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Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) women breastfeed at lower rates than non-Aboriginal women. Little is known about factors associated with breastfeeding specific to Aboriginal women and infants. Determine the protective and risk factors associated with breastfeeding for Aboriginal women in Australia. CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English reporting protective and risk factors associated with breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Ten percent of papers were co-screened, and two reviewers completed data extraction. Narrative data synthesis was used. The initial search identified 12,091 records, with 31 full text studies retrieved, and 17 reports from 14 studies met inclusion criteria. Protective factors included living in a remote area, attending an Aboriginal-specific service, attending a regional service, higher levels of education attainment, increased maternal age, living in larger households, being partnered, and having a higher reported number of stressful events and social health issues. The identified risk factors were smoking in pregnancy, admission to SCN or NICU, and being multiparous. This review identified factors associated with breastfeeding for Aboriginal women. Government focus, support, and consistent funding are required to plan and implement evidence-based interventions and services for Aboriginal women and infants in urban, rural, remote, and very remote locations. Rigorous research is required to understand the Aboriginal-specific factors associated with breastfeeding to improve rates and health outcomes for Aboriginal women and infants. [ABSTRACT FROM AUTHOR]

Australian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations. To determine rates of breastfeeding initiation and maintenance and compare individually collected survey data with existing routinely collected state and national breastfeeding data for Aboriginal women. CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10% of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance. The initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 78% (95% CI 0.71, 0.84), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding. Significant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies. [ABSTRACT FROM AUTHOR]

Australian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations. To determine rates of breastfeeding initiation and maintenance and compare individually collected survey data with existing routinely collected state and national breastfeeding data for Aboriginal women. CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10 % of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance. The initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 79 % (95 % CI 0.73, 0.85), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding. Significant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies. [ABSTRACT FROM AUTHOR]

There is little research to understand reasons for suboptimal influenza vaccination uptake among Aboriginal people of different ages in Australia. This study aimed to better understand the communication needs and preferences of Aboriginal families (Phase 2) in New South Wales, Australia, and their health service providers (Phase 1), to inform future interventions to improve influenza immunisation coverage in Aboriginal communities. This paper reports from Phase 1 of the study. Aboriginal and non-Aboriginal researchers designed and conducted the study, with cultural governance provided by Aboriginal health care professionals and other community members working within health departments or community healthcare settings across Australia. In Phase 1 we conducted interviews and focus groups with 18 Aboriginal immunisation providers and mainstream immunisation co-ordinators from three geographic areas in New South Wales. We used group-based thematic analysis with a cultural lens and sought participants' feedback prior to finalising results. We identified four themes, framed as opportunities for improvement: better supporting Aboriginal Medical Services as providers of influenza vaccinations; improving the accessibility and appropriateness of mainstream services for Aboriginal families; improving health providers' knowledge of Aboriginal people' influenza risk and their willingness to recommend vaccination; and engaging communities to design influenza vaccination resources. To achieve optimal influenza vaccination coverage, all health services must take responsibility for providing culturally responsive clinical care to Aboriginal families. We suggest that, where possible, mainstream services incorporate elements of the family-centred and broader model of health used by Aboriginal Medical Services. This includes creating a welcoming environment, appropriately identifying and getting to know Aboriginal patients, taking a preventative approach, and opportunistically offering and strongly encouraging influenza vaccination to the individual and their family. [ABSTRACT FROM AUTHOR]

