Barriers and facilitators for health professionals referring Aboriginal and Torres Strait Islander tobacco smokers to the Quitline

Objective: To examine the barriers and facilitators among health professionals to providing referrals to Quitline for Aboriginal and Torres Strait Islander clients who smoke. Methods: A brief online survey, based on the Theoretical Domains Framework, was completed by 34 health professionals who work with Aboriginal and Torres Strait Islander people in South Australia and the Northern Territory. Results: Respondents who frequently made referrals had higher domain scores than less frequent referrers for ‘Skills and knowledge’ (M=4.44 SD=0.39 vs. M=4.09 SD=0.47, p<0.05) and ‘beliefs about capabilities’ (M=4.33 SD=0.44 vs. M=3.88 SD=0.42, p<0.01). Barriers to providing referrals to Quitline were lack of client access to a phone, cost of a phone call, preference for face‐to‐face interventions, and low client motivation to quit. Conclusions: Health professionals working with Aboriginal and Torres Strait Islander clients should be supported to build their skills and confidence to provide referrals to Quitline and other brief cessation interventions. Building capacity for face‐to‐face support locally would be beneficial where phone support is not preferable. Implications for public health: Engaging with health professionals who work with Aboriginal and Torres Strait Islander people to increase referrals to Quitline is strategic as it builds on their existing capacity to provide cessation support.     

Evaluation of an intervention to train health professionals working with Aboriginal and Torres Strait Islander people to provide smoking cessation advice

Objective : To investigate the effectiveness and cultural relevance of Quitskills training tailored for health professionals working with Aboriginal and Torres Strait Islander people who smoke. Methods : A retrospective analysis was conducted with data collected from 860 participants (54% Aboriginal and Torres Strait Islander participants) in tailored Quitskills training from 2012 to 2016. Course participants took part in a survey at pre‐training, post‐training and four‐six weeks post‐training to assess confidence in skills to address tobacco, and perceptions of the strengths, areas for improvement and cultural relevance of the training. Results : Confidence in skills and knowledge to address tobacco increased significantly from pre‐ to post‐training (all indicators of confidence in skills increased p<0.001) and remained high at follow‐up. Tailored Quitskills training was perceived as being culturally relevant by Aboriginal and Torres Strait Islander participants, and the training facilitators were the most commonly cited strength of the training. Conclusions : Quitskills is an appropriate course for increasing skills and confidence among health professionals working with Aboriginal and Torres Strait Islander people who smoke. Implications for public health : Training courses that are tailored for Aboriginal and Torres Strait Islander people can build the capacity of the health workforce in a culturally relevant manner.     

Linking ‘data silos’ to investigate anaemia among Aboriginal and Torres Strait Islander mothers and children in Far North Queensland

Objective : Data collection ‘silos’ can be linked for health research. Anaemia in early childhood is a long‐recognised health issue in remote Aboriginal communities of the Northern Territory and Western Australia, but information is lacking for Queensland. The objective of this work was to compile existing information from health and education data collections to investigate anaemia among Aboriginal and Torres Strait Islander mothers and their children in Far North Queensland. Methods : Data mapping identified four health data collections and one education data collection holding relevant information. Data Custodians’ approval was secured for release of linked de‐identified information. Results : Approval processes and preparation of the dataset for release took 23 months. Birth information was obtained for 2,205 mother–child pairs where the Aboriginal and/or Torres Strait Islander child was born in Far North Queensland between 2006 and 2010. Pathology information from before/during pregnancy was obtained for 2,126 mothers (96.4%), growth and haemoglobin information for 982 children (44.5%), and childhood development indicators at school entry for 963 children (43.7%). Conclusion : Linking existing information ‘silos’ enables research into key public health issues. Implications for public health : Information linkage is particularly valuable in respect of vulnerable populations including rural and remote Aboriginal and Torres Strait Islander peoples.     

Do stress,life satisfaction,depression and alcohol use predict quitting among Aboriginal and Torres Strait Islander smokers?

Objective : To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. Methods : We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012–October 2013) and the 759 who completed a follow‐up survey a year later (August 2013–August 2014). Results : More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow‐up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health : Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.     

