Australian Indigenous HealthInfoNet
http://www.healthinfonet.ecu.edu.au

 

Factors contributing to Aboriginal and Torres Strait Islander health

  • Home
    • » Health facts
      • » Overview of Australian Aboriginal and Torres Strait Islander health status 2015
        • » Factors contributing to Aboriginal and Torres Strait Islander health

Factors contributing to Aboriginal and Torres Strait Islander health

Selected health risk and protective factors

The factors contributing to the poor health status of Aboriginal and Torres Strait Islander people should be seen within the broad context of the social determinants of health [1][2]. These determinants, which are complex and interrelated, include income, education, employment, stress, social networks and support, working and living conditions, gender, and behavioural aspects, all of which are integrated in terms of autonomy and the capacity to participate fully in society [3]. Related to these are cultural factors, such as traditions, attitudes, beliefs, and customs. Together, these social and cultural factors have a major influence on a person's behaviour [1][2].

In addition to indicators of Aboriginal and Torres Strait Islander social disadvantage, attention also needs to be focused on the 'health risk and protective factors', including those summarised in the following sections. These risk and protective factors are more proximal to adverse health outcomes, but the interpretation of the following information needs to recognise the potential roles of the underlying determinants of health.

Nutrition

The nutritional status of Aboriginal and Torres Strait Islander people is influenced by many factors such as socio-economic disadvantage, and geographical, environmental, and social factors [4][5]. Poor nutrition is an important factor contributing to overweight and obesity, malnutrition, CVD, type 2 diabetes, and tooth decay [5][6]. The National Health and Medical Research Council (NHMRC) guidelines recommend that adults eat fruit and plenty of vegetables every day, selected from a wide variety of types and colours [7]. The guidelines also recommend including reduced fat varieties of milk, yoghurts and cheeses, and limiting the intake of added sugar and salt and the consumption of ‘discretionary’1 foods and drinks.

Fruit consumption

According to the 2012-2013 National Aboriginal and Torres Strait Islander nutrition and physical activity survey (NATSINPAS), less than one-half (46%) of Aboriginal and Torres Strait Islander people consumed fruit products and dishes (fruit) in the 24 hours prior to the survey; 59% of children aged 2-18 years and 37% of adults aged 19 years or older consumed fruit [8]. Based on self-reported usual serves of fruit eaten per day, 54% of Aboriginal and Torres Strait Islander people met the recommendations for usual serves [9]. Females were more likely than males to have eaten an adequate amount of fruit (57% and 51% respectively). After age-adjustment, Aboriginal and Torres Strait Islander people aged 15 years or older were less likely than non-Indigenous people to be eating adequate amounts of fruit (ratio 0.9) [10]. Aboriginal and Torres Strait Islander people living in non-remote areas were more likely than those in remote areas to have consumed fruit in the 24 hours prior to the survey (49% and 35% respectively) [8]; however, similar proportions of Aboriginal and Torres Strait Islander people living in remote and non-remote areas usually met the guidelines for daily serves of fruit [9].

Vegetable consumption

According to the 2012-2013 NATSINPAS, almost two thirds (65%) of Aboriginal and Torres Strait Islander people consumed vegetable products and dishes (vegetables) in the 24 hours prior to the survey; 63% of children aged 2-18 years and 66% of adults aged 19 years or older consumed vegetables [8]. Based on self-reported usual serves of vegetables eaten per day, only 8% of Aboriginal and Torres Strait Islander people met the recommendations for usual serves [9]. Females aged 15 years and over were more likely than their male counterparts to have eaten an adequate amount of vegetables (7% and 3% respectively) [11]. After age-adjustment, Aboriginal and Torres Strait Islander people aged 15 years or older were less likely than non-Indigenous people to be eating adequate amounts of vegetables (ratio 0.8) [10]. Aboriginal and Torres Strait Islander people living in non-remote areas were more likely than those in remote areas to have consumed some vegetables in the 24 hours prior to the survey (67% and 56% respectively) [8].

Fruit and vegetable dietary behaviour, education and labour force

The 2012-2013 AATSIHS examined associations between dietary behaviour and labour force status and educational attainment [10]. After age-adjustment, unemployed Aboriginal and Torres Strait Islander people were more likely to have an inadequate daily fruit intake (63%) and inadequate vegetable intake (98%) than those who were employed (54% and 94% respectively) or not in the labour force (60% and 95% respectively). When considering educational levels, Aboriginal and Torres Strait Islander people who had completed year 10 or below were more likely to consume inadequate amounts of fruit (59%) and vegetables (95%) than those who had completed year 12 or equivalent (54% and 93% respectively).

Dairy food consumption

According to the 2012-2013 NATSINPAS, milk products and dishes (dairy foods) were consumed by 83% of Aboriginal and Torres Strait Islander people, which was similar to the proportion of non-Indigenous people who consumed dairy foods (85%) [8]. Similar proportions of males and females consumed dairy foods (84% and 82% respectively), and people in remote areas were just as likely as those in non-remote areas to have consumed these products (83%). Adults were about as likely to consume these products as children (81% and 84% respectively).

Discretionary foods

According to the 2012-2013 NATSINPAS, discretionary foods were consumed by a large proportion of Aboriginal and Torres Strait Islander people in the 24 hours prior to the survey, including confectionary (25%), snack foods (20%) and alcoholic beverages (11%) [8]. On average, Aboriginal and Torres Strait Islander people consumed 41% of their total daily energy in the form of discretionary foods; including 8.8% of daily energy as cereal-based products (such as cakes, biscuits and pastries), and 6.9% of daily energy as non-alcoholic beverages (such as soft drinks) [9]. Similar proportions of females and males consumed all discretionary foods except for alcoholic beverages for which twice as many males as females reported consuming (15% and 7.7% respectively) [8]. People in non-remote areas were more likely to consume all discretionary foods types than those in remote areas, except for non-alcoholic beverages.

Sugar consumption

According to the 2012-2013 NATSINPAS, sugar products and dishes (sugar) were consumed by more than half the Aboriginal and Torres Strait Islander population (54%) in the day prior to the survey [8]. Similar proportions of males and females consumed sugar (54% and 53% respectively) but more people in remote areas than non-remote areas consumed sugar (65% and 50% respectively). Although the consumption of sugar only contributed 2.5% to the total energy intake of Aboriginal and Torres Strait Islander people, this was still more than for non-Indigenous people (1.8%) [9].