• Aboriginal perceptions about the overrepresentation of Aboriginal infants in out-of-home care include adversities related to colonisation not addressed prenatally, unnecessary reports, and unnecessary removals. • System causes of unnecessary reports include bias in reporting, visibility bias, health worker lack of experience and high demand for community services. • System causes of unnecessary removals include bias in removal decisions, bias in risk assessment instruments, power imbalances in child protection decision-making and lack of culturally informed community-based residential services following birth. • System causes of unmet need prenatally include disparity between resources for Aboriginal services and need, fear and distrust of child protection, an inexperienced Aboriginal workforce and challenges identifying high risk Aboriginal families prenatally. • Core components of an effective response to tackle system causes of Aboriginal baby removals include mediation of child protection activities, supportive links between Aboriginal services, child protection and health workers, culturally grounded case practice, traditional cultural activities, and flexible support funds. The increasing rate of statutory Aboriginal infant removal in Australia, which has reached almost 10% of live births in the state of Victoria, is a crisis motivating radical change in child protection pathways. This paper describes the problem analysis and design phases of an Aboriginal-led systems change project intended to ensure Aboriginal infants are raised safe and strong in family, Community, and culture by creating a response capable of shifting underlying system factors. Dialogue and deliberation processes involving 27 practitioners working within Aboriginal health and social care programs in the Bayside Peninsula Area of metropolitan Melbourne, the traditional land of the Bunurong people, was the overarching method used to develop a shared understanding of the problem of Aboriginal infant removals and reach a consensus about what to do in the local system. The themes that emerged during problem analysis reflect a risk/bias theoretical perspective, and in the design phase, it was deemed necessary to reduce both child safety-related risk as well as bias in the child protection system that responds to risk. The ensuing Bringing Up Aboriginal Babies at Home program has a clear systems theory of change, and a service blueprint describing how it is going to be implemented. Bringing Up Aboriginal Babies at Home practice resonates with other programs that have evolved independently in Australia and in other western child protection jurisdictions to reduce infant removals, including building trust for engagement, inspiring hope, openness and transparency, activating extended networks of formal and informal supports, and close collaboration with antenatal and child protection services. Program evaluation will determine whether Bringing Up Aboriginal Babies at Home (BUABAH) can be implemented with fidelity, tackle identified system flaws, reduce the number of Aboriginal infants taken into statutory care and become sustainable. [ABSTRACT FROM AUTHOR]

Summary Background Despite numerous recommendations by governments, researchers, and education policymakers the recruitment, retention and success of undergraduate indigenous students in higher education is not commensurate of the wider student population. There is minimal evidence of valuing indigenous worldviews and perspectives in curricula, and effectiveness of educational strategies to strengthen indigenous student success rates in completing undergraduate studies. Objectives To conduct an integrative systematic review of educational strategies to promote academic success and resilience in undergraduate indigenous students. Methods Major databases of Scopus, ProQuest, Informit and Web of Science were searched. Inclusion criteria were peer reviewed research articles from scholarly journals that referenced indigenous, aboriginal, First Nation or Māori students in undergraduate programs in higher education. The search was limited to English language and studies conducted from 1995 to 2014. Results The search yielded 156 research papers which reduced to 16 papers that met the inclusion criteria. The included papers were critiqued from a standpoint theory approach that reflects feminism, cultural respect, and humanism. Much of the literature describes issues, and provides qualitative analyses of experiences, but empirical evaluations of interventions are rare. Conclusions There was a gap in current research evaluating strategies to improve indigenous student success and resilience. Key strategies for indigenous student success are multi-faceted, layered support, underpinned by the principles of respect, relationships, and responsibility. Implications for nursing and midwifery education, research and health care practice are outlined. [ABSTRACT FROM AUTHOR]

A series of papers using data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) explored the influence of clinical and organizational characteristics on the decision to place Aboriginal children in out-of-home placements at the conclusion of child maltreatment investigations. The purpose of this paper is to further explore a consistent finding of the previous analyses: the proportion of investigations involving Aboriginal children at a child welfare agency is associated with placement for all children in that agency. CIS-2008 data were used in the analysis, which allowed for inclusion of previously unavailable organizational and contextual variables. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables on the placement decision. Final models revealed that the proportion of investigations conducted by the child welfare agency involving Aboriginal children was again a key agency-level predictor of the placement decision for any child served by the agency. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur for any child. Further, this analysis demonstrated that structure of governance, an organizational-level variable not available in previous cycles of the CIS, is an important agency-level predictor of out-of-home placement. Further analysis is needed to fully understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This paper builds upon the analyses presented in two companion papers (Fluke et al., 2010; Fallon et al., 2013) using data from the 1998 and 2003 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-1998 and CIS-2003) to examine the influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. This paper explores various model specifications to explain the effect of an agency-level factor, proportion of Aboriginal reports, which emerged as a stable and significant factor through the two data collection cycles. It addresses the issue of data comparability between the two cycles and explores various re-specifications and descriptive analyses of reported models to evaluate their solidity with regards to the sampling schemes and the precise contribution of a multi-level specification. Methods: The decision to place a child in out-of-home care was examined using data from the CIS-2003. This child welfare dataset collected information about the results of nearly 12,000 child maltreatment investigations as well as a description of the characteristics of the workers and organization responsible for conducting those investigations. Multi-level statistical models were developed using MPlus software, which can accommodate dichotomous outcome variables and are more reflective of decision-making in child welfare. The models are thus multi-level binary logistic regressions. Results: Final models revealed that two agency-level variables, ‘Education degree of majority of workers’ and ‘Degree of centralization in the agency’ clarify the nature of the effect of ‘Proportion of Aboriginal reports’, a stable, key second level predictor of the placement decision. The comparability of the effect of this agency-level variable across the 1998 and 2003 cycles becomes further evident through this analysis. By using a unified database including both cycles and various specifications of models, the comparability was found to be robust, in addition to clarifying the precise contribution of a multi-level specification. Conclusions: This third paper in a series establishes the ‘Proportion of Aboriginal reports’ received by the child welfare agency as an important agency level predictor associated with a child''s likelihood of being placed in the Canadian child protection system. While the more complex models give support to the notion that unequal resources subtend those results, more analyses are needed to confirm this hypothesis. Unequal resources for agencies with larger Aboriginal caseloads may explain the persistence of the results. These findings suggest that specific resource constraints related to worker education may be explanatory. [Copyright &y& Elsevier]

