Torres Strait Islander Social Survey Research Articles

Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.

Physical violence and violent threats reported by Aboriginal and Torres Strait Islander people with a disability: cross sectional evidence from a nationally representative survey

BackgroundA recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities.MethodsData from the 2014–15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats.ResultsIn 2014–15, 17% of Aboriginal and Torres Strait Islander people aged 15–64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one’s natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals.ConclusionAboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.

The Financial Resilience and Life Satisfaction Nexus of Indigenous Australians*

Financial resilience is characterised by four sets of variables, namely economic resources, financial inclusion, financial capability and social capital. The purpose of this study is to examine the association between financial resilience and life satisfaction of Indigenous Australians using the (2014/2015) National Aboriginal and Torres Strait Islander Social Survey data. The results reveal that running out of money for living and problems in accessing financial services have significant negative implications on the life satisfaction of Indigenous Australians. The ability to raise money in an emergency, social connections and community support in times of crisis contributes to greater life satisfaction.

Exposure to interpersonal racism and avoidance behaviours reported by Aboriginal and Torres Strait Islander people with a disability

AbstractUsing the National Aboriginal and Torres Strait Islander Social Survey, this paper examines exposure to interpersonal racism and avoidance reported by Aboriginal and Torres Strait Islander people with disabilities. We find that in 2014–2015, 32 per cent of people aged 15–64 without a disability experienced racism compared with 42 per cent of those with a disability. Half of those living with an intellectual or psychological disability reported racism, and about 20 per cent of those with any disability avoided settings such as healthcare, education or the general public due to past instances of racism, relative to 11 per cent of those without a disability. After adjusting for confounding factors and complex survey design, presence of a disability was associated with a 1.6–1.8 odds increase in exposure to racism, more frequent racist exposure and avoidance. Disability was further associated with an approximate doubling of the odds of reporting multi‐context avoidance and the likelihood of reporting both racism and avoidance in tandem. Severity of disability, higher numbers of disabling conditions and specific disability types were associated with increased odds of racism and avoidance. Independent of these effects, removal from one's natural family and identifying with homelands was strongly associated with racism and avoidance.

Closing the (incarceration) gap: assessing the socio-economic and clinical indicators of indigenous males by lifetime incarceration status

BackgroundApproximately 1 in 5 to 1 in 6 Indigenous Australian males are currently imprisoned or have previously been imprisoned. Recent work has also pointed to a widening socio-economic gap within the Indigenous population. Given the myriad social, wellbeing and environmental risk factors associated with justice-involvement, it is conceivable that incarceration may contribute to the increasing disparities found within the Indigenous population. This study aimed to explore the presence and extent of an ‘incarceration gap’ within the Indigenous population and to uncover which social factors characterise the disparity.MethodsThe study utilised data from the 2014–5 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). A number of socio-economic, environmental and clinical factors were compared by life-time incarceration status. Chi-square tests were used to examine the association between incarceration status and each of the comparison variables.ResultsDisparities were observed within the Indigenous Australian population across a number of important health and socio-economic markers by incarceration status - the most pronounced being for educational obtainment – year 10 completion (Never incarcerated 73%, Ever incarcerated 50%), labour force participation (Never incarcerated 56%, Ever incarcerated 26%) and drug/alcohol problems (Never incarcerated 7%, Ever incarcerated 29%). Never-incarcerated Indigenous males yielded aggregate proportions across numerous variables that approximated or matched general Australian population estimates.ConclusionsThere appears to be evidence for a substantial ‘incarceration gap’ within the Indigenous Australian population.

Nexus between drinking patterns, gender and life satisfaction: Some evidence from Indigenous Australians

AbstractExcessive alcohol consumption results in a broad range of health problems and other social issues, such as violence, social disorder and family breakdown. As such, alcohol consumption is considered as a critical social policy issue in Australia. In this study, we have used ordered logit models to estimate the probability of an Indigenous person consuming alcohol and to assess the impact of alcohol consumption on self‐perceived life satisfaction. A heteroscedasticity‐corrected ordered logit model is used to identify the gender difference in such effects. For this purpose, we use the latest National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014/2015 data collected by the Australian Bureau of Statistics. The estimation results reveal that age, gender, employment status, income and the experience of unfair treatments significantly affect Indigenous people's (level of) alcohol consumption. The results also reveal that any level of alcohol consumption is linked with reduced overall life satisfaction, which is another reason why prevention of alcohol misuse should be a priority. A significant gender differences in the medium‐risk‐level alcohol consumption were also observed. These findings could be used as an alcohol prevention message in developing and implementing alcohol prevention strategies and policies.

