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Introduction: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence of distress in cancer patients is established at approximately 50%, yet uptake of psychosocial support is minimal. Objective: This study aimed to understand why clinically distressed oncology patients choose not to access psychosocial support, including whether this differs by geographic location. It also aimed to determine the proportion of rural and metropolitan patients experiencing clinical levels of distress, and of these, the proportion who do not wish to access support. Design: The study used a cross‐sectional design. Two hundred and ninety‐eight Australian cancer patients completed an online survey, including the Distress Thermometer and open‐ended questions about reasons for declining support. Descriptive statistics and content analysis were used to analyse the data. Findings: More than half (56%) of participants reported experiencing clinically significant levels of distress. Of these, almost half (47%) declined psychosocial support. Content analysis of reasons for declining psychosocial support resulted in six main concepts: I don't need support; I'm using personal resources to cope; negative perceptions and attitudes; life doesn't stop for cancer; I'm focussed on fighting cancer; and systemic barriers. Rural cancer patients most often indicated using personal resources to cope, while metropolitan participants most commonly indicated not needing support. A range of subconcepts were also identified. Perceiving distress as manageable or transient was almost exclusively reported by metropolitan participants, while stigma was almost exclusively reported by rural participants. Discussion: The findings provided greater depth of insight into reasons cancer patients decline psychosocial support and identified several qualitative differences in the reasons provided by metropolitan and rural patients. Recommendations are provided for clinicians, in particular for clinicians who work with rural cancer patients and their supporters. Conclusion: These findings can inform equitable resourcing of psychosocial support in rural areas and the adaptation of psychosocial interventions to be more flexible and responsive to individual needs. This may help increase patient uptake of support, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. Design: A cross‐sectional analysis of the Australian Chiropractic Research Network project data. Setting: Nationally representative sample of registered chiropractors practising in Australia. Participants: Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. Main outcome measure: The demographics, practice characteristics and clinical management of chiropractors. Results: The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro‐occipital technique. Conclusion: A substantial number of chiropractors practice in rural or remote Australia and these rural or remote‐based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban‐located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision. [ABSTRACT FROM AUTHOR]

Objective This paper aims to describe cancer survival and examine association between survival and socio-demographic characteristics across Barwon South- Western region ( BSWR) in Victoria, Australia. Design This study is based on the retrospective cohort database of patients accessing oncology services across BSWR. Setting Six rural and three urban hospital settings across the BSWR. Participants The participants were patients who were diagnosed with cancer in 2009. Main outcome measures Overall survival (OS) of participants was the main outcome measure. Results Total of 1778 eligible patients had four-year OS for all cancers combined of 59.7% (95% CI, 57.4-62.0). Improved OS was observed for patients in the upper socio-economic tertile (64.2%; 95% CI, 60.9-67.5) compared to the middle (59.3%; 95% CI, 55.5-63.1) and lowest tertiles (49.6%; 95% CI, 44.2-54.9) ( P < 0.01). On multivariate analyses, higher socio-economic status remained a significant predictor of OS adjusting for gender, remoteness and age ( HR [hazard ratio] 0.81; 95% CI 0.74-0.89; P < 0.01). Remoteness was significantly associated with improved OS after adjusting for age, gender and socio-economic status ( HR 0.86; 95% CI, 0.77-0.97; P = 0.01). Older age ≥70 years compared to <70 years conferred inferior OS ( HR 3.08; 95% CI, 2.64-3.59; P < 0.01). Conclusions Our study confirmed improved survival outcomes for patients of higher socio-economic status and younger age. Future research to explain the unexpected survival benefit in patients who lived in more remote areas should examine factors including the correlation between geographical residence and eventual treatment facility as well as compare the BSWR care model to other regions' approaches. [ABSTRACT FROM AUTHOR]