Abstract: This paper examines responses to racism and the pathways through which racism can affect health and wellbeing for Aboriginal people living in an urban environment. Face-to-face interviews were conducted in 2006/07 with 153 Aboriginal people living in Adelaide, Australia. Participants were asked about their experience of, and responses to, racism, and the impact of these experiences on their health. Racism was regularly experienced by 93% of participants. Almost two thirds of people felt that racism affected their health. Using a thematic analysis with a particular focus on how agency and structure interacted, a number of key reactions and responses to racism were identified. These included: emotional and physiological reactions; and responses such as gaining support from social networks; confronting the person/situation; ignoring it; avoiding situations where they might experience racism; ‘minimising’ the significance or severity of racism or questioning whether incidents were racist; and consuming alcohol, tobacco and other drugs. A further theme was a conscious decision to not ‘allow’ racism to affect health. Our study found that most people used more than one of these coping strategies, and that strategies were selected with an awareness of positive and negative health impacts. While individuals demonstrated substantial agency in their responses, there were clear structural constraints on how they reacted and responded. We found that not only was racism potentially detrimental to health, but so too were some responses. However, while some strategies appeared ‘healthier’ than others, most strategies entailed costs and benefits, and these depended on the meanings of responses for individuals. This paper concludes that initiatives to promote health-protective responses to racism need to consider structural constraints and the overarching goal of reducing systemic racism. [Copyright &y& Elsevier]

Although a number of authors have commented on what mental health practitioners should be taught to be effective and appropriate with indigenous people, rarely have traditional healers been asked for their views. This paper explores what a diverse group of traditional healing elders believe are the important attributes for mental health providers to embrace and what principles they should adopt to guide their training. How indigenous people understand the meaning of mental health is also examined. The research presented was conducted in preparation for developing a cross-cultural training program for human service providers that would include traditional elders as community mentors and adjunct faculty on equal status with academically trained faculty. The goal is to identify and summarize the core values and principles needed to train mental health providers to work in harmony with traditional healers. The term indigenous used in this paper refers to people who have lived in a place long enough to develop local knowledge and practices about that place, even though they might not have been the original inhabitants. For example, the Dene in Arizona are indigenous even though they have only occupied that area from about 1100 ad. Last, the paper is presented in an indigenous way, first by situating the author, telling a story, explaining the methodology, describing the elders and what they said, and ending with a story to dramatize the conclusions as indigenous elders would do. [Copyright &y& Elsevier]

In this paper, I suggest that the category of ‘ward,’ a designation used for Aboriginal Australians in the 1950s and 1960s, has re-emerged in contemporary Northern Territory (NT) life. Wardship represents an in-between status, neither citizens nor non-citizens, but rather an anticipatory citizenship formation constructed by the Australian state. The ward is a not-yet citizen, and the deeds, acts, and discourses that define the ward's capacities to act as a political subject can maintain their anticipatory nature even as people ‘achieve’ formal citizenship. Wardship can be layered on top of citizen and non-citizen status alike. Rather than accounting for the grey areas between ‘citizen’ and ‘non-citizen,’ therefore, wards exist beyond this theoretical continuum, demanding a more nuanced accounting of political subjectivities and people's relationships to the state. I trace the emergence of the category ‘ward’ in the 1950s and 1960s in Australia and its re-emergence for Aboriginal Australians impacted by the 2007 Northern Territory Emergency Response legislation. The promise of citizenship offered by the status of ‘ward’ is built upon expectations about family life, economic activity, and appropriate behaviour. These assumptions underscore an implicit bargain between individuals and the state, that neoliberalised self-discipline will lead to both formal citizenship rights and a sense of belonging. Built-in impediments, however, ensure that this bargain is difficult, if not impossible, to fulfil. [ABSTRACT FROM AUTHOR]

