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.     

Effects of Nutritional Interventions on Cardiovascular Disease Health Outcomes in Aboriginal and Torres Strait Islander Australians: A Scoping Review

Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components.     

Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic

Objective: Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. Methods: A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. Results: One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty‐nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. Conclusions: The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.     

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.     

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

Objective : Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods : Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results : While most ACCHOs had delivered post‐release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion : A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health : ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.     

Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia

Objective : To compare breast screening attendances of Indigenous and non‐Indigenous women. Methods : A total of 4,093 BreastScreen cases were used including 857 self‐identified Indigenous women. Chi‐squared analysis compared data between Indigenous and non‐Indigenous women. Logistic regression was used for groupings based on visits‐to‐screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. Results : Indigenous women were younger and had fewer visits to screening compared with non‐Indigenous women. Non‐English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3‐2.9). Living remotely was associated with fewer visits for non‐Indigenous women only (OR 1.3, 95%CI 1.1‐1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1‐18.8; and OR 11.5, 95%CI 9.6‐13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3‐3.3; and OR 1.8, 95%CI 1.5‐2.1, respectively). Conclusions : Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non‐Indigenous women. Implications for public health : Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote‐living non‐Indigenous women should also be addressed.     

Using data linkage to improve the completeness of Aboriginal and Torres Strait Islander status in communicable disease notifications in Victoria

Objective : The burden of notifiable diseases in Aboriginal and Torres Strait Islander Victorians cannot be accurately estimated due to under‐reporting of Indigenous status. We used data linkage to improve completeness of Indigenous status in people notified with viral hepatitis and gonococcal infection. Methods : Notifications made between 2009 and 2010 were linked with Victorian hospitalisation data (1997–2011). Notification rates by Indigenous status and rate ratios were calculated before and after linkage. Results : There were 12,448 cases of hepatitis B, hepatitis C and gonococcal infection notified in Victoria in 2009–2010, with Indigenous status missing in 61.6%, 67.8%, 33.1% of these conditions, respectively. Of the total notified cases, 82% were able to be linked. Following linkage, the proportion of notifications with missing Indigenous status decreased to less than 0.2% for all conditions. Age‐standardised notification rates among both Aboriginal people and non‐Aboriginal people increased for all conditions. Conclusions : Data linkage improved completeness of Indigenous status in notifications for viral hepatitis and gonococcal infection in Victoria. Completeness of these data is integral to monitoring progress in closing the Indigenous life expectancy gap. Implications : Greater emphasis is needed on addressing prevention, treatment and care for viral hepatitis and sexually transmissible infections for Indigenous Victorians.     

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.     

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.     

Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities

Issue addressed

Foetal Alcohol Spectrum Disorder (FASD) includes a range of life‐long impairments caused by alcohol exposure in utero. Health professionals are vital to preventing FASD but many are hesitant to discuss FASD with clients due to their need for additional resources to aid the conversation. This scan sought to identify the scope and gaps in publicly available FASD prevention and health promotion resources, and assess their cultural appropriateness for use among five key groups of Indigenous Australian people including: (i) pregnant women, (ii) women of childbearing age, (iii) grandmothers and aunties, (iv) men, and (v) health professionals.

Methods

Relevant resources published 1995‐2017 were identified through the Australian Indigenous HealthInfoNet, FASD organisation websites, grey literature, Google searches, and field experts. Results were screened by inclusion and cultural appropriateness criteria developed and piloted by the research team, and further screened by health professionals attending FASD training workshops.

Results

115 of the 2146 identified resources were eligible. Relevant resources were found for all five key groups; however, no resources were specifically designed for men, grandmothers or aunties.

Conclusions

A range of high‐quality, culturally appropriate resources were identified, however, health professionals attending the training workshops were not aware of their availability. Further resource development is suggested for men, grandmothers and aunties.

So what?

Prioritisation of active dissemination and implementation strategies is suggested to increase awareness and use of future resource developments. The inclusion of a resource trial among health professionals is a recommended strategy to increase awareness and use of newly developed resources.

     

Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach

Objective : To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. Methods : This paper applied qualitative and quantitative methods to evaluate a co‐designed multi‐strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. Results : Community readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56–94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). Conclusions : A multi‐component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public health : Partnering with community leaders in the co‐design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.     

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.     

Successes in sexual health communications development,programmatic implementation and evaluation in the Torres Strait region 2006 to 2012

Objective: To evaluate the Indigenous sexual health promotion program in the Torres Strait 2006–2012 that culminated in an education‐entertainment radio drama, Kasa Por Yarn (KPY). Methods: A mixed methods approach applied to unpublished program documents and program‐derived peer‐reviewed publications was utilised. Results: Early initiatives established a strong partnership with Torres Strait Islander stakeholders. Significant community engagement throughout ensured a positive process. Telephone survey data (n=100, TSI, 15–24 years) found: 95% had heard of KPY and 80% listened to 2 or more episodes (reach); 86% recalled storylines/characters (recall); and 54% talked about KPY to family/friends (resonance). There was improvement in sexual health knowledge scores (p<0.00) in the 15–19‐year‐old Torres Strait Islander population between 2007 and 2012. The 2012 15–24‐year‐old population exposed to KPY had higher sexual health knowledge scores compared with those unexposed (p=0.02). Conclusions: This is an uncommon comprehensive evaluation of population‐based sexual health communications strategies delivered over years in a remote Australian setting. The findings are encouraging but demonstrate that positive shifts take time and are incremental. Implications: In addition to clinical strategies, strategic and sustained investment in sexual health promotion expertise that leads community partnership and program development is required to reduce youth risk and prevent HIV/AIDS in remote populations.