Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs

Objective: To examine factors associated with hepatitis C virus (HCV) infection among a national sample of Indigenous and non‐Indigenous people who inject drugs (PWID) in Australia. Methods: Respondents were recruited from Australia's Needle Syringe Program Survey; an annual bio‐behavioural surveillance project that monitors HCV antibody prevalence among PWID. Data from 2006–2015 were de‐duplicated to retain only one record where individuals participated in >1 survey round. Univariate and multivariable logistic regression examined demographic characteristics and injection‐related behaviours associated with exposure to HCV. Results: Among 17,413 respondents, 2,215 (13%) were Indigenous Australians. Compared to their non‐Indigenous counterparts, Indigenous respondents were significantly more likely to be exposed to HCV infection (53% vs. 60% respectively, p<0.001). Among Indigenous respondents, HCV antibody positivity was independently associated with a history of imprisonment (Adjusted Odd Ratio [AOR] 2.13, 95%CI 1.73–2.64), opioid injection (AOR 1.53, 95%CI 11.43–2.16), recruitment in a metropolitan location (AOR 1.27, 95%CI 1.02–1.59), engagement in opioid substitution therapy (AOR 2.83, 95%CI 2.23–3.59) and length of time since first injection (p<0.001). Conclusion: Indigenous PWID are more likely to be exposed to HCV infection than their non‐Indigenous counterparts. Implications for public health: Increased access to culturally sensitive harm reduction programs is required to prevent primary HCV infection and reinfection among Indigenous PWID. Given recent advances in HCV treatment, promotion of treatment uptake among Indigenous PWID may reduce future HCV‐related morbidity and mortality.     

Correlates of physical activity among Australian Indigenous and non‐Indigenous adolescents

Objective: Physical inactivity is an important modifiable cause of the excess burden of disease among Indigenous Australians. We describe physical activity patterns and influencing factors, comparing Indigenous and non‐Indigenous adolescents. Methods: Indigenous (n=359) and non‐Indigenous (n=637) adolescents aged 13–17 years from disadvantaged New South Wales regions completed a health and lifestyle survey. Socio‐demographic, social, psychosocial and health correlates of out of school physical activity (high vs. low) among the whole sample, and stratified by Indigenous status were examined. Results: Only 21% of Indigenous and 28% of non‐Indigenous adolescents achieved higher levels of physical activity. Overall, higher levels were associated with being male; sports team membership; lower levels of TV viewing time and having an employed mother. Indigenous girls were less active than boys (OR=0.36; 85%CI=0.24–0.54), as were those whose mothers were unemployed (OR=0.66; 95%CI=0.40–1.09). Among non‐Indigenous adolescents, high levels of physical activity were associated with sports team membership (OR=2.28; 95%CI=1.39–3.74) and community involvement (OR=1.46; 95%CI=1.04–2.06). Conclusions: Physical activity levels were similarly low among disadvantaged Indigenous and non‐Indigenous adolescents. Some influencing factors existed across the whole sample; others in stratification by Indigenous status. Implications for public health: Early and targeted, supportive approaches are necessary. Some apply to disadvantaged adolescents broadly; others are Indigenous or non‐Indigenous specific.     

Low rates of predominant breastfeeding in hospital after gestational diabetes,particularly among Indigenous women in Australia

Objectives: To investigate rates of ‘any’ and ‘predominant’ breastfeeding in hospital among Indigenous and non‐Indigenous women with and without gestational diabetes mellitus (GDM). Methods: A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subsample of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non‐GDM pregnancy (n=7,894 infants). Results: More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27–0.38, p<0.0001); with lower rates among Indigenous women (53%) compared with non‐Indigenous (60%) women (OR 0.78, 0.70–0.88, p<0.0001); and women having a caesarean birth or pre‐term infant. Conclusions: Rates of predominant in‐hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre‐term birth. Implications: Strategies are needed to support predominant in‐hospital breastfeeding among women with GDM.     

