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Background Use of epidemiological research in policy and practice is suboptimal, contributing to significant preventable morbidity and mortality. Barriers to the use of research evidence in policy include lack of research–policy engagement, lack of policy-relevant research, differences in policymaker and researcher practice norms, time constraints, difficulties in coordination, and divergent languages and reward systems. Approach and outcomes In order to increase policy-relevant research and research uptake, we developed the output-orientated policy engagement (OOPE) model, in Australia. It integrates a foundational approach to engagement with cycles of specific activity focused around selected research outputs. Foundational elements include measures to increase recognition and valuing of policymaker expertise, emphasis on policy uptake, policy awareness of the research group’s work, regular policy engagement and policy-relevant capacity-building. Specific activities include (i) identification of an “output”—usually at draft stage—and program of work which are likely to be of interest to policymakers; (ii) initial engagement focusing on sharing “preview” evidence from this output, with an invitation to provide input into this and to advise on the broader program of work; and (iii) if there is sufficient interest, formation of a researcher–policy-maker partnership to shape and release the output, as well as inform the program of work. This cycle is repeated as the relationship continues and is deepened. As well as supporting policy-informed evidence generation and research-aware policymakers, the output-orientated model has been found to be beneficial in fostering the following: a pragmatic starting place for researchers, in often large and complex policy environments; purposeful and specific engagement, encouraging shared expectations; non-transactional engagement around common evidence needs, whereby researchers are not meeting with policymakers with the expectation of receiving funding; built-in translation; time and resource efficiency; relationship-building; mutual learning; policy-invested researchers and research-invested policy-makers; and tangible policy impacts. A case study outlines how the output-orientated approach supported researcher–policymaker collaboration to generate new evidence regarding Aboriginal and Torres Strait Islander cardiovascular disease risk and to apply this to national guidelines. Conclusion Output-orientated policy engagement provides a potentially useful pragmatic model to catalyse and support partnerships between researchers and policymakers, to increase the policy-relevance and application of epidemiological evidence.

The Australian e-Safety Commission reported in late May, 2023, that there had been more than a 10% rise in the proportion of complaints made by Aboriginal and Torres Strait Islander peoples about online cyber abuse, threats, and harassment.4 Furthermore, the First Peoples' Assembly of Victoria has gone from blocking two people a day for racist abuse on social media to blocking about 50 people, citing the national debate on an Indigenous Voice as the reason for this escalation.5 Similar discrimination was experienced by the LGBTQIA+ community during the plebiscites in the USA and the 2017 Australian Marriage Law Postal Survey plebiscite.15–20 The Voice referendum process creates a substantial cultural load for Aboriginal and Torres Strait Islander peoples. Speculating on the post-referendum situation: a No vote will have a profoundly negative effect on those in the Indigenous world who have walked a journey of reconciliation with politicians, business leaders, and Australian communities for nearly two decades. RL received funding from the Australian Government to monitor Indigenous mental health and racism during the referendum period.

The health disadvantages of Indigenous peoples around the world have their roots in colonisation and discrimination and are related to a loss of autonomy over lands and culture. This history has profoundly affected social determinants of health, such as poverty and marginalisation, and contributed to higher rates of communicable and non-communicable diseases in Indigenous people, and life expectancies that are typically 5 years or more lower than in non-Indigenous populations.1,2

Addressing Indigenous rights and interests in genetic resources has become increasingly challenging in an open science environment that promotes unrestricted access to genomic data. Although Indigenous experiences with genetic research have been shaped by a series of negative interactions, there is increasing recognition that equitable benefits can only be realized through greater participation of Indigenous communities. Issues of trust, accountability and equity underpin Indigenous critiques of genetic research and the sharing of genomic data. This Perspectives article highlights identified issues for Indigenous communities around the sharing of genomic data and suggests principles and actions that genomic researchers can adopt to recognize community rights and interests in data.In this Perspective article, the authors discuss how Indigenous Peoples' desires for greater involvement and oversight when participating in genomic research projects can be balanced against calls for unrestricted data access. They provide practical recommendations for the handling and sharing of Indigenous genomic data, with the aim of achieving mutual benefit for the research community and participating Indigenous communities.