Are Effects of Violence on Life Satisfaction Gendered? A Case Study of Indigenous Australians

Violence related Australian statistics reveal a higher prevalence of violence among indigenous Australians than non-indigenous Australians. Using the latest National Aboriginal and Torres Strait Islander Social Survey (2014/2015) available from the Australian Bureau of Statistics, this study investigates the socio-economic and demographic factors that influence the likelihood of physical violence among indigenous Australians and the effects of physical violence on life satisfaction, with a special focus on gender differences in such effects. The results indicate that while gender is an important determinant of violence victimisation, homelessness, alcohol and substance consumption, a victim of the stolen generation and remote living increase the likelihood of physical violence victimisation. Our results also reveal that, while physical violence negatively affects the life satisfaction of both women and men, exposure to physical violence reduces the life satisfaction of indigenous women more than indigenous men.

Aboriginal and Torres Strait Islander people and digital inclusion: what is the evidence and where is it?

ABSTRACTQuantitative research on digital inclusion has grappled with significant gaps in data with respect to Aboriginal and Torres Strait Islander people. We compare the survey methods and questions of the Australian Digital Inclusion Index (ADII) data, the National Aboriginal Torres Strait Islander Social Survey (NATSISS) and the Census of Population and Housing to identify these gaps. While the ADII is the most comprehensive examination of digital inclusion, encompassing access, affordability, and digital ability measures, the general ADII dataset excludes Aboriginal and Torres Strait Islander people living in remote areas. In addition, we draw together findings from qualitative research on digital inclusion within particular Aboriginal and Torres Strait Islander communities, to demonstrate why digital choices—including the preference for mobile devices—are important for understanding statistical trends.

Maintaining connection to family, culture and community: implications for remote Aboriginal and Torres Strait Islander pathways into higher education

ABSTRACTMaintaining connections to family, culture and community is essential for strengthening an Aboriginal child’s educational achievements. The Australian Bureau of Statistics collects self-reported information on a range of factors that can assist in understanding what influences Aboriginal children to complete school. The 2014–2015 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) provides a national snapshot about how various characteristics influence the educational experience of Aboriginal children in remote Australia. In this article, findings from NATSISS have been used to interrogate qualitative data from the Whole of Community Engagement initiative led by Charles Darwin University. This is a multi-site participatory action research project working across six remote communities in the Northern Territory, Australia. We use Indigenous community perspectives to describe why maintaining connection to family, culture and community is important for both Aboriginal high school completions in remote Australia, and the subsequent impact this has on pathways into higher education.

Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff.

To examine smoking among Aboriginal and Torres Strait Islander staff of Aboriginal community-controlled health services (ACCHSs). The Talking About The Smokes (TATS) project surveyed 374 Aboriginal and Torres Strait Islander staff at a national sample of 31 ACCHSs, from April 2012 to October 2013. We made comparisons with adult participants in the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and with 1643 smokers in a community sample of 2522 Aboriginal and Torres Strait Islander people also surveyed in the TATS project. Smoking status, smoking behaviour at work, quitting behaviour, attitudes and beliefs about smoking and quitting. Aboriginal and Torres Strait Islander ACCHS staff had a lower smoking prevalence than among all Aboriginal and Torres Strait Islander adults surveyed in the NATSISS (38% v 49.8%), but this difference was smaller when compared with only employed adults (38% v 44.8%). Staff smokers had higher odds than smokers in their communities of ever trying to quit (odds ratio [OR], 2.1; 95% CI, 1.1-3.7), of having often noticed anti-smoking advertising (OR, 2.8; 95% CI, 1.4-5.6), and of having used stop-smoking medications (OR, 3.0; 95% CI, 1.6-5.7), often with the support of their ACCHS. There was a significant association (P<0.001) between the smoking status of Aboriginal and Torres Strait Islander staff and their confidence in talking to others about smoking and quitting; ex-smokers were most likely to report being confident. Most Aboriginal and Torres Strait Islander staff who smoked (74%) agreed that being a non-smoker sets a good example to patients at their health service, and most did not smoke with patients or at work where patients could see them. Smoking prevalence among Aboriginal and Torres Strait Islander ACCHS staff is only modestly lower than among other employed Aboriginal and Torres Strait Islander people. Given that ex-smokers feel more confident to help others quit than any other group, smoking cessation in ACCHS staff is a useful contributor to reducing community smoking rates.

Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians.

