Torres Strait Research Articles (Page 1)

This study aimed to synthesise Australian evidence on the determinants of private hospital financial viability and the implications for system performance. We conducted a PRISMA-guided systematic review of English-language studies on Australia's mixed public-private system. Databases searched were PubMed, MEDLINE, Embase, Scopus, and EconLit. Eligible publications analysed financial, policy, or operational factors affecting private hospitals. Data were extracted and synthesised using thematic analysis. Twenty-three publications met the inclusion criteria. Five cross-cutting themes emerged. (1) Payment, pricing and fee transparency: fragmented schedules, out-of-pocket exposure, and contracting frictions weaken price signals and can erode margins. (2) Ownership, consolidation, and for-profit pressures: corporate and private-equity dynamics shape capital allocation, service mix, and bargaining power. (3) Insurance incentives and reforms: policy levers modestly influence demand and show limited impact on public waiting times, with mixed consequences for system efficiency. (4) Maternity, allied health, and pandemic disruptions: service lines with thin margins and workforce constraints are exposed to demand shocks and cost growth. (5) Consumer choice, emergency department usage, waiting times, and public-private overlaps: patient flows and portability influence revenue stability but create coordination challenges. The sector remains valuable yet financially fragile. Improving price transparency, reforming payment models and contracting arrangements to better align with value-based principles, and deepening public-private partnerships could strengthen resilience. Targeted data on Aboriginal and Torres Strait Islander peoples health and clearer outcome-price linkages are priorities for practice and policy.

Purpose This study described the relationship of age, body composition and ancestry on sleep behavior, knowledge, and attitudes in rugby league athletes. Methods Fifty rugby league athletes completed the Sleep Practices and Attitudes Questionnaire alongside demographic information (age, body composition, ancestry). The results were compared based on age (<20 years old, 20−24 years old and >25 years), body composition (body fat percentage (%)) and ancestral groups (Pasifika, Aboriginal and/or Torres Strait Islander (ATSI) and Anglo-European). Spearman's correlation determined the associations between body composition and sleep knowledge, beliefs and attitudes. An ANCOVA compared differences between ancestral groups with age and body composition as covariates, while a one-way ANOVA was used for age group comparisons. Results Younger athletes had higher scores for eating/drinking in bed (p = 0.039), while those with higher body fat percentage read less in bed (p = 0.022) and reported lower sleep quality (p = 0.027). For ancestry, significantly lower sleep difficulty scores were reported for Anglo-European compared to both ATSI and Pasifika (p < 0.05) athletes. Furthermore, significantly higher self-reported sleep durations existed between Anglo-Europeans and Pasifika (p = 0.030). Ancestry affected coping with chronic insomnia (prioritize sleep, reduce caffeine), activities in bed (eat/drink, work/thinking) and the physical environment (dark, physically comfortable, comfortable temperature). Conclusion These findings underscore the importance of accounting for cultural and physiological variation when designing sleep education and interventions in rugby leagues. Future research needs to consider ancestry, body composition and age when assisting sleep educational programs during rugby league.

Although acute rheumatic fever (ARF) is a preventable condition, it continues to be diagnosed in Far North Queensland, Australia. Enhanced primary prevention is necessary to reduce the local burden of ARF and rheumatic heart disease. In this retrospective clinical audit, all cases of definite ARF in the remote Torres Strait and Cape York region of Far North Queensland between January 2020 and December 2024 were examined. Clinical records were reviewed to identify and characterize any healthcare presentations of individuals during the 6 weeks preceding their ARF diagnosis. Of 67 individuals with definite ARF 65 (97%) identified as First Nations Australians; 43/67 (64%) did not present for any healthcare in the 6 weeks preceding their diagnosis; and a further 10/67 (15%) presented for healthcare that was unrelated to group A Streptococcus (Strep A) infection. Overall, a possible Strep A infection (skin infection or sore throat) was identified in 14/67 (21%) patients; 9/67 (13%) patients presented with skin infections, and 5/67 (7%) presented with sore throats. Of these, 5/14 (36%) received appropriate antibiotic treatment. Most individuals with definite ARF in this remote region of Australia do not present for healthcare before their diagnosis; however, there remain opportunities for the primary prevention of ARF among those who do. Culturally considered health promotion, opportunistic screening, and improved recognition and treatment of Strep A infection are critical for reducing ARF incidence in this region of Australia. It is also important to define the contribution of asymptomatic Strep A infections to the pathogenesis of ARF.

