BACKGROUND:Contraception enables reproductive choices, yet little is known about its use by Aboriginal and Torres Strait Islander youth. This study describes contraceptive awareness and use among Aboriginal and Torres Strait Islander youth. METHODS:We conducted a cross-sectional analysis of baseline data from the 'Next Generation Youth Wellbeing Study' participants aged 16-24 years from Central Australia, Western Australia and New South Wales. They reported their awareness of contraceptive methods, contraceptive use and reasons for not using condoms. RESULTS:Among the 375 participants, awareness was particularly high for condoms (83%), the oral contraceptive pill (78%) and Implanon (77%). Females, older participants and sexually active participants demonstrated higher awareness. Among 219 participants who were sexually active, 27% reported using no contraception the last time they had sex, whereas 44% used condoms. The most common reasons for not using condoms were using another contraception method (28%), being in a long-term relationship (24%) and not having or liking condoms (22%). After condoms, long-acting reversible contraception was most frequently used, then the oral contraceptive pill. CONCLUSIONS:Participants had a good awareness of contraceptive options. Understanding how females and sexually active participants became aware may guide initiatives to increase awareness in other groups. Not using contraception was common. Strategies to normalise discussions about contraception, increase health service visits, influence school sex education and address power imbalances in relationships may increase use. Higher uptake of long-acting reversible contraception over the oral contraceptive pill suggests that Aboriginal and Torres Strait Islander youth may have adopted these more effective contraceptives earlier in time than non-Indigenous youth.

The Strong Families Study (SFS) is an Indigenous-led, longitudinal birth cohort study that supports Aboriginal and Torres Strait Islander families during the first 1000 days across Queensland, Australia. Its success lies in a co-design approach that embeds Indigenous leadership and culturally responsive methodologies throughout the research process. A co-design, workshop approach was undertaken in partnership with an Indigenous Steering Committee (ISC), providing leadership, Indigenous knowledge, experiences, and priorities. The Aboriginal practices of Dadirri, that is, inner deep listening and quiet still awareness, and Yarning, which facilitated meaningful discussions, were utilised and helped redress power imbalances between researchers and ISC members. Other strategies effectively incorporated sticker exercises, active discussions, and reaching consensus across the group. Key outcomes of the co-design included the development of culturally responsive health priorities, informed consent practices, and data collection and governance processes. The ISC prioritised self-determination and fostered ongoing, meaningful dialogue between researchers and community members, reinforcing the study's ethical foundations and culturally responsive approach. The co-design process ensured that Indigenous voices were prioritised and respected, enhancing the study's cultural integrity. Therefore, the SFS offers a model for Indigenous-led research, highlighting the vital role of Indigenous leadership and knowledge in shaping health research and outcomes.

INTRODUCTION:Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities - highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. METHODS:Taking a strength-based approach and using data from 474 Aboriginal and Torres Strait Islander youth aged 16-24-years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018-2020, age-, sex- and family-adjusted prevalence ratios (PR) for never-smoking relative to sociodemographic, health, social and other factors across socioecological levels were estimated through Poisson regression. RESULTS:Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16-17-years (PR=1.9; 95% Confidence Interval=1.5-2.5), 18-20 (1.3;1.0-1.8)]; completing ≥Year 10 (1.8;1.1-3.0); no interaction with (1.9;1.5-2.5) or being charged by police (2.3;1.5-3.3); never being imprisoned (2.5;1.2-4.8); not having friends imprisoned (1.7;1.3-2.2); having non-smoker friends (1.8;1.4-2.2); never vaping (5.7;3.2-10.1) or smoking marijuana (7.9;4.9-12.8), never having tried alcohol (2.4;2.0-3.0); higher physical activity (1.4;1.1-1.7); lower psychological distress (1.3;1.1-1.6), never being diagnosed with depression (1.5;1.1-2.1) or anxiety (1.7;1.2-2.4) and having 'good-to-excellent' perceived health (1.5;1.1-2.1), compared with not having these attributes. CONCLUSION:These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation and call for sustained structural and policy reforms to address systemic drivers of tobacco use.