What isn't measured isn't done – eight years with no progress in Aboriginal and Torres Strait Islander adult influenza and pneumococcal vaccination

Objectives: To describe and compare vaccination coverage for Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) adults in 2004–05 and 2012–13, including the impact of national vaccination funding initiatives. Methods: National Aboriginal and Torres Strait Islander Health cross‐sectional surveys – 2004–05 (n=5,757) and 2012–13 (n=5,482) – were compared. Self‐reported influenza and pneumococcal vaccination coverage among Indigenous adults was analysed by age, remoteness, gender and risk factor status. Results: Influenza vaccination coverage among Indigenous adults in 2004–05 and 2012–13 remained low. While coverage increased for those aged 18–49 years from 23% to 29%, it declined for those aged ≥65 years from 84% to 74%. For remote areas, influenza coverage among those aged 50–64 years declined from 76% to 66%. Pneumococcal vaccination coverage remained very low and declined across all age groups in 2004–05 and 2012–13 (50–64 years: 30% to 23%). For remote areas, pneumococcal coverage declined among those aged 50–64 years from 52% to 32%. Conclusions: Indigenous adult vaccination coverage for influenza and pneumococcal disease remains unacceptably low. Between 2004–05 and 2012–13, declines occurred in pneumococcal vaccination coverage across all age groups ≥18 years. Despite national funding of influenza vaccine in 2010, there was no increase in influenza coverage, except for the 18–49‐year age group. Implications for public health: Current approaches to promote, deliver and monitor vaccination of Indigenous adults are inadequate.     

Driver licensing: descriptive epidemiology of a social determinant of Aboriginal and Torres Strait Islander health

Objective : Education, employment and equitable access to services are commonly accepted as important underlying social determinants of health. For most Australians, access to health, education and other services is facilitated by private transport and a driver licence. This study aimed to examine licensing rates and predictors of licensing in a sample of Aboriginal and Torres Strait Islander people, as these have previously been poorly described. Methods : Interviewer‐administered surveys were conducted with 625 people 16 years or older in four Aboriginal Community Controlled Health Services in New South Wales and South Australia over a two‐week period in 2012–2013. Results : Licensing rates varied from 51% to 77% by site. Compared to not having a licence, having a driver licence was significantly associated with higher odds of full‐time employment (adjusted OR 4.0, 95%CI 2.5–6.3) and educational attainment (adjusted OR 1.9, 95%CI 1.2–2.8 for trade or certificate; adjusted OR 4.0, 95%CI 1.6–9.5 for degree qualification). Conclusions : Variation in driver licensing rates suggests different yet pervasive barriers to access. There is a strong association between driver licensing, education and employment. Implications : Licensing inequality has far‐reaching impacts on the broader health and wellbeing of Aboriginal and Torres Strait Islander people, reinforcing the need for appropriate and accessible pathways to achieving and maintaining driver licensing.     

Limited progress in closing the mortality gap for Aboriginal and Torres Strait Islander Australians of the Northern Territory

Objectives : To assess whether progress is being made towards reducing Aboriginal and Torres Strait Islander inequality in life expectancy and under‐five mortality in the Northern Territory. Methods : Life tables for five‐year periods from 1966–71 to 2011–16 were calculated using standard abridged life table methods with Aboriginal and Torres Strait Islander deaths and population estimates as inputs. The latter were calculated using reverse cohort survival. Results : In 2011–16, life expectancy at birth for the Aboriginal and Torres Strait Islander population was 68.2 years for females and 64.9 years for males. Limited progress in under‐five mortality rates has been made in recent years. Conclusions : Although Aboriginal and Torres Strait Islander life expectancy has increased in the long run, the gap with all‐Australian life expectancy has not narrowed. The gap in under‐five mortality rates is much lower than it was in the 1960s and 1970s, but progress has been limited over the past decade. Implications for public health : The ‘Closing the Gap’ target of halving the gap in under‐five mortality by 2018 will not be met in the Northern Territory, and there is no evidence yet of progress on the target to eliminate the gap in life expectancy by 2031.     

Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples

Objective : Given the high prevalence of chronic disease, it is of concern that access to and sustained engagement with primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected. This study sought to explore ways in which relationships can support sustained engagement with healthcare services. Methods: Semi‐structured interviews were conducted with 126 Aboriginal and Torres Strait Islander participants with and without chronic disease and 97 Aboriginal and Torres Strait Islander and non‐Indigenous healthcare providers, healthcare service managers or administrative staff. Results : Our findings indicate that when faced with acute health issues, Aboriginal and Torres Strait Islander participants did prioritise care, provided that the service was both physically and emotionally welcoming. Trustworthiness of healthcare providers and strong relationships with patients were the most important factors for encouraging sustained engagement overtime. Conclusions : Responsibility for sustaining relationships does not rest solely with Aboriginal and Torres Strait Islander patients. Rather, healthcare providers need to commit to the process of building and maintaining relationships. Implications : First and foremost healthcare providers should take time to establish and then maintain relationships. Healthcare services can also contribute by ensuring facilities are welcoming for Aboriginal and Torres Strait Islander peoples.     

Knowledge,attitudes and behaviours in relation to safe sex,sexually transmitted infections (STI) and HIV/AIDS among remote living north Queensland youth

Objective: To assess the knowledge, attitudes and behaviours of remote Aboriginal and Torres Strait Islander youth living in far north Queensland in relation to sexually transmitted infections, HIV/AIDS and safe sex. Methods: Community consultation followed by local recruitment of a sample of young people who, in a facilitated same gender focus group setting, completed a questionnaire followed by open discussion of the issues in a range of remote locations during 2007. Results: The remote living Indigenous youth demonstrated lower levels of knowledge in relation to STI and HIV and higher levels of partner change than was demonstrated in the 2002 national secondary school survey. Despite the high rates of bacterial STI in the region, there was an extremely low level of awareness of personal risk in relation to STI and HIV. Conclusion: There is an urgent need to strengthen school‐based sex education and to develop innovative approaches to sexual health promotion in addition to improving clinical sexual health service provision.     

Public hospital activity,expenditure and staffing levels for indigenous and nonindigenous settlements in remote Queensland

Abstract: Aborigines and Torres Strait Islanders who live in discrete communities have poor health. Their life expectancy is relatively low and the underlying rates of morbidity, mortality and hospitalisation are much higher than the Australian average. For Aborigines and Torres Strait Islanders in the remote communities, the mortality rate is some three times higher than that of the total population. By comparing remote Aboriginal and Torres Strait Islander communities with similarly remote nonindigenous settlements, the paper shows that there was greater hospital activity per person in remote Aboriginal and Torres Strait Islander communities. Paradoxically, whereas there was greater hospital activity in discrete indigenous communities, there was lower expenditure per person on hospital services. The paper finds also that there were fewer medical and nursing staff per person in remote Aboriginal and Torres Strait communities.     

The validation of a self‐report measure and physical activity of Australian Aboriginal and Torres Strait Islander and non‐Indigenous rural children

Purpose: To validate a self‐report measure of physical activity for both Australian Aboriginal and Torres Strait Islander and non‐Indigenous rural children, and to describe their physical activity participation. Methods: In this cross‐sectional study, 84 Aboriginal and Torres Strait Islander and 146 non‐Indigenous children aged 10–12 years old completed the Many Rivers Physical Activity Recall Questionnaire (MRPARQ), a modified version of the Adolescent Physical Activity Recall Questionnaire (APARQ). A sub‐group (n=86) wore an accelerometer for seven consecutive days in order to validate the instrument. Results: Pearson and Intra Class Correlation coefficients between the survey and acceleromtery for weekdays only are 0.31 and 0.16, respectively, for Aboriginal and Torres Strait Islander children, and 0.38 and 0.31, respectively, for non‐Indigenous children, and demonstrate a modest (p<0.05) correlation. Self‐reported MVPA for Aboriginal and Torres Strait Islander children is between 162 and 172 minutes/day, and is 125 minutes by accelerometer; for non‐Indigenous children MVPA is between 123 and 149 minutes (survey) and 107 minutes (accelerometer). Conclusion: Australian Aboriginal and Torres Strait Islander children's self‐report of physical activity is at least as valid as non‐Indigenous children, given culturally appropriate support; they tend to be more active than non‐Indigenous children. Implications: The MRPARQ can be administered with Aboriginal and Torres Strait Islander and non‐Indigenous children.     

