Share on Facebook Share on Twitter Share on LinkedIn Share on Google+ Share by Email

Skip to content

Key resources

  • Bibliography
    Bibliography
  • Health promotion
    Health promotion
  • Health practice
    Health practice
  • Programs
    Programs
  • Conferences
    Conferences
  • Courses
    Courses
  • Funding
    Funding
  • Jobs
    Jobs
  • Organisations
    Organisations
  • Health Services MapHealth Services Map
Australian Indigenous HealthBulletin Alcohol and other drugs knowledge centre Yarning Places
 
Print this page Print

Factors contributing to Aboriginal and Torres Strait Islander health

Factors contributing to Aboriginal and Torres Strait Islander health

Selected health risk and protective factors

The factors contributing to the health status of Aboriginal and Torres Strait Islander people should be seen within the broad context of the social determinants of health [1][2][3][4]. The WHO describes the social determinants of health as the conditions in which people are born, grow, live, work and age [5]. A life course approach to ill-health, known as life course epidemiology, integrates theories about the social determinants of health, fetal and developmental origins of disease and the impact of lifestyle and individual behaviour [6]. The determinants of health, some of which are discussed in the Historical context and social determinants of Aboriginal and Torres Strait Islander health section, are shaped by a wider set of forces and systems, including policies, political systems and social norms [1][5].

For the health of Aboriginal and Torres Strait Islander people, social disadvantage needs to be considered together with 'health risk and protective factors'. These are the behaviours, characteristics, or exposures that may increase or decrease the likelihood of developing a particular health condition [7]. Health risk and protective factors can be divided into non-modifiable factors, often biomedical (e.g. age, sex, genetics), and modifiable factors which are environmental or behavioural and which, in theory, can be changed [3]. It is important to note that risk is based on probability, or likelihood [8]. Not everyone who is exposed to a known risk factor will have an adverse outcome, and people may develop a health condition without ever having been exposed to an associated risk factor.

The selected health risk and protective factors summarised in the following sections are generally related to individual behaviour. However, these behavioural factors should be considered within the context of the social determinants of health and structural influences that could be shaping behaviour and ability to make changes [3][9]. Recent research undertaken in WA emphasised the importance of having a strong cultural identity in enabling Aboriginal people to make healthy choices [10].

Environmental health

Environmental health refers to the physical, chemical and biological factors that may affect people in particular surroundings or settings [11]. Environmental factors can be associated with ill health conditions including intestinal and skin infections and some chronic diseases, for example, acute rheumatic fever, respiratory issues such as asthma and some cancers [12]. Aboriginal and Torres Strait Islander people are disproportionately affected by the diseases associated with environmental health due to: the remoteness of some communities; poor infrastructure; lack of access to tradespeople and repairs; and the cost of maintenance [12][13].

This section will primarily cover information relevant to housing and infrastructure. For more detailed information about some of the health conditions associated with environmental health, see the Cardiovascular health section for information on acute rheumatic fever, the Eye health section for information on trachoma, the Respiratory health section for information on asthma and other related conditions, as well as the Skin diseases, infections and infestations section.

Housing

Housing issues such as overcrowding and poor infrastructure contribute significantly to the ill health of some Aboriginal and Torres Strait Islander people [14].

Overcrowding

Cultural aspects need to be considered in relation to housing conditions and overcrowding for Aboriginal and Torres Strait Islander people. Contributions to overcrowding include: visits to other households (to see relatives, for funerals or because of ties to neighbourhoods or towns and to be closer to ‘country’) and the high importance placed on demand sharing1 [15].

There have been some small decreases in overcrowding in Aboriginal and Torres Strait Islander households in recent years. The proportion of Aboriginal and Torres Islander people living in overcrowded households in 2014-15 was 21%, this compares with 23% in 2012-13 and 28% in 2008 [16]. Overcrowding was significantly higher in remote and very remote areas, in 2014-15, 41% of Aboriginal and Torres Strait Islander people were living in overcrowded households, compared with 15% for non-remote areas. However, over time there has been a decrease in overcrowding in very remote areas. In 2004-05, 63% of Aboriginal and Torres Strait Islander people were living in an overcrowded household, decreasing to 49% in 2014-15. Aboriginal and Torres Strait Islander people were more than three times as likely to live in a household that required an additional bedroom compared with non-Indigenous people in 2014-15 (18% and 5% respectively) [14].

The proportion of Aboriginal and Torres Strait Islander people reporting overcrowding as a stressor has also decreased over time. In 2014-15, 6.5% of Aboriginal and Torres Strait Islander people reported overcrowding as a stressor, which was a decrease from 21% in 2002 [16]. This decrease was consistent across both remote and non-remote areas, but particularly so for remote areas, which dropped from 42% in 2002, to 9.2% in 2014-15.

Infrastructure

An important contributor to the health and wellbeing of Aboriginal and Torres Strait Islander people is access to working infrastructure in housing and communities, including sewerage, water supply and electricity [17].

In 2014-15, 82% of Aboriginal and Torres Strait Islander households were living in houses of an acceptable standard2 [16]. This proportion has remained relatively stable, with 78% of households living in houses of an acceptable standard in 2012-13, and 83% in 2008. In 2014-15, there was a substantial proportion of Aboriginal and Torres Strait Islander households living in a house with major structural problems, over one in four households (26%) reported structural issues within their dwelling. Dwellings with major structural problems increased with remoteness. For Aboriginal and Torres Strait Islander households living in very remote areas, 37% reported living in a house with major structural problem, compared with 25% for non-remote areas. Nationally, the most significant issue for Aboriginal and Torres Strait Islander dwellings was major cracks in the walls/floors (11%), walls or windows not straight (6.1%), and major plumbing problems (5.7%). The proportion of Aboriginal and Torres Strait Islander people living in a house with major structural problems has decreased in recent years, from 35% in 2012-13 to 26% in 2014-15.

In terms of access to household facilities, the majority of Aboriginal and Torres Strait Islander households across Australia in 2014-15 had access to working facilities, with over nine in ten households reporting functioning facilities [16]. This includes access to working facilities for: washing people (97%); washing clothes and bedding (91%); preparing food (92%) and sewerage facilities (97%). Access to working facilities in remote and very remote areas was lower than in non-remote areas. These results have remained relatively stable since 2008. More national detailed data about access to clean water, working sewerage and electricity services are not available.

Hospitalisation

In 2014-15, after age adjustment, Aboriginal and Torres Strait Islander people were hospitalised for selected diseases related to environmental health at 2.3 times the rate of non-Indigenous people [16]. In remote and very remote areas, this increased to 4.0 times the rate of non-Indigenous people. Hospitalisation for scabies and acute rheumatic fever are particularly high, with Aboriginal and Torres Strait Islander people nationally hospitalised at 51.3 and 43.2 times the rate of non-Indigenous people, respectively. There has been little change in the hospitalisation rates in recent years, with the rate for Aboriginal and Torres Strait Islander people 2.2 times higher than for non-Indigenous people in 2013-13.

Mortality

For 2010-2014 in NSW, Qld, WA, SA and the NT, Aboriginal and Torres Strait Islander people died as a result of diseases associated with poor environmental health at 1.7 times the rate of non-Indigenous people [16].

This is a decrease compared with 2003-2007, where Aboriginal and Torres Strait Islander people died at 1.8 times the rate of non-Indigenous people3.

Nutrition

The nutritional status of Aboriginal and Torres Strait Islander people is influenced by many factors such as socio-economic disadvantage, and geographical, environmental, and social factors [18][19]. Poor nutrition is an important factor contributing to overweight and obesity, malnutrition, CVD, type 2 diabetes, and tooth decay [19][20]. The National Health and Medical Research Council (NHMRC) guidelines recommend that adults eat fruit and plenty of vegetables every day, selected from a wide variety of types and colours [21]. The guidelines also recommend including reduced fat varieties of milk, yoghurts and cheeses, and limiting the intake of added sugar and salt and the consumption of ‘discretionary’4 foods and drinks.

Fruit consumption

According to the 2012-2013 National Aboriginal and Torres Strait Islander nutrition and physical activity survey (NATSINPAS), Aboriginal and Torres Strait Islander children (2-18 years) averaged 1.6 serves of fruit a day and adults (aged 19 years and over) averaged one serve per day [22]. Based on self-reported usual serves of fruit eaten per day, 54% of Aboriginal and Torres Strait Islander people met the recommendations for usual serves [23]. Females were more likely than males to have eaten an adequate amount of fruit (57% and 51% respectively). After age-adjustment, Aboriginal and Torres Strait Islander people aged 15 years or older were less likely than non-Indigenous people to be eating adequate amounts of fruit (ratio 0.9) [24]. Aboriginal and Torres Strait Islander people living in non-remote areas were more likely than those in remote areas to have consumed fruit in the 24 hours prior to the survey (49% and 35% respectively) [25]; however, similar proportions of Aboriginal and Torres Strait Islander people living in remote and non-remote areas usually met the guidelines for daily serves of fruit [23].

