Chronic disease and hospitalisation for pandemic (H1N1) 2009 influenza in Indigenous and non-Indigenous Western Australians

Indigenous and non-indigenous Western Australians with pandemic (H1N1) 2009 influenza (pH1N1) infection were compared for risk factors, influenza vaccination history, symptoms, use of antiviral medications, and hospitalisation. Data were collected systematically on 856 notified cases with laboratory confirmed pH1N1 infection during the first 10 weeks of pH1N1 virus transmission in Western Australia in 2009. Indigenous people with pH1N1 were approximately 3 times more likely to be hospitalised and were more likely to have a range of underlying medical conditions and be smokers, compared with non-Indigenous cases. Age (P < 0.001) and the presence of two or more co-morbidities (P < 0.001) were independent predictors of hospitalisation, while Indigenous status was not, indicating that higher pH1N1 hospitalisation rates in Indigenous Australians during the 2009 winter season were attributable to the higher prevalence of underlying chronic disease. These results underscore the need to ensure that influenza vaccination is delivered as widely as possible among those with chronic health conditions.     

Indigenous mortality in remote Queensland, Australia

OBJECTIVES: To quantify Indigenous mortality, compare it with non-Indigenous mortality, and identify causes of excess Indigenous mortality by remoteness in Queensland, 1997-2000. DESIGN: Cross-sectional survey of all deaths of Queensland residents registered in Australia during the study period. MAIN OUTCOME MEASURES: Mortality rates were standardised to the concurrent non-Indigenous population and categorised by age and sex. RESULTS: Death rates in Indigenous people were higher in remote areas. The difference between Indigenous and non-Indigenous mortality was also highest in remote areas. The leading causes of deaths were ischaemic heart disease, diabetes mellitus, respiratory diseases, malignant neoplasms, and injury, which accounted for more than 60% of excess deaths. CONCLUSIONS: Despite limitations with Indigenous identification, particularly in urban areas, Indigenous people, compared with the non-Indigenous population, have elevated mortality rates that increase by remoteness. This is in agreement with past work. To the extent that some of the causes of excess mortality can be attributed to lifestyle conditions, the health of Indigenous Australians can be substantially improved.     

Smoking behaviours in a remote Australian Indigenous community: the influence of family and other factors

In Australia, tobacco smoking is more than twice as common among Indigenous people as non-Indigenous people. Some of the highest smoking rates in the country are in remote Indigenous communities in the Northern Territory of Australia. Owing to this high prevalence, tobacco use today is the single biggest contributing risk factor for excess morbidity and mortality among Indigenous Australians. Despite this, there is a lack of published research which qualitatively explores the social context of Indigenous smoking behaviour or of meanings and perceptions of smoking among Indigenous people. The aim of this study was to understand why Indigenous people start to smoke, the reasons why they persist in smoking and the obstacles and drivers of quitting. We conducted semi-structured interviews with a purposive sample of 25 Indigenous community members in two remote communities in the Northern Territory and 13 health staff. The results indicate that there is a complex interplay of historical, social, cultural, psychological and physiological factors which influence the smoking behaviours of Indigenous adults in these communities. In particular, the results signal the importance of the family and kin relations in determining smoking behaviours. While most community participants were influenced by family to initiate and continue to smoke, the health and well being of the family was also cited as a key driver of quit attempts. The results highlight the importance of attending to social and cultural context when designing tobacco control programs for this population. Specifically, this research supports the development of family-centred tobacco control interventions alongside wider policy initiatives to counter the normalisation of smoking and assist individuals to quit.     

Improving access to medicines in urban, regional and rural Aboriginal communities--is expansion of Section 100 the answer?