Sodium (salt) consumption

According to the 2012-2013 NATSINPAS, the average daily amount of sodium consumed from food by Aboriginal and Torres Strait Islander people was 2,379mg (approximately one teaspoon of salt) [9]. This excludes salt added by consumers in household cooking or when preparing food. Sodium consumption was higher among males than females (2,638mg and 2,122mg respectively). Males in all age-groups, except for those 51 years and older, had average intakes that exceeded the upper level of sodium intake recommended by the NHMRC.

Almost half of Aboriginal and Torres Strait Islander people did not use salt in household cooking or preparing food (47%) [12]. This proportion was slightly higher for females than males (50% and 45% respectively), and higher for people living in non-remote areas compared with those in remote areas (48% and 44% respectively) and for children aged 2-18 years compared with people aged 19 years or older (51% and 44% respectively). For those who used salt in household cooking or preparing food, fewer people used iodised salt than non-iodised salt (21% and 24% respectively).

The average daily sodium intake was similar for Aboriginal and Torres Strait Islander people and non-Indigenous people (2,379mg and 2,408mg respectively) [9]. Males recorded a higher consumption of sodium than females in both populations.

Bush foods

Participants in the 2012-2013 NATSINPAS were asked about their consumption of foods that were naturally harvested or wild-caught, such as fish and seafood, wild harvested fruit and vegetables, reptiles and insects [8]. Aboriginal and Torres Strait Islander people in remote areas were more likely than their non-remote counterparts to eat non-commercially caught fin fish (7.8% and 1.8% respectively), crustacea and molluscs (1.2% and 0.3% respectively), wild harvested meat (7.7% and 0% respectively) and reptiles (3.9% and 0.1% respectively).

Biomarkers of nutrition

The National Aboriginal and Torres Strait Islander health measures survey (NATSIHMS) 2012-2013 collected information on biomarkers of nutrition, including vitamin D, anaemia and iodine [13]. It was found that:

Food security

The 2012-2013 NATSINPAS addressed the issue of food security by asking respondents if they had run out of food and couldn’t afford to buy more in the last 12 months [16]. This has been a problem for 22% of respondents; 7% of respondents had run out and gone without food, while 15% had run out but not gone without food. People in remote areas were more likely to run out of food than people in non-remote areas (31% and 20% respectively) and slightly more likely to go without (9.2% and 6.4% respectively).

Physical activity

To maintain good overall health, physical activity is important. Low levels of activity including high levels of sedentary behaviour are risk factors for a range of health conditions. [17]Australia’s physical activity and sedentary behaviour guidelines for adults recommend moderate physical activity on most, preferably all, days of the week to improve health and reduce the risk of chronic disease and other conditions [18]. However, doing any physical activity is better than doing none and the health benefits of physical activity are continuous, starting with any activity above zero [19]. Low levels of activity, including sedentary behaviour, are a risk factor for a variety of health conditions including CVD, type 2 diabetes, certain cancers, depression and other SEWB conditions, overweight and obesity, a weakened musculoskeletal system and osteoporosis [17][18].

According to the 2012-2013 AATSIHS, 47% of Aboriginal and Torres Strait Islander people aged 18 years and over living in non-remote areas had met the target of 30 minutes of moderate intensity physical activity on most days (or a total of 150 minutes per week); this level was 0.9 times that of their non-Indigenous counterparts [20]
A smaller proportion (41%) of Aboriginal and Torres Strait Islander adults had exercised for at least 150 minutes over five sessions in the previous week; this level was 0.9 times that of their non-Indigenous counterparts. Over one-quarter (29%) of Aboriginal and Torres Strait Islander adults had exercised at a moderate level and 10% at a high level; these levels of physical activity were 0.9 and 0.6 times those of their non-Indigenous counterparts. Aboriginal and Torres Strait Islander adults spent around one third the time on physical activity (39 minutes per day including 21 minutes on walking for transport) compared with children aged 5-17 years [17]. Those who participated in the survey’s pedometer study recorded an average of 6,963 steps per day; 17% met the recommended threshold of 10,000 steps or more.

Among Aboriginal and Torres Strait Islander adults living in non-remote areas, more males than females met the target of 150 minutes of moderate intensity exercise per week (52% compared with 42%) and had exercised for at least 150 minutes over five sessions in the previous week (45% compared with 38%) [20]. Aboriginal and Torres Strait Islander males in non-remote areas were significantly more likely than Aboriginal and Torres Strait Islander females to have exercised at moderate intensity (32% compared with 25%) and were twice as likely to have exercised at high intensity (14% compared with 7%) in the previous week. In remote areas, 55% of Aboriginal and Torres Strait Islander adults exceeded the recommended 30 minutes of physical activity and 21% did not participate in any physical activity on the day prior to the interview [17]. The most common type of physical activity for adults was ‘walking to places’ (71%). Around one-in-ten (11%) participated in cultural activities, including hunting and gathering bush foods or going fishing.

Among Aboriginal and Torres Strait Islander adults living in non-remote areas, 61% reported that they were physically inactive (sedentary or had exercised at a low level) in the week prior to the survey; this level of physical inactivity was 1.1 times that of their non-Indigenous counterparts [20]. A higher proportion of Aboriginal and Torres Strait Islander women than Aboriginal and Torres Strait Islander men were physically inactive (68% compared with 53%); this pattern was evident for all age-groups [20]. Aboriginal and Torres Strait Islander adults spent an average of 5.3 hours per day on sedentary activities, including 2.3 hours of watching television (TV), DVDs and videos [17].

Aboriginal and Torres Strait Islander children aged 2-4 years living in non-remote areas spent an average of 6.6 hours per day participating in physical activity and spent more time outdoors than their non-Indigenous counterparts (3.5 hours compared with 2.8 hours) [17]. Aboriginal and Torres Strait Islander children aged 2-4 years spent an average of 1.5 hours per day on sedentary screen-based activities such as watching TV, DVDs or playing electronic games.

Aboriginal and Torres Strait Islander children aged 5-17 years living in non-remote areas spent an average of two hours per day participating in physical activity (exceeding the recommendation of one hour per day); this was 25 minutes more than their non-Indigenous counterparts [17]. Around half (48%) of Aboriginal and Torres Strait Islander children met the recommended amount of physical activity, compared with 35% of non-Indigenous children. The most common physical activities among Aboriginal and Torres Strait Islander children were active play and children’s games (57%) and swimming (18%). Those who participated in the survey’s pedometer study, recorded an average of 9,593 steps per day, with an average of one-in-four children (25%) meeting the recommended 12,000 steps per day.

