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Methods for calculating health indicators profoundly influence understanding of and action on population health and inequities. Age-standardization can be useful and is commonly applied to account for differences in age structures when comparing health indicators across groups. Age-standardized rates have well-acknowledged limitations, including that they are relative indices for comparison, and not accurate measures of actual rates where the age structures of groups diverge. This paper explores these limitations, and demonstrates alternative approaches through a case study quantifying mortality rates within the Aboriginal and Torres Strait Islander (Indigenous) population of Australia and inequities compared with the non-Indigenous population, over 2001-16. Applying the Australian Standard Population, the Aboriginal and Torres Strait Islander age-standardized mortality rate was more than double the crude mortality rate in 2001 and 2016, inflated through high weighting of older age groups. Despite divergent population age structures, age-standardized mortality rates remain a key policy metric for measuring progress in reducing Indigenous-non-Indigenous inequities in Australia. Focusing on outcomes age-standardized to the total population can obscure inequities, and denies Aboriginal and Torres Strait Islander peoples and communities valid, actionable information about their health and well-being. Age-specific statistics convey the true magnitude of health risks and highlight high-risk subgroups. When requiring standardization, standardizing to a population-specific standard (here, an Indigenous standard) generates metrics centred around and reflective of reality for the population of focus, supporting communities' self-determination to identify priorities and informing resource allocation and service delivery. The principles outlined here apply across populations, including Indigenous and other populations internationally.

Background Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. Objective To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. Design Narrative review of qualitative studies. Data sources Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. Methods Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. Results Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported involve

Introduction Smoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care. The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples. Methods and analysis An Aboriginal-led, multisite non-randomised single-group, pre–post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial. Ethics and dissemination Ethics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation.

BACKGROUND: Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. OBJECTIVE: To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. DESIGN: Narrative review of qualitative studies. DATA SOURCES: Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. METHODS: Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. RESULTS: Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported i

OBJECTIVE: To describe smoking characteristics, quitting behaviour and other factors associated with longest quit attempt and the use of nicotine replacement therapy (NRT) and stop-smoking medication (SSM) in a population of Indigenous Australian women of reproductive age. DESIGN, SETTING AND PARTICIPANTS: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. MAIN OUTCOME MEASURES: Quitting experience: attempt to cut down, time since last quit attempt, longest period without smoking, attempt to cut down during last quit attempt, any use of NRT and/or SSM. RESULTS: Most of the 428 participating women (302 [70.6%]) reported using an Aboriginal health service. Younger women (16-20-year-olds) smoked fewer cigarettes daily (24/42 [57.1%], 0-5 cigarettes per day), waited longer to smoke after waking (20/42 [47.6%], > 60 minutes after waking), and were categorised as low smoking dependency compared with those aged 35 years and over. One-third of women (153 [35.7%]) had ever used NRT and/or SSM. A greater proportion of older women (35-49-year-olds) had sustained a quit attempt for years (62/149 [45.6%]) and reported trying NRT and/or SSM (78/149 [52.4%]) than women in younger age groups. Quitting suddenly rather than gradually was significantly associated with sustained abstinence (prevalence ratio, 1.27 [95% CI, 1.10-1.48]). Among women who had never used NRT or SSM, most (219/275 [79.6%]) reported reasons for this in the category of attitudes and beliefs. NRT and SSM use was also more likely among women who were confident talking to their doctor about quitting (odds ratio, 2.50 [95% CI, 1.23-5.10]) and those who received most of their information from a health professional (odds ratio, 1.71 [95% CI, 1.11-2.63]). CONCLUSION: Aboriginal and Torres Strait Islander women want to quit smoking and are making attempts to quit. Quitting suddenly

INTRODUCTION: Smoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples. METHODS AND ANALYSIS: An Aboriginal-led, multisite non-randomised single-group, pre-post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation. TRIAL REGISTRATION NUMBER: ACTRN12622000654752.

