Aboriginal Australians' experience of social capital and its relevance to health and wellbeing in urban settings

Ethnoracial Disparities in Self-Rated Health: Exploring the Impact of Skin Color and Other Ethnoracial Characteristics in Mexico

OBJECTIVES

This manuscript aims to understand the association between self-rated health and ethnic-racial characteristics (i.e., skin color, self-ascription, and Indigenous language) in the context of the Mexican population.

DESIGN

Logistic regression analyses, using the 2019 PRODER (N = 7187)-a representative survey at the national level. We centered the analysis on two measures of skin color: the interviewer assessment of color skin (that has been used in previous studies), and the ITA scale, a measure constructed from optical digital colorimeter readings (a novel method in ethnoraciality studies in Mexico, included in the PRODER survey).

RESULTS

In comparison to the interviewer's assessment of skin color, the ITA score shows a significant association with self-rated health, even in the presence of individual conditions, sociodemographic traits, and life-course events. In contrast, ethnic-racial self-ascriptions and speaking of an Indigenous language do not show any statistical associations.

CONCLUSION

Contrary to previous research, our results suggest a positive association between skin color and self-rated health, when the former is assessed with the colorimeter readings; it means that those with lighter color skin are more prone to report a better health perception. It has methodological implications in the way skin color is observed.

Indigenous lands and health access: The influence of a sense of place on disparities in post-stroke recovery in Taiwan

Despite many countries having policies and systems for universal healthcare coverage, health disparity persists, with significant variations in disease prevalence and life expectancy between different groups of people. This focused ethnography explored the post-stroke recovery of Indigenous and non-Indigenous populations in three geographical areas in Taiwan. Forty-eight observations and 24 interviews were carried out with 12 dyads of stroke survivors and family caregivers, revealing their varied experiences of healthcare. Findings indicate that repeatedly engaging in social activities in the same place increases stroke survivors' attachment to the environment, facilitating their reintegration into the community and improving wellbeing following stroke. The significance of 'place' in post-stroke life and healthcare access is particularly salient for Indigenous people's recovery. Indigenous people tend to employ cultural symbols, such as Indigenous languages and kinship ties, to define and interpret their surrounding environment and identity. Indigenous people residing within or close to their own native communities make better recoveries than those based in urban settings, who are attached to and yet located away from their native lands. A sense of place contributes to identity, while loss of it leads to invisibility and healthcare inaccessibility. To promote equitable healthcare access, future policymaking and care practices should address the environmental and cultural geography and structural barriers that impede the connection between minority groups and the mainstream community healthcare system. The study findings suggest extending welfare resources beyond Indigenous administrative regions and establishing partnerships between Indigenous organisations and the mainstream healthcare system. Leveraging Indigenous people's attachment to cultural symbols and increasing healthcare facilities staffed with Indigenous healthcare workers could help ease structural barriers, maintain identifiable Indigenous beneficiaries and increase entry points into the mainstream healthcare system.

Impact of community-based employment on Aboriginal and Torres Strait Islander wellbeing, aspirations, and resilience

BACKGROUND

This study evaluated a research project that provided employment in an Aboriginal and Torres Strait Islander community-based setting and supported participants to identify and achieve their goals and aspirations. The evaluation examined changes in personal, relationship, community and cultural strengths and resources and explored empowerment and resilience, in terms of promoting wellbeing.

METHODS

Ten Aboriginal people employed as life coaches and peer researchers participated in semi-structured interviews and also completed the Aboriginal Resilience and Recovery Questionnaire at the beginning of their employment and 6-months after employment. Interviews with the 10 participants explored changes in their wellbeing, relationships, resilience, opportunity to lead, aspirations, goal setting skills, connection to culture and community, and empowerment.

RESULTS

Participants personal strengths, and cultural and community strengths, sub-scale scores showed improvements across the 6-month period, however these changes were not statistically significant. Using reflexive thematic analysis, we generated five themes including Aspirations; Personal capabilities; Constraints to wellbeing; Community engagement and cultural connection; and Employment facilitators. Overall, participants identified that despite the challenges of their work and the additional challenges posed by the COVID-19 lockdowns, they were able to develop their skills to set and achieve goals. They reported feeling empowered and proud of their work, and engaged more frequently with their communities and culture.

CONCLUSIONS

The study outcomes evidence the role of employment in an Aboriginal and Torres Strait Islander community-based project in strengthening wellbeing, enhancing resilience, and supporting participants to advance their personal goals and aspirations. These findings reinforce the importance of supporting the aspirations and employment of Aboriginal and Torres Strait Islander Peoples through employment.

