Urban Australia Research Articles

Countering stereotypes: Exploring the characteristics of Aboriginal Australians who do not drink alcohol in a community representative sample.

Contrary to stereotypes, Aboriginal and Torres Strait Islander Australians are more likely to abstain from drinking than other Australians. We explored characteristics and experiences of Aboriginal and Torres Strait Islander Australians who do not drink alcohol. We conducted a cross-sectional, representative survey of 775 Aboriginal and Torres Strait Islander Australians (16+ years) in remote and urban South Australia. We explore correlates of not drinking alcohol using multi-level logistic regression. We describe reasons for non-drinking and harms participants experienced in past 12 months from others' drinking. Non-drinking participants were more likely to be older (OR 1.35 [95% CI 1.21, 1.50] per decade) and unemployed (OR 2.72 [95% CI 1.77, 4.20]). Participants who spoke Aboriginal Australian languages at home were three times more likely to be lifetime abstainers from drinking (OR 3.07 [95% CI 1.52, 6.21]). Common reasons for not drinking alcohol were health and family. Most did not report harms from others' alcohol consumption (79.6%, 76.9%, urban and remote respectively). Stress from others' alcohol consumption was the most reported harm by non-drinkers (14.5% and 23.1%, urban and remote, respectively). Culture such as speaking Aboriginal Australian languages might have protective effects that promote abstaining but was rarely explicitly cited as a reason for not drinking. A greater understanding of local values held by people who do not drink alcohol could help inform health messaging and other interventions to reduce alcohol-related harms. Understanding local reasons for abstaining can help tailor health messaging to suit local contexts.

Ferals and gentrification in urban Australia: place, death and memory

ABSTRACT In the city of Newcastle on Australia’s east coast, murky distinctions between feral and native, public and private, domestic and wild are being delineated and firmed as the city rapidly gentrifies. The suburb of Stockton, a peninsula with deep working-class roots, has long been considered an urban frontier, a liminal zone for plants, animals and humans. Here, ferality is entangled with place, with frontier-ness. As the area undergoes changes in step with gentrification in Newcastle and coastal Australia more generally, species once tolerated are being identified as risky and then eliminated. In this article, we focus on two feral species subject to elimination in Stockton, the Thorn Tree and the Breakwater Cats. We argue that shifting nature-city boundaries impacts urban frontiers during periods of gradual, then rapid, gentrification, disrupting the relationship between frontiers and feral ecologies. Second, while literature tends to focus on feral plants or animals, we consider the ways that hardening nature-city boundaries can make both plants and animals vulnerable to elimination. Third, despite their elimination, the Thorn Tree and the Breakwater Cats are subject to memory practices in the community, suggesting that even as the urban frontier amalgamates with the rest of the city, memories of feral co-habitants remain for some members of the human community.

The experiences and perspectives of people with gout on urate self-monitoring.

Gout management remains suboptimal despite safe and effective urate-lowering therapy. Self-monitoring of urate may improve gout management, however, the acceptability of urate self-monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self-monitoring in people with gout. Semistructured interviews were conducted with people taking urate-lowering therapy (N = 30) in a 12-month trial of urate self-monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self-management. Deidentified transcripts were analysed thematically. Participants valued the ability to self-monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self-monitoring at home was easy, convenientand informed gout self-management behaviours such as dietary modifications, hydration, exerciseand medication routines. Many participants self-monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases. Urate self-monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self-monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines. One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.

Vertebrates and flying insects provide biocontrol services to Australian urban food gardens

Biocontrol by wild insects and other organisms is an important service provided to agriculture, but few studies have linked the role of this service to urban garden crop production. In 15 urban food gardens in Sydney, Australia, we assessed predation and parasitism of two sentinel prey species, recorded pest control activities undertaken by gardeners and the produce yielded by garden crops. We observed substantial removal of sentinel prey (mean removal 22% for Tenebrio molitor larvae and 59% for Helicoverpa armigera) but no parasitism. Vertebrate predators primarily consisted of urban adapted birds and mammals common throughout Australian cities. We measured a range of local and landscape scale environmental variables including plant richness and abundance, light, canopy cover, building density and distance to remnant vegetation. We found that gardeners undertook only basic pest control activities with little chemical use, yet high amounts of produce were harvested. Pest control services were poorly explained by environmental variables. Low active pest control activities, and high predation rates suggest pests are either well controlled or in low numbers in the surveyed urban food gardens. Given the vertebrate predators were generalist birds and mammals common to many parts of urban Australia, the provision of predation services to urban gardens by these taxa could be widespread across the continent.

