NACCHO Aboriginal Health and @sistaquit Smoking : Smoking rates among pregnant Indigenous women tackled in major research project

 ” In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.”

Smoking rates among pregnant Indigenous women tackled in major research project 

See full ABC report here or Part 2 below

Part 1 Project update 26 September

Currently we have received EOIs from about 20 ACCHS in 5 states that we are targeting for the SISTAQUIT study. These states are NSW, QLD, SA, WA and NT.

These sites will now undergo a two-way discussion for mutual interest, and to find out what protocols we need to go through to get their communities signed up.

We are aiming for 30 services to be signed up to SISTAQUIT by end of the year.

We will have a trade table at the NACCHO AGM, so interested CEOs and managers of ACCHS can get more information,  meet with Joley Manton face-to-face, and sign up their interest or consent.

Our pilot study “ICAN QUIT in Pregnancy” has been successful wrapped up, and we are applying our learnings to go forward to this larger SISTAQUIT trial.

We would like to thank pilot ACCHS services in NSW, SA and QLD for their tremendous support in making this happen.

What does the SISTAQUIT™ in Pregnancy study aim to do?

Our study aims to improve the provision of timely, evidence-based smoking cessation support to pregnant women attending Aboriginal Medical Services (AMS), by training health providers such as GPs, Aboriginal Health Workers and midwives in culturally appropriate smoking cessation care.

The SISTAQUIT intervention (culturally appropriate smoking cessation training for health providers) has been developed over a decade. We most recently explored the feasibility and acceptability of the SISTAQUIT intervention through the ICAN QUIT in Pregnancy pilot study with six Aboriginal Community Controlled Health services.

We aim to increase the proportion of health providers offering assistance in quitting to pregnant smokers and to improve the quit rates of pregnant smokers, measured by carbon monoxide testing during pregnancy and after birth. We also aim to improve birth weights and respiratory outcomes of the babies in the first six months of life.

We are currently seeking EOIs from AMS interested in participating in the trial. Funding is available to cover AMS trial participation costs, and pregnant mothers will be offered a voucher for their time for each study visit.

Contact Details

School of Medicine and Public Health, University of Newcastle:

Assoc. Prof. Gillian Gould: gillian.gould@newcastle.edu.au

Ms Joley Manton: sistaquit@newcastle.edu.au;  Phone: (02) 4033 5720

Website: www.newcastle.edu.au/SISTAQUIT

Part 2

 

SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

 “We want to show that SISTAQUIT works, and that women are able to quit with our approach.

We wanted to be able to reach out eventually to any service in Australia through the internet, so we decided to do that through interactive webinars.

We know now that quite a few chronic diseases are set up by babies being exposed to smoking when they’re in the womb,”

Associate Professor Gould said

It is hoped a large-scale research project will help provide clearer solutions for tackling smoking rates among pregnant Indigenous women across the country.

In 2014 it was reported 45 per cent of surveyed Indigenous mothers smoked during pregnancy, compared to 13 per cent of non-Indigenous pregnant women.

Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.

It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.

“From that point of view, it is important.

“We know that one of the problems is that women are not given enough help to quit smoking.”

Associate Professor Gould has been working on the multi-phase research project for a number of years.

In the first phase of the study, the research team worked with Indigenous communities in the NSW Hunter Valley to develop a suite of resources to train health providers in supporting women while they quit smoking.

Many of those resources have been digitally focused.

Phase two involved a pilot project using those resources, and was implemented in NSW, South Australia and Queensland.

“We had trained all of the health providers at those services,” Associate Professor Gould said

Project aiming to give health workers effective tools

With the pilot study finished, the research is now expanding into 30 Aboriginal medical centres around the country, with the SISTAQUIT project aiming to help 450 Indigenous women quit smoking.

“We will link up with the services, and we’re conducting three one-hour webinars, which will be live and interactive,” Associate Professor Gould said.

“We [also] have this booklet that women receive, and within that booklet are embedded different videos.

“The women can use an app on their phone, and when they scan the little screenshot of the video that’s in the booklet, they can hear [information] from Aboriginal and Torres Strait Islander health professionals which is going to help them quit smoking.

“We’re mainly aiming it at the health professionals — GPs, midwives, Aboriginal health workers — to give them training, and then they have these resources that are going to, in consultation with women, help them quit.

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

“By doing it this way and being able to do it in enough women, we will get the answer — ‘is this approach the best approach?’ — and therefore, can the Government then scale-up our approach to make those webinars and resources available across the whole of Australia?”

Cultural sensitivities are observed in the training materials, and Associate Professor Gould said that helped build trust.

“We’re talking to women, giving them accurate, factual messages, but in a way that’s delivered by people they would trust,” she said.

“We’ve developed the whole approach with Aboriginal medical services, and we’ve had Aboriginal investigators on our team guiding us and working very closely with us

Hopes smoking rates will drop

The study is set to last until 2021, and Associate Professor Gould was optimistic the approach would help reduce rates of smoking.

“This is the real world; it’s a real-world study, so this is what life is like,” she said.

“In our pilot study so far, we’ve had four women quit out of 22, which means we’ve already got a quit rate of almost 25 per cent. The usual quit rate is about 3 per cent. So, we think we’re doing pretty good.

“We’re aiming in the bigger trial to improve the quit rate from the baseline of 3 per cent up to 11 per cent, but already in our pilot we’ve exceeded our aim.

“You never know if this is going to work or not, and that’s why [we’re] doing the study

 

NACCHO Aboriginal Health and #Racism : #UN #HRC36 told Australia must abandon racially discriminatory remote work for the dole program

Thank you Mr President,

Australia is denying access to basic rights to equality, income and work for people in remote Aboriginal and Torres Strait Islander communities, through a racially discriminatory social security policy.

