Cardiometabolic health markers among Aboriginal adolescents from the Next Generation Youth Wellbeing Cohort Study.

OBJECTIVE: The objective of this study was to investigate cardiometabolic health markers among Aboriginal adolescents aged 10-24 years and relationships with age, gender, and body composition. METHODS: Baseline data (2018-2020) from the Next Generation Youth Wellbeing Cohort Study (Western Australia, New South Wales, and Central Australia) on clinically assessed body mass index, waist/height ratio, blood pressure, glycated haemoglobin (HbA1c), total and high-density lipoprotein cholesterol, total/high-density lipoprotein cholesterol ratio, and triglycerides were analysed. RESULTS: Among 1100 participants, the proportion with individual health markers within the ideal range ranged from 59% for total cholesterol to 91% for HbA1c. Four percent had high blood pressure, which was more common with increasing age and among males; 1% had HbA1c indicative of diabetes. Healthier body composition (body mass index and waist/height ratio) was associated with having individual health markers in the ideal range and with an ideal cardiometabolic profile. CONCLUSIONS: Most Aboriginal adolescents in this study had cardiometabolic markers within the ideal range, though markers of high risk were present from early adolescence. Ideal health markers were more prevalent among those with healthy body composition. IMPLICATIONS FOR PUBLIC HEALTH: Specific screening and management guidelines for Aboriginal adolescents and population health initiatives that support maintenance of healthy body composition could help improve cardiometabolic health in this population.

Health behaviours associated with healthy body composition among Aboriginal adolescents in Australia in the 'Next Generation: Youth Well-being study'.

This study described the distribution of healthy body composition among Aboriginal adolescents in Australia aged 10-24 years and examined associations with health behaviours and self-rated health. Data were cross-sectional from the 'Next Generation: Youth Well-being study' baseline (N = 1294). We used robust Poisson regression to quantify associations of self-reported health behaviours (physical activity, screen time, sleep, consumption of vegetables, fruit, soft drinks and fast food, and tobacco smoking and alcohol) and self-rated health to healthy body mass index (BMI) and waist/height ratio (WHtR). Overall, 48% of participants had healthy BMI and 64% healthy WHtR, with healthy body composition more common among younger adolescents. Higher physical activity was associated with healthy body composition (5-7 days last week vs none; adjusted prevalence ratio (aPR) healthy BMI 1.31 [95% CI 1.05-1.64], and healthy WHtR 1.30 [1.10-1.54]), as was recommended sleep duration (vs not; aPR healthy BMI 1.56 [1.19-2.05], and healthy WHtR 1.37 [1.13-1.67]). There was a trend for higher proportion of healthy body composition with more frequent fast food consumption. Healthy body composition was also associated with higher self-rated health ('very good/excellent' vs 'poor/fair'; aPR healthy BMI 1.87 [1.45-2.42], and healthy WHtR 1.71 [1.40-2.10]). Culturally appropriate community health interventions with a focus on physical activity and sleep may hold promise for improving body composition among Aboriginal adolescents.

Cardiometabolic Risk Markers for Aboriginal and Torres Strait Islander Children and Youths: A Systematic Review of Data Quality and Population Prevalence.

Cardiovascular disease and type 2 diabetes mellitus are leading contributors to the health inequity experienced by Aboriginal and Torres Strait Islander peoples, and their antecedents can be identified from early childhood. We aimed to establish the quality of available data and the prevalence of cardiometabolic risk markers among Aboriginal and Torres Strait Islander children and youths (0-24-year-olds) to inform public health approaches. A systematic review of the peer-reviewed and grey literature was conducted between 1 January 2000-28 February 2021. Included studies reported population prevalence of cardiometabolic risks, including elevated blood pressure, obesity, central adiposity, dyslipidaemia, hyperglycaemia, and 'metabolic syndrome' for Aboriginal and Torres Strait Islander people aged 0-24 years. Fifteen studies provided population estimates. Data quality was limited by low response rates (10/15 studies) and suboptimal outcome measurements. Obesity is the most reported risk (13/15 studies). Aboriginal and Torres Strait Islander children have an excess risk of obesity from early childhood and prevalence increases with age: 32.1% of Aboriginal and Torres Strait Islander 18-24-year-olds had obesity and 50.8% had central adiposity. In a cohort of 486 9-14-year-olds in Darwin, 70% had ≥1 component of metabolic syndrome; 14% met the full criteria for the syndrome. The prevalence of cardiometabolic risk in Aboriginal and Torres Strait Islander young people is difficult to estimate due to limitations in measurement quality and sampling representativeness. Available data suggest that cardiometabolic risk markers are evident from early childhood. The establishment of national and state-level datasets and a core outcome set for cardiometabolic screening would provide opportunities for preventative action.