A health inequality analysis of childhood asthma prevalence in urban Australia

Long-standing health inequalities in Australian society that were exposed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were described as "fault lines" in a recent call to action by a consortium of philanthropic organizations. With asthma a major contributor to childhood disease burden, studies of its spatial epidemiology can provide valuable insights into the emergence of health inequalities early in life. The aims of this study were to characterize the spatial variation of asthma prevalence among children living within Australia's 4 largest cities and quantify the relative contributions of climatic and environmental factors, outdoor air pollution, and socioeconomic status in determining this variation. A Bayesian model with spatial smoothing was developed to regress ecologic health status data from the 2021 Australian Census against groups of explanatory covariates intended to represent mechanistic pathways. The prevalence of asthma in children aged 5 to 14 years averages 7.9%, 8.2%, 8.5%, and 7.6% in Sydney, Melbourne, Brisbane, and Perth, respectively. This small inter-city variation contrasts against marked intracity variation at the small-area level, which ranges from 6% to 12% between the least and most affected locations in each. Statistical variance decomposition on a subsample of Australian-born, nonindigenous children attributes 66% of the intracity spatial variation to the assembled covariates. Of these covariates, climatic and environmental factors contribute 30%, outdoor air pollution contributes 19%, and areal socioeconomic status contributes the remaining 51%. Geographic health inequalities in the prevalence of childhood asthma within Australia's largest cities reflect a complex interplay of factors, among which socioeconomic status is a principal determinant.

Implementing Stay Strong AIMhi for Youth: Protocol for Evaluation

Background: Good mental health and well-being are essential for fulfillment, productivity, and resilience. Mental disorders cause high levels of disability and economic impact worldwide. Vulnerable groups at significantly higher risk include youth and First Nations people. As the demand for mental health support and services increases, there is an urgent need to expand access to culturally appropriate quality mental health services (particularly for young people) and to promote self-care through integration of mobile health technologies. Objectives: This paper describes a protocol to evaluate implementation of the AIMhi for Youth support package into youth wellbeing services in urban, rural, and remote Northern Territory and South Australia. Codesign workshops will tailor the resources to these and other locations. The AIMhi-Y support package will be implemented as an innovative approach to suicide prevention through three years of codesign, training, implementation support and dissemination. Methods: Implementation is guided by the Consolidated Framework for Implementation Research (CFIR) incorporating the recent CFIR Outcomes Addendum and including strategies from the Expert Recommendations for Implementing Change. The protocol incorporates best practice principles in codesign and First Nations research. It builds on a decade of foundational work of the Stay Strong program implementing digital mental health resources in primary care and specialist settings. Implementation and related outcomes will be evaluated from each participant perspective (user, service provider, decision maker, First Nations people with lived experience and cultural consultants) using surveys and small group discussions. Intervention: AIMhi for Youth is a culturally responsive digital mental health solution codesigned with First Nations leaders and young people. Delivered via mobile device it is a gamified app supporting skills development in mental health literacy, emotional regulation, help seeking and goal setting. The app provides a structured intervention which complements existing services and addresses key risk factors for suicide and compromised mental health. The package includes training workshops and supplementary multimedia resources. Support resources will be hosted on a tailored website creating a seamless accessible ecosystem for users. Discussion: At the time of publication, 514 young people and 363 individual service providers have used the app, and 11 services have engaged in implementation planning discussions. Through our implementation evaluation we will identify why the AIMhi-Y package was implemented successfully in some contexts and not in others and will have an evidence-based strategy for successfully engaging First Nations young people and services in digital mental health solutions. This will inform further AIMhi-Y dissemination and provide a guide for implementation of other innovations in similar contexts. Conclusion: This study prospectively plans, monitors, and evaluates implementation through use of the Consolidated Framework for Implementation Research. This threefold approach potentially strengthens the design and enhances likelihood of implementation success. The emphasis on Indigenist research principles, and the addition of measuring outcomes including reach, impact, adoption, implementation, and sustainment, has potential to contribute to conceptual development and clarification of implementation approaches in First Nations communities.

