined for both the 2003 and2006 reports (Groves 1993; Tulba Malual 2004; vande Wijngaart 1997; Department of Human Services2000). Also in line with 2007 findings is the factthat practitioners interviewed for 2003 report alsostressed that encouraging and assisting CLD parentsto communicate effectively with their children isdesirable from a drug and/or alcohol preventionperspective.Interestingly, practitioners in the 2007 focus group,unlike practitioners interviewed for the 2003 report,did not raise the idea that the gender of CLD childreneffects the type of familial care that is likely toprevent or reduce their substance use. For instance,constraining parenting (by both mothers and fathers)has been found to yield the lowest drug use levels forboth sexes, and paternal neglect can make daughtersin CLD families vulnerable to drug use.One practitioner in the 2007 focus group describeda four-session information program for parentsof adolescents. This program was presented insix languages (including English) and aimed toimprove parents’ understanding of challenges facingadolescents in Australia. This practitioner noted thatCulturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.authe program was externally evaluated and deemedto be worthwhile. The practitioner thought that keyto the program’s success was the connectednessthat it promoted among those who participated inthe sessions. Parents were able to gain a sense ofthe acceptability or unacceptability of their children’sbehaviour, and to discuss issues such as where to setboundaries. The practitioner indicated that benefitscontinued even after the program itself had ended,as some parents stayed in touch with each other andprovided continuing support to each other.“The beauty of the program was that therewere opportunities for parents to build theirconnection with each other, in talking abouttheir children, and to get an idea of what wasnormal… A lot of the parents were concernedabout … where to put the boundaries. ‘Whenthey’re going to parties, how do I give themadvice? What should I expect? What’s beingfair, what’s not fair?’ And in working with theparents in their language … they came to … acommunity moré—this is where we draw theline in the sand.”“There was a lot of support for each other thatwent beyond just the four-session program …A lot of what was built up in connectednessamongst people who came, continued forthose families, and that’s been a real plus.”As outlined above, it would seem that initiatives thatimprove connectedness and family dynamics canhave significant prevention outcomes. Importantly, anumber of practitioners stressed that the effectivenessof initiatives often relied on them being culturallysensitive.The importance of initiativesbeing culturally sensitiveAs mentioned briefly in Section 1, a number of theexperts stressed that they believed it was essentialfor services to be culturally sensitive—that is, familiarwith the different needs and norms of differentCLD groups—if they were to attract members ofCLD groups. Consulting the target community andemploying ethno-specific workers were suggested toachieve this.A couple of the practitioners commented that itis very important for initiatives to be driven by thetarget community. They thought that initiatives weremore likely to have effect if practitioners consultedmembers of the target community and asked themwhat types of drug and/or alcohol prevention servicesthey thought their community needed, and howthey should be delivered. CLD workers could thenstructure the ideas, bring them together and deliverthe initiative. One practitioner commented that itwas only when their organisation had taken steps toestablish good links with a target CLD communitythat the true demand for services became evident.“That’s the big one I think for mainstreamaround prevention—it needs to be expertise inthe communities and it needs to be driven bythe communities.”Importantly, one practitioner highlighted thatconsidering only the wants and needs of CLDcommunity leaders or spokespeople might not bedesirable. This practitioner thought that they mighthave personal and/or community agendas that do notrepresent the needs and desires of the target groupas a whole. The implication was that attempts shouldbe made to consult a cross-section of people from thetarget group.“All layers of the CLD community [need tobe considered], not just the ‘gate keepers’ orcommunity spokespeople, as they may havepersonal (for example, based on gender or age)or community agendas that don’t reflect theissues and service needs of the target group.”A number of the practitioners were of the opinionthat drug and/or alcohol information was much morelikely to reach, and have resonance with, CLD groupsif ethno-specific workers were involved in the deliveryprocess. That is, prevention outcomes were morelikely if ethno-specific workers delivered preventioninitiatives to their communities.“I think ethno-specific workers are incrediblyvaluable to the community because they’rethe ones who make the links between what’sout there to help people and how to get themessages through to their local communities.”Issues Paper | No. 1 | June 2007