Aboriginal and Torres Strait Islander children aged 5-17 years living in non-remote areas spent an average of 2.6 hours per day on sedentary screen-based activities (exceeding the recommended limit of two hours). Aboriginal and Torres Strait Islander children aged 12-14 years spent half the time that non-Indigenous children spent using the internet or computer for homework (4 minutes compared with 8 minutes per day) and those aged 15-17 years spent nearly one third of the time spent by their non-Indigenous counterparts (8 minutes compared with 20 minutes per day). Aboriginal and Torres Strait Islander children aged 15-17 years spent more time on screen-based activities than those aged 5-8 years (3.3 hours compared with 1.9 hours) [17].

In remote areas, 82% of Aboriginal and Torres Strait Islander children aged 5-17 years did more than 60 minutes of physical activity on the day prior to the interview [17]. The most common activities were walking (82%), running (53%), and playing football or soccer (33%).

Bodyweight

The standard measure for classifying a person’s weight status is BMI (BMI: weight in kilograms divided by height in metres squared) [21]. Being overweight (BMI 25 to 29) or obese (BMI of 30 or more) increases a person's risk for CVD, type 2 diabetes, certain cancers, and some musculoskeletal conditions. A high BMI can be a result of many factors, alone or in combination, such as poor nutrition, physical inactivity, socioeconomic disadvantage, genetic predisposition, increased age, and alcohol use [7][21][22][23]. Being underweight (BMI less than 18.5) can also have adverse health consequences, including lower immunity (leading to increased susceptibility to some infectious diseases) and osteoporosis (bone loss) [7].

Abdominal obesity, a risk factor for the development of the metabolic syndrome, can be measured by waist circumference (WC) alone (greater than 94cm for men and greater than 80cm for women), or waist-hip ratio (WHR) (greater than or equal to 0.90 for men and greater than or equal to 0.85 for women) [24].

Obesity and abdominal obesity, as measured by BMI and WC, have been shown to be risk factors for type 2 diabetes and hypertension in Aboriginal and Torres Strait Islander people. However, optimal BMI and WC cut-offs are still uncertain for Aboriginal and Torres Strait Islander people (due to differences in body shape and other physiological factors) when calculating diabetes type 2 and cardiovascular risk [25][26][27]. It has been suggested that a BMI of 22 might be more appropriate than 25 as a measure of acceptable BMI for Aboriginal people. There is also evidence that measuring the WHR in Indigenous people is more accurate and easier to measure than BMI [27]. More recently, Hughes and colleagues [28]have developed an equation for calculating fat free mass in Aboriginal and Torres Strait Islander adults using the easily acquired variables of resistance2, height, weight, age and gender for use in the clinical assessment and management of obesity.

Based on BMI information collected as a part of the 2012-2013 AATSIHS, 66% of Aboriginal and Torres Strait Islander people aged 15 years or older were classified as overweight (29%) or obese (37%) [10]. A further 30% were normal weight and 4% were underweight. Combined overweight/obesity levels were significantly higher for people living in non-remote areas (67%) than for those living in remote areas (62%). Similar proportions of Aboriginal and Torres Strait Islander males and females were overweight or obese (66% and 67% respectively), however, a larger proportion of males than females were overweight (31% and 26% respectively) while a greater proportion of females than males were obese (40% and 34% respectively). After age-adjustment, the combined overweight/obesity levels were slightly higher for Aboriginal and Torres Strait Islander people aged 15 years or older than for their non-Indigenous counterparts (ratio 1.2) and Aboriginal and Torres Strait Islander people were 1.6 times as likely as non-Indigenous people to be obese (ratio 1.4 for males and 1.7 for females).

In 2012-2013, around 3.5% of Aboriginal and Torres Strait Islander people aged 15 years or older were underweight, with about 2.8% of Aboriginal and Torres Strait Islander males and 4.2% of Aboriginal and Torres Strait Islander females having a BMI of less than 18.5 [29]. After age-adjustment, Aboriginal and Torres Strait Islander people were 1.6 times more likely to be underweight than non-Indigenous people (rate ratio for males 1.8 and females 1.4) but less likely to be of normal weight (rate ratio 0.7).

Measurements of WC and WHR were taken in the 2012-2013 AATSIHS (not done in the previous health survey) to help determine levels of risk for developing certain chronic diseases [10]. Based on WC, a higher proportion of Aboriginal and Torres Strait Islander females (81%) than Aboriginal and Torres Strait Islander males (62%) aged 18 years or older were found to be at increased risk. Based on WHR, 81% of males and 73% of females aged 18 years or older were at increased risk of developing chronic diseases. The proportions of Aboriginal and Torres Strait Islander males and females who were at increased risk of developing chronic diseases based on both measures of WC and WHR increased with age.

According to the 2012-2013 AATSIHS, based on BMI information, around 30% of Aboriginal and Torres Strait Islander children aged 2-14 years were overweight (20%) or obese (10%), 62% were in the normal weight range, and 8% were underweight [10]. Similar proportions of Aboriginal and Torres Strait Islander boys and girls aged 2-14 years were overweight or obese (28% and 32% respectively). After age-adjustment, the combined overweight/obesity levels were slightly higher for Aboriginal and Torres Strait Islander children aged 2-14 years than those for their non-Indigenous counterparts (ratio 1.2) mainly due to higher obesity rates in both genders (boys - 10% compared with 6% respectively; and girls - 11% compared with 7% respectively).

Similar to this, a study of a child health program in remote central Australia in 2010 found that 21% of the Aboriginal children aged 3 to 17 years were overweight and 5.4% were obese (there was no difference between boys and girls).

A 2012 study of 277 Indigenous children aged 5 to 17 years in the Torres Strait in 2003 found that 46% were overweight or obese and 35% had abdominal obesity [30]. Girls had higher levels of abdominal obesity (50%) than boys (18%). The study also found a consistent association between overweight/obesity and low levels of physical activity.

Hardy and colleagues [31] found that from 1997 to 2010, overweight/obesity and WHR increased more rapidly in Aboriginal children aged 5-16 years than in non-Aboriginal children in the same age-group in NSW. They identified lack of daily breakfast, excessive screen time and soft drink consumption as the major risk factors and suggested that encouraging strategies to limit screen time held promise.

Immunisation

In recent decades, vaccination has been very successful in contributing to improvements in Aboriginal and Torres Strait Islander health and child survival [32] and national immunisation coverage rates for Aboriginal and Torres Strait Islander children have improved steadily since 2008 [33]. The National immunisation program schedule for the Australian population recommends vaccinations at different stages of life and additional recommendations for specific high risk populations, these include: hepatitis A; hepatitis B; diphtheria; tetanus; whooping cough; haemophilus influenzae type b; polio; pneumococcal conjugate; rotavirus; meningococcal C; measles; mumps and rubella (MMR); varicella (chickenpox); human papillomavirus (HPV) and influenza [32]. Due to some vaccine-preventable diseases still being experienced at higher rates among Aboriginal and Torres Strait Islander people, other supplementary vaccines3 are also specifically prescribed depending on age, location and health risk factors.