National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1–0.7)% per year, with the same decline in remote and non‐remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non‐remote areas. In non‐remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2–0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0–0.8)% per year. From 2002 to 2008, the percentage of ever‐smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non‐remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous‐specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister's goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008.     

Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail

Objective : To examine the extent and nature of coverage of nutrition in the Koori Mail. Methods : Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms ‘nutrition?’, ‘diet?’, ‘food’, ‘eating’, ‘weight’, ‘tucker’ or ‘sugary drinks’. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples’ voices and the framing of nutrition issues. Results : A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. Conclusion : Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health : Including more Aboriginal and Torres Strait Islander voices and using a strengths‐based approach in press releases may improve media advocacy.     

Social determinants in the sexual health of adolescent Aboriginal Australians: a systematic review

While research indicates that Aboriginal and Torres Strait Islander adolescents may be at increased risk of some sexually transmitted infections, there is limited information about factors that may place these young people at more risk of adverse sexual health than their non‐Indigenous counterparts. Current research has tended to focus on surveillance‐type data, but there is an increasing need to understand social determinants of sexual health risk. This systematic review assessed the evidence of social determinants impacting on Aboriginal and Torres Strait Islander adolescents’ sexual health in Australia. Published, English‐language literature was searched across key databases from 2003 to 2015. Fourteen studies were included in the qualitative synthesis. Findings suggest that social determinants such as access to healthcare, poverty, substance use, educational disadvantage, sociocultural context, gender inequalities, status and identity, and social disadvantage impacted on Indigenous adolescents’ sexual behaviours and sexual health risk. Evidence from the literature included in the review suggests that peer education may be an acceptable and appropriate approach for addressing such issues. There remains a need for programmes and services to be community‐developed and community‐led, thus ensuring cultural appropriateness and relevance. However, there is also a significant need for such programmes to be effectively and rigorously evaluated with data that goes beyond surveillance, and seeks to unpack how sexual norms are experienced by Indigenous adolescents, particularly outside of remote Australia – and how these experiences act as either risk or protective factors to good sexual health and positive social and emotional well‐being.     

DIABETIC FOOT CARE: DEVELOPING CULTURALLY APPROPRIATE EDUCATIONAL TOOLS FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES IN THE NORTHERN TERRITORY, AUSTRALIA

ABSTRACT: Evidence shows that Aboriginal and Torres Strait Islander people have the highest national percentage of morbidity in relation to diabetes. Aboriginal and Torres Strait Islander people also suffer the greatest risk of amputation as a complication of diabetes. This participatory action research project sought to discover the opinions of a range of people, including registered nurses, general practitioners, Aboriginal health workers, cross-cultural liaison officers and Aboriginal and Torres Strait Islander people with diabetes. Focus groups provided valuable information regarding relevant issues of foot care education in the Northern Territory. The emergent themes included communication issues, educational resources, changing behaviour and other practical resources required for health education. The themes provided evidence of the inherent issues of foot care for Aboriginal and Torres Strait Islander people and guidance for the development of a visual educational tool. The results have lead to the development of a foot care educational tool that will be used by health-care professionals and clients in urban, community, rural and remote areas. The use of a participant action research process will ensure that the educational tool will be owned by Aboriginal and Torres Strait Islander People and health-care professionals.     

Obesity,diabetes and associated cardiovascular risk factors among Torres Strait Islander people