Social and Behavioural Correlates of High Physical Activity Levels among Aboriginal Adolescent Participants of the Next Generation: Youth Wellbeing Study.

Physical activity typically decreases during teenage years and has been identified as a health priority by Aboriginal adolescents. We examined associations between physical activity levels and sociodemographic, movement and health variables in the Aboriginal led 'Next Generation: Youth Well-being (NextGen) Study' of Aboriginal people aged 10-24 years from Central Australia, Western Australia and New South Wales. Baseline survey data collected by Aboriginal researchers and Aboriginal youth peer recruiters from 2018 to 2020 examined demographics and health-related behaviours. Logistic regression was used to estimate odds ratios (OR) for engaging in high levels of physical activity in the past week (3-7 days; 0-2 days (ref), or 'don't remember') associated with demographic and behavioural factors. Of 1170 adolescents, 524 (41.9%) had high levels of physical activity; 455 (36.4%) had low levels; 191 (15.3%) did not remember. Factors independently associated with higher odds of physical activity 3-7 days/week were low weekday recreational screen time [55.3% vs. 44.0%, OR 1.79 (1.16-2.76)], having non-smoking friends [50.4% vs. 25.0%, OR 2.27 (1.03-5.00)] and having fewer friends that drink alcohol [48.1% vs. 35.2%, OR 2.08 (1.05-4.14)]. Lower odds of high physical activity were independently associated with being female [40.2% vs. 50.9%, OR 0.57 (0.40-0.80)] and some findings differed by sex. The NextGen study provides evidence to inform the co-design and implementation of strategies to increase Aboriginal adolescent physical activity such as focusing on peer influences and co-occurring behaviours such as screen time.

Potential Determinants of Cardio-Metabolic Risk among Aboriginal and Torres Strait Islander Children and Adolescents: A Systematic Review.

Prevention initiatives during childhood and adolescence have great potential to address the health inequities experienced by Aboriginal and Torres Strait Islander (Indigenous) populations in Australia by targeting modifiable risk factors for cardio-metabolic diseases. We aimed to synthesize existing evidence about potential determinants of cardio-metabolic risk markers-obesity, elevated blood pressure, elevated blood glucose, abnormal lipids, or a clustering of these factors known as the metabolic syndrome (MetS)-for Indigenous children and adolescents. We systematically searched six databases for journal articles and three websites for relevant grey literature. Included articles (n = 47) reported associations between exposures (or interventions) and one or more of the risk markers among Indigenous participants aged 0-24 years. Data from 18 distinct studies about 41 exposure-outcome associations were synthesized (by outcome: obesity [n = 18]; blood pressure [n = 9]; glucose, insulin or diabetes [n = 4]; lipids [n = 5]; and MetS [n = 5]). Obesity was associated with each of the other cardio-metabolic risk markers. Larger birth size and higher area-level socioeconomic status were associated with obesity; the latter is opposite to what is observed in the non-Indigenous population. There were major gaps in the evidence for other risk markers, as well as by age group, geography, and exposure type. Screening for risk markers among those with obesity and culturally appropriate obesity prevention initiatives could reduce the burden of cardio-metabolic disease.

Questioning the ethics of evidence-based practice for Indigenous health and social settings in Australia.