Vegetable consumption

According to the 2012-2013 NATSINPAS, Aboriginal and Torres Strait Islander children (2-18 years) averaged 1.4 serves of vegetables a day and adults (aged 19 years and over) averaged 2.1 serves per day [22]. Based on self-reported usual serves of vegetables eaten per day, only 8% of Aboriginal and Torres Strait Islander people met the recommendations for usual serves [23]. Females aged 15 years and over were more likely than their male counterparts to have eaten an adequate amount of vegetables (7% and 3% respectively) [26]. After age-adjustment, Aboriginal and Torres Strait Islander people aged 15 years or older were less likely than non-Indigenous people to be eating adequate amounts of vegetables (ratio 0.8) [24]. Aboriginal and Torres Strait Islander people living in non-remote areas were more likely than those in remote areas to have consumed some vegetables in the 24 hours prior to the survey (67% and 56% respectively) [25].

Fruit and vegetable dietary behaviour and labour force

The 2012-2013 AATSIHS examined associations between dietary behaviour and labour force status and educational attainment [24]. After age-adjustment, unemployed Aboriginal and Torres Strait Islander people were more likely to have an inadequate daily fruit intake (63%) and inadequate vegetable intake (98%) than those who were employed (54% and 94% respectively) or not in the labour force (60% and 95% respectively). When considering educational levels, Aboriginal and Torres Strait Islander people who had completed year 10 or below were more likely to consume inadequate amounts of fruit (59%) and vegetables (95%) than those who had completed year 12 or equivalent (54% and 93% respectively).

Dairy food consumption

According to the 2012-2013 NATSINPAS, Aboriginal and Torres Strait Islander people averaged 1.2 serves per day of milk, yoghurt, cheese and alternatives [22]. Dairy milk was the most frequently consumed product (65%) followed by cheese (30%). Milk products and dishes (dairy foods) were consumed by 83% of Aboriginal and Torres Strait Islander people, which was similar to the proportion of non-Indigenous people who consumed dairy foods (85%) [25]. Similar proportions of males and females consumed dairy foods (84% and 82% respectively), and people in remote areas were just as likely as those in non-remote areas to have consumed these products (83%). Adults were about as likely to consume these products as children (81% and 84% respectively).

Discretionary foods

According to the 2012-2013 NATSINPAS, discretionary foods5 were consumed by a large proportion of Aboriginal and Torres Strait Islander people in the 24 hours prior to the survey, including confectionary (25%), snack foods (20%) and alcoholic beverages (11%) [25]. On average, Aboriginal and Torres Strait Islander people consumed 41% of their total daily energy in the form of discretionary foods; including 8.8% of daily energy as cereal-based products (such as cakes, biscuits and pastries), and 6.9% of daily energy as non-alcoholic beverages (such as soft drinks) [23]. Similar proportions of females and males consumed all discretionary foods except for alcoholic beverages for which twice as many males as females reported consuming (15% and 7.7% respectively) [25]. People in non-remote areas were more likely to consume all discretionary foods types than those in remote areas, except for non-alcoholic beverages.

Sugar consumption

The WHO recommends that both adults and children consume less than 10% of daily dietary energy from free sugars [27]. According to the 2012-2013 NATSINPAS, Aboriginal and Torres Strait Islander people consumed 111 grams (g) of total sugars per day on average [28]. Around two-thirds of this (75 g or 18 teaspoons of white sugar) was free sugars6, which equated to an average of 14% of daily dietary energy from free sugars. Ninety-one percent (91%) of the free sugars were added7 sugars (Derived from [28]). Males consumed more total sugars on average than females (121 g compared with 101 g) especially in the 14-18 years age-group (147 g compared with 102 g). The variation in sugar consumption across age and sex was mostly due to the consumption of free sugars as the amount of intrinsic and milk sugars consumed remained relatively constant across all age and sex groups. The majority of free sugars consumed were from discretionary foods and beverages.

Sodium (salt) consumption

According to the 2012-2013 NATSINPAS, the average daily amount of sodium consumed from food by Aboriginal and Torres Strait Islander people was 2,379 mg (approximately one teaspoon of salt) [23]. This excludes salt added by consumers in household cooking or when preparing food. Sodium consumption was higher among males than females (2,638 mg and 2,122 mg respectively). Males in all age-groups, except for those 51 years and older, had average intakes that exceeded the upper level of sodium intake recommended by the NHMRC.

Almost half of Aboriginal and Torres Strait Islander people did not use salt in household cooking or preparing food (47%) [29]. This proportion was slightly higher for females than males (50% and 45% respectively), and higher for people living in non-remote areas compared with those in remote areas (48% and 44% respectively) and for children aged 2-18 years compared with people aged 19 years or older (51% and 44% respectively). For those who used salt in household cooking or preparing food, fewer people used iodised salt than non-iodised salt (21% and 24% respectively).

The average daily sodium intake was similar for Aboriginal and Torres Strait Islander people and non-Indigenous people (2,379 mg and 2,408 mg respectively) [23]. Males recorded a higher consumption of sodium than females in both populations.

Bush foods

Participants in the 2012-2013 NATSINPAS were asked about their consumption of foods that were naturally harvested or wild-caught, such as fish and seafood, wild harvested fruit and vegetables, reptiles and insects [25]. Aboriginal and Torres Strait Islander people in remote areas were more likely than their non-remote counterparts to eat non-commercially caught fin fish (7.8% and 1.8% respectively), crustacea and molluscs (1.2% and 0.3% respectively), wild harvested meat (7.7% and 0% respectively) and reptiles (3.9% and 0.1% respectively).

Biomarkers of nutrition

The 2012-2013 NATSIHMS collected information on biomarkers of nutrition, including vitamin D, anaemia and iodine [30]. It was found that:

Food security

The 2012-2013 NATSINPAS addressed the issue of food security by asking respondents if they had run out of food and couldn’t afford to buy more in the last 12 months [31]. This had been a problem for 22% of respondents; 7% of respondents had run out and gone without food, while 15% had run out but not gone without food. People in remote areas were more likely to run out of food than people in non-remote areas (31% and 20% respectively) and slightly more likely to go without (9.2% and 6.4% respectively).

Burden of disease

Burden of disease analysis measures the impacts of diseases, injuries and risk factors on a population [32]. The 2011 Australian Burden of Disease study considered the contribution of 29 selected risk factors to the burden of disease, of which 13 risk factors were dietary. When combined, the joint effect of all dietary risks contributed 9.7% to the total burden of disease for Aboriginal and Torres Strait Islander people. The contribution of dietary risk factors to the burden of disease was particularly notable in the 65 years and over age-group, with a diet low in fruit contributing 4% to the burden for Aboriginal and Torres Strait Islander males and 3% for Aboriginal and Torres Strait islander females. Around half of the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous people (51%) is attributable to the 29 selected risk factors, with combined dietary factors contributing 27% of the gap.

Breastfeeding

Breast milk is the natural and optimum food for babies and provides all the energy and nutrients that an infant needs for the first six months of life [21][33]. Breastfeeding promotes sensory and cognitive development and protects the infant against sudden infant death syndrome (SIDS), asthma, infectious diseases and chronic diseases later in life. Exclusive breastfeeding aids a quicker recovery from illness and reduces infant deaths from common childhood illnesses such as diarrhoea or pneumonia. The Australian dietary guidelines recommendation is to ‘encourage, support and promote breastfeeding’. The WHO recommends exclusive breastfeeding for six months followed by complementary feeding with continued breastfeeding for up to two years or beyond. Breastfeeding contributes to the health of the mother by reducing the risk of ovarian and breast cancers.

According to the 2012-2013 AATSIHS, 83% of Aboriginal and Torres Strait Islander children aged 0–3 years had been breastfed, compared with 93% of non-Indigenous children [34]. Aboriginal and Torres Strait Islander children aged 0–3 years were 2.3 times more likely than non-Indigenous infants to have never been breastfed (17% compared with 7% respectively). Of those who had been breastfed, Aboriginal and Torres Strait Islander infants were more likely than non-Indigenous infants to have been breastfed for less than 1 month (16% compared with 10% respectively). Aboriginal and Torres Strait Islander infants were less likely than non-Indigenous infants to have been breastfed for 12 months or more (12% compared with 21% respectively). Breastfeeding rates of Aboriginal and Torres Strait Islander children aged 0–3 years did not vary significantly by remoteness, 82% in non-remote areas and 84% in remote areas were breastfed.