Childhood vaccination

The National immunisation program for all children includes vaccines for hepatitis B, diphtheria-tetanus-pertussis (DTP), Haemophilus influenzae type B (Hib), measles, mumps, rubella (MMR), pneumococcal disease, meningococcal C, varicella (chickenpox), rotavirus, HPV, and influenza [32].

For December 2014 and March, June and September 2015, coverage estimates for full immunisation for Aboriginal and Torres Strait Islander children were [32]:

According to the Australian Childhood Immunisation Register (ACIR), the national coverage for full immunisation for Aboriginal and Torres Strait Islander children has increased for the following age-groups [32]:

The analysis of data from the rolling annualised percentage of Indigenous children fully immunised by 12 months of age for Australia increased from the previous report, ending September 2014, by 0.5 percent to 88% [34]. For individual vaccines due by 12 months of age, all states except WA had coverage levels above 85%. For 24 month old Indigenous children ‘full immunised’ coverage had decreased by 1.4 percent to 85% for all states except Tas which increased marginally. The percentage of Indigenous children ‘fully immunised’ by 60 months of age decreased from previous report by 0.1 percent to 93%. Coverage for individual vaccines due by 60 months remained greater than 90% in all states.

Immunisation coverage estimates comparisons at 31 December 2013 indicated that [35]:

Adult vaccination

Vaccination for influenza and pneumonia is recommended for Aboriginal and Torres Strait Islander people aged 50 years and over and for non-Indigenous people aged 65 years and over [36]. The AATSIHS 2012-2013 reported that for Aboriginal and Torres Strait Islander adults aged 50 years and older, influenza vaccination in the previous 12 months was reported by: 51% of those aged between 50-64 years old, 74% of those aged 65 years and above, and overall 57% of those aged 50 years and older.

Vaccination rates for pneumococcus vaccination in the last 5 years for Aboriginal and Torres Strait Islander people were: 23% of 50-64 year olds, 44% of 65 year olds and older, and 29% overall of 50 years and older.

Breastfeeding

Breast milk is the natural and optimum food for babies and provides all the energy and nutrients that an infant needs for the first six months of life [37]. Breastfeeding promotes sensory and cognitive development. It protects the infant against infectious and chronic diseases; exclusive breastfeeding aids a quicker recovery from illness and reduces infant deaths from common childhood illnesses such as diarrhoea or pneumonia. The Australian dietary guidelines recommendation is to ‘encourage, support and promote breastfeeding’ [7]. The WHO recommends exclusive breastfeeding for six months followed by complementary feeding with continued breastfeeding for up to two years or beyond [37]. Breastfeeding also contributes to the health of the mother by reducing the risk of ovarian and breast cancers.

According to the 2012-13 AATSIHS, 83% of Aboriginal and Torres Strait Islander children aged 0–3 years had been breastfed, compared with 93% of non-Indigenous children [35]. Aboriginal and Torres Strait Islander children aged 0–3 years were 2.3 times more likely than non-Indigenous infants to have never been breastfed (17% compared with 7% respectively). Of those who had been breastfed, Aboriginal and Torres Strait Islander infants were more likely than non-Indigenous infants to have been breastfed for less than 1 month (16% compared with 10% respectively). Aboriginal and Torres Strait Islander infants were less likely than non-Indigenous infants to have been breastfed for 12 months or more (12% compared with 21% respectively). Breastfeeding rates of Aboriginal and Torres Strait Islander children aged 0–3 years did not vary significantly by remoteness, 82% in non-remote areas and 84% in remote areas were breastfed.

According to the 2010 Australian national infant feeding survey, breastfeeding initiation levels were similar among Aboriginal and Torres Strait Islander and non-Indigenous mothers (87% and 90%, respectively), but levels of exclusive breastfeeding declined more rapidly among Indigenous mothers (Derived from [38]). At 5 months of age, only 11% of Indigenous babies were exclusively breastfed, compared with 27% of non-Indigenous babies.

The Footprints in time – the longitudinal study of Aboriginal children collected data from 11 sites (rural, remote and urban) around Australia in 2008-2009 [39]. Data on breastfeeding from this study showed that 80% of Indigenous children had been breastfed at some time during their early years, and 22% of Indigenous infants had been breastfed for at least 12 months. This study found that children living in more remote areas had been breastfed for a slightly longer period of time than those living in other areas.

Tobacco use

Tobacco use increases the risk of chronic disease, including CVD, many forms of cancer, and lung diseases, as well as a variety of other health conditions [40]. Tobacco use is also a risk factor for complications during pregnancy and is associated with preterm birth, LBW, and perinatal death. Environmental tobacco smoke (passive smoking) is of concern to health, with children particularly susceptible to resultant problems that include middle ear infections, asthma, and SIDS.

In 2003, tobacco use was the leading cause of the burden of disease and injury among Indigenous people, responsible for 12% of the total burden of disease [41]. Tobacco use accounted for one-in-five deaths in the Indigenous population.

Extent of tobacco use among Aboriginal and Torres Strait Islander people

The 2012-2013 AATSIHS found that 44% of Aboriginal and Torres Strait Islander people aged 15 years and over reported that they were current smokers [42]. This represents a significant reduction from levels reported in the NATSISS 2008 (47%), and 2002 (51%) [43][44]. The NATSISS 2008 found almost two-thirds (62%) of Indigenous current daily smokers reported trying to quit or reduce their smoking in the 12 months prior to interview [45].

In 2012-2013, the proportion of Aboriginal and Torres Strait Islander men who were current smokers (46%) was similar to the proportion of Aboriginal and Torres Strait Islander women (42%) [42]. After age-adjustment, Aboriginal and Torres Strait Islander people were 2.5 times more likely to smoke than non-Indigenous people (43% compared with 17%, respectively).

In 2012-2013, Aboriginal and Torres Strait Islander people living in remote areas reported a higher proportion of current smokers (53%) than those living in non-remote areas (41%) [46]. The age-group with the highest proportion of current smokers in remote areas was the 18-24 years age-group (65%). The overall proportion of current smokers in remote areas in 2012-2013 has not changed since 2002.

