Community controlled Aboriginal Medical Services (AMS) lead the way in addressing the health needs of Aboriginal and Torres Strait Islander peoples. If appropriately resourced, AMSs are inherently well-placed to address prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorder (FASD). The Strong Start, Bright Future project and a regional AMS co-created culturally-informed approaches to address PAE and FASD. This study reports baseline findings and proposed strategies for the implementation phase of the project. Using Indigenous and Western mixed methods, this study centred staff and Aboriginal and Torres Strait Islander community voices, knowledges and priorities through yarning. Questionnaires and a chart audit sought broad insights into staff knowledge, attitudes and practices. Yarns were analysed using Dadirri and narrative analysis, and questionnaire and chart audit results were summarised numerically (descriptive statistics). All findings were integrated to produce proposed service-specific implementation strategies. Findings revealed the strengths of Aboriginal and Torres Strait Islander relational and trust-building approaches, particularly within AMS community outreach services that foster connections with Aboriginal and Torres Strait Islander women in the community, facilitating access to PAE and FASD-related knowledge and services. However, clinical staff knowledge gaps, misconceptions, inconsistent practices and unclear diagnostic referral pathways were barriers to service access. Guided by Aboriginal and Torres Strait Islander community and staff knowledge and priorities, proposed strategies were multifaceted, including whole-of-service training, community learning opportunities, family-centred care and culturally safe messaging. The Aboriginal and Torres Strait Islander community and outreach staff knowledge featured in this research highlights the strengths of Aboriginal and Torres Strait Islander approaches for addressing PAE and FASD, and provides essential guidance informing safe and culturally responsive PAE and FASD services for Aboriginal and Torres Strait Islander peoples.
Emergency departments (EDs) are critical points of contact for treating and responding to the needs of Aboriginal and Torres Strait Islander women who have experienced traumatic brain injury (TBI) caused by violence. This study aimed to explore how care, support, and treatment can be improved for Aboriginal and Torres Strait Islander women who have experienced TBI caused by violence by drawing on the perspectives of ED staff in a regional hospital in Queensland (Australia). Using purposeful and snowballing sampling, 24 health professionals (including Indigenous hospital liaison officers and Aboriginal health workers and nursing, medical, and allied health staff) were recruited to participate in the study. Using reflexive thematic analysis, four key recommendations were identified: (1) development of a formalised pathway for head injury from family violence; (2) providing Aboriginal and Torres Strait Islander women with a timely acute-care-to-community pathway; (3) resourcing hospital- and community-based services for all Aboriginal and Torres Strait Islander women and their children; and (4) strengthening responses from health professionals to violence and head injury. The findings inform opportunities to strengthen ED and system-level responses to improve care and support for Aboriginal and Torres Strait Islander women who have experienced this injury.
In July 2022, Human Papillomavirus (HPV) self-collection became available as a choice to all participants in Australia's National Cervical Screening Program (NCSP). This policy change aims to facilitate equitable access to cervical screening; however, further evidence is needed to support its implementation and reach under-screened women and people with a cervix. This implementation study seeks to embed HPV self-collection into Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) and/or primary care organisations whose context is similar to that of an ACCHO. This will be achieved by co-designing, implementing, and evaluating models of care tailored to local needs. The aim is to increase cervical screening participation, particularly among under- and never-screened, Aboriginal and Torres Strait Islander women and people with a cervix. Ultimately the aim is to achieve equity in cervical cancer elimination. Screen Your Way will use a before-and-after study design to evaluate the effectiveness, acceptability and sustainability of implemented strategies on cervical screening participation among Aboriginal and Torres Strait Islander women and people with a cervix. The study will be guided by an Indigenist implementation research approach and will employ mixed methods. Ethical approval has been obtained from the Australian Institute of Aboriginal and Torres Strait Islander Studies Research Ethics Committee (REC-0092), Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (2078/23), Australian National University Human Research Ethics Committee (H/2023/1103), Northern Territory Department of Health and Menzies School of Health Research (HREC2023-4557), and Metro South Human Research Ethics Committee (HREC/2025/QMS/115155). Additional approvals will be obtained in accordance with the locally nominated governance protocols of each participating service. This may include approvals from ACCHO Boards, Community Juries, or other designated decision-making bodies. The research team will work closely with each service to ensure all required processes are respected and adhered to prior to commencing any research activities. Findings will be disseminated via workshops, reports, evidence briefs and resource creation to assist with the evidence-based scale up of self-collection in the ACCHO setting. Further dissemination will occur via conferences and peer-reviewed publications in partnership with the Screen Your Way Aboriginal and Torres Strait Islander Caucus.
