Academic literature on the topic 'Aboriginal Australian authors'

PurposeThe rise in the incarceration of Aboriginal and Torres Strait Islander mothers is a major public health issue with multiple sequelae for Aboriginal children and the cohesiveness of Aboriginal communities. The purpose of this paper is to review the available literature relating to Australian Aboriginal women prisoners’ experiences of being a mother.Design/methodology/approachThe literature search covered bibliographic databases from criminology, sociology and anthropology, and Australian history. The authors review the literature on: traditional and contemporary Aboriginal mothering roles, values and practices; historical accounts of the impacts of white settlement of Australia and subsequent Aboriginal affairs policies and practices; and women’s and mothers’ experiences of imprisonment.FindingsThe review found that the cultural experiences of mothering are unique to Aboriginal mothers and contrasted to non-Aboriginal concepts. The ways that incarceration of Aboriginal mothers disrupts child rearing practices within the cultural kinship system are identified.Practical implicationsAboriginal women have unique circumstances relevant to the concept of motherhood that need to be understood to develop culturally relevant policy and programs. The burden of disease and cycle of incarceration within Aboriginal families can be addressed by improving health outcomes for incarcerated Aboriginal mothers and female carers.Originality/valueTo the authors’ knowledge, this is the first literature review on Australian Aboriginal women prisoners’ experiences of being a mother.

In Black Words White Page (2004), his seminal study of Aboriginal cultural production in Australia, Adam Shoemaker notes that ‘when Oodgeroo Noonuccal’s first collection of poetry appeared in print in 1964, a new phase of cultural communication began in Australia’ (2004, p. 5). The ‘new phase’ to which Shoemaker refers pertains to the many plays, collections of poetry and novels by Aboriginal authors published between 1964 and 1988 and directed to Australian and international audiences. Flying under the radar of scholarly attention, Aboriginal authors and artists also produced significant numbers of children’s books during this time, including Wilf Reeves and Olga Miller’s The Legends of Moonie Jarl, published by Jacaranda Press in 1964 (see O’Conor 2007), Oodgeroo Noonuccal’s Stradbroke Dreamtime (1972), and the picture books of Dick Roughsey and many other Aboriginal authors and artists (see Bradford 2001, pp. 159-90).

The central aim of this excellent, timely and theoretically precise book is to deploy the concept of “cosmopolitanism” as a critical tool for investigating a range of cross-cultural performances in Australia. To set the stage for the main focus of their study, which examines the ways in which indigenization and Asianization have been “instrumental in forging Australian theatre’s current cosmopolitan credentials” (18) over the last two decades, the authors survey the history of racially inflected performance in Australia from the 1830s through to the late 1960s.

‘And there’ll be NO dancing’: Perspectives on policies impacting Indigenous Australia since 2007, edited by Elisabeth Baehr and Barbara Schmidt-Haberkamp. Cambridge, UK: Cambridge Scholars Publishing, 2017. 354 pp. ISBN 9781443898638 ‘THE PAST is now with us; it never went away.’ The 2007 Intervention into the lives of Aboriginal people living in the Northern Territory was a low point in the relationship between the Australian government and Indigenous people. As one of the Aboriginal authors in No Dancing, Warraimay historian Victoria Grieves puts it, the Northern Territory Emergency Response (NTER), as the Intervention was officially known, ‘leaves no doubt about the relationship of Aboriginal people to the settler colonial state’ (p. 89).

Three picture books by Aboriginal authors, Bob Randall and Kunyi June-Anne McInerney's 'Tracker Tjugingji', and Elaine Russell's 'A is for Aunty' and 'The Shack that Dad Built' are considered arguing that they represent Australian childhoods in ways which refer to and mobilise Aboriginal conceptualisations of embodied space. The analysis of these Aboriginal picture books insists on local, specific formulations of place, which are shaped by colonialism, but which reappropriate Aboriginal spaces.