OBJECTIVE: To identify smoking cessation support strategies that resonate with Aboriginal and Torres Strait Islander women. DESIGN, SETTING AND PARTICIPANTS: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. MAIN OUTCOME MEASURES: Preferred strategies, providers and locations for smoking cessation support. RESULTS: Among a total of 428 women who participated in the survey, group-based support and holistic support were the most preferred strategies (preferred by 31.8% and 22.2% of women, respectively). Use of an Aboriginal health service was positively associated with choosing holistic support programs (prevalence ratio, 1.14 [95% CI, ≥ 1.00-1.28]). Women with high or moderate nicotine dependency were more likely to consider group-based support to be helpful (prevalence ratio, 1.13 [95% CI, ≥ 1.00-1.27]) than those with low nicotine dependency. The most preferred providers for smoking cessation support were Aboriginal health workers (64.3%). Most women (73.4%) preferred face-to-face support at an Aboriginal health service, 38.8% preferred online support and 34.8% preferred phone support. A higher percentage of older women (≥ 35 years) preferred online or phone support (prevalence ratio, 1.70 [95% CI, 1.03-2.80]) compared with younger women (16-20 years). Use of an Aboriginal health service was positively associated with preference for an Aboriginal health worker (prevalence ratio, 1.35 [95% CI, 1.12-1.62]), and receiving face-to-face support at an Aboriginal health service (prevalence ratio, 1.28 [95% CI, 1.10-1.49]). CONCLUSION: Aboriginal and Torres Strait Islander women prefer a range of cessation supports, with most women preferring group support and holistic approaches. Cessation supports that resonated with women varied by age, remoteness, nicotine dependence, and whether participants used an Aboriginal health service. Wome

BACKGROUND: Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. METHODS: A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006-09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality-among current- and past- versus never-smokers-were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. RESULTS: Over 14 586 person-years' follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52-6.04) for current- and 1.95 (1.32-2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15-8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85-2.57) for those quitting at <45 years of age and 2.21 (1.29-3.80) at 45-54 years. Never-smokers lived an average >10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. CONCLUSIONS: In this population, >80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control mus

OBJECTIVE: To quantify the prevalence of known health-related risk factors for severe COVID-19 illness among Aboriginal and Torres Strait Islander adults, and their relationship with social determinants. METHODS: Weighted cross-sectional analysis of the 2018-19 National Aboriginal and Torres Strait Islander Health Survey; Odds Ratios for cumulative risk count category (0, 1, or ≥2 health-related risk factors) by social factors calculated using ordered logistic regression. RESULTS: Of the adult population, 42.9%(95%CI:40.6,45.2) had none of the examined health-related risk factors; 38.9%(36.6,41.1) had 1, and 18.2%(16.7,19.7) had ≥2. Adults experiencing relative advantage across social indicators had significantly lower cumulative risk counts, with 30-70% lower odds of being in a higher risk category. CONCLUSIONS: Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID-19 illness. Indigeneity itself is not a 'risk' factor and must be viewed in the wider context of inequities that impact health Implications for public health: Multi-sectoral responses are required to improve health during and after the COVID-19 pandemic that: enable self-determination; improve incomes, safety, food security and culturally-safe healthcare; and address discrimination and trauma.

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The Review of tobacco use among Aboriginal and Torres Strait Islander peoples provides a comprehensive synthesis of key information on the use of tobacco among Aboriginal and Torres Strait Islander peoples. The review provides the historical, social and cultural contexts; describes the extent of tobacco use in Australia; the health and social impacts in relation to Aboriginal and Torres Strait Islander peoples and communities; the burden of disease and mortality; and other factors relating to tobacco use. It also includes details of the related policies and strategies and programs addressing tobacco use. The review has extensive appendices which include the search strategy used to find the relevant literature. This is the first review the Australian Indigenous HealthInfoNet has published which focuses specifically on tobacco use; which is a national priority in Australia.

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Background: Effective knowledge translation (KT) is critical to implementing program and policy changes that require shared understandings of knowledge systems, assumptions, and practices. Within mainstream research institutions and funding agencies, systemic and insidious inequities, privileges, and power relationships inhibit Indigenous peoples' control, input, and benefits over research. This systematic review will examine literature on KT initiatives in Indigenous health research to help identify wise and promising Indigenous KT practices and language in Canada and abroad. Methods: Indexed databases including Aboriginal Health Abstract Database, Bibliography of Native North Americans, CINAHL, Circumpolar Health Bibliographic Database, Dissertation Abstracts, First Nations Periodical Index, Medline, National Indigenous Studies Portal, ProQuest Conference Papers Index, PsycInfo, Social Services Abstracts, Social Work Abstracts, and Web of Science will be searched. A comprehensive list of non-indexed and grey literature sources will also be searched. For inclusion, documents must be published in English; linked to Indigenous health and wellbeing; focused on Indigenous people; document KT goals, activities, and rationale; and

BACKGROUND: Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014-15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities. METHODS: MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement. RESULTS: Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were importa