Examining the Heat Health Burden in Australia: A Rapid Review

Extreme heat has been linked to increased mortality and morbidity across the globe. Increasing temperatures due to climatic change will place immense stress on healthcare systems. This review synthesises Australian literature that has examined the effect of hot weather and heatwaves on various health outcomes. Databases including Web of Science, PubMed and CINAHL were systematically searched for articles that quantitatively examined heat health effects for the Australian population. Relevant, peer-reviewed articles published between 2010 and 2023 were included. Two authors screened the abstracts. One researcher conducted the full article review and data extraction, while another researcher randomly reviewed 10% of the articles to validate decisions. Our rapid review found abundant literature indicating increased mortality and morbidity risks due to extreme temperature exposures. The effect of heat on mortality was found to be mostly immediate, with peaks in the risk of death observed on the day of exposure or the next day. Most studies in this review were concentrated on cities and mainly included health outcome data from temperate and subtropical climate zones. There was a dearth of studies that focused on tropical or arid climates and at-risk populations, including children, pregnant women, Indigenous people and rural and remote residents. The review highlights the need for more context-specific studies targeting vulnerable population groups, particularly residents of rural and remote Australia, as these regions substantially vary climatically and socio-demographically from urban Australia, and the heat health impacts are likely to be even more substantial.

Performing the ‘global citizen’ in social imaginaries: the value of intercultural exchange for Australian students in Mexico

ABSTRACT Due to the recent increase in Australian students undertaking study abroad opportunities, an effect of a neoliberal society, there has been a plethora of literature in this area with the extant literature focusing on students’ motivations and subsequent benefits of exchange. This paper examines how the capital acquired during intercultural experiences are performed by Australian exchange students. Interviewed before, during, and after Mexican sojourns, the students initially (re)produced a stylised pastiche of ‘Mexico’. Made in urban Australia, this imaginary comprises Frida-Kahlo themed restaurants and Day-of-the-Dead exotica. As a result of geographic distance and limited migration from Mexico, Mexicanidad in Australia operates as a vacant conceptual category into which ‘cool’ yearnings can be inscribed. Despite problematising their pre-departure constructions at times, the students continued to employ this version of Mexicanidad in their performance of the role of Mexican expert, in Mexico and on their return. This article theorises the functions of such identity performances, proposing that exchange experiences, and the intercultural capital they acquire, serve as a method by which students can construct and perform transnational identities.

Leafy localities, longer lives: A cross-sectional and spatial analysis

Are trees good for your health? Using detailed satellite imagery, we estimate the extent of tree coverage at a fine neighborhood level across urban Australia. We then look at the neighborhood-level association between tree canopy cover and mortality. Holding constant socioeconomic status, we find evidence of a strong beneficial relationship. Neighborhoods with more trees have lower levels of mortality, with a 10 percentage point increase in tree cover (about one standard deviation) associated with a reduction in mortality of 11 deaths per 100,000 people (about one eighth of a standard deviation). This association holds for most major causes of death, and is larger for men than for women. Health morbidity is better in areas with more trees, although this relationship is not statistically significant. Analysis of sub-samples does not support the critique that our results are merely driven by short-term selection effects in which healthier people move to tree-lined suburbs. Using standard estimates of the value of a statistical life, the mortality benefit of additional trees substantially exceeds the cost of planting and maintenance. Our findings support the protection and restoration of tree canopy in urban neighborhoods as a means of promoting public health and reducing health inequalities.

The lab, land, and longing: Discursive constructions of Australian identities in ‘future’ food consumption

Food consumption is being reconfigured as a consequence of consumers’ ethical concerns. While preferences and tastes may be influenced by broad ethical positions, constructions of social identity also reflect shifts in food consumption. Important tools within this nexus are ‘future foods’, produced through novel technologies such as artificial intelligence or genetic editing, supporting consumers in the construction of identity markers. Through 24 ( n = 121) focus groups in rural and urban Australia, we explore to what extent future foods contribute to alleviate tensions between broader ethical principles and consumer identities. We argue that the collective discourse around future foods has the potential to shift the culture of food ethics in the future, enabled through three moral identity markers. Specifically, identities of citizen-consumption that view ethics as ‘eating for change’; nationalism as a form of patriotic morality that encourages the consumption of national brands and protectionism; and nostalgic knowledge and historical identities of the past to reconfigure ethical ideals for the future. These discursive identity constructions shed light on how consumers may redefine food ethics in the future, legitimising citizenship through demonstrating virtue, patriotism as loyalty to social groups, and nostalgic capturing of history to ‘ethicise’ the future.

