Remote Australia Online

This study presents the outcomes of the first phase of a three phase research initiative which begins by identifying through the voices of Aboriginal students and community members the teaching practices that influence Aboriginal student engagement and learning. The study occurs within the Diocese of Townsville Catholic Education schools in North Queensland, primarily in the Mount Isa area. Through open-ended interviews, Aboriginal students and community members express their views of the characteristics of effective teachers and effective teaching. Considering that the national education discourse in Australia is monopolised by discussion on teaching and teacher quality, we problematize this discourse based upon what members of the local Aboriginal community assert as characteristics of effective teachers and their practice. Further phases of this research initiative, which investigate the effect of adjusted practice based upon community members assertions, are also presented.

There is a growing body of research documenting Indigenous Peoples and Local Communities' observations of changes in climate. The accuracy, efficacy, and transferability of this research depends on its motives and methods. In this paper, we report on research to produce a working knowledge of changes in climate and its impacts on local biophysical systems in the Tiwi Islands in Northern Australia. Interviews with 52 Tiwi people were combined with diverse forms of aerial data to produce a nuanced understanding of climate change in these remote islands. These data show changes in climate-sensitive biophysical systems that would otherwise remain undetected by instruments conventionally used for monitoring climate change. These include changes in shorelines, which are causing concerns about damage to buildings that are important for Tiwi well-being, and changes in the marine environment and wetlands, which are causing concerns about damage to natural heritage. We discuss the implications of these findings, arguing that systematic observations collected by networks of people ‘on Country’ can provide excellent monitoring of climate change impacts, and that Indigenous people's interests in the effects of climate change overlap with those of non-Indigenous people, as do their rights to support from the State for adaptation.

Introduction Telehealth programs are important to deliver otolaryngology services for Aboriginal and Torres Strait Islander children living in rural and remote areas, where distance and access to specialists is a critical factor. Objective To evaluate the inter-rater agreement and value of increasing levels of clinical data (otoscopy with or without audiometry and in-field nurse impressions) to diagnose otitis media using a telehealth approach. Design Blinded, inter-rater reliability study. Setting Ear health and hearing assessments collected from a statewide telehealth program for Indigenous children living in rural and remote areas of Queensland, Australia. Participants Thirteen board-certified otolaryngologists independently reviewed 80 telehealth assessments from 65 Indigenous children (mean age 5.7 ± 3.1 years, 33.8% female). Interventions Raters were provided increasing tiers of clinical data to assess concordance to the reference standard diagnosis: Tier A) otoscopic images alone, Tier B) otoscopic images plus tympanometry and category of hearing loss, and Tier C) as B plus static compliance, canal volume, pure-tone audiometry, and nurse impressions (otoscopic findings and presumed diagnosis). For each tier, raters were asked to determine which of the four diagnostic categories applied: normal aerated ear, acute otitis media (AOM), otitis media with effusion (OME), and chronic otitis media (COM). Main outcome measures Proportion of agreement to the reference standard, prevalence-and-bias adjusted κ coefficients, mean difference in accuracy estimates between each tier of clinical data. Results Accuracy between raters and the reference standard increased with increased provision of clinical data (Tier A: 65% (95%CI: 63–68%), κ = 0.53 (95%CI: 0.48–0.57); Tier B: 77% (95%CI: 74–79%), 0.68 (95%CI: 0.65–0.72); C: 85% (95%CI: 82–87%), 0.79 (95%CI: 0.76–0.82)). Classification accuracy significantly improved between Tier A to B (mean difference:12%, p < 0.001) and between Tier B to C (mean difference: 8%, p < 0.001). The largest improvement in classification accuracy was observed between Tier A and C (mean difference: 20%, p < 0.001). Inter-rater agreement similarly improved with increasing provision of clinical data. Conclusions There is substantial agreement between otolaryngologists to diagnose ear disease using electronically stored clinical data collected from telehealth assessments. The addition of audiometry, tympanometry and nurse impressions significantly improved expert accuracy and inter-rater agreement, compared to reviewing otoscopic images alone.