Australian government planning promotes evidence-based action as the overarching goal to achieving health equality for Aboriginal and Torres Strait Islander populations. However, an inequitable distribution of power and resources in the conduct of evidence-based practice produces a policy environment counterintuitive to this goal. This context of contemporary evidence-based practice gives legitimacy to 'expert practitioners' located in Australian governments and universities to use Western guidelines and tools, embedded in Western methodology, to make 'evidence' informed policy and programming decisions about Aboriginal and Torres Strait Islander populations. This method for decision making assumes a positional superiority that can marginalise the important perspectives, experiences and knowledge of Aboriginal Community Controlled Organisations and their processes for decision making. Here we consider the four steps of an evidence review: (1) developing a review question; (2) acquiring studies; (3) appraising the evidence and (4) assessing the evidence, as components of wider evidence-based practice. We discuss some of the limitations across each step that arise from the broader context within which the evidence review is produced. We propose that an ethical and just approach to evidence-based review can be achieved through a well-resourced Aboriginal community controlled sector, where Aboriginal organisations generate their own evidence and evidence is reviewed using methods and tools that privilege Aboriginal and Torres Strait Islander ways of knowing, doing and being.

Perspectives, understandings of dementia and lived experiences from Australian Aboriginal people in Western Australia.

OBJECTIVE: We explored understandings about dementia and lived experiences from carers among community-dwelling Aboriginal people in Western Australia (WA). METHODS: In partnership with Aboriginal medical services in WA, we conducted semi-structured interviews with Aboriginal people in Perth and Bunbury. All interviews were transcribed verbatim and coded thematically. RESULTS: We conducted 39 interviews. Dementia was associated with 'losing your memory', a 'change in behaviour' and unhealthy lifestyles. Increasing awareness about dementia in the community was noted particularly to enable people to recognise the early signs, feel safe to ask for help and know how to best support families. Families were primarily responsible for caring for people with dementia and were finding it difficult to manage. They expressed negative experiences with currently available aged care facilities. CONCLUSIONS: Increased awareness of dementia in the community through public health messaging and by health professionals and culturally secure services focussing on dementia care is required.

Young Aboriginal people in Australia who have never used marijuana in the 'Next Generation Youth Well-being study': A strengths-based approach.

BACKGROUND: Being young is a period of experimentation which can lead to increased vulnerability to poor health choices and outcomes. Aboriginal and Torres Strait Islander (Aboriginal) people have a long and strong history of resilience; however, a deficit approach is often taken with messages of poor health and low socioeconomic status. This study takes a strengths-based approach and examines the demographic factors and behaviours associated with never using marijuana among young Aboriginal people in Australia. METHODS: Overall, 521 Aboriginal people aged 16-24 years from Western Australia, Central Australia and New South Wales participated in the Next Generation: Youth Wellbeing Study. The baseline survey examined demographics, health-related behaviours and clinical indicators of young Aboriginal people. We calculated the number and proportion of young Aboriginal people who never used marijuana by demographics and behavioural factors. Logistic regression was used to assess the demographic and behavioural factors associated with never using marijuana. RESULTS: Of the 521 participants, 458 (87.9%) answered the question about marijuana use of which 220 had incomplete demographic or behavioural questions, leaving a final cohort of 301 participants. A total of 174 (57.8%) had never used marijuana. A higher proportion of young Aboriginal people who never used marijuana were younger (16-19 years old), female, queer, single, lived in Central Australia, were students, had never smoked tobacco, had never drank alcohol, never had anxiety and never had depression. Never using marijuana was independently associated with being a parent or carer of a child (Adjusted Odds Ratio (AOR): 2.80, 95% CI: 1.03-7.59, p = 0.043), never smoking tobacco (AOR: 29.73, 95 CI: 13.32-66.37, p < 0.001), never drinking alcohol (AOR: 2.78, 95 CI: 1.12-6.93, p = 0.028), not having anxiety (AOR: 3.49, 95 CI: 1.19-10.23, p = 0.022), and having lower levels of distress (AOR: 2.63, 95 CI: 1.20-5.77, p = 0.016). CONCLUSION: Our study shows that more than half of young Aboriginal people did not use marijuana, smoke, or drink alcohol and that those who had not used marijuana had lower levels of distress.