Australia should work with Aboriginal organisations and leaders to replace this discriminatory Program with an Aboriginal-led model that treats people with respect, protects their human rights and provides opportunities for economic and community development “

36th Session of the UN Human Rights Council 20 September see in full part 2 below

The program discriminates on the basis of race, with around 83 per cent of people in the program being Aboriginal and Torres Strait Islander. This is a racially discriminatory program that was imposed on remote communities by the Government and it’s having devastating consequences in those communities,”

John Paterson, a CEO of the Aboriginal Peak Organisations NT, told the Council that the Government’s program requires people looking for work in remote communities to work up to 760 hours more per year for the same basic payment as people in non-Indigenous majority urban areas.

Picture above Remote work-for-the-dole scheme ‘devastating Indigenous communities’

The Australian Government is denying access to basic rights to equality, work and income for people in remote Aboriginal and Torres Strait Islander communities, through its racially discriminatory remote work for the dole program.

In a joint statement to the UN Human Rights Council overnight, the Aboriginal Peak Organisations NT and Human Rights Law Centre urged the Council to abandon its racially discriminatory ‘Community Development Program’ and replace it with an Aboriginal-led model.

Adrianne Walters, a Director of Legal Advocacy at the Human Rights Law Centre, said that the program is also denying basic work rights to many people in remote communities.

“Some people are required to do work that they should be employed to do. Instead, they receive a basic social security payment that is nearly half of the minimum wage in Australia. People should be paid an award wage and afforded workplace rights and protections to do that work.” said Ms Walters.

The statement to the Council calls for the Federal Government to work with Aboriginal and Torres Strait Islander people on a model that treats people with respect, protects their human rights and provides opportunities for economic and community development.

“Aboriginal and Torres Strait Islander people in remote communities want to take up the reins and drive job creation and community development. Communities need a program that sees people employed on decent pay and conditions, to work on projects the community needs. It’s time for Government to work with us,” said Mr Paterson.

The Aboriginal Peak Organisations NT has developed an alternative model for fair work and strong communities, called the Remote Development and Employment Scheme, which was launched in Canberra two weeks ago with broad community support.

“The new Scheme will see new opportunities for jobs and community development and get rid of pointless administration. Critically, the Scheme provides incentives to encourage people into work, training and other activities, rather than punishing people already struggling to make ends meet,” said Mr Paterson.

The Human Rights Law Centre has endorsed the Aboriginal Peak Organisations NT’s proposed model.

“Aboriginal organisations have brought a detailed policy solution to the Government’s front door. The Scheme would create jobs and strengthen communities, rather than strangling opportunities as the Government’s program is doing,” said Ms Walters.

Part 2 36th Session of the UN Human Rights Council

Items 3 and 5

Human Rights Law Centre statement, in association with Aboriginal Peak Organisations Northern Territory, Australia

Thank you Mr President,

Australia is denying access to basic rights to equality, income and work for people in remote Aboriginal and Torres Strait Islander communities, through a racially discriminatory social security policy.

The Council has received the report of the Special Rapporteur on Indigenous peoples’ rights following her mission to Australia in 2017. This statement addresses one area of concern in the Special Rapporteur’s report.

The Australian Government’s remote ‘Community Development Program’ requires people looking for work in remote communities to work up to 760 more hours per year for the same basic social security payment as people in non-Indigenous majority urban areas.

The program discriminates on the basis of race, with around 83 per cent of people covered by the program being Indigenous.

High rates of financial penalty are leaving families without money for the basic necessities for survival.

In addition, the program denies basic work rights. People are required to do work activities that they should be employed, paid an award wage and afforded workplace rights to do. Instead, they receive a basic social security payment that is nearly half of the minimum wage in Australia.

The program undermines self-determination and was imposed on Aboriginal communities with very little consultation.

Australia should work with Aboriginal organisations and leaders to replace this discriminatory Program with an Aboriginal-led model that treats people with respect, protects their human rights and provides opportunities for economic and community development.

Mr President,

Australia is a candidate for a seat on the Human Rights Council for 2018. We call on the Council and its members to urge Australia to respect rights to self-determination and non-discrimination, and to abandon its racially discriminatory remote social security program and replace it with an Aboriginal-led model.

Part 3 Fair work and strong communities

Aboriginal Peak Organisations NT Proposal for a Remote Development and Employment Scheme

NACCHO is one of the many organisations that has endorsed this scheme

See full Story here

Download the brochure and full list of organisations endorsing

RDES-Summary_online

All Australians expect to be treated with respect and to receive a fair wage for work. But the Australian Government is denying these basic rights to people in remote communities through its remote work for the Dole program – the “Community Development Programme”.

Around 84 per cent of those subject to this program are Aboriginal and Torres Strait Islander people.

Most people in remote communities have to do more work than people in non-remote non Indigenous majority areas for the same basic social security payment.

In some cases, up to 760 hours more per year.

There is less flexibility and people are paid far below the national minimum wage.

Aboriginal and Torres Strait Islander people are also being penalised more because of the onerous compliance conditions.

In many cases, people are receiving a basic social security payment for work they should be employed to do.

The Government’s program is strangling genuine job opportunities in remote communities.

The Government’s remote Work for the Dole program is racially discriminatory and must be abandoned. Better outcomes will be achieved if Aboriginal and Torres Strait Islander people are given the opportunity to determine their own priorities and gain greater control over their own lives.

NACCHO Aboriginal Health and #Obesity : Download #TippingtheScales Report Leading health orgs set out 8 urgent actions for Federal Government

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 30 + NACCHO Obesity articles published last 5 years

Read over 30+ NACCHO Nutrition and Healthy foods published last 5 years

Thirty-four leading community, public health, medical and academic groups have today united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking new action plan, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition (OPC) and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required. Areas include:

  1. Time-based restrictions on TV junk food advertising to kids
  2. Set clear food reformulation targets
  3. Make the Health Star Rating mandatory by July 2019
  4. Develop a national active transport strategy
  5. Fund weight-related public education campaigns
  6. Introduce a 20% health levy on sugary drinks
  7. Establish a national obesity taskforce
  8. Develop and monitor national diet, physical activity and weight guidelines.