Why research productivity of some scientists is higher? Effects of social, economic and cultural capital on research productivity

In the past decades, the awareness about the concept of research productivity at higher education institutions has improved which led to an increase in the number of studies dealing with the subject. Such studies mostly deal with correlations between research productivity and organizational elements, gender, age, professional experience, and alma mater characteristics. To provide an innovative dimension to the existing studies this study focuses on the interaction between the research productivity of the scientists and their childhood period and childhood setting. In this context, the aim of our study is to examine the effects of cultural, economic, and social capitals on research productivity of both scientists' current status and their parents' during their childhood. The data were collected from 9499 faculty members through a survey questionnaire which included items on cultural, economic, and social capital. The data on research productivity of the participants were taken from the Web of Science. The major findings of the study are as follows: (a) Turkish scientists both have lower levels of parents' level of-during childhood- and their current level of cultural capital, and they mostly come from families with the lower-middle economic level; (b) they have medium level social capital; (c) cultural and social capitals together can account for 69% of research productivity, and the order of the related items are found to be childhood objectified cultural capital, current embodied cultural capital and parents' embodied cultural capital during childhood; (d) among social capital structures, relational social capital is the strongest predictor of research productivity and (e) economic capital is not a significant predictor of research productivity. We believe that our current findings contribute to the studies on higher education research by uncovering the new relationships between structures.

Deconstructing type 2 diabetes self-management of Australian Pacific Islander women: Using a community participatory research and talanoa approach

Community-based participatory research using culturally appropriate talanoa approaches provided the framework to explore diabetes self-management of Australian Pacific Islander (API) women living with type 2 diabetes in South-East Queensland. Data collection included interviews with key informants (21), in-depth interviews with API women with diabetes (10), talanoa group discussions (7) and monthly steering committee meetings. Using an interpretive-constructionist lens and the interpretations of community members, four cultural constructs in diabetes self-management emerged: self-identity, spirituality, stigma and denial, and structural factors. Self-identity connected the women to their Pacific heritage that framed their collective roles as primary caregivers in the community. This gave the women a strong sense of belonging and helped maintain cultural, family and relational connections which were important for their day-to-day management of diabetes. Although spirituality through religion supported the women to cope with their diabetes a total reliance on God resulted in disengagement with self-care. Shame associated with disclosure also prevented effective self-management. Finally, structural factors such as access to healthcare, poor health literacy and cultural barriers associated with obesogenic environments impeded women from seeking appropriate diabetes care. However, family and community were critical in ensuring women were supported with their diabetes self-management. The findings highlight the importance of engaging families in healthcare planning decisions in the development of culturally responsive models of diabetes support care for API women with type 2 diabetes.

Team members influence retention in a First Peoples’ community-based weight-loss program

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Program completion is strongly influenced by teammate completion.

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Other factors influencing program completion vary with participation occasion.

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Previous participation and health behaviors do not influence subsequent completion.

The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant’s odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples’ engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.

Experiences of Ethnic Discrimination Among US Hispanics: Intersections of Language, Heritage, and Discrimination Setting

BACKGROUND

Informed by Latino Critical Race Theory, the present study examined how intersections between English use/proficiency, Spanish use/proficiency, and heritage group shape the varying experiences of ethnic discrimination reported by US Hispanic adults.

METHODS

The study utilized data from 7,037 Hispanic adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Multivariable binomial logistic regression modeled language use/proficiency, heritage, and demographic characteristics as predictors of past-year self-reported perceived ethnic discrimination, overall and in six different settings.

RESULTS

Both English and Spanish use/proficiency were positively associated with increased adjusted odds of reporting ethnic discrimination overall, in public, or with respect to employment/education/ housing/courts/police; however, with respect to being called a racist name or receiving verbal/physical threats/assaults, a positive association was observed for English, yet not Spanish. Results also indicated a significant interaction between English use/proficiency and Spanish use/proficiency when predicting past-year ethnic discrimination overall or for any of the six types/settings examined, although the relationship between language use/proficiency and ethnic discrimination varied by Hispanic heritage group.

CONCLUSION

Study findings emphasize that experiencing some form of ethnic discrimination is relatively common among US Hispanic adults, yet the prevalence and types or settings of ethnic discrimination vary widely on the basis of demographics, immigrant generation, heritage, and the interplay between English and Spanish use/proficiency.

Weight change among repeat participants of an Aboriginal community-based weight loss program

Background

Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests.

Methods

Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest.

Results

One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation.