Staying smoke-free: Factors associated with nonsmoking among urban Aboriginal adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

ISSUE ADDRESSED: To examine the factors associated with preventing regular smoking among Aboriginal adolescents. METHODS: Cross-sectional analysis of data from 106 Aboriginal adolescents aged 12-17 years, and their caregivers, from four Aboriginal Community Controlled Health Services in urban New South Wales, 2008-2012. The relation of individual, social, environmental and cultural factors to having 'never' smoked tobacco regularly was examined using Poisson regression. RESULTS: Overall, 83% of adolescents had never smoked regularly; 13 reported current and five past smoking. Most lived in smoke-free homes (60%) despite 75% reporting at least one current smoker caregiver. Participants were significantly more likely to have never smoked regularly if they had good mental health (PR = 1.4, 95% CI: 1.1-1.9), their mother as their primary caregiver (1.3, 1.0-1.6), good family relationships (1.2, 1.0-1.5), stable housing (1.3, 1.1-1.7), had never used alcohol (1.8, 1.3-2.4), were not sexually active (3.1, 1.3- 7.2) and had no criminal justice interactions (1.8, 1.2-2.8). CONCLUSIONS: Most participants lived in smoke-free homes and the vast majority had never smoked regularly. Promoting good mental health and strengthening social connections may be protective against smoking as those experiencing less social disruption were more likely to have never smoked regularly. Smoking may be an indicator of psychosocial conditions and a prompt for screening and simultaneous treatment. SO WHAT?: Organisations should be resourced to deliver holistic adolescent health promotion programs. Programs and policies should support positive family relationships and stable housing as this may protect against the uptake of regular smoking.

"Cultural Security Is an On-Going Journey " Exploring Views from Staff Members on the Quality and Cultural Security of Services for Aboriginal Families in Western Australia.

Cultural security is a key element of accessible services for Indigenous peoples globally, although few studies have examined this empirically. We explored the scope, reach, quality, and cultural security of health and social services available to Aboriginal and/or Torres Strait Islander families in Western Australia (WA), from the point of view of staff from the services. We recruited staff from health and social services for Aboriginal people in the Perth, Kalgoorlie, Great Southern, and South West regions of WA between December 2015 and September 2017 to complete online surveys. We examined the proportions of participants that responded saying the service was culturally secure, the reasons for the response, and perceived factors related to a high-quality service. Sixty participants from 21 services responded to the survey. Seventy-three percent stated the service was culturally secure; however, only 36% stated that the staff employed at the service had sufficient knowledge on cultural security. Participants suggested having Aboriginal staff and better cultural awareness training as methods to improve cultural security within the service. Participants highlighted that staffing, funding for resources, and patient financial difficulties in accessing care as key areas for quality improvement. Much greater effort is required in improving knowledge through on-going training of staff in the practice of culturally safe care. Organisations must also be required to meet specific standards in cultural safety.

Factors Influencing Smoking Among Indigenous Adolescents Aged 10-24 Years Living in Australia, New Zealand, Canada, and the United States: A Systematic Review.

INTRODUCTION: Smoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults. AIMS AND METHODS: We searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10-24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework. RESULTS: A total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors. CONCLUSIONS: Young Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection. IMPLICATIONS: This review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.

'Next Generation Youth Well-being Study:' understanding the health and social well-being trajectories of Australian Aboriginal adolescents aged 10-24 years: study protocol.

INTRODUCTION: Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as 'Aboriginal') adolescents (10-24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. METHODS AND ANALYSIS: The 'Next Generation: Youth Well-being Study' is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10-24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services; medication; immunisation; hospitalisations and emergency department presentations; death registrations; education; child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The 'Next Generation' study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. ETHICS AND DISSEMINATION: Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats that will be most useful and informative to the participants and community organisations.

Exploring factors impacting early childhood health among Aboriginal and Torres Strait Islander families and communities: protocol for a population-based cohort study using data linkage (the 'Defying the Odds' study).

INTRODUCTION: Empirical evidence on family and community risk and protective factors influencing the comparatively high rates of potentially preventable hospitalisations and deaths among Aboriginal and Torres Strait Islander infants and children is limited. As is evidence on geographical variation in these risks. The 'Defying the Odds' study aims to explore the impact of perinatal outcomes, maternal social and health outcomes and level of culturally secure service availability on the health outcomes of Western Australian (WA) Aboriginal infants and children aged 0-5 years. METHODS AND ANALYSIS: The study combines a retrospective cohort study that uses state-wide linked health and administrative data from 12 data sources for multiple generations within Aboriginal families in WA, with specifically collected survey data from health and social services supporting Aboriginal families in regions of WA. Data sources include perinatal/birth registration, hospital, emergency department, mental health services, drug and alcohol service use, mortality, infectious disease notifications, and child protection and family services. Multilevel regression models will be used to examine the intensity of admissions and presentations, mortality, intensity of long stays and morbidity-free survival (no admissions) for Aboriginal children born in WA in 2000-2013. Relationships between maternal (and grand-maternal) health and social factors and child health outcomes will be quantified. Community-level variation in outcomes for Aboriginal children and factors contributing to this variation will be examined, including the availability of culturally secure services. Online surveys were sent to staff members at relevant services to explore the scope, reach and cultural security of services available to support Aboriginal families across selected regions of WA. ETHICS AND DISSEMINATION: Ethics approvals have been granted for the study. Interpretation and dissemination are guided by the study team's Aboriginal leadership and reference groups. Dissemination will be through direct feedback and reports to health services in the study and via scientific publications and policy recommendations.

Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous-non-Indigenous disparities.

OBJECTIVE: To explore factors associated with high psychological distress among Aboriginal and non-Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. METHODS: Questionnaire data from 1,631 Aboriginal and 233,405 non-Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler-10 score ≥22) for socio-demographic, health and disability-related factors, and to quantify contributions to differences in distress prevalence. RESULTS: While high-distress prevalence was increased around three-fold in Aboriginal versus non-Aboriginal participants, distress-related risk factors were similar. Morbidity and physical disability had the strongest associations; high distress affected 43.8% of Aboriginal and 20.9% of non-Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non-Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully-adjusted PR 1.19 [95% 1.08, 1.30]); physical morbidity and disability explained the bulk. CONCLUSIONS: The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health: Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential.

Physical activity, healthy lifestyle behaviors, neighborhood environment characteristics and social support among Australian Aboriginal and non-Aboriginal adults.

Physical inactivity is the third leading cause of the burden of disease for Australian Aboriginal adults. The neighborhood environment and social support are known to influence physical activity (PA) participation. This study examined these factors in relation to achieving PA recommendations in Aboriginal and non-Aboriginal Australians. Cross-sectional data from the 2010 Social, Economic, and Environmental Factor (SEEF) Study in New South Wales, Australia were used to estimate adjusted odds ratios (OR) for Aboriginal versus non-Aboriginal participants for PA-related attributes, including achieving PA recommendations. ORs for achieving PA recommendations were estimated in both groups. Overall, 63.1% of Aboriginal (n = 314) and 65.4% of non-Aboriginal (n = 59,175) participants met PA recommendations. Odds of healthy sleep duration were lower, and receiving GP advice to be active was higher, among Aboriginal versus non-Aboriginal participants. Aboriginal respondents had higher odds of reporting that the crime rate made it unsafe to walk and that local public transport was inaccessible. They had higher odds of disagreeing they have local shops, footpaths or free/low cost recreation facilities. PA correlates were similar in both groups. The factors relating to PA were similar in Aboriginal and non-Aboriginal people. Neighborhood and social features were less PA-favorable for Aboriginal participants suggesting multiple possible avenues for increasing PA in this older population group.

Factors relating to participation in follow-up to the 45 and up study in Aboriginal and non-Aboriginal individuals.