OPC Executive Manager Jane Martin said the eight definitive policy actions in Tipping the Scales addressed the elements of Australia’s environment which set individuals and families up for unhealthy lifestyles, rather than just focusing on treating the poor health outcomes associated with obesity.

Watch video HERE : How does junk food marketing influence kids

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese. This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult,” Ms Martin said.

“The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 But Australia still has no strategy to tackle our obesity problem. It just doesn’t make sense.

“Without action, the costs of obesity and poor diet to society will only continue to spiral upwards. The policies we have set out to tackle obesity therefore aim to not only reduce morbidity and mortality, but also improve wellbeing, bring vital benefits to the economy and set Australians up for a healthier future.”

Professor of Epidemiology and Equity in Public Health at Deakin University, Anna Peeters, said the 34 groups behind the report were refusing to let governments simply sit back and watch as growing numbers of Australians developed life-threatening weight and diet-related health problems.

“For too long we have been sitting and waiting for obesity to somehow fix itself. In the obesogenic environment in which we live, this is not going to happen. In fact, if current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by diseases linked to overweight and obesity, such as type 2 diabetes, cancer heart disease, between 2011-20501,” Professor Peeters said.

“Obesity poses such an immense threat to Australia’s physical and economic health that it needs its own, standalone prevention strategy if progress is to be made. There are policies which have been proven to work in other parts of the world and have the potential to work here, but they need to be implemented as part of a comprehensive approach by governments. And they need to be implemented now.

“More than thirty leading organisations have agreed on eight priorities needed to tackle obesity in Australia. We would like to work with the Federal Government to tackle this urgent issue and integrate these actions as part of a long-term coordinated approach.”

In addition to the costs to society, the burden of obesity is felt acutely by individuals and their families.

As a Professor of Women’s Health at Monash University and a physician, Professor Helena Teede sees mothers struggle daily with trying to achieve and sustain healthy lifestyles for themselves and their families, while having to deal with the adverse impact of unhealthy weight, especially during pregnancy.

“As a mother’s weight before pregnancy increases, so does the substantive health risk to both the mother and baby. Excess weight gain during pregnancy further adds to these risks and is a key driver of infertility, long-term obesity, heart disease and type 2 diabetes, while for the child, their risk of becoming overweight or obese and developing chronic diseases in later life greatly increases,” Professor Teede said.

“The women I see are generally desperate for help to improve their lifestyle and that of their families. They want to set themselves and their families up for healthy, long lives.

“Currently, there is a lot of blame placed on individuals with unhealthy diets and lifestyles seen as being due to individual and family discipline. Women from all backgrounds and walks of life struggle with little or no support to achieve this. It is vital that we as a community progress beyond placing all responsibility on the individual and work towards creating a policy context and a society that supports healthy choices and tips the scales towards obesity prevention to give Australian families a healthy start to life.”

The calls to action outlined in Tipping the Scales are endorsed by the following organisations: Australian Chronic Disease Prevention Alliance (which includes the Heart Foundation, Cancer Council Australia, Kidney Health Australia, Diabetes Australia and the Stroke Foundation), Australian Health Policy Collaboration (AHPC), Australian Medical Students’ Association (AMSA), Australian & New Zealand Obesity Society (ANZOS), Australasian Society of Lifestyle Medicine, Baker Heart & Diabetes Institute, CHOICE, Consumers Health Forum of Australia, Deakin University’s Global Obesity Centre (GLOBE), Institute For Physical Activity and Nutrition (IPAN), Monash Centre for Health, Research and Implementation (MCHRI), LiveLighter, Menzies School of Health Research, The University of Melbourne’s Melbourne School of Population & Global Health, Melbourne Children’s (which includes The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute and the University of Melbourne), the National Rural Health Alliance Inc, Nutrition Australia, Obesity Australia, Obesity Policy Coalition, Obesity Surgery Society of Australia & New Zealand, Parents’ Voice, Public Health Association of Australia and Sugar By Half.

Download the Tipping the Scales action plan and snapshot at opc.org.au/tippingthescales


1. Obesity Australia. Obesity: Its impact on Australia and a case for action. No time to Weight 2. Sydney, 2015.

NACCHO Aboriginal Health : #Indigenous groups say work for the dole scheme racially discriminatory and “unhealthy “

“ Aboriginal Peak Organisations of the Northern Territory (APONT ), and our members have received widespread concerns about the debilitating impacts that CDP is having on its participants, their families and communities.

Financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry.

Such consistent and strong concerns expressed by those at the coalface must be taken seriously and acted upon,

Onerous and discriminatory obligations applied to remote CDP work for the dole participants mean they have to do significantly more work than those in non-remote, mainly non-Indigenous majority areas, up to 670 hours more per year.”

The chief executive of Aboriginal Medical Services Alliance Northern Territory, John Paterson, said the program was causing significant harm to communities. He said financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry (see Guardian article in full below Part 2 )

In press conference picture below

  • John Paterson, CEO, Aboriginal Medical Services Alliance NT (APO NT)
  • David Ross, Director, Central Land Council (APO NT)
  • Rod Little, Co-Chair, National Congress
  • David Thompson, CEO, Jobs Australia
  • Ged Kearney, President, Australian Council of Trade Union
  • Maria Harvey, CEO, Tiwi Islands Training & Employment Board
  • Dickie Bedford, CEO, Marra Worra Worra

 

Part 1 Fair work and strong communities

Aboriginal Peak Organisations NT Proposal for a Remote Development and Employment Scheme

NACCHO is one of the many organisations that has endorsed this scheme

Download the brochure and full list of organisations endorsing

RDES-Summary_online

All Australians expect to be treated with respect and to receive a fair wage for work. But the Australian Government is denying these basic rights to people in remote communities through its remote work for the Dole program – the “Community Development Programme”.