In a similar vein, literature reviewed for the 2006DrugInfo report (Sangster, Shiner, Sheik & Patel 2002)also highlighted the value of employing people fromdifferent cultural backgrounds as drug service staff.Improving the employment opportunities availableto CLD groups, and their socioeconomic status, wasseen by a number of practitioners in the 2007 focusgroup as ideal for prevention and reduction of drugand/or alcohol problems in CLD communities. Onepractitioner noted that it can be depressing for thosewhose qualifications and skills are not recognised inAustralia—out-work is sometimes the only option.Using drugs and/or alcohol can be a means ofdealing with this depression. Practitioners in thefocus group gave more weight, however, to initiativesthat increase connectedness to the community, andthat improve family dynamics, perhaps because theysee these as more feasible and practical avenues forprevention work.Certainly, literature explored for the 2003 and 2006reports also suggested that supporting members ofCLD groups to perform well at school, and to gainemployment, are desirable and effective meansof preventing and reducing drug and/or alcoholproblems.A suggestion not made in the 2007 focus group,but that was made in the 2006 report, was thatface-to-face consultations that do not involve muchpaperwork (in order to avoid language difficulties)tend to work well with CLD groups.In summaryIn a similar vein to findings of past CLD DrugInforeports (2003, 2006), analysis of the current data alsoindicates that effective prevention initiatives are thosethat:◗◗◗provide information about drug and/or alcohol use(to children and adults)tackle the social determinants of drug and/oralcohol use for CLD communitiesprovide culturally sensitive services.This is a good indication that both policy makers andprogram designers should be aware of, and take intoaccount, these elements when allocating funding tocurrent and future programs.Obstacles to effective prevention work are discussedin the following section.3. Obstacles to effective preventionwork with CLD communitiesas outlined by practitionersIt is valuable to explore obstacles that practitionershave faced when carrying out drug and/or alcoholprevention work with CLD groups. This type ofinformation can draw attention to areas that it wouldbe desirable to address. It may be practical to addresssome obstacles, and while attempting to addressothers may be more idealistic, the likelihood of theseobstacles being overcome in the future is arguablyincreased through identifying them. Most of theobstacles discussed by practitioners revolved aroundfunding issues; however, some practitioners foundthat the fragmented nature of the drug preventionsector also posed problems. These are discussed infurther detail below.The fragmentation of servicesA couple of the practitioners commented that thedrug services sector is fragmented and that there islittle communication between service providers. Onepractitioner noted that an overarching structure ordirection for the CLD prevention sector would bedesirable. This practitioner did not believe that onecurrently existed. In addition, another practitionerimplied that it would be beneficial to improve orincrease avenues for information sharing and thatit would be useful to be aware of the type of workbeing done with specific CLD groups in other areas orregions.“Most services are fragmented … There is nostructure that we can fit into and contribute tothe whole prevention [field].”“Probably no-one in the African communityapart from the Somalis [in the session] actuallyknow that I’ve talked to the Somalis.”Obstacles/difficulties relating to fundingA number of the practitioners suggested that fundingfor the drug prevention sector was too limited, andthat there were areas that would greatly benefit fromincreased funding. The majority of the practitionerscommented on the difficulty in obtaining fundingCulturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.aufor new projects and to sustain established projects.It was suggested that tackling drug issues hasbecome “yesterday’s news”, even though drug usewas still widespread. One practitioner expresseddisappointment that funding for projects can beceased even if they have shown to be effectivethrough external evaluation.“It was independently evaluated, it was foundto be very worthwhile [but] funding ceased.”The comment was made that it was undesirableto “stop and start” programs. When funding wasstopped and a project could not continue, there werefew (if any) ongoing benefits from the resources thatwere invested in it. One practitioner pointed out thatwhen funding “disappeared”, so did the workersgathered for the project and the knowledge andexperience that they accumulated.“Losing what you’ve already invested in is oneof the major issues about being able to keepthe continuity of services going.”“The thing is that you had trained facilitatorswho spoke Arabic and Vietnamese andwhatever ... and as soon as the funding isreleased, those people go off to other things.We can’t just access them and bring themback.”As mentioned in Section 1, it was suggestedthat some drug agencies did not feel sufficientlyequipped to cater for CLD groups. One practitionerthought it would be desirable to increase fundingfor collaborative work. That is, funding that allowedincreasing and stronger partnerships betweenorganisations in the drug sector, and organisationsthat offered other services for ethnic communities.This practitioner was of the opinion that suchpartnerships only eventuated if sustained fundingcould be assured.A practitioner noted difficulty in justifying expenditureon prevention projects that stepped outside of thedrug sector per se. This practitioner found thatfunding bodies were reluctant to finance projectsthat did not have an obvious drug prevention focus,even if they had been evaluated as having effectiveprevention outcomes. The example given wasdifficulty obtaining funding for parenting classes eventhough they were shown to be effective in improvingfamily dynamics and thus effective in reducing thelikelihood of children developing drug and/or alcoholproblems (as outlined in Section 2). The implicationwas that it would be desirable for funding bodies tohave a broader conception of drug prevention work.That way, a greater number of projects that hadeffective prevention outcomes (but did not necessarilyhave an obvious drug prevention focus) may be giventhe “green light”.