Mobile technologies are proving transformative in enabling financial inclusion across both the developing and developed worlds. Policymakers in developing countries are at the forefront of innovative financial inclusion policies. In Australia however, the nearly universal access to banking draws attention away from a growing underbanked population, and technology-enabled financial inclusion is not yet on the policy radar. Remote Indigenous communities are the most financially and digitally excluded group in Australia. The literature on the use of mobile phones in these communities, and patterns of money management and banking is fragmentary. For underbanked Indigenous participants, their remoteness, combined with cultural preferences for face to face banking, means that many people pay higher account keeping and transaction fees. Though many have access to mobile phones (half of which are smart phones), mobile phone banking is not yet popular. An ongoing study of money, banking and mobile phones in remote Indigenous Australia frames the design and policy problems for industry and government. It outlines a methodology for gaining evidence about the underbanked and identifying user problems. It also suggests ways of designing 'culturally appropriate' financial products, services and education programs, which can be followed to address financial exclusion of other underbanked communities in Australia.

By the 1970s, Christian missions to Aboriginal people in the Northern Territory were enthusiastic supporters of Indigenous self-determination, even as they sought to maintain a missionary presence in Aboriginal communities. This article asks how missions continued to seek to influence and direct Aboriginal churches and communities through espousing self-determination, and how Aboriginal leaders engaged with and exploited this apparent contradiction. Focusing on contributions to the missiological publication Nelen Yubu from Deacon Boniface Pedjert, Patrick Dodson, Miram Rose Ungunmerr-Baumann, Dyiniyini Gondarra and Alice Kelly this article considers how Aboriginal leaders and thinkers managed and challenged non-Indigenous expectations set for them around how their decolonisation was to proceed. Self-determination, for missionaries, could be achieved by a new, supposedly more enlightened mission to ‘inculturate’ the gospel. Whereas missionaries presumed Aboriginal church leaders' authority rested in their cultural authenticity, these Aboriginal leaders were also asserting other sources of authority including their culture, but especially the authority that arises from Country itself.

This paper reports on a large-scale quantitative psychometric study conducted in very remote and remote Indigenous communities in the Northern Territory Australia. Thirteen school sites and 1,044 participants contributed to the study. The full study is concerned with examining the inter-relationships between multiple achievement goals, future goals, self-regulation, and learning processes and their relationship to achievement outcomes in communities that are very remote geographically and culturally from Western settings. The study reported in this paper sets out to examine four key issues: the construct validity and reliability of the multiple motivational scales drawn from Personal Investment theory for very remote and remote Indigenous students in Australia; the level of endorsement of these motivational scales for remote and very remote Indigenous students; any differences between groups considered collectivist and individualist on these multiple goals, and lastly, the theoretical, methodological, cultural, and logistical difficulties encountered in conducting the research that may have impacted on its external validity.

Using frameworks for the analysis of policy devised by Colebatch and Bacchi, three accounts are developed of the emergence of an Australian government program for Indigenous employment and community participation in remote areas. Timeframes increase and types of actors change moving from an authoritative choice account to structured interaction and then problematisation. Individual agents in authoritative choice are replaced in structured interaction by government departments as distinctive organisational actors. In the problematisation account, concepts become the dominant actors, changing over longer timeframes. In remote Indigenous employment a change in problematisation is discerned in the 1970s, from inclusion in award wages and social security to concerns about welfare dependence. A later problematisation change reframes a 1970s program from employment to welfare.