Around 84 per cent of those subject to this program are Aboriginal and Torres Strait Islander people.

Most people in remote communities have to do more work than people in non-remote non Indigenous majority areas for the same basic social security payment.

In some cases, up to 760 hours more per year.

There is less flexibility and people are paid far below the national minimum wage.

Aboriginal and Torres Strait Islander people are also being penalised more because of the onerous compliance conditions.

In many cases, people are receiving a basic social security payment for work they should be employed to do.

The Government’s program is strangling genuine job opportunities in remote communities.

The Government’s remote Work for the Dole program is racially discriminatory and must be abandoned. Better outcomes will be achieved if Aboriginal and Torres Strait Islander people are given the opportunity to determine their own priorities and gain greater control over their own lives.

A Fair Wage for Work

There is an opportunity for the Australian government to meaningfully partner with remote communities, rather than impose a “one size fits all” model from Canberra.

Aboriginal and Torres Strait Islander people in remote communities want to take up the reins and drive job creation and community development initiatives.

Remote communities need a program that sees people employed to work on projects the community needs.

And to do so with decent pay and conditions, and the right to earn more for extra effort. The current program keeps people in the welfare system and excessive penalties see people just disengage. It provides no reward for effort and does not address the need to support people into the workforce.

Remote communities need a program that encourages school leavers to move straight into employment or training.

Not one that leaves young people trapped in a welfare cycle or disengaged.

Tailored community-led approaches are needed that reflect the diverse cultural, economic and social aspirations of Aboriginal and Torres Strait Islander peoples and the realities of the remote job market.

A Fair and Positive Scheme for waged work and strengthening communities

Five Aboriginal organisations in the Northern Territory, working with Aboriginal and Torres Strait Islander remote service providers, have developed a new, fair and positive model for job creation and community building – the Remote Development and Employment Scheme.

The Scheme will see people placed into part time work with award wages and conditions.

People will be protected by the workplace rights so many Australians take for granted. It would reduce the role that the welfare system plays in people lives. It will see more time and money spent creating new opportunities for jobs, enterprise and community development and less on pointless administration.

The Scheme is a place-based and community-driven model.

It will establish long term collaboration across governments, employers and Aboriginal and Torres Strait Islander organisations to increase opportunities in remote communities.

Critically, the Scheme provides incentives to encourage people into work, training and other activities, rather than punishing people already struggling to comply.

Keys features of the Remote Development and Employment Scheme :

  • Establish a wages fund to empower Aboriginal and Torres Strait Islander and other local organisations to create 10,500 part time jobs on award wages and conditions, working on services and projects important to their communities, with the ability to “top up” these wages from other funds when extra work is done.
  • Create 1,500 paid work experience and training places for young people, supported by locally driven youth development strategies.
  • Remove the discriminatory requirement for people in remote communities who remain on social security payments to work more hours than people in non- remote areas.
  • Create Remote Job Centres, with local governance bodies, focused on long term support to help people get into work, stay in work, and progress into better jobs based on their skills and aspirations.
  • Retain activity obligations for people who can work and receive social security but aren’t in a job. Obligations will be based on their capabilities and the needs and views of communities.
  • Support people with disabilities and family responsibilities to meet their gaols and contribute to their communities in a manner appropriate to their capabilities and aspirations.
  • Maintain and improve access to government services in remote communities, including Centrelink, and help people with disabilities access the right payment through the support of Remote Job Centres.
  • Ensure the Scheme is managed with Aboriginal and Torres Strait Islander people, through shared learning and evidence, by establishing an independent body with an Aboriginal and Torres Strait Islander led board.

Part 2 from The Guardian

Indigenous groups say work for the dole scheme racially discriminatory

An alliance of Indigenous groups has called the government’s remote work for the dole scheme a racially discriminatory, onerous and debilitating program that is causing children to go hungry.

The community development program was introduced in 2015, aiming to reduce welfare dependency in rural and remote areas.

The scheme relies heavily on private job service providers, and places more onerous requirements on jobseekers, who are required to work or engage in related activities for 25 hours a week across 46 weeks of the year.

Its 35,000 participants, who are 83% Indigenous, earn about $11 an hour, and those who fail to meet their obligations face financial penalties.

Witnesses told a Senate inquiry on Friday that a lack of job opportunities in remote communities made it unworkable and impractical.

Participants have been left to engage in “activity for activity’s sake” with little prospect for learning new skills or gaining a job.

If they fail to comply with rigid requirements, jobseekers face financial punishment. The government issued 35,122 financial penalties in the final quarter of last year, mostly through no show no pay penalties, usually of about $53.

An Australian National University study showed Indigenous people were 27 times more likely to be penalised by a loss of income than those on a similar program in a largely white area.

On Friday the Aboriginal Peak Organisations of the Northern Territory (Apont), an alliance of five groups, gave evidence to a Senate inquiry into the program.

One of the members, the chief executive of Aboriginal Medical Services Alliance Northern Territory, John Paterson, said the program was causing significant harm to communities. He said financial penalties were being imposed at an astonishing scale – causing families, including children, to go hungry.

“Apont and our members have received widespread concerns about the debilitating impacts that CDP is having on its participants, their families and communities. Such consistent and strong concerns expressed by those at the coalface must be taken seriously and acted upon,” Paterson said.

“Onerous and discriminatory obligations applied to remote CDP work for the dole participants mean they have to do significantly more work than those in non-remote, mainly non-Indigenous majority areas, up to 670 hours more per year.”

Apont, which was created to end the top-down approach of Indigenous policy, has proposed a new model, which focuses on increasing jobs, boosting community development, and lessening the welfare system’s intrusion into people’s lives.