To describe the research methods and baseline sample of the Talking About The Smokes (TATS) project. The TATS project is a collaboration between research institutions and Aboriginal community-controlled health services (ACCHSs) and their state and national representative bodies. It is one of the studies within the International Tobacco Control Policy Evaluation Project, enabling national and international comparisons. It includes a prospective longitudinal study of Aboriginal and Torres Strait Islander smokers and recent ex-smokers; a survey of non-smokers; repeated cross-sectional surveys of ACCHS staff; and descriptions of the tobacco policies and practices at the ACCHSs. Community members completed face-to-face surveys; staff completed surveys on paper or online. We compared potential biases and the distribution of variables common to the main community baseline sample and unweighted and weighted results of the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). The baseline survey (Wave 1) was conducted between April 2012 and October 2013. 2522 Aboriginal and Torres Strait Islander people in 35 locations (the communities served by 34 ACCHSs and one community in the Torres Strait), and 645 staff in the ACCHSs. Sociodemographic and general health indicators, smoking status, number of cigarettes smoked per day and quit attempts. The main community baseline sample closely matched the distribution of the Aboriginal and Torres Strait Islander population in the weighted NATSISS by age, sex, jurisdiction and remoteness. There were inconsistent differences in some sociodemographic factors between our sample and the NATSISS: our sample had higher proportions of unemployed people, but also higher proportions who had completed Year 12 and who lived in more advantaged areas. In both surveys, similar percentages of smokers reported having attempted to quit in the past year, and daily smokers reported similar numbers of cigarettes smoked per day. The TATS project provides a detailed and nationally representative description of Aboriginal and Torres Strait Islander smoking behaviour, attitudes, knowledge and exposure to tobacco control activities and policies, and their association with quitting.

Aboriginal Disadvantage in Major Cities of New South Wales: Evidence for Holistic Policy Approaches

AbstractAboriginal Australians experience disadvantage relative to other Australians across multiple socioeconomic indicators. Whilst Aboriginal disadvantage occurs across the nation, its characteristics may differ between locations. This article presents the first econometric analysis of Aboriginal disadvantage in major cities of New South Wales. The analysis is based on a multiple indicator framework devised by the Productivity Commission, populated with data from the National Aboriginal and Torres Strait Islander Social Survey of 2002. The results demonstrate the key drivers and interdependence of various indicators of Aboriginal disadvantage. This supports holistic approaches to improving Aboriginal welfare, rather than focusing on individual policy areas in isolation.

Aboriginal and Torres Strait Islander smoke‐free homes, 2002 to 2008

To describe the social patterning of and trends in the prevalence of Aboriginal and Torres Strait Islander smoke-free homes, and the association between these smoke-free homes and smoking initiation, intensity and cessation. Analyses of responses to questions about whether any householders usually smoke inside in the 2004 National Aboriginal and Torres Strait Islander Health Survey, the 2008 National Aboriginal and Torres Strait Islander Social Survey, and in the comparable National Health Surveys in 2004 and 2007. The proportion of Indigenous children living with at least one daily smoker who smokes inside declined significantly from 28.4% in 2004 to 20.8% in 2008, with significant improvements only detected among the most disadvantaged categories of Indigenous children. The proportion of Indigenous daily smokers who lived in multi-person households where no daily smoker householder usually smoked inside increased significantly from 45.0% in 2004 to 56.3% in 2008. The absolute size of these changes was greater among Indigenous children and smokers than among all Australians. More disadvantaged Indigenous children were more likely to be exposed to secondhand smoke at home, and more disadvantaged Indigenous smokers were more likely to live in households where smokers usually smoked inside. Indigenous smokers in smoke-free homes smoke significantly less cigarettes. The increases in Indigenous smoke-free homes are encouraging, especially as they are from the period before recent increased attention to Indigenous tobacco control, which should accelerate these trends and their resultant health benefits for Aboriginal and Torres Strait Islander children and families.

Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008

Objectives: To describe smoking intensity among Indigenous Australians and any changes that occurred between 1994 and 2008. Design, setting and participants: Analysis of data from two national cross-sectional household surveys conducted among Aboriginal and Torres Strait Islander people — the 1994 National Aboriginal and Torres Strait Islander Survey, and the 2008 National Aboriginal and Torres Strait Islander Social Survey, with 8565 and 7803 respondents aged 15 years and over, respectively. Main outcome measure: Self-reported number of cigarettes per day (CPD) smoked. Results: In 2008, the mean number of CPD smoked by Indigenous smokers was 14.8 (95% CI, 14.1–15.4 CPD). The age-standardised proportion of Indigenous people who smoked more than 20 CPD declined from 17.3% in 1994 (95% CI, 15.8%–18.7%) to 9.4% in 2008 (95% CI, 8.4%–10.5%), a 45% relative reduction. The proportion of respondents who smoked 1–10 CPD increased from 16.8% (95% CI, 15.1%–18.5%) to 21.6% (95% CI, 20.1%–23.2%). Conclusions: Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.

