Teenage motherhood is an important public health issue due to an associated increased risk of adverse neonatal and maternal outcomes. There is ample evidence that childhood adversity is associated with teenage motherhood. Parental incarceration is a recognised childhood adversity that has been increasing in prevalence due to the escalating global rate of female incarceration. However, the incidence of teenage motherhood in females exposed to parental incarceration is unknown. This study examined whether adolescent females whose mothers were incarcerated had a greater likelihood of teenage motherhood compared to non-exposed adolescent females.

The study sample included 12,629 Western Australian females aged ≥12 years who did (n=3703) or did not (n=8926) have exposure to maternal incarceration. We compared the rate of births to teenage mothers for exposed and non-exposed females and used Kaplan-Meier plots to estimate the unadjusted probability of births for each group. We ran multivariate Cox proportional hazards regression models to estimate the risk of births to teenage mothers with versus without maternal incarceration exposure, stratified by Aboriginal ethnicity. Proportions of babies born preterm, low birthweight, and requiring additional antenatal care were also compared amongst groups.

The unadjusted rate of births to teenage females exposed to maternal incarceration was 2.23 (95%CI = 2.03, 2.44) times higher than the rate among non-exposed females. After adjustment for sociodemographic risk and adversity factors, maternal incarceration was associated with an increased risk of teenage motherhood for both non-Aboriginal (aHR=2.60, 95%CI=1.89, 3.58) and Aboriginal (aHR=1.26, 95%CI=1.11, 1.43) females. Babies born to teenage mothers had equivalent neonatal outcomes regardless of maternal incarceration exposure.

Maternal incarceration was the strongest risk factor of all included variables for teenage motherhood amongst non-Aboriginal females. Results for Aboriginal females were more moderate, but still demonstrated an increased risk associated with maternal incarceration. Provision of timely and sensitive support services to address adversity and disadvantage for all children of incarcerated mothers may help to address the high rate of teenage motherhood in this population and contribute to interrupting intergenerational cycles of disadvantage.

There is a high prevalence of substance use amongst incarcerated women; however, the risk of neonatal abstinence syndrome (NAS) amongst infants born to women incarcerated during pregnancy is unknown. This study examines the incidence of NAS in infants born to women incarcerated during pregnancy and those with a recent history of incarceration.

Infants born between 1985 and 2011 in Western Australia were divided into three mutually exclusive groups: born to women incarcerated during pregnancy (n=708); born within 9-24 months of the mother’s release from prison (n=651); born to women who were never incarcerated (n=17,712). Odds of NAS were compared using logistic regression. Differences in outcomes according to the timing of incarceration during pregnancy were also examined.

The odds of NAS in infants born to currently or recently incarcerated women were 55-times and 58-times the odds of infants in the non-exposed group, respectively. The difference in odds of NAS between the two prison groups was not statistically significant. Infants born to women incarcerated during the 2nd trimester had two-times increased odds of NAS compared to infants born to women incarcerated during the month of birth.

The findings show that babies born to currently or formerly incarcerated women are equally likely to experience NAS. Women incarcerated during the 2nd trimester and released prior to birth have increased odds of birthing a baby with NAS compared to women who are still in prison around the time of birth.

Enhanced maternal health care must be provided during incarceration and after release. Ensuring continuity of antenatal care for pregnant women recently released from prison is essential. Additional screening may also be warranted to identify pregnant women in the community who have a history of incarceration, with the aim of providing additional education and supports around substance use.

What requires public health action?

Current Australian polices regarding preventive health, Aboriginal and Torres Strait Islander health, and child protection all emphasise the importance of preventive action to address the social determinants of health. This is critically important for families experiencing complex biopsychosocial and economic disadvantages and involved in child protection systems. However, concerns persist regarding inadequate family support, the number of infant and child removals, and the enduring impact on families. An enhanced understanding of families’ experiences of child protection involvement is needed to inform the delivery of early and appropriate support to meet their needs, promote health and wellbeing, and help keep families together.