Twenty-first century Australia is a multi-cultural and multi-ethnic democracy, a developed and prosperous nation. However, it’s history of ‘settler colonialism’ has its own shades of grey. The original inhabitants of Australia were the Aboriginals who resided in the island territory for about more than 40,000 years till 1788, that is, about 234 years from now. However, their share in the total population of Australia has dwindled to about 2.5%. Even today, they are at the fringes of society, both economically and politically. The mainstream discourse, which is white, male and written from a Euro-centric perspective, brushes under the carpet such inconvenient facts. The dominant narrative presents a much distorted picture of Australian history and culture, eulogizing the colonizers and demonizing the Aboriginals as barbarous heathens who were in dire need of being reformed, civilized, cultured and Christianized. Few Aboriginals, who have managed to ascend the economic ladder take this responsibility of speaking up and revealing their community’s story, history, culture and what was and is being done to them. The present paper is a reading of one such memoir by an Aboriginal woman, Am I Black Enough for You? (2012) by Anita Heiss. What is unique about Heiss is that unlike majority of her people, she is educated, urban, economically independent, an academic and an established author. Her predicament is also unique, which is, the accusation from her white peers of false claims to Aboriginal heritage for upward mobility by grabbing government doles for the minorities. The paper is a humble attempt to contest the pervasive cultural stereotype which portrays the Aboriginal race as primitive, backward, illiterate, unhygienic, savage and doomed to extinction. The paper attempts to analyze the historical, social and economic reasons for their post-1788 disadvantageous position. The paper also strives to emphasize that with support from the government and the people, the same Aboriginal race could once again be an engine for nation-building. Moreover, besides demolishing the lies propagated by the colonizers and presenting their own truth, authors like Heiss reach out to the larger community beyond the individual self.

This article aims to critically assess the projection of ‘Indigenous Futurism’ by examining the select Australian young adult novels using Jaques Lacan’s Anamorphosis from a postcolonial perspective. Ambelin Kwaymullina’s speculative fiction The Interrogation of Ashala Wolf (2012) projects a futuristic Australia where the tribal people are seeking independence from a colonial authority. Similarly, the plot of Marianne de Pierres’ Nylon Angel (2004) revolves around the issues of the marginalized people in Australia in a techno-dystopian world. The objective of this article is to critically examine these two speculative novels using Lacan’s anamorphosis concept to correlate how these authors have connected the contemporary issues in Australia and also how they have speculated the issues of the Aboriginal people in Australia in the future. Additionally, this article also aims to highlight how they have projected the ‘Indigenous Futurism’ from an Aboriginal man’s perspective using anamorphosis.

There is a consensus in the literature that hunger and community violence inaugurates adverse health impacts for survivors and for their descendants. The studied cohorts do not include Western Australian Aboriginal people, although many experienced violence and famine conditions as late as the 1970s. This article describes the pathways and intergenerational impacts of studied cohorts and applies these to the contemporary Western Australian context. The authors found that the intergenerational impacts, compounded by linguistic trauma, may be a contributor to current health issues experienced by Aboriginal people, but these are also contributing to the resurgence in population numbers.

Romance and fantasy fiction by non-Indigenous authors from the nineteenth through to the twentieth century positions non-Indigenous readers as the natural, normal inhabitants of the Australian nation through strategies of appropriation and indigenisation. At the same time, these narratives exclude Indigenous children from the category 'Australian children' and construct narrators as experts on Aboriginal culture and traditions.

The article discusses personal and collective life ways of native people residing in remote settlements of the Cape York Peninsula, Australia, and offers a number of observations on the native population of Central Australia. It is drawn on the authors’ field materials collected in 2005, 2007-2009, 2015, and 2022. If set against the backdrop of the likewise framed project exploring the Evens and Evenkis of Eastern Siberia, the situation in faraway settlements of Australian Aboriginal people manifests both substantial similarities and important differences. Neither in the past when the colonization began to unfold, nor in the present did the Aboriginal people, for the most part, willingly join the commercial and entrepreneurial activities of the Australian mainstream circles or get involved in trade and economic relationships with the newcomers. They rather resisted, and still do, the authorities' and entrepreneurs' attempts at getting them involved in such relationships. We argue that the underlying reason behind that is the very character of the local traditional culture, the key aspects of which are consciously and resiliently preserved - even if sometimes in a transformed or deviant manner - by the native people.

