Lisa Jackson Pulver

Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.

Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed

Objective: To describe and critique methodological aspects of interventions targeting reductions in smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) among Indigenous Australians.

The Gudaga Study: establishing an Aboriginal birth cohort in an urban community

Objective: This paper describes the establishment of the Gudaga Study, an Aboriginal birth cohort in south‐west Sydney, and our approach to follow‐up of participants. The Study describes the health, development, and services use of Aboriginal infants and their mothers. The research team works closely with the local Aboriginal community to implement the research.

Types and timing of breastfeeding support and its impact on mothers' behaviours

Aim:  To determine the types and timing of breastfeeding support for mothers of newborn babies and the extent to which this affects breastfeeding intentions and behaviours in a region with low rates of breastfeeding initiation and duration.

Cancer mortality in Aboriginal people in New South Wales, Australia, 1994–2002

Objective: To describe, for the first time, mortality from cancer for Aboriginal residents of New South Wales (NSW).

Initiation and duration of breastfeeding in an Aboriginal community in South Western Sydney

The Gudaga Study is a prospective, longitudinal birth cohort study of Australian urban Aboriginal children. Mothers of Aboriginal infants were recruited using a survey of all mothers admitted to the maternity ward of an outer urban hospital in Sydney. These data established initiation rates among Gudaga infants and those of non-Aboriginal infants born locally (64.7% and 75.2%, respectively) and factors associated with breastfeeding. Older (relative risk, 1.24; confidence interval, 1.01-1.44), more educated (relative risk, 1.30; confidence interval, 1.11-1.48) mothers who intended to breastfeed (relative risk, 2.22; confidence interval, 2.12-2.3) were more likely to breastfeed. Smokers (relative risk, 0.72) and mothers of Aboriginal infants (relative risk, 0.78) were less likely to initiate breastfeeding. Breastfeeding rates for Gudaga infants dropped rapidly, with 26.3% breastfeeding at 2 months. Local health services providers can benefit from such information as they target relevant prenatal, perinatal, and postnatal services for Aboriginal mothers and their infants.

Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS

Background:  The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi‐centre population health study is considered low risk with minimal ethical impact.

Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains

Objective: To examine how OTDs and staff in rural and remote Indigenous health contexts communicate and negotiate identity and relationships, and consider how this may influence OTDs’ transition, integration and retention.

Using linkage between hospital and ABS mortality data to enhance reporting of deaths among Aboriginal and Torres Strait Islander peoples

Objective: To investigate the potential of record linkage between the Australian Bureau of Statistics (ABS) mortality data and the NSW Admitted Patient Data Collection (APDC) to improve reporting of deaths among Aboriginal and Torres Strait Islander peoples.

Identification of Aboriginal infants at an urban hospital

Aim:  This study explored the accuracy of identification of Aboriginal infants at an urban hospital.