Clough, Alan R., Cairney, Sheree, d'Abbs, Peter, Parker, Robert, Maruff, Paul, Gray, Dennis, and O'Reilly, Bridie (2004) Measuring exposure to cannabis use and other substance use in remote Indigenous populations in Northern Australia: a 'community epidemiology' approach using proxy respondents. Addiction Research and Theory, 12 (3). pp. 261-274.

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Abstract

We evaluate a method to describe changing substance use patterns in northern Australia's remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 101 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-κ statistic) among health workers for a history of substance use and current use, varied from κ = 0.207 for petrol sniffing (P = 0.006) up to κ = 0.749 for cannabis use (P<0.001), all better than would be expected by chance. In communities A and B, agreement between health workers’ consensus and self-reported substance use was weaker (0.103<κ<0.482) probably because of under-reporting in interviews. In community C, where interviews were conducted in a confidential clinic setting, agreement between health workers’ concensus and self-report varied from κ = 0.273 for petrol sniffing (P<0.001) up to 0.819 for tobacco use (P<0.001). Aboriginal health worker consensus classification clarified equivocal self-report data.

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