The poor health of Indigenous Australians is highlighted by the fact that their life expectancy is 17 years less than that of non-Indigenous Australians. The cause of this health disparity is multifactorial, and includes the under use of health services and medications. Distance, cost, and embarrassment, or fear of seeking help from culturally inappropriate services have all contributed to the reduced health status of Indigenous Australians. The introduction of Aboriginal medical services (AMS), Aboriginal health workers, and Section 100 (S100) of the Australian Pharmaceutical Benefits Scheme (PBS) have been important steps towards improving Aboriginal access to health services and medications. Despite this, spending on pharmaceuticals under the PBS per capita among the Indigenous population remains significantly lower than that of the non-Indigenous population. Because Aboriginal people from all areas experience similar barriers in their access to medicines, it has been suggested that the S100 scheme be made available to all AMS. Ensuring quality use of medicines needs to be addressed because patient counselling is carried out by the clinic staff, rather than the pharmacist and, therefore, in this case the pharmacist's role converts to one of training and providing information to the AMS. This expansion of S100 services may lead Indigenous health down a path of separation from mainstream services, which in turn would require nearly no adjustment by pharmacies and pharmacists to meet the needs of Indigenous people. Unfortunately, for no known reasons, previous suggestions to improve Aboriginal people's utilisation of mainstream health services and pharmacies have not been actioned.     

Original: anti-smoking media campaign messages: theory and practice

This study examined televised anti-smoking advertisements that were designed to discourage adult and teen smoking. A content analysis of 399 television advertisements catalogued in the Media Campaign Resource Center (MCRC) database were evaluated to determine (a) whether the advertising content reflected core health communication theories used in the design of health campaign messages to change behavior and (b) the affective presentation of tobacco-control advertisements aimed to decrease smoking. The results revealed that anti-smoking advertising relied overwhelmingly on appeals to attitudes. Although the benefits of not smoking were mentioned in 61% of advertisements, barriers were mentioned in only 17% of advertisements. Advertisements emphasized the consequences of smoking more than the viewer's self-efficacy. Finally, advertisements were more likely to use informational and humor appeals, rather than sadness, fear, or anger appeals. The research identifies the types of advertisements that are most likely to be utilized and underutilized in national and statewide anti-smoking advertising campaigns catalogued in the MCRC database.     

Anti-Smoking Media Campaign Messages: Theory and Practice

This study examined televised anti-smoking advertisements that were designed to discourage adult and teen smoking. A content analysis of 399 television advertisements catalogued in the Media Campaign Resource Center (MCRC) database were evaluated to determine (a) whether the advertising content reflected core health communication theories used in the design of health campaign messages to change behavior and (b) the affective presentation of tobacco-control advertisements aimed to decrease smoking. The results revealed that anti-smoking advertising relied overwhelmingly on appeals to attitudes. Although the benefits of not smoking were mentioned in 61% of advertisements, barriers were mentioned in only 17% of advertisements. Advertisements emphasized the consequences of smoking more than the viewer's self-efficacy. Finally, advertisements were more likely to use informational and humor appeals, rather than sadness, fear, or anger appeals. The research identifies the types of advertisements that are most likely to be utilized and underutilized in national and statewide anti-smoking advertising campaigns catalogued in the MCRC database.     

Potential effectiveness of anti-smoking advertisement types in ten low and middle income countries: Do demographics,smoking characteristics and cultural differences matter?

Unlike high income countries, there is limited research to guide selection of anti-tobacco mass media campaigns in low and middle income countries, although some work suggests that messages emphasizing serious health harms perform better than other message types. This study aimed to determine whether certain types of anti-smoking advertisements are more likely to be accepted and perceived as effective across smokers in 10 low to middle income countries. 2399 18–34 year old smokers were recruited in Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam to view and rate 10 anti-tobacco ads. Five ads were shown in all countries and five ads were chosen by country representatives, providing a total of 37 anti-smoking ads across all countries (10 graphic health effects ads, 6 simulated health effects, 8 emotional stories of health effects, 7 other health effects and 6 non-health effects). Smokers rated ads on a series of 5-point scales containing aggregated measures of Message Acceptance and Perceived Effectiveness. All ads and materials were translated into the local language of the testing regions. In multivariate analysis, graphic health effects ads were most likely to be accepted and perceived as effective, followed by simulated health effects ads, health effects stories, other health effects ads, and then non-health effects ads. Interaction analyses indicated that graphic health effects ads were less likely to differ in acceptance or perceived effectiveness across countries, gender, age, education, parental status and amount smoked, and were less likely to be affected by cultural differences between characters and contexts in ads and those within each country. Ads that did not emphasize the health effects of smoking were most prone to inconsistent impact across countries and population subgroups. Graphic ads about the negative health effects of smoking may be most suitable for wide population broadcast in low and middle income countries.     

