National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Chapter 4. The health of young people
Unplanned pregnancy

Recommendations: Preventing child maltreatment – Supporting families to optimise child safety and wellbeing
Preventive intervention type	Who is at risk?	What should be done?	How often?	Level/ strength of evidence	References
Screening	_{All young people aged 12–24 years}	_{Ask if sexually active, conduct a social emotional wellbeing assessment, and identify at-risk sexual behaviours (eg unprotected sexual intercourse – refer to Chapter 14: Sexual health and blood-borne viruses, Box 1)}	_{Opportunistic and as part of an annual health check}	_GPP	_{^1, ^10, ³⁷}
Behavioural	_{All young people aged 12–24 years}	_{Provide anticipatory guidance¹ and sexual health education (refer to Chapter 14: Sexual health and blood-borne viruses), tailoring the information to the young person’s needs Discussion should include the following:} _{sexual development and sexual feelings} _{prevention of unplanned pregnancies} _{resisting sexual and peer pressure} _{methods of reversible contraception, access to and use of emergency contraception}	_{Opportunistic and as part of an annual health check}	_GPP	_{^1, ^11, ^37, ⁴⁶}
	_{Young people who are considering initiating sexual activity or who are sexually active}	Provide contraceptive services		_III-2B	_^11, ³⁷
		_{Recommend use of and/or provide condoms} _{Discuss the proper methods for condom usage} _{Discuss and offer hormonal contraception} _{Discuss advance emergency contraception}	_{Opportunistic and as part of annual health check}	_I	_^11, ³⁷
	_{Young people engaging in risky sexual behaviour}	_{Use individual behaviour change techniques such as brief interventions (eg information giving, motivational interviewing) and cognitive behavioural therapy}	_{Opportunistic}	_III–3C	^₃₇
	_{Young people engaging in risky sexual behaviour}	_{Offer or refer to theory-based pregnancy prevention/education programs to improve knowledge and increase contraceptive use. Examples include social cognitive theory,* motivational interviewing program, AIDS Risk Reduction Model (Box 1)}		_IA	_{^45, ^50, ^52, ⁵³}
	_{Parents or guardians of young people}	_{Provide health guidance to parents and other guardians regarding youth sexual health following the principles of anticipatory guidance^†}	_{Opportunistic}	_GPP	_^40,41,42
Chemo-prophylaxis	_{Young females who are sexually active or considering initiating sexual activity}	_{Assess suitability for, and offer, hormonal contraception. Methods include the oral contraceptive pill (OCP) and longacting reversible contraception (LARC) (ie progestogen-only injections, progestogenonly subdermal implants, progestogen-only intrauterine devices)}	_{Opportunistic and as part of annual health check}	_GPP	_^45, ⁴⁶
		_{Offer advance emergency contraception}	_{Opportunistic and as part of annual health check}	_IA	^₁₁
	_{Young females who have had unprotected intercourse}	_{Conduct a detailed history to assess the context} _{Discuss and recommend emergency contraception as necessary} _{Arrange for appropriate follow-up}	_{Opportunistic}	_IIB	^₃₅
Environmental		_{Promote youth-friendly primary healthcare services}		_GPP	_{^1,16, ⁵⁴}
*Social cognitive theory is a learning theory based on the idea that people learn by watching what others do and will not do. ^†Anticipatory guidance is a developmentally based counselling technique that focuses on a young person’s stage of development. Counselling is focused toward gaining a better understanding of young people’s physical growth, psychosocial and psychosexual development. It emphasises the importance of the young person becoming actively involved in decisions regarding their healthcare.¹⁷

