Housing conditions associated with recurrent gastrointestinal infection in urban Aboriginal children in NSW, Australia: findings from SEARCH.

OBJECTIVE: To examine the associations between housing and gastrointestinal infection in Aboriginal children in urban New South Wales. METHODS: A total of 1,398 Aboriginal children were recruited through four Aboriginal Community Controlled Health Services. Multilevel regression modelling of survey data estimated associations between housing conditions and recurrent gastrointestinal infection, adjusting for sociodemographic and health factors. RESULTS: Of the sample, 157 children (11%) had recurrent gastrointestinal infection ever and 37 (2.7%) required treatment for recurrent gastrointestinal infection in the past month. Children in homes with 3+ housing problems were 2.51 (95% CrI 1.10, 2.49) times as likely to have recurrent gastrointestinal infection ever and 6.79 (95% CrI 2.11, 30.17) times as likely to have received recent treatment for it (versus 0-2 problems). For every additional housing problem, the prevalence of recurrent gastrointestinal infection ever increased by a factor of 1.28 (95% CrI 1.14, 1.47) and the prevalence of receiving treatment for gastrointestinal infection in the past month increased by a factor of 1.64 (95% CrI 1.20, 2.48). CONCLUSIONS: Housing problems were independently associated with recurrent gastrointestinal infection in a dose-dependent manner. Implications for public health: The role of housing as a potential determinant of health in urban Aboriginal children merits further attention in research and policy settings.

Housing conditions of urban households with Aboriginal children in NSW Australia: tenure type matters.

BACKGROUND: Housing is a key determinant of the poor health of Aboriginal Australians. Most Aboriginal people live in cities and large towns, yet research into housing conditions has largely focused on those living in remote areas. This paper measures the prevalence of housing problems amongst participants in a study of urban Aboriginal families in New South Wales, Australia, and examines the relationship between tenure type and exposure to housing problems. METHODS: Cross-sectional survey data was provided by 600 caregivers of 1406 Aboriginal children aged 0-17 years participating in Phase One of the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). Regression modelling of the associations between tenure type (own/mortgage, private rental or social housing) and housing problems was conducted, adjusting for sociodemographic factors. RESULTS: The majority (60%) of SEARCH households lived in social housing, 21% rented privately and 19% either owned their home outright or were paying a mortgage ("owned"). Housing problems were common, particularly structural problems, damp and mildew, vermin, crowding and unaffordability. Physical dwelling problems were most prevalent for those living in social housing, who were more likely to report three or more physical dwelling problems than those in owned (PR 3.19, 95%CI 1.97, 5.73) or privately rented homes (PR 1.49, 1.11, 2.08). However, those in social housing were the least likely to report affordability problems. Those in private rental moved home most frequently; children in private rental were more than three times as likely to have lived in four or more homes since birth than those in owned homes (PR 3.19, 95%CI 1.97, 5.73). Those in social housing were almost half as likely as those in private rental to have lived in four or more homes since birth (PR 0.56, 95%CI 0.14, 0.77). Crowding did not vary significantly by tenure type. CONCLUSIONS: The high prevalence of housing problems amongst study participants suggests that urban Aboriginal housing requires further attention as part of efforts to reduce the social and health disadvantage experienced by Aboriginal Australians. Particular attention should be directed to the needs of those renting in the private and social housing sectors, who are experiencing the poorest dwelling conditions.

Psychological distress in carers of Aboriginal children in urban New South Wales: findings from SEARCH (phase one).

OBJECTIVE: To examine the factors associated with psychological distress in parents and carers of Aboriginal children living in urban communities in New South Wales. DESIGN: Cross-sectional survey (phase one of the Study of Environment on Aboriginal Resilience and Child Health [SEARCH], November 2007 - December 2011). SETTING AND PARTICIPANTS: Primary care; 589 parents and carers of Aboriginal children were recruited when attending one of the four Aboriginal Community Controlled Health Services (ACCHSs) in urban NSW that participated in SEARCH. MAIN OUTCOME MEASURE: Kessler Psychological Distress Scale (K10) scores; a score of 22 or higher was deemed to indicate high levels of psychological distress. RESULTS: High levels of psychological distress were identified in 18% of our sample. The factors most strongly associated with this distress were functional limitations (v those with K10 scores under 22: adjusted odds ratio [aOR], 4.2; 95% CI, 1.3-13.5), previous hospitalisation (aOR, 5.5; 95% CI, 1.5-19.4) or other treatment for social and emotional wellbeing (aOR, 3.3; 95% CI, 1.3-8.4), low satisfaction with feeling part of the community (aOR, 0.83; 95% CI, 0.70-0.98) and low involvement in clubs and groups (aOR, 2.9; 95% CI, 1.2-7.3). CONCLUSIONS: Clinicians should note that those with functional limitations or a history of treatment for mental health problems are at higher risk of psychological distress and may require additional support. Increased funding that allows ACCHSs to provide mental health services, and funding and promoting programs and activities that increase social connectedness should remain focuses for ACCHSs and policy makers.