Effective injury prevention for Aboriginal and Torres Strait Islander people hinges on the availability of culturally safe policies, resources and programmes, alongside best-practice research. Contemporary injury prevention research has increasingly centred Aboriginal and Torres Strait Islander knowledges, yet there is still room for improvement. Identification of relevant resources, policies and programmes, as well as the extent to which injury prevention research meets international criteria for ethical research with Aboriginal and Torres Strait Islander peoples will provide practitioners with critical insights into best-practice injury prevention initiatives. We examined the breadth and scope of Aboriginal and Torres Strait Islander injury-related publications, health promotion and practice resources, and policies and programmes available in Australia using a publicly available online database. We then reviewed injury prevention articles published since 2020 against an international criterion for best practice research with Indigenous populations. There were 1143 injury-related publications (113 specific to injury prevention and safety promotion), 147 policies, 106 resources, and 87 current or past injury prevention programmes. The majority of publications and programmes were focused on responses to violence. Policies focused on safety promotion and resources focused on road safety. The majority of reviewed studies met at least one domain for best-practice research. While progress has been made for Aboriginal and Torres Strait Islander injury prevention in Australia, these outcomes have been undermined by stagnation surrounding policy reform and frameworks to support policy implementation. Urgent radical action is needed to prevent Australia's growing injury inequity gap.
Aboriginal and Torres Strait Islander adolescents living in rural communities do not have sufficient access to health promotion services. Community programs that respond to adolescent needs, highlight community strengths, and are locally tailored are needed. Set in Queensland (Australia), this study was cross-sectional and qualitative in design. Using implementation science and Aboriginal and Torres Strait Islander frameworks, this study aimed to identify community priorities for the co-design of a culturally appropriate, empowerment-focused nutrition program with rural Aboriginal and Torres Strait Islander adolescents. Through community yarning, the barriers, enablers, and opportunities for program implementation were explored within an Aboriginal and Torres Strait Islander community-controlled health organization. Ten adolescents, two parents/caregivers, eight healthcare staff, six community leaders, and four Elders participated. Thematic analysis identified six themes that outline community health priorities, contextualization to the local food environment, and the importance of cooking skills for empowerment and involving the family unit. Thematic analysis also explored community preferences for program evaluation. Themes were integrated with other knowledge sources to develop a program outline that is aligned with evidence-based practice and community voice. Implementation of the co-designed program is recommended and will be explored in partnership with the community through future research.
Skin disease is a major cause of morbidity in Australia and a leading reason for primary care visits. Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of skin conditions but face barriers to accessing culturally safe specialist services. This study described patient demographics, presentations and experiences at a new community-based dermatology clinic. A mixed-methods study was conducted at an urban Aboriginal and Torres Strait Islander primary health care dermatology clinic in South East Queensland. Retrospective analysis of medical records (March 2021-December 2023) examined demographics, attendance and diagnoses. Verbal semi-structured interviews were undertaken with patients to explore their experiences, and data were analysed thematically. Across 338 encounters, 76% of patients identified as Aboriginal and/or Torres Strait Islander and 72% were female. Attendance was 55%. 27% had previously accessed specialist dermatology care. In this urban cohort, inflammatory dermatoses predominated, including atopic dermatitis (n = 26), acne (n = 15), chronic spontaneous urticaria (n = 12) and psoriasis (n = 12). This differs from existing literature in rural and remote settings where infectious dermatoses often predominate. Seventeen patients participated in interviews led by Aboriginal and Torres Strait Islander Research Officers. Participants valued the clinic's accessibility, shorter wait times compared with hospital services and culturally safe environment. Barriers included transport, scheduling challenges and medication costs. A community-based, culturally tailored clinic was perceived by patients as more accessible, culturally safe and responsive to their needs. Supporting similar models may help close the gap in dermatological care and outcomes for Aboriginal and Torres Strait Islander peoples.