“It’s very hard when you’re in the drug andalcohol service and you have to justify that yourmoney is being spent in a narrow way … Youhave to constantly try to shake that little bucketof money to fit something that’s a little bitmore that drug and alcohol, even though it isreally about prevention, but to put it on paperand justify is hard.”Another point made was that working conditionswere often quite poor for ethno-specific workers inthe drug prevention sector, and thus that attractingsuch workers to the sector was difficult. It was noted,for instance, that it was difficult for ethno-specificworkers to obtain full-time work with one employer;hence it was difficult to obtain a job that offeredholiday benefits and the like. Given that ethno-specificworkers were thought to be incredibly valuable(as discussed in Section 2), it was suggested thatimproving the opportunities for these workers, andthe recognition they receive, would be an effectiveway of enticing them to the field.“You look at any service that’s got ethnospecificworkers, and those poor people havegot a day a week there, and two days a weekthere, and another day a week there. Andthey’re trying to support a family and keepthem going. They’re doing fantastic work that’snot recognised very much in the money stream… There’s no-one with enough money to say‘come and work for us full-time, we’ll give youall the benefits’ … It doesn’t happen for them. Ithink that’s a problem.”Interestingly, while the majority of practitionersinterviewed for the DrugInfo 2007 report highlightedthat funding was an obstacle to them being ableto carry out effective prevention work, the majorityof practitioners interviewed for the 2006 reportIssues Paper | No. 1 | June 2007

commented that funding was not a significant issuefor them.Literature examined for the 2006 report (Reid, Crofts& Beyer 2001; Coker 2001) outlined a number ofaspects not raised in the 2007 focus group that mayreduce or prevent CLD groups’ access to drug serviceproviders. These included:◗◗◗confusion as to how to use medical services and/orlack of awareness of services availableinability to meet medical expensesmistrust of drug and/or alcohol services.In summaryThe findings presented in this report indicate that itwould be desirable to achieve the following in orderto reduce obstacles to effective prevention work:◗◗◗Improve working conditions for ethno-specificworkers in order to attract more of these workersto the drug prevention field and hence to makethe field more culturally sensitive.It was suggested that working conditions forethno-specific workers were inadequate in thesense that full-time positions were scarce. Onemeans of overcoming this would be to createfull-time positions for ethno-specific workersthrough collaboration with organisations outsideof the drug sector (for example, organisationsthat catered for a range of CLD issues includinghousing, employment, psychological support etc).Sustained funding.This study conveyed that ceasing funding forprojects that worked well can be undesirable. Thefunds invested in the initiative are essentially lost,as is the knowledge and experience gathered. It isrecommended that funding bodies recognise thiswastefulness, and endeavour to invest in initiativesthat they are open to financing in the long (orrather, not short) term.Improved communication within the sector.As did the 2003 report, the 2007 study indicatedthat there was limited communication betweenCLD drug prevention organisations. Thus, it seemsimportant to develop communication channels sothat service providers are better able to learn fromother service providers’ experiences.◗Cost-effective prevention initiatives.Given that funding was identified as a significantissue for the sector, it seems desirable to try todevelop programs that are more cost-effective.For example, it may be cost-effective for drugprevention workers to work with organisationsoutside of the drug sector, in whose interests itmay be to address the same risk and protectivefactors.As mentioned in the Introduction, one of the aims ofthe current study was to gain some sense of whetherthe evidence base is used to inform effective practice,and used to find ways around obstacles such as thoseoutlined in this section. Practitioners’ use of, andopinions about, the CLD prevention evidence-base areoutlined in the following section.4. Does evidence-based researchinform prevention workwith CLD communities?Evidence-based research“Evidence-based research aims toachieve the appropriate balanceof sound theory and relevantempirical evidence to makedecisions.” (Reczek 2002)Evidence-based practice“A conscientious, explicit, andjudicious use of the current bestevidence to make a decision aboutthe care of patients.” (Marwick1997)Evidence-based practice—that is, practice informedby research findings—plays a key role in current drugprevention. It is interesting to explore practitioners’conceptions of the evidence-base for prevention workwith CLD communities, as gaps and strengths can beidentified through such investigation. The followingwere discussed in the focus group:10 Culturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.au◗◗◗practitioners’ understandings of the term,“evidence-based research”the extent to which practitioners utilised andcontributed to the evidence-basecriticisms of the current evidence-base.Practitioners’ understandings of theterm, “evidence-based research”Practitioners differed somewhat in their interpretationof what