OBJECTIVE: To describe the lifestyle-related chronic disease and risk factor prevalence among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area Health Service District and to compare this information with that available for the general Australian population. METHODS: Voluntary community-based screening for persons aged 15 years and older, including oral glucose tolerance test, anthropometry, health questionnaire, measurement of lipids and lipoprotein levels, blood pressure and urinary albumin to creatinine ratio. RESULTS: Nine communities participated in screening between 1993 and 1997. Five hundred and ninety-two participants (286 male and 306 female) identified as Torres Strait Islander. There were high prevalences of overweight (30%), obesity (51%), abdominal obesity (70%), diabetes (26%), hypercholesterolaemia (33%), albuminuria (28%), hypertension (32%) and tobacco smoking (45%). Only 8.5% of men and 6.5% of women were free of any cardiovascular risk factors (abdominal obesity, hypercholesterolaemia, hypertension, dyslipidaemia, smoking, diabetes, albuminuria). Comparisons of this information for Torres Strait Islander people with results from the AusDiab survey show rates of obesity three times higher and diabetes six times higher than for other Australians. CONCLUSIONS: There is a very high prevalence of preventable chronic disease and associated risk factors among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area. Implications: Effective interventions to prevent and manage obesity, diabetes and associated cardiovascular risk factors are essential if the health of the Torres Strait Islander people is to improve. Such interventions could inform initiatives to stem the burgeoning epidemic of obesity and diabetes among all Australians.     

Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program

Objective : This study reports findings from an uncontrolled evaluation of a course designed to educate participants in how to recognise and respond to mental health problems until professional help is received. Methods : Utilising a mixed methods design, participants in 21 different courses, delivered across two Australian states, were invited to complete pre‐, post‐, and follow‐up surveys and provide qualitative feedback on their training experiences. Results : Participants reported feeling more confident in their capacity to respond appropriately to a person presenting with a mental health need and believed they would be more likely to provide assistance. Satisfaction was attributed to the skills and sensitivities of instructors who had lived experience of mental health concerns in Aboriginal and Torres Strait Islander communities. Conclusion : This course holds promise in improving mental health literacy in relation to Aboriginal and Torres Strait Islander mental health. Implications for public health : Few courses are available that address issues relating to the social and emotional wellbeing of Aboriginal and Torres Strait Islander People. This study illustrates how community engagement with primary health and specialist mental health services might be strengthened.     

Rapid review of five years of Aboriginal and Torres Strait Islander health research in Australia – persisting under‐representation of urban populations

Objective : To review how published Aboriginal and Torres Strait Islander health research reflects the geographical distribution of the Indigenous population of Australia. Methods : Rapid review using Lowitja Institute Lit.search tool for PubMed indexed Indigenous health research papers (January 2013 to January 2018). Geographic location, participant age, study type and recruitment site were identified for each paper. Results : A total of 1,258 research papers were identified: 190 (15%) focused exclusively on Indigenous people living in urban areas; 563 (45%) in rural/remote areas; and 505 (40%) spanned urban and rural/remote areas. Despite similar burdens of disease, three times as many papers were published per 1,000 DALYs for rural/remote areas than urban areas. Conclusions : Indigenous health research publications have more than doubled since 2010. However, research focusing on the health needs of urban Indigenous people remains low relative to disease burden and population. Implications for public health : More research to address the health needs of Indigenous people living in urban areas is required although this should not be at the expense of research for rural and remote areas. Increased funding quarantined for Indigenous health research, coupled with self‐determination of the research agenda and reporting on the geographic representativeness of research, may help address geographical inequities in research outputs.     

Ageing of the Aboriginal and Torres Strait Islander population: numerical,structural, timing and spatial aspects

Objectives : To assess levels of numerical, structural, timing and spatial aspects of ageing of the Aboriginal and Torres Strait Islander population. Methods : Population projections for 15 Australian regions were created by a multi‐state cohort‐component model. Results : The older (45‐plus) population grew from 29,815 in 1986 to 167,259 in 2016. In the subsequent 30 years, we project growth to 448,785 people. Growth rates of the older population vary: from 200% in the 60–64‐year‐old group to 800% growth in the 85‐plus age group by mid‐century. This strong numerical ageing is reflected in a shift in structural ageing by about six percentage points. Selected areas outside of capital cities are structurally older than many cities. Numerical ageing is strongest in capital cities and New South Wales. Cohort flow is the primary driver of ageing. Conclusions : Numerical and structural ageing is projected to increase significantly to mid‐century with important spatial variations. Population ageing is largely irreversible. Implications for public health : High numerical growth in the older Aboriginal and Torres Strait Islander population poses implications for increased demand for a range of health and care services. Variations in spatial and timing aspects of ageing indicate demand will peak earlier in some geographical locations relative to others.