INTRODUCTION: In remote Australia timely access to pathology results and subsequent follow-up of patients for treatment is very challenging due to the long distances to the nearest laboratory. Point-of-care testing (POCT) offers a practical solution for pathology service provision in such remote communities. Since 2008, POCT for haemoglobin A1c (HbA1c) has been conducted in remote Northern Territory (NT) health centres for diabetes management of Indigenous patients through the national Quality Assurance in Aboriginal and Torres Strait Island Medical Services (QAAMS) Program. METHODS: Point-of-care testing HbA1c results performed on Indigenous diabetes patients in the NT from July 2008 to April 2011 was accessed via the NT's electronic patient information system. Patients who had three or more HbA1c results performed by POCT across this period were assessed to determine their overall change in glycaemic control. An audit of 40 of these Indigenous diabetes patients (who exhibited a decrease in HbA1c levels of more than 1.5%) was undertaken to compare clinical and operational efficiency of POCT versus laboratory testing over an equivalent time period (15 months). RESULTS: No change in glycaemic control was observed when these patients received laboratory HbA1c testing prior to the introduction of POCT. Long turnaround times for receipt of results and follow-up consultation with patients were identified during this period, compared to immediate receipt and actioning of results using POCT. Frequency of HbA1c testing was higher with POCT than for the laboratory. CONCLUSIONS: This audit demonstrates that POCT can significantly improve the timeliness and clinical follow-up of pathology results in remote locations, while also reinforcing the clinical and cultural effectiveness of POCT and its critical role in assisting to improve diabetes management in Indigenous Australians.

Objective: To determine the rates of HIV testing among people who had received positive test results for chlamydia, gonorrhoea and trichomoniasis, or who had been tested for syphilis. Design, setting and participants: Pathology data for the period January 2010 - December 2014 from 65 remote Aboriginal communities participating in the STRIVE trial of sexually transmissible infection (STI) control were analysed. Main outcome measures: Rates of HIV testing within 30 and 90 days of an STI test (for chlamydia, gonorrhoea or trichomoniasis), the result of which was positive, and within 30 days of a test for syphilis; factors independently associated with concurrent HIV testing. Results: 31.8% of 15 260 positive STI test results were linked with an HIV test within 30 days of the test (including 5.6% not on the same day), and 34.8% within 90 days; 44.1% were linked with syphilis testing within 30 days. 53.4% of all those tested for syphilis were also tested for HIV within 30 days. Multivariate analysis found that HIV testing was more likely for men, in geographical regions 3 and 4, in association with positive STI test results during 2012, 2013 or 2014 (v 2010), and in association with positive test results for gonorrhoea or chlamydia. Similar associations with these factors were found for syphilis testing. Conclusions: A significant challenge in Aboriginal health is avoiding an increase in the number of HIV infections. One critical intervention in this regard is timely and appropriate testing. Adhering to screening recommendations is clearly an aspect of the delivery of sexual health services to remote communities that can be improved in striving to achieve this aim.

Objective: To describe the epidemiology of infectious syphilis among Aboriginal and Torres Strait Islander (Indigenous) people in Australia. Design and setting: We assessed trends in national infectious syphilis notification rates from 2005 to 2009 using Poisson regression, with a focus on geographic and demographic differences by Indigenous status. We compared Indigenous and non-Indigenous rate ratios over the study period and summarised the annual changes (summary rate ratio). Main outcome measures: Crude notification rates and summary rate ratios by Indigenous status, jurisdiction, sex, age group and area of residence. Results: From 2005 to 2009, in the Indigenous population, there was a substantial decline in the notification rate for infectious syphilis nationally; as well as in the following subgroups: females, 15?29 year olds, and people living in outer regional and remote areas in the Northern Territory and Queensland. In contrast, there was a significant (P < 0.001) upward trend in the notification rate in the non-Indigenous population nationally; as well as in males, in people aged 20 years and over, and in residents of metropolitan and regional areas, New South Wales, Queensland, South Australia, Victoria and Western Australia. The highest summary rate ratios were seen in remote/very remote areas (86.33; 95% CI, 57.45-129.74), in 15-19 year olds (64.65; 95% CI, 51.12-81.78), in females (24.59; 95% CI, 19.73-30.65), and in Western Australia (23.89; 95% CI, 19.82-28.82). Conclusion: These data demonstrate that Australia has two distinct patterns of infectious syphilis: a substantially declining occurrence in Indigenous remote communities and an increasing incidence in males residing in urban and regional areas. Given the decline in notification rates in Indigenous remote communities, now might be the right time to move toward eliminating infectious syphilis from Indigenous communities.

