Jamie Bryant

This study aimed to assess the recorded prevalence of a dementia diagnosis and the receipt of appropriate dementia care among current Aboriginal and Torres Strait Islander clients of Aboriginal and Community Controlled Health Services (ACCHS) aged 45 and over, as documented in medical records. ACCHSs are Australian primary healthcare organisations that are initiated, governed and operated by local Aboriginal and Torres Strait Islander communities. A manual audit of medical records was undertaken by a staff member from each participating ACCHS to identify current clients with a documented diagnosis of dementia and examine their receipt of key elements of dementia-related care. Across 9 ACCHSs located in New South Wales, a total of 70 clients with a recorded diagnosis of dementia were identified (1.2% recorded prevalence rate). The majority of clients with a dementia diagnosis had documented receipt of elements of appropriate dementia care including an active chronic disease management plan (61%), annual health assessment (56%), referral to aged care services (69%), and assessment of one or more dementia-related risks (94%). However, less than half of clients had a documented cognitive assessment within the last 12 months (41%) or completed any advance planning documentation (37%). Clients with a dementia diagnosis received a mean of 3.6 out of 6 assessed elements of best practice dementia care. As with primary care nationally and internationally, ACCHSs require co-designed support strategies to enhance their processes for dementia diagnosis and documentation and to build upon their delivery of best-practice dementia care. Priority dementia care areas for older clients with a confirmed dementia diagnosis include the evaluation of dementia-related risks such as elder abuse and driving safety, and the implementation of advance care planning including discussion or completion of relevant legal documents. Australian New Zealand Clinical Trials Registry ( https://anzctr.org.au/ ): Registration Number: 12621000905864.

Issue Addressed: Oppression and violence associated with colonisation have contributed to intergenerational trauma and health inequities for Aboriginal and Torres Strait Islander peoples. Health promotion can help reduce inequities by strengthening connections that support social and emotional wellbeing and enable conditions for communities to lead healthy lives. While culturally responsive health promotion strategies exist, it is unknown the extent to which these account for trauma. Methods: We conducted a narrative review to examine the intersection of evidence describing social and emotional wellbeing, trauma and health promotion for Aboriginal and Torres Strait Islander peoples. Literature was identified between April 2025 and June 2025, with an update performed in July 2026, through iterative searches of Google Scholar, Medline and HealthInfoNet, supplemented by citation tracking of key publications and relevant grey literature. Sources were selected based on relevance to the review aim, with the scope iteratively broadened from trauma‐informed approaches within Indigenous health promotion internationally to include trauma‐informed approaches in health promotion more broadly and health promotion for Aboriginal and Torres Strait Islander peoples. Results: Limited guidance was identified on how to apply trauma‐aware, healing‐informed approaches within health promotion for Aboriginal and Torres Strait Islander peoples. While frameworks exist in trauma‐informed care and health promotion separately, limited evidence of the integration of these two concepts was found. Where integration occurs, the guidance found was largely conceptual and lacks detail for implementation. Conclusions: Recognising the influence that trauma can have on health behaviours and applying trauma‐aware, healing‐informed principles may strengthen the safety, relevance and effectiveness of health promotion initiatives for Aboriginal and Torres Strait Islander peoples. So What?: Continuing to apply health promotion strategies without accounting for the social, historical and cultural impacts of colonisation and trauma may risk disengagement or unintended harm. A trauma‐aware, healing‐informed approach builds on existing culturally responsive, strengths‐based and community‐controlled health promotion by making explicit how trauma shapes health behaviours, which helps create the conditions for healing. This review provides the evidence and conceptual rationale for the development of a community‐led framework to guide the design, implementation and evaluation of trauma‐aware, healing‐informed health promotion for Aboriginal and Torres Strait Islander peoples.

