Built Environment Features and Cardiometabolic Mortality and Morbidity in Remote Indigenous Communities in the Northern Territory, Australia.

Indigenous Australians experience poorer health than non-Indigenous Australians, with cardiometabolic diseases (CMD) being the leading causes of morbidity and mortality. Built environmental (BE) features are known to shape cardiometabolic health in urban contexts, yet little research has assessed such relationships for remote-dwelling Indigenous Australians. This study assessed associations between BE features and CMD-related morbidity and mortality in a large sample of remote Indigenous Australian communities in the Northern Territory (NT). CMD-related morbidity and mortality data were extracted from NT government health databases for 120 remote Indigenous Australian communities for the period 1 January 2010 to 31 December 2015. BE features were extracted from Serviced Land Availability Programme (SLAP) maps. Associations were estimated using negative binomial regression analysis. Univariable analysis revealed protective effects on all-cause mortality for the BE features of Education, Health, Disused Buildings, and Oval, and on CMD-related emergency department admissions for the BE feature Accommodation. Incidence rate ratios (IRR's) were greater, however, for the BE features Infrastructure Transport and Infrastructure Shelter. Geographic Isolation was associated with elevated mortality-related IRR's. Multivariable regression did not yield consistent associations between BE features and CMD outcomes, other than negative relationships for Indigenous Location-level median age and Geographic Isolation. This study indicates that relationships between BE features and health outcomes in urban populations do not extend to remote Indigenous Australian communities. This may reflect an overwhelming impact of broader social inequity, limited correspondence of BE measures with remote-dwelling Indigenous contexts, or a 'tipping point' of collective BE influences affecting health more than singular BE features.

Association of Built Environmental Features with Rates of Infectious Diseases in Remote Indigenous Communities in the Northern Territory, Australia.

The health of Indigenous Australians is far poorer than non-Indigenous Australians, including an excess burden of infectious diseases. The health effect of built environmental (BE) features on Indigenous communities receives little attention. This study's objective was to determine associations between BE features and infectious disease incidence rates in remote Indigenous communities in the Northern Territory (NT), Australia. Remote Indigenous communities (n = 110) were spatially joined to 93 Indigenous Locations (ILOC). Outcomes data were extracted (NT Notifiable Diseases System) and expressed as ILOC-specific incidence rates. Counts of buildings were extracted from community asset maps and grouped by function. Age-adjusted infectious disease rates were dichotomised, and bivariate binomial regression used to determine the relationships between BE variables and infectious disease. Infrastructure Shelter BE features were universally associated with significantly elevated disease outcomes (relative risk 1.67 to 2.03). Significant associations were observed for Services, Arena, Community, Childcare, Oval, and Sports and recreation BE features. BE groupings associated with disease outcomes were those with communal and/or social design intent or use. Comparable BE groupings without this intent or use did not associate with disease outcomes. While discouraging use of communal BE features during infectious disease outbreaks is a conceptually valid countermeasure, communal activities have additional health benefits themselves, and infectious disease transmission could instead be reduced through repairs to infrastructure, and more infrastructure. This is the first study to examine these associations simultaneously in more than a handful of remote Indigenous communities to illustrate community-level rather than aggregated population-level associations.

Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study.

PURPOSE: To investigate the successful strategies of health workers who support and regularly communicate with Aboriginal and Torres Strait Islander people about cancer and its treatment. METHODS: Semi-structured interviews were conducted face-to face or via telephone and audio-recorded with twenty-three health professionals (medical and radiation oncologists, oncology nurses and Aboriginal Health Workers), 5 identifying as Aboriginal or Torres Strait Islander in the Northern Territory and South Australia. When data saturation was reached, thematic analysis using a bottom up, essentialist/realist approach was used. RESULTS: Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves considering the physical environment and allowing time in interviews to establish a relationship. (2) Employ specific communication strategies to explain cancer, treatment and its side effects through language choices and employing visual aids such as drawings, metaphors and relatable analogies. (3) Obtain support from Aboriginal and Torres Strait Islander staff and patient escorts who can assist in communication. (4) Consider culture which involves collective decision making, strong connection to country and community, with cultural obligations and a unique understanding of cancer. (5) Anticipate the contextual complexities of conflicts between Western medicine and Aboriginal culture, practitioner bias and difficulty maintaining contact with patients. (6) Develop personal qualities of good communicators, including being patient-centred, showing respect, patience, empathy and honesty. CONCLUSION: These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal and Torres Strait Islander people with cancer.

Prioritizing Built Environmental Factors to Tackle Chronic and Infectious Diseases in Remote Northern Territory (NT) Communities of Australia: A Concept Mapping Study.