Excess Indigenous mortality: are Indigenous Australians more severely disadvantaged than other Indigenous populations?

BACKGROUND: International targets for reducing health inequalities, such as the Millennium Development Goals, are stated in terms of national targets. However, dramatic health differentials exist within countries, even developed ones. Studies indicate that the Indigenous population of Australia suffers a life expectancy disadvantage greater than differentials found in Indigenous populations of other developed countries. We re-examine recent national mortality levels and trends of Indigenous Australians. METHODS: Analyses of Indigenous mortality are plagued by 'numerator-denominator bias', whereby reporting of Indigenous status differs in deaths (numerators) and population (denominators). We apply demographic evaluation methods developed to address such problems to data from the 1991, 1996 and 2001 censuses of Australia and to the death registration data for the period. RESULTS: The propensity of Australia's population to report Indigenous status increased between each census, particularly between 1991 and 1996, while recording of deaths as Indigenous increased sharply. Adjusted for bias, the Indigenous population had a life expectancy approximately 13 years below that of the non-Indigenous population, a 2-year greater disadvantage than recently estimated for the Maori in New Zealand. Indigenous mortality fell during the 1990s, but slightly more slowly than that of non-Indigenous Australians, leaving differentials slightly increased. CONCLUSIONS: Around the world Indigenous populations are estimated to suffer a mortality disadvantage compared with non-Indigenous populations. However, establishing the magnitude of and trend in the disadvantage is difficult because of bias. Using appropriate methods to adjust for bias, the Indigenous population of Australia is estimated to suffer a life expectancy shortfall of about 13 years, greater than similar gaps in other developed countries.     

First-time hospital admissions with illicit drug problems in indigenous and non-indigenous Western Australians: an application of record linkage to public health surveillance

OBJECTIVE: To monitor incidence rates of first-time hospital admission with an illicit drug problem in the Indigenous and non-Indigenous populations of Western Australia in 1980-95. METHOD: Some 10,533 first admissions among 16,294 total admissions mentioning any of 19 groups of illicit drug problems were identified using linked hospital separation data from the WA Health Services Research Linked Database. RESULTS: Trends in age-standardised rates showed two distinct features: a rapid acceleration in first-time admission rates commencing from about 1991; and a cross-over of the rates in Indigenous and non-Indigenous people. In 1980, the rates were 9.2 per 100,000 PY in Indigenous and 16.4 per 100,000 PY in non-Indigenous people. By 1995, the respective rates were 180.7 and 95.5 per 100,000 PY. Largest proportional increases were observed in first-time admissions mentioning amphetamine dependence or abuse, although increases were seen also in problems due to opiates, hallucinogens, cocaine and cannabis. CONCLUSION: The results are consistent with data on the rising use of injectable amphetamines and other illicit drugs, especially among Aboriginal people. IMPLICATIONS: Urgent attention is required to identify ways of reducing health problems due to illicit substance use in both Indigenous and non-Indigenous Australians.     