Background: Education for health literacy of Australian Aboriginal people living remotely is challenging as their languages and worldviews are quite different from English language and Western worldviews. Becoming health literate depends on receiving comprehensible information in a culturally acceptable manner. Methods: The study objective was to facilitate oral health literacy through community education about scabies and strongyloidiasis, including their transmission and control, preceding an ivermectin mass drug administration (MDA) for these diseases. A discovery education approach where health concepts are connected to cultural knowledge in the local language was used. Aboriginal and non-Aboriginal educators worked collaboratively to produce an in-depth flip-chart of the relevant stories in the local language and to share them with clan elders and 27% of the population. Results: The community health education was well received. Feedback indicated that the stories were being discussed in the community and that the mode of transmission of strongyloidiasis was understood. Two-thirds of the population participated in the MDA. This study documents the principles and practice of a method of making important Western health knowledge comprehensible to Aboriginal people. This method would be applicable wherever language and culture of the people differ from language and culture of health professionals.

Tropical savannas are characterized by high primary productivity and high fire frequency, such that much of the carbon captured by vegetation is rapidly returned to the atmosphere. Hence, there have been suggestions that management-driven reductions in savanna fire frequency and/or severity could significantly reduce greenhouse gas emissions and sequester carbon in tree biomass. However, a key knowledge gap is the extent to which savanna tree biomass will respond to modest shifts in fire regimes due to plausible, large-scale management interventions. Here, we: (1) characterize relationships between the frequency and severity of fires and key demographic rates of savanna trees, based on long-term observations in vegetation monitoring plots across northern Australia; (2) use these relationships to develop a process-explicit demographic model describing the effects of fire on savanna tree populations; and (3) use the demographic model to address the question: to what extent is it feasible, through the strategic application of prescribed burning, to increase tree biomass in Australian tropical savannas? Our long-term tree monitoring dataset included observations of 12,344 tagged trees in 236 plots, monitored for between 3 and 24 years. Analysis of this dataset showed that frequent high-severity fires significantly reduced savanna tree recruitment, survival, and growth. Our demographic model suggested that: (1) despite the negative effects of frequent high-severity fires on demographic rates, savanna tree biomass appears to be suppressed by only a relatively small amount by contemporary fire regimes, characterized by a mix of low- to high-severity fires; and (2) plausible, management-driven reductions in the frequency of high-severity fires are likely to lead to increases in tree biomass of about 11.0 t DM ha 1 (95% CI: -1.2-20.8) over a century. Accounting for this increase in carbon storage could generate significant carbon credits, worth, on average, three times those generated annually by current greenhouse gas (methane and nitrous oxide) abatement projects, and has the potential to significantly increase the economic viability of fire/carbon projects, thereby promoting ecologically sustainable management of tropical savannas in Australia and elsewhere. This growing industry has the potential to bring much-needed economic activity to savanna landscapes, without compromising important natural and cultural values.

