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.     

The validity of a depression screening tool modified for use with Aboriginal and Torres Strait Islander people

OBJECTIVES: To assess the reliability and validity of a depression screening tool--the PHQ-9Pfizer Inc. modified for use with Aboriginal and Torres Strait Islander people. We also sought to determine the prevalence of depression in a sample of Indigenous people with ischaemic heart disease (IHD). METHODS: The modified PHQ-9 was administered to a sample of Indigenous people with IHD by an Aboriginal Health Worker (AHW). Tool results were then compared with the results of a psychiatric diagnostic interview conducted by a medical practitioner. Thirty four IHD patients attending an Aboriginal Community Controlled Health Service (ACCHS) in Darwin in 2006 and 2007 participated in the study. The modified PHQ-9's sensitivity, specificity, positive and negative predictive value were calculated for major and minor depression. Chronbach's alpha of the screening test was calculated to measure internal consistency. The prevalence of depression in the study group was also determined. RESULTS: The prevalence of major depression in the sample was 15.4% (95% CI 7.2%-29.7%). When assessing for major depression the modified PHQ-9 was 80% sensitive (95% CI 66.4-93.6%) and 71.4% (95% CI 56.0-86.8%) specific. A 'mini' version of the modified PHQ-9 demonstrated 100% sensitivity (95% CI 100%-100%) and 12.5% specificity (95% CI 7.0% -25.7%) Chronbach's alpha was 0.8. CONCLUSION: The modified PHQ-9 and the mini-tool, showed promise in this setting. Further investigation with a larger number of Aboriginal and Torres Strait Islander participants is warranted. IMPLICATIONS: This study has implications both for the Medicare funded Aboriginal Adult Health Checks and for program planning for Aboriginal IHD patients.     

Pre-pregnancy predictors linked to miscarriage among Aboriginal and Torres Strait Islander women in North Queensland

Objective : Identify preventable pre‐pregnancy risk factors that may affect the prevalence of miscarriage among a cohort of Australian Indigenous women. Methods: Data from 1,009 Indigenous women of childbearing age who participated in a 1999–2000 health screening program in far‐north Queensland were linked to Queensland hospitalisation data. Women who attended hospital after their health check (censor date: March 2008) for a pregnancy‐related condition were identified. Characteristics associated with becoming pregnant and subsequent miscarriage were analysed using generalised linear models. Results: After adjusting for age and ethnicity, women who became pregnant were more likely to be smokers and to have low red cell folate at baseline. The risk of miscarriage increased with age. Women who reported risky drinking or had elevated gamma‐glutamyl transferase were also at higher risk. After further adjustment for risky drinking, the presence of chlamydia or gonorrhoea before pregnancy was associated with miscarriage. The presence of both infections at baseline compared with women who had no infection, again after further adjustment for risky drinking, was strongly associated with miscarriage; these women had more than a four‐fold increase in risk (PR: 4.57 [2.21–9.46]). Elevated body mass index, high blood pressure and smoking were not statistically significantly associated with risk of miscarriage. Conclusions and implications: A high prevalence of pre‐pregnancy sexually transmitted infections and high rates of risky drinking are associated with miscarriage among young Indigenous women in rural and remote communities in north Queensland.     

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.     

The social determinants and starting and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers

Objective: To assess whether social, economic and demographic measures are associated with initiating and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers. Methods: We analysed data from 759 adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012 – October 2013) and completed a follow up survey a year later (August 2013 – August 2014). Results: Almost none of the standard baseline socioeconomic indicators predicted making or sustaining quit attempts. However, becoming employed was associated with making quit attempts (OR 1.88) and both becoming employed (OR 3.03) and moving to purchase a home (OR 2.34) were both positively associated with sustaining abstinence of one month or more. More smokers who had insufficient money for food or essentials because of money spent on cigarettes had made a quit attempt (OR 1.47) and sustained abstinence of one month or more (OR 1.74). Conclusions and implications: Disadvantage does not seem to have pervasive negative effects on quitting. We should be more optimistic in our tobacco control activities with the most disadvantaged among Aboriginal and Torres Strait Islander smokers. Increasing personal empowerment (e.g. getting a job) may lead to at least short‐term improvements in quitting.     