A review of tobacco interventions for Indigenous Australians

OBJECTIVE: To conduct a review of interventions to reduce the harm resulting from tobacco use among Indigenous Australians and to discuss the likely effect of a range of tobacco interventions if conducted in this population. METHODS: A systematic review of medical literature and an audit of information from 32 government departments, non-government organisations and indigenous health organisations, which was completed in March 2001. RESULTS: A number of small tobacco programs had been conducted. Only four tobacco interventions had been evaluated in indigenous communities: a trial of training health professionals in conducting a brief intervention for smoking cessation; a trial of a CD-ROM on tobacco for use with indigenous schoolchildren; a qualitative evaluation of the effect of a mainstream advertising campaign on Indigenous people; and a pilot study of smoke-free workplaces, evaluated by qualitative methods. None of these studies assessed smoking cessation as an outcome. Two of these studies were unable to conclusively show any effect of the interventions; training health professionals in delivering a brief intervention resulted in some changes to practice and the evaluation of the mainstream advertising campaign showed that following the campaign, knowledge about tobacco had increased. CONCLUSIONS: There was a major lack of research on and evaluation of tobacco interventions for Indigenous Australians. IMPLICATIONS: More research and evaluation is required to ensure that tobacco interventions are appropriate and effective for Indigenous people. It is time to cease chronicling the ill health of Indigenous Australians and time to ensure the availability of well-evaluated, effective tobacco programs.     

Socioeconomic status and self-reported asthma in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

Background

Asthma is more common among Indigenous than non-Indigenous Australian adults, but little is known about socioeconomic patterning of asthma within the Indigenous population, or whether it is similar to the non-Indigenous population.

Methods

I analysed weighted data on self-reported current diagnosed asthma and a range of socio-economic and demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05.

Results

Current asthma prevalence was higher for Indigenous than non-Indigenous people in every age group. After adjusting for age and sex, main language and place of residence were significantly associated with asthma prevalence in both populations. Traditional SES variables such as education, income and employment status were significantly associated with asthma in the non-Indigenous but not the Indigenous population. For example, age-and sex-adjusted relative odds of asthma among those who did not complete Year 10 (versus those who did) was 1.2 (95% confidence interval (CI) 1.0-1.5) in the non-Indigenous population versus 1.0 (95% CI 0.8-1.3) in the Indigenous population.

Conclusions

The socioeconomic patterning of asthma among Indigenous Australians is much less pronounced than for other chronic diseases such as diabetes and kidney disease, and contrasts with asthma patterns in the non-Indigenous population. This may be due in part to the episodic nature of asthma, and the well-known challenges in diagnosing it, especially among people with limited health literacy and/or limited access to health care, both of which are more likely in the Indigenous population. It may also reflect the importance of exposures occurring across the socioeconomic spectrum among Indigenous Australians, such as racism, and discrimination, marginalization and dispossession, chronic stress and exposure to violence.

     

Data for diagnosis, monitoring and treatment in Indigenous health: the case of cervical cancer

Deficiencies in the availability and quality of data on the health status of Indigenous Australians have long been recognised. For cervical cancer, data demonstrate a 2–5 fold greater incidence rate and an 8–10 fold greater mortality rate for Indigenous women compared to non-Indigenous Australians. However, incidence and mortality data are only available for some states and there is little or no information available on the geographic or social distribution of risk, or the reasons for risk differentials. There are also little or no data on the utilisation of, or preferences for, screening services. Thus, while there is clearly a need for a cervical cancer control program specifically to target Indigenous women, current data are inadequate to inform planning and implementation, and current systems are inadequate to monitor effectiveness. This situation is the result of insufficient research and inadequate attention to recording of Indigenous status in routine data systems and applies to a greater or lesser extent across the spectrum of health of Indigenous Australians. Health workers across the spectrum in mainstream and Indigenous medical services have a shared responsibility for improving the availability and quality of data and ensuring the appropriate use of information necessary to achieve and monitor improvements in service delivery and health status of Indigenous people.     