This creative practice-led thesis is in two parts - a novella entitled Leaning into the Light and an exegesis dealing with issues for creative writers who are non-Indigenous engaging with Indigenous characters and inter-cultural relationships. The novella is based on a woman's tale of a cross cultural friendship and is set in a Queensland Cape York Aboriginal community over a period of fifteen years. Leaning into the Light is for the most part set in the late 1960s, and as such tracks some of the social and personal cost of colonisation through its depiction of Indigenous and non-Indigenous relationships within a Christian run mission. In short, Leaning into the Light creates an imaginary space of intercultural relationships that is nevertheless grounded in a particular experience of a 'real' place and time where Indigenous and non-Indigenous subjectivities collide and communicate. The exegesis is principally concerned with issues of non-Indigenous representation of indigeneity, an area of enquiry and scholarship that is being increasingly theorized and debated in contemporary cultural and literary studies. In this field, two questions raised by Fee (in Ashcroft, Griffiths and Tiffin, 1995) are key concerns in the exegesis. How do we determine who is a member of the Aboriginal minority group, and can majority members speak for this minority? The intensification of interest around these issues follows a period of debate in the 1990s which in turn was spawned by the "unprecedented politicisation of {Australian} history" (Collins and Davis, 2004, p.5) following the important Mabo decision which overturned the "nation's founding doctrine of terra nullius" (ibid, p.2). These debates questioned whether or not non-Aboriginal authors could legitimately include Aboriginal themes and characters in their work (Huggins, 1994; Wheatley, 1994, Griffiths, et al in Tiffin and Lawson, 1994), and covered important political and ethical considerations, at the heart of which were issues of representation and authenticity. Moreover, there were concerns about non-Indigenous authors competing for important symbolic and publishing space with Indigenous authors. In the writing of Leaning into the Light, these issues became pivotal to the representation of character and situation and as such constitute the key points of analysis in the exegesis.

This creative practice-led thesis is in two parts - a novella entitled Leaning into the Light and an exegesis dealing with issues for creative writers who are non-Indigenous engaging with Indigenous characters and inter-cultural relationships. The novella is based on a woman's tale of a cross cultural friendship and is set in a Queensland Cape York Aboriginal community over a period of fifteen years. Leaning into the Light is for the most part set in the late 1960s, and as such tracks some of the social and personal cost of colonisation through its depiction of Indigenous and non-Indigenous relationships within a Christian run mission. In short, Leaning into the Light creates an imaginary space of intercultural relationships that is nevertheless grounded in a particular experience of a 'real' place and time where Indigenous and non-Indigenous subjectivities collide and communicate. The exegesis is principally concerned with issues of non-Indigenous representation of indigeneity, an area of enquiry and scholarship that is being increasingly theorized and debated in contemporary cultural and literary studies. In this field, two questions raised by Fee (in Ashcroft, Griffiths and Tiffin, 1995) are key concerns in the exegesis. How do we determine who is a member of the Aboriginal minority group, and can majority members speak for this minority? The intensification of interest around these issues follows a period of debate in the 1990s which in turn was spawned by the "unprecedented politicisation of {Australian} history" (Collins and Davis, 2004, p.5) following the important Mabo decision which overturned the "nation's founding doctrine of terra nullius" (ibid, p.2). These debates questioned whether or not non-Aboriginal authors could legitimately include Aboriginal themes and characters in their work (Huggins, 1994; Wheatley, 1994, Griffiths, et al in Tiffin and Lawson, 1994), and covered important political and ethical considerations, at the heart of which were issues of representation and authenticity. Moreover, there were concerns about non-Indigenous authors competing for important symbolic and publishing space with Indigenous authors. In the writing of Leaning into the Light, these issues became pivotal to the representation of character and situation and as such constitute the key points of analysis in the exegesis.