Box 1. The AIDS Risk Reduction Model⁵⁵
This model has three stages, and is based on several other behaviour change theories, including the Health Belief Model, ‘efficacy’ theory, emotional influences and interpersonal processes. The three stages outlined below are behaviour labelling, commitment to change and taking action.
Stage	Influences
1. Recognition and labelling of one’s behaviour as high risk	Knowledge of sexual activities associated with human immunodeficiency virus (HIV) transmission Believing that one is personally susceptible to contracting HIV Believing that having acquired immune deficiency syndrome (AIDS) is undesirable Social norms and networking
2. Making a commitment to reduce highrisk sexual contacts and to increase low-risk activities	Cost and benefits Enjoyment (eg will the changes affect my enjoyment of sex?) Response efficacy (eg will the changes successfully reduce my risk of HIV infection?) Self-efficacy Knowledge of the health utility and enjoyability of a sexual practice, as well as social factors (group norms and social support), are believed to influence an individual’s cost and benefit and self-efficacy beliefs
3. Taking action. This consists of three phases: information seeking obtaining remedies enacting solutions Depending on the individual, phases may occur concurrently or phases may be skipped	Social networks and problem-solving choices (self-help, informal and formal help) Prior experiences with problems and solutions Level of self-esteem Resource requirements of acquiring help Ability to communicate verbally with sexual partner Sexual partner’s beliefs and behaviours

Background

Despite improvements in reproductive health outcomes over the last five years, the rates of pregnancy in Australian young women remain high. In 2014, almost 16% of all births in Australia were to young women aged less than 25 years. The fertility rate of teenage Aboriginal and Torres Strait Islander women (57.3 babies per 1000 women) was over four times that of all teenage women (13 babies per 1000). Aboriginal and Torres Strait Islander mothers, compared with non-Indigenous mothers, were over eight times as likely to be teenage mothers (17% compared with 2%).^29,30 Not only are Aboriginal and Torres Strait Islander young women more likely to become pregnant, they are also more likely than their non-Indigenous counterparts to smoke during pregnancy, have fewer antenatal attendances, and be at greater risk of adverse outcomes for themselves and their babies. Young mothers have higher rates of not completing their education, separation from the child’s father, and restricted access to financial resources compared with older mothers. Adverse neonatal outcomes include higher rates of preterm birth, small for gestational age, and neonatal death. In 2014, babies born to Aboriginal and Torres Strait Islander mothers were more likely to be admitted to a special care nursery or intensive care unit than babies of non-Indigenous mothers (22% and 15% respectively).²⁹ Adverse health outcomes in childhood include increased risk of developmental delay, behavioural problems, substance abuse, early sexual activity and becoming teenage parents themselves.^31,32

There are no recent national data on induced abortions, the last collation being in 2003. Western Australian data from 2012 reveal an induced abortion rate of 29.3 per 1000 women in young women aged 20–24 years, and 14.4 per 1000 in those aged 15–19 years. Young women aged ≤24 years accounted for almost 43% of all abortions. In addition, almost 46% of pregnancies in young women aged 15–19 years and 34% of pregnancies in women aged 20–24 years resulted in induced abortions.³³ This implies that many pregnancies in young women are unplanned events. This is strengthened by evidence from several qualitative studies that there is a lack of knowledge among young women and young mothers about consequences of sexual activity, contraception methods, and correct contraceptive use. There is also a suggestion that this lack of knowledge is more marked in young women from minority groups or social disadvantage.¹¹

According to the 2004–05 National Aboriginal and Torres Strait Islander Household Survey, condoms followed by the Oral Contraceptive Pill (OCP) were the main methods of contraception reported by Aboriginal and Torres Strait Islander women aged 18–24 years (25% and 16% respectively). Both implants and injections had a reported usage of 6%. An estimated 14% of young Aboriginal and Torres Strait Islander women reported not using any contraception.³⁴

Interventions

Evidence of effectiveness of preventive interventions

Most of the evidence on effective interventions is derived from US studies. In addition, there is a dearth of evidence on the effectiveness of interventions in socially disadvantaged or minority groups. Consequently, the evidence base is immature and provides mixed evidence in regard to the effectiveness of preventive practice.¹¹ For example, there is good evidence that the clinic visit can be used to engage the young person in a discussion targeting reproductive health, within the context of broader and more general health issues. Indeed, commencing the consultation with a more general approach rather than with a discussion about sexual health is better suited to the needs of a young person.^1,10,11 The evidence is less clear in regard to more specific interventions. These are discussed in detail in the sections below. The components of routine antenatal health assessments are outlined in Chapter 2: Antenatal care.