‘It had to be my choice’ Indigenous smoking cessation and negotiations of risk,resistance and resilience

While Australia is considered a world leader in tobacco control, smoking rates within the Aboriginal and Torres Strait Islander population have not declined at the same rate. This failure highlights an obvious shortcoming of mainstream anti-smoking efforts to effectively understand and engage with the socio-cultural context of Indigenous smoking and smoking cessation experiences. The purpose of this article is to explore the narrative accounts of 20 Indigenous ex-smokers within an urban community and determine the motivators and enablers for successful smoking cessation. Our findings indicated that health risk narratives and the associated social stigma produced through anti-smoking campaigns formed part of a broader apparatus of oppression among Indigenous people, often inspiring resistance and resentment rather than compliance. Instead, a significant life event and supportive relationships were the most useful predictors of successful smoking cessation acting as both a motivator and enabler to behavioural change. Indigenous smoking cessation narratives most commonly involved changing and reordering a person's life and identity and autonomy over this process was the critical building block to reclaiming control over nicotine addiction. Most promisingly, at an individual level, we found the important role that individual health professionals played in encouraging and supporting Indigenous smoking cessation through positive rather than punitive interactions. More broadly, our findings highlighted the central importance of resilience, empowerment and trust within health promotion practice.     

Quality comparison of electronic versus paper death certificates in France, 2010

Background

National cancer survival statistics are available for the total Australian population but not Indigenous Australians, although their cancer mortality rates are known to be higher than those of other Australians. We aimed to validate analysis methods and report cancer survival rates for Indigenous Australians as the basis for regular national reporting.

Methods

We used national cancer registrations data to calculate all-cancer and site-specific relative survival for Indigenous Australians (compared with non-Indigenous Australians) diagnosed in 2001-2005. Because of limited availability of Indigenous life tables, we validated and used cause-specific survival (rather than relative survival) for proportional hazards regression to analyze time trends and regional variation in all-cancer survival between 1991 and 2005.

Results

Survival was lower for Indigenous than non-Indigenous Australians for all cancers combined and for many cancer sites. The excess mortality of Indigenous people with cancer was restricted to the first three years after diagnosis, and greatest in the first year. Survival was lower for rural and remote than urban residents; this disparity was much greater for Indigenous people. Survival improved between 1991 and 2005 for non-Indigenous people (mortality decreased by 28%), but to a much lesser extent for Indigenous people (11%) and only for those in remote areas; cancer survival did not improve for urban Indigenous residents.

Conclusions

Cancer survival is lower for Indigenous than other Australians, for all cancers combined and many individual cancer sites, although more accurate recording of Indigenous status by cancer registers is required before the extent of this disadvantage can be known with certainty. Cancer care for Indigenous Australians needs to be considerably improved; cancer diagnosis, treatment, and support services need to be redesigned specifically to be accessible and acceptable to Indigenous people.     

Tuberculosis notifications in Australia, 2005

The National Notifiable Disease Surveillance System received 1,072 tuberculosis (TB) notifications in 2005, of which 1,022 were new cases and 50 were relapses. The incidence of TB in Australia was 5.3 cases per 100,000 population in 2005 and has remained at a stable rate since 1985. The high-incidence groups remain people born overseas and Indigenous Australians at 20.6 and 5.9 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.8 cases per 100,000 population. Rates in the Australian-born, both Indigenous and non-Indigenous have been declining since 1991, while rates in the overseas-born have been increasing. TB control in Australia relies on pre-migration screening and provision of free and effective treatment.     