OBJECTIVES: To assess the impact of plain packaging with larger graphic health warnings on perceptions of risk and prestige related to different cigarette brands among Aboriginal and Torres Strait Islander people in the Australian Capital Territory. We hypothesised that the changes would decrease perceptions that 'some cigarette brands are more harmful than others', and that 'some brands are more prestigious than others', and this would be stronger among participants aged ≤35 years, and among smokers compared with non-smokers. METHODS: Participants completed the survey prior to packaging changes, and were followed up 12 months later (n=98). Repeated measures ANCOVAs assessed perception changes. RESULTS: Following plain packaging implementation, there was a significant reduction in perceptions that 'some cigarette brands are more harmful than others'. There was no overall change in perceptions of prestige. However, there was a significant interaction for age. Analyses indicated a reduction in perceptions that 'some cigarette brands are more prestigious than others' among younger participants (p=0.05), but no change among older participants (p>0.20). There was no interaction for smoking status for perceptions of prestige, indicating smokers' and non-smokers' perceptions did not differ on this measure. CONCLUSIONS: These findings provide support for the packaging changes.

BACKGROUND: Tobacco use is the single most preventable cause of death in the world. Evidence indicates that behaviours such as tobacco use can influence social networks, and that social network structures can influence behaviours. Social network analysis provides a set of analytic tools to undertake methodical analysis of social networks. We will undertake a systematic review to provide a comprehensive synthesis of the literature regarding social network analysis and tobacco use. The review will answer the following research questions: among participants who use tobacco, does social network structure/position influence tobacco use? Does tobacco use influence peer selection? Does peer selection influence tobacco use? METHODS: We will follow the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines and search the following databases for relevant articles: CINAHL (Cumulative Index to Nursing and Allied Health Literature); Informit Health Collection; PsycINFO; PubMed/MEDLINE; Scopus/Embase; Web of Science; and the Wiley Online Library. Keywords include tobacco; smoking; smokeless; cigarettes; cigar and 'social network' and reference lists of included articles will be hand searched. Studies will be included that provide descriptions of social network analysis of tobacco use.Qualitative, quantitative and mixed method data that meets the inclusion criteria for the review, including methodological rigour, credibility and quality standards, will be synthesized using narrative synthesis. Results will be presented using outcome statistics that address each of the research questions. DISCUSSION: This systematic review will provide a timely evidence base on the role of social network analysis of tobacco use, forming a basis for future research, policy and practice in this area. This systematic review will synthesise the evidence, supporting the hypothesis that social network structures can influence tobacco use. This will also include exploring the

Australia’s comprehensive approach to tobacco control has resulted in reductions in smoking prevalence so that Australian smoking rates are among the lowest in the world. However, smoking prevalence and the burden from smoking is not evenly spread across all population groups. Aboriginal and Torres Strait Islander people have a smoking rate approximately double that of the broader community. It is clear and well documented that tobacco control measures influence different population groups to varying degrees. This study aimed to explore the evidence of smoke-free policy development, implementation and management within Indigenous community settings.

BACKGROUND: Tobacco use is the most preventable cause of morbidity and mortality in Australia. Comprehensive tobacco control has reduced smoking rates in Australia from approximately 34 per cent in 1980 to 15 per cent in 2010. However, 46 per cent of Aboriginal and Torres Strait Islander people (Indigenous Australians) smoke on a daily basis, more than double the rate of non-Indigenous Australians. The evidence of effective tobacco control strategies for Indigenous Australians is relatively scarce. The aim of this study is to (i) explore the influences of smoking in Indigenous Australian people and to (ii) help inform and evaluate a multi-component tobacco control strategy. The study aims to answer the following questions:--do individuals' social networks influence smoking behaviours;--is there an association between various social and cultural factors and being a smoker or non-smoker; and--does a multi-component tobacco control program impact positively on tobacco behaviours, attitudes and beliefs in Indigenous Australians. METHODS AND DESIGN: Our prospective study will use a mixed-method approach (qualitative and quantitative), including a pre- and post-test evaluation of a tobacco control initiative. The study will explore the social and cultural context underlying Indigenous Australian tobacco use and associated factors which influence smoking behaviour. Primary data will be collected via a panel survey, interviews and focus groups. Secondary data will include de-identified PBS items related to smoking and also data collected from the Quitlines call service. Network analysis will be used to assess whether social networks influence smoking behaviours. For the survey, baseline differences will be tested using chi(2) statistics for the categorical and dichotomous variables and t-tests for the continuous variables, where appropriate. Grounded theory will be used to analyse the interviews and focus groups. Local Aboriginal community controlled organisations will part

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