According to the 2010 Australian national infant feeding survey, breastfeeding initiation levels were similar among Indigenous and non-Indigenous mothers (87% and 90% respectively), but levels of exclusive breastfeeding declined more rapidly among Indigenous mothers (Derived from [35]). At 5 months of age, only 11% of Indigenous babies were exclusively breastfed, compared with 27% of non-Indigenous babies.

A study of infant feeding behaviour among Aboriginal women in rural Australia concluded that lack of intergenerational support, unsupportive social factors and the pervasive presence of infant formula produced strong barriers to breastfeeding [36].

Commencing in 2008, the Footprints in time – the longitudinal study of Indigenous children collects data annually from 11 sites (rural, remote and urban) and from up to 1,700 Aboriginal and Torres Strait Islander children and their families around Australia [37]. Data on breastfeeding from this study showed that 80% of Aboriginal and Torres Strait Islander children had been breastfed at some time during their early years, and 22% of infants had been breastfed for at least 12 months. This study found that children living in more remote areas had been breastfed for a slightly longer period of time than those living in other areas [38].

Physical activity

Physical activity is important for maintaining good overall health and wellbeing [39]. Low levels of activity including high levels of sedentary behaviour are risk factors for a range of health conditions as well as being a strong contributor to obesity. Australia’s physical activity and sedentary behaviour guidelines for adults recommend a combination of moderate and vigorous physical activity on most, preferably all, days of the week to improve health and reduce the risk of chronic disease and other conditions [40]. However, doing any physical activity is better than doing none and the health benefits of physical activity are continuous, starting with any activity above zero. The benefits of regular physical activity include reductions in the risk of health conditions such as heart disease, type 2 diabetes, certain cancers, depression and some injuries [40][41].

According to the 2012-2013 AATSIHS, 47% of Aboriginal and Torres Strait Islander people aged 18 years and over living in non-remote areas had met the target of 30 minutes of moderate intensity physical activity on most days (or a total of 150 minutes per week) [42]. A smaller proportion (41%) of Aboriginal and Torres Strait Islander adults had exercised for at least 150 minutes over five sessions in the previous week. Over one-quarter (29%) of Aboriginal and Torres Strait Islander adults had exercised at a moderate level and 10% at a high level; these levels of physical activity were 0.9 and 0.6 times those of non-Indigenous people. Those who participated in the survey’s pedometer study recorded an average of 6,963 steps per day; 17% met the recommended threshold of 10,000 steps or more [39].

Among Aboriginal and Torres Strait Islander adults living in non-remote areas, more males than females met the target of 150 minutes of moderate intensity exercise per week (52% compared with 42%) and had exercised for at least 150 minutes over five sessions in the previous week (45% compared with 38%) [42]. Aboriginal and Torres Strait Islander males in non-remote areas were significantly more likely than Aboriginal and Torres Strait Islander females to have exercised at moderate intensity (32% compared with 25%) and were twice as likely to have exercised at high intensity (14% compared with 7%) in the previous week [39][42]. In remote areas, 55% of Aboriginal and Torres Strait Islander adults exceeded the recommended 30 minutes of physical activity and 21% did not participate in any physical activity on the day prior to the interview [39]. The most common type of physical activity for adults was ‘walking to places’ (71%). Around one-in-ten (11%) participated in cultural activities, including hunting and gathering bush foods or going fishing [39].

Among Aboriginal and Torres Strait Islander adults living in non-remote areas, 61% reported that they were physically inactive (sedentary or had exercised at a low level) in the week prior to the survey [42]. A higher proportion of Aboriginal and Torres Strait Islander females than Aboriginal and Torres Strait Islander males were physically inactive (68% compared with 53%); this pattern was evident for all age-groups. Aboriginal and Torres Strait Islander adults spent an average of 5.3 hours per day on sedentary activities, including 2.3 hours of watching television (TV), DVDs and videos [39].

On average, Aboriginal and Torres Strait Islander adults engaged in around one third the amount of physical activity as children aged 5-17 years (39 minutes per day including 21 minutes on walking for transport) [39].

Aboriginal and Torres Strait Islander children aged 5-17 years living in non-remote areas spent an average of two hours per day participating in physical activity (exceeding the recommendation of one hour per day); this was 25 minutes more than their non-Indigenous counterparts [39]. Around half (48%) of Aboriginal and Torres Strait Islander children met the recommended amount of physical activity, compared with 35% of non-Indigenous children. The most common physical activities performed by Aboriginal and Torres Strait Islander children were active play and children’s games (57%) and swimming (18%). Those who participated in the survey’s pedometer study, recorded an average of 9,593 steps per day, with a quarter of the children (25%) meeting the recommended 12,000 steps per day. For Aboriginal and Torres Strait Islander children aged five years and over in remote areas, 82% did more than 60 minutes of physical activity on the day prior to the interview. Other than walking (82%) the two most common activities were running (53%) and playing football or soccer (33%).

Aboriginal and Torres Strait Islander children spent less time than non-Indigenous children using the Internet or computer for homework; four minutes compared with eight minutes per day for 12-14 year-olds and eight minutes compared with 20 minutes per day for 15-17 year-olds [39]. Aboriginal and Torres Strait Islander children aged 15-17 years spent more time on screen-based activities than those aged 5-8 years (3.3 hours compared with 1.9 hours).

Aboriginal and Torres Strait Islander children aged 2-4 years living in non-remote areas spent an average of 6.6 hours per day participating in physical activity and spent more time outdoors than their non-Indigenous counterparts (3.5 hours compared with 2.8 hours) [39]. Aboriginal and Torres Strait Islander children aged 2-4 years spent an average of 1.5 hours per day on sedentary screen-based activities such as watching TV, DVDs or playing electronic games.

Bodyweight

The standard measure for classifying a person’s weight status is body mass index (BMI) (BMI: weight in kilograms divided by height in metres squared) [43]. Being overweight (BMI 25 to 29) or obese (BMI of 30 or more) increases a person's risk for CVD, type 2 diabetes, certain cancers, and some musculoskeletal conditions. A high BMI can be a result of many factors, alone or in combination, such as poor nutrition, physical inactivity, socio-economic disadvantage, genetic predisposition, increased age, and alcohol use [3][21][43][44][45]. Being underweight (BMI less than 18.5) [3] can also have adverse health consequences, including lower immunity (leading to increased susceptibility to some infectious diseases) and osteoporosis (bone loss) [21].

Abdominal obesity, a risk factor for the development of the metabolic syndrome, can be measured by waist circumference (WC) alone (greater than 94 cm for males and greater than 80 cm for females), or waist-hip ratio (WHR) (greater than or equal to 0.90 for males and 0.85 for females) [46].

Obesity and abdominal obesity, as measured by BMI and WC, have been shown to be risk factors for hypertension [47] and type 2 diabetes in Aboriginal and Torres Strait Islander people [48]. However, optimal BMI and WC cut-offs are still uncertain for Aboriginal and Torres Strait Islander people (due to differences in body shape and other physiological factors) when calculating diabetes type 2 and cardiovascular risk [49][50][51]. It has been suggested that a BMI of 22 might be more appropriate than 25 as a measure of acceptable BMI for Aboriginal people [51]. There is also evidence that measuring the WHR in Indigenous people is more accurate and easier to measure than BMI. More recently, Hughes and colleagues  have developed an equation for calculating fat free mass in Aboriginal and Torres Strait Islander adults using the easily acquired variables of resistance8, height, weight, age and sex for use in the clinical assessment and management of obesity [52].

Nationally in 2012-13, 69% of Aboriginal and Torres Strait Islander people aged over 18 years were considered to be overweight (29%) or obese (40%) [16]. A further 28% were normal weight and 3% were underweight. More Aboriginal and Torres Strait Islander males than Aboriginal and Torres Strait Islander females were overweight (32% and 27% respectively). However, females were more likely to be obese than males (43% and 36% respectively). The rates of overweight remained relatively stable as age increased, however the obesity rates increased with age, from 28% for those aged 18-24 years to 49% for those aged 55 years and over. This was similar for both males and females. After age-adjustment, the combined overweight/obesity levels were slightly higher for Aboriginal and Torres Strait Islander people aged 18 years or older than for their non-Indigenous counterparts (rate ratio 1.2). Aboriginal and Torres Strait Islander people were 1.6 times as likely as non-Indigenous people to be obese (rate ratio 1.4 for males and 1.7 for females) [53].

In 2012-2013, 3.1% of Aboriginal and Torres Strait Islander people aged 18 years or older were underweight, with 2.4% of Aboriginal and Torres Strait Islander males and 3.8% of Aboriginal and Torres Strait Islander females having a BMI of less than 18.5 [53]. After age-adjustment, Aboriginal and Torres Strait Islander people were 1.6 times more likely to be underweight than non-Indigenous people (rate ratio for males 1.8 and females 1.5) but less likely to be of normal weight (rate ratio 0.7).