Aboriginal and Torres Strait Islander smoke‐free homes, 2002 to 2008

Objective : To describe the social patterning of and trends in the prevalence of Aboriginal and Torres Strait Islander smoke‐free homes, and the association between these smoke‐free homes and smoking initiation, intensity and cessation. Methods : Analyses of responses to questions about whether any householders usually smoke inside in the 2004 National Aboriginal and Torres Strait Islander Health Survey, the 2008 National Aboriginal and Torres Strait Islander Social Survey, and in the comparable National Health Surveys in 2004 and 2007. Results : The proportion of Indigenous children living with at least one daily smoker who smokes inside declined significantly from 28.4% in 2004 to 20.8% in 2008, with significant improvements only detected among the most disadvantaged categories of Indigenous children. The proportion of Indigenous daily smokers who lived in multi‐person households where no daily smoker householder usually smoked inside increased significantly from 45.0% in 2004 to 56.3% in 2008. The absolute size of these changes was greater among Indigenous children and smokers than among all Australians. More disadvantaged Indigenous children were more likely to be exposed to secondhand smoke at home, and more disadvantaged Indigenous smokers were more likely to live in households where smokers usually smoked inside. Indigenous smokers in smoke‐free homes smoke significantly less cigarettes. Conclusions and Implications : The increases in Indigenous smoke‐free homes are encouraging, especially as they are from the period before recent increased attention to Indigenous tobacco control, which should accelerate these trends and their resultant health benefits for Aboriginal and Torres Strait Islander children and families.     

Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

Background  

Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.     

How do trends in smoking prevalence among Indigenous and non‐Indigenous Australian secondary students between 1996 and 2005 compare?

Objective: To compare trends in smoking prevalence between 1996 and 2005 among Indigenous and non-Indigenous secondary students across Australia.
Methods: Representative random samples of secondary students aged 12-17 years completed self-report anonymous surveys. Questionnaires assessed any cigarette smoking in lifetime, and smoking in past month, week and on at least three of the previous seven days. Intention to smoke in the next 12 months was assessed on a 7-point scale. Students self-identified as being of Aboriginal or Torres Strait Islander descent.
Results: Three to four per cent of students identified as being Indigenous at each survey. Smoking was more common among Indigenous than non-Indigenous students. Between 1996 and 2005, the proportion of smoking declined among both Indigenous and non-Indigenous students. However, among 12-15 year olds, the rate of decline was different for the two groups. Among non-Indigenous students in this age group, prevalence decreased steadily between 1996 and 2005. Among Indigenous students, the decrease mainly occurred between 1999 and 2002. Smoking intention was higher for Indigenous than non-Indigenous students. The mean intention decreased between 1996 and 2005 among both student groups.
Conclusions: Smoking prevalence decreased among both Indigenous and non-Indigenous students between 1996 and 2005.
Implications: Reductions in Indigenous students' tobacco use and intentions coincided with a period of increased tobacco control activity, suggesting that these activities may positively influence smoking behaviours.     

Substance use by indigenous and non-indigenous primary school students

OBJECTIVE: Recent Australian research with adolescents aged 13 to 17 years has found that Indigenous youth are more likely than non-Indigenous adolescents to smoke tobacco and cannabis, although they may be less likely to use alcohol. The objective of this study was to examine whether this pattern exists among younger children. METHOD: A school-based, self-report survey was conducted in primary schools that had high proportions of Aboriginal and Torres Strait Islander children. Four schools were located in metropolitan Brisbane and three in Far North Queensland (sample n = 507 students: 270 girls, 237 boys, aged 9-13 years). RESULTS: Significant numbers of these children had started to experiment with recreational drugs. Twenty-two per cent had attempted to smoke at least one cigarette, 14% smoked in the preceding year, while 3% had smoked more than 10 cigarettes in their lives. Thirty-eight per cent had had at least one drink of alcohol, while 6% had smoked marijuana at least once. There was no significant association between Indigenous/non-Indigenous background and risk of smoking tobacco or marijuana, while Indigenous children were less likely than non-Indigenous children to report experience with alcohol. CONCLUSIONS: Contrary to data from secondary school students, Indigenous youth in primary schools were not more likely than non-Indigenous children to have experimented with tobacco or marijuana, or to be frequent tobacco smokers. It appears therefore that the excessive uptake of drug use among Indigenous youth occurs in the early stages of secondary school. This finding underlines the importance of preventive education in primary schools, especially for Indigenous children who have a high risk of making the transition to drug use in adolescence.