Background Acquired zoonotic infections with Pasteurella bacterial species have a wide clinical spectrum of disease from invasive infections to localised bite-wound infections. Methods This study reviewed the spectrum of the demographic, clinical, temporal, and microbiological trends of laboratory confirmed Pasteurella species infections presenting to a single-centre tropical tertiary hospital over a twenty-year period. Results 195 episodes from 190 patients were included. 51.3% patients were female, and 20.5% Aboriginal or Torres Strait Islander peoples. Crude incidence of Pasteurella spp. infections increased from 1.5 per 100,000 population in 2000, to 11.4 per 100,000 population in 2021. There were 22 (11.3%) bloodstream infections, 22 (11.3%) invasive, 34 (17.4%) deep local, 98 (50.2%) superficial infections, and 19 (9.7%) other or unknown. Adults over 65 years of age accounted for the majority of bacteraemias (63.7%). More severe infections, including bacteraemia, invasive and deep local infections, were more common in lower limb infections and in those with underlying comorbidities. Animal contact with cats was more common in bloodstream infections (36.4%), but dog bites more common in invasive, deep local and superficial infections. 30-day all-cause mortality was low at 1.0%. Pasteurella multocida was most commonly identified (61.1%), but P. canis, P. dagmatis, and other Pasteurella infections were also noted. 67.7% of specimens were polymicrobial, with other significant organisms being Staphylococcus aureus, Streptococcus pyogenes, Group G Streptococcus and Pseudomonas aeruginosa. Conclusion Pasteurella species remain clinically important pathogens, with the ability to cause severe and invasive infections with associated morbidity. Presentations to hospital are becoming more common, and the polymicrobial nature of bites wounds has implications for empiric antibiotic guidelines.

Objectives: The aim of this study was to describe prevalence and characteristics of psychotic disorders in a remote Indigenous population.Method: Clinical review of all patients with an active diagnosis of a psychotic disorder in remote communities of Cape York and the Torres Strait.Results: 170 patients were identified and demographic, social and treatment variables described.Conclusions: Psychotic disorders are common and more so among young adult Aboriginal men, with high rates of comorbid conditions including substance use, intellectual impairment and diabetes. In parallel to this case complexity, there are high rates of coercive treatments. Certain differences by ethnicity and location are described and possible explanations proposed.

This document reports on the outcomes of the ARC Linkage funded project, Garuwanga: Forming a Competent Authority to Protect Indigenous Knowledge (the Garuwanga Project). The Garuwanga Project employs the Nagoya Protocol as the basis upon which the research seeks to explore possible options in Australia for implementing the Protocol’s provisions regarding competent authorities for the protection, administration and management of Indigenous knowledge. The Nagoya Protocol came into force on 12 October 2014, and has already been ratified by 138 United Nations (UN) member states including the European Union. Implementation of the Protocol requires the establishment of national focal points and competent national authorities (which may be one and the same). Such authorities, if created as non-government organisations and/or if governed by representatives of the communities they are intended to protect, could assist Indigenous communities to achieve self-determination in accordance with the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). This report outlines the forms of competent authorities already established by other nations to protect Indigenous knowledge as well as the legal and governance structures already utilised by Indigenous communities in Australia to protect their knowledge and culture. A key feature of this project is the Indigenous governance principles developed to evaluate Australian-based organisations that could provide potential models for such a competent authority. With the assistance of these principles and the outcomes of the Garuwanga Project 'on Country' consultations, the project has proposed a tiered approach for competent authorities to operate in Australia starting with the local or regional level and being supported by a reporting and standard-setting body at the national level. A national level organisation of this kind may form the Australian national competent authority as provided for under the Nagoya Protocol.

Up to 98% of visual loss secondary to diabetic retinopathy (DR) can be prevented with early detection and treatment. Despite this, less than 50% of Australian and American diabetics receive appropriate screening. Diabetic patients living in rural and remote communities are further disadvantaged by limited access to ophthalmology services. Research Design and Methods. DR screening using a nonmydriatic fundal camera was performed as part of a multidisciplinary diabetes service already visiting remote communities. Images were onforwarded to a distant general practitioner who identified and graded retinopathy, with screen-positive patients referred to ophthalmology. This retrospective, descriptive study aims to compare the proportion of remote diabetic patients receiving appropriate DR screening prior to and following implementation of the service. Results. Of the 141 patients in 11 communities who underwent DR screening, 16.3% had received appropriate DR screening prior to the implementation of the service. In addition, 36.2% of patients had never been screened. Following the introduction of the service, 66.3% of patients underwent appropriate DR screening (). Conclusion. This innovative model has greatly improved accessibility to DR screening in remote communities, thereby reducing preventable blindness. It provides a holistic, locally appropriate diabetes service and utilises existing infrastructure and health workforce more efficiently.