High prevalence of chronic and infectious diseases in Indigenous populations is a major public health concern both in global and Australian contexts. Limited research has examined the role of built environments in relation to Indigenous health in remote Australia. This study engaged stakeholders to understand their perceptions of the influence of built environmental factors on chronic and infectious diseases in remote Northern Territory (NT) communities. A preliminary set of 1120 built environmental indicators were systematically identified and classified using an Indigenous Indicator Classification System. The public and environmental health workforce was engaged to consolidate the classified indicators (n = 84), and then sort and rate the consolidated indicators based on their experience with living and working in remote NT communities. Sorting of the indicators resulted in a concept map with nine built environmental domains. Essential services and Facilities for health/safety were the highest ranked domains for both chronic and infectious diseases. Within these domains, adequate housing infrastructure, water supply, drainage system, reliable sewerage and power infrastructure, and access to health services were identified as the most important contributors to the development of these diseases. The findings highlight the features of community environments amenable to public health and social policy actions that could be targeted to help reduce prevalence of chronic and infectious diseases.

Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature.

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the "community infrastructure" domain within the built environment, and the "community capacity" domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study.

BACKGROUND: Providing culturally safe health care can contribute to improved health among Aboriginal people. However, little is known about how to make hospitals culturally safe for Aboriginal people. This study assessed the impact of an emergency department (ED)-based continuous quality improvement program on: the accuracy of recording of Aboriginal status in ED information systems; incomplete ED visits among Aboriginal patients; and the cultural appropriateness of ED systems and environments. METHODS: Between 2012 and 2014, the Aboriginal Identification in Hospitals Quality Improvement Program (AIHQIP) was implemented in eight EDs in NSW, Australia. A multiple baseline design and analysis of linked administrative data were used to assess program impact on the proportion of Aboriginal patients correctly identified as Aboriginal in ED information systems and incomplete ED visits in Aboriginal patients. Key informant interviews and document review were used to explore organisational changes. RESULTS: In all EDs combined, the AIHQIP was not associated with a reduction in incomplete ED visits in Aboriginal people, nor did it influence the proportion of ED visits made by Aboriginal people that had an accurate recording of Aboriginal status. However, in two EDs it was associated with an increase in the trend of accurate recording of Aboriginality from baseline to the intervention period (odds ratio (OR) 1.31, p < 0.001 in ED 4 and OR 1.15, p = 0.020 in ED 5). In other words, the accuracy of recording of Aboriginality increased from 61.4 to 70% in ED 4 and from 72.6 to 73.9% in ED 5. If the program were not implemented, only a marginal increase would have occurred in ED 4 (from 61.4 to 64%) and, in ED 5, the accuracy of reporting would have decreased (from 72.6 to 71.1%). Organisational changes were achieved across EDs, including modifications to waiting areas and improved processes for identifying Aboriginal patients and managing incomplete visits. CONCLUSIONS: The AIHQIP did not have an overall effect on the accuracy of recording of Aboriginal status or on levels of incomplete ED visits in Aboriginal patients. However, important organisational changes were achieved. Further research investigating the effectiveness of interventions to improve Aboriginal cultural safety is warranted.

Assessing research impact: Australian Research Council criteria and the case of Family Wellbeing research.

Researchers worldwide are increasingly reporting the societal impact of their research as part of national research productivity assessments. However, the challenges they encounter in developing their impact case studies against specified government assessment criteria and how pitfalls can be mitigated are not reported. This paper examines the key steps taken to develop an Aboriginal Family Wellbeing (FWB) empowerment research impact case study in the context of an Australian Research Council (ARC) pilot research impact assessment exercise and the challenges involved in applying the ARC criteria. The requirement that researchers demonstrate how their institutions support them to conduct impactful research has the potential to create supportive environments for researchers to be more responsive to the needs of users outside academia. However, the 15-year reference period for the associated research underpinning the reported impact and the focus on researcher's current institutional affiliation constitute potential constraints to demonstrating the true impact of research. For researchers working with Indigenous people, relationships that build over long periods of time, irrespective of university affiliation, are critical to conducting impactful research. A more open-ended time-frame, with no institutional restrictions for the 'associated research' provides the best opportunity to demonstrate the true benefits of research not only for Indigenous people but for Australian society more broadly.

'Imagine if I gave up smoking ...': a qualitative exploration of Aboriginal participants' perspectives of a self-management pilot training intervention.

This paper reports on a pilot qualitative study investigating Aboriginal participants' perspectives of the Flinders Living Well Smoke Free (LWSF) 'training intervention'. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care-planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation, the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study, 10 Aboriginal clients who had been volunteers in the mock care-planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal community controlled health services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care-planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program.