Measurements of WC and WHR were taken in the 2012-2013 AATSIHS (not collected in the previous health survey) to help determine levels of risk for developing certain chronic diseases [54]. Based on WC, a higher proportion of Aboriginal and Torres Strait Islander females (81%) than Aboriginal and Torres Strait Islander males (62%) aged 18 years or older were found to be at increased risk of developing chronic diseases. Based on WHR, 81% of males and 73% of females aged 18 years or older were at increased risk of developing chronic diseases. The proportion of Aboriginal and Torres Strait Islander males and females who were at increased risk of developing chronic diseases based on both measures of WC and WHR increased with age.

According to the 2012-2013 AATSIHS, based on BMI information, around 30% of Aboriginal and Torres Strait Islander children aged 2-14 years were overweight (20%) or obese (10%), 62% were in the normal weight range, and 8% were underweight [24]. Similar proportions of Aboriginal and Torres Strait Islander boys and girls aged 2-14 years were overweight or obese (28% and 32% respectively). After age-adjustment, the combined overweight/obesity levels were slightly higher for Aboriginal and Torres Strait Islander children aged 2-14 years than for non-Indigenous children (rate ratio 1.2) mainly due to higher obesity rates in both boys and girls: boys 10% compared with 6% respectively; and girls 11% compared with 7% respectively).

Similar to this, a study of a child health program in remote central Australia in 2010 found that 21% of the Aboriginal children aged 3-17 years were overweight and 5.4% were obese (there was no difference in the prevalence between boys and girls) [55].

A 2003 study of 277 Indigenous children aged 5-17 years in the Torres Strait found that 46% were overweight or obese and 35% had abdominal obesity [56]. Girls had higher levels of abdominal obesity (50%) than boys (18%). The study also found a consistent association between overweight/obesity and low levels of physical activity.

From 1997 to 2010, overweight/obesity and WHR increased more rapidly in Aboriginal children aged 5-16 years than in non-Aboriginal children in the same age-group in NSW [57]. It was identified that a lack of daily breakfast, excessive screen time and soft drink consumption were major risk factors and suggested that encouraging strategies to limit screen time held promise.

Immunisation

In recent decades, vaccination has been very successful in contributing to improvements in Aboriginal and Torres Strait Islander health and child survival [58]. National immunisation coverage rates for Aboriginal and Torres Strait Islander children have improved steadily since 2008, reducing the gap between Indigenous and non-Indigenous children [59]. The NIP schedule for the Australian population recommends vaccinations at different stages of life and additional recommendations for specific high risk populations, these include: hepatitis A; hepatitis B; diphtheria; tetanus; whooping cough; Haemophilus influenzae type b; polio; pneumococcal conjugate; rotavirus; meningococcal C; measles; mumps and rubella (MMR); varicella (chickenpox); HPV and influenza [58]. Due to some vaccine-preventable diseases still being experienced at higher rates among Aboriginal and Torres Strait Islander people, other supplementary vaccines9 are also specifically prescribed depending on age, location and health risk factors.

Childhood vaccination

Nationally, in late 2014 it was agreed by the Australian Chief Medical Officer and other chief health officers to set a goal of having 95% of children fully immunised in line with the schedule’s recommendations relevant to their age [60]. The NIP for all children includes vaccines for hepatitis B, diphtheria-tetanus-pertussis (DTP), Hib, MMR, pneumococcal disease, meningococcal C, varicella (chickenpox), rotavirus, HPV, and influenza [58]. Across primary health networks in 2014-15, percentages for Aboriginal and Torres Strait Islander children fully immunised were highest among five years old children when compared to one and two year-olds [60].

Data from the Australia Childhood Immunisation Register (ACIR) for December 2015 and March, June and September 2016, showed that coverage estimates for fully immunised Aboriginal and Torres Strait Islander children were [58]:

According to the to the ACIR, the national coverage for fully immunised Aboriginal and Torres Strait Islander children has increased for the following age-groups; the 12 month cohort by 0.7%, the 24 month cohort by 0.8% and the 60 month cohort by 0.5%.

Adult vaccination

Vaccinations for hepatitis B, influenza and pneumococcal disease are recommended for Aboriginal and Torres Strait Islander adults. Due to the high rates of mortality and morbidity associated with hepatitis B in Aboriginal and Torres Strait Islander people, it is important that they are tested for hepatitis B infection, and be offered vaccination if they are not immune. Vaccination for influenza and pneumonia is recommended for Aboriginal and Torres Strait Islander people aged 50 years and over and for non-Indigenous people aged 65 years and over [61]. The 2012-2013 AATSIHS found that for Aboriginal and Torres Strait Islander adults aged 50 years and older, influenza vaccination in the previous 12 months was reported by: 51% of adults aged between 50-64 years old, 74% of adults aged 65 years and above, and overall 57% of adults aged 50 years and older. Vaccination for pneumococcus in the previous five years was reported by: 23% of 50-64 year-olds, 44% of 65 year-olds and older, and 29% overall of 50 years and older.

Tobacco use

Tobacco use has a number of health impacts, including increasing the risk of chronic disease, such as CVD, many forms of cancer, and lung diseases, as well as a variety of other health conditions [62]. Tobacco use is also a risk factor for complications during pregnancy and is associated with preterm birth, LBW, and perinatal death. Environmental tobacco smoke (passive smoking) is of concern to health, with children particularly susceptible to resultant problems that include middle ear infections, asthma, and SIDS.

Extent of tobacco use among Aboriginal and Torres Strait Islander people

The 2014-2015 NATSISS found that 39% of Aboriginal and Torres Strait Islander people aged 15 years and over reported that they were current daily smokers [14]. This represents a significant reduction from levels reported in the 2008 NATSISS (45%) and 2002 (49%).

In 2014-2015, the proportion of Aboriginal and Torres Strait Islander males who were current daily smokers (42%) was higher than the proportion of Aboriginal and Torres Strait Islander females (36%) [14]. After age-adjustment, Aboriginal and Torres Strait Islander people were 2.8 times more likely to smoke than non-Indigenous people (39% compared with 14% respectively). In terms of age, the group with the highest proportion of current daily smokers was the 35-44 years age-group (47%). When comparing by sex, Aboriginal and Torres Strait Islander males had the highest proportion of current daily smokers across all age-groups, most notably in the 45-54 years age-group (51% compared with 41% of females).

In 2014-2015, Aboriginal and Torres Strait Islander people living in remote areas reported a higher proportion of current daily smokers (47%) than those living in non-remote areas (37%) [14]. The overall proportion of current smokers in remote areas in 2014-2015 has only seen a minor decrease since 2002 (47% and 50% respectively).

When comparing smoking prevalence over the six years between the 2014-2015 NATSISS, and the 2008 NATSISS, the highest reductions have been found in the younger age-groups [14]. In 2008, the proportion of 15-24 year-olds smoking was 39%, compared with 31% in 2014-2015. The proportion for the 25-34 years age-group was 53% in 2008 compared with 45% in 2014-2015.

This drop in smoking among these age-groups is reflected in the increased prevalence of young people who have ‘never smoked’. The 2014-2015 NATSISS found that 36% of Aboriginal and Torres Strait Islander people had never smoked, compared with 34% in 2008 and 33% in 2002 [14][63].

High rates of smoking have been reported for Aboriginal and Torres Strait Islander mothers [64]. In 2014, almost half of Aboriginal and Torres Strait Islander mothers (45%) reported smoking during pregnancy, compared with 13% of non-Indigenous mothers. The proportion of smoking cessation for Aboriginal and Torres Strait Islander women during the second 20 weeks of pregnancy was 12%, compared with 24% among non-Indigenous women.

In 2014-2015, 57% of Aboriginal and Torres Strait Islander children aged 0-14 years lived in households with a daily smoker (a decline from 63% in 2008) [14]. For those children living with a daily smoker, 13% were living in households where people smoked indoors. 

Burden of disease

In 2011, tobacco use remained the leading cause of the burden of disease and injury among Aboriginal and Torres Strait Islander people, responsible for 12% of the total burden of disease [32]. Tobacco use was also the risk factor contributing the most (23%) to the health gap between Aboriginal and Torres Strait Islander and non-Indigenous people.

Alcohol use

Alcohol-related harm includes chronic diseases, accidents and injury, and is not limited to the user but extends to families and the broader community [65]. Consumption of alcohol in pregnancy can affect the unborn child leading to fetal alcohol spectrum disorder (FASD), a diagnostic term that describes a range of conditions including central nervous system dysfunction, poor growth, characteristic facial features and developmental delay [66][67].

Surveys have consistently shown that Aboriginal and Torres Strait Islander people are less likely to drink alcohol than non-Indigenous people, but those who do drink are more likely to consume it at harmful levels [62][68][69].