Conclusions

While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

Social capital and health status: longitudinal race and ethnicity differences in older adults from 2006 to 2014

OBJECTIVES

We examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults.

METHODS

We used Health and Retirement Study, a nationally representative sample of US adults aged ≥ 50 years evaluated every 2 years (2006-2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons.

RESULTS

We observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the correlations with self-rated health were lower for neighborhood social cohesion (0.19) and negative social support (- 0.09), compared to Whites (0.29 and - 0.20). African-Americans showed lower correlations of positive social support (0.14) compared to Whites (0.21) and Hispanics (0.28).

CONCLUSIONS

Interventions targeting social capital are in need, specifically those reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support of older adults.

Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia

While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.

Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012-2015

OBJECTIVE

To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015.

METHODS

Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models.

RESULTS

Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions.

CONCLUSION

The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.

Aboriginal and Torres Strait Islander people's domains of wellbeing: A comprehensive literature review

There are significant health and social disparities between the world's Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians' QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians' wellbeing.

The impact and importance of place on health for young people of Pasifika descent in Queensland, Australia: a qualitative study towards developing meaningful health equity indicators

Background

Health equity is a priority in the global sustainable development agenda. Available health equity indicators often focus on health outcomes, access to healthcare, risk factors and determinants such as income, education, and gender. Less attention has been given to other social determinants, including those related to place and ethnicity. Measures such as income, education, and gender, however, may not provide policy-makers with sufficient information to redress inequities. In this paper, we begin to develop health equity indicators for young Pasifika peoples in Logan, Queensland, Australia. While health data on Pasifika young people in Queensland is scant, available data suggests significant inequalities. The purpose of the study was to develop an understanding of the drivers of these disparities through the lens of the social determinants of health, to create health equity indicators.

Methods

Following meetings with community stakeholders to develop respectful and collaborative partnership processes, we took a youth participatory action research approach. Six peer researchers (3 male, 3 female) were recruited from the Logan area for the project. Following training, the peer researchers undertook 31 qualitative interviews with young Pasifika (16–24 years old). Data was manually analysed, coded and grouped into themes to develop the draft indicators. Interviews used the culturally appropriate Talanoa storytelling approach.

Results

Six key themes were identified from the interviews and were used to develop example indicators related to: spiritual and socio-cultural dimensions, place, access to culturally responsive services, economic and material dimensions and political dimensions. The results demonstrate health inequities experienced by Pasifika populations are strongly linked to place and their economic, social and cultural position.

Conclusions

This study emphasises the need to understand the multiplicity of place-based factors that interact in complex ways to shape health inequities for young Pasifika peoples. It highlights health equity indicators must go beyond healthcare services, outcomes and a limited number of objective determinants, to include a more holistic focus. Starting to measure health and wellbeing via the lens of the social determinants of health will help to identify where policy-makers and programmes can intervene to begin to more adequately address inequities.

Psychosocial Determinants of Chronic Disease: Implications for Lifestyle Medicine

We have previously identified a number of "determinants" of chronic disease, using the acronym NASTIE ODOURS. These have been given the collective term "anthropogens," in this journal and other publications, to help direct the management of modern chronic ailments to a monocausal focus, akin to that afforded infectious diseases by the "germ theory." We suggested the acronym NASTIE ODOURS as a starting point for a taxonomy of lifestyle medicine determinants. In the current article, we add 3, less quantifiable, but currently increasingly more important psychosocial experiences to these: Lack of Meaning, Alienation, and Loss of culture, changing the previous acronym to NASTIE MAL ODOURS. As with other determinants, all have accumulating evidence of an underlying low-grade, systemic, inflammatory physiological base ("metaflammation"), but with the need for further research to solidify these findings.

Healthy spaces: Exploring urban Indigenous youth perspectives of social support and health using photovoice

Ongoing injustices perpetrated by colonization and racism have resulted in a disproportionate burden of health disparities among Indigenous peoples, with youth being particularly vulnerable. However, very little is known about the health experiences of Indigenous youth, particularly how they understand and interpret such experiences. In collaboration with an Indigenous-led youth program, this research explored the relationship between social support and health among a unique group of Indigenous youth living in Winnipeg, Canada. Through Photovoice, youth revealed how residential mobility and racism negatively influenced the types of social support and relationships formed, and called for improved access to health-promoting social programs.