Immunisation

Immunisation against vaccine-preventable sexually transmitted infections, such as hepatitis B and human papilloma virus, should be enquired about and offered as appropriate to all youth (refer to Chapter 3: Child Health, ‘Immunisation’).

Screening and behavioural interventions

Consensus-based recommendations from Australia, US and UK include three interventions for young people: anticipatory guidance/counselling; screening for sexual activity and at-risk sexual behaviour; and appropriate counselling for preventing unplanned pregnancies.^1,11,35–37
Anticipatory or health guidance is defined as a proactive, developmentally based counselling technique that focuses on a young person’s stage of development. It is meant to ‘promote a better understanding of their physical growth, psychosocial and psychosexual development, and the importance of becoming actively involved in decisions regarding their health care’.^17,38 There is strong evidence that, interventions such as oneto-one, nurse-led counselling or computer-aided contraception decision-making results in fewer unplanned pregnancies. There is some evidence that one-to-one counselling with young people aged <18 years can increase contraception use.^{11,35–37,39}

Parents or guardians should also receive health guidance regarding adolescent development and behaviour.^40–42
Barrier methods of contraception, especially male condoms, are effective for both pregnancy prevention and reducing risk of some sexually transmitted infections (STIs). While the method-specific failure rate for condoms is 2%, the typical use failure rate is around 15% due to improper and inconsistent use.¹¹ There is strong evidence that counselling on condom use combined with demonstration of condom use results in increased condom use and engagement with clinical services.¹¹ Condoms are recommended as a primary prevention intervention with ongoing education to emphasise the importance of consistent and proper use.

Chemoprophylaxis

Hormonal contraception includes the progestin-only and combined oral contraceptive pills (OCP), and longacting reversible contraception (LARC), which is defined as any method that requires administration less than once per cycle or month. Examples of hormonal LARCs available in Australia include progestogen-only injections, progestogen-only sub-dermal implants, and progestogen-only intra-uterine devices (IUDs) while copper intrauterine devices are a form of non-hormonal LARC. Unlike the oral contraceptive pill, effectiveness of LARC does not depend on daily compliance. There is some evidence that copper IUDs are more effective than hormonal methods in pregnancy prevention.⁴³

There is insufficient evidence to compare the contraceptive efficacy and continuation usage in young people, between the various contraception options mentioned.⁴⁴ There is scant but reassuring literature on the use of IUDs in adolescents.⁴⁵ Due to the adverse but reversible effect of progestogen-only injections on bone mineral density, this should be used cautiously as first line contraception in young women aged below 18 years.⁴⁶ On the other hand, sub-dermal progestogen LARCS are not known to be associated with reduced bone mineral density, and are highly effective.^46,47 On the basis of extrapolated evidence, all other hormonal contraception has the same safety and efficacy profile in young women as in adult women. It is recommended to provide advice on and provide access to all hormonal contraception methods.^11,37

Hormonal contraception is traditionally commenced with the onset of menses to avoid contraceptive use during an undetected pregnancy. An alternative is immediate initiation if pregnancy can be reliably ruled out. The advantage of this method in young women is to improve the uptake of contraception. However, with the exception of injectable progestogen, there is limited evidence that immediate commencement of contraception reduces unintended pregnancies.⁴⁸ There is good evidence that dispensing contraceptives from school-based health centres increases the provision of contraception, but the outcomes in terms of contraceptive use are unknown.¹¹