Box 6: Assessing risks from use of alcohol

In 2009, the NHMRC introduced revised guidelines that depart from specifying 'risky' and 'high risk' levels of drinking [65]. The revised guidelines seek to estimate the overall risk of alcohol-related harm over a lifetime and to reduce the level of risk to one death for every 100 people. For males and females:

  • guideline one states that to reduce the risk of alcohol-related harm over a lifetime, no more than two standard drinks should be consumed on any day
  • guideline two states that to reduce the risk of injury on a single occasion of drinking, no more than four standard drinks should be consumed
  • guideline three recommends that the safest option is not drinking alcohol for those aged under 15 years and delaying alcohol use for as long as possible for those aged 15 to 17 years
  • guideline four recommends that the safest option for pregnant and breastfeeding women is not to drink alcohol.
Abstinence or no consumption of alcohol in the last 12 months

In the 2012-2013 AATSIHS, 23% of Aboriginal and Torres Strait Islander people aged 18 years or older had never consumed alcohol or had not done so for more than 12 months [70]. After age-adjustment, abstinence was 1.6 times more common among Aboriginal and Torres Strait Islander people than among non-Indigenous people. The abstinence difference was mostly attributed to those Aboriginal and Torres Strait Islander people who had stopped drinking for at least 12 months (16% of Aboriginal and Torres Strait Islander people and 7% of non-Indigenous people). Similar proportions of Aboriginal and Torres Strait Islander and non-Indigenous people have never consumed alcohol (10% and 8.9% respectively).

The 2012-2013 AATSIHS found that 17% of Aboriginal and Torres Strait Islander males and 28% of Aboriginal and Torres Strait Islander females aged 18 years or older had never consumed alcohol or had not done so in the previous 12 months [70]. After age-adjustment, abstinence was 1.7 times and 1.5 times more common among Aboriginal and Torres Strait Islander males and females than among non-Indigenous males and females (20% and 32% compared with 12% and 21% respectively). Again, this difference in abstinence between Aboriginal and Torres Strait Islander males and females and non-Indigenous males and females is mostly attributable to those who consumed alcohol 12 months or more ago (15% and 17% compared with 6.0% and 8.7% respectively).

Short-term and single occasion risk

The 2012-2013 AATSIHS reported that 18% of Aboriginal and Torres Strait Islander people aged 18 years and over did not exceed the 2009 guidelines (four or less standard drinks on a single day for both males and females) [70].

Similar proportions of Aboriginal and Torres Strait Islander and non-Indigenous people exceeded the 2009 guidelines for drinking at short-term/single occasion risk (52% and 45% respectively after age-adjustment) [70]. Aboriginal and Torres Strait Islander males were 1.5 times more likely than Aboriginal and Torres Strait Islander females to exceed the 2009 guidelines for drinking at risk on a single occasion (68% compared with 46% respectively).

The proportion of Aboriginal and Torres Strait people exceeding the guidelines for single occasion risk was lower in very remote areas compared with other areas [61].

Lifetime risk

According to the 2013 National drug household survey (NDSHS), between 2010 and 2013 there was a significant decline for risky drinking in the proportion (from 32% to 23%) of Indigenous people 14 years and older exceeding the 2009 NHMRC guidelines for lifetime risk10 [69]. Findings from the 2012-2013 AATSIHS show that among Aboriginal and Torres Strait Islander people aged 18 years and over who consumed alcohol, 20% drank at levels exceeding the 2009 guidelines for long-term/lifetime drinking risk [71]. After age-adjustment, lifetime drinking risk was similar for both Aboriginal and Torres Strait Islander people and non-Indigenous people (ratio 1.0). Aboriginal and Torres Strait Islander males were 2.7 times more likely than Aboriginal and Torres Strait Islander females to exceed the guidelines for risk of long-term harm (29% compared with 11% respectively).

A lower proportion of Aboriginal and Torres Strait Islander people in very remote areas have been found to exceed the guidelines for lifetime risk when compared with those in other areas (specifically inner regional and remote areas) [61].

Alcohol and pregnancy

According to the 2008 NATSISS, 80% of mothers of Indigenous children aged 0-3 years did not drink during pregnancy, 16% drank less alcohol than usual, and 3.3% drank the same or more alcohol during pregnancy [72]. The proportion of mothers who drank the same or more alcohol during pregnancy was greatest in Tas/ACT (6.0%), followed by Vic (5.4%), and WA (5.0%).

Burden of disease

In 2011, alcohol use was responsible for 8.3% of the total burden of disease among Aboriginal and Torres Strait Islander people [32]. The highest levels of disease burden attributable to alcohol use among Aboriginal and Torres Strait Islander people were for mental and substance use disorders (22%), injury (19%), and gastrointestinal diseases (15%).

Hospitalisation

For 2011-12 to 2012-13, there were 9,995 hospitalisations of Aboriginal and Torres Islander people for alcohol-related diagnoses, after age-adjustment, the rate was 9.3 per 1,000, which was 4.1 times the rate for non-Indigenous people [34]. Aboriginal and Torres Islander males were hospitalised at 4.5 times the rate for non-Indigenous males and Aboriginal and Torres Islander females were hospitalised at 3.6 times the rate for non-Indigenous females.

For 2011-12 to 2012-13, in inner regional areas, Aboriginal and Torres Islander people were hospitalised for alcohol-related diagnoses at 2.9 times the rate for non-Indigenous people [34]. In remote areas, Aboriginal and Torres Islander people were hospitalised for alcohol-related diagnoses at 9.3 times the rate for non-Indigenous people.

Among Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, SA and the NT, between 2004-2005 and 2012-2013, age-adjusted hospital separations due to acute intoxication increased from 2.1 per 1,000 to 5.4 per 1,000 [61]. This was an increase from 5.7 to 12 times the rates for non-Indigenous people. In 2012-13, the highest rate of hospital separations related to alcohol use for Aboriginal and Torres Strait Islander people was for mental/behavioural disorders (8.3 per 1000) which was 4.2 times the rate of non-Indigenous people.

Hospital separation rates related to alcohol use due to acute intoxication for Aboriginal and Torres Strait Islander people in 2012-13 varied by level of remoteness [61]. Aboriginal and Torres Strait Islander people living in remote and very remote areas had the highest rate of hospitalisation due to acute intoxication (9.9 per 1,000) while Aboriginal and Torres Strait Islander people in inner and outer regional areas had the lowest (3.4 per 1,000).

Mortality

From 2008-2012, after age-adjustment, the Aboriginal and Torres Strait Islander death rate due to alcohol was 4.9 times greater than that for non-Indigenous people (22 per 100,000 in NSW, Qld, WA, SA and NT combined compared with 4.5 per 100,000 for non-Indigenous people) [61][73]. Aboriginal and Torres Strait Islander males were 2.5 times as likely to die due to alcohol use compared with Aboriginal and Torres Strait Islander females. The NT had the highest Aboriginal and Torres Strait Islander death rate from alcohol (37 per 100,000) which was 5.1 times the rate for non-Indigenous people in the NT.

Illicit substance use

Illicit substance use describes the use of drugs that are illegal to possess (e.g. cannabis, heroin, ecstasy, and methamphetamine), and the non-medical use of prescribed drugs such as painkillers [16][74]. Illicit substance use is associated with an increased risk of mental illness, poisoning, self-harm, infection with blood borne viruses from unsafe injection practices and death [75][16].

Extent of illicit substance use among Aboriginal and Torres Strait Islander people

Surveys consistently show that most Aboriginal and Torres Strait Islander people do not use illicit drugs [14][76]. The two most recent national surveys to collect this data, the 2014-2015 NATSISS and the 2012-2013 AATSIHS, found that 69% and 52% respectively of Aboriginal and Torres Strait Islander people aged 15 years and older had never used illicit substances.

The 2014-2015 NATSISS found that 30% of Aboriginal and Torres Strait Islander people reported using substances in the last 12 months an increase from 23% in the 2008 NATSISS [14][77].

The 2012-2013 AATSIHS reported that 22% of Aboriginal and Torres Strait Islander people aged 15 years and over had used an illicit substance in the previous 12 months [76]. Similarly, after age-adjustment, the 2013 NDSHS found that 23% of Aboriginal and Torres Strait Islander people aged 14 years and older had ‘recently used’ an illicit substance, compared with 15% of non-Indigenous people [69].11

When comparing different age cohorts, the 2012-2013 AATSIHS found that the level of illicit substance use in the previous 12 months was highest among younger age-groups and decreased as people aged: 28% in the 15-24 years age-group; 27% in the 25-34 years age-group; 23% in the 35-44 age-group, 19% in the 45-54 years age-group; and 7.0% in the 55 years and older age-group [76].