“The CDP is racially discriminatory, and Apont believes it must be abandoned. In seeking this we are not just coming here armed with criticisms, but with a solution, an alternative.”

Cassandra Goldie, the chief executive of the Australian council of social service (Acoss), said the significant resources being spent on the CDP – about $268m in 2015-16 – would be better directed to creating employment in rural communities.

“When the term ‘welfare dependency’ is used, it’s often understood that it’s the social security payment that’s the problem,” Goldie said.

“But … the very important task of generating local employment, real employment opportunities, that is where the significant capabilities of the commonwealth, institutionally, should be coming in behind the deep desire by Atsi [Aboriginal and Torres Strait Islander] leadership, and also Indigenous people locally, to drive this agenda,” she said.

That was a position backed by non-profit job service providers, represented by the chief executive of Jobs Australia, David Thompson. “There’s been nothing done, nothing of any significant note, to actually increase the stock of jobs in those communities,” he said.

The Department of Social Services was questioned about why it imposed stricter requirements on participants of the CDP.

Labor senator Malarndirri McCarthy asked, “If there are less jobs in a remote and rural region and less opportunities, why would there be a higher expectation of the hours?”

The DSS’s Bronwyn Field said the government had heard significant concerns from community leaders about sit-down welfare. To resolve that, it had decided daily activities from participants would be required.

“The government, when they started consultation prior to introducing the CDP, spent a lot of time with communities. One of the clear pieces of feedback was the fact that many Indigenous community leaders were concerned about people … doing sit-down welfare,” Field said.

McCarthy responded, “So you’re saying that was a result of government consultations to have those hours – 25 in the community, and 15 in town?”

Aboriginal Health Lifestyle Campaigns : Minister @KenWyattMP investing in #DeadlyRoos partnership, a Community Controlled initiative. #DeadlyChoices

“Deadly Choices is what I like to call a ‘jewel in the crown’ of Indigenous health, achieving some stunning results since it kicked off in South East Queensland four years ago.

The Deadly Kangaroos is an expansion of this program, using the star power of the ambassadors and the excitement of this year’s World Cup to reach more even communities.

Our national rugby league stars need to be in peak physical condition to play at the top of their game and we appreciate the players’ support to start discussions with Aboriginal and Torres Strait Islander people about ways to improve their health “

Minister for Indigenous Health, Ken Wyatt AM, said legendary Kangaroos coach Mal Meninga and other Indigenous and non-Indigenous players would become ambassadors for the Institute for Urban Indigenous Health’s Deadly Choices program, to extend its reach across Australia.

The launch in Canberra was attended by the NACCHO Chair Matthew Cooke (pictured on right )

Members of the elite Australian Kangaroos Rugby League 2017 World Cup squad will headline the expansion of a successful grassroots campaign to improve Aboriginal and Torres Strait Islander health.

Deadly Choices is a community-based health lifestyle campaign launched in 2013.

There is particular focus on young people and the importance of exercise, education, school attendance, quitting smoking and regular preventive health checks.

Through media campaigns, sports carnivals and community events it has prompted:

    • Almost 19,000 annual health checkups in South East Queensland
    • Active patient numbers to triple to over 330,000
    • 1,155 smoke-free household pledges
    • More than 3,300 smoker interventions

“Experience shows that sport and sporting legends can help communities kick major goals in health awareness and foster real change,” the Minister said.

“I encourage everyone to support Australia in the World Cup in October, just as the Kangaroos are supporting better health outcomes for Aboriginal and Torres Strait Islander people, and all Australians.”

The ambassadors will make appearances at game day events as the Australian team travels through the ACT, New South Wales, the Northern Territory and regional Queensland for the World Cup.

“Key ambassadors for the Deadly Kangaroos are Johnathan Thurston and Greg Inglis,” the Minister said. “Also, the best three players from the national men’s and women’s teams at the Arthur Beetson Deadly Choices Murri Rugby League carnival will also be chosen as community ambassadors to promote positive health messages.

“Merchandise, including a special Deadly Kangaroos World Cup jersey, has been produced as an incentive for people to have a health check.

“The messages will also be promoted through television, radio, social media and at coaching clinics and Aboriginal community controlled health services.”

The Australian Government is contributing $235,000 to help support the Deadly Kangaroos campaign

The Rugby League World Cup runs from 26 October – 2 December 2017.

NACCHO #Aboriginal Health and #Diabetes @theMJA the @NHMRC #Indigenous guidelines need update

Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening.

Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable “

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

Originally published MJA

Read over 120 diabetes related posts by NACCHO over past 5 years

MORE can be done to increase diabetes screening rates among Indigenous Australians and enable earlier intervention, say experts who are calling for a greater focus on young adults.

A study published in the MJA found enormous variation in diabetes screening rates between different Aboriginal Community Controlled Health Services (ACCHSs).

The proportion of Indigenous adults screened for diabetes at least once in 3 years – as per the Royal Australian College of General Practitioners and Diabetes Australia (RACGP/DA) guidelines – ranged from 16% to 90% between different services.

Overall, 74% of Indigenous adults received a screening test for diabetes at least once between 2010 and 2013, the study found, based on de-identified data on 20 978 patients from 18 ACCHSs.

Only 18% of Indigenous adults were tested for diabetes annually, as per the more intensive guidelines by the National Aboriginal Community Controlled Health Organisation (NACCHO), leading the authors to claim that the RACGP/DA guidelines were more practicable.

Extract Overview provided by NACCHO

Download a full copy of 2 nd edition

http://www.racgp.org.au/download/documents/AHU/2ndednationalguide.pdf

Type 2 diabetes is most commonly found in obese adults who develop increasing insulin resistance over months or years. For these patients there is a substantial ‘prediabetic’ window period of opportunity to offer preventive interventions. Screening for diabetes is safe, accurate and cost effective, and detects a substantial proportion of people who may not otherwise have received early intervention.1 This chapter discusses type 2 diabetes in adults who are not pregnant.