A preliminary adaptation of the Problem Gambling Severity Index for Indigenous Australians: internal reliability and construct validity.

OBJECTIVE: This paper describes the process employed to adapt the Problem Gambling Severity Index (PGSI) for use with Indigenous Australian populations. METHODS: This study comprised a two-stage process: an initial consultation with Indigenous health workers, informing the textual and conceptual adaptation of items, followed by trial of the adjusted instrument with Indigenous community members (n=301). RESULTS: Internal reliability was demonstrated: Australian Indigenous Problem Gambling Index (AIPGI) Cronbach's alpha α = 0.92 (Original PGSI, α = 0.84). Item-rest correlations confirmed that responses to items were consistent and related to the total score of remaining items. The AIPGI could predict gambling severity based on gambling frequency, when controlling for age and gender (OR=1.28, 95%CI 1.17-1.40). CONCLUSIONS: The adapted instrument is accessible to a cross-section of Indigenous Australians and has demonstrated properties of reliability and validity. An extended trial is needed to test the application of the instrument to a broader Indigenous audience and to further explore and confirm psychometric properties of the adapted instrument. IMPLICATIONS: This study introduces a culturally adapted tool for measuring rates of disordered gambling among Indigenous Australians.

Characterising the smoking status and quit smoking behaviour of aboriginal health workers in South Australia.

The study objectives were to characterise the smoking status and quit smoking behaviour of Aboriginal Health Workers (AHWs) in South Australia (SA), Australia; and identify the psychosocial, socio-demographic, and household smoking characteristics that distinguish smokers from quitters and never smokers. A self-reported cross-sectional survey was completed by AHWs in SA. Non-parametric statistics were used for inferential analyses. Eighty-five AHWs completed surveys representing a response rate of 63.0%. The prevalence of current smokers was 50.6%. Non-smokers (49.5%) included quitters (22.4%) and never smokers (27.1%). Smoking status did not differ by gender or geographic location. Of current smokers, 69.0% demonstrated a readiness to quit and 50.0% had made at least one quit attempt in the last 12 months. Compared to quitters and never smokers, current smokers expressed lower emotional wellbeing, and three times as many resided with another smoker. Quitters had the highest levels of perceived social support and part-time employment. A high proportion of AHWs who smoke desire, and are ready to quit. Individual, social and household factors differentiated smokers from non-smokers and quitters. Social support, and relationships and structures that favour social support, are implicated as necessary to enable AHWs who smoke to act on their desire to quit smoking.

Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: a concept mapping approach.

Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.

South Australian four-year-old Aboriginal children: residence and socioeconomic status influence weight.

OBJECTIVE: Obesity rates have increased in children in Australia in the past 15 years. However, there is little available population data describing rates of overweight and obesity in Aboriginal children. METHODS: Anthropometric data of four-year-old children (n=11,859) were collected by trained nurses at routine statewide preschool health checks during 2009. Weight status (underweight, healthy weight, overweight and obese) was determined using age and gender specific International Obesity Task Force (IOTF) cut-points. RESULTS: There were 337 Aboriginal children (3%) in the study population. Aboriginal children had significantly higher rates of overweight and obesity compared to non-Aboriginal children (28% compared to 18% respectively, χ(2) p=0.0001). A statistically significant association between BMIz score and identifying as Aboriginal remained after controlling for rural/urban residence and socioeconomic status using multiple regression analyses. CONCLUSIONS: Aboriginal children have higher rates of overweight and obesity compared to their non-Aboriginal peers by the time they are four years of age. Aboriginal children have higher BMIz scores compared to non-Aboriginal children after controlling for rural/urban residence and socioeconomic status. IMPLICATIONS: A significant investment is required to optimise the health of Aboriginal women before pregnancy and throughout pregnancy. A rethink may be necessary in the approach to dietary management and catch-up growth of Aboriginal children of low birth weight or having growth failure in early childhood.

An oral health literacy intervention for Indigenous adults in a rural setting in Australia.

BACKGROUND: Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy. METHODS/DESIGN: This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrollment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism. DISCUSSION: This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study.

INTRODUCTION: Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking. METHODS: We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes. RESULTS: Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting. CONCLUSIONS: Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community.

Reducing disease burden and health inequalities arising from chronic disease among Indigenous children: an early childhood caries intervention.