Scholars have theorized that advocates who listen to the experiences of traumatized individuals suffer from ‘vicarious trauma,’ where they become affected by the process of working with trauma sufferers. Yet I argue that trauma is contagious, rather than vicarious: contagious trauma spreads , compounding and binding together sometimes unrelated life traumas. This paper focuses on the spread of contagious trauma within advocates who work together with people affected by two sets of policies that compound trauma in Australia's Northern Territory, Aboriginal Australians affected by the 2007 Northern Territory Emergency Response Legislation and asylum seekers affected by Australia's policies of mandatory detention. Using ethnographic data from participant observation and interviews with advocates as well as autoethnographic excerpts from field notes, I argue that advocates experience contagious trauma as the effects of witnessing trauma combine toxically with their own life traumas. Contagious trauma expands the destructive effects of traumatic public policy, and simultaneously shrinks the capacity of advocacy that contests these policies. Capacity shrinks as advocates construct barriers to keep trauma at bay. [ABSTRACT FROM AUTHOR]

Background In Australia, Aboriginal women and babies experience higher maternal and perinatal morbidity and mortality rates than their non-Aboriginal counterparts. Whilst midwifery led continuity of care has been shown to be safe for women and their babies, with benefits including reducing the preterm birth rate, access to this model of care in remote areas remains limited. A Midwifery Group Practice was established in 2009 in a remote city of the Northern Territory, Australia, with the aim of improving outcomes and access to midwifery continuity of care. Aim The aim of this paper is to describe the maternal and newborn outcomes for women accessing midwifery continuity of care in a remote context in Australia. Methods A retrospective descriptive design using data from two existing electronic databases was undertaken and analysed descriptively. Findings In total, 763 women (40% of whom were Aboriginal) gave birth to 769 babies over a four year period. There were no maternal deaths and the rate of perinatal mortality was lower than that across the Northern Territory. Lower rates of preterm birth (6%) and low birth weight babies (5%) were found in comparison to population based data. Conclusion Continuity of Midwifery Care can be effectively provided to remote dwelling Aboriginal women and appears to improve outcomes for women and their infants. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to illustrate a case in which social desirability bias may have affected exit survey results. In this case, an exit survey of visitors to a First Nations (or aboriginal) campground, the results varied according to who collected the data (two aboriginal or First Nations research assistant versus a Caucasian researcher or mailbox). Overall, those who delivered the results to the First Nations research assistants provided answers that were more favorable than those delivered to the Caucasian researcher or mailbox. Many of results were found to be overly positive especially in regards to questions related to staff performance. The results of this study indicate that tourism researchers must be wary of data collection procedures (especially when attempting to measure cross culturally). Finally, this paper examines methods to counter act situations, which may produce social desirability bias. [Copyright &y& Elsevier]

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity. [ABSTRACT FROM AUTHOR]

Highlights: [•] This paper describes 692 Indigenous Australian children's language competence. [•] Cross-sectional and longitudinal data are reported from 3 to 7 years of age based on parent report and direct assessment. [•] Children spoke between one and eight languages: English, Indigenous languages, creoles, foreign languages, and sign languages. [•] Children who spoke an Indigenous language were more likely to live in moderate to extreme isolation. [•] Language environments were rich. Family members and friends told stories, read books, and listened to the children read. [ABSTRACT FROM AUTHOR]

Objective: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. Design: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. Setting: the 'top end' of the Northern Territory of Australia. Participants: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. Findings: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. Key conclusions and implications for practice: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth. [ABSTRACT FROM AUTHOR]