Background: Childhood Obesity is a significant and growing Public Health threat among Aboriginal and Torres Strait Islander (ATSI) children and adolescents in Australia. Health sectors in Australia have been focusing on health intervention programs across various states to prevent childhood obesity. This review aims to analyse the impact of obesity intervention programs conducted among children and adolescents of ATSI communities across Australia and report on the best practices for conducting future research. Objectives: This scoping review synthesised existing literature on the obesity prevention interventions programs among ATSI Children and Adolescents in Australia and examined their scope, implementation, and outcomes; evaluated their cultural appropriateness; and highlighted critical enablers and barriers. Methods: This scoping review analysed scholarly journal articles that reported on the findings of obesity intervention programs delivered across ATSI children and adolescents. Only Quasi-experimental and Randomized Control Trials (RCTs) were selected for the review. A full search has been carried out in Health databases such as Cochrane Library, Medline, PubMed, and ProQuest Central for the past 15 years. The framework of the Joanna Briggs Institute (JBI) for Scoping reviews was followed throughout this review. Results: Eleven studies met inclusion criteria. Findings were clustered into five themes: (i) community-led, systems-based interventions improved health behaviours and anthropometry; (ii) culturally tailored, community-embedded programs enhanced engagement and health literacy; (iii) early childhood and family-focused approaches showed promise; (iv) community or policy initiatives yielded mixed results; and (v) behavioural interventions were ineffective without addressing social and structural determinants. The most effective programs were community-delivered, multi-stakeholder, and centred on empowerment and capacity building. Conclusions: Obesity prevention efforts targeting Aboriginal and Torres Strait Islander children and adolescents are most successful when community-led, culturally grounded, and supported by multiple stakeholders. These findings underscore the necessity of culturally sensitive, participatory approaches. Further research is needed to strengthen the evidence base and inform sustainable, policy-relevant strategies for childhood obesity.

Abstract Wildlife management is increasingly challenged by ecological pressures and public controversy, particularly in relation to pest control strategies in Australia and globally. As invasive species and human–wildlife conflicts intensify, understanding public support for wildlife management has become essential to the design and legitimacy of effective interventions. This study aimed to quantify public support for novel control interventions utilizing semiochemicals to manage crown-of-thorns starfish (COTS) outbreaks on the Great Barrier Reef (GBR). A national survey ( n = 1,061) of Australian residents was conducted in 2024 to better understand how people perceive the benefits and risks of both conventional and semiochemical-based control interventions, which influence COTS behavior, whether they support research and implementation of these interventions, and factors associated with support for scaled deployment across the GBR. Public support for both conventional and semiochemical-based COTS control was high across all stages of research and development from the provision of research funding to laboratory research and small-scale trials, while support for large-scale outdoor use was medium to strong. Support for large-scale use was particularly high among Aboriginal and Torres Strait Islander respondents, those with high self-assessed knowledge of the technology, those convinced of its environmental and economic feasibility, and men. Support was lower among those who voted for independent political candidates and minor parties, and those who know COTS are native to the GBR. Poor respondent knowledge of COTS and inconsistent relationships between knowledge and support suggest public communication and engagement about the rationale for innovation in COTS control will be critical to successful implementation.