The Taiwan Strait is a crucial marine passage that connects the East China Sea and South China Sea. However, the nutrient conditions of this region and their temporal trends over the past decade remain poorly understood. This study investigated changes in nutrient conditions in the Taiwan Strait by comparing the spatiotemporal distributions of dissolved inorganic nitrogen, PO4-P, and SiO3-Si between the present period and a decade ago. The results showed that PO4-P concentrations remained relatively stable and acted as a limiting nutrient. However, SiO3-Si concentrations have decreased significantly over the past decade, which may be attributed to reduced surface runoff resulting from human activities, such as water-conservancy projects and the "sponge city" program, as well as declining precipitation associated with climate change. These changes suggest modifications in terrestrial nutrient inputs and their subsequent impact on offshore marine ecosystems. This study highlights the influence of temporal variability on nutrient availability along the western coast of the Taiwan Strait and provides important insights into potential shifts in the structure of biological communities.
The Kuroshio, a major western boundary current in the North Pacific, critically influences regional climate, ocean circulation, and marine ecosystems across the East China Sea (ECS) and Luzon Strait. Despite its importance, long-term, three-dimensional characterizations of its variability remain sparse. Here, we present a daily-resolved three-dimensional dataset spanning 1993-2024 that quantifies the position of the Kuroshio axis and its lateral boundaries throughout the ECS-Luzon Strait system. Using the GLORYS12V1 ocean reanalysis product, we developed a streamline-constrained maximum velocity method that combines streamline continuity with local velocity maxima to robustly identify the Kuroshio axis and boundaries across 30 vertical layers, effectively reducing interference from branching currents and mesoscale eddies. Validation against prior studies and observational data confirms that the dataset accurately reproduces both surface and subsurface Kuroshio structures, captures seasonal variability, and aligns well with subsurface flow cores at key latitudes. This high-resolution, multi-year dataset offers a valuable resource for studies of Kuroshio dynamics, heat transport, interactions with mesoscale processes and the atmosphere, and related ecological and engineering applications.
Aboriginal and Torres Strait Islander communities experience a disproportionate burden of road traffic injuries yet little work has been done to develop a comprehensive epidemiological profile. We analysed data from the South Australian Trauma Registry for road traffic injuries in Aboriginal and Torres Strait Islander adults (≥18 years) admitted to hospital between July 2018 and June 2023. Descriptive statistics summarised demographics and hospital presentation characteristics, and an ordinal logistic regression examined the association between length of stay and injury severity scores (ISSs). Indigenous research methodologies guided study design and interpretation. A total of 127 patients were identified, all sustaining blunt trauma. Most patients identified as male (63%) and 30% were aged 25-34 years. Road traffic injuries frequently occurred on roads with speeds ≥60 km/hour (60%) and over 60% occurred in the afternoon/evening. Approximately 52% of cases reported ISS >12, and 32% of patients arrived at the hospital more than 12 hours after the time of injury. Median hospital stay was 9 days (IQR: 3.1 to 17.0) and greater ISS scores were associated with longer hospital stays (OR=1.2, 95% CI 1.08 to 1.26, p<0.001). Our findings suggest a need to focus on addressing the overrepresentation of men and individuals of working age while also targeting key risk factors like speed, with improved support and resourcing for rural and remote communities. Central to these efforts should be community-led co-design initiatives to ensure relevant and sustainable prevention strategies.