Emergency contraception can decrease the chance of pregnancy. To date however, there is no evidence that either advance provision of or increased access to emergency contraception reduces unintended pregnancies at a population level.³⁹ On the encouraging side, advance provision has not led to increased rates of STIs, increased frequency of unprotected intercourse, or changes in contraceptive methods. In particular, women who received advance emergency contraception were as likely to use condoms as women who did not receive this. In adolescents, there is strong evidence to support advance provision of emergency contraception as it demonstrates increased use of emergency contraception without adversely impacting on use of other contraception or increasing risky behaviour.¹¹ In addition, experience with emergency contraception was associated with an increased probability of condom use and an increased perceived capacity to negotiate condom use.³⁵ The recommendation is therefore to support young women’s knowledge of, and access to, emergency contraception.

Environmental

There have been a few reviews of the effectiveness of primary pregnancy prevention programs in young people.
Interventions studied have been in both low-income and middle-income countries and high-income countries. They include school-based programs, community-based programs, family planning clinics, workplace programs, use of social media, mass-media programs (including social marketing) and health facility–based programs.^45,49 Overall, most of these programs have a positive impact on knowledge and attitudes.

There is strong evidence that combining educational curriculum interventions with community outreach can be effective in preventing teenage pregnancy and risky sexual behaviour. There is moderate evidence that outreach programs on their own do encourage youth to attend mainstream sexual health services, but their effect on reducing unintended pregnancies is unknown.¹¹ There is also good evidence that multi-session support and home visiting for disadvantaged, low-income pregnant women or mothers can prevent repeat pregnancies.³⁷

There is moderate evidence that a) computer-based interventions can reduce pregnancy and increase use of emergency contraception; and b) a ‘virtual world’ intervention was effective when associated with a curriculum-based intervention about sexual risk behaviour, in increasing understanding about reproductive health.¹¹ A clearer picture is therefore emerging of the utility of information technology–based interventions in increasing understanding and reducing risky sexual behaviour. There is also moderate evidence that generic health programs for teenage mothers could be effective in reducing repeat pregnancies.¹¹
One systematic review of educational interventions to inform contraceptive choice – theory-based groups as compared to usual care – consistently demonstrated favourable results in terms of reduced pregnancies, choice of effective contraception and adherence to contraception. These included social cognition models (particularly social cognitive theory), motivational interviewing and the AIDS Risk Reduction Model.⁵⁰ Communitybased programs tend to be more effective than school-based programs, and clinic-based programs more effective than non–clinic-based programs. Programs in youth-friendly services can improve knowledge, increase contraceptive use and increase use of the service.¹¹

There is weak evidence that social marketing campaigns could have a significant effect on the use of contraception or emergency contraception.¹¹ Abstinence programs were the least successful intervention and are not recommended.⁵¹