"Here we are part of a living culture": Understanding the cultural determinants of health in Aboriginal gathering places in Victoria, Australia

This article provides an exploration of the cultural determinants of health, based on a research evaluation investigating a number of Aboriginal gathering places in Victoria (Australia). Gathering places are recognised as settings in which people practice and learn about local Aboriginal culture, history and place. Academic literature on gathering places is sparse. Thirteen gathering places were evaluated in this research. Each site is unique and has a specific story that connects it to the history and geography of the place in which it is located. Sixty-nine gathering place members participated in qualitative semi-structured interviews or focus groups. Using thematic analysis, the findings were divided into four key themes associated with cultural determinants of health (social networks; inclusiveness; empowerment; connections). These elements create a safe place to learn about culture and Country, and support an environment for strengthening identity, improving health and building resilience. The findings from this study highlight the benefits of using gathering places to explore the cultural determinants of health.

Quality of social and emotional wellbeing services for families of young Indigenous children attending primary care centers; a cross sectional analysis

BACKGROUND

The quality of social and emotional wellbeing services for Indigenous families of young children is not known, in many settings especially services provided by primary care centers.

METHODS

Our primary objective was to assess delivery of social and emotional wellbeing services to the families of young (3-11 months) and older (12-59 months) Indigenous children attending primary care centers. Our secondary objective was to assess if delivery differed by geographic location. Two thousand four hundred sixty-six client files from 109 primary care centers across Australia from 2012 to 2014 were analysed using logistic regression and generalised estimating equations.

RESULTS

The proportion of families receiving social and emotional wellbeing services ranged from 10.6% (102) (food security) to 74.7% (1216) (assessment of parent child interaction). Seventy one percent (71%, 126) of families received follow up care. Families of children aged 3-11 months (39.5%, 225) were more likely to receive social and emotional wellbeing services (advice about domestic environment, social support, housing condition, child stimulation) than families of children aged 12-59 months (30.0%, 487) (adjusted odds ratio [aOR] 1.68 95% CI 1.33 to 2.13). Remote area families (32.6%, 622) received similar services to rural (29.4%, 68) and urban families (44.0%, 22) (aOR 0.64 95% CI 0.29, 1.44).

CONCLUSIONS

The families of young Indigenous children appear to receive priority for social and emotional wellbeing care in Australian primary care centers, however many Indigenous families are not receiving services. Improvement in resourcing and support of social and emotional wellbeing services in primary care centers is needed.

The dark side of social capital: A systematic review of the negative health effects of social capital

There is a growing literature demonstrating the health benefits of social capital (defined as the resources accessed through social connections). However, social capital is also acknowledged to be a "double-edged" phenomenon, whose effects on health are not always positive. We sought to systematically review studies that have found a negative (i.e. harmful) association between social capital and health outcomes. Our objective was to classify the different types of negative effects, following a framework originally proposed by Portes (1998). We conducted a literature search in Pubmed, Embase and PsychInfo. We identified 3530 manuscripts. After detailed review, we included 44 articles in our systematic review. There are at least two negative consequences of social capital besides the classification proposed by Portes: behavioral contagion and cross-level interactions between social cohesion and individual characteristics. When leveraging the concept of social capital for health promotion interventions, researchers need to take account of these potential "downsides" for health outcomes.

Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review

RATIONALE

There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health.

OBJECTIVE

The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community.

METHOD

The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used.

RESULTS

Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied.

CONCLUSION

It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings.

Contextualising the social capital of Australian Aboriginal and non-Aboriginal men in prison

Social capital is a valuable resource that has received little attention in the prison context. Differences in the construct and accessibility of bonding, bridging, and linking social capital exist for Aboriginal Australians in mainstream society, but were previously unexplored in prison. This study seeks to understand contextual differences of social capital for Australian Aboriginal and non-Aboriginal men in prison. Thirty male inmates participated in qualitative interviews across three New South Wales (NSW) correctional centres. Interviews were completed between November 2014 and March 2015. Experiences of bonding and linking social capital varied among Aboriginal and non-Aboriginal participants. Opportunities for bridging social capital were limited for all participants. There is greater scope for building bonding social capital among male inmates than either bridging or linking social capital. Bonding social capital, particularly among Aboriginal men in prison, should be utilised to promote health and other programs to inmates.

"There's a housing crisis going on in Sydney for Aboriginal people": focus group accounts of housing and perceived associations with health

BACKGROUND

Poor housing is widely cited as an important determinant of the poor health status of Aboriginal Australians, as for indigenous peoples in other wealthy nations with histories of colonisation such as Canada, the United States of America and New Zealand. While the majority of Aboriginal Australians live in urban areas, most research into housing and its relationship with health has been conducted with those living in remote communities. This study explores the views of Aboriginal people living in Western Sydney about their housing circumstances and what relationships, if any, they perceive between housing and health.

