Evaluation of acceptance and efficiency of exercise for Indigenous Australians to benefit physiological, anthropometric and metabolic syndrome outcomes

The proposed study will provide an increased understanding in a much-understudied area of how the Australian Indigenous community perceives physical activity and the beneficial effects for improving health outcomes. The PhD will be made up of three studies: 1) To design an exercise prescription that is culturally appropriate and specifically addresses the major Indigenous health issues around metabolic syndrome. The first will be a cross sectional study that surveys the motivators and barriers to physical activity within the Perth Noongar community. The results of this study will be used to enhance the intervention section of the PhD. It will provide a more accurate and the best means of ensuring not only a greater uptake, but also ways of developing positive lifelong physical activity habits. 2) Determining the amount of physical activity taking place within the Noongar community. Utilising the Global Physical Activity Questionnaire to measure the amount of physical activity and sedentary rates within the Indigenous community. 3) Evaluate the compliance and effectiveness of the developed intervention to inform future exercise therapy programmes for this population. The second study will be a randomised control trial looking at the physiological responses to a combination of aerobic and anabolic (resistance) exercise. The significance of this aspect of the PhD will be to capture and record physiological and quality of life measures some not previous recorded in the Indigenous community. This will inform policy relation to the most appropriate targets for eliciting successful behaviour change to improve health in Indigenous and non-Indigenous population

Feasibility of 12 weeks of combined aerobic and resistance training in Indigenous Australian adults: A Phase I, single group, pre-post intervention study

Objectives: To investigate the feasibility and potential of an exercise program based on current recommendations for health to decrease cardiometabolic risk factors in Indigenous Australian adults in a metropolitan setting. Design: Phase I, single-group, pre-post intervention study. Methods: Sixteen previously inactive adults (55% female, mean age 32 y) undertook supervised exercise involving aerobic and progressive resistance training for 3 days per week for 12 weeks. Results: Eleven participants (69%) completed the exercise intervention with high exercise adherence rates (92% of sessions completed). Compared with baseline, there was a significant improvement with training in sub-maximal aerobic capacity (MD 5 ml/kg/min, 95% CI 3 to 7), pulse wave velocity (MD -2 m/s, 95% CI: -2.3 to -0.7), percentage body fat (MD -2%, CI: -3.4 to 0.2), bench press (MD 17 kg, 95% CI: 10 to 25), leg press (MD 67 kg, CI: 36 to 110), waist circumference (MD -3 cm, 95% CI: -4.0 to -1.0) and hip circumference (MD -2 cm, 95% CI: -4.4 to -1.1). Conclusions: A supervised fitness centre based aerobic and resistance training program has the potential to reduce cardiovascular disease risk factors in Indigenous adults and can be delivered in a metropolitan gym environment

Protective factors against self-harm and suicidality among Australian Indigenous adolescents: A strengths-based analysis of the longitudinal study of Indigenous children

Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time—The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2 %). Previous self-harm was reported by 8.2 % (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p \u3c 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95 % CI 1.31–26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress

The facilitators and barriers to exercise in the Noongar Aboriginal population in Perth, Australia

Indigenous Standpoint Theory forms the epistemological foundation for this study and methodological choices were made within this theoretical framework to ensure culturally responsive research processes that engaged the Indigenous agenda of self-determination and rights. The objectives of this research were to determine: (i) Indigenous perceptions of the facilitators and barriers to exercise; (ii) The potential feasibility and sustainability of an exercise intervention. In this context, Participatory Action Research methods were used to design the data-gathering instrument for the study—a questionnaire, co-designed with the Noongar Aboriginal community of Perth, Western Australia. This self-administered questionnaire, distributed to participants by email, post and manual delivery, sought to elicit the factors that impact uptake and retention of regular exercise activities. Questionnaire data included individual demographic detail and specific question responses on labelled 5 point Likert Scales. Specific question responses were tabulated by Likert Scale label category and the response distribution for each question was enumerated. Simple descriptive statistics (measures of central tendency and variance) were used to characterize the data set and the Chi squared test was used to evaluate frequency differences between males and females. A total of 133 participants (71 females) completed the questionnaire. The results indicated that people valued exercise. The most common barriers indicated by participants were exercising with an injury (63%), changing diet (58%), finding time to exercise every day (55%) and exercising the next day with pain from exercising the day before (54%). A larger proportion of males (34%) than females (24%) reported greater ease in finding time to exercise every day (p \u3c 0.05). Facilitators mainly related to the potential social and community benefits of exercising with other people, preferably in small groups, and the importance of a culturally secure venue. These findings shed light on what a culturally secure exercise programme might involve for the Noongar community. As this may have implications for other Aboriginal and Torres Strait Islander and international First Nations’ Peoples, more focused research is needed on the place of traditional physical activities and the nature of culturally secure exercise programmes and spaces to enable wider application