Mapping pandemic responses in urban Indigenous Australia: Reflections on systems thinking and pandemic preparedness

ObjectivesWe investigate some of the strengths and challenges associated with Covid-19 responses in urban Indigenous communities in Brisbane, Australia. Our research reflects on the interconnected dynamics that impact health outcomes and mitigate or exacerbate the risk of Covid-19 spreading within urban Indigenous communities. MethodsThree systems thinking workshops were held in 2021 with Indigenous and non-Indigenous stakeholders (N15/workshop) from State and Federal services, along with Aboriginal Community Controlled Health Organisations. All worked in the urban Indigenous health sector. Stakeholders produced a Causal Loop Diagram (CLD) incorporating the critical feedbacks determining the dynamics influencing health outcomes. The aim of the research was to help stakeholders’ build awareness of how the structure of the system influences health outcomes. ResultsStakeholders identified 6 key dynamics which have a negative or positive impact on mitigating risks of Covid-19 infection. By mapping these dynamics within a CLD, 7 intervention points were identified. ConclusionsSystems thinking provides a useful tool in identifying the complexities associated with navigating health challenges, but further research is needed to develop frameworks that work in conjunction with Indigenous Australian methodologies. Implications for public healthIndigenous voices and communities must lie central to health responses/policies for Indigenous peoples. When systems thinking is done by or in collaboration with stakeholders it provides a visual language that can help design public health policy. What can be ascertained is that their effectiveness is predicated on systems thinking’s integration with Indigenous methodologies that acknowledges Indigenous self-determination and challenges Eurocentric representations of health and Indigeneity.

Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians – analysis of cross-sectional data (Crossroads II)

BackgroundResearch suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems.MethodsThe Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016–18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders.ResultsOf the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions.ConclusionsThe high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.

Characterising variability in youth mental health service populations: A detailed and scalable approach using digital technology.

This study utilised digital technology to assess the clinical needs of young people presenting for care at headspace centres across Australia. 1490 young people (12-25years) who presented to one of 11 headspace services from four geographical locations (urban New South Wales, urban South Australia, regional New South Wales, and regional Queensland) completed a digital multidimensional assessment at initial presentation. Characteristics were compared between services and geographical locations. We identified major variation in the demographics, and the type and severity of needs across different services. Individuals from regional services were more likely to be younger, of Aboriginal and Torres Strait Islander origin, and present with psychotic-like symptoms and suicidality, while those in urban areas were more likely to have previously sought help and have problematic alcohol use. Further differences in age, distress, depressive symptoms, psychotic-like experiences, trauma, family history, alcohol use, education/employment engagement, and days out of role were identified between different urban sites. The variability between services provides insight into the heterogeneity of youth mental health populations which has implications for appropriate early intervention and prevention service provisions. We propose that integrating digital technologies has the potential to provide insights for smarter service planning and evaluation.

Hypocenter, Fault Plane, and Rupture Characterization of Australian Earthquakes: Application to the September 2021 Mw 5.9 Woods Point Earthquake

AbstractThe Australian Seismometers in Schools (AuSIS) network operates 50 broadband seismic stations across Australia that are hosted at schools. The instruments augment the Australian National Seismograph Network providing valuable data from urban and regional Australia. The network coverage is quite sparse, but these vital records of rare, moderate Australian earthquakes can improve our understanding of the deformation within the stable continental region of Australia, especially for events with no surface rupture. In this study, we present the feasibility of identifying the fault plane of moderate earthquakes on the Australian continent, using data from the AuSIS network. We examine the fault plane of the September 2021 Mw 5.9 Woods Point earthquake that occurred about 130 km northeast of the Melbourne metropolitan area. We estimate the hypocenter and the centroid moment tensor (CMT) to identify the fault plane from the auxiliary plane in the focal mechanism. We explore a range of 1D models and a 3D Earth model to simulate seismic arrivals and full waveform data. The hypocenter is resolved using P- and S-wave arrivals in a probabilistic framework and the CMT is derived from full waveform modeling through grid search over a set of trial points around the hypocenter. Our solution suggests the mainshock ruptured the depth of 15 ± 4 km, with a strike-slip mechanism striking 348° north on a nearly vertical plane. The high double-couple percentage of this event indicates a simple rupture that propagated from the south (hypocenter) toward the north (centroid) and remained subsurface. This indicates that the causative fault had a deeper structure than the previously known shallow, northwest–southeast-striking faults of the region. The P and T axes deduced from our fault model are notably aligned with the maximum horizontal crustal stress in the region.