Socio‐economic gradients in self‐reported diabetes for Indigenous and non‐Indigenous Australians aged 18–64

Objective : To examine and compare socio‐economic gradients in diabetes among Indigenous and non‐Indigenous Australians. Methods : I analysed weighted data on self‐reported diabetes and a range of socio‐economic status (SES) 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 : After adjusting for age, diabetes prevalence was significantly higher among those of lower SES in both Indigenous and non‐Indigenous populations. The age‐ and sex‐adjusted odds ratios (OR) for diabetes for the lowest versus the highest SES group were similar for the two populations on many variables. For example, the OR for the lowest quintile of equivalised household income (compared with quintiles 3–5 combined) was 2.3 (95% CI 1.6–3.4) for the Indigenous population and 2.0 (95% CI 1.5–2.8) for the non‐Indigenous population. However, Indigenous people of high SES had greater diabetes prevalence than low SES non‐Indigenous people on every SES measure examined. Conclusion : Socio‐economic status explains some but not all of the difference in diabetes prevalence between Indigenous and non‐Indigenous Australians. Other factors that may operate across the socio‐economic spectrum, such as racism, stress, loss and grief, may also be relevant and warrant further examination. Implications : Indigenous Australians do not constitute a homogeneous group with respect to socio‐economic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage.     

Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non‐Indigenous Australian women

Objectives: To explore factors associated with postpartum glucose screening among women with Gestational Diabetes Mellitus (GDM). Methods: A retrospective study using linked records from women with GDM who gave birth at Cairns Hospital in Far North Queensland, Australia, from 1 January 2004 to 31 December 2010. Results: The rates of postpartum Oral Glucose Tolerance Test (OGTT) screening, while having increased significantly among both Indigenous* and non‐Indigenous women from 2004 to 2010 (HR 1.15 per year, 95%CI 1.08–1.22, p<0.0001), remain low, particularly among Indigenous women (10% versus 27%, respectively at six months postpartum). Indigenous women in Cairns had a longer time to postpartum OGTT than Indigenous women in remote areas (HR 0.58, 0.38–0.71, p=0.01). Non‐Indigenous women had a longer time to postpartum OGTT if they: were born in Australia (HR 0.76, 0.59–1.00, 0.05); were aged <25 years (HR 0.45, 0.23–0.89, p=0.02); had parity >5 (HR 0.33, 0.12–0.90, p=0.03); smoked (HR 0.48, 0.31–0.76, p=0.001); and did not breastfeed (HR 0.09, 0.01–0.64, p=0.02). Conclusions: Postpartum diabetes screening rates following GDM in Far North Queensland are low, particularly among Indigenous women, with lower rates seen in the regional centre; and among non‐Indigenous women with indicators of low socioeconomic status. Implications: Strategies are urgently needed to improve postpartum diabetes screening after GDM that reach women most at risk.     

Estimating cancer incidence in Indigenous Australians

Objective: To assess data quality of cancer registrations for Indigenous Australians and produce reliable national Indigenous cancer incidence statistics. Methods: Completeness of Indigenous identification was assessed for the eight Australian cancer registries using an innovative indirect assessment method based on registry‐specific registration rates for smoking‐related cancers. National age‐standardised incidence rates and rate ratios (Indigenous:non‐Indigenous) were calculated for all cancers combined and 26 individual cancer sites. Multivariate regression analysis was used to investigate trends in Indigenous cancer incidence by time or remoteness of residence, and whether the incidence rate ratio (Indigenous:non‐Indigenous) was different in younger than older age‐groups. Results: Four registries covering 84% of the Indigenous population had sufficiently complete Indigenous identification to be included in analysis. Compared to other Australians, Indigenous Australians had much higher incidence of lung and other smoking‐related cancers, cervix, uterus and liver cancer, but much lower incidence of breast, prostate, testis, colorectal and brain cancer, melanoma of skin, lymphoma and leukaemia. Incidence was higher in remote areas for some cancers (including several smoking‐related cancers) but lower for others. The incidence rate ratios (IRRs) for smoking‐related cancers were higher in younger than older people. Conclusions: Indigenous Australians have a different pattern of incidence of specific cancers than other Australians and large geographical variations for several cancers. Implications: All cancer registries need to further improve Indigenous identification, but national Indigenous cancer incidence statistics can, and should, be regularly reported. Tobacco control is a critical cancer‐control issue for Indigenous Australians.     