The 2014-2015 NATSISS found that marijuana (marijuana, hashish or cannabis resin) was the most commonly used illicit substance, used by 19% of Aboriginal and Torres Strait Islander people aged 15 years and over in the previous 12 months (Figure 3) [14]. This was followed by analgesics and sedatives for non-medical use (13%), and ‘other’ drugs (heroin, cocaine, petrol, LSD/synthetic hallucinogens, naturally occurring hallucinogens, ecstasy/designer drugs, methadone and kava (6.4%)). In addition, 4.8% of Aboriginal and Torres Strait Islander people reported using amphetamines compared with 4.0% in the 2008 NATSISS [77].

Figure 3. Proportion of Aboriginal and Torres Strait Islander people who reported substance use in the last 12 months: 2014-2015

 

Note:       ‘Other’ includes heroin, cocaine, petrol, LSD/synthetic hallucinogens, naturally occurring hallucinogens,    ecstasy/designer drugs, methadone and kava

Source: ABS, 2016 [14]

In 2014-2015, Aboriginal and Torres Strait Islander males were more likely than females to have used an illicit drug in the previous 12 months (34% and 27% respectively) [14]. The higher proportions of use by males were found for all drug types, except analgesics and sedatives where the proportions for females were higher (15% and 10% respectively). Almost twice as many Aboriginal and Torres Strait Islander males as females had used cannabis (25% compared with 14%), amphetamines (6.3% compared with 3.2%), and ‘other’ drugs (9% compared with 5%). Use of illicit drugs in the previous 12 months was greater among Aboriginal and Torres Strait people aged 15 years or over living in non-remote areas than among those living in remote areas in 2014-2015 (33% compared with 21%).

In 2014-15, among people using specialist alcohol and other drug treatment services, 15% of clients seeking treatment for their own drug use were Aboriginal and Torres Strait Islander people and 10% of clients receiving support for someone else’s drug use were Aboriginal and Torres Strait Islander people [78]. The principal illicit drugs of concern for both Aboriginal and Torres Strait Islander and non-Indigenous clients seeking treatment were cannabis (24%), amphetamines (20%) and heroin (6.1%).

For the 5 year period April 2008-March 2013, GPs managed drug use for Aboriginal and Torres Strait Islander patients at an age-adjusted rate of 10 per 1,000 encounters [34].

Burden of disease

In 2011, illicit substance use made a greater contribution to the burden of disease for Aboriginal and Torres Strait Islander people than for the total population with an overall burden of 3.7% compared with 1.8% respectively [32][79]. The highest level of disease burden for Aboriginal and Torres Strait Islander people attributable to illicit substances was for gastrointestinal disorders including chronic liver disease (31% compared with 17% for the total population) followed by injury (7.4% compared with 1.7 % for the total population). Illicit substance use contributed 5.9% to the burden of disease for mental health for both Aboriginal and Torres Strait Islander and the total population.

Hospitalisation

In 2014-2015, the most common drug-related conditions resulting in hospitalisation for Aboriginal and Torres Strait Islander people were for ‘poisoning’ and ‘mental and behavioural disorders’ [14]. The hospitalisation rate for Aboriginal and Torres Islander people from poisoning due to drug use (2.9 per 1,000) was 2.3 times the rate for non-Indigenous people (1.3 per 1,000). The hospitalisation rate for mental and behavioural disorders due to drug use for Aboriginal and Torres Strait Islander people (3.5 per 1,000) was 3.1 times the rate for non-Indigenous people (1.1 per 1,000). Hospitalisation for mental/behavioural disorders from use of amphetamines12 had the highest rate of separations due to drug use and was 3.7 times higher for Aboriginal and Torres Strait Islander people (1.5 per 1,000) than non-Indigenous people (0.4 per 1,000). Cannabis use was the second highest cause of hospitalisation for mental and behavioural disorders due to drug use, with Aboriginal and Torres Strait islander people 3.9 times more likely to be hospitalised (0.8 per 1,000) than non-Indigenous people (0.2 per 1,000).

Hospitalisation rates due to drug use were higher for Aboriginal and Torres Strait Islander people in major cities (9.1 per 1,000) than in inner and outer regional areas (6.2 per 1,000) and remote areas (3.9 per 1,000) [14].

Mortality

The rate of drug-induced deaths was around 1.9 times higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than for non-Indigenous people for the period 2010-2014 (Table 31) [16]. Rates of drug-induced deaths for Aboriginal and Torres Strait Islander people in SA were significantly higher than those in other states and territories. The rate of drug-induced deaths for Aboriginal and Torres Strait Islander males (14 per 100,000) was higher than for females (10 per 100,000).

 Table 31. Rate of drug induced deaths, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA, SA, and the NT, 2010-2014

Jurisdiction

Indigenous rate

Non-Indigenous rate

Rate ratio

NSW

17

6.4

2.6

Qld

9.1

6.7

1.3

WA

9.4

7.1

1.3

SA

24

6.5

3.7

NT

6.1

4.1

1.5

NSW, Qld, WA, SA and the NT

12

6.5

1.9

Notes:     1   Rates are per 100,000 (age-standardised)

              2   Deaths where Indigenous status was not stated are excluded from the analysis          

Source: Derived from Steering Committee for the Review of Government Service Provision, 2014 [61]

Volatile substance use

Volatile substance use (VSU) involves the inhaling of chemical compounds that give off fumes at room temperature such as solvents (e.g. petrol and glue), gases (e.g. lighter fuels) and aerosols (sprays containing propellants e.g. paints) [80]. They are also called ‘inhalants’ in recognition of their route of administration through the nose and mouth. They are central nervous system depressants, and their use involves deliberate inhalation to produce a state of altered consciousness or intoxication [81][82]. With short lasting effects, users continue to inhale for hours to extend the feelings and this long-term use increases the risk of losing consciousness or suffocation.

VSU can cause hangover headaches and drowsiness which can last for hours or days and also damage the kidneys, liver heart and lungs and can cause hearing loss and bone marrow damage [82][83]. There is also growing acknowledgement that excessive harmful inhalant use can lead to permanent acquired brain injury [84]. Petrol sniffing is the use of one of most dangerous volatile substances and can have long-term health risks, especially relating to tetraethyl lead found in leaded petrol (no longer sold in Australia) [85].

Extent of VSU use among Aboriginal and Torres Strait Islander people

There are limited data about VSU in Australia as it is not a criminal offence and the data collected do not always include Indigenous status. It is known that VSU is an issue of concern to Aboriginal and Torres Strait Islander people as well as to non-Indigenous people [86]. Although there has there has been significant progress, particularly in remote Aboriginal communities, in recent years (based on reviews, reports and enquiries conducted over the past three decades which highlight VSU as a critical issue), there is still much to be done [87][88][89][90][91][92][93].

A study of petrol sniffing in 41 Aboriginal and Torres Strait Islander communities found that the number of people sniffing petrol decreased by 29% from 298 in 2011-12 to 204 in 2013-14 [93]. Since 2005, an overall decline in reported use for 17 of these communities for which there are comparable data, shows that the total number of people sniffing petrol has fallen, from 647 in 2005-06 to 78 in 2013-14, a reduction of 88%. This decrease in prevalence of sniffing has been associated with the replacement of regular unleaded petrol with low aromatic fuel (LAF).

The 2012-2013 AATSIHS reported that 6.6% of males and 4.2% of females had ever used petrol or other inhalants [34].

Hospitalisation

There is no current systematic collection of VSU-associated mortality or morbidity data in Australia at the state, territory or national level. Volatile substance users typically present to health services with illnesses such as pneumonia or injuries such as burns caused by VSU, but the record only reflects the presenting problem [80].

The national rate of hospital separations in 2014-15 related to drug use due to poisoning and the toxic effects of organic solvents was 3.9 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. For accidental poisoning due to organic solvents, including petroleum derivatives, the rate was 5.1 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people and for glues and paints it was 2.0 times higher than for non-Indigenous people [16].

 A way of calculating Aboriginal and Torres Strait Islander hospital admissions attributable to petrol sniffing is through the aetiological fraction methodology which uses epidemiological studies to determine the proportion of a health condition attributable to various risk factors [94]. Petrol sniffing is a risk factor in the Australian Refined Diagnosis Related Groups (AR-DRG) codes13, which provide information on the diagnosis/intervention for that hospital admission. When the relevant aetiological fractions are applied to the 282 Indigenous admissions in 2007-08, 77.4 (27%) can be attributed wholly to petrol sniffing [94].

Mortality

As previously noted, the systematic collection of VSU associated mortality data is very limited due to the practice of listing the medical explanation for death rather than the use of volatile substances as a cause [95]. For example, the death of a chronic petrol sniffer may be recorded as ‘end stage renal failure’, not ‘petrol sniffing’. This practice has most likely resulted in the underestimation of VSU mortality and morbidity rates.

Early research using a combination of coronial and government reports, community death registers and personal communication identified 37 petrol sniffing deaths between 1998 and 2003 in Australia with the main reported causes of death being respiratory failure/asphyxia and suicide [94][96][97].