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

References

Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health GP resource kit: Enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds. 2nd edn. Westmead, NSW: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008. [Accessed 20 November 2017].
Australian Institute of Health and Welfare. Young Australians: Their health and wellbeing 2011. Cat. no. PHE 140. Canberra: AIHW, 2011. [Accessed 20 November 2017].
United Nations Department of Economic and Social Affairs. Definition of youth. Geneva: UNDESA, [date unknown]. [Accessed 20 November 2017].
World Health Organization. Adolescents: Health risks and solutions – Fact sheet. Geneva: WHO, 2017. [Accessed 20 November 2017].
World Health Organization. Promoting and safeguarding the sexual and reproductive health of adolescents. Geneva: WHO, 2006.
Institute of Medicine and National Research Council. Investing in the health and well-being of young adults. Washington, DC: The National Acadamies Press, 2015.
Hwang LY, Tebb KP, Shafer MB, Pantell RH. Examination of the treatment and follow-up care for adolescents who test positive for Chlamydia trachomatis infection. Arch Pediatr Adolesc Med 2005;159:1162–66.
Carr-Gregg MR, Enderby KC, Grover SR. Risk-taking behaviour of young women in Australia: Screening for health-risk behaviours. Med J Aust 2003;178(12):601–04.
Bradford S, Rickwood D. Psychosocial assessments for young people: A systematic review examining acceptability, disclosure and engagement, and predictive utility. Adolesc Health Med Ther 2012;3:111–25.
Ham P, Allen C. Adolescent health screening and counseling. Am Fam Physician 2012;86(12):1109–16.
National Institute for Health and Care Excellence. Contraceptive services for under 25s. Public health guideline [PH51]. UK: NICE, 2014. [Accessed 20 November 2017].
Duncan P, Frankowski B, Carey P, et al. Improvement in adolescent screening and counseling rates for risk behaviors and developmental tasks. Pediatrics 2012;130(5):e1345–51.
Oscós-Sánchez MA, White D, Bajorek E, et al. SAFE TEENS: Facilitators of and barriers to adolescent preventive care discussions. Fam Med 2008;40(2):125–31.
Australian Bureau of Statistics. Census 2011. Australia: ABS, 2011. [Accessed 20 November 2017].
van der Sterren A, Greenhalgh E, Knoche D, Winstanley M. Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders. In: Scollo MM, Winstanley MH. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria, 2016.
Queensland Health. Aboriginal and Torres Strait Islander adolescent sexual health guideline. Brisbane: Queensland Health, 2013. [Accessed 20 November 2017].
Elster A. Guidelines for adolescent preventive services. US: United States Preventive Services Task Force, updated 2017. [Accessed 20 February 2017].
UK Department of Health. You’re welcome – Quality criteria for young people friendly health services. London: Department of Health, 2011.
Walker R. The Youth Education Peers (YEP) Project final report. Perth: Youth Affairs Council of Western Australia, 2011.
Beall S. Talking with teens: Successfully screening for high-risk behavior. J Soc Pediatr Nurs 2000;5(3):139–42.
Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2014. Recommendations of the US Preventive Services Task Force. Pub. no. 14-05158. Rockville, MD: AHRQ, 2014.
Klein DA, Goldenring JM, Adelman WP. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. Ohio: Modern Medicine Network, 2014.
Christie D, Viner R. Adolescent development. BMJ 2005;330(7486):301–04.
NSW Ministry of Health. Youth Health 2015: Report on the annual survey of the NSW Youth Health Policy 2011–16. North Sydney, NSW: NSW Ministry of Health, 2016. [Accessed 21 November 2017].
Graybeal C. Strengths-based social work assessment: Transforming the dominant paradigm. Families in Society: Journal of Contemporary Social Services 2001;82(3):233–42.
Brough M, Bond C, Hunt J. Strong in the city: Towards a strength based approach in Indigenous health promotion. Health Promot J Austr 2004;15(3):215–20.
Nori A, Piovesan R, O’Connor J, Rigney D, McMillan MM, Brown N. ‘Y Health – Staying Deadly’: An Aboriginal Youth focussed Translational Action Research Project. Canberra: ANU, 2014.