Thesis (PhD)--Macquarie University, Division of Society, Culture, Media & Philosophy, Department of Critical and Cultural Studies, 2005.
Bibliography: p. 274-291.
Introduction -- The emergence of "honyakugeki" -- Shôgekijô and the quest for national identity -- "Honyakugeki" after the rise of Shôgekijô -- The presentation of Australian plays as "honyakugeki" -- Representations of Aborigines in Japan -- Minorities in Japan and theatre -- The Japanese productions of translated Aboriginal plays -- Significance of the productions of Aboriginal plays in Japan -- Conclusion.
Many Australian plays have been presented in Japan since the middle of the 1990s. This thesis demonstrates that in presenting Australian plays the Japanese Theatre has not only attempted to represent an aspect of Australian culture, but has also necessarily revealed aspects of Japanese culture. This thesis demonstrates that understanding this process is only fully possible when the particular cultural function of 'translated plays' in the Japanese cultural context is established. In order to demonstrate this point the thesis surveys the history of so-called 'honyakugeki' (translated plays) in the Japanese Theatre and relates them to the production of Western plays to ideas and processes of modernisation in Japan. -- Part one of the thesis demonstrates in particular that it was the alternative Theatre movement of the 1960s and 1970s which liberated 'honyakugeki' from the issue of 'authenticity'. The thesis also demonstrates that in this respect the Japanese alternative theatre and the Australian alternative theatre of the same period have important connections to the quest for 'national identity'. Part one of the thesis also demonstrates that the Japanese productions of Australian plays such as The Floating World, Diving for Pearls and Honour reflected in specific ways this history and controversy over 'honyakugeki'. Furthermore, these productions can be analysed to reveal peculiarly Japanese issues especially concerning the lack of understanding of Australian culture in Japan and the absence of politics from the Japanese contemporary theatre. -- Part two of the thesis concentrates on the production of translations of the Australian Aboriginal plays Stolen and The 7 Stages of Grieving. 'This part of the thesis demonstrates that the presentation of these texts opened a new chapter in the history of presenting 'honyakugeki' in Japan. It demonstrates that the Japanese theatre had to confront the issue of 'authenticity' once more, but in a radically new way. The thesis also demonstrates that the impact of these productions in Japan had a particular Japanese cultural and social impact, reflecting large issues about the issue of minorities and indigenous people in Japan and about the possibilities of theatre for minorities. In particular the thesis demonstrates that these representations of Aborigines introduced a new image of Australian Aborigines to that which was dominant amongst Japanese anthropologists.
Mode of access: World Wide Web.
291 p

The portrayal of identity in contemporary Aboriginal writing is as varied and multifaceted as the notion of ' Aboriginality' itself. This thesis explores some of the issues and aspects of identity arising from Indigenous literature, particularly focusing on four recent texts that each, at times loosely, falls into the category of fiction. Postcolonial theory is considered in relation to the aims of Aboriginal writing, especially as to how such theory may, or may not, contribute to the project of decolonisation.

Submitted in fulfilment of the requirements for the degree of Masters in English in the Division of Humanities, Dept. of English, 2006.
Thesis (MA)--Macquarie University (Division of Humanities, Department of English), 2006.
Bibliography: p. 199-210.
Introduction -- Defiance and servility in Andrew Bovell's Holy day -- Writing a reconciled nation: Katherine Thomson's Wonderlands -- Transformation of trauma: Tammy Anderson's I don't wanna play house -- The rage inside the pain: Richard J. Frankland's Conversations with the dead -- Conclusion: towards an understanding of witness to the trauma of invasion.
In an Australia shaped by neo-conservative government and by searing contention, national and global, over what the past is, how it should be allowed to affect the present and who are authentic bearers of witness, this thesis compares testimony to Australia's black/white relations in two plays by white writers, Andrew Bovell's 'Holy day' (2001) and Katherne Thomson's 'Wonderlands' (2003), and two black writers, Tammy Anderson's 'I don't wanna play house' (2001) and Richard J. Frankland's 'Conversations witht the dead' (2002).
Mode of access: World Wide Web.
210 p. ill. 30 cm

Human health is multidimensional: apart from physical, mental, and social aspects, it also incorporates subjective perceptions of health, and functional status (FS). Given that elderly persons have very distinctive health and social needs, multidimensional assessment (MA) of health proves particularly useful in this age group.¶ Aboriginal populations suffer poor health, and there are relatively few studies addressing the health problems of older Aboriginal Australians, mainly because of their distinctive demographic structure, and the low proportion of their elderly. Also, there is no prior information available on MA of health in this Australian population group.¶ This thesis offers a MA of health in older Aboriginal persons from two, urban and rural/isolated, locations in the NT, Katherine and Lajamanu (the NT survey).¶ ...

In this chapter, an Australian university tree-planting event to welcome international students is looked at as a scene with multiple possible histories and futures. The chapter asks how Australian universities became structurally dependent on international student fee revenue and were thrown into crisis when Australia’s borders were closed in 2020. During this crisis period, Australian universities continued to acknowledge in ritual ways their position on unceded (stolen) Aboriginal Country. Using ideas about generosity, vulnerability and thinking with care,the authors asks whether the provenance of Australian university real estate portfolios can be made good in any way, or whether one can rethink a sense of property and face the facts about the historic theft of land that makes tree-planting possible.

