Glenn Pearson

Awareness and impact of the ‘Bubblewrap’ advertising campaign among Aboriginal smokers in Western Australia

Background Antismoking mass media campaigns have been shown to reduce smoking prevalence in the mainstream community, however there is little published research on their effect on Aboriginal Australian smokers. Objectives To evaluate the awareness and impact of a mainstream mass media advertising campaign (the ‘Bubblewrap’ campaign) on Aboriginal smokers in the state of Western Australia. Methods A personal intercept survey was conducted in July 2008 across three sites (the Perth metropolitan area and the non-metropolitan towns of Kalgoorlie and Broome). An opportunity or convenience sampling strategy was used to recruit Aboriginal participants, and face-to-face interviews were conducted with 198 Aboriginal smokers to ascertain awareness of the campaign advertisements, whether they were seen as believable and relevant, and the impact the advertisements had on smoking behaviour. Results The majority of the participants interviewed had seen and/or heard the ‘Bubblewrap’ campaign advertisements, although there was considerably greater awareness of the television advertisement than the radio advertisements. Both forms of advertising were considered to be believable and relevant by the majority of Aboriginal smokers. Most of the smokers interviewed thought about cutting down and/or quitting after seeing or hearing the advertisements. Conclusions Our findings suggest that mainstream antismoking mass media campaigns can positively influence the thoughts and behaviours that Aboriginal smokers have, and exhibit, towards quitting smoking. Notwithstanding this, advertisers should continue to look for better ways to incorporate Aboriginal themes in campaign messages. Future mainstream antismoking campaigns should source sufficient funds to ensure that advertising messages reach the large Aboriginal populations in regional and remote Australia.

Adjusting for under-identification of Aboriginal and/or Torres Strait Islander births in time series produced from birth records: Using record linkage of survey data and administrative data sources

BackgroundStatistical time series derived from administrative data sets form key indicators in measuring progress in addressing disadvantage in Aboriginal and Torres Strait Islander populations in Australia. However, inconsistencies in the reporting of Indigenous status can cause difficulties in producing reliable indicators. External data sources, such as survey data, provide a means of assessing the consistency of administrative data and may be used to adjust statistics based on administrative data sources.MethodsWe used record linkage between a large-scale survey (the Western Australian Aboriginal Child Health Survey), and two administrative data sources (the Western Australia (WA) Register of Births and the WA Midwives’ Notification System) to compare the degree of consistency in determining Indigenous status of children between the two sources. We then used a logistic regression model predicting probability of consistency between the two sources to estimate the probability of each record on the two administrative data sources being identified as being of Aboriginal and/or Torres Strait Islander origin in a survey. By summing these probabilities we produced model-adjusted time series of neonatal outcomes for Aboriginal and/or Torres Strait Islander births.ResultsCompared to survey data, information based only on the two administrative data sources identified substantially fewer Aboriginal and/or Torres Strait Islander births. However, these births were not randomly distributed. Births of children identified as being of Aboriginal and/or Torres Strait Islander origin in the survey only were more likely to be living in urban areas, in less disadvantaged areas, and to have only one parent who identifies as being of Aboriginal and/or Torres Strait Islander origin, particularly the father. They were also more likely to have better health and wellbeing outcomes. Applying an adjustment model based on the linked survey data increased the estimated number of Aboriginal and/or Torres Strait Islander births in WA by around 25%, however this increase was accompanied by lower overall proportions of low birth weight and low gestational age babies.ConclusionsRecord linkage of survey data to administrative data sets is useful to validate the quality of recording of demographic information in administrative data sources, and such information can be used to adjust for differential identification in administrative data.

Genetic Research and Aboriginal and Torres Strait Islander Australians

While human genetic research promises to deliver a range of health benefits to the population, genetic research that takes place in Indigenous communities has proven controversial. Indigenous peoples have raised concerns, including a lack of benefit to their communities, a diversion of attention and resources from non-genetic causes of health disparities and racism in health care, a reinforcement of “victim-blaming” approaches to health inequalities, and possible misuse of blood and tissue samples. Drawing on the international literature, this article reviews the ethical issues relevant to genetic research in Indigenous populations and considers how some of these have been negotiated in a genomic research project currently under way in a remote Aboriginal community. We consider how the different levels of Indigenous research governance operating in Australia impacted on the research project and discuss whether specific guidelines for the conduct of genetic research in Aboriginal and Torres Strait Islander communities are warranted.

Early Vocabulary Development of Australian Indigenous Children: Identifying Strengths

The current study sought to increase our understanding of the factors involved in the early vocabulary development of Australian Indigenous children. Data from the Longitudinal Study of Indigenous Children were available for 573 Indigenous children (291 boys) who spoke English ( months, months, at wave 3). Data were also available for 86 children (51 boys) who spoke an Indigenous language ( months, months, at wave 3). As hypothesised, higher levels of parent-child book reading and having more children’s books in the home were associated with better English vocabulary development. Oral storytelling in Indigenous language was a significant predictor of the size of children’s Indigenous vocabulary.

Reduced forced vital capacity in Aboriginal Australians: Biology or missing evidence?