References

  1. Wilkinson R, Marmot M (2003) Social determinants of health: the solid facts. Denmark: World Health Organization
  2. Marmot M (2016) Health inequality and the causes of the causes [lecture]. : ABC Radio National
  3. Australian Institute of Health and Welfare (2016) Australia's health 2016. Canberra: Australian Institute of Health and Welfare
  4. Gubhaju L, McNamara BJ, Banks E, Joshy G, Raphael B, Williamson A, Eades SJ (2013) The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study. BMC Public Health; 13: 661 Retrieved 17 July 2013 from http://dx.doi.org/10.1186/1471-2458-13-661
  5. World Health Organization (2016) What are social determinants of health?. Retrieved 2016 from http://www.who.int/social_determinants/sdh_definition/en/
  6. Kuh D, Ben-Shlomo Y, Tilling K, Hardy R (2015) Life course epidemiology and analysis. In: Detels R, Gulliford M, Abdool KQ, Tan CC, eds. Oxford textbook of global public health. 6th ed. Oxford, UK: Oxford University Press: 5.20
  7. World Health Organization (2016) Risk factors. Retrieved 2016 from http://www.who.int/topics/risk_factors/en/
  8. Rickwood D (2006) Pathways of recovery: preventing further episodes of mental illness (monograph). Canberra: Commonwealth of Australia
  9. The implications for training of embracing: a life course approach to health (2000) World Health Organization
  10. Waterworth P, Dimmock J, Pescud M, Braham R, Rosenberg M (2016) Factors affecting Indigenous West Australians' health behavior: Indigenous perspectives. Qualitative Health Research; 26(1): 55-68
  11. enHealth (2013) National environmental health strategy 2012 - 2015. Canberra: Australian Department of Health
  12. Clifford HD, Pearson G, Franklin P, Walker R, Zosky GR (2015) Environmental health challenges in remote Aboriginal Australian communities: clean air, clean water and safe housing. Australian Indigenous HealthBulletin; 15(2): 1-14
  13. enHealth (2010) Environmental health practitioner manual: a resource manual for environmental health practitioners working with Aboriginal and Torres Strait Islander communities. Canberra: Department of Health, Australia
  14. Australian Bureau of Statistics (2016) National Aboriginal and Torres Strait Islander Social Survey, 2014-15. Canberra: Australian Bureau of Statistics
  15. Memmott P, Greenop K, Birdsall-Jones C (2014) How is crowding in Indigenous households managed?. Melbourne: Australian Housing and Urban Research Institute
  16. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. Canberra: Productivity Commission
  17. Ware V-A (2013) Housing strategies that improve Indigenous health outcomes. Canberra: Closing the Gap Clearinghouse
  18. Gracey MS (2007) Nutrition-related disorders in Indigenous Australians: how things have changed. Medical Journal of Australia; 186(1): 15-17
  19. National Health and Medical Research Council (2000) Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: National Health and Medical Research Council
  20. National Public Health Partnership (2001) National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 and first phase activities 2000-2003. Canberra: National Public Health Partnership
  21. National Health and Medical Research Council (2013) Australian Dietary Guidelines: providing the scientific evidence for healthier Australian diets. Canberra: National Health and Medical Research Council
  22. Australian Bureau of Statistics (2016) Australian Aboriginal and Torres Strait Islander Health Survey: consumption of food groups from the Australian Dietary Guidelines, 2012-13. Canberra: Australian Bureau of Statistics
  23. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13. Canberra: Australian Bureau of Statistics
  24. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics
  25. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 4 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_04.xls&4727.0.55.005&Data%20Cubes&F3E8C224BFBA2FE0CA257E0D000EC970&0&2012-13&20.03.2015&Latest
  26. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012-13: table 13 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500613.xls&4727.0.55.006&Data%20Cubes&D751183318983C51CA257CEE0010D97D&0&2012%9613&06.06.2014&Latest
  27. World Health Organization (2015) Guideline: sugars intake for adults and children. Geneva: World Health Organization
  28. Australian Bureau of Statistics (ABS) (2016) Australian Aboriginal and Torres Strait Islander Health Survey: consumption of added sugars, 2012-13. Canberra: Australian Bureau of Statistics (ABS)
  29. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 12.1 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_12.xls&4727.0.55.005&Data%20Cubes&2DC1BC4A0840357FCA257E0D000ECE96&0&2012-13&20.03.2015&Latest
  30. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012-13. Canberra: Australian Bureau of Statistics
  31. Australian Bureau of Statistics (2015) Australian Aboriginal and Torres Strait Islander health survey: nutrition results - food and nutrients, 2012-13: Table 14.1 [data cube]. Retrieved 20 March 2015 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&4727055005_201213_14.xls&4727.0.55.005&Data%20Cubes&2ABA2FFD38663577CA257E0D000ECF19&0&2012-13&20.03.2015&Latest
  32. Australian Institute of Health and Welfare (2016) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: Australian Institute of Health and Welfare
  33. World Health Organization (2013) Exclusive breastfeeding. Retrieved 2013 from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
  34. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  35. Australian Institute of Health and Welfare (2011) 2010 Australian national infant feeding survey: indicator results. Canberra: Australian Institute of Health and Welfare
  36. Helps C, Barclay L (2015) Aboriginal women in rural Australia; a small study of infant feeding behaviour. Women and Birth; In press(http://dx.doi.org/10.1016/j.wombi.2014.12.004):
  37. Footprints in Time (2015) Footprints in Time: the longitudinal study of Indigenous children: report from Wave 5. Canberra: Department of Social Services
  38. Department of Families Housing Community Services and Indigenous Affairs (2009) Footprints in time: the longitudinal study of Indigenous children - key summary report from Wave 1. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  39. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: physical activity, 2012–13. Canberra: Australian Bureau of Statistics
  40. Australia's physical activity and sedentary behaviour guidelines (2014) Australian Government Department of Health
  41. Australian Bureau of Statistics (2015) National Health Survey: first results, Australia, 2014-15. Canberra: Australian Bureau of Statistics
  42. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  43. World Health Organization (2013) Obesity and overweight: fact sheet no 311. Retrieved March 2013 from http://www.who.int/mediacentre/factsheets/fs311/en/
  44. Australian Institute of Health and Welfare (2012) Australia's health 2012. Canberra: Australian Institute of Health and Welfare
  45. Eat for Health: Australian dietary guidelines summary (2013) National Health and Medical Research Council
  46. World Health Organization (2011) Waist circumference and waist–hip ratio: report of a WHO expert consultation .
  47. Li M, McDermott R (2015) Obesity, albuminuria, and gamma-glutamyl transferase predict incidence of hypertension in Indigenous Australians in rural and remote communities in northern Australia. Journal of Hypertension; 33(4): 704–710
  48. Adegbija O, Hoy WE, Wang Z (2015) Corresponding waist circumference and body mass index values based on 10-year absolute type 2 diabetes risk in an Australian Aboriginal community. BMJ Open Diabetes Research & Care; 3(1): e000127 Retrieved 16 September 2015 from http://dx.doi.org/10.1136/bmjdrc-2015-000127
  49. Daniel M, Rowley K, McDermott R, O'Dea K (2002) Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk. Diabetes Research and Clinical Practice; 57: 23-33
  50. Li M, McDermott RA (2010) Using anthropometric indices to predict cardio-metabolic risk factors in Australian Indigenous populations. Diabetes Research and Clinical Practice; 87(3): 401-406
  51. Gracey M, Burke V, Martin DD, Johnston RJ, Jones T, Davis EA (2007) Assessment of risks of "lifestyle" diseases including cardiovascular disease and type 2 diabetes by anthropometry in remote Australian Aborigines. Asia Pacific Journal of Clinical Nutrition; 16(4): 688-697
  52. Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C (2014) Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Medical Research Methodology; 14: 42 Retrieved from http://dx.doi.org/10.1186/1471-2288-14-42
  53. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012-13: table 8 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500608.xls&4727.0.55.006&Data%20Cubes&2414D8800A3A8364CA257CEE0010D832&0&2012%9613&06.06.2014&Latest
  54. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012-13: table 14 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500614.xls&4727.0.55.006&Data%20Cubes&7116BB02CF341792CA257CEE0010D9AF&0&2012%9613&06.06.2014&Latest
  55. Shultz R (2012) Prevalences of overweight and obesity among children in remote Aboriginal communities in central Australia. Rural and Remote Health; 12: 1872 Retrieved 9 March 2012 from http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=1872
  56. Valery PC, Ibiebele T, Harris M, Green AC, Cotterill A, Moloney A, Sinha AK, Garvey G (2012) Diet, physical activity, and obesity in school-aged Indigenous youths in northern Australia. Journal of Obesity; 2012: 893508 Retrieved 28 March 2012 from http://www.hindawi.com/journals/jobes/2012/893508/abs/
  57. Hardy LL, O’Hara BJ, Hector D, Engelen L, Eades SJ (2014) Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children. Medical Journal of Australia; 200(11): 667-671
  58. The Australian immunisation handbook 10th edition (2016 update) (2016) Immunise Australia Program
  59. Haupt I, Fisher R, Weber J, Dunn K (2014) Review of the National Partnership Agreement on Essential Vaccines. Canberra: Sapere Research Group and Sironis Health
  60. National Health Performance Authority (2016) Healthy communities: immunisation rates for children in 2014-15. Sydney: National Health Performance Authority
  61. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  62. Australian Health Ministers' Advisory Council (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet
  63. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13: table 11 smoker status by age by remoteness, 2002, 2008 and 2012–13 [data cube]. Retrieved 6 June 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&472705500611.xls&4727.0.55.006&Data%20Cubes&2DFC3927395AF56DCA257CEE0010D921&0&2012%9613&06.06.2014&Latest
  64. Australian Institute of Health and Welfare (2016) Australia's mothers and babies 2014: in brief. Canberra: Australian Institute of Health and Welfare
  65. National Health and Medical Research Council (2009) Australian guidelines to reduce health risks from drinking alcohol. Canberra: National Health and Medical Research Council
  66. Australian guide to the diagnosis of FASD (2016) Bower C, Elliott EJ
  67. Watkins RE, Elliott EJ, Wilkins A, Mutch RC, Fitzpatrick JP, Payne JM, O'Leary CM, Jones HM, Latimer J, Hayes L, Halliday J, D'Antoine H, Miers S, Russell E, Burns L, McKenzie A, Peadon E, Carter M, Bower C (2013) Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatrics; 13: 156 Retrieved 2 October 2013 from http://dx.doi.org/10.1186/1471-2431-13-156
  68. Australian Institute of Health and Welfare (2011) 2010 National Drug Strategy Household Survey report. Canberra: Australian Institute of Health and Welfare
  69. Australian Institute of Health and Welfare (2014) National Drug Strategy Household Survey detailed report: 2013. Canberra: Australian Institute of Health and Welfare
  70. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 14 Alcohol consumption - Short-term or Single occasion risk by age, Indigenous status and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4727.0.55.001Main+Features12012-13?OpenDocument
  71. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 13 Alcohol consumption - Long-term or Lifetime risk by age, Indigenous status and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4727.0.55.001Main+Features12012-13?OpenDocument
  72. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  73. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014: Table 11A.1.2.6 Alcohol induced deaths (rate per 100 000), age standardised, by sex, NSW, Queensland, WA, SA and the NT, 2008−2012. Canberra: Productivity Commission
  74. Stafford J, Breen C (2016) Australian drug trends 2015: findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre
  75. Degenhardt L, Hall W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet; 379(9810): 55-70
  76. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 15 Substance use by age, remoteness and sex [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%2015%20substance%20use%20by%20age,%20remoteness%20and%20sex,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&E6B1092ED1C8DC69CA257C2F00145F58&0&2012-13&27.11.2013&Latest
  77. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
  78. Da Silva K, Petricevic M, Petrie M (2016) Alcohol and other drug treatment services in Australia 2014-15. Canberra: Australian Institute of Health and Welfare
  79. Australian Institute of Health and Welfare (2016) Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011. Canberra: Australian Institute of Health and Welfare
  80. d'Abbs P, Maclean S (2008) Volatile substance misuse: a review of interventions. Barton, ACT: Australian Government Department of Health and Ageing
  81. Lubman DI, Hides L, Yucel M (2006) Inhalant misuse in youth: time for a coordinated response. Medical Journal of Australia; 185(6): 327-330
  82. National Institute on Drug Abuse (2012) NIDA InfoFacts: inhalants. Retrieved 2010 from http://drugabuse.gov/infofacts/inhalants.html
  83. Brouette T, Anton R (2001) Clinical review of inhalants. The American Journal on Addictions; 10(1): 79-94
  84. Wilkes E, Gray D, Casey W, Stearne A, Dadd L (2014) Harmful substance use and mental health. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet: 125-146 (chapter 8)
  85. Cairney S, Maruff P, Burns CB, Currie J, Currie BJ (2005) Neurological and cognitive recovery following abstinence from petrol sniffing. Neuropsychopharmacology; 30(5): 1019-1027
  86. National Inhalant Abuse Taskforce (2006) National directions on inhalant abuse: final report. Melbourne: Victorian Department of Human Services
  87. Senate Community Affairs References Committee (2010) Combined Australian Government response to two Senate Community Affairs References Committee reports on petrol sniffing in Indigenous communities. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  88. Senate Standing Committee on Community Affairs (2009) Inquiry into Petrol Sniffing and Substance Abuse in Central Australia. Retrieved 2009 from http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2008-10/petrol_sniffing_substance_abuse08/index
  89. Standing Committee on Community Affairs (2009) Grasping the opportunity of Opal: assessing the impact of the Petrol Sniffing Strategy. Canberra: Senate Community Affairs Committee, Parliament of Australia
  90. Senate Select Committee on Regional and Remote Indigenous Communities (2010) Select Committee on Regional and Remote Indigenous Communities: final report 2010. Canberra: Parliament of Australia
  91. Select Committee on Substance Abuse in the Community (2004) Petrol sniffing in remote Northern Territory communities. Darwin: Select Committee on Substance Abuse in the Community, Legislative Assembly of the Northern Territory
  92. Marcus D, Shaw D (2013) Whole of strategy evaluation of the petrol sniffing strategy: future directions for the PSS: final report. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  93. d’Abbs P, Shaw G (2016) Monitoring trends in the prevalence of petrol sniffing in selected Australian Aboriginal communities 2011-2014: final report. Darwin: Menzies School of Health Research
  94. South Australian Centre for Economic Studies (2010) Cost benefit analysis of legislation to mandate the supply of opal fuel in regions of Australia: final report. Adelaide: Australian Government Department of Health and Ageing
  95. Parliament of Victoria Drugs and Crime Prevention Committee (2002) Inquiry into the inhalation of volatile substances: final report. Melbourne: Parliament of Victoria
  96. Shaw G, Biven A, Gray D, Mosey A, Stearne A, Perry J (2004) An evaluation of the Comgas scheme: they sniffed it and they sniffed it but it just wasn't there. Canberra: Department of Health and Ageing
  97. Marel C, MacLean S, Midford R (2016) Review of volatile substance use among Aboriginal and Torres Strait Islander people. Perth: Australian Indigenous HealthInfoNet