BACKGROUND: This study seeks to determine if implementing a culturally-appropriate early childhood caries (ECC) intervention reduces dental disease burden and oral health inequalities among Indigenous children living in South Australia, Australia. METHODS/DESIGN: This paper describes the study protocol for a randomised controlled trial conducted among Indigenous children living in South Australia with an anticipated sample of 400. The ECC intervention consists of four components: (1) provision of dental care; (2) fluoride varnish application to the teeth of children; (3) motivational interviewing and (4) anticipatory guidance. Participants are randomly assigned to two intervention groups, immediate (n = 200) or delayed (n = 200). Provision of dental care (1) occurs during pregnancy in the immediate intervention group or when children are 24-months in the delayed intervention group. Interventions (2), (3) and (4) occur when children are 6-, 12- and 18-months in the immediate intervention group or 24-, 30- and 36-months in the delayed intervention group. Hence, all participants receive the ECC intervention, though it is delayed 24 months for participants who are randomised to the control-delayed arm. In both groups, self-reported data will be collected at baseline (pregnancy) and when children are 24- and 36-months; and child clinical oral health status will be determined during standardised examinations conducted at 24- and 36-months by two calibrated dental professionals. DISCUSSION: Expected outcomes will address whether exposure to a culturally-appropriate ECC intervention is effective in reducing dental disease burden and oral health inequalities among Indigenous children living in South Australia.

"I know it's bad for me and yet I do it": exploring the factors that perpetuate smoking in Aboriginal Health Workers--a qualitative study.

BACKGROUND: Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients. METHODS: We conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives. RESULTS: AHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding). CONCLUSIONS: An extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated.

Exploring differences in survival from cancer among Indigenous and non-Indigenous Australians: implications for health service delivery and research.

The aim of this study is to compare cancer survivals of Indigenous and non-Indigenous Australians and consider health-service and research implications Cancer registry data from South Australia were used to calculate disease-specific survivals for Indigenous (n=671) and sampled non-Indigenous (n=15,799) patients diagnosed during 1977-2007, using Kaplan-Meier estimates and Cox proportional hazards regression. Indigenous and non-Indigenous five-year survivals were respectively: 40% and 57% for all cancer sites combined; 61% and 80% for female breast; 34% and 56% for colon/rectum; and 63% and 73% for cervix; whereas one-year survivals for cancers of unknown primary site were 5% and 22% respectively. Conversely, although not statistically significant (p=0.262), lung cancer survival tended to be higher in Indigenous than non-Indigenous patients. For all sites combined, Indigenous patients had lower survivals up to 70-79 years. The relative risk of death in Indigenous compared with non-Indigenous patients was 2.0 after adjusting for socio-demographic factors and diagnostic period, reducing to 1.4 when also adjusting for prognosis by primary site. Relative risks were 3.7 and 2.7 respectively for Indigenous compared with non-Indigenous patients from Far North remote communities. We conclude that relative risks for Indigenous compared with non-Indigenous patients for all cancers combined are elevated, as seen in the Northern Territory and Queensland. Despite uncertain accuracy of recording of Indigenous status, independent studies show risk elevations and point to the need to prevent cancers, particularly those of high lethal potential, to detect cancers earlier, and to complete planned treatment. A concerted health-service response is needed to address contributing geographic, socio-economic and cultural factors.

Comparing cancer profiles and survival of aboriginal and non-aboriginal patients in South Australia: where are the opportunities for improving Aboriginal health?

Data from the South Australian Cancer Registry (SACR) for 1977-2003 were used to calculate expected and actual distributions of cancer sites in Aboriginal versus non-Aboriginal populations. Expected distributions were calculated using indirect standardisation and compared with actual distributions using a global Chi-square test. Individual contributions to the Chi-square statistic (from each cancer site) were examined using a z-test and Bonferroni corrected p-value. The expected figure for each cancer site corresponds to the number of cancers we would have expected in Aboriginal patients if they had the same cancer distribution of site by age as the non-Aboriginal population. Expected 5- and 10-year survivals were also calculated and compared to expected survivals drawn from Statewide survivals adjusted for age at diagnosis. There was an overall significant difference in expected and actual cancer site distributions for South Australian Aboriginal male (c2 (17df) = 202.94) and female (c2 (20df) = 311.93) patients, and all patients collectively (c2 (22df) = 485.43). Aboriginal patients had poorer expected 5- and 10-year survival compared with South Australian non-Aboriginal patients, and even poorer actual 5- and 10-year survival than expected. The differences between the expected and actual cancer site distributions reflect the disparities in risk factor prevalence for largely preventable cancers and the survival results reflect the multitude of obstacles confronting Aboriginal patients with cancer compared with non-Aboriginal cancer patients. This study provides areas of focus for interventions to reduce cancer levels in the Aboriginal population and to improve survival of Aboriginal people diagnosed with cancer.