Chronic lung disease is the third largest contributor to the burden of disease in Aboriginal and Torres Strait Islanders (collectively referred to as Aboriginal Australians) and is estimated to contribute to 6% of the mortality gap between Aboriginal and nonAboriginal Australians. The prevalence of selfreported chronic obstructive pulmonary disease (COPD) in the Aboriginal population has been reported to be ∼2.5 times higher than that of the non-Aboriginal population. Hospitalizations for COPD are five times higher in Aboriginal people compared with the non-Aboriginal population, are increasing and may reflect a more severe phenotype profile in the Aboriginal population. It is possible that the self-reported rates of COPD in Aboriginal people are lower than that actually occurring, due to a range of factors including barriers to accessing healthcare and/or a lack of accurate lung function measurements in this patient population. Spirometry plays an important role in the diagnosis and management of COPD. However, there are very few studies that have accurately defined the normal range of spirometry in Aboriginal people or conducted a detailed assessment of lung function in older Aboriginal Australians at risk of COPD. As such, policy and practice in this critical area of healthcare remains mired in the too hard basket. In this issue of Respirology, Cooksley et al. offer an important contribution to understanding the prevalence of COPD in the Aboriginal population. Following the internationally standardized Burden of Lung Disease (BOLD) protocols, the authors obtained preand post-bronchodilator spirometry and respiratory symptoms in 231 and 451 Aboriginal and nonAboriginal adults from the Kimberley region of Western Australia. These data represent the first comprehensive objective assessment of non-reversible obstruction in Aboriginal people and give us an insight into the complexities of the challenges facing us. As well recognized, the prevalence of current smoking in Aboriginal participants was significantly higher than that in the non-Aboriginal group from the same geographical region being 48.5% and 21.4%, respectively. Surprisingly, the history of smoking was not different between the Aboriginal and nonAboriginal people in the Kimberley region (68.3% and 64.7%) and was higher than that reported in the broader Australian BOLD study, highlighting the importance of appropriate geographically relevant controls when assessing the impact of chronic disease in Aboriginal populations. As expected, this high level of past and current smoking in Aboriginal people was associated with significantly increased respiratory symptoms, including shortness of breath, cough and sputum production, but not wheeze. Given this picture of significant smoking history and respiratory symptoms, it was startling to see that the level of post-bronchodilator airflow obstruction based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage 1 or higher in Aboriginal people from the Kimberley region was significantly lower (8.4%) than that of non-Aboriginal residents in the same area (16.0%), although these differences were not apparent at GOLD Stage 2 or higher. A further, even more, unexpected finding was the reporting that 74% of the Aboriginal group in this study had ‘low FVC’ compared with 9.7% of the nonAboriginal control population. The reasons for these differences highlight the complexities of both modern respiratory medicine and applying global respiratory models to Indigenous populations. The international approach of BOLD is to define airflow obstruction as being present with a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.7 for GOLD Stage 1 and higher, with more severe obstruction (GOLD Stage 2 or higher) being FEV1/FVC < 0.7 and FEV1 < 80% predicted. This approach has been repeatedly questioned, and the use of a fixed spirometry cut-off has been shown to lead to an overestimation of airflow obstruction that increases with age and can result in up to 20% misclassification in older individuals. It could be argued that as the same criteria for defining obstruction was used in all groups that the between group difference would not be significantly influenced by these factors, particularly as the statistical analysis adjusted for age and sex. However, in this study, the outcomes are further confounded by the use of the National Health and Nutrition Examination Survey III spirometry reference values without any ethnic adjustments. Therefore, the estimates of obstruction in this study are affected by the differences between both the true lower limit of normal of both FEV1/FVC and FEV1 and the arbitrary fixed cut-offs used by BOLD and any differences in spirometry outcomes between healthy Caucasian and Aboriginal peoples. There is a paucity of spirometry reference ranges for Aboriginal Australians; however, it has been reported that on average, healthy Aboriginal Australians have spirometry approximately 20–30% lower than that of bs_bs_banner

The rationale for action to end new cases of rheumatic heart disease in Australia

n 25 November 2016, the Australian Medical Association (AMA) launched their annual OReport Card on Indigenous Health entitled A call to action to prevent new cases of rheumatic heart disease in Indigenous Australia by 2031. In 14 years of AMA report cards, this is the first to focus on a single pathology. The choice of rheumatic heart disease (RHD) is telling: the disease is a striking marker of inequality, a novel lens for considering health systems and a feasible target for definitive disease control.

Translating aboriginal genomics — four letters closing the gap

379 TO THE EDITOR: Rare diseases (RD) are typically complex, chronic, often multisystem, and frequently genetic disorders associated with significant morbidity and mortality. They affect up to 6e8% of the population and 30% of AustralianswithRDwaitedbetween 5 to 30 or more years for a diagnosis. There are now game-changing clinical genomic approaches that are reducing these diagnostic odysseys. However, parallel to hitherto unachieved improvements in RD diagnosis is the known and recently demonstrated risk that Indigenous Australians will not enjoy the same diagnostic opportunities as non-Indigenous Australians.