ABSTRACTObjectivesDementia is the leading cause of burden of disease in older Australians. Older Aboriginal and Torres Strait Islander people experience an increased risk of cognitive impairment and dementia. This article describes the clinical profile of the first patients seen at a memory clinic established in an Aboriginal community‐controlled health service (ACCHS) in metropolitan Perth, Western Australia.MethodsThis was an audit of 64 patients attending a memory clinic between March 2020 and February 2023 (inclusive).ResultsThe median age of patients was 67.7 years (range 35–95 years; interquartile range [IQR] 13.4 years) and 34 (53%) were female. The majority (94%) were living independently. Thirty‐four patients (53%; 95% confidence interval 41%–65%) were diagnosed with cognitive impairment. A further six (9%) were diagnosed with depression without cognitive impairment. The most common diagnoses in cognitively impaired patients were cognitive impairment not dementia (CIND; 27%); mild neurocognitive disorder (21%); dementia due to Alzheimer's disease (15%); Alzheimer's disease dementia, mixed type (9%); and other mixed dementias (9%). Women were slightly more likely than men to have cognitive impairment (56% vs. 52%), although this was not statistically significant (p = 0.74). The number of Aboriginal people seen in the clinic's first 3 years of operation was over 12 times that seen at a nearby hospital‐based service during the same period.ConclusionsA memory clinic located within an ACCHS was well‐attended and fulfilled a need not met by mainstream services. The successful model described in this article could be adopted by other Aboriginal health services.

Retrospective analysis of surgically treated orbital fractures in a Western Australian hospital with a focus on Aboriginal and Torres Strait Islander outcomes

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web App) to reduce OOPHE. It is grounded in citizen science approaches that value the lived experience and knowledge of Aboriginal people in shaping solutions. The project uses a citizen science methodology adapted for these communities, using knowledge interface methodology to weave together Indigenous and Western knowledges. Research methods (Indigenous, quantitative, qualitative) explore the relational nature of OOPHE risks and protective factors through co-design and workshops with Aboriginal participants to develop the Web App. A community-centric developmental evaluation guides the trial and refinement of the platform, allowing for ongoing learning and adaptation. Process measures inform a national scale-up and evaluation framework. Addressing OOPHE is essential to improving health and wellbeing for Aboriginal and Torres Strait Islander individuals and families living with or at risk of CCDs. This initiative aims to reduce the impact of OOPHE through digital social prescribing, there by connecting people with essential community services to access healthcare, offering a scalable approach to addressing health inequities nationwide.

Abstract In this paper, we present an analysis of the Foundation to Year 10 Australian Curriculum in relation to its adequacy as a tool to support the provision of curriculum justice. We identify how Indigenous mandated content is dispersed across disciplinary structures unevenly, and provide insights into how this enables certain ways for teachers and students to understand Indigenous ways of knowing and being. Indigenous content is included in the Australian curriculum in the form of cross curriculum content, fragmented and then deployed only to provide context for disciplinary content and outcomes. In this paper, we consider Fraser's three‐dimensional frame for social justice to interrogate the response of consecutive governments to the inequitable education provided to Aboriginal and Torres Strait Islander students. We then accept the policy logic to look at what the curriculum offers in regard to Indigenous content and the representations offered to Aboriginal and Torres Strait Islander students and their non‐Indigenous peers.

ABSTRACT We analyse interview data from two projects undertaken in Australia and England to explore gender-related violence (GRV) and its impact on university staff. This focus is novel and important as most research on GRV in universities has focused on students, meaning that staff experiences are largely absent. We argue that universities are unsafe spaces for women staff, particularly those in minoritized groups, and in Australia for Aboriginal and Torres Strait Islander women. We consider spatial aspects of GRV, focusing on three interrelated themes: spaces of resignation, disciplinary spaces, and spaces of challenge/resistance. We end by discussing key requirements for much-needed, systemic change. Notably, university leaders need to acknowledge that GRV pervades HE and is a substantial problem for staff as well as students. They must understand what underpins GRV and commit to meaningful change across the sector. Without such acknowledgment, understanding and transformation, universities will continue to be unsafe spaces.