constitutes evidence-based research. Somewere of the opinion that only scientific researchthat has been carried out systematically, is replicableand has been evaluated, counts as evidence-basedresearch. Others had a less scientific, more generalconception, in the sense that they thought sharingknowledge through meetings and discussions withcolleagues was a means of contributing to theevidence-base. Importantly, one practitioner wasunfamiliar with the term.The extent to which practitioners utiliseand contribute to the evidence-base, andundertake evidence-based practiceMost practitioners noted that they undertookevidence-based practice. Websites, journal articles,DrugInfo Clearinghouse publications and MedLinewere some of the sources that they had accessedto inform their prevention work. A few of thepractitioners stated that they contributed to theevidence-base through state and national forumsand/or publications.It was noted that having an evidence-base to refer tocan be an effective means of facilitating discussionsabout topics that are taboo is some cultures, suchas harm minimisation. Some cultures are morallyopposed to provision of harm-minimisationinformation, as they believe that providing peoplewith information about ways to minimise the risksassociated with drug use suggests an acceptance andtolerance of drug use. One practitioner commentedthat being able to demonstrate the theoretical basisof such concepts can make them more palatable.“I think it’s very hard to teach the concept ofharm reduction to people from cultures wherethe penalties from drug use are really, reallyhigh.”“Often parents weigh up their values that theyhold so dearly against what the evidence is …And they often reassess where they’re at andthey think, ‘Well maybe I have to sacrifice, ormaybe I have to look at this a bit differently.”In a similar vein, one practitioner noted that referringto evidence-based research can be useful whenintroducing a new (evidence-based) program thatCLD workers are uncertain about because their “gutfeeling” is that it will be unsuccessful, or becausethe program differs substantially from the type ofwork that has been done with the community in thepast. This practitioner thought that emphasising thatresearch suggests a program will be successful can bean effective means of allaying these fears.Criticisms of the currentevidence-based researchA couple of practitioners had reservations about theevidence-base for prevention work with CLD groups.They thought that there was not enough upto-dateevidence or research about the types ofprevention initiatives that are effective with CLDcommunities. One practitioner was of the opinionthat the evidence-base for CLD prevention work waisdominated, unduly, by quantitative research.“I think it tends to be related to quantitativekinds of research, and it doesn’t take enoughacknowledgement of the qualitative … There’sa whole discussion about ‘what are youdiscounting as evidence’.”Practitioners in the 2007 focus group did not outlinethe type of research that they would like to seecontribute to the CLD prevention evidence-base. Thisis perhaps an area requiring further investigation.Practitioners’ use of the evidence-base was not afocus of past DrugInfo reports. However, in additionto suggesting a need for more prevalence research(as outlined in Section 1), the 2006 report didrecommend that appropriate prevention strategies fornewly arrived CLD communities be researched.In summaryAnalysis of the data suggests that there was somevariability in practitioners’ understanding of whatconstituted ‘evidence-based research’, and oneIssues Paper | No. 1 | June 200711

practitioner was unfamiliar with the term. For thesereasons it is highly recommended that practitioners inthe field receive education about the importance ofutilising evidence-based research to inform practice,as well as education and/or information about thefollowing factors:◗◗◗what constitutes evidence-based researchways of accessing the evidence-basehow drug and alcohol workers can employevidence-based practice effectively.There was some indication from this study that manypractitioners do access and utilise the preventionevidence-base. Given reports, however, that researchon CLD prevention work is somewhat limited anddated, it is recommended that effort be put intoexpanding the evidence-base and ensuring that it iscurrent and relevant. Future research could explorethe types of research that practitioners believe wouldbe useful.In conclusionAustralia has a 200-year history of immigration andimmigrants are an integral part of Australian society.It is therefore important to provide continuing andeffective support for different CLD communities.The aims of the current study were to explore theopinions and experiences of practitioners who workin a drug prevention capacity with CLD communitiesin terms of the prevalence of substance use in CLDcommunities, the types of prevention initiatives thatthey believe are effective with CLD communities,obstacles to prevention work with CLD communitiesand the degree to which the evidence-base is utilisedin the design of prevention initiatives.The current study has led to a number ofrecommendations and suggestions regarding thoseareas of the sector that could benefit from attentionand/or further research. It is hoped that furtherresearch will assist those advocating for changes andimprovements in the sector.ReferencesAustralian Bureau of Statistics (ABS) 1999 Standards forstatistics on cultural and linguistic diversity, Canberra: ABSCatalogue no. 1289.0Australian Institute of Health and Welfare (AIHW) 2001Statistics on drug use in Australia 2000, Drug StatisticsSeries no. 8, AIHM Catalogue no. PHE 30, Canberra: AIHWCoker N 2001 “Asylum seekers’ and refugees’ healthexperience”, Health Care UK, available at www.kingsfund.org.au/pdf/AsylumSeekersExp.pdf (accessed 24/3/2006)Department of Human Services, Victoria 2000 Drugs in amulticultural community: An assessment of involvement,Melbourne: Public Health Division, Victorian Department ofHuman ServicesDepartment of Immigration and Citizenship 2007 www.immi.gov.au (accessed 12/3/2007)Goren N 2006 “Newly arrived refugees and drugprevention”, Prevention Research Evaluation ReportNumber 17, West Melbourne: DrugInfo Clearinghouse,Australian Drug Foundation, pp. 1–13Groves R 1993 “The lost families: Refugees andInternational Year of the Family”, Development Bulletin, 29,pp. 8–9Marwick C 1997 “Proponents gather to discuss practicingevidence-based medicine”, Journal of the American MedicalAssociation, 278:7, pp. 531–32Reczek K 2002 “Evidence-based research: Its role indeveloping the DPHT strategic plan, Information Outlook,6:7, www.sla.org/content/Shop/Information/infoonline/2002/jul02/kex.cfm (accessed 3/4/2007)Reid G, Crofts N & Beyer L 2001 “Drug treatmentservices for ethnic communities in Victoria, Australia: Anexamination of cultural andv institutional barriers”, EthnicHealth, 1, pp. 13−26Rowland B, Toumbourou JW & Stevens C 2003 “Preventionissues for communities characterised by cultural andlinguistic diversity”, Prevention Research Evaluation ReportNumber 8, West Melbourne: DrugInfo Clearinghouse,Australian Drug Foundation, pp. 1–12Sangster D, Shiner M, Sheik N & Patel K 2002 Deliveringdrug services to black and minority ethnic communities,London: Home Office Drug Prevention and Advisory Service,p. 16Tulba Malual M 2004. Issues facing young people fromsouthern Sudan and their community as they settle inAustralia, Sydney: AnglicareTurning Point 2005 Khat use in Somali, Ethiopianand Yemeni communities in England: Issuesand solutions. Downloaded from: www.drugs.gov.uk/ReportsandPublications/Diversity/1119266422?portal_status_message=Status+changed (accessed in 2006)van de Wijngaart GF 1997 “Drug problems amongimmigrants and refugees in The Netherlands and theDutch health care and treatment system”, Substance Use &Misuse, 32:7–8, pp. 909–3812 Culturally and linguistically diverse communities and drug prevention

Reading and Resource ListNo. 20 • June 2007DRUGNFOclearinghousewww.druginfo.adf.org.auDrug prevention in culturallyand linguistically diversecommunitiesEvidence to date suggests that alcohol and other drug use is generally lower in culturally andlinguistically diverse (CLD) communities, when compared with the general population. However,although the reasons for drug use are often similar for most young people, there may bespecific factors, such as migration and integration, which increase the risk of initiation intodrug use by young people from CLD backgrounds. The challenge for workers is to find effectiveways of working with specific CLD communities to prevent drug-related harms. Althoughfurther research is required, promising strategies include parent education, addressing barriersto accessing services and providing recreation activities for young people. This list has beenprepared as a starting point for researchers, educators and other professionals seeking currentresearch and information relating to drug issues for CLD communities. If you require assistancelocating further research articles, reports and other information on this subject please contactthe DrugInfo Clearinghouse Resource Centre.Books and reportsCentre for Culture, Ethnicity and Health 2005Resource kit for developing health promotioninformation for CLD communities, Richmond: Centrefor Culture, Ethnicity and HealthThis kit includes a checklist for reviewing existingtranslated materials, “how to” sheets for translatinghealth promotion materials into communitylanguages, and includes information on building acommunity profile, identifying CLD groups for healthpromotion and communicating for diversity.DrugInfo Clearinghouse no. CEH 05Victoria, Department of Human Services 2004Cultural diversity guide. Planning and deliveringculturally appropriate human services, Melbourne:Department of Human ServicesWithout seeking to duplicate the detailed qualityand accountability approaches pursued by individualprograms and services, the Department of HumanServices Cultural diversity guide offers advice as tohow these challenges can be met, and illustrates howthe human services sector is meeting its obligations.DrugInfo Clearinghouse no. vf DHS 04Australian Health Promotion Association 2004Community strengthening initiatives stories from thenorth. The Northern Metropolitan Region Alcohol andOther Drug Health Promotion Development Project2001−2003, Melbourne: Department of HumanServicesThis booklet contains descriptions of 15 local drugprevention projects undertaken in the northernmetropolitan region of Melbourne, and funded byCommunity Strengthening Initiative (CSI).DrugInfo Clearinghouse no. GA32 AHPVictoria, Department of Human Services 2000Drugs in a multicultural community: An assessmentof involvement, Melbourne: Macfarlane BurnetCentre for Medical Research and the North RichmondCommunity Health CentreReading and Resource List | No. 20 | June 200713