Physical activity and self-reported metabolic syndrome risk factors in the Aboriginal population in Perth, Australia, measured using an adaptation of the global physical activity questionnaire (gpaq)

Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2 . Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18–25, 26–44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life

Exploring sociodemographic correlates of suicide stigma in Australia: Baseline cross-sectional survey findings from the life-span suicide prevention trial studies

The risk of suicidal behaviour in Australia varies by age, sex, sexual preference and Indigenous status. Suicide stigma is known to affect suicide rates and help-seeking for suicidal crises. The aim of this study was to investigate the sociodemographic correlates of suicide stigma to assist in prevention efforts. We surveyed community members and individuals who had attended specific emergency departments for suicidal crisis. The respondents were part of a large-scale suicide prevention trial in New South Wales, Australia. The data collected included demographic characteristics, measures of help-seeking and suicide stigma. The linear regression analyses conducted sought to identify the factors associated with suicide stigma. The 5426 participants were predominantly female (71.4 %) with a mean (SD) age of 41.7 (14.8) years, and 3.9 % were Indigenous. Around one-third of participants reported a previous suicide attempt (n = 1690, 31.5 %) with two-thirds (n = 3545, 65.3 %) seeking help for suicidal crisis in the past year. Higher stigma scores were associated with Indigenous status (β 0.123, 95 % CI 0.074 – 0.172), male sex (β 0.527, 95 % CI 0.375 – 0.626) and regional residence (β 0.079, 95 % CI 0.015 – 0.143). Lower stigma scores were associated with younger age (β − 0.002, 95 % CI − 0.004 – − 0.001), mental illness (β − 0.095, 95 % CI − 0.139 to − 0.050), male bisexuality (β − 0.202, 95 % CI − 0.351 to − 0.052) and males who glorified suicide (β − 0.075, 95 % CI − 0.119 to − 0.031). These results suggested that suicide stigma differed across the community, varying significantly by sex, sexual orientation and Indigenous status. Targeted educational programs to address suicide stigma could assist in suicide prevention efforts

Cross-sectional changes in weight status and weight related behaviors among Australian children and Australian Indigenous children between 2010 and 2015

Since 2006 there has been substantial long-term investment in school-based child obesity prevention programs in New South Wales (Australia). Whether these programs have led to population level improvements in children's weight status and weight-related behaviors are yet to be determined. The purpose of this study was to describe changes in children's weight status and weight-related behaviors, including Indigenous children, who are at greater risk of poorer health outcomes than non-Indigenous children.Representative cross-sectional population surveys conducted in 2010 and 2015 among children age 5-16 years (n = 15,613). Objective measurements included height, weight, waist circumference, cardiorespiratory fitness, and fundamental movement skills. Indigenous status and indicators of weight-related behavior (i.e., diet, physical activity, school travel, screen-time) were measured by questionnaire with parents responding for children ag

Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10–15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community

At the cultural interface: A systematic review of study characteristics and cultural integrity from twenty years of randomised controlled trials with Indigenous participants

Purpose and aim: To identify and describe characteristics of Randomised Control Trial (RCT) design, implementation, and interpretation with a view tostrengtheningen the cultural integrity and scientific quality of this genre of research when used with, for and by Indigenous peoples. Issue: RCTs are widely regarded as the ‘gold standard’ method for evaluating the efficacy of an intervention. However, issues of cultural acceptability and higher attrition rates among RCT participants from diverse populations, including Indigenous participants, have been reported. A better understanding of cultural acceptability and attrition rates of RCTs has the potential to impact the translation of findings into effective policies, programs and practice. Method: A search of four electronic databases identified papers describing RCTs enrolling exclusively Australian Indigenous peoples over a 20-year period. The RCTs were assessed using: The Effective Public Health Practice Project's Quality Assessment Tool (EPHPP) and the Aboriginal & Torres Strait Islander Quality Appraisal Tool (QAT). The scores for each paper and the average scores of all papers were visualised using a Microsoft Excel™ Filled Radar Plot. Results: Seventeen trials met the inclusion criteria. There was wide variation in the quality of the included trials as assessed by the EPHPP and almost universally poor results when assessed for cultural appropriateness and integrity by the QAT. Conclusion: The value of the RCT research method, when applied to ultimately improve Australian Indigenous peoples' health, is diminished if issues of cultural integrity are not intrinsic to study design and execution. Our review found that it is feasible to have an RCT with both strong cultural integrity and high scientific quality. Attention to cultural integrity and community engagement, along with methodological rigour, may strengthen community ownership and contribute to more successful study adherence and potentially more effective translation of study findings into policy and practice

Bullied because of their teeth: Evidence from a longitudinal study on the impact of oral health on bullying victimization among Australian Indigenous children

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10–15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p \u3c 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community