Lowitja Institute

BackgroundRacism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children’s mental health and sleep problems if interpersonal racial discrimination was eliminated. MethodsWe drew on cross-sectional data from the Speak Out Against Racism (SOAR; N=2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N=8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10-15 years; LSAC: 4-5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10-15 years; LSAC: 12-13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10-15 years; LSAC: 14-15 years). An interventional effects causal mediation approach was used. FindingsAboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40·1% versus 13·5%; LSAC: 25·3% versus 7·6%) and sleep problems (SOAR: 28·5% versus 18·4%; LSAC: 14·0% versus 9·9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children’s experiences of interpersonal racial discrimination could reduce 42·4% and 48·5% of mental health and sleep inequities in SOAR (equivalent to 11·2% and 4·7% absolute reductions) and 25·6% and 1·6% of mental health and sleep inequities in LSAC (equivalent to 5·5% and 0·1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes. InterpretationTargeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.Funding: National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia

This study documents evaluation of the Her Tribe and His Tribe Aboriginal-designed empowerment pilot programs. The programs were designed to support Victorian Aboriginal people to strengthen mental health, social and emotional wellbeing, community connection, and to reduce psychological distress. A second aim was to explore participants’ experiences of the programs, including the feasibility and acceptability of the evaluation component. Her Tribe ran for 16 weeks and His Tribe for 12 weeks. In total, 43 women and 26 men completed assessments at pre- and post-program completion, and 17 and 10, respectively, participated in yarning circles at the 6-month follow up. For both programs, there were significant increases in participants’ access to personal strengths and resources, relationship–community–cultural strengths and resources, and decreases in psychological distress. These changes were associated with small to moderate effects that were maintained at the 6-month follow up. There was a significant increase in aerobic fitness for female but not male participants, and no significant changes in weight for either group. Participants described a range of benefits from the programs, including positive elements and areas for improvement. They also viewed the evaluation as feasible and acceptable, and the findings of value. The outcomes from both pilot programs provide evidence that Aboriginal-designed programs, with a focus on physical and cultural activities, can help to strengthen mental health and wellbeing, community connection, and reduce psychological distress in Victorian Aboriginal communities.

ABSTRACT The prevalence of low to very low adult English literacy levels in First Nations communities in Australia continues to be an issue, despite ten years of government-supported Foundation Skills training provided through the national vocational education and training system. This study examines an innovative First Nations community-controlled approach to improving adult literacy training, utilising an internationally recognised mass campaign model. Literacy improvements were assessed for 63 participants in 6 communities, using validated pre- and post-tests aligned to the Australian Core Skills Framework (ACSF). Overall, 73% of participants improved their literacy, defined as moving up at least one level on one or more of six ACSF indicators. The number of lessons completed and entry ACSF literacy levels were significantly associated with literacy progression, with previous school education positively associated but not statistically significant. The minimum number of lessons associated with literacy improvement is estimated as 47–49 (80–83% of lessons).

Introduction:Secondhand smoke (SHS) is a significant cause of acute respiratory illness (ARI) and 5 times more common in indigenous children. A single-blind randomized trial was undertaken to determine the efficacy of a family centered SHS intervention to reduce ARI in indigenous infants in Australia and New Zealand.Methods:Indigenous mothers/infants from homes with ≥1 smoker were randomized to a SHS intervention involving 3 home visits in the first 3 months of the infants’ lives (plus usual care) or usual care. The primary outcome was number of ARI-related visits to a health provider in the first year of life. Secondary outcomes, assessed at 4 and 12 months of age, included ARI hospitalization rates and mothers’ report of infants’ SHS exposure (validated by urinary cotinine/creatinine ratios [CCRs]), smoking restrictions, and smoking cessation.Results:Two hundred and ninety-three mother/infant dyads were randomized and followed up. Three quarters of mothers smoked during pregnancy and two thirds were smoking at baseline (as were their partners), with no change for more than 12 months. Reported infant exposure to SHS was low (≥95% had smoke-free homes/cars). Infant CCRs were higher if one or both parents were smokers and if mothers breast fed their infants. There was no effect of the intervention on ARI events [471 intervention vs. 438 usual care (reference); incidence rate ratio = 1.10, 95% confidence intervals (CI) = 0.88–1.37, p = .40].Conclusions:Despite reporting smoke-free homes/cars, mothers and their partners continue to smoke in the first year of infants’ lives, exposing them to SHS. Emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal.

We sought to assess the impact of a 25% tax excise rise on tobacco sales in Aboriginal communities in remote Australia and to explore local perceptions about tobacco tax rises and their impact. Tobacco sales data were collected from 18 stores in small remote Aboriginal communities from October 2009 to December 2010. Sales in the 7 months before and after the tax increase were compared. Interviews were conducted with 54 informants in 6 communities. There was a nonsignificant 2.2% average reduction (95% CI = -5 to 10) in total tobacco sold in a store in the 7 months after the price increase compared with the 7 months before the price increase, with a large variation across the 18 stores. The magnitude of this apparent impact may have been reduced by seasonal effects. There were increased demands to share cigarettes, with a perception that there was increased reliance on those with more disposable income to purchase cigarettes for other smokers. The main reasons given for not quitting or reducing smoking were dependence, the normative nature of smoking, and the lack of support to quit. All Aboriginal interviewees supported price increases as important in reducing smoking. The wide confidence interval around our estimated reduction in consumption means that the tax increase could have either been associated or not with a reduction in consumption. Future excise rises are supported but should be carefully monitored in Australian Indigenous populations.