When comparing smoking prevalence in non-remote areas over the ten years between the AATSIHS 2012-2013 and the NATSISS 2002, the highest reductions have been found in the younger age-groups [46]. This drop in smoking among these age-groups is reflected in the increased prevalence of young people who have ‘never smoked’. The 2012-2013 AATSIHS found that more than one-third (36%) of Aboriginal and Torres Strait Islander people had never smoked, compared with 34% in 2008 and 33% in 2002.

High rates of smoking have been reported for Indigenous mothers [47]. In 2011, half of Aboriginal and Torres Strait Islander mothers (50%) reported smoking during pregnancy, compared with 12% of non-Indigenous mothers. The proportion of smoking cessation for Aboriginal and Torres Strait Islander women during the second 20 weeks of pregnancy was 11%, compared with 22% among non-Indigenous women. Between 2005 and 2011, after age-adjustment, there was a significant decline of 6% in the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy [48].

In 2012-2013, 57% of Aboriginal and Torres Strait Islander children aged 0-14 years lived in households with a daily smoker [49]. For those children living with a daily smoker, Aboriginal and Torres Strait Islander children were 2.4 times more likely to live in households where people smoked indoors when compared with non-Indigenous children (28% and 12% respectively).

Alcohol use

Alcohol-related harm includes chronic diseases, accidents and injury, and is not limited to the user but extends to families and the broader community [50]. Consumption of alcohol in pregnancy can affect the unborn child leading to fetal alcohol spectrum disorder (FASD), an umbrella term that describes a range of conditions including central nervous system dysfunction, poor growth, characteristic facial features and developmental delay [51][52].

In 2003, the burden of disease attributable to alcohol use among Indigenous people was more than twice that among other Australians (5.4% compared with 2.3%) [53][54]. Of 11 selected risk factors, alcohol was the fifth leading cause of the burden of disease among Indigenous people [53]. The highest levels of disease burden attributable to alcohol use among Indigenous people were for injury (22%), mental disorders (16%), and cancers (6.3%).

Surveys have shown consistently that Aboriginal and Torres Strait Islander people are less likely to drink alcohol than non-Indigenous people, but those who do drink are more likely to consume it at harmful levels [55][56][57].

Extent of alcohol use among Aboriginal and Torres Strait Islander people

Box 7: Assessing risks from use of alcohol

In 2009, the NHMRC introduced revised guidelines that depart from specifying 'risky' and 'high risk' levels of drinking [50]. The revised guidelines seek to estimate the overall risk of alcohol-related harm over a lifetime and to reduce the level of risk to one death for every 100 people. For men and women:

  • guideline one states that to reduce the risk of alcohol-related harm over a lifetime, no more than two standard drinks should be consumed on any day
  • guideline two states that to reduce the risk of injury on a single occasion of drinking, no more than four standard drinks should be consumed
  • guideline three recommends that the safest option is not drinking alcohol for those aged under 15 years and delaying alcohol use for as long as possible for those aged 15 to 17 years
  • guideline four recommends that the safest option for pregnant and breastfeeding women is not to drink alcohol.
Abstinence or no consumption of alcohol in the last 12 months

In the 2012-2013 AATSIHS, 23% of Aboriginal and Torres Strait Islander people aged 18 years or older had never consumed alcohol or had not done so for more than 12 months [57]. After age-adjustment, abstinence was 1.6 times more common among Aboriginal and Torres Strait Islander people than among non-Indigenous people. Most of the difference in abstinence between the Aboriginal and Torres Strait Islander and non-Indigenous population was attributable to those Aboriginal and Torres Strait Islander people who had stopped drinking for at least 12 months (16% of Aboriginal and Torres Strait Islander people and 7% of non-Indigenous people). Similar proportions of Aboriginal and Torres Strait Islander and non-Indigenous people have never consumed alcohol (10% and 8.9%, respectively).

The 2012-2013 AATSIHS found that 17% of Indigenous men and 28% of Indigenous women aged 18 years or older had never consumed alcohol or had not done so in the previous 12 months [57]. After age-adjustment, abstinence was 1.7 times and 1.5 times more common among Indigenous men and women than among non-Indigenous men and women (20% and 32% compared with 12% and 21%, respectively). Again, this difference in abstinence between Indigenous men and women and non-Indigenous men and women is attributable to those who drank alcohol 12 months or more ago (15% and 17% compared with 6.0% and 8.7%, respectively).

Short-term and single occasion risk

The 2012-2013 AATSIHS reported that 22% of the Aboriginal and Torres Strait Islander people aged 18 years and over drank at short-term low risk in relation to the 2001 guidelines (four or less standard drinks on a single day for women and six or less standard drinks per day for men) and a similar proportion (18%) did not exceed the 2009 guidelines (four or less standard drinks on a single day for both males and females) [57][58].

Similar proportions of Aboriginal and Torres Strait Islander and non-Indigenous people exceeded the 2009 guidelines for drinking at short-term/single occasion risk (52% and 45% respectively after age-adjustment) [57]. However, levels of short-term/single occasion risky drinking (as defined by the 2001 guidelines) were 1.4 times higher for the Aboriginal and Torres Strait Islander population compared to their non-Indigenous counterparts. Aboriginal and Torres Strait Islander men were 1.5 times more likely than Aboriginal and Torres Strait women to exceed the 2009 guidelines for drinking at risk on a single occasion (68% compared with 46%, respectively).

The proportion of Aboriginal and Torres Strait people exceeding the guidelines for single occasion risk was lower in very remote areas compared with other areas [36].

Lifetime risk

According to the 2013 National drug household survey (NDSHS), since 2010 there has been significant decline for risky drinking in the proportion (from 32% to 23%) of Indigenous people exceeding the 2009 NHMRC guidelines for lifetime risk4 [59]. Findings from the 2012-2013 AATSIHS show that among Aboriginal and Torres Strait Islander drinkers aged 18 years and over, 20% drank at levels exceeding the 2009 guidelines for long-term/lifetime drinking risk [60]. After age-adjustment, lifetime drinking risk was similar for both Aboriginal and Torres Strait Islander people and non-Indigenous people (ratio 1.0). However, Aboriginal and Torres Strait Islander people were 1.4 times more likely to drink at ‘high risk’ levels of long-term harm (2001 guidelines). Aboriginal and Torres Strait Islander men were 2.7 times more likely than Aboriginal and Torres Strait Islander women to exceed the guidelines for risk of long-term harm (29% compared with 11%, respectively).

A lower proportion of Aboriginal and Torres Strait Islander people in very remote areas has been found to exceed the guidelines for lifetime risk when compared with those in other areas (specifically inner regional and remote areas) [36].