Sampling and recruitment methodology for a national eye health survey of Indigenous Australians

Objective: To review the process of sample selection and highlight the methodological difficulties encountered during a nationwide survey of Indigenous Australians, to determine the prevalence and causes of vision impairment and evaluate access to and utilisation of eye care services. Methods: Using a multi‐stage, random cluster sampling methodology, 30 geographic areas stratified by remoteness, were selected to provide a representative population of approximately 3,000 Indigenous Australians aged 5–15 and 40 years and older, and a small non‐Indigenous sample in selected remote areas. Recruitment was adapted to local conditions. The rapid assessment methodology included a questionnaire, tests of visual acuity, trachoma grading, frequency doubling perimetry and non‐mydriatic fundus photography. Results: The number of people examined was 2883/3662 (78.7%) Indigenous and 136 (83.4%) non‐Indigenous. The percentage of the expected population who were enumerated during the survey varied; discrepancies were largest in urban areas (34.5%) compared to very remote areas (97.1%). Conclusions: The unexpected variation in predicted population numbers and participation rates could be explained in part by local circumstances, degree of urbanisation, interpretation of the definition of ‘Indigenous’ and time constraints. Implications: For successful recruitment, a community‐specific approach is essential, including collaboration with local organisations and liaison with health workers of each gender.     

Measures of Indigenous social capital and their relationship with well‐being

Objective: To provide the first estimates of a comprehensive measure of social capital for the Indigenous population and to link the indicators to well‐being. Design: Observational study‐based. Setting: Household survey. Participants: Nationally representative sample of 7823 Indigenous Australians aged 15 years and over who were usual residents of private dwellings. Main outcome measure: Whether or not the respondent felt happy in the last 4 weeks all or most of the time (happiness), and whether or not they felt so sad that nothing could cheer them up at least a little bit of the time over the same period (sadness). Results: There were no consistent differences in social capital measures between Indigenous men and women, nor were there consistent differences between the remote and non‐remote population. High levels of social capital were, however, associated with higher subjective well‐being. Conclusion: Social capital is both an indicator and determinant of well‐being. It was possible to derive an index of social capital for Indigenous Australians that had a strong positive association with self‐reported happiness and a negative association with self‐reported sadness. However, the analysis also showed that there are a set of related domains of social capital, rather than there being a single underlying concept.     

Trends in the incidence of treated end-stage kidney disease among Indigenous Australians and access to treatment

OBJECTIVE: To determine temporal trends of incidence of treated end-stage kidney disease in Indigenous Australians and the extent to which these patients had to move from their home community to access renal replacement therapy. METHODS: Data for 1993-2001, regarding place of residence before starting renal replacement therapy, were analysed to give accurate incidence for 1,194 Indigenous treated end-stage kidney disease patients. We calculated indirectly standardised incidence ratios of treated end-stage kidney disease by State and Territory. We surveyed treating renal units about which Indigenous patients relocated to access therapy from 1999 to 2001. RESULTS: The incidence of treated end-stage kidney disease among Indigenous Australians is high and rising; however, the rate of increase is lower than has been previously reported. The Northern Territory (NT) and Queensland have the most new Indigenous treated end-stage kidney disease cases. The highest standardised incidence ratio was in the NT (17.0), followed by Western Australia (WA) (11.9). From 1999 to 2001, half of the 476 Indigenous patients starting therapy had to relocate to access treatment. CONCLUSIONS: The incidence of end-stage kidney disease among Indigenous Australians continues to rise. However, significant gaps in knowledge remain about the burden of early chronic kidney disease and whether many Indigenous patients with end-stage kidney disease still choose not to receive renal replacement therapy. The need to relocate to access treatment has a strong negative impact on individuals, families and entire communities.     

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.     

Imprisonment of opioid‐dependent people in New South Wales,Australia, 2000–2012: a retrospective linkage study

Objective : There are few data about the incarceration of opioid‐dependent people involving large representative cohorts. We aimed to determine the prevalence and duration of incarceration in a large cohort of opioid‐dependent people in Australia using data linkage methods, and estimate the costs associated with their incarceration. Method : Retrospective linkage study of all entrants to opioid substitution therapy (OST) for the treatment of opioid dependence in NSW, 1985–2010, with data on incarceration, 2000–2012. The number and duration of incarcerations were calculated. The average daily cost of incarceration was applied to days of incarceration in the cohort. Results : Among 47,196 opioid‐dependent people, 37% (43% of men and 24% of women) had at least one episode of incarceration lasting one or more days. Men had a median of three (ranging between 1–47) incarcerations, and women, two (1–35). Indigenous men spent 23% of follow‐up time incarcerated, compared with 8% for non‐Indigenous men; similarly, Indigenous women spent a substantially greater proportion of time incarcerated than non‐Indigenous women (8% vs. 2%). Costs of incarceration of this cohort between 2000 and 2012 totalled nearly AUD$3 billion. Conclusions : This is the first study to examine incarceration of opioid‐dependent people across an entire population of such users. Our findings suggest that a substantial minority of opioid‐dependent people experience incarceration, usually on multiple occasions and at significant cost. Treatment for opioid dependence, inside and outside prisons, may help reduce incarceration of this cohort.     