The voices of children on movement behaviours: implications for promoting international guidelines to support obesity-prevention efforts

BackgroundAs a key factor for the prevention of childhood obesity, WHO recommends a specific balance of movement behaviours (ie, physical activity, sedentary behaviour, and sleep) across the 24-h day for children younger than 5 years. Substantial evidence underpins our understanding of the benefits for healthy growth and development; however, little is known about young children's experiences and perceptions, and whether context-specific factors that might influence movement behaviours differ across the globe. MethodsAcknowledging children's agency as knowledgeable informants on matters affecting their lives, children aged 3–5 years from communities and preschools in urban and rural Australia, Chile, China, India, Morocco, and South Africa, were interviewed. Discussions were based on a socioecological framework of the multifactorial, complex influences on young children's movement behaviours. Prompts were adapted to ensure relevance across diverse study sites. Ethics approval and guardian consent were obtained, and the Framework Method used for analysis. Findings156 children (101 [65%] from urban areas, 55 [45%] from rural areas; 73 [47%] female, 83 [53%] male) shared their experiences, perceptions, and preferences related to movement behaviours and the barriers and enablers of outdoor play. Physical activity, sedentary behaviour, and to a lesser degree screen time occurred predominantly through play. Barriers to outdoor play included weather, air quality, and safety concerns. Sleep routines varied considerably and were influenced by room or bed sharing. Screen use was ubiquitous, presenting a challenge to meeting recommendations. The effect of daily structure, degree of autonomy, and interactions were consistent themes, and differences in how these factors influenced movement behaviours across study sites were evident. InterpretationThe findings highlight that although movement behaviour guidelines are universal, contextual realities need to be considered in how socialisation and promotion of the guidelines are enacted. How young children's sociocultural and physical environments are constructed and influenced can foster or disrupt healthy movement behaviours, which might have implications for childhood obesity. FundingBeijing High Level Talents Cultivation Project for Public Health Academic Leader; Beijing Medical Research Institute (Public service development and reform pilot project); British Academy for the Humanities and Social Sciences; KEM Hospital Research Centre; Ministry of Education and Universidad de La Frontera (Innovation in Higher Education Program); and National Health and Medical Research Council (Investigator Grant Leadership Fellow, Level 2).

Practising care in a pandemic: Accounting for everyday life during COVID-19 among people who inject drugs.

From the outset of the COVID-19 pandemic, fears have been raised worldwide regarding the unique challenges facing socially marginalised people such as those who inject drugs. This article draws on in-depth interviews conducted during the first year of the pandemic with people who inject drugs living in urban and regional Australia. Perhaps the most surprising finding to emerge was the number of participants who reported minimal disruption to their everyday lives, even improved wellbeing in some instances. Attempting to make sense of this unanticipated finding, our analysis draws on the concept of 'care', not as a moral disposition or normative code but as something emergent, contingent and realised in practice. Working with Foucault's ethics and recent feminist insights on the politics of care from the field of Science and Technology Studies, we explore how care was enacted in the everyday lives of our participants. We examine how participants' daily routines became objects of care and changed practice in response to the pandemic; how their ongoing engagement with harm reduction services afforded not only clinical support but vital forms of social and affective connection; and how for some, care was realised through an ethos and practice of constrained sociality and solitude.

Planning laws and Aboriginal and Torres Strait Islander peoples’ rights and interests

ABSTRACT Contemporary Australian planning has for too long ignored its fundamental responsibilities in its relations with Aboriginal and Torres Strait Islander peoples in urban and regional Australia. Australian land-use planning and development processes do not have a good track record of taking account of the rights and interests of Aboriginal and Torres Strait Islander peoples, or of adequately involving them, especially in our capital cities and major regional centres where the larger proportion of Aboriginal and Torres Strait Islander peoples live and the where the extent of dispossession is perhaps at its greatest. It is a sad indictment of our planning system that more than 30 years after the High Court of Australia’s landmark decision in Mabo (No. 2), that most of the planning statutes around Australia still do not require prior consultation with or the direct involvement of registered native title holders or claimants during plan formulation or decision-making about land uses for an area of land or waters. This paper examines the current state of affairs with respect to how well or otherwise our planning statutes still fail to give adequate recognition to Aboriginal and Torres Strait Islander peoples’ rights and interests in contemporary statutory planning processes.