The prevalence of type 2 diabetes in Aboriginal and Torres Strait Islander populations is 3–4 times higher at any age than the general population, with an earlier age of onset.2 The precise prevalence is hard to pinpoint; a 2011 systematic review of 24 studies showed prevalence estimates ranged from 3.5–31%, with most lying between 10% and 20%. Diabetes prevalence in remote populations is approximately twice that of urban populations and is higher among Aboriginal and Torres Strait Islander people.3

Aboriginal and Torres Strait Islander men and women die from diabetes at 23 and 37 times the rate of non-Indigenous Australian men and women respectively, in the 35–54 years age group.4 Large scale clinical trials have demonstrated that appropriate management of diabetes can prevent the development or delay the progression of complications such as myocardial infarction, eye disease and renal failure.5

Obesity is a very strong predictor for diabetes; a body mass index (BMI) ≥30 kg/m2 increases the absolute risk of type 2 diabetes by 1.8–19-fold, depending on the population studied. A cohort study of non-diabetic Aboriginal adults aged 15–77 years in central Australia found that those with a BMI of ≥25 kg/m2 had 3.3 times the risk of developing diabetes over 8 years of follow up compared to those with a BMI <25 kg/m2.1 The AusDiab study found that three measures of obesity: BMI, waist circumference and waist-to-hip ratio, all had similar correlations with diabetes and CVD risk.6 Waist circumference performed slightly better than BMI at predicting diabetes in a remote Aboriginal community

The study defined screening tests to include glycated haemoglobin (HbA1c) testing as well as the oral glucose tolerance test and venous glucose level testing.

Barriers to screening included being aged under 50 years, being transient rather than a current patient and attending the service less frequently, the study found. The authors concluded that particular attention should be given to increasing the screening rate in these groups.

The finding that young people were less likely to be tested was “intuitively reasonable”, the authors said, given that the risk of developing diabetes rises with age. However, they suggested that it was still best practice to test Indigenous adults from the age of 18 years, as it provided a “substantial opportunity for limiting the impact of type 2 diabetes”.

Indigenous Australians aged 25–34 years are five times more likely to have diabetes or high blood sugar levels than non-Indigenous Australians of the same age, they noted.

Despite this difference between Indigenous and non-Indigenous people, the National Health and Medical Research Council (NHMRC) only recommends screening Indigenous people for diabetes once they are aged over 35 years, and doing it every 3 years.

Professor Kerin O’Dea, Professor Emeritus at the University of South Australia and Honorary Professor at the University of Melbourne, said that the NHMRC recommendations “really need to be updated”.

“Early onset of type 2 diabetes is very common in Aboriginal communities following Westernisation, so I agree with the recommendations of NACCHO and the RACGP, which recommended early screening,” she told MJA InSight.

“Whether you do it annually or every 3 years is a less important question to me, and very patient-dependent,” she said.

Professor O’Dea said that more widespread use of HbA1c testing could increase the screening rate in Aboriginal communities, particularly among younger people and those who were more transient.

“If screening for diabetes was just a simple opportunistic HbA1c test, you wouldn’t have so many problems getting people to have it done,” she said. “HbA1c testing will give you a good idea of the mean glucose level, and unlike the glucose tolerance test, you don’t have to ask the patient to return in the fasting state.

“If it does turn out that the patient has borderline diabetes, then you can ask if they are prepared to do a glucose tolerance test,” she added.

Study co-author, Associate Professor Christine Paul, said that there was significant variation in the use of HBA1c testing across sites and across time in the study.

“I think it is possible that increasing the use of HbA1c as a screening test may help [to increase screening rates]; however, I don’t think it’s the main answer,” she said. “Clearly some health services need support to get systems in place, regardless of which test they use.”

 

NACCHO Aboriginal Health #Strokeweek : #Fightstroke Aboriginal people are up to three times more likely to suffer a stroke than non-Indigenous

 

” Aboriginal and Torres Strait Islander people are up to three times more likely to suffer a stroke than non-Indigenous Australians and almost twice as likely to die, according to the Australian Bureau of Statistics. It’s an alarming figure and one that  prompted the National Stroke Foundation in 2016 to urge the Federal Government to fund a critical $44 million awareness campaign in a bid to close the gap .

The good news is most strokes are preventable and treatable.

However communities need to be empowered to protect themselves from this insidious disease.”

Sharon McGowan, Stroke Foundation CEO ( see full Aboriginal Stroke statistics part 2 below

Download the 48 Page support guide :

journeyafterstroke_indigenous_0

Read over 75 Stroke related articles published by NACCHO over past 5 years

“Never had I ever come across one ( stroke ) or heard much about them. I had nothing to do with them,”

When I woke up, I didn’t know what was going on. I couldn’t communicate. I couldn’t tell anyone I was still here. It was really scary. I’d never seen the effects of a stroke.

First, I lost my voice, then my vision, my [ability to] swallow and my movement of all my body parts. I lost all my bowel and bladder function. I’ve still got bad sight but I can see again. My speech took about six months.

With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home “

For Tania Lewis, an Awabakal woman, stroke was something that only happened to older people. But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Board Member Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )

Part 1 Stroke Foundation in 2016 called on government to close the gap

Originally published here

A stroke occurs when supply of blood to the brain is disturbed suddenly. The longer it remains untreated, the heightened the risk of stroke-related brain damage.

Medical treatment during the first onset of symptoms can significantly improve a sufferer’s chance of survival and of successful rehabilitation.

In Australia, stroke is the leading cause of long-term disability in adults, accounting for 25 per cent of all chronic disability. The NSF reports that roughly 50,000 strokes occur per year with over 437,000 people living with stroke across the country. While severity varies, two thirds of victims, like Tania, are left with impeding disabilities

But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

The burden of stroke doesn’t just fall on the patient, but can take a significant toll on family and carers.