Australian Aboriginal and Torres Strait Islander (Indigenous) peoples experience many inequalities in health status and outcomes compared to non-Indigenous Australians. Given the strong association between health literacy and health status and outcomes, exploring definitions from an Indigenous perspective is critical to understanding what skills and attributes contribute to the development and maintenance of health literacy among Indigenous Australians. This scoping review sought to identify and describe definitions for health literacy found in health and wellbeing studies involving Indigenous Australians and how those definitions informed resource development in these populations. A scoping review was conducted using Arksey and O'Malley's framework with the modifications recommended by Levac etal. MEDLINE, CINAHL, Emcare, ERIC, Informit and Scopus databases were searched for eligible studies with no restrictions on language or year of publication. The inclusion criteria were that studies required to be full-text peer-reviewed journal articles and empirical studies focused on culturally safe health literacy with Australian Indigenous peoples. Eighteen studies published between 2012 and 2022 met the inclusion criteria. Three of the studies defined health literacy and acknowledged how it assists Indigenous peoples to access and understand health-related information, aiding in their ability to make informed decisions about their health. In the remaining studies, no explicit definition of health literacy was provided; however, they each described various strategies Indigenous peoples learned to incorporate health information into decisions about health and wellbeing. Three themes within the included studies were identified: underlying health literacy problems, misaligned Western medical practices and difficulties accessing culturally appropriate services. While many of the studies included in this review reported adaptations of health literacy resources for Indigenous Australians, none of the health literacy definitions reflect the worldview of Indigenous Australians. This review highlights the lack of culturally safe definitions of health literacy informing the development of resources for improving health literacy in Indigenous populations. Definitions of health literacy must include cultural perspectives for future health resource development, including the understanding of health literacy through an Indigenous lens. SO WHAT?: This review provides a summary of definitions of health literacy found in the literature reporting on the development of health resources for Indigenous Australians. These definitions are limited to Western notions of health literacy and therefore may be deemed culturally unsafe for Indigenous Australians. In order to improve health literacy for this population, culturally safe definitions are required to inform resource development. Further co-designed research that privileges the perspectives of Indigenous Australians is warranted to improve health literacy in this population.

There is an urgent need for community-led and embedded smoking and vaping cessation programs developed for and by Indigenous people to address the disproportionate tobacco-related harms stemming from colonisation. This paper describes the development of an Indigenous-led program for Aboriginal and Torres Strait Islander women during pregnancy and the perinatal period, drawing on Indigenous knowledges to prioritise and integrate behaviour change techniques. A systematic process involving four steps was implemented to uphold Indigenous knowledges, rights and self-determination in program co-creation. First, we identified and prioritised behaviour change techniques that are important and meaningful to Aboriginal and Torres Strait Islander people, and identified effective behaviour change techniques from existing published literature. These steps informed a collective program development process of iterative development, reflection, and feedback to weave behaviour change techniques in the final program. The behaviour change technique domains prioritised by Aboriginal and Torres Strait Islander people included natural consequences, antecedents, goals and planning, social support and comparison of outcomes. Twenty-four behaviour change techniques across fifteen domains were identified from the peer-reviewed literature. The final program incorporates fifteen behaviour change domains and 60 unique individual behaviour change techniques. The Which Way? Women's Group-based Smoking and Vaping Cessation Program was co-created with Aboriginal and Torres Strait Islander women and community partners, drawing on the knowledges and wisdom of Aboriginal and Torres Strait Islander people and behaviour change techniques. The effectiveness of the program will be tested in a hybrid-Type 1 implementation trial. This paper reports a novel co-creation process led by Aboriginal and Torres Strait Islander women in partnership with community to develop a smoking and vaping cessation program for women during the pregnancy and perinatal period. In detailing the development process used, this work upholds Indigenous rights to self-determination as outlined in the World Health Organisation Framework Convention on Tobacco Control. Our transparent reporting upholds Indigenous ethics and provides valuable insights to inform the development of other interventions aimed at supporting Indigenous women and communities in empowering smoke and vape free generations.