Associations between discrimination and dental visiting behaviours in an Aboriginal Australian birth cohort

contained a higher proportion of older adults, females, and regional and remote adults, and the NSW-NATSIHS sample contained a higher proportion of females, and regional and remote adults. Finding that the majority of the risk behaviours and all the health status prevalence estimates were not significantly different was encouraging. The higher rate of alcohol non-drinking and lower rate of current smoking in the NSWPHS was likely due to the underrepresentation of young Aboriginal and Torres Strait Islander men in the NSWPHS telephone survey. Although 98% of Aboriginal and Torres Strait Islander persons had used telephones in the month prior to the National Aboriginal and Torres Strait Islander Social Survey (NATSISS) interview, landline phone ownership still remains low (71% in non-remote and 40% remote) compared to the general public; however, mobile phone ownership is becoming more common (more than 90% in non-remote and more than 80% remote). 9 Expanding the NSWPHS sampling frame, as planned in 2012, to include mobile phones could potentially increase access to young Aboriginal and Torres Strait Islander men and improve the accuracy of the estimates for alcohol and smoking.

Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008

To describe smoking intensity among Indigenous Australians and any changes that occurred between 1994 and 2008. Analysis of data from two national cross-sectional household surveys conducted among Aboriginal and Torres Strait Islander people--the 1994 National Aboriginal and Torres Strait Islander Survey, and the 2008 National Aboriginal and Torres Strait Islander Social Survey, with 8565 and 7803 respondents aged 15 years and over, respectively. Self-reported number of cigarettes per day (CPD) smoked. In 2008, the mean number of CPD smoked by Indigenous smokers was 14.8 (95% CI, 14.1-15.4 CPD). The age-standardised proportion of Indigenous people who smoked more than 20 CPD declined from 17.3% in 1994 (95% CI, 15.8%-18.7%) to 9.4% in 2008 (95% CI, 8.4%-10.5%), a 45% relative reduction. The proportion of respondents who smoked 1-10 CPD increased from 16.8% (95% CI, 15.1%-18.5%) to 21.6% (95% CI, 20.1%-23.2%). Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.

Assessing the Influence of “Standard” and “Culturally Specific” Risk Factors on the Prevalence and Frequency of Offending

This is an empirical study which uses a multifactorial risk framework to investigate the factors that influence the prevalence and frequency of offending by indigenous Australians (as measured through self-reported arrest rates). The study uses regression modeling of data from the 2002 National Aboriginal and Torres Strait Islander Social Survey to estimate the effects of a range of individual, family, and community factors on indigenous arrest rates. The study considers a range of explanatory factors and includes both “standard” and “culturally specific” influences. Drawing upon the works of Homel, Lynch, and Herd, Broadhurst, and other Australian researchers, the study investigates the influence of multiple risk factors (including factors such as cultural strength and connection to community) and assesses whether these play a part in explaining the interaction between the indigenous population and the Australian criminal justice system.

Influences on Indigenous Labour Market Outcomes

Key points: This paper uses data from the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) to model the links between various personal characteristics and activities, and four Indigenous labour market outcomes. As causality may run in either direction, results are interpreted as associations. Results typically differ between men and women, in part because of different responsibilities in relation to child rearing, broader family responsibilities and other specialisation in unpaid work. Of these differences, the most notable were those for educational attainment. Results suggest that for women, attainment of year 10 or above is associated with a higher probability of employment and labour force participation, whereas this is less evident for men. Results confirm findings from previous research that other human capital factors, such as good health, are positively associated with Indigenous employment and labour force participation. Arrest and imprisonment were found to be negatively associated with Indigenous employment and labour force participation. A history of arrest was found to have a larger negative association with employment for women compared to men. Models that omit personal characteristics that might determine an individual’s labour supply (such as ability, motivation and preferences) are likely to produce biased estimates of the effect of the human capital factors that are included in the model (such as education, health and disability). One benefit of including variables in the model that represent cultural and social engagement is that they may act as proxies for unobserved personal characteristics, reducing the impact of this source of bias. The cultural and social engagement factors were found to have statistically significant associations with Indigenous labour market outcomes for women, but not for men. For women there were positive associations between employment and labour force participation, and engagement in social cultural events and the provision of support outside the household. A greater understanding of the links between social capital and labour market outcomes could be explored using alternative econometric models. However, there are limits to the indicators that can be derived from the data.

Wholesale data for surveillance of Australian Aboriginal tobacco consumption in the Northern Territory

ObjectivesEffective monitoring of trends in tobacco use is an essential element of tobacco control policy. Monitoring tobacco consumption using tobacco wholesale data has advantages over other methods of surveillance. In...

Culture and Wellbeing: The Case of Indigenous Australians

A recurring theme in Indigenous affairs in Australia is a tension between maintenance of Indigenous culture and achievement of socio-economic ‘equity’: essentially ‘self-determination’ versus ‘assimilation’. Implicit in this tension is the view that attachment to traditional cultures and lifestyles is a hindrance to achieving ‘mainstream’ economic goals. Using data from the National Aboriginal and Torres Strait Islander Social Survey, stronger attachment to traditional culture is found to be associated with enhanced outcomes across a range of socio-economic indicators. This suggests Indigenous culture should be viewed a part of the solution to Indigenous disadvantage in Australia, and not as part of the problem.