Needs of Aboriginal and Torres Strait Islander clients residing in Australian residential aged-care facilities

This review was undertaken to identify evidence-based practice guidelines to support the care needs of Aboriginal and Torres Strait Islander clients residing in residential aged-care facilities. A systematic literature review was undertaken. An electronic search of online databases and subsequent manual retrieval process was undertaken to identify relevant reports and studies that explored interventions for care of an Aboriginal and Torres Strait Islander person. Very limited published material identified strategies necessary within residential aged care. Sixty-seven articles were considered for inclusion, and a subsequent review resulted in 34 being included due to direct alignment with the study aim. Strategies recommended within the review cover areas such as care, communication, palliative care, activities and the environment. Care for an Aboriginal and Torres Strait Islander person in an Australian residential aged-care facility requires a collaborative and individual approach. Cultural safety principles should be maintained across a culturally competent workforce. Aboriginal and Torres Strait Islander persons in care is a significant experience that should not be considered 'routine' as there is much to consider in the care of this person and their community.     

Exploring the characteristics of the research workforce in Aboriginal and Torres Strait Islander health

OBJECTIVE: This study was conducted to better understand the characteristics of current and past researchers in Indigenous health in Australia and the factors that may influence decisions about working in this field. METHODS: A self-administered survey by e-mail or post to all individuals listed as an author on a published paper or who completed a PhD or masters research degree in the field of Indigenous health between 1995 and 2004. RESULTS: We identified 472 papers and 151 theses; from these, 1,067 authors were identified. Completed questionnaires were returned by 373 authors (35%), of whom 32 (9%) identified as Aboriginal and/or Torres Strait Islander. The majority (80%) of respondents were active in research but only 38% considered Indigenous health to be their primary area of research. The most important attractive factor about Indigenous health research (IHR) selected by respondents was "important area/national priority" (35%) and the most unattractive factor was "politics" (30%). There was considerable ambivalence about recommending a career in IHR to an early career researcher. When asked what was required to attract researchers into IHR, respondents cited the need for improved institutional support, mentoring, long-term funding and sustainable career pathways. CONCLUSIONS AND IMPLICATIONS: This study contributes to a greater understanding of Australia's research workforce in Indigenous health. It provides evidence of a strongly perceived need for institutional reform that supports Indigenous health research, for sustainable approaches to funding, and for mentoring initiatives for early career researchers.     

A comparison of dietary estimates from the National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data

Objective : We compared self‐reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR‐NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ～8,500 individuals). Methods : Differences in food (% energy from food groups) and nutrients were analysed using t‐test with unequal variance. Results : Per‐capita energy estimates were not significantly different between the surveys (899 MJ/person/day [95% confidence interval ?152,1950] p=0.094). Self‐reported intakes of sugar, cereal products/dishes, beverages, fats/oils, milk products/dishes and confectionery were significantly lower than that purchased, while intakes of meat, vegetables, cereal‐based dishes, fish, fruit and eggs were significantly higher (p<0.05). Conclusion : Differences between methods are consistent with differential reporting bias seen in self‐reported dietary data. Implications for public health : The NATSINPAS provides valuable, much‐needed information about dietary intake; however, self‐reported data is prone to energy under‐reporting and reporting bias. Purchase data can be used to track population‐level food and nutrient availability in this population longitudinally; however, further evidence is needed on approaches to estimate wastage and foods sourced outside the store. There is potential for these data to complement each other to inform nutrition policies and programs in this population.     

Coverage of Aboriginal and Torres Strait Islander nutrition in major Australian newspapers, 1996–2015

Objective: To examine the extent and nature of coverage of Aboriginal and Torres Strait Islander nutrition issues in major Australian newspapers over two decades. Methods : Content and framing analysis of Australian newspaper articles published between 1996 and 2015 that included the terms ‘Aboriginal or Indigenous’ and ‘nutrition or diet’ in the headline and/or lead paragraph. Analysis focused on the nature of coverage, trends over time, stakeholder representation and how coverage related to policy. Results : A total of 79 articles were included. Coverage of nutrition fluctuated over time, with peaks in 1998 and 2008. The majority of articles focused on remote Aboriginal communities. Both individual and structural representations of nutrition were used and dietary quality and food insecurity were the most commonly reported nutrition issues. Few articles employed positive representations of Aboriginal peoples. Six policy functions of articles were identified: highlighting problems; reporting government announcements; promoting programs; advocating solutions; critiquing government; and defending policy. Conclusion : The coverage of Aboriginal and Torres Strait Islander nutrition in newspapers does not reflect the diversity and strengths of Australia’s First Peoples. Implications for public health : This study highlights the role of the media in policy advocacy; however, advocates should ensure that they do not perpetuate negative representations of Aboriginal and Torres Strait Islander peoples.     