What have we learned and how?

Our systematic review has synthesised qualitative evidence to gain an understanding of the experiences of pregnant women and parents involved in child protection processes in the perinatal period (conception to one year following birth). Multi-disciplinary electronic databases (13) were searched for relevant peer-reviewed journal articles written in English. Twenty-four articles published between 2005 and 2023 met the inclusion criteria. Analysis involved a socio-ecological approach and thematic synthesis. Selected studies included diverse participants from six countries, but parents’ experiences were strikingly similar. While they frequently displayed strength and personal agency as they endeavoured to keep or be reunified with their babies, they also described: limited personal and professional support; inadequate communication; power imbalances; cultural bias; increased poverty and homelessness; enduring fear and pain; and chronic poor health.

How will this be used in practice?

Our findings have contributed to a broader program of research that is co-creating recommendations to support families and improve child protection processes in the perinatal period. They will be piloted in service settings in Western Australia.

What future actions are needed?

A public health approach to child protection has been endorsed within national policy but the public health community can do more to explicitly recognise and respond to the needs of families involved in child protection systems. Future action will require enhanced cross-sector collaboration and coordinated care to address the social determinants of health, prioritise prevention and early intervention; and promote healthy and safe families.

Context and aim: An estimated 1 in 5 Australians adults (4.3 million) experienced a mental illness in the past twelve months. This study examines the prevalence, levels, and predictors of psychological distress and depression among Bangladeshi migrants in Australia.
Methods: Quantitative survey data were collected in 2023 from Bangladeshi-born adult migrants living in Australia for ≥1 year. Psychological distress and depression were assessed using the Kessler 10 Psychological Distress Scale (K10) and the Center for Epidemiologic Studies Depression Scale Revised scale (CESDR-10) respectively. Predictors were identified using logistic regression.
Results: Of the 196 participants, mean age was 39 years (±8.3). Most were male (57%, n=112) with bachelor's/master's degrees (75%, n=147). Nearly half resided in Australia for over a decade (48%, n=92), mainly from Victoria (68%, n=133). The prevalence of ‘high to very high levels’ of psychological distress among Bangladeshi migrants was 43% and that of depression was 35%, more than double the Australian average. Novel risk factors identified include non-engaging in activities with family/friends (AOR 5.34, 95% Cis 1.35-26.77) and community (2.65,1.16-6.09), and absence of prior income in Bangladesh (3.37,1.09–13.13). Migrants from rural Bangladesh (0.42,0.17-0.97), aged ≥30 years (0.17,0.04-0.63), and active on social media (0.26,0.08-0.78) were less likely to be depressed. Other predictors identified are loneliness (6.24, 2.64-16.69), poor friendship (4.51,2.01-11.12), discrimination (2.72,1.32-5.79) and racism (2.71,1.27-5.91), multiple comorbidities (3.37,1.34-9.07), and low English proficiency (2.52,0.96-6.71).
Conclusions: This study highlights the very high prevalence of psychological distress and depression among Bangladeshi migrants. The findings suggest that a range of social, economic, and cultural factors contribute to the mental health issues experienced by them. We recommend advocacy for policy changes to develop targeted mental health interventions and support services for migrants, focusing on enhancing social connectedness, building language skills, addressing discrimination, encouraging community-based initiatives that foster social connections and a sense of belonging.

Context and Aim
The Western Public Health Unit (WPHU) delivers place-based public health to a catchment of eight local government areas in Melbourne, Australia. Strategic objectives include tackling public health challenges with an explicit focus on health equity. While national surveillance of health inequalities is widely adopted, insights derived from smaller-area data may better inform local public health action. We explored the feasibility of monitoring health inequalities in the context of an Australian metropolitan local public health unit.

