Academic literature on the topic 'Aboriginal studies'

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.OBJECTIVE: To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.METHODS: MEDLINE, EMBASE, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.RESULTS: Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).CONCLUSIONS: Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.

Aboriginal Studies is now being taught at Year 12 level in South Australian schools as an externally moderated, school assessed subject, accredited by the Senior Secondary Assessment Board of South Australia.It is a course in which students learn from Aboriginal people through their literature, their arts, their many organizations and from visiting Aboriginal communities. Current issues about Aborigines in the media form another component of the study.

In the first of two articles (see Brady in this issue) reviewing the field of Aboriginal alcohol use and misuse, the author describes tenacious stereotypes of Aboriginal drinking, and outlines problems that have until recently prevented the development of quantitative studies. The available research material indicates that while non-drinkers constitute a higher proportion of the surveyed populations, those Aborigines who are drinking are likely to be consuming alcohol at harmful levels. These findings, which are consistent with research on other indigenous groups in the Pacific and North America, are cause for concern, being associated with high levels of morbidity and mortality. The need for more systematic and reliable research, particularly longitudinal studies, is emphasised.

In 2006, the Canadian Helicobacter Study Group identified Aboriginal communities among Canadian population groups most at risk ofHelicobacter pylori-associated disease. The objective of this systematic review was to summarize what is known about theH pylori-associated disease burden in Canadian and related Arctic Aboriginal populations to identify gaps in knowledge. Six health literature databases were systematically searched to identify reports onH pyloriprevalence in Canadian population groups, or any topic related toH pyloriin Canadian Aboriginals, Alaska Natives or Aboriginals of other Arctic regions. Identified reports were organized by subtopic and summarized in narrative form. Key data from studies ofH pyloriprevalence in defined populations were summarized in tabular form. A few Arctic Aboriginal communities were represented in the literature: two Canadian Inuit; one Canadian First Nation; two Greenland Inuit; one Russian Chutkotka Native; and several Alaska Native studies. These studies uniformly showed elevatedH pyloriprevalence; a few studies also showed elevated occurrence ofH pylori-related diseases and high rates of treatment failure. Based on the evidence, it would be warranted for clinicians to relax the criteria for investigatingH pyloriand related diseases in patients from Arctic Aboriginal communities, and to pursue post-therapy confirmation of eradication. Additional community-based research is needed to develop public health policies for reducingH pylori-associated health risks in such communities.

Aim. The aim of this article is to analyse Aboriginal myths and discover the relationship between animals and humans in the beliefs of the indigenous Australians. The article attempts to explain how animals are described when compared to people and vice. Furthermore, the author endeavours to establish what the relationship looks like and how it is presented. Methods. As Aboriginal myths and mythologies have been evolving for hundreds and thousands of years, it is not possible to analyse every single myth. Hence, in order to narrow them down, only the myths presented by Alexander Wyclif Reed will be analysed. The analysis will be conducted from the perspective of Animals Studies, with a particular focus on the contemporary ecological views presented by a contemporary representative of an ecological turn and animal rights scholar, Peter Wohlleben. The analysis will focus on three main aspects: parenting/motherly love, instincts, feelings and emotions. Results. The analysis shows that animals were of the utmost importance in the Aboriginal everyday life and most of the time were treated on a par with humans. Just like the Aboriginal point of view, contemporary attitude to Animal Studies attempts to alter the view according to which animals are devoid of feelings and intelligence. Conclusions. Animals seem to have a crucial role in every aspect of Aboriginal everyday life, including religious and social. They were not perceived as lesser or worse; conversely, Aboriginals considered them to be as intelligent and significant as the Aboriginal people themselves.

IntroductionDepression is among the most common mental illnesses in Canada. Although many factors contribute to depression, stress is among the most commonly reported. Studies suggest that marginalized groups often experience high levels of stress.ObjectiveTo examine associations between ethnicity and depressive symptoms among university students.AimTo identify if ethnic groups, particularly Aboriginal students, are at greater risk of depression.MethodsOnline survey data were collected from students attending eight universities in the Canadian Maritime Provinces (n = 10,180). Depressive symptoms were assessed using the 12-item version of the Center for Epidemiological Studies Depression Scale. Ethnicity was organized into five groups: Caucasian only, Aboriginal only, Aboriginals with other ethnicities, Mixed Ethnicity (not including Aboriginal), and Other (single ethnicity not including Aboriginal or Caucasian). Unadjusted and adjusted logistic regression models were used to assess associations between ethnicity and elevated depressive symptoms. Adjusted models accounted for demographic, socioeconomic, and behavioural characteristics.ResultsIn adjusted analyses for men, Mixed (OR: 2.01; 95% CI: 1.12–3.63) and Other ethnic students (OR: 1.47; 95% CI: 1.11–1.96) were more likely to have elevated depressive symptoms than Caucasians. There were no differences between those who were Aboriginal and those who were Caucasian. In unadjusted and adjusted analyses for women, depressive symptoms in ethnic groups (including Aboriginals) were not significantly different from Caucasians.ConclusionAmong male university students in the Maritime, ethnicity (other than being Aboriginal) was associated with depressive symptoms in comparison to Caucasians, after adjusting for covariates. However, among women, ethnicity was not significantly associated with depressive symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A number of issues critical to Aboriginal Studies Courses are extrapolated from the literature. These issues are expressed as questions important for evaluators of Aboriginal Studies Courses to ask. They may also be seen as guidelines for the construction of Aboriginal Studies Courses. In conclusion, a summary of the developed guidelines is presented.