Widening inequality in extreme macrosomia between Indigenous and non‐Indigenous populations of Québec,Canada

Objective : To evaluate trends in macrosomia by severity in Indigenous vs. non‐Indigenous populations of Québec, Canada. Methods: We used a retrospective cohort of 2,298,332 singleton live births in the province of Québec, 1981–2008. Indigenous births were identified by community of residence (First Nations, Inuit, non‐Indigenous) and language spoken (First Nations, Inuit, French/English). High birth weight (HBW) and large‐for‐gestational‐age (LGA) births were categorised by severity (moderate, very, extreme). Time trends in HBW and LGA, by severity, were estimated using odds ratios (OR) and rate differences for Indigenous vs. non‐Indigenous births, adjusting for maternal characteristics. Results: Relative to non‐Indigenous, First Nations (but not Inuit) had higher rates of extreme HBW (1.3% vs. 0.1%) and extreme LGA birth (12.6% vs. 2.2%), and rates increased over time. First Nations had progressively elevated ORs with greater severity of macrosomia, and associations were strongest for extreme HBW >5,000 g (OR=12.4) and LGA >97th percentile (OR=7.2). Conclusion: Inequalities in extreme macrosomia between First Nations and non‐Indigenous Quebecers are pronounced and widened between 1981 and 2008. Implications: Studies are needed to determine why macrosomia rates are increasing in Québec's First Nations, and how they compare with Indigenous sub‐groups of demographically similar countries, including Australia and New Zealand.     

Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence

Objective: Indigenous Australians experience a disproportionately higher burden of disease compared to non‐Indigenous Australians. High‐quality evaluation of Indigenous health programs is required to inform health and health services improvement. We aimed to quantify methodological and other characteristics of Australian Indigenous health program evaluations published in the peer‐reviewed literature. Methods: Systematic review of peer‐reviewed literature (November 2009–2014) on Indigenous health program evaluation. Results: We identified 118 papers describing evaluations of 109 interventions; 72.0% were university/research institution‐led. 82.2% of evaluations included a quantitative component; 49.2% utilised quantitative data only and 33.1% used both quantitative and qualitative data. The most common design was a before/after comparison (30.5%, n=36/118). 7.6% of studies (n=9/118) used an experimental design: six individual‐level and three cluster‐randomised controlled trials. 56.8% (67/118) reported on service delivery/process outcomes (versus health or health risk factor outcomes) only. Conclusions: Given the number of Indigenous health programs that are implemented, few evaluations overall are published in the peer‐reviewed literature and, of these, few use optimal methodologies such as mixed methods and experimental design. Implications for public health: Multiple strategies are required to increase high‐quality, accessible evaluation in Indigenous health, including supporting stronger research‐policy‐practice partnerships and capacity building for evaluation by health services and government.     

Indigenous Australians are under-represented in longitudinal ageing studies

Objective: Evidence‐based policy depends on the availability of high‐quality research that is relevant to the population. This study aimed to identify the available data on the health of older Indigenous Australians in population‐based longitudinal studies of ageing. Approach: Evaluation of the Dynamic Analyses to Optimise Ageing Project (DYNOPTA) dataset that has pooled nine Australian longitudinal ageing studies, six of which were analysed here. Main outcome measures: Proportions of the DYNOPTA sample identified as Indigenous. Results: Indigenous participants made up 0.7% of males and 0.5% of females in the weighted sample, compared with 0.8% of both sexes in the Australian population. Indigenous under‐representation is greater at ages 45–54 than at older ages, despite overall greater participation in this age range. Conclusions and implications: Within the existing Australian longitudinal ageing studies, Indigenous Australians are under‐represented. This means there is a significant gap in the evidence base relating to the health of older Indigenous Australians. Research approaches specifically designed to address the health and wellbeing of older Indigenous Australians are urgently required.     