This research is considered to represent the mostcomprehensive study in this area to have beenundertaken in Australia to date. It includes a detailedlist of recommendations including parent education,harm reduction, resources, services and suggestionsfor further research.www.health.vic.gov.au/drugservices/pubs/drugsmulti.htmDrugInfo Clearinghouse no. MA6 VICJournal articlesGoren N 2006 “Newly arrived refugees andprevention”, Prevention Research Quarterly: Currentresearch evaluated, 17, pp. 1–13Migration continues to shape Australia into adynamic and diverse multicultural country, one withdifferent ethnic groups and cultures. Being a refugeeusually involves a mixture of additional challengesthat increase the potential risk of drug and alcoholabuse. Therefore, careful attention should be givento this specific group in helping its members toadopt healthy lifestyles and to assist them to achievedesirable behavioural changes if necessary.Hecht ML & Raup-Krieger JL 2006 “The principleof cultural grounding in school-based substance useprevention: The Drug Resistance Strategies Project”,Journal of Language and Social Psychology, 25:3,pp. 301–19Using communication accommodation theory asa framework, this paper articulates the principleof cultural grounding using the Drug ResistanceStrategies Project as an exemplar. Describes researchon youth, ethnic and gender cultures leading to thedevelopment and evaluation of the “keepin’ it REAL”curriculum. Demonstrates a multicultural approach toprevention in controlling the onset of adolescent druguse.http://drugresistance.la.psu.edu/project_publications/Hecht,Krieger%20CULTURAL%20GROUNDING.pdfDrugInfo Clearinghouse no. vf HECHT 05Holley LC, Kulis S, Marsiglia FF & Keith VM 2006“Ethnicity vs ethnic identity: What predicts substanceuse norms and behaviors?”, Journal of Social WorkPractice in the Addictions, 6:3, pp. 53–79This paper explores whether ethnicity and threeethnic identity (EI) instruments are useful in predictingsubstance use outcomes. Findings include that age,gender, and/or racial or ethnic group membershipinfluenced the strength of EI and that age, sex, andstrength of EI influence substance use norms andbehaviours. The authors conclude with a discussionthat includes implications for preventing substanceuse among middle school youth from different ethnicgroups by building on and strengthening ethnicidentity.http://drugresistance.la.psu.edu/project_publications/pubs1/EthidHolley.pdfStrada M, Donohue J, Lefforge B & NoelleL 2006 “Examination of ethnicity in controlledtreatment outcome studies involving adolescentsubstance abusers: a comprehensive literaturereview”, Psychology of Addictive Behaviors, 20,pp. 11–28Results of this study indicated that there is muchwork to do regarding the examination of ethnicityin controlled treatment outcome studies involvingadolescent substance abusers. Indeed, modificationswere rarely made to the treatment components toaccommodate ethnicity related variables. Futurerecommendations are presented in light of thesefindings. (PsycINFO Database Record (c) 2006 APA, allrights reserved)Bersamin M, Paschall M & Flewelling RL 2005“Ethnic differences in relationships between riskfactors and adolescent binge drinking. A nationalstudy”, Prevention Science, 6:2, pp. 127–37This study examines ethnic differences in relationshipsbetween a large number of risk factors andadolescent binge drinking with data collected from14 to 17-year-olds. The findings suggest that researchis needed to identify additional risk factors that areassociated with binge drinking among adolescents,particularly ethnic minority groups.DrugInfo Clearinghouse no. vf BERSAMIN 05Holleran LK & MacMaster SA 2005 “Applyinga cultural competency framework to twelve stepprograms”, Alcoholism Treatment Quarterly, 23:4,pp. 107–2014 Culturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.auAn understanding of cross-culture is important to anyclinician working with clients who may be referredto and/or are members of a twelve-step group. Thisarticle defines cultural competency, applies this tothe culture that has developed around twelve-stepgroups, and provides information to familiariseclinicians with these cultural norms (Haworth)Milat AJ & Taylor JJ 2005 “Culturally andlinguistically diverse population health socialmarketing campaigns in Australia. A considerationof evidence and related evaluation issues”, HealthPromotion Journal of Australia, 16:1, pp. 20–5There is insufficient evidence to clearly identify thecharacteristics of effective CLD campaigns. Campaignevaluation designs used to evaluate social marketingstrategies targeting CLD communities in Australiaare generally weak, but there is tentative evidencesupporting the potential efficacy of these strategies insome Australian settings.DrugInfo Clearinghouse no. vf MILAT 05Amodeo MP, Grigg-Saito S, Berke D & Pin-Riebe H 2004 Providing culturally specificsubstance abuse services in refugee and immigrantcommunities. Lessons from a Cambodian treatmentand demonstration project”, Journal of Social WorkPractice in the Addictions, 4:3, pp. 23–46This article looks at Project Sangkhim, a substanceabuse treatment project for non-Englishspeaking Cambodian adults in the United States.Recommendations for refugee and immigrantpopulations include education about addiction as atreatable illness. Looks at treatment programs in nonstigmatisingsettings, the combination of domesticviolence and addiction treatment.DrugInfo Clearinghouse no. vf AMODEO 04Hecht ML 2004 “Cultural factors in adolescentprevention. Multicultural approach works well”,Addiction Professional, 2:3, May, pp. 21–5This paper describes the principle of culturalgrounding. This approach proved successful whenused to develop the “keepin’ it REAL” curriculum. Arandomised clinical trial evaluating the curriculumdemonstrated the efficacy of the principle andidentified a multicultural version as the optimal levelof accommodation for the prevention messages.http://drugresistance.la.psu.edu/project_publications/pubs1/Hecht,Marsiglia,Kayo%202004.pdfRowland B, Toumbourou JW & Stevens C 2003“Preventing drug related harm in communitiescharacterised by cultural and linguistic