Introduction: Mailed smoking and vaping cessation support provided through the Which Way? Quit Pack programme has demonstrated acceptability and preliminary effectiveness in delivering culturally grounded support. However, there is no evidence of the effectiveness of mailed cessation programmes for Aboriginal and Torres Strait Islander people when implemented on a national scale. Building on previous work, this study aims to evaluate both the implementation effectiveness and cost-effectiveness analysis of the Which Way? Quit Pack mailed smoking and vaping cessation intervention for Aboriginal and Torres Strait Islander people. Methods and analysis: A national single-group hybrid type 2 effectiveness-implementation study with 2000 Aboriginal and/or Torres Strait Islander people who use cigarettes and/or e-cigarettes (vapes) daily, want to quit and are aged ≥18 years. Participants will receive access to a culturally tailored mailed quit pack that includes up to a 12-week supply of nicotine replacement therapy, phone-based behavioural counselling and access to an online support forum. Cessation outcomes including 7-day point prevalence abstinence, prolonged abstinence and quit rates will be evaluated at 3, 6 and 12 months. An intention-to-treat approach will be used for cessation outcomes, with participants lost to follow-up classified as smokers or vapers. Exploratory logistic regression analyses will examine factors associated with quitting, and causal machine learning methods will be used to explore variation in intervention effectiveness across participant subgroups. The Reach-Effectiveness-Adoption-Implementation-Maintenance framework will guide evaluation of implementation and effectiveness outcomes. Analysis measures include cessation and quit attempt rates, number of participants recruited, representativeness and intervention uptake. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) will guide the cost-effectiveness analysis. Ethics and dissemination: This study is governed by Aboriginal and Torres Strait Islander leadership and community-controlled partnerships and is conducted in line with Indigenous data sovereignty and Indigenous research ethics principles. The study has also received approval from the following human research ethics committees: Aboriginal Health & Medical Research Council of NSW (2493/25), Aboriginal Health Committee South Australia (04-25-1209), the Western Australian Aboriginal Health (HREC1474), the Victorian Aboriginal Community Controlled Health Organisation (2025/HREC0061) and the University of Newcastle Human Research (H-2025-0311). Findings will be disseminated in forms determined, governed and endorsed by Aboriginal and Torres Strait Islander people and communities through the project Governance, including peer-reviewed publications, policy briefs, community-led knowledge translation activities and presentations at local, national and international conferences. Trial registration number: ACTRN12626000459325.

Introduction: To compare the characteristics of people who vape, smoke commercial tobacco, or engage in dual use among a cohort of Aboriginal and Torres Strait Islander people participating in the Which Way? Quit Pack study. Methods: An online cross-sectional survey was conducted with Aboriginal and Torres Strait Islander people who: were aged 16 and above; resided in New South Wales, Victoria, and the Australian Capital Territory; smoked commercial tobacco and/or vaped; and wanted to quit. Data were collected from October 2, 2023 to August 9, 2024. Self-reported sociodemographic characteristics and cessation experiences were assessed, and differences were examined based on whether participants used commercial tobacco only, vaping only, or both. Results: A total of 880 participants completed the survey and were included for analysis. Participants predominantly smoked commercial tobacco only (n = 614; 69.8%), followed by dual-use (n = 170; 19.3%) and vaping only (n = 96; 10.9%). Participants <25 years were significantly more likely to engage in vaping and dual-use compared with all other age groups. Participants living in outer regional and remote areas were less likely to report dual-use (95% CI = 0.32, 1.00; P = .049) and less likely to use vapes (95% CI = 0.11, 0.56; P < .001) than those in major cities. Women were more likely to use vapes than men (95% CI = 1.46, 5.90; P = .002). Regardless of use type, participants reported an interest in cessation medications. Conclusions: This study highlights important differences in smoking and vaping behaviors among Aboriginal and Torres Strait Islander people seeking to quit warranting further investment and research. Tailored cessation support that reflects the diverse experiences and needs of Aboriginal and Torres Strait Islander peoples, particularly in relation to age, gender, and geographic location is needed. Implications: The high use of vapes and dual use among Aboriginal and Torres Strait Islander women, young people, and those living in major cities highlights the critical need for equitable, targeted cessation support for populations subjected to targeted marketing. Increased access to evidence-based support for Aboriginal and Torres Strait Islander people, regardless of their nicotine and tobacco use type, is needed to empower nicotine-free generations.