Mercury (Hg) is a toxic contaminant that biomagnifies along marine food chains, particularly exposing top predators such as seabirds through their diet. Bass Strait, in southeastern Australia, is one of the fastest warming oceanic regions on the planet and is influenced by several currents that create a highly variable physical and biological environment. Here, we studied the feather and blood Hg concentrations in two Procellariiformes species, the common diving petrel (Pelecanoides urinatrix) and the fairy prion (Pachyptila turtur) over four breeding seasons with different environmental conditions on site. We hypothesized that years marked by marine heatwaves would show different blood Hg contamination than colder years, due to differences in prey availability. Both species exhibited significantly higher blood Hg levels during incubation than during chick-rearing, suggesting a carry-over effect from pre-breeding period contamination. Inter-annual variation in blood Hg concentrations was observed in both species, and common diving petrels showed significant differences in Hg and isotopic values between the two colder years of the study. These results suggest that factors other than the increase of sea surface temperature associated with marine heatwaves caused inter-annual variation in Hg contamination. In particular, changes in the relative dominance of water masses may have altered the prey composition in Bass Strait, subsequently leading to fluctuations in Hg contamination. As the East Australian Current is expected to intensify, our results highlight that environmental variability associated with climate change could result in further variation in Hg contamination in seabirds in the future.
The 239 + 240Pu activity concentrations and 240Pu/239Pu atom ratios in surface sediments and sediment cores from the Taiwan Strait (TS) were measured to identify Pu sources and quantify their contributions. The 239+240Pu activity concentrations ranged from 0.06 to 1.11 mBq g-1 in surface sediment and 0.03-1.17 mBq g-1 in four sediment cores, while 240Pu/239Pu atom ratios varied from 0.205 to 0.277 and 0.220-0.287, respectively. These ratios consistently exceeded the characteristic value for global fallout (0.180 ± 0.014), indicating an additional, non-global fallout source. The spatial analysis confirms that the excess Pu originates from close-in fallout from the Pacific Proving Grounds (PPG), characterized by higher ratios (0.30-0.36). Application of a two-end-member mixing model reveals that the PPG and global fallout contribute 58% ± 10% and 42% ± 10% to the Pu inventory in surface sediments of the TS. Correspondingly, their contributions in sediment cores deposited over the past 40-50 years are 57%-59% and 41%-43%, respectively. Furthermore, using a dual-method framework that combines the 239+240Pu activity concentration and total organic carbon content relationship with a δ13Corg-based mixing model, the contributions of terrestrial input (Terr-global fallout) and direct atmospheric deposition (Mar-global fallout) were quantified. The results indicate that Terr- and Mar-global fallout contribute 17% ± 10% and 25% ± 7%, respectively, to surface sediment, and 15%-19% and 23%-25% to sediment cores. Additionally, elevated sedimentation fluxes (2.14-4.67 mBq cm⁻² yr⁻¹) and inventories (48.8-241.0 Bq m⁻²) of 239+240Pu indicate that the TS functions as an effective sink for this particle-reactive radionuclide. Finally, this study fills a key gap in Pu isotope distribution between the South China Sea and the East China Sea, providing baseline data for future environmental risk assessments related to nuclear power plant operations along the Chinese coast.
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Homelessness is a significant issue in the context of violence, particularly for Indigenous women in settler colonial countries, as are the long-lasting impacts of violence such as traumatic brain injury (TBI) including concussion. Understanding of the relationship between homelessness and healthcare access for TBI from violence among Indigenous women is critical for informing service delivery; however, research in this area remains limited. Situated within the broader experiences of accessing healthcare following violence-related TBI, this study aimed to explore the relational dynamics between violence, homelessness, healthcare access, and the implications for long term recovery and wellbeing. Using purposive and snowball sampling, semi-structured interviews and focus groups were completed with 18 Indigenous women who have experienced TBI from violence, 28 community members, and 90 community-based frontline workers to gather insights into the experiences of living with TBI family violence or supporting someone with this injury. All data were transcribed verbatim and analyzed using thematic analysis. Two themes were identified regarding how responses to family violence-related homelessness created barriers for Indigenous women to access healthcare for TBI: (1) Housing service barriers affect access to healthcare and TBI management, and (2) The (in)visibility of TBI within crisis accommodation and housing services. The dominant experience for Indigenous women who had experienced violence and homelessness was characterized by complexity, uncertainty, and distress, largely due to service delays and barriers encountered across housing pathways. Some Indigenous women were required to relocate away from their home region to secure temporary accommodation. While crisis accommodation services were widely viewed as places of safety, many did not consider TBI in environmental design or service delivery. Multi-agency case management and outreach were identified as valuable approaches for improving healthcare access. The findings illustrate the importance of TBI-informed policy and practice within housing and homelessness services, especially for Indigenous women in rural and remote regions, alongside strengthened workforce training. Stronger linkages between women's shelters, housing services, and healthcare systems - including concussion clinics - are critical for supporting both immediate and long-term care. Needs-based funding is required to ensure regional and remote housing systems can support women-led responses, including more streamlined transitions from crisis or short-term accommodation to secure housing.