In Australia, despite overall declines in cardiovascular disease (CVD)-related mortality, Aboriginal and Torres Strait Islander women develop heart disease earlier and experience more than twice the rate of related morbidity and mortality compared with non-Indigenous women. This study explores Aboriginal women's understandings of the factors that shape their heart health and lived experiences of CVD. We spoke with 28 Aboriginal women aged ≥18 years-15 semistructured interviews and two yarning circles with an additional 13 Aboriginal women-with/without pre-existing CVD, and 10 healthcare professionals (HCPs) working with Aboriginal communities in the Perth metropolitan region, between May 2024 and April 2025. Data were analysed thematically using a combination of inductive and deductive strategies. Five major themes emerged from the data: (i) understanding heart health and CVD, (i) experiences of living with and seeking care for CVD, (iii) caregiving responsibilities and cardiovascular health, (iv) achieving a healthy heart, and (v) culturally grounded approach to ways moving forward. Participants' accounts revealed how caregiving dynamics, together with systemic constraints and life circumstances, influenced efforts to build and sustain Aboriginal women's heart health. Aboriginal women emphasized the importance of holistic, community- and Aboriginal-led approaches to strengthen heart health-related care and their overall wellbeing. Incorporating the perspectives of Aboriginal women and HCPs is essential to addressing the disproportionate burden of CVD among Aboriginal women. Limited access to heart health-related information and the structural issues impacting Aboriginal women's lives on a daily basis underscore the urgent need for tailored, targeted, and community-driven strategies to improve their cardiovascular health.

Longitudinal, Indigenous-led research integrated with community-controlled continuity of care can improve and support perinatal outcomes for Aboriginal and Torres Strait Islander families in Australia. Across the past 35 years, seven cohorts have contributed complementary insights from pregnancy through early childhood with varying geographic reach and appropriate Indigenous governance. This paper discusses each of these cohorts and how these studies across pregnancy, birth and some continuing through early childhood, have substantially added to the body of knowledge related to perinatal health needs for women. Early cohorts (e.g., MUSP; Raine) advanced life‑course epidemiology but had low Indigenous representation, limiting perinatal inference for these communities. The Aboriginal Birth Cohort achieved exceptional long‑term retention and partnerships and from the late 2000s, Gomeroi gaaynggal enabled causation analyses using biomarkers. Finally, systems initiatives such as PANDORA and BiOC demonstrate successes with culturally safe pathways and Indigenous‑governed continuity models. Evidence suggests the approaches undertaken in the perinatal period must ensure the voices of Indigenous people are paramount particularly when care and research is being delivered to communities. Lessons learned from these cohorts highlight that Indigenous governance and workforce, co‑design and community‑embedded engagement enhance retention, relevance and translation; registries and continuity models deliver measurable outcome gains. The depth of knowledge identified in life-course research for Indigenous women can significantly add to the standard data collection tools used by state and national services.

Aboriginal and Torres Strait Islander children with a disability are over-represented in child welfare systems worldwide. Despite this, little is known about their involvement with the Australian child protection system or their lived experiences. Led by Indigenous researchers and methodologies, qualitative findings from yarning sessions with 46 kinship carers across Western Australia informed this research. This research is part of the Indigenous Child Removals WA (I-CaRe WA) project. Difficulty accessing disability assessments and diagnoses for children resulted in a lack of access to disability support services and missed opportunities for early intervention. Priority areas for improvement included appropriate and accessible training for carers and practice support. Urgent reform to account for the needs of Aboriginal kinship carers and children with disabilities in their care is required to improve their health and wellbeing.

The COVID-19 pandemic evidenced the critical role of vaccination in reducing the severity of illness and the risk of infection. Despite the policies and efforts of governments to increase vaccination uptake, COVID-19 immunization among Australian Aboriginal pregnant women is lower compared to vaccine uptake of non-Indigenous pregnant women. To date, there have been no national Aboriginal Participatory Action Research (APAR) co-designed Aboriginal-led studies exploring the factors influencing uptake of COVID-19 vaccination in Aboriginal women of childbearing age. This Aboriginal-led research was conducted with Aboriginal women of childbearing age and non-Aboriginal mothers of Aboriginal children in the Great Southern region of Western Australia (WA). The study aimed to explore the factors influencing COVID-19 vaccine knowledge, confidence, and uptake and was conducted in consultation with Aboriginal Elders and health service partners in the region. This research employed an explanatory sequential mixed methods design, with co-design principles embedded at every stage of the study. Using Western quantitative methods and Indigenous qualitative methodologies, the research completed 110 surveys and conducted 5 Yarning Circles. Participants reported safety and trust as key factors influencing vaccination decision making. Although the vaccine mandate increased vaccine uptake, the study found a decline in vaccination following the end of the mandate. Participants also reported ongoing challenges following the COVID-19 pandemic as lack of engagement and access to health information and services. The findings underscore the importance of cultural legitimacy in research and the need for sustained partnerships between Indigenous communities and health researchers to foster trust and promote health equity. This paper outlines the methodological framework implemented in the Ngarngk Koolangka Moorditj Yarning Project (NKMY) conducted in Australia (2022–2024).

Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women-particularly Indigenous women-whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%-100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.