Abstract: The high rate of youth suicide in some First Nations villages of Northern Quebec is an important public health problem. Based on a six-year field study in three villages belonging to the Atikamekw and Anishinabe groups, this paper proposes changes in three areas of social policy that could contribute to prevention of youth suicide. These three areas are: youth protection, administration of justice, and housing. An argument is made first to adapt the youth protection law of Quebec and to give greater responsibility to communities in individual cases in order to prevent child placement outside the villages. Regarding the administration of justice, we suggest initiatives to encourage rapid prosecution of crimes on reserves and the adoption of an approach based on reconciliation between perpetrator and victim. Finally, we indicate how housing measures could help safeguard children's wellbeing given that overcrowding can contribute to suicide. The discussion also proposes that these three key changes in social policy could be relevant in other Aboriginal communities both within and outside of Quebec. [Copyright &y& Elsevier]

Abstract: Scholars and environmental managers of complex social–ecological systems (SESs) have called for new institutional models to facilitate adaptive governance. This paper explores one adaptive governance approach as used by Girringun Aboriginal Corporation, an association of Australian Aboriginal groups in north-eastern Australia. Girringun uses this approach to translate customary obligations into sophisticated management actions that address the complex social, economic, land and sea management challenges encountered on its members’ country. Its decision-making is informed by philosophies of ‘caring for country’ and ‘healthy country, healthy people’. Girringun’s strategies articulate cultural, social and livelihood development aspirations into environmental management, education and visual art projects and activities. Governance emphasises strong and visionary leadership, reconciliation, and strategic partnerships developed to expand its role as SES managers in co-operation with non-Aboriginal organisations. Girringun’s innovative structure and creative strategies provide insight into adaptive governance of cross-cultural SES, where differing aspirations and institutional arrangements can be melded towards creative management opportunities. [Copyright &y& Elsevier]

Abstract: Objective: Fluke et al. (2010) analyzed Canadian Incidence Study on Reported Child Abuse and Neglect (CIS) data collected in 1998 to explore the influence of clinical and organizational characteristics on the decision to place Aboriginal children in an out-of-home placement at the conclusion of a child maltreatment investigation. This study explores this same question using CIS data collected in 2003 which included a larger sample of Aboriginal children and First Nations child and family service agencies. Methods: The decision to place a child in an out-of-home placement was examined using data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003 and a reanalysis of CIS-1998 data (Fluke et al., 2010). The CIS-2003 dataset includes information on nearly 12,000 child maltreatment investigations from the time of report to case disposition. The CIS-2003 also captures information on the characteristics of investigating workers and the child welfare organizations for which they work. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables using MPlus software. MPlus allows the use of dichotomous outcome variables, which are more reflective of decision-making in child welfare and facilitates the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. Results: Final models revealed the proportion of investigations conducted by the child welfare agency involving Aboriginal children was a key single agency level predictor of the placement decision. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur. Contrary to the findings in the first paper (Fluke et al., 2010), individual Aboriginal status also remained significant in the final model at the first level. Conclusions: Further analysis needs to be conducted to further understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children. There is also a need for research that is sensitive to differences among, and between, Métis, First Nations and Inuit communities. Results are not generalizable to Québec because data from this province were excluded. [Copyright &y& Elsevier]

Background: In trying to help Aboriginal and Torres Strait Islander (Indigenous) individuals or communities to stop smoking or reduce the harms from alcohol, it is important to be aware of the strong biological basis of the drive to return to nicotine or alcohol. Methods: In this paper we briefly describe the social and neurobiological factors that drive a dependent smoker or drinker to keep using. We set out the current range of pharmacological treatments for dependence, their role in assisting a person to either stop using or avoid relapse, and we discuss issues relating to their use in Aboriginal Australians. Concluding comments: There is a firm evidence base for the use of pharmacological treatments for nicotine or alcohol dependence, particularly in severe dependence or when counselling or non-pharmacological approaches have failed. Indigenous Australians should be able to access the full range of approaches to managing these conditions. Working in partnership with Indigenous health staff and agencies can help ensure that appropriate access to treatment and quality treatment delivery occurs. [ABSTRACT FROM AUTHOR]

Summary: Aboriginal nursing students face numerous challenges in North American nursing educational programs, as reflected in the relatively high attrition rate of these students. In this paper, the authors argue that nurse educators need to create more culturally relevant curriculum and instructional approaches for Aboriginal students. Such approaches would help nursing educators to ensure that current aboriginal nursing programs—which are largely assimilative in nature—can be more successful and transformative in nature. [Copyright &y& Elsevier]