“The doctor at the hospital tried to take Power of Attorney and Guardianship away from me and give it to the Guardianship Board, because he didn’t believe that [my husband] Len or anyone could look after me,” Tania recalls.

“I was put through hell. I figured life wasn’t worth living anymore because they took everything away from me. I couldn’t go home to my family. So I tried to off myself.

“Then all of a sudden, one day the doctor said, ‘You can go home. We can’t rehabilitate you anymore’. At home, I was having seizures for a while. My hubby wouldn’t sleep. He and his mum would take shifts looking after me. We tried to get assistance but there was nothing for young people. So one day, my husband collapsed on the lounge room floor from exhaustion. It was just a nightmare. That’s how I ended up in aged care.”

Tania spent the next two and a half years between three aged care facilities.

“I wouldn’t wish it upon nobody,” she says.

It was during her nightly ritual of chatting with her daughter via Facebook that Tania typed “young people in nursing homes” into Google. The search engine’s results would lead to her life-changing encounter with the YPINH.

“With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home. Whatever I need, physio, OT – they’ve got my back. I can’t thank them enough for what they’ve done for me.”

Today, Tania is working with the Aboriginal Disability Network, helping Indigenous Australians navigate their way through the National Healthcare System.

It has long been recognised that Aboriginal and Torres Strait Islander people have a life expectancy that is approximately 20 years less than non-Indigenous Australians (Australian Bureau of Statistics). Recent data from the ABS shows that up to 80 per cent of the mortality gap can be attributed to chronic diseases such as heart disease, stroke, diabetes and kidney disease.

For many Aboriginal communities, especially those in remote regions, socio-economic factors play an important role. Kerin O’Dea from Darwin’s Menzies School of Health Research cites unemployment, poor education outcomes and limited access to fresh foods as key factors in her paper, Preventable chronic diseases among Indigenous Australians.

Lifestyle related risks such as smoking, alcohol misuse, stress, poor diet, and inadequate physical activity also need to be addressed, according to the Australian Institute of Health and Welfare .

But the first step, McGowan says, is for indigenous stroke sufferers to recognise the signs of a stroke in themselves and their family members. The NSF recommends the F.A.S.T. test as the most effective way to remember the most common signs of a stroke.

Face: Check their face. Has their mouth drooped?
Arms: Can they lift both arms?
Speech: Is their speech slurred? Do they understand you?
Time: Is critical. If you see any of these signs call 000 straight away.

“If I had known that because I’d lost my vision I had suffered a stroke, I could’ve put two and two together and got help, but I didn’t know anything,” Tania says.

“I was a heavy smoker, but not anymore – no way. Life’s too important. I didn’t ever know anything about a stroke – I was more thinking when you smoke, you can have lung problems and lose your fingers, like on the packets. But they don’t say anything about a stroke – they don’t advertise that stuff.”

The Stroke Foundation called on the Federal Government to fund an urgent $44 million campaign to address the gap in stroke care. For more information on stroke and the campaign, visit strokefoundation.com.au.

Part 2 Aboriginal Stroke Facts

From here

  • The incidence rate of stroke for Aboriginal and Torres Strait Islander Australians has been found to be 2.6 times higher for men and 3.0 for women (Australian Institute of Health and Welfare, 2008; Katzenellenbogan et al. 2010) compared to non-Aboriginal and Torres Strait Islander Australians and many suggest that these figures may in fact be underestimates (Thrift et al 2011).
  • Aboriginal and Torres Strait Islander Australians are known to experience stroke at a younger age than their non-Aboriginal and Torres Strait Islander counterparts, (Katzenellenbogen et al., 2010; Australian Institute of Health and Welfare, 2004) with 60% of Aboriginal and Torres Strait Islander non-fatal stroke burden occurring in the 25-54 year age-group compared to 24% in the non-Aboriginal and Torres Strait Islander group (Katzenellenbogen et al., 2010).
  • The prevalence of stroke is similarly significantly higher at younger ages among Aboriginal and Torres Strait Islander people (Katzenellenbogen 2013), with a significantly higher prevalence of co-morbidities among Aboriginal and Torres Strait Islander patients under 70 years of age, including heart failure, atrial fibrillation, chronic rheumatic heart disease, ischaemic heart disease, diabetes and chronic kidney disease. This reflects the increased clinical complexity among Aboriginal and Torres Strait Islander stroke patients compared with non-Aboriginal/Torres Strait Islander patients.
  • Aboriginal and Torres Strait Islander stroke patients aged 18–64 years have a threefold chance of dying or being dependent at discharge compared to non-Aboriginal and Torres Strait Islander patients (Kilkenny et al., 2012).

NACCHO Aboriginal Health and @MHPNOnline free webinar : Reducing the mental health impact of Indigenous incarceration

NACCHO Member Alert speaker update August 30

 ” Our CEO Pat Turner and NACCHO staff would like to invite all health workers to be a part of this free webinar: Reducing the mental health impact of Indigenous incarceration on people, communities and services.
 
Developed by NACCHO and produced by Mental Health Professionals’ Network (MHPN) the webinar features Q&A with a panel of experts and will explore the key issues and the impact that incarceration has on individuals, families and communities.”

Download FLYER HERE and share /promote this free webinar

No need to travel to benefit from this free PD opportunity.
Simply register and log in to participate from your home, work or anywhere you have a computer or tablet with a high speed internet connection.
 
Register now to attend this free webinar for health practitioners on
Wednesday 13 September 2017, from 4:30pm – 5:45pm AEST.
 
NACCHO also invites all Member services to ask staff to register now to access a free Mental Health Professionals’ Network webinar for their own professional development.
 
The Indigenous interdisciplinary panel will explore and discuss ways of reducing the mental health impact of Indigenous incarceration on people, communities and services.
 
This professional development opportunity is free and the previous webinar conducted by the MHPN had 680 participants across Australia.
 