METHODS

Four focus groups were conducted with clients and staff of an Aboriginal community-controlled health service in Western Sydney (n = 38). Inductive, thematic analysis was conducted using framework data management methods in NVivo10.

RESULTS

Five high-level themes were derived: the battle to access housing; secondary homelessness; overcrowding; poor dwelling conditions; and housing as a key determinant of health. Participants associated their challenging housing experiences with poor physical health and poor social and emotional wellbeing. Housing issues were said to affect people differently across the life course; participants expressed particular concern that poor housing was harming the health and developmental trajectories of many urban Aboriginal children.

CONCLUSIONS

Housing was perceived as a pivotal determinant of health and wellbeing that either facilitates or hinders prospects for full and healthy lives. Many of the specific health concerns participants attributed to poor housing echo existing epidemiological research findings. These findings suggest that housing may be a key intervention point for improving the health of urban Aboriginal Australians.

Use of prescription stimulant for Attention Deficit Hyperactivity Disorder in Aboriginal children and adolescents: a linked data cohort study

BACKGROUND

Increasing recognition of Attention Deficit Hyperactivity Disorder (ADHD) among Aboriginal children, adolescents and young adults is a public health challenge. We investigated the pattern of prescription stimulants for ADHD among Aboriginal individuals in Western Australia (WA).

METHODS

Using a whole-population-based linked data we followed a cohort of individuals born in WA from 1980-2005, and their parents were born in Australia, to identify stimulant prescription for ADHD derived from statutory WA stimulant prescription dispensing between 2003 and 2007. Parental link was ascertained through WA Family Connections Genealogical Linkage System. Cox proportional hazards regression (HR) models were performed to determine the association between stimulant use and Aboriginal and non-Aboriginal status.

RESULTS

Of the total cohort of 186,468, around 2% (n = 3677) had prescription stimulants for ADHD. Individuals with both Aboriginal parents were two-thirds (HR 0.33, 95 % CI 0.26-0.42), and with only Aboriginal mother were one-third (HR 0.69, 95% CI 0.53-0.90) less likely to have stimulants, compared to individuals with non-Aboriginal parents. HR in Aboriginals was 62% lower (HR 0.35, 95% CI 0.25-0.49) in metropolitan areas, and 72% lower (HR 0.28, 95% CI 0.20-0.38) in non-metropolitan areas, than non-Aboriginals. The risk for simulant use was four times higher among Aboriginal boys than Aboriginal girls (HR 4.08, 95% CI, 2.92-5.69).

CONCLUSION

Aboriginal cultural understanding of ADHD and attitude towards stimulant medication serve as a determinant of their access to health services. Any ADHD intervention and policy framework must take into account a holistic approach to Aboriginal culture, beliefs and individual experience to provide optimal care they need.

Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: a cross-sectional population based study

Aboriginal and Torres Strait Islander adults in the Australian state of Victoria have a higher prevalence of psychological distress than their non-Aboriginal and Torres Strait Islander counterparts. We sought to explain this inequality, focussing on the social determinants of health. We used population-based survey data from the 2008 Victorian Population Health Survey; a cross-sectional landline computer-assisted telephone survey of 34,168 randomly selected adults. We defined psychological distress as a score of 22 or more on the Kessler 10 Psychological Distress scale. We used logistic regression to identify socio-demographic characteristics and social capital indicators that were associated with psychological distress. We then created multivariable models to explore the association between psychological distress and Aboriginal and Torres Strait Islander status that incorporated all significant socioeconomic status (SES) and social capital variables, adjusting for all non-SES socio-demographic characteristics. Aboriginal and Torres Strait Islander Victorians (24.5%) were more than twice as likely than their non-Aboriginal and Torres Strait Islander counterparts (11.3%) to have psychological distress (odds ratio (OR) = 2.56, 95% confidence interval; 1.67-3.93). Controlling for SES, negative perceptions of the residential neighbourhood, lack of social support from family, social and civic distrust, and all non-SES socio-demographic variables (age, sex, marital status, household composition, and rurality), rendered the previously statistically significant inequality in the prevalence of psychological distress, between Aboriginal and Torres Strait Islander Victorians and their non-Aboriginal and Torres Strait Islander counterparts, insignificant at the p = 0.05 level (OR = 1.50; 0.97-2.32). Psychological distress is an important health risk factor for Aboriginal and Torres Strait Islander adults that has yet to be widely acknowledged and addressed. Addressing the underlying inequalities in SES and social capital may be the key to addressing the inequality in psychological distress.