To examine the geographic and demographic variability in diabetic retinopathy (DR) screening uptake in Australian general practice (GP) and assess factors influencing screening disparities. A retrospective, population-based observational study was conducted using Medical Benefits Schedule (MBS) claims data for DR screening using non-mydriatic fundus cameras, under items 12,325 and 12,326 from 2016 to 2024 across Australia. MBS data was obtained from Services Australia and the demographic and socioeconomic indicators from the Australian Bureau of Statistics (ABS). Screening uptake was stratified by state, age, gender, and socioeconomic indicators. The association between screening uptake and sociodemographic factors was assessed. A total of 15,817 DR screenings were conducted under the two MBS items, representing only 1.2% of Australia's estimated diabetic population, highlighting a substantial unmet need. New South Wales and Western Australia had the highest total screening, while Tasmania recorded the lowest uptake. Screening uptake was highest in the < 25 age group (due to statistical inflation from low diabetes prevalence) and lowest in those aged ≥ 75 years. he COVID-19 pandemic contributed to a significant decline in screening uptake during 2020-2022, with partial recovery in 2023-2024. DR screening uptake showed no significant association with socio-demographic factors. Despite national guidelines, GP-led DR screening uptake remains low, with substantial geographic, demographic and temporal disparities in Australian general practice settings. Addressing systemic barriers, strengthening GP-led screening, and implementing targeted interventions are crucial for improving DR screening uptake in Australia. The inability to calculate per-capita screening among Aboriginal and Torres Strait Islander populations due to data limitations restricts equity analysis; future studies should address this gap.

The Good Spirit, Good Life (GSGL) assessment tool was co-developed in urban and regional Australia to address quality of life (QoL) for older Aboriginal and Torres Strait Islander peoples and inform culturally responsive care. This study aimed to determine the acceptability and validity of the GSGL tool in Australian remote settings. A co-design methodology was applied to this study. Yarning groups were conducted in 5 communities across 2 remote regions of Australia with older Aboriginal and Torres Strait Islander people. Required adaptations to the tool were refined with governance groups in each region. Forward and back translation was performed for the adapted tool with consensus achieved through an expert committee. Adaptations to the GSGL tool involved small wording changes to two items (Country/Island Home and Elder role). Five items were adapted through additional prompts and examples (culture, respect, supports and services, safety and security, basic needs). The remaining five items were retained (family and friends, community, health, spirituality, future planning). During forward and back translation, translation errors were identified with an expert language committee highlighting the importance of clear translation methods. The adapted GSGL tool is an acceptable QoL tool for use in health and aged care with urban, regional and remote-living Aboriginal and Torres Strait Islander Australians. When translating a tool, forward-back translation with an expert language committee is recommended to reach concordance in meaning. The adapted GSGL tool is suitable for use with an interpreter when required.

Abstract This article contributes to a First Nations-led research agenda exploring risk and protective factors influencing suicidality and self-harm among secondary-aged Aboriginal and Torres Strait Islander youth. Using Wave 14 (2021) data from Footprints in Time: The Longitudinal Study of Indigenous Children , this article focuses on relationships between factors of the school environment and self-harm, suicidal thoughts, and suicide attempts among 906 Aboriginal and Torres Strait Islander Study Youth aged 13–18. We found reduced odds of self-harm among students who reported supportive adults (Odds Ratio: 0.65, 95% Confidence Interval: [0.51–0.83]), supportive friends (OR: 0.73, 95% CI: [0.58–0.91]), a sense of safety (OR: 0.36, 95% CI: [0.19–0.68]), and belonging (OR: 0.66, 95% CI: [0.5–0.85]) in school. Higher odds were found among those who experienced bullying (OR: 3.24, 95% CI: [1.72–6.12]), teacher racism (OR: 1.87, 95% CI: [1.05–3.35]), and other forms of school-based racism (OR: 1.87, 95% CI: [1.05–3.35]). Results were similar for suicidal thoughts and attempts. Concerningly, 18% of Study Youth reported the risk factor of feeling unsafe, and 21% reported bullying at school. Closing the Gap Target 14 seeks to reduce the rate of suicide among Aboriginal and Torres Strait Islander peoples towards zero. Our findings suggest sustained investment in positive school environments is an essential pillar for achieving this goal. We draw on Aboriginal and Torres Strait Islander-led strategies for reimagining school environments to reduce these harms.