"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.

The health of urban Aboriginal people: insufficient data to close the gap.

The Australian Government has committed to reducing Indigenous disadvantage, including closing the life-expectancy gap within a generation, and to halving the gap in mortality rates for children under 5 years of age within a decade. Sixty per cent of the health gap between Indigenous and non-Indigenous Australians is attributable to the health of Indigenous people living in non-remote areas of Australia. We conducted a brief review of recent Australian original research publications on the health of the 53% of Indigenous people who live in urban areas, and found that data are sparse; there were only 63 studies in the past 5 years (11% of all articles about Indigenous health during this period). Although Indigenous Australians living in remote areas experience greater health disparity, the government will not achieve its aims without paying due attention to the non-remote-living population. More research is required, and particularly research that actually tests the impact of policies and programs.

Emerging themes in Aboriginal child and adolescent mental health: findings from a qualitative study in Sydney, New South Wales.

OBJECTIVE: To explore emerging themes related to the mental health of Aboriginal children and adolescents ("young people") arising from focus groups conducted in Sydney, New South Wales. DESIGN, SETTING AND PARTICIPANTS: A qualitative study was conducted between April 2008 and September 2009 in three Aboriginal community-controlled health organisations in Sydney. A semi-structured approach was used in focus groups and small group interviews to elicit the views of 15 Aboriginal parents and 32 Aboriginal workers from a variety of health and social work backgrounds on important factors surrounding the mental health of Aboriginal young people. RESULTS: Major themes identified were the centrality of family and kinship relationships, the importance of identity, confounding factors in the mental health of Aboriginal young people, and issues related to service access and implementation. CONCLUSION: Clinicians working with Aboriginal young people should be mindful of the critical importance of family and identity issues and should assess possible physical health or social factors that may complicate a diagnosis. Improvements in access to mental health services for Aboriginal families and a more holistic approach to mental health treatment are urgently required.

Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study.

OBJECTIVE: To investigate whether the observed elevated levels of psychological distress in cancer survivors relate specifically to aspects of cancer diagnosis, to treatment or to disability. DESIGN, PARTICIPANTS AND SETTING: Self-reported questionnaire data on demographic, health and lifestyle factors and mental health from 89574 Australian men and women aged 45 years or older, sampled from the Medicare database for the 45 and Up Study from 1 February 2006 to 30 April 2008. Logistic regression was used to examine the risk of high levels of psychological distress in relation to cancer diagnosis and disability, adjusting for age, sex, income and education. MAIN OUTCOME MEASURE: High psychological distress (Kessler Psychological Distress Scale score > or = 22). RESULTS: Overall, 7.5% of participants had high levels of psychological distress. Among cancer survivors, the median time since diagnosis was 7.3 years. Compared with people without cancer, the odds ratios (95% CIs) for psychological distress were: 1.17 (1.09-1.26) in people reporting having had any cancer apart from non-melanoma skin cancer; 1.34 (1.08-1.67) in those with cancer diagnosed in the previous year; 1.53 (1.33-1.76) for those reporting treatment for cancer in the previous month and 1.11 (1.03-1.19) for those with cancer but without recent treatment. Using individuals with neither cancer nor disability as the reference group, the adjusted odds ratio (95% CI) for psychological distress was 6.51 (5.95-7.12) in those reporting significant disability but no cancer, 1.14(1.04-1.24) in those without disability but with cancer and 5.81(4.88-6.91) in those with both cancer and disability. CONCLUSION: The risk of psychological distress in individuals with cancer relates much more strongly to their level of disability than it does to the cancer diagnosis itself.