diversity”,Prevention Research Evaluation Report, 8, pp. 3–11While this paper does not discuss specific preventionprograms targeted at CLD communities, it hasdocumented research and field evidence thatmay help in the composition and delivery of suchprograms. It discusses CLD drug prevention programsgenerally.Sosin MR & Grossman SF 2003 “The individualand beyond: a socio-rational choice model of serviceparticipation among homeless adults with substanceabuse problems“, Substance Use & Misuse, 38:3–4,pp. 505–49This article seeks to explain service participationthrough the application of an alternative, sociorationalchoice model through three premises: (a)clients weigh the costs and benefits of participatingin services against alternative uses of their time andresources, (b) the clients’ weighing procedures reflecttheir personal situations and perceptions of thetreatment environment, (c) the perceptions of theirpersonal situations and perceptions of the treatmentenvironment.Reid G, Higgs P, Beyer L & Crofts N 2002“Vulnerability among Vietnamese illicit drug usersin Australia: Challenges for change”, InternationalJournal of Drug Policy, 13:2, pp. 127–36Addressing drug problems among the ethnicVietnamese community in Australia is hamperedby a lack of structured, appropriate education andemployment programs, biased media reportingand poor utilisation of drug treatment services.Socioeconomic disadvantage and level of exclusionfrom the legitimate economy heighten involvement inillicit drug use and its associated harms.Johnson TP & Bowman PJ 2003 “Cross-culturalsources of measurement error in substanceuse surveys”, Substance Use & Misuse, 38:10,pp. 1447–90Reading and Resource List | No. 20 | June 200715

United States data from 36 surveys are examined toevaluate the reliability and validity of substance usereports across various cultural groups. The researchsuggests that the quality of data on racial and ethnicgroups can be limited by differential measurementerror.Kelly AB & Kowalyszyn M 2003 “The association ofalcohol and family problems in a remote IndigenousAustralian community”, Addictive Behaviors, 28:3,pp. 761–7Indigenous Australians who consume alcoholfrequently show severe alcohol problems. Europeanderivedsamples of heavy drinking are usuallyassociated with relationship stress, conflict andviolence. Due to Aboriginal groups’ differing familystructures, values and obligations, their alcoholrelatedproblems may differ. It was found familycohesion was unrelated to alcohol or family troubles.Collins RL & McNair LD 2003 “Minority womenand alcohol use”, Alcohol Research and Health, 26:4,pp. 251–6Examines the drinking behaviour of women fromthe four largest non-European ethnic groups in theUnited States, addressing a specific variable in relationto each group: religious activity among AfricanAmerican women; the facial flushing response inAsian American women; the level of acculturation toUnited States society among Latinas; and historical,social, and policy variables unique to NativeAmericans.http://www.niaaa.nih.gov/publications/arh26–4/251–256.htmKimberley M 2003 “Substance-abusing adolescentsshow ethnic and gender differences in psychiatricdisorders”, NIDA Notes, 18:1, June, pp. 8–10NIDA researchers have found that the patterns ofco-occurring psychiatric disorders in adolescentsubstance abusers differ between ethnic groupsand between boys and girls. This information mayhelp clinicians be particularly alert to symptomsof the most common psychiatric disorders wheninterviewing patients from each group. Eventually,it may aid in the development of tailored screening,assessment and treatment interventions for differentgroups.Weiss SB, Kung HC & Pearson JL 2003 “Emergingissues in gender and ethnic differences in substanceabuse and treatment”, Current Women’s HealthReports, 3:3, pp. 245–53The emerging understanding of gender differencesamong ethnic minorities in the rates, aetiology,course, and treatment of substance abuse andcommon comorbid mental health disorders hassignificant scientific and practical implications.Research challenges to improving limited knowledgeabout the rates, course, and treatment of substanceabuse disorders among ethnic minority women arehighlighted.Reid G, Crofts N & Beyer L 2001 “Drug treatmentservices for ethnic communities in Victoria, Australia:An examination of cultural and institutional barriers”,Ethnicity & Health, 6:1, pp. 13–26Comprehensive review of international and Australianliterature to identify problems their membersexperience upon the discovery of illicit drug use intheir community, how drug treatment is addressedand challenges for improved drug treatmentoutcomes.Indermaur, D 2001 “Young Australians anddomestic violence”, Trends & Issues in Crime andCriminal Justice, 195Indigenous youth were significantly more likely tohave experienced physical domestic violence amongtheir parents or parents’ partners. The findings inrelation to the effect of witnessing domestic violenceon both attitudes and experience give support tothe “cycle of violence” thesis: witnessing parentaldomestic violence is the strongest predictor ofperpetration of violence in young people’s ownintimate relationships.www.aic.gov.au/publications/tandi/tandi195.htmlKenny S 2001 “Bringing communities together.Breaking the petrol sniffing cycle”, Drugs in Society,March, pp. 16–17A review of interventions carried out by theCooperative Research Centre for Aboriginal andTropical Health. How do you successfully intervene inan Indigenous community to overcome the escalatingand debilitating problem of petrol sniffing? Wheredo you start and how do you know what is best16 Culturally and linguistically diverse communities and drug prevention