Abstract: Climate change has been identified as potentially the biggest health threat of the 21st century. Canada in general has a well developed public health system and low burden of health which will moderate vulnerability. However, there is significant heterogeneity in health outcomes, and health inequality is particularly pronounced among Aboriginal Canadians. Intervention is needed to prevent, prepare for, and manage climate change effects on Aboriginal health but is constrained by a limited understanding of vulnerability and its determinants. Despite limited research on climate change and Aboriginal health, however, there is a well established literature on Aboriginal health outcomes, determinants, and trends in Canada; characteristics that will determine vulnerability to climate change. In this paper we systematically review this literature, using a vulnerability framework to identify the broad level factors constraining adaptive capacity and increasing sensitivity to climate change. Determinants identified include: poverty, technological capacity constraints, socio-political values and inequality, institutional capacity challenges, and information deficit. The magnitude and nature of these determinants will be distributed unevenly within and between Aboriginal populations necessitating place-based and regional level studies to examine how these broad factors will affect vulnerability at lower levels. The study also supports the need for collaboration across all sectors and levels of government, open and meaningful dialogue between policy makers, scientists, health professionals, and Aboriginal communities, and capacity building at a local level, to plan for climate change. Ultimately, however, efforts to reduce the vulnerability of Aboriginal Canadians to climate change and intervene to prevent, reduce, and manage climate-sensitive health outcomes, will fail unless the broader determinants of socio-economic and health inequality are addressed. [ABSTRACT FROM AUTHOR]

The use of kinos, a class of polyphenol-rich, characteristically coloured astringent plant exudates, is a feature of many ethnomedical systems. Though once well-regarded in formal health care systems, since the mid 20th century they have declined in popularity. In view of the current interest in traditional medicines as a source of new therapeutic agents and the information published in the past 30 years in respect of the bioactivity of compounds known to occur in kinos, a review of the current knowledge of this class of plant exudates is overdue. This paper therefore presents information on the history, botany, natural formation, chemistry and pharmacology as well as technical and potential medical applications of kinos, with particular reference to those of Australian Eucalyptus species and Aboriginal ethnomedical and also early European settlers’ practices. [Copyright &y& Elsevier]

The life-expectancy gap between Indigenous and non-Indigenous Australians remains one of contemporary Australia''s most enduring health divides. The reduction of observed health outcome disparity between population groups based on measures of socioeconomic status, geography, or ethnicity stands as a key target of coordinated societal and health system reform. CVD remains the principal cause of death among all Australian population groups, including Aboriginal males and females, and is the primary contributor to the 17-year life-expectancy gap between Aboriginal and non-Aboriginal Australians. This paper discusses the challenges inherent, from the perspective of broader policy frameworks and health system reform, to reducing disparity between population groups within Australia, and outlines the opportunities for change that could contribute benefit to Aboriginal and mainstream Australians in regards to reducing the burden of CVD and related conditions. Further, through mapping adverse outcomes to acute cardiac events it seeks to discuss several key targets for reform that may serve to reduce health disparity between Aboriginal and non-Aboriginal Australians. [Copyright &y& Elsevier]

Summary: Motivated by a shortage of Aboriginal nurses and recurring difficulties in recruitment and retention of Aboriginal peoples in nursing education, a critical ethnography was conducted to examine the experiences of undergraduate Aboriginal nursing students in two Canadian schools of nursing. We conducted audiotaped interviews with Aboriginal nursing students (n =31), Aboriginal nurses (n =5), nursing faculty members (n =24), and individuals who were identified as knowledgeable about the context that might shape the experiences (n =16). Other data sources included reflexive and descriptive fieldnotes from 200h of fieldwork in classroom and laboratory practice sessions and 135 texts from the participating schools. Nursing textbooks, course syllabi, policies, procedures, clinical evaluation forms and websites were randomly selected and analyzed to explicate how texts shaped the students’ experiences. In this paper, we discuss the findings of the study and briefly share our recommendations. [Copyright &y& Elsevier]

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In 1999 the Supreme Court of Canada ruled that the aboriginals of Atlantic Canada had a treaty right to maintain a moderate livelihood through fishing. Following this decision, the Government of Canada implemented a plan to provide access to the fisheries. This paper reviews the implementation of the policy and focuses on a specific case where serious disputes arose. Policy implementation is compared to implementation in other jurisdictions and lessons are drawn from what has been described as a mechanistic strategy to effect social change. [Copyright &y& Elsevier]