Footnotes

[1] Demand sharing is mainly where resources and money are shared within an extended family group [15].

[2] Housing of an acceptable standard includes two components: working household facilities; and major structural components [16].

[3] Due to incomplete identification of Aboriginal and Torres Strait Islander status, these figures probably underestimate the true difference between Aboriginal and Torres Strait Islander and non-Indigenous rates.

[4] Foods that are energy dense but do not provide many/any nutrients [21].

[5] Discretionary foods are energy dense, nutrient-poor foods that typically contain high levels of sugar, salt and fat [28].

[6] Free sugars are added sugars plus those naturally occurring in honey, fruit juice and fruit concentrate [28].

[7] Added sugars are added to foods during manufacture or by the consumer during food preparation or consumption [28].

[8] When an electrical current is passed through the body, fatty tissue offers more resistance than lean tissue. The resistance to the flow of electricity is used to calculate the proportion of body fat in the individual.

[9] These include vaccinations for Bacille Calmette-Guérin (BCG) for newly born babies living in areas of high TB incidence, hepatitis A for children living in Qld, WA, SA and the NT, hepatitis B for adults not previously vaccinated against hepatitis B, influenza for all persons aged 6 months or over, pneumococcal conjugate for children living in Qld, WA, SA and the NT and pneumococcal polysaccaride for persons aged 15-49 years old with underlying conditions increasing the risk of invasive pneumococcal disease (IPD) and all persons aged 50 years and older [58].

[10] No more than two standard drinks on any single day.

[11] Because of the small sample size, comparison of data between Aboriginal and Torres Strait Islander people and non-Indigenous people should be viewed with caution.

[12] ICD code F15 hospitalisation from use of other stimulants includes amphetamine-related disorders and caffeine but not cocaine.

[13] The AR-DRG codes for petrol sniffing include: C91 lymphoid leukaemia; C92 myeloid leukaemia; F18 mental and behavioural disorders due to the use of volatile solvents; T52 toxic effects of organic solvents; G92 toxic encephalopathy; X46 accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours [94].

 

 

 

 

 

Table of Contents

collapseCollapse
expand Expand
    Last updated: 11 May 2017
     
    Return to top
    spacing
    general box

    Contribute

    Share your information » Give us feedback » Sign our guestbook »
    spacing
    spacing