non-Indigenous Counterparts Research Articles

Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia.

In-depth interviews with 35 young Aboriginal women and men aged 16-21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted. Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms. Findings broaden understanding of young Aboriginal people's sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people's existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people's sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as 'youth health workers'.

Hogares guatemaltecos y etnicidad en el sur de México: perfiles demográficos y socioeconómicos

El objetivo general de este artículo es analizar los perfiles demográficos y socioeconómicos de los hogares guatemaltecos por habla de lengua indígena en las entidades de la frontera sur de México. En particular, se explora cuántos hogares guatemaltecos están asentados, cómo se configuran y cómo se han integrado en términos estructurales, con base en la Encuesta Intercensal 2015. Para tal fin se emplea estadística descriptiva y un modelo de regresión logística multinomial. El análisis indica que los hogares guatemaltecos se concentran en áreas rurales, son numerosos y más jóvenes, y laboran principalmente en el sector primario. Su integración socioeconómica es desventajosa en rubros como las condiciones del empleo y de la vivienda y el acceso a servicios sociales. No obstante, los hogares guatemaltecos indígenas exhiben niveles más altos de integración social que sus contrapartes no indígenas en el acceso a la ciudadanía mexicana, vivienda y apoyos económicos gubernamentales.

Planning mass eradication of Helicobacter pylori infection for indigenous Taiwanese peoples to reduce gastric cancer.

The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006-2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. Gastric cancer incidence (24.4 vs 12.3 per 100000 person-years) and mortality rates (15.8 vs 6.8 per 100000 person-years) were higher in Indigenous than in non-Indigenous, with 2.19-fold (95% confidence interval [CI]: 2.06-2.33) and 2.47-fold (2.28-2.67) increased risk, respectively. In Indigenous communities, H.pylori infection was more prevalent in Indigenous than in non-Indigenous (59.4% vs 31.5%, P<0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89-fold (95% CI: 1.34-2.66) and 1.73-fold (95% CI: 1.24-2.41) increased risk for H.pylori infection, respectively, as compared with non-Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle-aged, and older adults. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73.7%, 95% CI: 70.0-77.4%); the habits of smoking (1.70-fold, 95% CI: 1.01-2.39) and betel nut chewing (1.54-fold, 95% CI: 0.93-2.16) were associated with the higher risk of treatment failure. Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non-Indigenous counterparts. Eliminating the prevalent risk factor of H.pylori infection is a top priority to reduce this health disparity.

Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala

BackgroundIndigenous persons living in Latin America suffer from a higher prevalence of type 2 diabetes compared to their non-indigenous counterparts. This difference has been attributed to a wide range of factors. Future interventions could be influenced by a deeper understanding of the challenges that impact care in rural regions and in other low-income settings.MethodsThis study was conducted using a modified grounded theory approach. Extended observations and fifteen interviews were performed with adult male and female residents of three rural Mayan towns in Sololá Department, Guatemala using purposive sampling. Questions focused on the perceptions of individuals living with type 2 diabetes and their caregivers regarding disease and treatment.ResultsAcross interviews the most common themes that emerged included mistreatment by healthcare providers, mental health comorbidity, and medication affordability. These perceptions were in part influenced by indigeneity, poverty, and/or gender.ConclusionsBoth structural and cultural barriers continue to impact diabetes care for indigenous communities in rural Guatemala. The interviews in this study suggest that indigenous people experience mistrust in the health care system, unreliable access to care, and mental health comorbidity in the context of type 2 diabetes care. These experiences are shaped by the complex relationship among poverty, gender, and indigeneity in this region. Targeted interventions that are conscious of these factors may increase their chances of success when attempting to address similar health disparities in comparable populations.

The cost of hospitalisation for youth self-harm: differences across age groups, sex, Indigenous and non-Indigenous populations.

To report the comparative rates, average length of stay and cost per episode of hospital management for self-harm in three age cohorts: 15-19years, 20-24years and 25-29years; by sex and indigeneity. A secondary data analysis of the Australian Institute of Health and Welfare (AIHW) dataset between 1st January 2014 and 31st December 2014 inclusive. Cost per episode of hospitalised self-harm and rates by age group, sex and Indigenous status. The rate of hospitalised self-harm among Australian youth was 254.0 per 100,000 population. This rate resulted in an annual cost to the healthcare system of AU$55 million or an average cost per episode of $4649 (95% CI $4488:$4810). Hospitalised self-harm was 21 times higher than the rate of suicide (11,820 episodes of hospitalised self-harm/564 suicides). Indigenous youth had on average a 1.4 times higher rate of hospitalised self-harm and 2.2 times higher rate of suicide than non-Indigenous counterparts. When controlling for age and sex, the average cost per episode was significantly lower for Indigenous youth compared to non-Indigenous youth, estimated marginal means $4538 and $4954, respectively (p < 0.001). Hospitalised self-harm among Australian youth resulted in a substantial cost to the healthcare system. This cost is only part of the overall burden associated with self-harm. The rate of hospitalised self-harm was significantly higher in Indigenous youth, but the associated cost per episode was significantly lower.