Objectives: This study aimed to explore the perceptions of Australian healthcare providers (HCPs) of the usefulness of smart inhalers for children with asthma and considerations for their effective integration into routine care. Design: Qualitative descriptive study using semi-structured interviews. A hybrid thematic analysis approach was used to analyse the data. Setting: Healthcare services in Australia including general practice, hospitals and Local Health Districts. Participants: Eight general practitioners, six paediatric specialists and nine respiratory nurses were recruited using a unique purposive sampling strategy for each HCP group. Primary and secondary outcome measures: Perceptions of the facilitators and challenges to the adoption of smart inhalers for childhood asthma management. Results: Most HCPs had not previously used smart inhalers. Perceived benefits of smart inhalers included access to objective medication use data to inform asthma treatment decisions and enable opportunities to discuss asthma management with parents and carers. Key facilitators for implementation included evidence of clinical effectiveness, financial incentives (both in terms of subsidised smart inhaler costs for users and reimbursement for HCPs) and integration of smart inhaler data into existing medical record systems. The primary barrier to implementation identified was related to workflow issues, including available resourcing, support and time. Conclusions: HCPs expressed generally positive views about the potential of smart inhalers to improve asthma management among children. However, they also identified several practical, logistical and clinical barriers that must be addressed prior to widespread implementation of smart inhalers. Targeted strategies that address these barriers will be essential for successful implementation into routine care.

Introduction: Aboriginal and Torres Strait Islander people report disproportionately high rates of tobacco use, driven by the tobacco industry and sustained through coloniality. A gap remains regarding the effectiveness of culturally tailored, community-led cessation strategies. Methods: A pre-post hybrid type 1 effectiveness-implementation trial was conducted across NSW, ACT, and Victoria, Australia. Eligible participants identified as Aboriginal and/or Torres Strait Islander, current daily smokers aged ≥16 years and willing to quit in the next 30 days. Participants received the Quit Pack intervention, consisting of mailed cessation resources, free combination nicotine replacement therapy (NRT), and behavioral support. Surveys were completed at baseline, 3 months, and 6 months. Data were collected between October 2023 and February 2025. Intention-to-treat (ITT) and complete case (CC) analyzes were conducted. Results: A total of 722 participants were included. At 6-months follow-up, 16% reported 7-day PPA in the ITT analysis (39% CC). At 3-months follow-up, 23% reported 7-day PPA (ITT; 44% CC). At 6-months, continuous abstinence was reported by 11% of participants (30% CC), and 30% of participants reported making a quit attempt lasting at least 24 hours (97% CC). Almost all participants (97.5%) requested NRT at baseline, and 96% reported using NRT at 3 months. Intervention acceptability was high; 88% rated receiving free NRT and having it mailed home as very important. Conclusions: This Indigenous-led cessation trial, the largest conducted in Australia to date, demonstrates the acceptability and potential effectiveness of culturally responsive mailed cessation support incorporating combination NRT. Findings support national expansion of the intervention. Implications: Urgent investment in cessation supports are required to address the significant burden of disease caused by tobacco on the health of Aboriginal and Torres Strait Islander people. Quit Pack shows promise as both an acceptable and effective smoking cessation intervention for Aboriginal and Torres Strait Islander people in New South Wales, Victoria and the Australian Capital Territory. The program has potential to scale up country-wide with appropriate funding and partnerships with diverse Aboriginal and Torres Strait Islander communities.

Introduction Early-life socioeconomic status (SES) increases the risk of poor mental health outcomes in adulthood. However, the mechanistic pathways underlying this relationship remain poorly understood. While addressing socioeconomic inequalities remains a long-term goal, identifying specific mediating pathways could reveal more immediate opportunities for effective interventions. Methods and analysis Using linked administrative data from New South Wales, Australia (1990–2022), we will emulate a target trial examining the relationship between SES at birth and acute mental health admissions and presentations between the ages of 18 and 25 years. An interventional mediation analysis will be used to examine the effect of multiple mediating pathways, including education, housing stability, child protection contact, parental incarceration and justice system involvement, on the outcome. The analysis will estimate direct and indirect interventional effects, quantifying how much of the SES-mental health relationship could be modified by interventions on specific mediators. Ethics and dissemination This study has received ethics approval from the University of Newcastle (H-2024-0015) and Aboriginal Health and Medical Research Council (2265/24) Human Research Ethics Committees. All dissemination activities will be conducted in accordance with data access agreements and following approval from all relevant data custodians (New South Wales Health System Data Services). Key findings will be communicated to relevant government agencies and policymakers through policy briefs and stakeholder meetings, and publication in appropriate academic journals.