BACKGROUND: This study aimed to characterise the factors relating to participation in a postal follow-up study in Aboriginal and non-Aboriginal individuals, given the need to quantify potential biases from loss to follow-up and the lack of evidence regarding postal surveys among Aboriginal people. METHODS: The first 100,000 participants from the Sax Institute's 45 and Up Study, a large scale cohort study, were posted a follow-up questionnaire gathering general demographic, health and risk factor data, emphasising Social, Economic and Environmental Factors ("The SEEF Study"). For each variable of interest, percentages of those invited who went on to participate in follow-up were tabulated separately for Aboriginal and non-Aboriginal participants and age- and sex-adjusted participation rate ratios (aPRR) were calculated. RESULTS: Of the 692 Aboriginal and 97,178 non-Aboriginal invitees to the study, 314 Aboriginal (45 %) and 59,175 non-Aboriginal (61 %) individuals responded. While Aboriginal people were less likely to respond than non-Aboriginal people (aPRR 0.72, 95 % CI 0.66-0.78), factors related to response were similar. Follow-up study participants were more likely than non-participants to have university versus no educational qualifications (1.6, 1.3-2.0 [Aboriginal]; 1.5, 1.5-1.5 [non-Aboriginal]) and an annual income of ≥70,000 versus < $20,000 (1.6, 1.3-2.0; 1.2, 1.2-1.3 [χ (2) = 7.7; p = 0.001]). Current smokers (0.55, 0.42-0.72; 0.76, 0.74-0.77 [χ (2) = 7.14; p = 0.03]), those reporting poor self-rated health (0.68, 0.47-0.99; 0.65, 0.61-0.69), poor quality of life (0.63, 0.41-0.97; 0.61, 0.57-0.66) and very high psychological distress (0.71, 0.68-0.75 [non-Aboriginal]) were less likely than other cohort members to respond. CONCLUSIONS: Relatively large numbers of Aboriginal and non-Aboriginal individuals participated in the first 45 and Up Study follow-up suggesting that postal surveys can be used to follow Aboriginal participants in cohort studies. Despite somewhat greater loss to follow-up in Aboriginal people (after considering socio-demographic and health characteristics), factors related to follow-up participation were similar in both groups: greater loss was observed in those experiencing disadvantage, ill-health and health risk, with implications for interpretation of future findings. Aboriginal low income earners and current regular smokers had a particularly elevated likelihood of non-participation compared to non-Aboriginal people. These findings highlight the importance of identifying and addressing barriers to participation among hard-to-reach population groups.

Trends in maternal and newborn health characteristics and obstetric interventions among Aboriginal and Torres Strait Islander mothers in Western Australia from 1986 to 2009.

BACKGROUND: Detailed analyses of long-term trends in Aboriginal maternal and newborn health characteristics are lacking. AIM: To examine trends in maternal and newborn health characteristics for all mothers who were recorded as Aboriginal in the Western Australian Midwives' Notification System from 1986 to 2009. MATERIALS AND METHODS: Births were categorised into four-year time intervals (1986-1989, 1990-1993, 1994-1997, 1998-2001, 2002-2005, 2006-2009). Trends in maternal demographic characteristics, pre-existing medical conditions, pregnancy complications and neonatal characteristics were examined. RESULTS: For 37 424 births recorded from 1986 to 2009, the proportion of births to mothers aged ≤19 years decreased (31-22%, P < 0.001) along with the prevalence of pre-eclampsia (6.8-4.0%, P < 0.001) and antepartum haemorrhage (4.8-3.2%, P < 0.001). There were increases in the prevalence of diabetes in pregnancy (3.8-6.6%, P < 0.001), induction of labour (17.8-21.4%, P < 0.001), elective caesarean (6.6-8.2%, P < 0.001) and emergency caesarean (9.5-14.9%, P < 0.001) deliveries. There were no changes in the overall prevalence of preterm births (15.4-15.9%, P = 0.32). However, increases were observed in the prevalence of medically indicated preterm births with and without prelabour rupture of membranes (1.0-1.7%; P < 0.001 and 3.3-4.3%; P = 0.005, respectively). There were no significant changes in the rates of smoking during pregnancy (51-52% from 1998 to 2009, P = 0.18), small-for-gestational age (16.9-17.2%, P = 0.07), suboptimal-birthweight (20.4-20.1%, P = 0.92), stillbirths (14.7 per 1000-12.1 per 1000, P = 0.22) and neonatal deaths (6.2 per 1000-5.5 per 1000, P = 0.68). CONCLUSION: Encouraging trends include reduced rates of teenage pregnancy, pre-eclampsia and antepartum haemorrhage. The persistent high rates of smoking during pregnancy, preterm births, stillbirths, neonatal deaths and increasing rates of diabetes in pregnancy are of concern.

Physical Functional Limitations among Aboriginal and Non-Aboriginal Older Adults: Associations with Socio-Demographic Factors and Health.