AbstractThis chapter reviews two strategies for managing alcohol deployed in some Aboriginal communities: community-owned liquor outlets, usually in the form of licensed clubs, and liquor permit systems that authorise approved individuals to import and consume liquor in communities where doing either is otherwise not allowed under local restrictions.The rationale underlying community-owned outlets is that they retain the revenue derived from drinking by community members in the community, foster a culture of moderation and deter illicit importation of liquor (i.e. ‘grogrunning’). Historically, most community-owned outlets have failed to achieve either the second or third of these objectives, but rather have become centres for heavy drinking and associated harms. Some community-owned outlets, however, have succeeded in fostering moderate drinking, and the chapter outlines factors conducive to their doing so.The use of individual liquor permit systems today is confined to some remote communities in the Northern Territory, Australia, and some Inuit communitiesin Nunavut, Canada. Evidence of their impact is sparse but suggests that liquor permit systems can enhance community management of alcohol provided three conditions are met: permit committees and others responsible for administering permit systems are adequately supported and resourced; effective controls are in place to deal with illegal supply of alcohol, and the rules and procedures that constitute the permit system enjoy legitimacy in the eyes of the community.

The positive and negative aspects of using Facebook© as a crucial communication tool between Aboriginal academics and their Aboriginal students will be discussed within this chapter. Initially, the authors’ use of Facebook © was to provide support for our Australian Aboriginal students within their own communities. The original intention was to supplement existing electronic forums provided by the University to maintain contact with students between study blocks, encourage reluctant technology users to interact online, and build links to the students’ own communities and families. In 2009, the authors’ students were involved in a research project (Milton, Gruppetta, Vozzo & Mason, 2009) and their use of Facebook © to interact with students was recognised as innovative and the authors were encouraged to investigate the potential within another research project (Vozzo, et al., 2011). From a peripheral practice conducted by two Australian Aboriginal academics, the importance of utilizing Facebook © to build social capital and support an Indigenous Academic community has become crucial to the success and retention of our Aboriginal tertiary students. The authors’ most recent research project relies heavily on Facebook © as the main communication tool due to the vast distances between Aboriginal communities in Australia and the variety of technology provided by each state/territory.

Abstract Over the last decade of Australian archaeology there has been a notable absence of studies of Aboriginal social and economic systems on a regional scale, due in part to preference for generic modeling incorporating metadata. Such broad narratives generated by meta-data models and use of carbon dates as proxies for understanding demographic transitions can gloss over important local dynamics and details. In this study, the authors employed a regional approach to assess Australian Aboriginal food production systems. They combined early ethnographic observations with available archaeological evidence to reconstruct Mithaka economies, especially pertaining to fish traps, water management, fishing, and utilization of seeding grasses. These specific activities were targeted as being central to current debates on Australian Aboriginal food production systems. The ethnohistoric record was found to support a model of the Mithaka and their neighbors being considerably less mobile than previously assumed, concentrating on permanent waterholes especially during dry periods. The study revealed an economy uniquely adapted to the region’s “boom and bust” ecology. It was dominated by the construction and use of gigantic nets, fish traps, long-distance trade, and the processing and storage of “preserves.” On the basis of this case study, the authors propose methodologies for further archaeological investigation that could inform the “Dark Emu” debate that is currently prevalent in interpreting Australia’s deep past.

Abstract This chapter provides an overview of the volume, the research context for Australian languages, and a summary of the themes that emerge from the papers. Following a description of the five parts of the volume, it describes some of the editorial choices that led to the shaping of the volume’s contents and terminological conventions, including omitted topics. Furthermore. it provides some background to Aboriginal conceptions of language and land and how individuals relate both to Country and to Language, as well as to linguistic terminology typically used in discussing Australian languages. Some discussion is given of the ways that Indigenous authors have described their relationship to language and how language was placed on Country by Dreamtime culture heroes.

This chapter describes work with an Aboriginal community group using an approach described as structural community development, a ‘bottom-up, citizen-led and -owned approach that seeks to challenge racism at its source in systems, laws, and policies based on white privilege’. Because the Benarrawa group owned this approach, the authors argue that it provides an excellent example of how grounded practice by community groups can inform the theorising of community development. The work of the group involved a range of activities, including workshops, cultural events, commemorative gatherings, and social activities, all designed to affirm the ownership of land by Aboriginal groups and strengthen their determination to assert that ownership against the depredations of the Australian state.