Indigenous Perspectives on Help-Seeking for Family Violence: Voices From an Australian Community.

Indigenous peoples experience high rates of family violence (FV) yet are said to access support at lower rates than their non-Indigenous counterparts. There is an absence of Indigenous voices regarding their help-seeking behaviors for FV, particularly concerning men's views. The aim of this research was to seek Indigenous perspectives on their help-seeking behaviors for FV. Individual, face-to-face semistructured interviews took place with 23 Indigenous Australians (14 women and 9 men) recruited from one large community in Victoria, Australia. Interviews were audiotaped and transcribed verbatim. Data were categorized and organized, and themes were identified using thematic analysis. Five main themes emerged from the data. "You're Aboriginal, so that's just how it is" describes the experiences with discrimination and judgment that create general barriers for Indigenous peoples to access services. The second theme "putting a big blanket over it" articulates the role that shame plays in deterring support-seeking for FV. "How do you trust somebody?" defines the fear in the hearts and minds of Indigenous participants who contemplate help-seeking. A further main theme of "someone that they could have a yarn with" explores what occurs when participants initially decide to seek support. Their thoughts on what participants want from interactions with formal services are explored in the final theme "a safe space." Significant barriers to seeking support for FV exist for Indigenous peoples, including discrimination, shame, and fear. Service providers need to work on addressing these barriers through an increased understanding of Indigenous experiences and beliefs in an effort to encourage help-seeking behaviors. Interventions to assist kin in dealing with FV and for service providers to create safe spaces are urgent. More research informed by Indigenous voices is needed.

Characterizing the Indigenous Forest Peoples of Latin America: Results from Census Data.

Indigenous populations in Latin America are central to regional and global efforts toward achieving socially and environmentally sustainable development. However, existing demographic research on indigenous forest peoples (IFPs) has many limitations, including a lack of comparable cross-national evidence. We address this gap by linking representative census microdata to satellite-derived tree cover estimates for nine countries in the region. Our analyses describe the demographic and socioeconomic characteristics of IFPs, and draw comparisons with reference groups. Our first goal is to examine within- and between-population variation in the age structure, human capital attainment, and economic status of IFPs. We then analyze patterns of fertility among indigenous forest-dwelling women and comparison groups. Finally, we examine the association between migration patterns and tree cover among indigenous and non-indigenous populations. Findings demonstrate that Latin America's IFPs are materially deprived and characterized by high fertility levels overall. Importantly for sustainable development efforts, we show that non-indigenous forest-dwellers outnumber IFPs by more than eight to one and that IFPs have lower fertility than their non-indigenous counterparts when other characteristics are accounted for. Additionally, we find that most in-migrants to heavily-forested areas are non-indigenous, and that in-migrants tend to settle in areas that are forested but have few indigenous inhabitants. These results provide new cross-national evidence on the state of IFPs in Latin America, and highlight the need to empower these groups in the face of growing social and environmental crises in the region.

Ya’at’eeh: Race-reimaged belongingness factors, academic outcomes, and goal pursuits among Indigenous community college students

For decades, students’ sense of belonging has been conceptualized through colonial perspectives, assuming students are to assimilate to educational institutions in order to belong. To challenge these perspectives, we race-reimaged belongingness factors in an investigation of Indigenous students (n = 887) from 156 U.S. community colleges in a secondary dataset. We first used measurement invariance testing to examine how Indigenous students interpret belongingness items differently from their non-Indigenous counterparts. Second, we used multilevel modeling to assess the role of Native-specific sense of belonging, operationalized through Indigenous ways of knowing and being, on GPA and goal pursuits. Our findings suggest that both traditional conceptualizations of belongingness factors (i.e., student relationships to teachers and peers) and Native-specific constructions of belongingness factors via relationships to community, family, and cultural identity were salient. Native-specific factors were more consistently associated with Indigenous students’ outcomes. Implications for best practices to foster belongingness and future directions for race-reimaging research will be discussed.