Suicide prevention training in Aboriginal and Torres Strait Islander communities is a national health priority in Australia. This paper describes a qualitative study to increase understanding of how a mobile application (app) could be used to support suicide prevention gatekeepers in Indigenous communities. We respectfully use the term Indigenous to refer to Australian peoples of Aboriginal and/or Torres Strait Islander descent. Two participatory design workshops were held with 12 participants who were either Indigenous health workers or community members. The workshops first explored what knowledge, skills, and support suicide prevention gatekeepers in Indigenous communities may require, as well as how technology, specifically mobile apps, could be used to support these needs. Qualitative analysis identified four themes related to perceptions of who gatekeepers are, their role requirements, technology and supporting resources, as well as broader community issues. Participants thought training programs should target key, accessible, and respected people from diverse, designated, and emergent groups in Indigenous communities to act as gatekeepers, but requested an alternative, more culturally appropriate term to 'gatekeeper' (e.g., responder). Training should prepare gatekeepers for multifaceted suicide prevention roles, including the identification and management of at-risk Indigenous persons, the provision of psychoeducation and ongoing support, as well as facilitate integrated care in collaboration with community services. A combination of multiple support resources was recommended, including multi-platform options in the technology (e.g., mobile applications, social media) and physical domains (e.g., wallet cards, regular meetings). Recommended app features included culturally appropriate refresher content on suicide intervention, training recall, integrated care, how to access gatekeeper peer support, and debriefing. Broader community concerns on gatekeeper support needs were also considered. • Qualitative study explores new suicide prevention tools for Indigenous Australians. • Multi-platform technology and physical gatekeeper support resources recommended. • Key app functions include suicide intervention, refresher training, and referral. • Gatekeeper/responder selection criteria and training recommendations are provided. [ABSTRACT FROM AUTHOR]

• Aboriginal students scored lower than non-Aboriginal students for all sources of support. • Aboriginal students scored lower than non-Aboriginal students for all measures of wellbeing. • Family support is more likely to contribute to wellbeing for Aboriginal students. Appropriate support is crucial for Australian Aboriginal students to do well. The purpose of this paper was to investigate relations between 3 sources of educational support and 5 wellbeing outcomes for Aboriginal and non-Aboriginal Australian students and how these relations may differ for each group. Data were collected from students in Years 4–6 (N = 660) from 171 primary schools in the state of New South Wales, Australia. Findings not only further revealed that there is a need to improve the psychosocial wellbeing of Aboriginal students in Australia, but also suggest that to improve wellbeing, educational support needs to be provided from various sources, including working with Indigenous families to capitalize on family support for the wellbeing of Aboriginal students. [ABSTRACT FROM AUTHOR]

Abstract: Objective: the Malabar Community Midwifery Link Service was developed to meet the needs of women from Aboriginal and Torres Strait Islander communities in suburban Sydney, Australia. This paper reports the evaluation from the perspective of the Aboriginal and Torres Strait Islander women who accessed the service. Methods: a descriptive study using quantitative and qualitative approaches was undertaken for the first two years of the service. Clinical outcomes for women who gave birth in 2007 and 2008 were collected prospectively. A focus group with Aboriginal and Torres Strait Islander women was conducted, then tape recorded, transcribed verbatim and analysed qualitatively. Findings: 353 women gave birth through the Malabar service during 2007 and 2008. Over 40% of the babies born were identified as Aboriginal and Torres Strait Islander. Almost all the women had their first antenatal visit before 20 weeks of pregnancy. The service was successful in reducing the number of women smoking cigarettes during pregnancy. Women felt the service provided ease of access, continuity of care and caregiver, trust and trusting relationships. Conclusions: the Malabar service is an excellent example of a primary health care model of care that is meeting the needs of the community. Improving maternal and neonatal outcomes takes considerable time as the underlying causes of the disparities are complex. Implications: further research into ways to ensure that services like Malabar can address issues like smoking in pregnancy and the range of social and emotional issues faced by Australian Aboriginal and Torres Strait Islander women and families needs to be undertaken. More community-based appropriate services should be developed for these families. [Copyright &y& Elsevier]

Summary: The issue of family violence and sexual abuse in Indigenous communities across Australia has attracted much attention throughout 2007, including significant intervention by the federal government into communities deemed to be in crisis. This paper critically examines the reporting and recording of Indigenous violence in Australia and reflects on what ‘statistics’ can offer as we grapple with how to respond appropriately to a problem defined as a ‘national emergency’. [Copyright &y& Elsevier]