BACKGROUND: Australian Aboriginal people are disproportionately affected by physical disability; the reasons for this are unclear. This study aimed to quantify associations between severe physical functional limitations and socio-demographic and health-related factors among older Aboriginal and non-Aboriginal adults. METHODS: Questionnaire data from 1,563 Aboriginal and 226,802 non-Aboriginal participants aged ≥45 years from the Sax Institute's 45 and Up Study (New South Wales, Australia) were used to calculate age- and sex-adjusted prevalence ratios (aPRs) for severe limitation [MOS-PF score <60] according to socio-demographic and health-related factors. RESULTS: Overall, 26% (410/1563) of Aboriginal participants and 13% (29,569/226,802) of non-Aboriginal participants had severe limitations (aPR 2.8, 95%CI 2.5-3.0). In both Aboriginal and non-Aboriginal participants, severe limitation was significantly associated with: being ≥70 vs <70 years old (aPRs 1.8, 1.3-2.4 and 5.3, 5.0-5.5, within Aboriginal and non-Aboriginal participants, respectively), none vs tertiary educational qualifications (aPRs 2.4, 1.7-3.3 and 3.1, 3.0-3.2), lower vs higher income (aPRs 6.6, 4.2-10.5 and 5.5, 5.2-5.8), current vs never-smoking (aPRs 2.0, 1.6-2.5 and 2.2, 2.1-2.3), obese vs normal weight (aPRs 1.7, 1.3-2.2 and 2.7, 2.7-2.8) and sitting for ≥7 vs <7 hours/day (aPRs 1.6, 1.2-2.0 and 1.6, 1.6-1.7). Severe limitations increased with increasing ill-health, with aPRs rising to 5-6 for ≥5 versus no chronic conditions. It was significantly higher in those with few vs many social contacts (aPRs 1.7, 1.4-2.0 and 1.4, 1.4-1.4) and with very high vs low psychological distress (aPRs 4.4, 3.6-5.4 and 5.7, 5.5-5.9). CONCLUSIONS: Although the prevalence of severe physical limitation among Aboriginal people in this study is around three-fold that of non-Aboriginal people, the factors related to it are similar, indicating that Aboriginal people have higher levels of risk factors for and consequences of severe limitations. Effective management of chronic disease and reducing the prevalence of obesity and smoking are important areas for attention.

Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: a comparison of the K-10 and K-5.

OBJECTIVES: To assess the cross-cultural validity of two Kessler psychological distress scales (K-10 and K-5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non-Aboriginal individuals from NSW Australia. METHODS: Self-reported questionnaire data from the 45 and Up Study for 1,631 Aboriginal and 231,774 non-Aboriginal people were used to examine the factor structure, convergent validity, internal consistency and levels of missing data of K-10 and K-5. RESULTS: We found excellent agreement in classification of distress of Aboriginal participants by K-10 and K-5 (weighted kappa=0.87), high internal consistency (Cronbach's alpha K-10: 0.93, K-5: 0.88), and factor structures consistent with those for the total Australian population. Convergent validity was evidenced by a strong graded relationship between the level of distress and the odds of: problems with daily activities due to emotional problems; current treatment for depression or anxiety; and poor quality of life. CONCLUSIONS AND IMPLICATIONS: K-10 and K-5 scales are promising tools for measuring psychological distress among Aboriginal and Torres Strait Islanders aged 45 and over in research and clinical settings.

Assessment of renal functional maturation and injury in preterm neonates during the first month of life.

Worldwide, approximately 10% of neonates are born preterm. The majority of preterm neonates are born when the kidneys are still developing; therefore, during the early postnatal period renal function is likely reflective of renal immaturity and/or injury. This study evaluated glomerular and tubular function and urinary neutrophil gelatinase-associated lipocalin (NGAL; a marker of renal injury) in preterm neonates during the first month of life. Preterm and term infants were recruited from Monash Newborn (neonatal intensive care unit at Monash Medical Centre) and Jesse McPherson Private Hospital, respectively. Infants were grouped according to gestational age at birth: ≤28 wk (n = 33), 29-31 wk (n = 44), 32-36 wk (n = 32), and term (≥37 wk (n = 22)). Measures of glomerular and tubular function were assessed on postnatal days 3-7, 14, 21, and 28. Glomerular and tubular function was significantly affected by gestational age at birth, as well as by postnatal age. By postnatal day 28, creatinine clearance remained significantly lower among preterm neonates compared with term infants; however, sodium excretion was not significantly different. Pathological proteinuria and high urinary NGAL levels were observed in a number of neonates, which may be indicative of renal injury; however, there was no correlation between the two markers. Findings suggest that neonatal renal function is predominantly influenced by renal maturity, and there was high capacity for postnatal tubular maturation among preterm neonates. There is insufficient evidence to suggest that urinary NGAL is a useful marker of renal injury in the preterm neonate.