Experimentation with continuous quality improvement (CQI) processes is well underway in Indigenous Australian primary health care. To date, little research into how health organizations take up, support, and embed these complex innovations is available on which services can draw to inform implementation. In this paper, we examine the practices and processes in the policy and organisational contexts, and aim to explore the ways in which they interact to support and/or hinder services' participation in a large scale Indigenous primary health care CQI program.

The use of medications is the most common intervention in healthcare. However, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. A Virtual Clinical Pharmacy Service (VCPS) was introduced in rural and remote New South Wales public hospitals to support safe and effective use of medications. In this model clinical pharmacy services are delivered via a telehealth cart at the patient’s bedside and through electronic medical and pharmaceutical record systems. The aim of this research was to understand healthcare staff perspectives of the VCPS and identify areas for improvement.

In remote Aboriginal communities in NSW when family violence or child sexual assault or sexual assault occurs there is a lack of accessible legal services that can assist such victims. Many rural and remote communities have gone for years without access to a counselor, psychologist or sexual assault worker. The solution lies in government departments and community organizations working with Aboriginal communities . All sections of the community must take responsibility by addressing these problems and removing violence from Aboriginal communities.

Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.

Objective: To determine the extent to which depressive symptoms are associated with heavy cannabis use in an Aboriginal population in Arnhem Land, Northern Territory. Design, participants and setting: Cross-sectional study involving interviews with 106 Indigenous participants (57 males, 49 females) aged 13-42 years in three remote Aboriginal communities in Arnhem Land, NT, Australia. Main outcome measures: Measures of depressive symptoms (a raw score of ≥ 6 out of a possible 18 on a modified version of the Patient Health Questionnaire-9) and self-reported heavy cannabis use (six or more cones daily). Results: After adjusting for other substance use (tobacco, alcohol and lifetime petrol sniffing), age and sex, heavy cannabis users were four times more likely than the remainder of the sample to report moderate to severe depressive symptoms (odds ratio, 4.1; 95% CI, 1.3-13.4). Conclusions: Given its high prevalence in Indigenous populations, the development of clinical and prevention strategies for cannabis misuse are warranted.

Objectives: To evaluate a 12-month trial of an evidence-based non-residential treatment program for Indigenous clients with alcohol problems, offering three streams of care: pharmacotherapy, psychological and social support. Methods: Process evaluation of program implementation; outcome evaluation of client outcomes. Results: Implementation: despite constraints of time and remoteness, the trial demonstrated the feasibility of implementing such a program. The medical stream generated fewer pharmacotherapy prescriptions than expected. The most active stream was the psychological therapy stream. Outcomes: between March 2008 and April 2009, 129 clients were referred to the program, of whom 49 consented to have de-identified data used for the evaluation. Of these, 19 clients received one or more streams of care, 15 of whom (78.9%) subsequently stopped or reduced drinking. However, among the remaining 30 consenting clients who had not received an intervention, 70.0% also reported stopping or reducing drinking. The evidence of program effectiveness is therefore equivocal and evaluation over a longer period is required. Conclusion and implications: The trial demonstrated the viability of, and demand for, evidence-based non-residential treatment for Indigenous clients with alcohol problems. Reasons behind an apparent reluctance among GPs to prescribe pharmacotherapy for Indigenous clients, and steps to overcome this, need further attention.

Discharge against medical advice (DAMA), also referred to as self-discharge, occurs when an in-patient leaves a hospital or healthcare setting before discharge is advised by the treating provider. DAMA causes interruption of treatment therapies and is strongly associated with post-operative complications, increased morbidity and mortality, readmission, and increased healthcare expenditure. It is widely known that Aboriginal and Torres Strait Islander peoples suffer from increased rates of chronic disease and have poorer health outcomes than the non-Indigenous population.

Introduction and Aims. We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Design and Methods. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Results. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Discussion and Conclusions. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.

Editorial: Battling the tyranny of distance: Mental health in regional, rural, and remote Australia