Leisure, cultural continuity, and life promotion

ABSTRACT Colonization has left in its wake alarming suicide rates for Indigenous youth. The suicide rate of Indigenous youth in Canada is five to six times higher than their non-Indigenous counterparts. This article presents the findings of a research project that explored and promoted wellness and life promotion with Indigenous youth living on a reserve in Saskatchewan, Canada. Data collection occurred through an arts-based workshop, where youth collectively created stories about healing, life, relationships, hope, and ceremony. Specifically, authors discuss a two-eyed seeing approach and emphasize the importance of cultural continuity, cultural connectedness, and cultural revitalization when considering the process in which leisure programmes and services are organized.

Using Coronary Artery Calcium Scoring as Preventative Health Tool to Reduce the High Burden of Cardiovascular Disease in Indigenous Australians

BackgroundIndigenous Australians suffer higher rates of ischaemic heart disease resulting in premature mortality. Despite this, Indigenous Australians undergo less cardiovascular investigation and intervention than their non-Indigenous counterparts. Recent evidence suggests that computed tomography coronary angiography (CTCA) is not only able to accurately predict cardiovascular risk, but also results in reduced rates of myocardial infarction and cardiovascular death. MethodsThis is a prospective longitudinal study of patients in regional Australia referred for CTCA at a regional centre from 2012 to 2017. Patients were identified as Indigenous at registration. Results were recorded from formal radiology reports. Logistic regression was used to compare calcium score, as a measure of coronary artery disease burden in Indigenous and non-Indigenous patients. ResultsIndigenous patients are 2.8 times more likely to have a higher burden of coronary artery disease than non-Indigenous patients, even after accounting for the higher rate of cardiovascular risk factors in the Indigenous population (OR 2.77; p = 0.008). In the study population, Indigenous patients were well represented as compared to the background population. ConclusionThis is the first study of CTCA in an Indigenous Australian population, and one of the first using CTCA for an Indigenous population worldwide. It demonstrates a higher burden of cardiovascular disease for Indigenous Australians, independent of the higher rate of cardiovascular risk factors. Access to CTCA presents an opportunity to reduce the rate of myocardial infarction and early mortality in the Indigenous Australian population.

SUN-339 Are Indigenous Australians with diabetes and kidney disease receiving specialist renal care at greater risk of end stage kidney failure than their non-indigenous counterparts?

SUN-339 Are Indigenous Australians with diabetes and kidney disease receiving specialist renal care at greater risk of end stage kidney failure than their non-indigenous counterparts?

Renal cell carcinoma in the Canadian Indigenous population.

Diagnosis and treatment of renal cell carcinoma (rcc) might be different in Indigenous Canadians than in non-Indigenous Canadians. In this cohort study, we compared rcc presentation and treatments in Indigenous and non-Indigenous Canadians. Patients registered in the Canadian Kidney Cancer Information System treated at 16 institutions between 2011 and 2018 were included. Baseline patient, tumour, and treatment characteristics were compared between Indigenous and non-Indigenous Canadians. The primary objective was to determine if differences in rcc stage at diagnosis were evident between the groups. The secondary objective was to determine if treatments and outcomes were different between the groups. During the study period, 105 of the 4529 registered patients self-identified as Indigenous. Those patients were significantly younger at the time of clinical diagnosis (57.9 ± 11.3 years vs. 62.0 ± 12.1 years, p = 0.0006) and had a family history prevalence of rcc that was double the prevalence in the non-Indigenous patients (14% vs. 7%, p = 0.004). Clinical stage at diagnosis was similar in the two groups (p = 0.61). The disease was metastatic at presentation in 11 Indigenous Canadians (10%) and in 355 non-Indigenous Canadians (8%). Comorbid conditions that could affect the management of rcc-such as obesity, renal disease, diabetes mellitus, and smoking-were more common in Indigenous Canadians (p < 0.05). Indigenous Canadians experienced a lower rate of active surveillance (p = 0.01). Treatments and median time to treatments were similar in the two groups. Compared with their non-Indigenous counterparts, Indigenous Canadian patients with rcc are diagnosed at an earlier age and at a similar clinical stage. Despite higher baseline comorbid conditions, clinical outcomes are not worse for Indigenous Canadians than for non-Indigenous Canadians.

Investigation of the factors contributing to Indigenous students’ retention and attrition rates at the University of Adelaide

Abstract Aboriginal and Torres Strait Islander peoples remain significantly under-represented in higher education systems. There are significant disparities in university completion rates for Aboriginal and Torres Strait Islander students compared with their non-Indigenous counterparts. The poor-retention and high-attrition rates among Aboriginal and Torres Strait Islander students come at significant financial and personal cost for the individual, families, community, universities and governments. Existing evidence in relation to attrition has identified complex and multifaceted reasons including ill health, family and community responsibilities, financial difficulties, lack of social support, academic disadvantage and issues surrounding personal well-being. The current study aimed to add to evidence of the academic, financial, social support and well-being factors affecting Aboriginal and Torres Strait Islander student's decision to continue or withdraw from their university studies. Contrary to expectation, students' decision to withdraw was not related to academic and social factors. It was found that students between 22 and 25 years old strongly agreed they were likely to withdraw from studies. There was a significant association between withdrawal and type of enrolment. This study provided important insights into the factors that contribute to a students' decision to withdraw from their university studies, with implications for future educational interventions.