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Aboriginal and Torres Strait Islander youth hold central roles in the preservation and transmission of cultural knowledge, community leadership and Australia's social and political future. Fostering youth well-being is essential in the context of historical, social and political impacts of colonisation. Social and emotional well-being (SEWB) is a holistic concept grounded in First Nations worldviews, encompassing connections to country, culture, spirituality, family, community, body and mind. Many programmes aim to support SEWB among First Nations youth; however, evidence describing programme success factors outcomes remains fragmented and is often shaped by Western-centric methodologies. This protocol outlines a culturally responsive scoping review that will map success factors and SEWB impacts of programmes delivered in Australia for First Nations youth aged 10-18 years that is designed to be undertaken collaboratively with First Nations people and non-Indigenous allies. In recognition of the diversity of Aboriginal and Torres Strait Islander peoples and their right to self-identify using preferred terminologies, in this protocol, we respectfully use 'First Nations peoples' to refer to all Aboriginal and Torres Strait Islander peoples in Australia and 'First Nations youth' to refer to those aged 10-18 years. We further acknowledge that this use of this terminology may not capture the many and varied First Nations identities within Australia. This scoping review protocol outlines a revised, culturally responsive version of the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be conducted using an Indigenous-informed, decolonising approach. Peer-reviewed and grey literature reporting on Australian SEWB programmes delivered to First Nations youth between 2000 and 2025 will be included. Databases to be searched include MEDLINE/PubMed, PsycINFO, ProQuest and EBSCOhost. Targeted Indigenous sources will be searched, including Informit Indigenous Collection, Australian Indigenous HealthInfoNet, National Aboriginal Controlled Community Health Organisation and Lowitja Institute repositories, along with relevant organisational and government websites. Three reviewers will independently screen records and extract data. Articles requiring cultural responsivity assessment will be reviewed by First Nations researchers. Data will be analysed using inductive content analysis to identify programme success factors and reported SEWB outcomes, with interpretation guided by First Nations members of the research team. The protocol is guided by Australian Indigenous research ethics frameworks including the National Health and Medical Research Council (NHMRC), Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Code of Ethics for Aboriginal and Torres Strait Islander Research and the Lowitja Institute's guidance for Aboriginal and Torres Strait Islander health research. Findings will be disseminated through culturally appropriate channels to communities and stakeholders. Protocol registration will be made available online via the Open Science Framework (osf.io/yq6sv).
Strong communication skills support Australian Aboriginal and Torres Strait Islander children's connections to community, culture, and education. Ongoing impacts of colonisation and social determinants of health may increase the likelihood of speech, language, and communication needs for Aboriginal and Torres Strait Islander children, however national data is limited. Speech-language pathology can address speech, language, and communication needs, but factors impacting access for this population are not well understood. This study aimed to establish caregiver reported prevalence of speech, language, and communication needs in Aboriginal and Torres Strait Islander children aged 0-6 years and identify facilitators and barriers to accessing support. Mixed modelling and qualitative content analyses were used to examine data for 474 children in a national longitudinal study of Aboriginal and Torres Strait Islander children. In total, 47.0% of children had speech, language, and communication needs between 0-6 years, with only 48.0% with speech, language, and communication needs, accessing support. Higher access was linked to caregiver-rated health, concern duration, and concerns across multiple communication domains. Key access barriers included service availability and awareness. The high prevalence of speech, language, and communication needs and limited access to support highlights the need to reduce access barriers and consider public health models of intervention that incorporate Aboriginal and Torres Strait Islander views of health.