Goldenring J, Rosen D. Getting into adolescent heads: An essential update. Contemporary Pediatrics 2004:21:64.
Australian Institute of Health and Welfare. Australia’s mothers and babies 2014 – In brief. Cat. no. PER 87. Canberra: AIHW, 2016.
Australian Indigenous HealthInfoNet. Overview of Aboriginal and Torres Strait Islander health status, 2015. Perth: Australian Indigenous Health InfoNet, 2016. [Accessed 21 November 2017].
World Health Organization. Adolescent pregnancy: Fact sheet. Geneva: WHO, 2016. [Accessed 21 November 2017].
State of Victoria. Teenage pregnancy. Vic: Better Health Channel, [date unknown]. [Accessed 21 November 2017].
Hutchinson M, Joyce A, Cheong M. Induced abortions in Western Australia 2010–2012. Fourth report of the Western Australian abortion notification system. WA: DoH, 2013.
Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2004–05. Cat. no. 4715.0. Canberra: ABS, 2006; p. 47.
Walker D, Torres P, Gutierrez J, Flemming K, Bertozzi S. Emergency contraception use is correlated with increased condom use among adolescents: Results from Mexico. J Adolesc Health 2004;35(4):329–34.
Killoran A, McCormick G. Towards an integrated approach to sexual health services: The contribution of NICE guidance on one-toone interventions to prevent STIs and under 18 conceptions. Health Educ J 2010;69(3):297–310.
National Institute for Health and Care Excellence. Sexually transmitted infections and under-18 conceptions: Prevention. Public health guideline [PH3]. UK: NICE, 2007.
Minnesota Department of Health. Anticipatory guidance 13–21 years. St Paul, MN: Minnesota Department of Health, 2017. [Accessed 21 November 2017].
Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency contraception for pregnancy prevention: A meta-analysis. Obstet Gynecol 2007;110(6):1379–88.
American Psychological Association. Developing adolescents: A reference for professionals. Washington, DC: APA, 2002.
Robinson E. Young people and their parents: Supporting families through changes that occur in adolescence. Australia: Child Family Community Australia, 2006.
Robinson E, Power L, Allan D. What works with adolescents? Family connections and involvement in interventions for adolescent problem behaviours. AFRC Briefing no. 16. Melbourne: Australian Institute of Family Studies, 2010. [Accessed 21 November 2017].
Hofmeyr GJ, Singata M, Lawrie TA. Copper containing intra-uterine devices versus depot progestogens for contraception. Cochrane Database Syst Rev 2010;(6):CD007043.
Tang JH, Lopez LM, Mody S, Grimes DA. Hormonal and intrauterine methods for contraception for women aged 25 years and younger. Cochrane Database Syst Rev 2012;11:CD009805.
Deans EI, Grimes DA. Intrauterine devices for adolescents: A systematic review. Contraception 2009;79(6):418–23.
National Institute for Health and Care Excellence. Long-acting reversible contraception. Clinical guideline [CG30]. UK: NICE, 2005. [Accessed 21 November 2017].
Power J, French R, Cowan FM. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods for preventing pregnancy. Cochrane Database Syst Rev 2007;(3):CD001326.
Lopez LM, Newmann SJ, Grimes DA, Nanda K, Schulz KF. Immediate start of hormonal contraceptives for contraception. Cochrane Database Syst Rev 2008;(2):CD006260.
McGaurr L. Young Australians and sexual health. Canberra: Australian Clearinghouse for Youth Studies, 2015.
Lopez LM, Grey TW, Chen M, Tolley EE, Stockton LL. Theory‐based interventions for contraception. Cochrane Database Syst Rev 2016;11:CD007249.
Thomas J, Vigurs C, Oliver K, et al. Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes. London: Institute of Education University of London, 2008.
DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: Systematic review of randomised controlled trials. BMJ 2002;324(7351):1426–30.
Speizer IS, Magnani RJ, Colvin CE. The effectiveness of adolescent reproductive health interventions in developing countries: A review of the evidence. J Adolesc Health 2003;33(5):324–48.