Background Aboriginal and Torres Strait Islander kinship carers are crucial to keeping Aboriginal children connected to their cultural identity and community, particularly in the face of high, increasing and disproportionate out-of-home care for Aboriginal Children. Despite this, little is known about their lived experiences and interactions with the Australian child protection system. Methods Led by Indigenous researchers and methodologies, qualitative findings from yarning sessions with 46 kinship carers across Western Australia informed this research. This research is part of the Indigenous Child Removals WA (I-CaRe WA) project. Results Kinship carers considered their role beneficial for their own emotional and social wellbeing. Managing kinship caring responsibilities and financial insecurity made it difficult to prioritise personal health. Kinship carers reported the importance of cultural responsibility and maintaining children’s cultural connection as reasons for becoming carers. Several participants reported feeling unsafe asking for help with caregiving in their interactions with child protection services. Priority areas for system improvement included better access to financial and practical support for both formal and informal kinship carers. Conclusion Urgent reform to account for the needs of Aboriginal kinship carers is required so that they can thrive in their roles and continue providing culturally safe care to Aboriginal children.

ISSUE ADDRESSED:Smoking rates have been steadily declining among Aboriginal and Torres Strait Islander people. Examining the factors associated with not smoking in young people is crucial for understanding the motivations and influences that lead individuals to adopt healthy behaviours. METHODS:Secondary analysis was undertaken of data collected as part of the National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2014-15 (n = 1456). Factors associated with not smoking were explored with three multivariate regressions: (1) socio-demographic characteristics; (2) health, social and emotional factors; and (3) cultural identity characteristics. RESULTS:Overall, 66% of Aboriginal and Torres Strait Islander young people aged 15-24 years did not smoke. Factors associated with not smoking included being younger, female, and engaged in study or employment. Those who lived with no smoking in the house, had lower illicit drug and alcohol use, and participated in Aboriginal or Torres Strait Islander sports carnivals were also more likely to be non-smokers. CONCLUSIONS:Study findings reinforce the influence of social determinants on smoking behaviour. Efforts to reduce smoking among Aboriginal and Torres Strait Islander young people should focus on removing barriers to education and employment, promoting positive peer and family influences within households, taking a multi-drug approach to cessation, and considering cultural identity and its role in promoting healthy lifestyles. SO WHAT?: Understanding the protective factors associated with not smoking in young Aboriginal and Torres Strait Islander people will help with developing effective policies and initiatives to improve health outcomes.

ISSUE ADDRESSED:Smoking during pregnancy poses serious health risks for mother and baby. Addressing smoking among pregnant Aboriginal and Torres Strait Islander women is an Australian national priority. This study aimed to understand the geographical variation in rates of not smoking during pregnancy among Aboriginal and Torres Strait Islander women. METHODS:Data from the National Perinatal Data Collection were obtained for all births in Australia recorded between 2014 and 2017 to women aged 18 and over who were recorded as Aboriginal and/or Torres Strait Islander. Sociodemographic characteristics were obtained from national data for each of the 340 included geographic areas of residence (SA3). The characteristics associated with not smoking in the first 20 weeks of pregnancy were explored with conditional autoregressive spatial regression modelling. RESULTS:Over half (56%) of the 49 341 women included in the dataset reported they did not smoke in the first 20 weeks of pregnancy. The prevalence of not smoking ranged from 39% to 86% across geographic areas. Not smoking was highest in areas with higher median age, lower levels of socio-economic disadvantage and increased participation in employment. CONCLUSIONS:Not smoking during the first 20 weeks of pregnancy among Aboriginal and Torres Strait Islander women was strongly associated with area-level socioeconomic disadvantage driven primarily by the level of employment in the area. SO WHAT?: Targeted public health strategies that focus on areas identified as having high rates of maternal smoking and on improving employment opportunities and addressing socioeconomic disadvantage could contribute to a reduction in smoking rates.

OBJECTIVES:To examine researchers' reports of adherence to ethical principles in their most recent research project, including factors associated with higher self-reported adherence, and perceptions of how research conduct could be improved. STUDY DESIGN:Online cross-sectional survey. SETTING, PARTICIPANTS:Researchers who had conducted any health or medical research that included Aboriginal and Torres Strait Islander people or their data. MAIN OUTCOME MEASURES:Researchers rated their adherence to 15 ethical principles extracted from ethical guidelines in their most recent research project on a 5-point Likert scale (poor to excellent), and reported what they believe is needed to improve the conduct of Aboriginal and Torres Strait Islander health and medical research. RESULTS:391 researchers completed the survey. Those with > 10 years' experience in the field were significantly more likely to self-report adhering to all 15 key ethical principles compared with those with ≤ 5 years' experience. Compared with those with ≤ 5 years' experience, those with 6-10 years' experience were significantly more likely to self-report adhering to: engaging community in identifying research priorities (odds ratio [OR], 2.05; [95% confidence interval (CI), 1.23-3.40]); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.32-3.55); and engaging community in research implementation (OR, 2.10; 95% CI, 1.25-3.54). Aboriginal and Torres Strait Islander participants were significantly more likely to self-report adhering to the following principles than non-Indigenous participants: engaging community in identifying research priorities (OR, 1.90; 95% CI, 1.16-3.10); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.30-3.61); engaging community in research implementation (OR, 1.92; 95% CI, 1.14-3.20); embedding Aboriginal governance, advisory and decision making on the project (OR, 2.10; 95% CI, 1.26-3.50); embedding opportunities in the research for capacity building for communities (OR, 1.70; 95% CI, 1.04-2.77); and enacting Indigenous data sovereignty and governance principles (OR, 1.67; 95% CI, 1.02-2.70). Open-ended responses indicated research conduct could be improved by recognition of community as experts, genuine partnerships and engagement, and pathways for Aboriginal and Torres Strait Islander researchers and support to strengthen the field. CONCLUSION:Structural and individual change is required to accommodate community priority setting, governance, consultation, leadership and translation in the conduct of ethical Aboriginal and Torres Strait Islander health and medical research. Such changes should be flexible and responsive to calls made by Aboriginal and Torres Strait Islander researchers and communities.