Methods and analysis/findings
Guided by the World Health Organization’s Handbook on Health Inequality Monitoring, we consulted senior team members to select health topics, indicators and dimensions of inequality most relevant to our catchment population, and mapped data sources to determine whether sufficient data were available for analysis. Twenty health topics, 39 health indicators and 6 dimensions of inequality were shortlisted. Data mapping indicated the availability of 21 indicators for monitoring, against 6 dimensions of inequality: geographic region, age, socio-economic disadvantage, ethnicity, sex and gender.

Translational outcomes
Through consultation and a data mapping process, we found that monitoring health inequalities using small area data is feasible. Some limitations exist, including small cell counts due to disaggregation of the data across multiple dimensions. Nonetheless, unique benefits for place-based public health can be derived from monitoring health inequalities using small-area data, including: 1) identifying the size, location and characteristics of communities affected by health inequalities; 2) enabling tailored interventions, policies and programs to respond to inequalities at a scale proportionate to the level of disadvantage and; 3) evaluating the impact of equity-oriented interventions.

Future actions
Local public health—like global public health—is reliant on epidemiology; of knowing the ‘who and where’ so that public health action is commensurate and proportionate to populations with the greatest need. We encourage local public health units and councils to consider this method of analysis. Revealing what is hidden behind state or national figures will help identify and address inequities in health at a local level.

[Context and aim]
To inform Australia’s response to climate change and increasingly frequent, extreme environmental events, there is a pressing need to better understand the impact of environmental factors on human health and health service use. The aim of this project was to provide a publicly available, national data set which allows researchers and other practitioners (e.g. people working in the areas of health service planning, disaster resilience and response or public health policy) to gain insights into changes in health service use coincident with environmental events (particularly, bushfires).
[Methods and analysis/research findings]
The AIHW created and released up to 20 years of weekly data by small geographic area (Statistical Area 4 – SA4) for service use related to selected health conditions (respiratory, cardiovascular, mental health and other potentially bushfire-related health conditions). Health service use data in scope include:
• hospitalisations (2002–03 to 2021–22)
• hospital emergency department presentations (2014–15 to 2021–22)
• Medicare Benefits Schedule service claims (2002–03 to 2021–22)
• Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions dispensed (2002–03 to 2021–22).
The published data set includes accompanying notes and data visualisations that allow users to explore the data.
[Translational outcomes]
These data are now available to researchers and other practitioners. It is envisaged that the data and visualisations could be combined with environmental data (e.g. air quality data; temperature data) to derive insights about the impact of environmental events on health service use. The data may also be useful in identifying particular periods and/or locations of interest for further, more detailed, analysis.
[Future actions]
Work is required to enhance the data with methods that, for example, highlight peaks and troughs in service use or includes data by population groups.

Context & aim
The healthcare sector is responsible for ~7% of Australia’s total carbon emissions. To reduce this, clinical practice must switch to low-carbon alternatives where clinically appropriate. A ‘carbon hotspot’ is respiratory inhalers. Traditionally, metered dose inhalers (MDIs) have been used, which contain potent greenhouse gases as propellants. Switching to newer more environmentally sustainable Dry Powder Inhalers (DPIs), which are clinically equivalent and appropriate for most individuals, has the potential to significantly reduce carbon emissions without compromising patient outcomes. We provide the first baseline measure for current utilisation of MDIs and DPIs in Australia, describing patterns and investigating variations in care.

Methods & findings
In this analysis of administrative health data, we use five years of Pharmaceutical Benefits Scheme (PBS) data to provide a descriptive overview of all respiratory inhalers dispensed in Australia and estimate the associated carbon footprint. Variation in inhaler dispensing is presented over time, by state, regionality, age and gender of consumer, enabling us to identify hotspots of MDI-dispensing. In 2023 over 17 million inhalers were dispensed in Australia (562 per 1,000 population), of which 63% were MDIs. Total CO2e emission from inhalers were estimated at 290,000 tonnes, with 98% of these from MDIs.