In Australia, it is widely acknowledged that Indigenous Australians have been significantly traumatised by invasion, ongoing colonisation and the impact of previous racist government policies, creating cycles of disadvantage and inequality. Racism remains a major determinant of poor health, impacting daily life and wellbeing - central to the national ′Closing the Gap′ intiative. Health administrators and researchers often misinterpret these issues, viewing Indigenous health through a deficit-based lens. Discussion While the link between Cultural Safety and patient outcomes is clear, consistent application in practice is lacking. Cultural Safety is equally vital as clinical safety in ensuring quality care, particularly for Indigenous Australians affected by culturally unsafe practices. Recommendations In healthcare delivery Indigenous Australians health and the ‘Closing the Gap’ agenda is everybody’s business, it is not the responsibility of the patient, their family or their Community. The authors propose a reconceptualisation of the way health and wellbeing is perceived by health professionals, in which providing culturally safe care is symbiotic with providing clinically safe care. As an integrated foundation for quality and safety in health care, this strategy brings together the social determinants of culturally safe care with competent, evidence-based, equitable and non-bias care for all, and could help advance the Closing the Gap agenda.

Bacterial sexually transmissible infections (STIs) cause a substantial disease burden worldwide, and disproportionately impact young people. In Australia, Aboriginal and Torres Strait Islander people are a priority population in STI testing guidelines. The More Options for STI Testing (MOST) trial evaluated whether providing an incentive impacted STI testing rates in select central Australian communities. Aboriginal and Torres Strait Islander people aged 16 to 29 years were eligible for a A$30 phone voucher if they had an STI test at a participating Aboriginal community-controlled primary health care clinic. An interrupted time series analysis examined monthly STI test counts for chlamydia, gonorrhoea or syphilis from 2015 to 2020, to determine whether testing increased during the incentives phase (2018-2020). There were a total of 10,457 visits to the clinic in which an STI test was conducted, 5,110 of which were during the incentives period. A total of 1,526 incentives were provided to eligible clients. The baseline and incentives periods were each divided into two phases to account for new clinic openings and the COVID-19 pandemic. Among men, average monthly visits for an STI test were 32.6 (baseline phase 1), 44.1 (baseline phase 2), 50.8 (incentives phase), and 35.4 (incentives/COVID-19 phase). Women had 93.5, 111.3, 118.8 and 113.4 visits respectively. No significant change in STI testing was observed during the incentives phase. The proportion of visits for an STI test where an incentive was paid (coverage) varied by month, from 36% to 76% of consultations. The limited impact of incentives could be explained by low coverage, or that the incentive was not motivating enough to overcome STI testing barriers. Future studies should investigate alternative methods of increasing STI testing in remote central Australia, including through primary care clinics.