Trends in hepatitis B prevalence and associated risk factors among Indigenous and non‐Indigenous prison entrants in Australia, 2004 to 2013

Objective : This study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non‐Indigenous prison entrants. Methods : A cross‐sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. Results : The study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti‐HBc) prevalence than non‐Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti‐HBc prevalence to non‐Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)^?. Being more than 30 years old and coming from an area classified as ‘non‐highly accessible’ were associated with anti‐HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti‐HBc positivity. For non‐Indigenous participants, a history of injecting drug use and body piercings was associated with anti‐HBc positivity. Conclusion : There are unique risk factors associated with HBV prevalence for both Indigenous and non‐Indigenous prison entrants. Implications for public health : In developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non‐Indigenous offenders is required.     

Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians

Objective: To describe the prevalence of falls and associated risk factors in older Indigenous Australians, and compare the accuracy of validated falls risk screening and assessment tools in this population in classifying fall status. Method: Cross‐sectional study of 289 Indigenous Australians aged ≥45 years from the Kimberley region of Western Australia who had a detailed assessment including self‐reported falls in the past year (n=289), the adapted Elderly Falls Screening Tool (EFST; n=255), and the Falls Risk for Older People‐Community (FROP‐Com) screening tool (3 items, n=74) and FROP‐Com falls assessment tool (n=74). Results: 32% of participants had ≥1 fall in the preceding year, and 37.3% were classified high falls risk using the EFST (cut‐off ≥2). In contrast, for the 74 participants assessed with the FROP‐Com, only 14.9% were rated high risk, 35.8% moderate risk, and 49.3% low risk. The FROP‐Com screen and assessment tools had the highest classification accuracy for identifying fallers in the preceding year (area under curve >0.85), with sensitivity/specificity highest for the FROP‐Com assessment (cut‐off ≥12), sensitivity=0.84 and specificity=0.73. Conclusions: Falls are common in older Indigenous Australians. The FROP‐Com falls risk assessment tool appears useful in this population, and this research suggests changes that may improve its utility further.     

The oral health status and treatment needs of Indigenous adults in the Kimberley region of Western Australia

Objective: The oral health of Indigenous Australians, whether urban or rural, is significantly poorer than their non‐Indigenous counterparts, and it would be expected that the oral health of rural and remote Indigenous Australians would be particularly poor, although the extent of this extra disadvantage has not been thoroughly documented. The aim of this study was to assess the oral health status and oral health needs in a sample of adult residents of selected towns and remote communities in the Kimberley region of North‐west Australia. Design: A cross‐sectional survey (dental examinations and oral health questionnaires) was carried out. Setting: Rural and remote communities in the Kimberley region of Western Australia. Participants: Adults in four selected communities. Results: The mean Decayed, Missing and Filled Teeth (DMFT) score for all participants was 9.8 (SD 8.3). The mean DMFT increased with increasing age. Only 7.3% of people were caries‐free. A total of 13% of participants had periodontal pockets of 6 mm or more, and only 3% had no periodontal disease. More than a third (37%) of all participants had advanced periodontal disease. Only 21% of participants did not need any dental treatment. Conclusions: The oral health of Aboriginal and Torres Strait Islander people are listed as one of the priority areas of Australia's National Oral Health Plan. Based on the above results, oral health is clearly an important priority in the Kimberley.     

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.     

Epidemiology of alcohol‐related burden of disease among Indigenous Australians

Objective: To compare the burden of alcohol‐related harm and underlying factors of this harm, by age and sex, for Indigenous and general population Australians. Methods: Population attributable fractions are used to estimate the disability adjusted life years (DALYs) for alcohol‐related disease and injury. The DALYs were converted to rates per 1,000 by age and sex for the Indigenous and general populations. Results: Homicide and violence rates were much higher for Indigenous males: greatest population difference was for 30–44 years, Indigenous rate 8.9 times higher. Rates of suicide were also greater: the largest population difference was for 15–29 years, Indigenous rate 3.9 times higher. Similarly, for Indigenous females, homicide and violence rates were much higher: greatest population difference was for 30–44 years, Indigenous rate 18.1 times higher. Rates of suicide were also greater: the largest population difference was for 15–29 years, Indigenous rate 5.0 times higher. Conclusions: Alcohol consumption and associated harms are of great concern for Indigenous Australians across all ages. Violent alcohol‐related harms have been highlighted as a major concern. Implications: To reduce the disproportionate burden of alcohol‐related harm experienced by Indigenous Australians, targeted interventions should include the impact on families and communities and not just the individual.     

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.