DRUGNFOclearinghousewww.druginfo.adf.org.aupractice? For such a widely entrenched problem,the sheer scope can seem daunting. This Australianpaper looks at the publication and the information itpresents.Coffey C, Lynskey M, Wolfe R & Patton GC 2000“Initiation and progression of cannabis use in apopulation-based Australian adolescent longitudinalstudy”, Addiction, 95:11, pp. 1679–90Risk factors for daily cannabis use in late high schoolwere identified in a representative cohort of Victorianstudents. In an adjusted multi-variate model,significant predictors included early involvement infrequent cannabis use, for males peer involvement incannabis use and for females high-dose alcohol useand or anti-social behaviour in early adolescence.Holder H 2000 “Community prevention of alcoholproblems”, Behavior, 25:6, pp. 843–59This United States paper describes an effort inthree communities over five years to reduce alcoholproblems at a community level. The communitiescontained racial and ethnic diversity as well as a mixof urban, suburban and rural settings. Results showthat the project reduced alcohol-involved crashes,lowered sales to minors, increased the responsiblealcohol servicing practices of bars and restaurantsand increased community support and awareness ofalcohol problems.Rissell C, McLellan L & Bauman A 2000 “Socialfactors associated with ethnic differences in alcoholand marijuana use by Vietnamese, Arabic andEnglish-speaking youths in Sydney, Australia”, Journalof Paediatrics and Child Health, 36:2, pp. 145–52These results confirm lower marijuana and alcoholuse among students from Vietnamese- and Arabicspeakingbackgrounds compared with students froman English-speaking background. Harm minimisationstrategies may be learned from some migrantcommunities.Williams P 1999 “Alcohol related social disorder andrural youth; part 1. Victims”, Trends & Issues in Crimeand Criminal Justice, 140While there has been much anecdotal evidenceof an increase in alcohol (and other drug) relatedsocial disorder in rural Australia in recent years, andparticularly so for disorders involving young persons,there has been very little empirical data to support, orcontradict, the commonly held perceptions. However,knowing the extent and nature of the differencesand similarities is a necessary first step in developingappropriate interventions.McKey J 1999 “Cultural challenge”, Connexions,19:2, pp. 20–1Promoting health messages to the community isnever an easy task. But when that community’s mainlanguage is not English, the job becomes much moredifficult. This Australian article looks at the challengehealth workers faced in three Sydney area healthservices when they chose to address high levels ofsmoking in the Vietnamese and Arabic communities.Swift W, Maher L & Sunjic S 1999 “Transitionsbetween routes of heroin administration: a study ofCaucasian and Indochinese heroin users in southwesternSydney, Australia”, Addiction, 94:1, pp.71–82This research documents the existence of smokingas a popular route of administration among bothIndochinese and Caucasian heroin users in thestudy sample. There is an urgent need to providesmokers and injectors with information explaining thepotential risks and ways to minimise harms associatedwith both routes of use.Alaniz ML 1998 “Alcohol availability and targetedadvertising in racial/ethnic minority communities”,Alcohol Health & Research World, 22:4, pp. 286–9Alcohol availability and advertising aredisproportionately concentrated in racial/ethnicminority communities. This article reviews researchshowing that certain neighbourhood characteristicscan be stronger predictors of homicide and violencethan race or ethnicity.Louie R, Krouskos D, Gonzalez M & Crofts N1998 “Vietnamese-speaking injecting drug users inMelbourne: The need for harm reduction programs”,Australian and New Zealand Journal of Public Health,22:4, pp. 481–4There has been little research on non-English speakingbackground communities in Australia, particularlythe South-East Asian communities, of which theReading and Resource List | No. 20 | June 200717

Vietnamese is the largest. This exploratory studyemployed and trained peer workers to recruit andinterview injecting drug users (IDUs) of Vietnameseorigin in Melbourne on a wide range of subjectsrelated to risks associated with their drug using, as aninitial assessment of risk-taking behaviours for bloodborneviruses among Vietnamese-speaking IDUs.Bertram S 1995 “Knowledge of HIV/AIDS issuesamong Vietnamese and Spanish-speakers in Sydney”,Health Promotion Journal of Australia, 5:2, pp. 60–1This study, conducted in the Spanish-speaking andVietnamese communities of Sydney, found thatknowledge of the transmission of HIV/AIDS throughsexual intercourse and needle sharing was good.However, both groups assumed inaccurately that thevirus could be transmitted in other ways. Also theresearch does not indicate whether knowledge isbeing translated into practice.All material listed is available from the Australian Drug Foundation library.Membership to the library is open to professionals in Victoria who work in the areas of health, welfare,and education.Members are able to borrow from the collection as well as access other services provided by the library.Membership is free to these groups.For more information about membership or how to access material:Tel. (03) 9278 8121 (Monday to Friday, 9am to 5pm)Fax (03) 9328 3008Email library@adf.org.auOr visit our website at www.druginfo.adf.org.au/library18 Culturally and linguistically diverse communities and drug prevention

www.druginfo.adf.org.auDrugInfo Clearinghouse409 King Street West Melbourne VIC 3003Email. druginfo@adf.org.au

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