Planning Mass Eradication of Helicobacter Pylori Infection for Indigenous Taiwanese Peoples to Reduce Gastric Cancer

Background: To identify the gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. Methods: First, we quantified the gastric cancer burden for Indigenous peoples using data from Taiwan Cancer and Mortality Registries. Risk factor analyses were carried out based on literature review and data from ongoing mass screening for other cancers. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. Findings: Gastric cancer incidence (24·4 vs. 12·3 per 100,000 person-years) and mortality rates (15·8 vs. 6·8 per 100,000 person-years) were higher in Indigenous peoples than in non-Indigenous, with 2·19-fold (95% Confidence Interval [CI]: 2·06-2·33) and 2·47-fold (2·28-2·67) increased risk, respectively. Despite similar cancer stage at diagnosis, the survival rate in Indigenous peoples was 9·6% (0·1-20·1%) lower. Helicobacter pylori infection is a well-documented risk factor and smoking for >10 years increased the risk by 26·3% (7·9-47·8%). In Indigenous communities, both H. pylori infection (56·1%, 95% CI: 53·6-58·6%) and smoking (28·4%, 95% CI: 25·7-31·0%) were prevalent. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73·7%, 95% CI: 70·0-77·4%); the habits of smoking (1·49-fold, 95% CI: 1·10-2·02) and betel nut chewing (1·40-fold, 95% CI: 1·03-1·89) were associated with the higher risk of treatment failure. Interpretation: Gastric cancer burden is higher in Indigenous Taiwanese than in their non-Indigenous counterparts. Eliminating risk factors, including H. pylori eradication and smoking cessation, is a top priority to reduce this health disparity. Funding: Health Promotion Administration, Ministry of Health and Welfare, Taiwan. Declaration of Interest: The authors report no conflicts of interest. Ethical Approval: The Research Ethics Committee of National Taiwan University Hospital (201804108RINB) and the Council of Indigenous Peoples in Taiwan (1070056368) approved the protocol for this program. The informed consent has been obtained from each participant.

Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study

ObjectiveBoth pregestational and gestational diabetes mellitus (PGDM, GDM) occur more frequently in First Nations (North American Indians) pregnant women than their non-Indigenous counterparts in Canada. We assessed whether the impacts...

Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study

BackgroundRacism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. We quantified the population-based prevalence of experiences of racism of Indigenous adults in the Australian state of Victoria and investigated whether this was independent of social determinants and lifestyle risk factors.MethodsWe combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys to obtain a sample size of 33,833 Victorian adults, including 387 Indigenous adults. The survey is a cross-sectional, population-based, computer-assisted telephone interview survey conducted annually. Using logistic regression, experiences of racism was the dependent variable and Indigenous status the primary independent variable of interest. Secondary independent variables included age, sex, rurality, socioeconomic status, social capital, and lifestyle risk factors.ResultsIndigenous Victorian adults were four times more likely than their non-Indigenous counterparts to have experienced racism in the preceding 12 months; odds ratio (OR) = 4.3 (95% confidence interval (CI): 3.2–5.8). Controlling for social determinants and lifestyle risk factors attenuated, but did not eliminate, the association between experiences of racism and Indigenous status; OR = 3.1 (95% CI: 2.2–4.3). The social determinants of age and social trust made the largest contribution to the attenuation of the association. Education also had a large impact on the association, but in the opposite direction, suggesting that a low level of education may be protective against experiences of racism. When the non-Indigenous comparison group consisted of adults of mainly Anglo-Celtic origin, Indigenous adults were seven times more likely (OR = 7.2; 5.3–9.7) to have experienced racism.ConclusionsRacism directed against Indigenous Victorians is significant and cannot be ascribed to any specific attributes such as socioeconomic status or lifestyle risk factors. We argue that a human rights-based approach to policy-making for the elimination of systemic and interpersonal racism offers an opportunity and viable alternative to current policy-making, that continues to be dominated by a paternalistic approach that reinforces racism and the resulting inequities.Please noteThroughout this document, the term Indigenous is taken to include people of Aboriginal and Torres Strait Islander descent. While not our preferred term, Indigenous is used in preference to Aboriginal and Koori as not all Indigenous people living in Victoria are Aboriginal or Koori. We recognise that, with the exception of the term ‘Koori’, these terms are Eurocentric having been imposed upon a people of many nations with distinct languages and cultures. The use of such terms is akin to referring to the peoples of the continent of Europe as ‘Europeans’.

Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia

BackgroundIndigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the number of additional services required if access was equal between Indigenous and non-Indigenous people with cancer.MethodsWe used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years.ResultsOn average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0–12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13–24 months: mean $200 vs $484; and 25–36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people.ConclusionsIndigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners.

Echocardiography in Pregnant Indigenous Australians: Need for Screening?

The Indigenous population of Australia has one of the highest rates of rheumatic heart disease (RHD) globally. RHD is more common in females and peak incidence corresponds with child-bearing age. Significant valvular disease can complicate pregnancy. In the Northern Territory, pregnant women are referred for echocardiogram if there are signs or symptoms of cardiac pathology or a history of RHD. To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of RHD. A retrospective review of all echocardiograms performed between 2014–2018 for an indication relating to pregnancy was completed. Data included indication, clinical history, echocardiographic findings and location of delivery. A total of 322 cases with echocardiography during pregnancy were reviewed, 195 Indigenous and 127 non-indigenous women (mean age 25 vs 30 years, p-value <0.01). Indigenous women had significantly higher rates of abnormal echocardiograms (35.9% vs 10%, p-value <0.01) and higher burden of rheumatic fever/RHD (39.4% vs 0.8% p-value <0.01). Moderate or severe valve lesions were detected in 26 (13.3%) indigenous women and 11 (5.6%) had previous cardiac surgery. Transfer to a tertiary centre with valve intervention services available was required for 12 (6.2%) Indigenous women. In the Northern Territory, Indigenous pregnant women have significantly higher rates of abnormal echocardiograms compared with non-indigenous counterparts. This is mainly due to RHD. Data suggests that Indigenous pregnant women are being under serviced by the current referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.

Heart Failure Treatment in Northern Australia: Can We Do Better?

Background: Heart failure (HF) is a significant cause of disease burden for Indigenous Australians. Understanding the prevalence, aetiology and treatment in Indigenous populations is vital to improving health outcomes. Aim: To compare the management of systolic HF between Indigenous and non-indigenous populations in the Northern Territory. Methods: A retrospective study of systolic heart failure admissions between July 2016 and July 2017 was performed. Data collected included patient demographics, co-morbidities, echocardiographic findings, medical therapy and 12-month outcomes. Results: There were 102 patients; 51 Indigenous and 52 non-indigenous (prevalence 77/100,000 vs 29/100,000). Indigenous patients were younger (52 years vs 72 years, p-value <0.01) and more likely female (45% vs 27%, p-value <0.01) with higher rates of rheumatic heart disease (15.6% vs 0% p-value <0.01) and chronic kidney disease (74.5% vs 50% p-value <0.01). Ischaemic cardiomyopathy was the most common aetiology in both groups (41.2%, 44%). Beta-blockers were the most prescribed treatment in both groups (86.2%, 75%) with lower rates of ACE-inhibitor (68.6%, 63.4%) and aldosterone antagonist (66.6%, 54%). At 12 months, treatment prescription had not reduced significantly for Indigenous patients. Readmission rates for heart failure were high (74.5% vs 61.5%) with 6 deaths in each group. Conclusion: Indigenous patients are younger, more likely to be female and have a markedly higher prevalence of systolic heart failure than their non-indigenous counterparts. Their burden of chronic disease is significant and rehospitalisation rates are high. Addressing the underlying causes of heart failure and barriers to treatment adherence are necessary to reduce the disease burden.

Rewarding Commitment to Attend School: A Field Study with Indigenous Australian High School Students

We introduce a novel incentive program aimed at decreasing school absenteeism based on the effect of voluntary promises in motivating desirable behaviour. In contrast to a standard program, in which students receive a reward conditional on having achieved a school attendance rate of at least 90 percent, in the promise program, they receive the reward up front, conditional on their commitment to invest their best efforts to reach the attendance target. We assess the effectiveness of the promise program through a field study involving Indigenous Australian high school students, a population who tends to have lower education achievement and socioeconomic advantage than their non-Indigenous counterparts. We find that the promise program significantly decreased unexplained absences compared to the standard program but that it did not influence overall school absences. Our findings suggest that voluntary promises coupled with small gifts are effective in influencing behaviour of disadvantaged students. At the same time, we need further research on how to best design such programs to achieve positive effects in reducing school absenteeism.