Prevalence Rates of Depression and Anxiety among Young Rural and Urban Australians: A Systematic Review and Meta-Analysis.

Globally, depression and anxiety are major public health concerns with onset during adolescence. While rural Australia experiences overall lower health outcomes, variation in mental health prevalence rates between rural and urban Australia is unclear. The aim of this paper was to estimate the pooled prevalence rates for depression and anxiety among young Australians aged between 10 and 24 years. Selected studies from a systematic literature search were assessed for risk of bias. Random effects model using DerSimonian and Laird method with Freeman-Tukey Double Arcsine Transformation was fitted. Sensitivity analyses were performed. Prevalence estimates were stratified by region and disorder. The overall pooled prevalence of depression and anxiety was 25.3% (95% CI, 19.9-31.0%). In subgroup analysis, anxiety prevalence was 29.9% (95% CI, 21.6-39.0%); depression: 21.3% (95% CI, 14.9-28.5%); and depression or anxiety: 27.2% (95% CI, 20.3-34.6%). Depression and anxiety prevalence were higher in urban 26.1% (95% CI, 17.3-35.9%) compared to rural areas 24.9% (95% CI, 17.5-33%), although the difference was not statistically significant. The heterogeneity was high with an I2 score of 95.8%. There is need for further research on healthcare access, mental health literacy and help-seeking attitude in Australia.

General practitioner assessment of lifestyle risk factors for chronic disease: a cross-sectional study in urban, rural and remote South Australia.

The assessment and management of the SNAP lifestyle risk factors (smoking, nutrition, alcohol intake and physical activity) is fundamental to primary prevention of chronic disease. This study investigates the prevalence of SNAP assessments conducted in South Australian general practice, according to patient risk profiles, and across urban, rural and remote locations. A cross-sectional population-based survey was conducted in South Australia in 2017. Survey data included information on health characteristics, lifestyle risks and general practitioner (GP) assessments for 2775 participants, aged ≥18years, who visited a GP in the past 12months. The main outcome measure was assessment for two or more (≥2) SNAP risks in this time. Logistic regression models were used to estimate the prevalence of ≥2 SNAP assessments by remoteness area, using the Modified Monash Model (MMM) classifications for urban (MMM), rural (MMM3-4) and remote (MMM5-6), and adjusting for sociodemographic, SNAP lifestyle risks and clinical variables. Of the 2775 participants (mean age 49.1±18.7years; 52.7% women), 32% were assessed for ≥2 SNAP in the past 12months. The adjusted prevalence of assessments was higher in rural (43.8%; 95% CI 36.4-51.2%) than urban (29.7%; 95% CI 27.2-32.2%) or remote (34.7%; 95% CI 28.4-41.0%) areas. Depending on rurality, ≥2 SNAP assessments were 2.5-3.4times more likely among participants with existing cardiovascular disease, and two to seven times more likely among participants with three or four SNAP risk factors (P<0.05 in all cases). Greater attention to GP SNAP assessments is warranted to match the prevalence of SNAP risks across South Australia.

Hybridity with exclusion: Chinese tea rebrewed in Australia

This article aims to deepen understanding of the concept of cultural hybridity through ethnographic investigation of Australian engagement with Chinese practices of tea drinking. The consumption of tea in urban Australia, despite its apparent novelty, embeds a story of decline. Unlike the development of coffee and wine consumption, a mature Australian tea drinking style is yet to arise. Whilst being influenced by Chinese tea culture, the actors in Australian tea culture also adopt a strategy of distancing and exclusivity, demonstrating “hybridity with exclusion.” When unable to articulate what denotes an Australian style, they instead locate themselves by declaring what they don't belong to. I argue that the concept of cultural hybridity should not be taken for granted as a totally blurred boundary between different cultures; rather, it critically demands to be understood in terms of rejection and exclusion, and it could incorporate an intentional distinction and distance between the self and the other.