Alcohol and pregnancy

According to the 2008 NATSISS, 80% of mothers of Indigenous children aged 0-3 years did not drink during pregnancy, 16% drank less alcohol than usual, and 3.3% drank the same or more alcohol during pregnancy [55]. The proportion of mothers who drank the same or more alcohol during pregnancy was greatest in Tas/ACT (6.0%), followed by Vic (5.4%), and WA (5.0%).

Hospitalisation

For 2011-12 to 2012-13, there were 9,995 hospitalisations of Aboriginal and Torres Islander people for alcohol-related diagnoses, after age-adjustment, the rate was 9.3 per 1,000, which was 4.1 times the rate for non-Indigenous people [35]. Aboriginal and Torres Islander males were hospitalised at 4.5 times the rate for non-Indigenous males and Aboriginal and Torres Islander females were hospitalised at 3.6 times the rate for non-Indigenous females.

For 2011-12 to 2012-13, in inner regional areas, Aboriginal and Torres Islander people were hospitalised for alcohol-related diagnoses at 2.9 times the rate for non-Indigenous people [35]. In remote areas, Aboriginal and Torres Islander people were hospitalised for alcohol-related diagnoses at 9.3 times the rate for non-Indigenous people.

Among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, SA and the NT, between 2004-2005 and 2012-2013, age-adjusted hospital separations due to acute intoxication increased from 2.1 per 1,000 to 5.4 per 1,000 [36]. This was an increase from 5.7 to 12 times the rates for non-Indigenous people. In 2012-13, the highest rate of hospital separations related to alcohol use for Aboriginal and Torres Strait Islander people was for mental/behavioural disorders (8.3 per 1000) which was 4.2 times the rate of non-Indigenous people.

Hospital separation rates related to alcohol use due to acute intoxication for Aboriginal and Torres Strait Islander people in 2012-2013 varied by level of remoteness [36]. Aboriginal and Torres Strait Islander people living in remote and very remote areas had the highest rate of hospitalisation due to acute intoxication (9.9 per 1,000) while Aboriginal and Torres Strait Islander people in inner and outer regional areas had the lowest (3.4 per 1,000).

Mortality

From 2008-2012, after age-adjustment, the Aboriginal and Torres Strait Islander death rate due to alcohol was 4.9 times greater than that for non-Indigenous people (22 per 100,000 in NSW, Qld, WA, SA and NT combined compared with 4.5 per 100,000 for non-Indigenous people) [36][61]. Aboriginal and Torres Strait Islander males were 2.5 times as likely to die due to alcohol use compared with Aboriginal and Torres Strait Islander women. The NT had the highest Aboriginal and Torres Strait Islander death rate from alcohol (37 per 100,000) which was 5.1 times the rate for non-Indigenous people in the NT.

Illicit substance use

Illicit substance use describes the use of those drugs that are illegal (e.g. cannabis, heroin, ecstasy, and cocaine), the use of volatile substances (e.g. petrol, glue, and solvents), and the non-medical use of prescribed drugs [36]. Illicit substance use is associated with an increased risk of mental illness, poisoning, self-harm, infection with blood borne viruses from unsafe injection practices and death [36][62].

In 2003, illicit substance use accounted for 2.0% of the overall burden of disease in Australia including 8.0% of the mental health burden of disease, and 3.6% of the injury burden of disease [54]. For the Indigenous population, illicit substance use was responsible for 3.4% of the burden of disease. The highest level of disease burden attributable to illicit substances was for mental health (13%) and injury (3.6%) [53].

Extent of illicit substance use among Aboriginal and Torres Strait Islander people

Surveys consistently show that most Aboriginal and Torres Strait Islander people do not use illicit drugs. According to the 2012-2013 AATSIHS, more than half (52%) of Aboriginal and Torres Strait Islander people aged 15 years and older had never used illicit substances [63], which is slightly lower than the proportions that were reported in the 2008 NATSISS (57%) [29].

The 2012-2013 AATSIHS reported that 22% of Aboriginal and Torres Strait Islander people aged 15 years and over had used an illicit substance in the previous 12 months [63], a slight decrease from that reported in the 2008 NATSISS (23%) [29]. Similarly, after age-adjustment, the 2013 NDSHS found that 23% of Aboriginal and Torres Strait Islander people aged 14 years and older had ‘recently used’ an illicit substance, compared with 15% of non-Indigenous people [59].5 When comparing different age cohorts, the 2012-2013 AATSIHS found that illicit substance use in the previous 12 months was highest among younger age-groups: 15-24 years (28%) and 25-34 years (27%), but decreased for the 35-44 and 45-54 years age-groups (23% and 19%, respectively) and 55 and older age-groups (7.0%) [63].

The 2012-2013 AATSIHS found that cannabis was the most commonly used illicit substance being used by 19% of Aboriginal and Torres Strait Islander people aged 15 years and over in the previous 12 months [63]. This was followed by analgesics and sedatives (3.9%), other drugs (heroin, cocaine, petrol, LSD/synthetic hallucinogens, naturally occurring hallucinogens, ecstasy/designer drugs, methadone and other inhalants) (2.8%) and amphetamines (2.3%).

Aboriginal and Torres Strait Islander males were around 1.5 times more likely than females to have used an illicit drug in the previous 12 months (27% and 18%, respectively) in 2012-2013 [63]. The higher proportions of use by males were found for all drug types, except analgesics and sedatives where proportions were similar for males and females (3.6% and 4.1%, respectively). Around twice as many Indigenous males as Indigenous females had used cannabis (24% compared with 14%), amphetamines (2.9% compared with 1.8%), and ‘other drugs’ (3.7% compared with 1.9%). Use of illicit drugs in the previous 12 months was greater among Aboriginal and Torres Strait people aged 15 years or over living in non-remote areas than among those living in remote areas in 2012-2013 (23% compared with 19%) [63].

In 2013-14, for alcohol and other drug treatment services in Australia, 14% of clients seeking treatment were Indigenous [64]. The principal illicit drugs of concern for both Indigenous and non-Indigenous clients seeking treatment were cannabis, amphetamines, and heroin.

For the 5 year period April 2008-March 2013, GPs managed drug use for Indigenous patients at an age-adjusted rate of 10 per 1,000 encounters [35].