To undertake a descriptive analysis of the Aboriginal and Torres Strait Islander Health Worker workforce to quantify the changes from 2006–2016. We analysed data on Indigenous Health Workers from three waves of Australian Census: 2006, 2011 and 2016. We described the workforce by gender, age and state/territory. There has been overall growth in the number of Indigenous Health Workers (from 1,009 in 2006 to 1,347 in 2016), but this is not commensurate with Aboriginal and Torres Strait Islander population growth (221 Indigenous Health Workers per 100,000 people in 2006 to 207 Indigenous Health Workers per 100,000 people in 2016). The growth is in Indigenous Health Workers aged ≥45 years, with declines in the proportion of Indigenous Health Workers aged ≤44 years. There was growth in workers in two states only, Queensland (increase 4.2 percentage points) and New South Wales (increase 6.6 percentage points). There are pressing concerns regarding the lack of growth and the ageing workforce of Aboriginal and Torres Strait Islander Health Workers. We remain concerned that little is being done to increase the retention and recruitment of this workforce. Greater effort is needed to improve the recruitment and retention of Aboriginal and Torres Strait Islander Health Workers, particularly for younger age groups and males. A National Aboriginal and Torres Strait Islander Health Workforce Strategy needs to be implemented.

The ability of Aboriginal and Torres Strait Islander nations to inform and influence policy, program decisions and outcomes is heavily reliant on there being appropriate data to inform results and therefore direction. The cost to our nations, and to Australia broadly, of unreliable or inappropriate data in the area of Aboriginal and Torres Strait Islander health and wellbeing means that, at best, we progress little because of uncertainty about the direction in which to proceed. At worst, unreliable or inappropriate data lead to the perpetuation of ineffective policies and programs because our ability to assess their outcomes and effectiveness is

Objective. The aim of this study was to assess the change in recording of client population smoking attributes (smoking status recorded and smoking status) in Tackling Indigenous Smoking (TIS)-funded services compared with nonfunded services for Aboriginal and Torres Strait Islander people, 2014-16. Methods. The study included a cohort of 152 Aboriginal-community controlled services with aggregate client smoking data from 2014 to 2016. Negative binomial regression was used to assess change in smoking status recorded and smoking status between TIS and non-TIS funded organisations. The models controlled for size of client population, jurisdiction and remoteness. Results. From 2014 to 2016, the overall reporting rate (change in recording of smoking status) of client smoking status was 1.58-fold higher (95% confidence interval (CI) 1.30-1.91; P < 0.001) in TIS-funded than non-TIS-funded services after controlling for year, remoteness and their interaction. The highest change in reporting of client smoking status was for TIS-funded services inremote areas (reporting ratio 6.55; 95% CI 5.18-8.27; P < 0.001). In2016, TIS-funded services reported higher overall levels of recording client smoking status (current, ex- and non-smokers) than non-TIS funded services (RR 1.11; 95% CI 1.00-1.28; P < 0.001). There was no significant change in the reporting of smokers, ex-smokers or non-smokers over the three reporting periods. Conclusion. The analysis shows higher reporting of the proportion of the service client population for services funded under the TIS program compared with non-TIS-funded services. Existing evidence suggests that following-up smokers with targeted clinical interventions once they have had smoking status recorded could reduce smoking rates in the long term. The public health contribution of this study has defined one method for assessing smoking attributes when using aggregate health service data. This method could be applied to future tobacco control programs in health services.

