Matthew Stevens

Skin infection, housing and social circumstances in children living in remote Indigenous communities: testing conceptual and methodological approaches

BackgroundPoor housing conditions in remote Indigenous communities in Australia are a major underlying factor in poor child health, including high rates of skin infections. The aim of this study is to test approaches to data collection, analysis and feedback for a follow-up study of the impact of housing conditions on child health.MethodsParticipation was negotiated in three communities with community councils and individual participants. Data were collected by survey of dwelling condition, interviews, and audit health centre records of children aged under seven years. Community feedback comprised immediate report of items requiring urgent repair followed by a summary descriptive report. Multivariate models were developed to calculate adjusted incidence rate ratios (IRR) for skin infections and their association with aspects of household infrastructure.ResultsThere was a high level of participation in all communities. Health centre records were inadequate for audit in one community. The records of 138 children were available for development of multivariate analytic models. Rates of skin infection in dwellings that lacked functioning facilities for removing faeces or which had concrete floors may be up to twice as high as for other dwellings, and the latter association appears to be exacerbated by crowding. Younger children living in older dwellings may also be at approximately two-fold higher risk. A number of socioeconomic and socio-demographic variables also appear to be directly associated with high rates of skin infections.ConclusionThe methods used in the pilot study were generally feasible, and the analytic approach provides meaningful results. The study provides some evidence that new and modern housing is contributing to a reduction in skin infections in Aboriginal children in remote communities, particularly when this housing leads to a reduction in crowding and the effective removal of human waste.

Exploring cross-sectional associations between common childhood illness, housing and social conditions in remote Australian Aboriginal communities

BackgroundThere is limited epidemiological research that provides insight into the complex web of causative and moderating factors that links housing conditions to a variety of poor health outcomes. This study explores the relationship between housing conditions (with a primary focus on the functional state of infrastructure) and common childhood illness in remote Australian Aboriginal communities for the purpose of informing development of housing interventions to improve child health.MethodsHierarchical multi-level analysis of association between carer report of common childhood illnesses and functional and hygienic state of housing infrastructure, socio-economic, psychosocial and health related behaviours using baseline survey data from a housing intervention study.ResultsMultivariate analysis showed a strong independent association between report of respiratory infection and overall functional condition of the house (Odds Ratio (OR) 3.00; 95%CI 1.36-6.63), but no significant association between report of other illnesses and the overall functional condition or the functional condition of infrastructure required for specific healthy living practices. Associations between report of child illness and secondary explanatory variables which showed an OR of 2 or more included: for skin infection - evidence of poor temperature control in the house (OR 3.25; 95%CI 1.06-9.94), evidence of pests and vermin in the house (OR 2.88; 95%CI 1.25-6.60); for respiratory infection - breastfeeding in infancy (OR 0.27; 95%CI 0.14-0.49); for diarrhoea/vomiting - hygienic state of food preparation and storage areas (OR 2.10; 95%CI 1.10-4.00); for ear infection - child care attendance (OR 2.25; 95%CI 1.26-3.99).ConclusionThese findings add to other evidence that building programs need to be supported by a range of other social and behavioural interventions for potential health gains to be more fully realised.

Exploring relationships between racism, housing and child illness in remote indigenous communities

Background Although racism is increasingly acknowledged as a determinant of health, few studies have examined the relationship between racism, housing and child health outcomes. Methods Cross-sectional data from the Housing Improvement and Child Health study collected in ten remote indigenous communities in the Northern Territory, Australia were analysed using hierarchical logistic regression. Carer and householder self-reported racism was measured using a single item and child illness was measured using a carer report of common childhood illnesses. A range of confounders, moderators and mediators were considered, including socio-demographic and household composition, psychosocial measures for carers and householders, community environment, and health-related behaviour and hygienic state of environment. Results Carer self-reported racism was significantly associated with child illness in this sample after adjusting for confounders (OR 1.65; 95% CI 1.09 to 2.48). Carer negative affect balance was identified as a significant mediator of this relationship. Householder self-reported racism was marginally significantly associated with child illness in this sample after adjusting for confounders (OR 1.43; 95% CI 0.94 to 2.18, p=0.09). Householder self-reported drug use was identified as a significant mediator of this relationship. Conclusions Consistent with evidence from adult populations and children from other ethnic minorities, this study found that vicarious racism is associated with poor health outcomes among an indigenous child population.

SOGS and CGPI: parallel comparison on a diverse population.

The Northern Territory of Australia, one of the most demographically and socially diverse jurisdictions in the country, conducted its first population-based gambling and problem gambling prevalence survey in 2005. Both the South Oaks Gambling Screen (SOGS) and the Canadian Problem Gambling Index (CPGI) were administered to the same sample of respondents. Using data from this survey, the current paper presents a parallel comparison of the respective screens with particular reference to gender, region, and the socio-demographic characteristics of respondents. The respective screens produced significantly different groups of problem gamblers as measured by their association with a range of socio-demographic variables. Specifically, the large number of SOGS items related to money issues may cause selective overrepresentation among low socioeconomic groups, including Indigenous people, who exist in relatively high proportions in the Northern Territory. In addition, there existed substantial gender-based differences within screens. Identified female problem gamblers were associated with household level variables (i.e. employment status, household type and marital status), while males were associated with socio-economic variables including language, education, and income. Further research is required to validate the use of problem gambling screens within the Indigenous population and to understand the role of gender in the experience and categorisation of problem gambling.