Social media can bring together diverse people, providing a platform to facilitate discussions about various issues across races, cultures, and religions. These platforms shape social change by bringing to light individuals' perceptions on social issues whilst simultaneously becoming echo chambers that exclude contradictory or dissenting voices. Increases in digital violence, racism, and discrimination can be seen on social media websites, particularly towards those whose ideas challenge the dominant discourses of their cultural groups. The authors explore this phenomenon through four case studies: Aboriginal Australian academic Anthony Dillon, Aboriginal politician Jacinta Nampijinpa Price, African American former gubernatorial candidate and radio presenter Larry Elder, and African American political commentator Candace Owens. Their experiences are considered through the lens of free speech, civil discourse, and how social media users choose vilification instead of debate to address dissenting voices.

Abstract Through colonisation in Australia, Western paradigms of health and mental health have dominated the discourse on mental health and excluded Indigenous knowledges, which consider wellbeing from a more holistic perspective. Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) understand health through the Social and Emotional WellBeing (SEWB) model, which considers the body and mind as well as spiritual, cultural, kinship, community, and physical dimensions, and the impact of historical, political, social, and cultural determinants on wellbeing. An inclusive science of wellbeing requires Western and Indigenous knowledges to be valued alongside each other, accepting their differences. This chapters outlines the path from colonisation toward the recognition of Indigenous knowledges, and the authors describe the SEWB model and interventions developed using this model. The authors provide an example of how the SEWB model can be operationalised for health and mental health settings, through the ‘Dance of Life’ framework, which uses the culturally relevant medium of art to facilitate discussion of holistic wellbeing.

Aim/Purpose: [This Proceedings paper was revised and published in the journal "Issues in Informing Science and Information Technology,"16, 21-40.] The purpose of this paper is to illuminate the learning that happens in assuming a supervisee’s role during the postgraduate study. Background: The facilitators and barriers students encountered while pursuing postgraduate studies, strategies to achieve success in postgraduate studies, and how to decrease attrition rates of students, have been sufficiently explored in literature. However, there is little written about the personal and professional impact on students when they are being supervised to complete their postgraduate studies. Methodology: Autoethnographic method of deep reflection was used to examine the learning that transpired from the supervisee’s perspective. Two lecturers (a Senior Lecturer in Nursing and an Aboriginal Tutor) focused on their postgraduate journeys as supervisees, respectively, with over 30 years of study experience between them, in Australia and abroad. Contribution: Future postgraduate students, researchers, would-be supervisors and experienced supervisors could learn from the reflections of the authors’ postgraduate experiences. Findings: Four themes surfaced, and these were Eureka moments, Critical friend(s), Supervisory relationship, and Transformative learning. The authors highlighted the significance of a supervisory relationship which is key to negotiating the journey with the supervisor. Essential for these students also were insights on finding the path as well as the destination and the transformative aspects that happened as a necessary part of the journey. Conclusion. The postgraduate journey has taught them many lessons, the most profound of which was the change in perspective and attitude in the process of being and becoming. Personal and professional transformative learning did occur. At its deepest level, the authors’ reflections resulted in self-actualization and a rediscovery of their more authentic selves. Recommendations for Practitioners: This article highlights the importance of the supervisory relationship that must be negotiated to ensure the success of the candidate. Reflections of the transformation are recommended to support the students further. Recommendation for Researchers: Quality supervision can make a significant influence on the progress of students. Further research on the supervisory relationship is recommended. Impact on Society: The support in terms of supervision to ensure postgraduate students’ success is essential. Postgraduate students contribute to the human, social, professional, intellectual, and economic capital of universities and nations globally. Future Research: Further reflections of the transformative learning will advance the understanding of the personal and professional changes that occur with postgraduate supervision.

This Evidence Snapshot provides a rapid review of evidence on strategies to address COVID-19 vaccine hesitancy in Aboriginal and Torres Strait Islander peoples. The authors examined strategies to address vaccine hesitancy among Indigenous peoples in well-resourced settings worldwide, focusing on COVID-19 vaccination and the program roll-out. The review included peer-reviewed and grey literature published up to December 2021. Most studies were descriptive qualitative or quantitative with few intervention or evaluation reports to date. However, the review specifically lists author-recommended interventions and provides a list of communication materials publicly available in Australia. The themes for success common across the literature encompass the following headings: know why people aren’t vaccinated to tailor strategies; vaccination rollouts ‘with us not for us’; keep it local; make services convenient and culturally respectful; and support the Aboriginal and Torres Strait Islander workforce.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.