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Physical activity typically decreases during teenage years and has been identified as a health priority by Aboriginal adolescents. We examined associations between physical activity levels and sociodemographic, movement and health variables in the Aboriginal led ‘Next Generation: Youth Well-being (NextGen) Study’ of Aboriginal people aged 10–24 years from Central Australia, Western Australia and New South Wales. Baseline survey data collected by Aboriginal researchers and Aboriginal youth peer recruiters from 2018 to 2020 examined demographics and health-related behaviours. Logistic regression was used to estimate odds ratios (OR) for engaging in high levels of physical activity in the past week (3–7 days; 0–2 days (ref), or ‘don’t remember’) associated with demographic and behavioural factors. Of 1170 adolescents, 524 (41.9%) had high levels of physical activity; 455 (36.4%) had low levels; 191 (15.3%) did not remember. Factors independently associated with higher odds of physical activity 3–7 days/week were low weekday recreational screen time [55.3% vs. 44.0%, OR 1.79 (1.16–2.76)], having non-smoking friends [50.4% vs. 25.0%, OR 2.27 (1.03–5.00)] and having fewer friends that drink alcohol [48.1% vs. 35.2%, OR 2.08 (1.05–4.14)]. Lower odds of high physical activity were independently associated with being female [40.2% vs. 50.9%, OR 0.57 (0.40–0.80)] and some findings differed by sex. The NextGen study provides evidence to inform the co-design and implementation of strategies to increase Aboriginal adolescent physical activity such as focusing on peer influences and co-occurring behaviours such as screen time.

Conventional dietary assessment methods are based predominately on Western models which lack Aboriginal and Torres Strait Islander knowledges, methodologies, and social and cultural contextualisation. This review considered dietary assessment methods used with Aboriginal and Torres Strait Islander populations and assessed their applicability. Four electronic databases and grey literature were searched with no time limit applied to the results. Screening, data extraction and quality appraisal were undertaken independently by two reviewers. Out of 22 studies, 20 were conducted in rural/remote settings, one in an urban setting, and one at the national population level. The most frequently used and applicable dietary assessment method involved store data. Weighed food records and food frequency questionnaires had low applicability. Modifications of conventional methods were commonly used to adapt to Indigenous practices, but few studies incorporated Indigenous research methodologies such as yarning. This highlights an opportunity for further investigation to validate the accuracy of methods that incorporate qualitative yarning-based approaches, or other Indigenous research methodologies, into quantitative data collection. The importance of developing validated dietary assessment methods that are appropriate for this population cannot be understated considering the high susceptibility to nutrition-related health conditions such as malnutrition, overweight or obesity, diabetes, and cardiovascular disease.

Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components.

Objective The primary objective of this systematic review was to identify contributing causes to leave events from health services for Australian patients. The second objective was to identify evidence based preventative measures for effectively reducing leave events, which could be implemented. Study design Articles published in Australia were included if they reported on Aboriginal and/or Torres Strait Islander people and other Australians who leave health services prior to being seen or discharged by a medical professional. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed, and data were extracted with standardised tools.Data sources MEDLINE and Google Scholar were searched for relevant publications from May 27th to June 30th, 2020. The search returned 30 relevant records. Nine additional records were identified by manual search in Google Scholar. References of included articles were searched. From these articles, 11 met the inclusion criteria. Of these 5 were from New South Wales, 2 from Western Australia, 1 each from Queensland and Northern Territory, two were conducted nationally. Data synthesis Four studies used a retrospective cohort method, one included patient interviews,(1) Four cohort studies and two systematic reviews were included. Two government reports and one health policy document were included in this review. All studies were from Australia using mixed methods.Conclusions This review identified causes for, and evidence based preventative measures that have been or could be implemented to reduce Leave Events and describes additional terms and definitions used for Leave Events.

Introduction Reduced licence participation in Aboriginal and Torres Strait Islander communities contributes to transport disadvantage, higher rates of transport-related morbidity and mortality. This study will incorporate a social ecology framework to better understand the economic, social inclusion and cultural impacts of licensing at all levels of the system from individuals, families, communities and the socio-political environment. Methods Qualitative methods underpinned by a social ecology approach triangulates in-depth interviews (n = 17) and community discussion groups (n = 21). Analysis was inductive and deductive. Results The impacts of licence participation were evident at multiple levels of the social ecology and it emerged that licensing greatly impacts the mobility of individuals, families and communities. Beyond mobility, the data amalgamated into four main themes: 1) Social and economic opportunity; 2) Access to services; 3) Cultural identity; and 4) Autonomy and the justice system. Discussion Reduced driver licensing is impacting individuals, families and communities with an immense cost to multiple levels of the social ecology. This study has highlighted the value of licence participation for cultural identity and community well-being. Further, licence participation interacts with persistent inequity in the licensing and justice system and impacts on the capacity of individuals, families and communities to function autonomously within the parameters of the law. Accordingly, policy should be directed at facilitating equitable access to driver licensing to promote social inclusion. Licensing is not simply a “Transport” problem; addressing this complex issue of health and social justice is a prime example of the need for an intersectoral approach that targets change at the socio-political level to improve the equity, health and wellbeing of Aboriginal and Torres Strait Islander people.