There is an ongoing syphilis outbreak in regional and rural areas of Australia, with Aboriginal and Torres Strait Islander peoples disproportionately represented in notification data. Innovative screening approaches are needed in healthcare settings frequented by at-risk communities. The emergency department (ED) was hypothesised to be an ideal location for screening Aboriginal and Torres Strait Islander peoples, who traditionally underutilise healthcare services. A quality improvement initiative introduced an opt-out syphilis screening program at the Townsville University Hospital ED. For Aboriginal and Torres Strait Islander clients aged 15-40 years, syphilis screening was automatically added to blood tests collected as part of routine care. A retrospective audit of the program assessed screening rates, diagnosis, linkage to treatment and contact tracing outcomes. The program added 5471 tests for 3942 individuals within the target age range. Twenty-seven Aboriginal and Torres Strait Islander peoples were diagnosed with syphilis infections requiring treatment, indicating a 0.68% prevalence. The odds of untreated syphilis were significantly higher in the oldest age group (aged 36-40 years) compared with the youngest age group (aged 15-20 years; OR 3.88, 95% CI 1.05-14.40, P=0.04). All diagnoses of late latent or syphilis of unknown duration (n=5) were made in the oldest age group. One pregnant woman was diagnosed with early syphilis. All infections, except one, were successfully treated by sexual health services. The ED screening program effectively identified undetected syphilis cases in the Aboriginal and Torres Strait Islander population. This audit informed future adaptations to the program, including expanding the target age range and increasing the screening interval between tests. Similar ED syphilis screening protocols could be adopted by other hospitals in syphilis outbreak areas.

BackgroundIn Australian Aboriginal and Torres Strait Islander communities, childcare is traditionally shared by kin. Little is known about how grandparental care impacts Aboriginal child health and evidence from other countries is mixed. We explored relationships between grandparental health (a proxy for grandparental care) and health and health service use by Aboriginal children born in Western Australia from 2000 to 2013.MethodsThis is a retrospective cohort study using linked administrative health data. Outcomes were child mortality, hospital admissions, and emergency department (ED) presentations up to five years old. Grandparental health when the child was born was categorised as healthy (none/one Elixhauser condition), unhealthy (two or more conditions), or deceased. Grandparental-child health associations were estimated using regression with adjustment for birth year, sex, remoteness, socioeconomic advantage, maternal smoking, and maternal age.Results29,409 Aboriginal children linked to their maternal grandmothers. 70% also linked to maternal grandfathers, 66% to paternal grandmothers, and 49% to paternal grandfathers. 86% of maternal grandmothers were healthy, 7% unhealthy, and 7% deceased. Children with healthy grandmothers had an average of 27% fewer hospital days (adjusted incidence rate ratio: 0.73, 95% CI: 0.65, 0.83) than those with deceased grandmothers. They also had lower mortality and fewer potentially avoidable admissions and emergency department presentations. Children with unhealthy or deceased grandmothers had comparable rates. These patterns were similar for all four grandparents, but generally stronger for maternal grandmothers. Stillbirth and unavoidable admissions were unrelated to grandparental health.ConclusionsAboriginal children with healthy grandparents had better health and lower health service use. If this relationship is causal, healthy ageing and strong family connections must be supported to improve child health. Even if the relationship is not causal, healthy ageing, a family-centred approach to health care, and social support may help families experiencing poor health in multiple generations simultaneously.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24577-0.

Women and gender-diverse people are a fast-growing population in prisons in Australia. Incarceration can create barriers to accessing sexual and reproductive healthcare. The objective of this scoping review was to identify what is known about the sexual and reproductive health experiences, needs and outcomes of women and gender-diverse people incarcerated in Australia. We used the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched included PsycINFO, Gender Studies Database, MEDLINE and CINAHL. The search yielded 658 titles and abstracts of which 17 met the criteria for inclusion. We identified 17 studies published between 2000 and 2023 across three states. The studies included qualitative, quantitative and mixed-methods designs. The main outcomes of interest included: pregnancy and maternal health, contraception, sexually transmitted infections, experiences of sexual violence, and cervical health screening and outcomes. Evidence indicates that women and gender-diverse populations in prison in Australia experience high rates of sexually transmitted infections, poor perinatal health outcomes, and unmet needs related to contraception access and perinatal health services and programmes. The negative health impacts of incarceration are especially pronounced for Aboriginal and/or Torres Strait Islander women, who face additional discriminatory institutional barriers to participating in health programmes and experience a lack of culturally safe and appropriate care.