The webinar features a Q&A with a panel of experts and will explore the key issues and the impact that incarceration has on Aboriginal and Torres Strait Islander peoples.
The panel will discuss strategies to enhance cultural awareness and develop responsive services for Indigenous communities affected by incarceration.

WHO’S ON THE PANEL?
 
Julie Tongs OAM : CEO Winnunga Nimmityjah Aboriginal Health Service ACT
Dr Louis Peachy : QLD-based rural medical advisor
Dr Marshall Watson : SA-based psychiatrist
Dr Jeff Nelson : QLD-based psychologist
 
Facilitator: Dr Mary Emeleus (QLD-based general practitioner and psychotherapist).
 
Simply register and log in to participate from your home, work or anywhere you have a computer or tablet with a high speed internet connection.
Registrations close at midnight on Tuesday 12th September, 2017.
 
Please find attached a flyer about the updated webinar and it would be appreciate if you could distribute this to your local network.
 
 

NACCHO Aboriginal Health and #Smoking : @TheMJA #npc Mass-reach #anti-smoking campaigns must return

Disadvantaged groups are and should be a key focus of action to reduce smoking further. This has long been recognised, including in the report of the National Preventative Health Taskforce, which specifically called for action in relation to Aboriginal and Torres Strait Islander people and other highly disadvantaged groups, such as people with mental health problems,”

The evidence tells us that we need a mix of approaches. We need whole-of-community approaches, with measures such as tax increases and strong mass media campaigns, which benefit disadvantaged groups disproportionately. We also need specific targeted approaches, as this article notes: the Talking About the Smokes project and the Tackling Indigenous Smoking program have played valuable role in complementing mainstream activity.”

 Professor Mike Daube, professor of health policy at Curtin University, welcomed calls for further action on smoking prevalence in disadvantaged groups, and said that a mix of approaches was needed. Professor Daube told MJA InSight.

Read over 100 NACCHO Smoking articles published in past 5 years

NACCHO Aboriginal Health and Smoking : Download Tackling Indigenous Smoking Program prelim. evaluation report

TARGETED tobacco control strategies are urgently needed to tackle the “remarkably high” smoking rates in some high-risk groups, according to Australian authors, but leading public health experts say reinstatement of mass-reach campaigns should be a priority.

Writing in the MJA, Professor Billie Bonevski, a health behaviour scientist and researcher at the University of Newcastle, and co-authors said that the overall smoking prevalence in Australia was now 14%, but among population subgroups, such as those with severe mental illness and those who had been recently incarcerated, the rates were upwards of 67%.

Tobacco use among Aboriginal and Torres Strait Islander people also remained high, with the prevalence among Indigenous people aged 15 years and older being about 39% in 2014–15.

Listen to Podcast HERE

The authors said that a truly comprehensive approach to tobacco control should include targeted campaigns in high smoking prevalence populations.

“If we are truly concerned about this issue, we must focus more attention on the groups that are being left behind,” they wrote.

Novel, targeted interventions and increased delivery of evidence-based interventions was needed, the authors said, noting that tobacco harm reduction strategies, such as vaporised nicotine, should also be further investigated.

In an MJA InSight podcast, lead author Professor Bonevski said that smoking was still “almost … socially acceptable” in some subgroups, such as those from low socio-economic populations.

“People who have lower incomes end up smoking from a younger age and, by the time they reach adulthood, they are more heavily nicotine dependent and … it becomes much harder to quit,” she said. “This is a vicious cycle in terms of socio-economic status contributing to high smoking rates, and then high smoking rates contributing to poor health, and then poor health keeping you in that low socio-economic status group, and so on.”

Professor Simon Chapman, Emeritus Professor in the University of Sydney’s School of Public Health, said that targeting high smoking prevalence subgroups sounded sensible “until we unpack what targeting involves”.

“The world-acclaimed, highly successful Australian national Quit campaign has been scandalously mothballed since 2013. So, talk of fracturing what is now a zero-budgeted, non-operational population-wide campaign into multiple targeted campaigns is currently a ‘brave’ call,” he said.

Professor Chapman said that Australia’s main goal should be to restore our “family silver”: properly funded, mass reach campaigns that reach all subgroups.

He pointed to research, published in 2014, that found that the decline in smoking prevalence in Australia – from 23.6% in 2001 to 17.3% in 2011 – was largely due (76%) to stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns.

Professor Chapman said that higher smoking rates among disadvantaged groups were more likely to be explained by higher uptake, than by failure to quit.

He noted that 22.7% of the most disadvantaged people were ex-smokers, versus 26.9% of the least disadvantaged. “But only 53.5% of the least disadvantaged people have never smoked, compared with 62.9% of the most advantaged,” he said.

Professor Chapman said that labour-intensive interventions were inefficient in preventing uptake among young people.

“It remains the case that most kids who don’t start smoking and most smokers who quit do not attribute their status to a discrete intervention,” he said.

Professor Mike Daube, professor of health policy at Curtin University, welcomed calls for further action on smoking prevalence in disadvantaged groups, and said that a mix of approaches was needed.

See opening statement

 

Professor Daube said that strong action at the public policy and health system levels was crucial.

“At the policy level, this should include immediate resumption by the federal government of national mass media campaigns, which have, incomprehensibly, been absent over the past 4 years; and action to combat the tobacco industry’s cynical strategies to counter the impacts of tax increases and plain packaging,” he said.

“We also need more than lip service within health systems about the physical health of people with mental health problems, not least through support and assistance in quitting smoking. There are some who try, but they are the exception.”

Professor Daube said that the suggestion that vaporised nicotine may play a role in reducing smoking was “very speculative”, and still “some way ahead of the evidence”.

“[We] should await any determination by the [Therapeutic Goods Administration] as to their safety and efficacy,” he said.

Earlier in 2017, the TGA decided to uphold the ban on vaporised nicotine in e-cigarettes in Australia