Reconciliation action plans (RAPs) are increasingly used by commercial organizations in Australia to demonstrate commitment to Aboriginal and Torres Strait Islander peoples. Framed as tools to promote understanding and address historical injustice, these documents also serve organizational interests, particularly in reputation management and corporate social responsibility (CSR). This research critically examined the structure, practices, portfolios, resources, and transparency of high-level RAPs of for-profit organizations operating in the state of Queensland, Australia. Drawing on frame analysis, critical discourse analysis (CDA), and commercial determinants of health frameworks, this study explored how reconciliation and associated commitments are defined, justified, and operationalized within corporate discourse. The analysis showed that resource-rich corporations leveraged their power to manage reconciliation as a corporate asset rather than address structural inequities. Five overlapping frames, 'instrumental reconciliation, performative accountability, symbolic leadership, truth signalling, and substantive recognition', were identified through which reconciliation is positioned within corporate discourse of legitimacy, measurement, and control. While many organizations adopt languages of codesign, self-determination, and cultural safety, translation into demonstrable processes and measurable outcomes remains inconsistent and limited. These findings highlight how RAPs can both provide entry points for engagement while simultaneously reinforcing existing power relations. The research contributes to understanding the commercial determinants influencing Aboriginal and Torres Strait Islander health and wellbeing, calling for stronger accountability, transparency, and Aboriginal and Torres Strait Islander leadership within corporate reconciliation agendas.
Diet affordability is a critical determinant of food security, health and wellbeing. However, the cost and affordability of diets have not been routinely measured in Queensland (Australia) in over a decade. This study assessed the cost and affordability of healthy (based on national healthy eating guidelines) and habitual (less healthy, based on national reported intake) diets across six Queensland regions. Data were collected in 35 communities, over two years (2023 and 2024), using the evidence-based Healthy Diets Australian Standardised Affordability and Pricing protocol. Data were analyzed relative to a six-person intergenerational Aboriginal and Torres Strait Islander reference household. Results indicate that, across Queensland, healthy diet costs are above the threshold for food stress in Aboriginal and Torres Strait Islander households. On average, healthy diets were 30% cheaper than the habitual diet (which include alcohol and takeaway foods) but cost at least 26% of household income (above the 25% threshold for food stress). In 2023, healthy diets were on average 31% more expensive in remote communities compared to urban and regional centers. In 2024, the cost of a healthy diet in remote communities decreased significantly by 24%, narrowing diet cost differences between remote and non-remote regions. This shift could be associated with the implementation of a freight subsidy in remote Queensland, or other influences on remote food pricing. Findings highlight diet-related cost-of-living challenges for Aboriginal and Torres Strait Islander families, underscore the need for ongoing monitoring and provide insight for policy interventions (such as targeted subsidies) to improve diet affordability and reduce nutrition-related health inequity.
A decade ago the author published a commentary on the content relating to Aboriginal and Torres Strait Islander populations in the RANZCP clinical practice guidelines for the treatment of schizophrenia and related disorders. The recently released ANZJP guidelines bring a fresh framework - the GRADE approach - but, in relation to consideration of Indigenous Australians, not much else. The author reflects on considerations a decade ago and now, and what has changed in relation to the social determinants of Indigenous vulnerability over that time. A decade ago I wrote a commentary (Hunter, 2016) on the Indigenous content of the (then) recently published guidelines for the management of schizophrenia (Galletly et al., 2016). The updated guidelines (Suetani et al., 2026) bring a fresh orientation, being informed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. That shift is consequential for consideration of Aboriginal and Torres Strait Islander populations which are consigned - with Māori - to a brief section - 'special populations' - the salient recommendation being: 'we advocate for universal cultural safety in mental health systems'.