Objectives The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment. Methods Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014-15 (n=7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012-13 (n=10896 adults), were used to map the prevalence of smoking by Indigenous regions. Results Daily smoking prevalence in 2014-15 at Indigenous regions ranges from 27.1% (95%CI 18.9-35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1-77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region. Conclusion There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys. What is known about the topic? The last geospatial analysis of Aboriginal and Torres Strait Islander smoking prevalence was undertaken in 1997. Current national survey data have not been analysed geospatially. What does this paper add? This paper provides new insights into the use of national survey data for understanding regional patterns and prevalence levels of smoking in Aboriginal and Torres Strait Islander populations. What are the implications for practitioners? The findings of the study suggest caution when interpreting prevalence maps and highlight the need for greater sample sizes in national survey data. The analysis is also an opportunity to assess the use of national survey data in evaluating the policy impact of programs targeted at a regional level.

To describe the design and implementation of a culturally mediated case management model at Winnunga Nimmityjah Aboriginal Health Service (Winnunga) for Indigenous clients who consume alcohol at problematic levels. Our research took place from March 2008 to March 2010 in the Australian Capital Territory and built on previous research partnerships between Winnunga and The Australian National University's National Centre for Epidemiology and Population Health. We conducted a review of existing models to determine elements for consideration in the community controlled setting, and conducted staff surveys to assess current levels of skill and confidence around alcohol screening, brief intervention and care planning. Using the information from the review and staff surveys, we then undertook staff capacity building to build confidence and skills in conducting alcohol screening, brief intervention and care planning. This process was driven by Winnunga's social health team. To meet Medicare benefits schedule requirements, and frame the study within the Aboriginal and Torres Strait Islander Chronic Disease Package framework, we included team care arrangements, care planning and health checks. Elements of case management were suggested by staff and incorporated into the final model. Forty staff in the health service participated in identifying training needs for the development of the case management model and undertook a range of training before the model was implemented. Staff working within the social health team decided that the focus of the case management was to build a stronger future for their clients, hence the name of the case management model 'Walan Girri' (Wiradjuri language for strong future). The model included a package of screening instruments and brief intervention, related polices and discussion of 'mob' and 'country.' Changes in Winnunga management and staff, the composition of the research team and the way Walan Girri evolved led to protracted development and implementation. This project highlights considerations for implementing a case management model in a dynamic health service environment. Capacity building for Winnunga staff and for an Indigenous PhD scholar were part of the process and were integral in maintaining momentum in the project.

Background Tobacco use is the most preventable cause of morbidity and mortality in Australia. Comprehensive tobacco control has reduced smoking rates in Australia from approximately 34 per cent in 1980 to 15 per cent in 2010. However, 46 per cent of Aboriginal and Torres Strait Islander people (Indigenous Australians) smoke on a daily basis, more than double the rate of non-Indigenous Australians. The evidence of effective tobacco control strategies for Indigenous Australians is relatively scarce. The aim of this study is to (i) explore the influences of smoking in Indigenous Australian people and to (ii) help inform and evaluate a multi-component tobacco control strategy. The study aims to answer the following questions: - do individuals' social networks influence smoking behaviours; - is there an association between various social and cultural factors and being a smoker or non-smoker; and - does a multi-component tobacco control program impact positively on tobacco behaviours, attitudes and beliefs in Indigenous Australians. Methods and design Our prospective study will use a mixed-method approach (qualitative and quantitative), including a pre- and post-test evaluation of a tobacco control initiative. The study will explore the social and cultural context underlying Indigenous Australian tobacco use and associated factors which influence smoking behaviour. Primary data will be collected via a panel survey, interviews and focus groups. Secondary data will include de-identified PBS items related to smoking and also data collected from the Quitlines call service. Network analysis will be used to assess whether social networks influence smoking behaviours. For the survey, baseline differences will be tested using chi 2 statistics for the categorical and dichotomous variables and t-tests for the continuous variables, where appropriate. Grounded theory will be used to analyse the interviews and focus groups. Local Aboriginal community controlled organisations will partner in the study. Discussion Our study will explore the key factors, including the influence of social networks, that impact on tobacco use and the extent to which smoking behaviours transcend networks within the Indigenous Australian community in the ACT. This will add to the evidence-base, identifying influential factors to tobacco use and the effectiveness and influence of a multi-component tobacco control strategy.