World Health Organization. Core competencies in adolescent health and development for primary care providers: Including a tool to assess the adolescent health and development component in pre-service education of health-care providers. Geneva: WHO, 2015.
Family Health International. Behavior change – A summary of four major theories. Durham, NC: FHI, 2004. [Accessed 21 November 2017].
Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183. Canberra: AIHW, 2014.
Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander health survey 2012–13. Canberra: ABS, 2013. Available at [Accessed 21 November 2017].
Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. Cat. no. IHW 147. Canberra: AIHW, 2015.
Al Iede M, Nunn K, Milne B, Fitzgerald DA. The consequences of chronic cannabis smoking in vulnerable adolescents. Paediatr Respir Rev 2017;24:44–53.
Loxley W, Toumbourou JW, Stockwell T, et al. The prevention of substance use, risk and harm in Australia: A review of the evidence. Monograph prepared by the National Drug Research Institute and the Centre for Adolescent Health. Canberra: Department of Health and Ageing, 2004.
d’Abbs P, Shaw G. Monitoring trends in the prevalence of petrol sniffing in selected Australian Aboriginal communities 2011–2014: Final report. Darwin: Menzies School of Health Research, 2016.
Marel C, MacLean SJ, Midford R. Review of volatile substance use among Aboriginal and Torres Strait Islander people. Perth: Australian Indigenous HealthInfoNet, 2015.
Jamieson L, Gunthorpe W, Cairney S, Sayers S, Roberts-Thomson K, Slade G. Substance use and periodontal disease among Australian Aboriginal young adults. Addiction 2010;105(4):719–26.
Crossin R, Cairney S, Lawrence AJ, Duncan JR. Adolescent inhalant abuse leads to other drug use and impaired growth; implications for diagnosis. Aust N Z J Public Health 2017;41(1):99–104.
Aboriginal Drug and Alcohol Council. Conference resolutions: Paper presented at 4th National Indigenous Drug and Alcohol Conference, 2016. Adelaide: Aboriginal Drug and Alcohol Council, 2016.
Commonwealth of Australia. Final report of the National Ice Taskforce. Australia: Department of the Prime Minister and Cabinet, 2015. Available at www.pmc.gov.au/sites/default/files/publications/national_ice_taskforce_final_report.pdf [Accessed 21 November 2017].
Stockwell T, Gruenewald P, Toumbourou J, Loxley W, eds. Preventing harmful substance use: The evidence base for policy and practice. West Sussex, UK: John Wiley & Sons, 2005.
Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey 2012–13. Canberra: ABS, 2014.
Bashford J. Screening and assessment for cannabis use disorders. Background paper for Management of cannabis use disorder and related issues: A clinician’s guide. Sydney: National Cannabis Prevention and Information Centre, 2009. [Accessed 21 November 2017].
Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th edn. Canberra: Department of Health, 2017.
New Zealand Guidelines Group. Identification of common mental disorders and management of depression in primary care. Wellington: New Zealand Guidelines Group, 2008.
Department of Health and Ageing. Alcohol treatment guidelines for Indigenous Australians. Canberra: DoHA, 2007.
Christie G, Marsh R, Sheridan J, et al. The substances and choices scale (SACS) – The development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Addiction Sep 2007;102(9):1390–98.
Schlesinger CM, Ober C, McCarthy MM, Watson JD, Seinen A. The development and validation of the Indigenous Risk Impact Screen (IRIS): A 13-item screening instrument for alcohol and drug and mental health risk. Drug Alcohol Rev 2007;26(2):109–17.
Smedslund G, Berg RC, Hammerstrøm KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011;(5):CD008063.
Carney T, Myers BJ, Louw J, Okwundu CI. Brief school-based interventions and behavioural outcomes for substance-using adolescents. Cochrane Database Syst Rev 2014;(2):CD008969.
Gray D, Stearne A, Wilson M, Doyle M. Indigenous-specific alcohol and other drug interventions: Continuities, changes and areas of greatest need. Canberra: Australian National Council on Drugs, 2010.
MacLean S, d’Abbs P. Petrol sniffing in Aboriginal communities: A review of interventions. Drug Alcohol Rev 2002;21(1):65–72.