Hospitalisation

In 2012-2013, the most common drug-related conditions resulting in hospitalisation for Aboriginal and Torres Strait Islander people were for ‘poisoning’ and ‘mental and behavioural disorders’ [36]. The hospitalisation rate for Aboriginal and Torres Islander people for poisoning (2.8 per 1,000) was more than twice the rate for non-Indigenous people (1.2 per 1,000). The hospitalisation rate for mental and behavioural disorders for Aboriginal and Torres Strait Islander people (2.6 per 1,000) was around three times the rate for non-Indigenous people (0.9 per 1,000). Hospitalisation for mental/behavioural disorders from use of amphetamines6 had the highest rate of separations due to drug use and was more than three times higher for Aboriginal and Torres Strait Islander people when compared with non-Indigenous people. Hospitalisation rates due to drug use were higher for Aboriginal and Torres Strait Islander people in major cities (3.7 per 1000) than in inner and outer regional areas (2.6 per 1,000) and remote areas (1.8 per 1000).

Mortality

The rate of drug-induced deaths was around 1.5 times higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than for their non-Indigenous counterparts in 2008-2012 (Table 36) [36]. Rates of drug-induced deaths for Aboriginal and Torres Strait Islander people in SA (22 per 100,000) were significantly higher than those in NSW (13 per 100,00), Qld (7.2 per 100,000) or WA (8.7 per 100,000). The rate for Indigenous males (11 per 100,000) was higher than for Indigenous females (8.9 per 100,000).

Table 36. Rates of drug induced deaths, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA, SA, and the NT, 2008-2012

Jurisdiction

Indigenous rate

Non-Indigenous rate

Rate ratio

NSW

13

6.2

2.0

Qld

7.2

6.3

1.1

WA

8.7

7.1

1.2

SA

22

6.8

3.3

NSW, Qld, WA, SA and the NT

9.9

6.4

1.5

Notes:

  1. Rates are per 100,000 (indirect standardisation)
  2. Deaths where Indigenous status was not stated are excluded from the analysis
  3. Separate rates for the NT were not provided due to low numbers of deaths

Source: Derived from Steering Committee for the Review of Government Service Provision, 2014 [36]

In 2003-2007, 63 of the deaths of Indigenous people living in NSW, Qld, WA, SA and the NT were attributed to drug use [65]. More than one-half (52%) of these deaths were due to accidental poisoning from narcotics, and 17% from accidental poisoning from organic solvents. In comparison, there were 993 drug-related deaths among their non-Indigenous counterparts, 53% of which were due to accidental poisoning from narcotics and 28% from accidental poisoning from antidepressants.