Elder abuse is defined as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an old...

Introduction: Tobacco use is the most significant modifiable risk factor for adverse health outcomes, and early research indicates there are also significant harms associated with vaping. National targets aim to reduce smoking and vaping during pregnancy for Aboriginal and Torres Strait Islander people. While most Aboriginal and Torres Strait Islander people want to quit, cessation is frequently attempted without support, increasing the chance of relapse. Group-based smoking cessation programmes increase quit success by 50%–130% in the general population; however, they have never been evaluated in Aboriginal and/or Torres Strait Islander communities. Methods and analysis: The Gulibaa study is an Indigenous-led and community-embedded project that will co-design, implement and evaluate a group-based model of care to support Aboriginal and Torres Strait Islander women to be smoke- and vape-free. Staff of Health Services in New South Wales, Australia, will receive training to deliver a face-to-face group-based smoking and vaping cessation intervention. Aboriginal and/or Torres Strait Islander people who identify as a woman or non-binary, are pregnant or of reproductive age (16 to 49 years), currently smoke or vape at least once per day and are willing to attend the programme are eligible to participate. Up to 500 participants will be recruited. A mixed method evaluation approach will be implemented guided by the RE-AIM framework. Outcomes will include intervention reach, intervention effectiveness (determined primarily by self-reported 7-day point prevalence abstinence at 6 months follow-up), acceptability and feasibility of the intervention, programme fidelity and maintenance and cost effectiveness. Ethics and dissemination: Embedding culturally safe support to quit during pregnancy can result in improved outcomes for both mother and child and immediately improve intergenerational health and well-being. Ethics approval has been provided by the Aboriginal Health and Medical Research Council and the University of Newcastle. Study findings will be disseminated to Aboriginal and Torres Strait Islander communities in ways that are meaningful to them, as well as through Aboriginal health services, key national bodies, relevant state and federal government departments. Trial registration number: ACTRN12625001050448.

Introduction: There is an urgent need for community-led and embedded smoking and vaping cessation programs developed for and by Indigenous people to address the disproportionate tobacco-related harms stemming from colonization. This article describes the development of an Indigenous-led program for Aboriginal and Torres Strait Islander women during pregnancy and the perinatal period, drawing on Indigenous knowledges to prioritize and integrate behavior change techniques (BCTs). Methods: A systematic process involving four steps was implemented to uphold Indigenous knowledges, rights and self-determination in program co-creation. First, we identified and prioritized BCTs that are important and meaningful to Aboriginal and Torres Strait Islander people, and identified effective BCTs from existing published literature. These steps informed a collective program development process of iterative development, reflection, and feedback to weave BCTs in the final program. Results: The BCT domains prioritized by Aboriginal and Torres Strait Islander people included natural consequences, antecedents, goals and planning, social support and comparison of outcomes. Twenty-four BCTs across fifteen domains were identified from the peer-reviewed literature. The final program incorporates fifteen behavior change domains and 60 unique individual BCTs. Conclusions: The Which Way? Women’s Group-based Smoking and Vaping Cessation Program was co-created with Aboriginal and Torres Strait Islander women and community partners, drawing on the knowledges and wisdom of Aboriginal and Torres Strait Islander people and BCTs. The effectiveness of the program will be tested in a hybrid-Type 1 implementation trial. Implications: This article reports a novel co-creation process led by Aboriginal and Torres Strait Islander women in partnership with community to develop a smoking and vaping cessation program for women during the pregnancy and perinatal period. In detailing the development process used, this work upholds Indigenous rights to self-determination as outlined in the World Health Organization Framework Convention on Tobacco Control. Our transparent reporting upholds Indigenous ethics and provides valuable insights to inform the development of other interventions aimed at supporting Indigenous women and communities in empowering smoke and vape-free generations.