Gray D, Saggers S. Indigenous Australian alcohol and other drug issues: Research from the National Drug Institute. Perth: National Drug Research Institute, 2002.
McCain MN, Mustard JF. Reversing the brain drain: Early years study: Final report. Toronto: Canadian Institute for Advanced Research, 1999.
Shonkoff JP, Phillips DA, eds. From neurons to neighborhoods: The science of early childhood development. Washington, DC: NRCIM, 2000.
Shonkoff JP, Meisels SJ, eds. Handbook of early childhood intervention. 2nd edn. Cambridge: Cambridge University Press, 2000.
Centre for Reviews and Dissemination. Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: A systematic review. Database of Abstracts of Reviews of Effects, 2011.
Toumbourou J, Gregg M. Impact of an empowerment-based parent education program on the reduction of youth suicide risk factors. J Adolesc Health 2002;31(3):277–85.
Bry B, Catalano R, Kumpfer K, Lochman J. Scientific findings from family prevention intervention research. In: Ashery R, Robertson E, Kumpfer K, eds. Drug abuse prevention through family interventions: NIDA research monograph 177. Rockville, MD: US Department of Human Services, 1998; p. 103–29.
Marel C, Mills K, Shakeshaft A, Shand F, Teesson M. Evaluation of the CAYLUS Youth Worker Brokerage: Executive summary 2014–2016. NSW: National Drug and Alcohol Research Centre, 2016. [Accessed 21 November 2017].
Contributors to the Cochrane Collaborative and the Campbell Collaboration. Evidence from systematic reviews of research relevant to implementing the ‘wider public health’ agenda. York: NHS Centre for Reviews and Dissemination, 2000.
Kaldor J, Lapsley H, Mattick R, Weatherburn D. Six month process report on the Medically Supervised Injecting Centre. Sydney: National Drug and Alcohol Research Centre, 2002.
Kaldor J, Lapsley H, Mattick R, Weatherburn D, Kimber J, MacDonald M. Twelve-month process evaluation report on the Medically Supervised Injecting Centre. Sydney: National Drug and Alcohol Research Centre, 2002.
Salmon A, van Beek I, Amin J, Kaldor J, Maher L. The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. Addiction 2010;105(4):676–83.
MSIC Evaluation Committee. Final report on the evaluation of the Sydney Medically Supervised Injecting Centre. Sydney: MSIC Evaluation Committee, 2003.
Ma Jun WY, Stafford RS. US adolescents receive suboptimal preventive counseling during ambulatory care. J Adolesc Health 2005;36(5):441e441–47.
National Institute for Health and Care Excellence. Drug misuse prevention: Targeted interventions. UK: NICE, 2017. [Accessed 21 November 2017].
National Institute for Health and Care Excellence. Hepatitis B and C testing: People at risk of infection. UK: NICE, 2012. [Accessed 21 November 2017].
Martin G. Adolescents. Background paper for Management of cannabis use disorder and related issues: A clinician’s guide. Sydney: National Cannabis Prevention and Information Centre, 2009.
Shonkoff JP, Meisels SJ, eds. Handbook of early childhood intervention. 2nd edn. Cambridge: Cambridge University Press, 2000.
Faggiano F, Minozzi S, Versino E, Buscemi D. Universal school-based prevention for illicit drug use. Cochrane Database Syst Rev 2014;(12):CD003020.
Westerman T. Engaging Australian Aboriginal youth in mental health services. Australian Psychologist 2010;45(3):212–22.
Sanci L. Adolescent health care principles. East Melbourne, Vic: RACGP, 2001.
Australian Bureau of Statistics. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, 2008. Cat. no. 4704.0. Canberra: AIHW and ABS, 2008. [Accessed 20 May 2013].
Browne J, Laurence S, Thorpe S. Acting on food insecurity in urban Aboriginal and Torres Strait Islander communities: Policy and practice interventions to improve local access and supply of nutritious food. Perth: Australian Indigenous HealthInfoNet, 2009. [Accessed 20 May 2013].
Menzies School of Health. Resources: Child health clinical audit. Darwin: Menzies School of Health, 2014. [Accessed 18 December 2017].
Australian Institute of Health and Welfare. Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. Cat. no. IHW 24. Canberra: AIHW, 2009: 5–6.