The Changing Landscape of Indigenous Gambling in Northern Australia: Current Knowledge and Future Directions

Little is formally known about the gambling practices, both regulated (e.g. poker machines) and unregulated (e.g. card games), of indigenous people in northern Australia, nor of the range of social consequences of these practices. To begin addressing this shortfall, a scoping study of indigenous gambling in the Northern Territory (NT) was conducted. This paper reports the key findings of this study and integrates them with information on indigenous gambling from the Northern Territory Prevalence Survey 2005 and from the National Aboriginal and Torres Strait Islander Social Survey 2002. The emergent picture of indigenous gambling in the NT is one of widespread incorporation of gambling, both regulated and unregulated, into contemporary indigenous social practices with considerable negative consequence. However, the strength of this conclusion is tempered by the paucity of available data, by the limitations of existing gambling research methodologies and by the scoping purpose of the exercise.

Gambling problems amongst the CALD population of Australia: hidden, visible or not a problem?

There have been mixed research results when studying gambling problems in Culturally and Linguistically Diverse (CALD) communities in Australia and internationally. This study tests the feasibility of using nationally representative General Social Surveys for examining trends and patterns in gambling problems and other life stressors amongst the Australian CALD population. Two surveys were analysed to determine whether the CALD population experienced gambling problems and other life stressors at different levels to the non-CALD population, and to identify, using multivariable models, whether CALD related variables showed evidence of an association with reported gambling problems after adjustment for other covariates. There was no evidence that 2002 estimates of gambling problems were different in CALD and non-CALD populations. In 2006, there was evidence that gambling problems were lower in the CALD population compared with the non-CALD population (1.3% cf. 3.5%). In 2002 multivariable models there was no evidence of an association between CALD status or related variables with gambling problems, after adjustment for other variables. In 2006 multivariable models, there was evidence of an association between being the CALD population (protective), and being born in Oceania or New Zealand (risk) with gambling problems, after adjustment for other variables.

Evaluation of an Australian indigenous housing programme: community level impact on crowding, infrastructure function and hygiene

Background and Aim Housing programmes in indigenous Australian communities have focused largely on achieving good standards of infrastructure function. The impact of this approach was assessed on three potentially important housing-related influences on child health at the community level: (1) crowding, (2) the functional state of the house infrastructure and (3) the hygienic condition of the houses. Methods A before-and-after study, including house infrastructure surveys and structured interviews with the main householder, was conducted in all homes of young children in 10 remote Australian indigenous communities. Results Compared with baseline, follow-up surveys showed (1) a small non-significant decrease in the mean number of people per bedroom in the house on the night before the survey (3.4, 95% CI 3.1 to 3.6 at baseline vs 3.2, 95% CI 2.9 to 3.4 at follow-up; natural logarithm transformed t test, t=1.3, p=0.102); (2) a marginally significant overall improvement in infrastructure function scores (Kruskal–Wallis test, χ2=3.9, p=0.047); and (3) no clear overall improvement in hygiene (Kruskal–Wallis test, χ2=0.3, p=0.605). Conclusion Housing programmes of this scale that focus on the provision of infrastructure alone appear unlikely to lead to more hygienic general living environments, at least in this study context. A broader ecological approach to housing programmes delivered in these communities is needed if potential health benefits are to be maximised. This ecological approach would require a balanced programme of improving access to health hardware, hygiene promotion and creating a broader enabling environment in communities.

Problem Gambling within the Non-Indigenous Population of the Northern Territory of Australia: A Multivariate Analysis of Risk Factors

This paper estimates, through the use of a telephone survey and the Canadian Problem Gambling Index (CPGI), the prevalence of gambling and problem gambling among the non-indigenous population of the Northern Territory, Australia. Multivariate predictive models of regular and problem gambling group membership were constructed using socio-demographic and gambling mode variables. Of the socio-demographic variables, household type (particularly being single or living in a group household) was a predictor for both gambler types. In addition, male gender and formal education below tertiary level were associated with regular gambling. Gambling mode proved to be of greater explanatory power for both groups. In particular, electronic gaming machines (EGMs) were strongly associated with problem gambling. While these results provide a necessary knowledge base, the gaps they highlight are as valuable as the empirical results they provide. Any comprehensive understanding of risk factors in demographically distinctive jurisdictions such as the Northern Territory requires a broader approach; one that meaningfully extends beyond the non-indigenous population.

Player Preferences and Social Harm: An Analysis of the Relationships Between Player Characteristics, Gambling Modes, and Problem Gambling

To explore the structure of gambling participation and its association with problem gambling, we draw upon Caillois’s distinction between games based on competition (i.e. agôn) and those based on chance (i.e. alea). The idea that alea and agôn are socially patterned and associated with differing levels of problem gambling, as measured by the Canadian Problem Gambling Index (CPGI), was empirically tested using data from the 2005 Northern Territory Gambling Prevalence Survey (Australia). This survey collected information on gambling participation, problem gambling, and a range of socio-demographic variables from a representative sample of the Northern Territory adult population. Principal Components Analysis of participation in eight different gambling activities was used to explore the underlying structure of participation. Subsequently, regression was used to identify associations between dimensions of participation, social characteristics, and problem gambling. While a two-factor solution supported a basic distinction between agonistic and aleatory games, the third factor of a three-factor solution combined the two categories, indicating that activity preferences are more complex than the agôn-alea duality would suggest. There were significant associations between the two-factor solution and socio-demographic variables including geographic remoteness, age, gender, and household type. No association was found between alea, agôn and the CPGI, suggesting that it is the configuration of specific games, rather the broad structure of activities, that influence problem gambling risk. In terms of harm minimisation, strategies that target specific gambling games may be more effective than those that cover a range of gambling modes.

Betting on the evidence: Reported gambling problems among the Indigenous population of the Northern Territory

Objectives: To address a shortfall in evidence with which to justify gambling‐specific interventions for the Indigenous population, we analysed two surveys (2002 National Aboriginal and Torres Strait Islander Social Survey and General Social Survey) that contain information on reported gambling problems for the NT.