Translational outcomes
We estimate that replacing 40% of dispensed MDIs with DPIs can result in a reduction of 110,000 tonnes of CO2e emissions p.a. (~ driving 450 million km, equivalent to 3x the distance between sun and earth). Results will inform development of an update-able indicator to track inhaler carbon emissions over time. The indicator will be a publicly accessible measure to show progress over time towards health system decarbonisation. It will inform strategies to reduce MDI use by quantifying the extent of the issue for Australia and pinpointing hotspots for intervention.

Future actions
We are currently co-designing further qualitative and quantitative analyses to explore consumer awareness and knowledge regarding the environmental impact of respiratory inhalers and to assess how environmental impact influences their inhaler choices. Understanding consumer and clinician perspectives is critical to developing strategies that support shared decision-making as well as high-quality and environmentally sustainable asthma care.

Context and Aim
Australia’s universal healthcare system should mean that no one is financially disadvantaged by having a chronic condition like cancer, although this is currently not the case. Financial toxicity is the negative patient-level impact of the financial costs of healthcare, which can lead to physical and psychological harm, altered decision making and ultimately sub-optimal health outcomes.
Cancer Council developed the Financial Cost of Cancer policy to address the impact of both direct and indirect financial costs of accessing adequate cancer care, as well as reducing the impact of changing financial circumstances experienced during cancer care such as reduced capacity to work, which may in turn affect the whole household. However, our findings are much broader than cancer care, with many people affected by chronic conditions facing the same barriers.
Methods and Analysis
Several literature reviews guided the development of this policy, and the priorities were refined following consultation with individuals and organisations with expertise in the financial costs of cancer, including people with a lived experience of cancer.
Four overarching priority areas emerged: 1) Ensuring informed financial consent; 2) Improving the experience of people with cancer who require income support; 3) Enhancing financial support for people living in regional and remote areas to access cancer treatment and care; 4) Increasing access to financial counsellors.
Translational Outcomes
A person’s financial situation should not hinder access to optimal cancer care in Australia. The financial cost of cancer policy provides clear priorities for ensuring that all people affected by cancer, regardless of the direct or indirect costs of treatment, can access the care that they need. The policy was developed in collaboration with several stakeholders ensuring that it is fit-for-purpose and adequately reflects the policy environment and context.
Future Actions
The Financial Cost of Cancer policy reflects the Australian cancer care environment and provides feasible and actionable policy solutions that would support more equitable cancer outcomes and support delivery of several of the goals and priorities of the Australian Cancer Plan.

Increasing pressures from climate change and our surrounding environment are having a negative impact on human health. Yet Australia lacks a set of nationally representative environmental health indicators as identified by the National Preventive Health Strategy 2020–2030 and National Health and Climate Strategy.

Climate change and environmental health indicators play an important role in monitoring the effects of current and emerging environmental hazards on health. Understanding the extent to which the environment affects health, and monitoring changes over time, can inform strategies, policies and indicator development.

To address this gap, the AIHW has developed a framework of climate change and environmental health indicators informed by extensive literature reviews, sub-national and international examples of indicator frameworks. Topics important to monitor were informed by the Driving force, Pressure, State, Exposure, Effect, Action (DPSEEA) framework, selection and data sources criteria, expert stakeholder consultation and evidence of causal association between exposure and health effects based on burden of disease methodology and available health data.

Thirty reportable indicators specific to Australia were identified and arranged within 8 broad domains: air quality (indoor/outdoor), water quality, UV and sun radiation, climate and extreme weather, housing, built environment, food environment and waste. Indicator profile specifications were developed to provide information on aspects such as rationale, measures, data sources/frequency and disaggregations.

A further 24 indicators with known data gaps and requiring development were identified. Whilst they are relevant, suitable and may be necessary for inclusion, issues such as data availability and evidence, prevent this. It is intended that these indicators would become reportable, if data gaps are filled, or development occurs.

It is envisaged that reportable indicators will inform baseline reporting on climate change and the environment’s impact on health in Australia. Ongoing surveillance and monitoring will be important to assess health impacts now and into the future.