Introduction Access to a valid driver licence for most Australians can be essential for employment. Aboriginal and Torres Strait Islander peoples however are under-represented as driver licence holders. As such driver licensing programs have been established across Australian States and Territories to support them to obtain a driver licence. The aim of this review is to identify these driver licensing programs and examine the effectiveness and impact on licensing and employment rates for Aboriginal and Torres Strait Islander peoples. Methods Two independent searches were performed. The first, a scoping review of the literature to identify and describe driver licensing programs throughout Australia. The second, a systematic review of electronic databases and relevant grey literature to examine the effectiveness and impact of driver licensing programs on licensing and employment rates. Two independent authors assessed publications for eligibility. Results The scoping review identified 42 driver licensing programs across all Australian States and Territories between the years 2000–2019. Considerable variations exist between program services and characteristics. The systematic review included eight publications that evaluated four driver licensing programs. Findings suggested end-to-end culturally appropriate driver licensing programs are effective in improving licensing rates. No program evaluated the impact of licence attainment on employment rates although two publication commented on a correlation. Conclusion Driver licensing programs are effective in increasing licensing rates amongst Aboriginal and Torres Strait Islander program clients, but despite the significant number of licensing programs operating, few are reporting program outcomes and even fewer have been evaluated. There is considerable variation between program designs, support provision, service delivery and limited consistency amongst evaluation frameworks used. A standardised approach to evaluating driver licensing programs should be adopted that incorporates a nationally agreed framework that include Aboriginal and Torres Strait Islander culture and employment outcomes.

Background Little is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats. Methods Focus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members. Results Parents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge. Conclusions We developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial.

Aboriginal and Torres Strait Islander people in Australia experience fatal road crashes at 2–3 times the rate of other Australians and sustain serious injuries at a rate about 20% higher. High rates of transport injury have been attributed to reduced driver licence participation in Aboriginal communities. Community-based licensing programs are an innovative multi-sectoral approach to addressing barriers to licensing (identification, literacy, supervised driving and costs) and reducing risks associated with unauthorised driving including transport injury and incarceration. We review the economic, social inclusion and cultural impacts of embedding a multi-sectoral injury prevention program, Driving Change, in Aboriginal communities in New South Wales, Australia using a social ecology framework. Qualitative methods underpinned by a social ecology approach triangulated in-depth interviews (n=17) and community discussion groups (n=21). Analysis was inductive and deductive. The data amalgamated into four main themes: 1) Social and economic opportunity; 2) Access to services; 3) Cultural identity; and 4) Autonomy and the justice system. Program impacts were evident at multiple levels of the social ecology; it emerged that licensing greatly impacts the mobility of individuals, families and communities. A driver licence facilitates access to employment, education, healthcare and social activities, which impacts the health and well-being of individuals, families and communities. The results highlight the value of licence participation for cultural identity and community well-being. Improving licence participation in Aboriginal communities has far-reaching effects that benefit all levels of the social ecology from individuals and families through to government across multiple sectors: health, education, human services, justice. Licensing is not simply a ‘Transport’ problem; addressing this complex issue of safety and social justice is a prime example of the need for multi-sectoral policy action to prevent injury, promote social inclusion and improve health and wellbeing of Aboriginal people.

The Driving Change programme was developed to facilitate access to licensing in Aboriginal communities in Australia. This process evaluation aimed to explore whether Driving Change was implemented as intended and was addressing the needs of the communities. A mixed methods approach was used, with triangulation of client data (n = 984), semi-structured interviews (n = 18) and client discussion groups (n = 21). Descriptive and regression analyses of quantitative and thematic analysis of qualitative data were drawn together to develop an integrated understanding of implementation barriers and facilitators. The programme reached 984 clients, with the majority from the target age group 16-24 years (56-89%). In multivariate analysis, clients who had supervised driving practice were 2.4 times more likely to attain a licence (95% CI: 1.9-3.1) and clients who received a high level of case management were 1.8 times more likely to progress to attain a licence than those who received low levels of case management (95% CI: 1.3-2.6). Implementation was facilitated by community partnerships and this was attributed to local delivery, Aboriginal leadership, connections with community networks and community ownership of solutions. Driving Change is engaging communities and reaching clients with a high level of need for licensing support. The programme is working with communities, benefiting from the input of cultural values and sharing ownership of local solutions. Community partnerships were critical to successfully supporting clients to overcome challenging barriers to participation. The learnings from this programme are relevant to complex community programme implementation and evaluation, particularly with diverse or hard to reach populations.

Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications. The trial is registered with Australia New Zealand Clinical Trials Registry ( ACTRN12613001068752 ). Date of registration: 24 September 2013.