References

  1. Carson B, Dunbar T, Chenhall RD, Bailie R, eds. (2007) Social determinants of Indigenous health. Crows Nest, NSW: Allen and Unwin
  2. Wilkinson R, Marmot M (2003) Social determinants of health: the solid facts. Denmark: World Health Organization
  3. Marmot M (2004) The status syndrome: how social standing affects our health and longevity. New York: Holt Paperbacks
  4. Gracey MS (2007) Nutrition-related disorders in Indigenous Australians: how things have changed. Medical Journal of Australia; 186(1): 15-17
  5. National Health and Medical Research Council (2000) Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: National Health and Medical Research Council
  6. National Public Health Partnership (2001) National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 and first phase activities 2000-2003. Canberra: National Public Health Partnership
  7. National Health and Medical Research Council (2013) Australian Dietary Guidelines: providing the scientific evidence for healthier Australian diets. Canberra: National Health and Medical Research Council
  8. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 4 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_04.xls&4727.0.55.005&Data%20Cubes&F3E8C224BFBA2FE0CA257E0D000EC970&0&2012-13&20.03.2015&Latest
  9. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13. Canberra: Australian Bureau of Statistics
  10. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics
  11. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012-13: table 13 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500613.xls&4727.0.55.006&Data%20Cubes&D751183318983C51CA257CEE0010D97D&0&2012%9613&06.06.2014&Latest
  12. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 12.1 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_12.xls&4727.0.55.005&Data%20Cubes&2DC1BC4A0840357FCA257E0D000ECE96&0&2012-13&20.03.2015&Latest
  13. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012-13. Canberra: Australian Bureau of Statistics
  14. Footprints in Time (2012) Footprints in Time: the longitudinal study of Indigenous children: key summary report from Wave 3. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  15. Footprints in Time (2013) Footprints in Time: the longitudinal study of Indigenous children: report from Wave 4. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  16. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 14.1 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_14.xls&4727.0.55.005&Data%20Cubes&2ABA2FFD38663577CA257E0D000ECF19&0&2012-13&20.03.2015&Latest
  17. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: physical activity, 2012–13. Canberra: Australian Bureau of Statistics
  18. Australia's physical activity and sedentary behaviour guidelines (2014) Australian Government Department of Health
  19. Australian Government Department of Health (2014) Australia's physical activity and sedentary behaviour guidelines - guidelines evidence summary. Canberra: Australian Government Department of Health
  20. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  21. World Health Organization (2013) Obesity and overweight: fact sheet no 311. Retrieved March 2013 from http://www.who.int/mediacentre/factsheets/fs311/en/
  22. Australian Institute of Health and Welfare (2012) Australia's health 2012. Canberra: Australian Institute of Health and Welfare
  23. Eat for Health: Australian dietary guidelines summary (2013) National Health and Medical Research Council
  24. World Health Organization (2011) Waist circumference and waist–hip ratio: report of a WHO expert consultation .
  25. Daniel M, Rowley K, McDermott R, O'Dea K (2002) Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk. Diabetes Research and Clinical Practice; 57: 23-33
  26. Li M, McDermott RA (2010) Using anthropometric indices to predict cardio-metabolic risk factors in Australian Indigenous populations. Diabetes Research and Clinical Practice; 87(3): 401-406
  27. Gracey M, Burke V, Martin DD, Johnston RJ, Jones T, Davis EA (2007) Assessment of risks of "lifestyle" diseases including cardiovascular disease and type 2 diabetes by anthropometry in remote Australian Aborigines. Asia Pacific Journal of Clinical Nutrition; 16(4): 688-697
  28. Hughes JT, Maple-Brown LJ, Piers LS, Meerkin J, O'Dea K, Ward LC (2015) Development of a single-frequency bioimpedance prediction equation for fat-free mass in an adult Indigenous Australian population. European Journal of Clinical Nutrition; 69(1): 28–33
  29. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
  30. Valery PC, Ibiebele T, Harris M, Green AC, Cotterill A, Moloney A, Sinha AK, Garvey G (2012) Diet, physical activity, and obesity in school-aged Indigenous youths in northern Australia. Journal of Obesity; 2012: 893508 Retrieved 28 March 2012 from http://www.hindawi.com/journals/jobes/2012/893508/abs/
  31. Hardy LL, O’Hara BJ, Hector D, Engelen L, Eades SJ (2014) Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children. Medical Journal of Australia; 200(11): 667-671
  32. The Australian immunisation handbook: 10th edition 2015 (updated June 2015) (2015) Immunise Australia Program
  33. Haupt I, Fisher R, Weber J, Dunn K (2014) Review of the National Partnership Agreement on Essential Vaccines. Canberra: Sapere Research Group and Sironis Health
  34. Immunise Australia Program (2015) ACIR - Annual coverage historical data - Aboriginal and Torres Strait Islander children. Retrieved 11 February 2016 from http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/acir-ann-hist-data-ATSI-child.htm
  35. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  36. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  37. World Health Organization (2013) Exclusive breastfeeding. Retrieved 2013 from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
  38. Australian Institute of Health and Welfare (2011) 2010 Australian national infant feeding survey: indicator results. Canberra: Australian Institute of Health and Welfare
  39. Department of Families Housing Community Services and Indigenous Affairs (2009) Footprints in time: the longitudinal study of Indigenous children - key summary report from Wave 1. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  40. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
  41. Vos T, Barker B, Stanley L, Lopez A (2007) The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: Centre for Burden of Disease and Cost-Effectiveness, University of Queensland
  42. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13: table 10 smoker status by age, Indigenous status and sex [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500610.xls&4727.0.55.006&Data%20Cubes&848805EF76A00F55CA257CEE0010D8F0&0&2012%9613&06.06.2014&Latest
  43. Australian Bureau of Statistics (2010) National Aboriginal and Torres Strait Islander social survey, 2008: Table 10. Indigenous persons aged 15 years and over, by age groups by sex [data cube]. Retrieved from http://abs.gov.au/AUSSTATS/SUBSCRIBER.NSF/log?openagent&4714.0_aust_010_2008.xls&4714.0&Data%20Cubes&6959208EE47E867DCA25770B0016F56D&0&2008&21.04.2010&Previous
  44. Australian Bureau of Statistics (2004) National Aboriginal and Torres Strait Islander Social Survey, 2002. Canberra: Australian Bureau of Statistics
  45. Australian Bureau of Statistics (2010) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples, Oct 2010. Canberra: Australian Bureau of Statistics
  46. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13: table 11 smoker status by age by remoteness, 2002, 2008 and 2012–13 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500611.xls&4727.0.55.006&Data%20Cubes&2DFC3927395AF56DCA257CEE0010D921&0&2012%9613&06.06.2014&Latest
  47. Li Z, Zeki R, Hilder L, Sullivan EA (2013) Australia's mothers and babies 2011. Canberra: Australian Institute of Health and Welfare
  48. Australian Institute of Health and Welfare (2014) Birthweight of babies born to Indigenous mothers. Canberra: Australian Institute of Health and Welfare
  49. Australian Health Ministers' Advisory Council (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet
  50. National Health and Medical Research Council (2009) Australian guidelines to reduce health risks from drinking alcohol. Canberra: National Health and Medical Research Council
  51. Western Australian Department of Health (2010) Fetal alcohol spectrum disorder model of care. Perth, WA: Health Networks, Western Australian Department of Health
  52. Watkins RE, Elliott EJ, Wilkins A, Mutch RC, Fitzpatrick JP, Payne JM, O'Leary CM, Jones HM, Latimer J, Hayes L, Halliday J, D'Antoine H, Miers S, Russell E, Burns L, McKenzie A, Peadon E, Carter M, Bower C (2013) Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatrics; 13: 156 Retrieved 2 October 2013 from http://dx.doi.org/10.1186/1471-2431-13-156
  53. Vos T, Barker B, Stanley L, Lopez A (2007) Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: summary report. Brisbane: Centre for Burden of Disease and Cost-Effectiveness: School of Population Health, University of Queensland
  54. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A (2007) The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfare
  55. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  56. Australian Institute of Health and Welfare (2011) 2010 National Drug Strategy Household Survey report. Canberra: Australian Institute of Health and Welfare
  57. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 14 Alcohol consumption - Short-term or Single occasion risk by age, Indigenous status and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%2014%20alcohol%20consumption%20-%20sh-term%20or%20single%20occ%20risk%20-age,%20indigenous%20status,%20sex,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&0E985E680C399BF7CA257C2F
  58. National Health and Medical Research Council (2001) Australian alcohol guidelines: health risks and benefits. Canberra: National Health and Medical Research Council
  59. Australian Institute of Health and Welfare (2014) National Drug Strategy Household Survey detailed report: 2013. Canberra: Australian Institute of Health and Welfare
  60. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 13 Alcohol consumption - Long-term or Lifetime risk by age, Indigenous status and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%2013%20alcohol%20consumption%20-%20long-term%20or%20lifetime%20risk%20by%20age,%20indigenous%20status%20and%20sex,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&D5ABABF005F0BEF3C
  61. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014: Table 11A.1.2.6 Alcohol induced deaths (rate per 100 000), age standardised, by sex, NSW, Queensland, WA, SA and the NT, 2008−2012. Canberra: Productivity Commission
  62. Degenhardt L, Hall W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet; 379(9810): 55-70
  63. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 15 Substance use by age, remoteness and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%2015%20substance%20use%20by%20age,%20remoteness%20and%20sex,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&E6B1092ED1C8DC69CA257C2F00145F58&0&2012-13&27.11.2013&Latest
  64. Australian Institute of Health and Welfare (2015) Alcohol and other drug treatment services in Australia 2013 - 14. Canberra: Australian Institute of Health and Welfare
  65. Australian Institute of Health and Welfare (2011) Substance use among Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare

Endnotes

  1. Foods that are energy dense but do not provide many/any nutrients [7].
  2. When an electrical current is passed through the body, fatty tissue offers more resistance than lean tissue. The resistance to the flow of electricity is used to calculate the proportion of body fat in the individual.
  3. These include vaccinations for Bacille Calmette-Guérin (BCG) for newly born babies living in areas of high TB incidence, hepatitis A for children living in NT, Qld, SA and WA, hepatitis B for adults not previously vaccinated against hepatitis B, influenza for all persons aged 6 months or over, pneumococcal conjugate for children living in NT, Qld, SA and WA and pneumococcal polysaccaride for persons aged 15-49 years old with underlying conditions increasing the risk of invasive pneumococcal disease (IPD) and all persons aged 50 years and older [32].
  4. No more than two standard drinks on any single day.
  5. Because of the small sample size, comparison of data between Aboriginal and Torres Strait Islander people and non-Indigenous people should be viewed with caution.
  6. ICD code F15 hospitalisation from use of other stimulants includes amphetamine-related disorders and caffeine but not cocaine
 
© 2001-2016 Australian Indigenous HealthInfoNet