Suicides in Aboriginal and Torres Strait Islander children: analysis of Queensland Suicide Register

Objective: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children. Methods: Using the Queensland Suicide Register, suicides in Indigenous children (10–14 years) and other Australian children in the same age band were compared. Results: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children – 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children. Conclusions: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required.     

Measuring the gap: accuracy of the Western Australian hospital morbidity data in the identification of adult urban Aboriginal and Torres Strait Islander people

Objective: To assess the sensitivity of the recording of Aboriginality in the Western Australia Linked Data.
Methods: This was a follow-up study using record linkage. Demographic data was obtained from 993 adult, urban-dwelling Aboriginal Australian participants in the Perth Aboriginal Atherosclerosis Risk study (PAARS). These were linked to the Western Australian Linked Data (State-wide hospital admissions and discharges, and deaths) to provide the number of admissions and Indigenous status coding from 1980 to 2006.
Results: There were 14,413 admissions for PAARS participants in the study period. The sensitivity of coding of Indigenous status in hospital admissions data significantly improved over time, exceeding 0.9 in every year since 2002. Prior to 2002 sensitivity was around 0.8, but poorer for males, with some anomalous years.
Conclusions: The coding of Indigenous status in the Western Australia Hospital Morbidity Database since 2002 has improved. The data from earlier decades must be approached with more caution.
Implications: The improved accuracy of identification of Indigenous status in the Western Australia Hospital Morbidity Database allows comparative studies of adult Aboriginal and non-Aboriginal population health outcomes to be undertaken with confidence.     

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.     

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.     

Evaluating performance of and organisational capacity to deliver brief interventions in Aboriginal and Torres Strait Islander medical services

Objective: This study assessed brief intervention (BI) activity and organisation capacity for smoking, nutrition, alcohol and physical activity (SNAP framework) and key clinical prevention activities in four Aboriginal and Torres Strait Islander medical services in Queensland.
Methods: A mixed methods design was used including: staff surveys of knowledge and attitudes (n=39), focus groups to discuss perceived barriers and enablers and chart audits (n=150) to quantify existing BI activity.
Results: Of 50 clinical staff, 46 participated in the staff survey and focus groups across the four sites. BI was perceived to be important. There was significant variation in completion of records for SNAP risk factors, key clinical and BI activities across the sites. At least one SNAP factor status was recorded in 130/150 (86.7%) patient charts audited and there was a significant trend of increased recording of SNAP factors with increasing number of patient visits. Of those identified at risk 78% received at least one BI. Where risk was identified 65/96 (67.7%) patients required multiple BIs. BI for tobacco use was consistently high across all sites. Only one site recorded regular care planning and Adult Health Checks. Impacting factors included leadership, high staff turnover, multiple medical records and staff health status.
Conclusions: Inflexible staff training, competing health priorities and high levels of staff turnover were identified as key barriers to the delivery of BI in clinical settings. The data suggests a good base of existing BI activity for smoking and key clinical activities which may improve with further support.     

Socioeconomic disparities in physical health among Aboriginal and Torres Strait Islander children in Western Australia

Objective. Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia.

Design. We used a diverse set of health and SES indicators from a representative survey conducted in 2000–2002 on the health and development of 5289 Indigenous children aged 0–17 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework.

Results. After controlling for age and sex, we found statistically significant socio-economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient – where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators.

Conclusion. Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health.     

The facilitators and barriers of physical activity among Aboriginal and Torres Strait Islander regional sport participants

Background : Disparities in health perspectives between Indigenous and non‐Indigenous populations are major concerns in many of the world's well‐developed nations. Indigenous populations are largely less healthy, more prone to chronic diseases, and have an earlier overall mortality than non‐Indigenous populations. Low levels of physical activity (PA) contribute to the high levels of disease in Indigenous Australians. Method : Qualitative analysis of structured one‐on‐one interviews discussing PA in a regional setting. Participants were 12 Indigenous Australian adults, and 12 non‐Indigenous Australian adults matched on age, sex, and basketball division. Results : Most participants reported engaging in regular exercise; however, the Indigenous group reported more barriers to PA. These factors included cost, time management and environmental constraints. The physical facilitators identified by our Indigenous sample included social support, intrinsic motivation and role modelling. Conclusion : Findings describe individual and external factors that promote or constraint PA as reported by Indigenous Australian adults. Results indicate that Indigenous people face specific barriers to PA when compared to a non‐Indigenous sample. Implications for public health: This study is the first to compare the perspective of Indigenous Australians to a matched group of non‐Indigenous Australians and provides useful knowledge to develop public health programs based on culturally sensitive data.