Rationale: Aboriginal Community Controlled Health Services (ACCHSs) are primary care services, providing healthcare in culturally safe environments for Aboriginal and Torres Strait Islander Peoples, the Indigenous peoples of Australia. New South Wales (NSW) is the most populated state in Australia with a population of 8.3 million, approximately 3% (246,000) of whom are Aboriginal or Torres Strait Islander Peoples. There is little information about respiratory services provided by ACCHSs to ensure that Aboriginal people with chronic respiratory diseases have access to best-practice care. Aim: To describe current provision of respiratory services by NSW-based ACCHSs, especially identifying barriers and facilitators to providing pulmonary rehabilitation. Methods: The study used a Zoom-assisted survey with ACCHSs that were members of the NSW Aboriginal Health and Medical Research Council. Exclusions were ACCHSs that only delivered drug and alcohol rehabilitation, housing or employment services. The survey questions related to client population, demographics, workforce, respiratory services, and pulmonary rehabilitation. Results: Of the 41 eligible ACCHSs, 18 (44%) completed the survey and represented ACCHSs in metropolitan, regional, rural and remote regions. Eleven of the participating ACCHSs provided client numbers which totalled 27,932 Aboriginal people. The ACCHS workforce was mostly general medical practitioners (family doctors), (median, IQR) (3.7 fulltime equivalent (FTE) per ACCHS, IQR 2.1 to 5.4), nurses (3.0 FTE, 2.4 to 5.0), and Aboriginal Health Workers (3.0 FTE, 3.0 to 6.0), with negligible allied health professionals employed. 78% of ACCHSs reported some access to respiratory physicians, either face-to-face or tele-health, mostly at regional hospitals via established referral pathways. Aboriginal clients with a COPD diagnosis as a percent of those with a smoking history ranged from 7%-24%. The main respiratory services provided were smoking cessation (100% of ACCHSs), spirometry (89%), respiratory clinics (33%). At the time of completing the survey, no ACCHSs provided pulmonary rehabilitation, with the main reasons being financial constraints, staff shortages, lack of staff training, and inadequate space. Ten ACCHSs (56%) reported that Aboriginal clients would not access hospital-based pulmonary rehabilitation mainly due to experiences of racism, transportation issues and geographical location. Conclusions: ACCHSs mainly support respiratory services that have been government funded e.g smoking cessation and spirometry. Additional funding is required to enable equitable access to best-practice, evidenced-based care for Aboriginal people living with COPD, such as establishing culturally safe and accessible pulmonary rehabilitation programs.

BACKGROUND:In 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. METHODS:This 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. RESULTS:29,409 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. CONCLUSIONS:Aboriginal 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.

Objective: To identify factors protective of healthy weight for Aboriginal children living in urban and regional Australia. Methods: Data were collected from 1139 Aboriginal children aged 2–19 years from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMI z-scores were calculated using WHO age and sex specific cut-offs. Poisson regression models were used to examine the association between BMI z-scores and child- and family-level socio-demographic, lifestyle, and environmental factors. Results: A majority of children had a healthy weight (67 %); 17 % had overweight and 16 % had obesity, with similar percentages for females and males in all three categories. Children were more likely to have a healthy weight if they were younger, had a lower waist-to-height (WHtR) ratio, a caregiver with a healthy weight and had housing affordability problems. For every extra hour of physical activity undertaken per day children were 7 % more likely to have a healthy weight. Conclusions: Healthy weight prevalence decreased with increasing age and decreasing physical activity levels in Aboriginal children and was strongly linked to caregiver BMI. Implications for public health: Implementing effective, community-led, culturally sensitive programs that support increased physical activity and promote healthy weight in childhood should be a public health priority.