In the 20 years before the Second World War the frontier war dragged to a close in remote parts of north Australia with the 1926 Daly River massacre and the 1928 Coniston massacre. There was a rapid decline in the Aboriginal population, giving rise to the idea of the ‘dying race’ which had found policy expression in the State ‘Protection’ Acts. Aboriginal and Islander labour was exploited under scandalous rates of pay and conditions in the struggling north Australian beef industry and the pearling industry. In south east Australia, Aborigines endured repressive white control on government reserves and mission stations described by some historians as being little better than prison farms. A largely ineffectual Aboriginal political movement with a myriad of organisations, none of which had a pan-Aboriginal identity, struggled to make headway against white prejudice. Finally, in 1939, John McEwen's ‘assimilation policy’ was introduced and, though doomed to failure, it at least recognised that Aborigines had a place in Australia in the long term.

The aim of this thesis is to provide a framework, background material and argument for the A.C.T. Aboriginal community and other Aboriginal educational and cultural groups to develop submissions seeking funds for Aboriginal Studies Resource Centres. The ACT Aboriginal Education Consultative Group has given the thesis a definite focus and underlined the importance of gaining Aboriginal, systemic and political support. The study includes both theoretical and empirical components and practical suggestions as to the organisation and activities of such a centre. The early part of the study is devoted to providing background to an Aboriginal Studies Resource Centre, it also covers the formation and development of the A.C.T. Aboriginal Education Consultative Group. Following the outlining of the aims and objectives of such a centre, theoretical issues concerned with selection and organisation of centre materials, the need for interpretation of objectives and the understanding of values together with curriculum implications and learning activities of an Aboriginal studies resource centre are discussed. Two major thrusts in these discussions are that Aboriginal people must be involved and the question of values must be considered because human behaviour depends on values, and behavioural change is regarded as one of the main measures of success. It is intended that while an Aboriginal Studies resource centre should concentrate on its local area, it should draw materials from other parts of Australia and the world, so that the local area can be placed in context. It is envisaged that the materials would come from a wide range of disciplines. The A.C.T. Centre will endeavour to increase the comprehension of A.C.T. Aborigines and non-Aborigines in matters Aboriginal, and will follow a philosophy which holds that learning is the discovery of meaning or understanding. A range of learning activities, including hands on experiences are outlined. The functions of the Centre are described and the involvement of Aborigines and non-Aborigines at all levels is discussed. Evaluation of the Centre's success or otherwise will take cognisance of its objectives and involve a range of outcomes. It is acknowledged that success will be difficult to measure because of different amounts of student time spent at the Centre and teacher and student expectations. The thesis concludes that Aboriginal studies has not achieved its rightful place in Australian education and that an Aboriginal Studies Resource Centre would provide the material and human resources required for Aboriginal studies to take its proper place in Australian education.

Improving Aboriginal community governance is increasingly recognised as pivotal to closing the gap in social and economic outcomes between Aboriginal and non-Aboriginal Australians. The past decade has seen a shift in Indigenous policy from a preoccupation with national governance structures and a broader human rights agenda to a focus on governments engaging directly with local Indigenous communities to address the specific manifestations of Indigenous disadvantage. In discrete Aboriginal settlements, community governments are central to this new strategy, both as advocates for community needs and as agencies for program and service delivery. Yet Aboriginal Councils have had a chequered history, leading to persistent misgivings about their capacity to achieve desired outcomes. There is a dearth of empirical evidence about ‘what works and what doesn’t’ in the unique and challenging context of Aboriginal community governance. The current study was motivated by the desire to discover what is required for an Aboriginal Council to be successful in achieving the outcomes desired by its constituents. Specifically, what governance attributes contribute to successful Aboriginal community government performance? Moreover, the research sought to delve deeper, to seek answers to the more fundamental question concerning the contextual, historical or cultural factors that shape a particular Aboriginal community’s approach to governance, whether successful or unsuccessful. The research involved three case studies of Aboriginal Councils, in the far north Queensland communities of Yarrabah, Hope Vale and Lockhart River. Unlike previous studies of Indigenous community governance, the research design included a detailed assessment of the level of performance achieved by each Council, revealing one high-performing Council and two Councils whose performance was generally poor. An assessment of performance covering each Council outcome area is essential in order to make valid causal inferences about the specific determinants of Council performance. The study adopted a holistic conception of performance, focusing on the extent to which the Councils were achieving the particular set of outcomes desired by their constituents. Such an approach recognises that different communities seek different outcomes from their community governments and that desired outcomes will include not only deliverables such as programs and services but also preferences about governance processes, which will reflect cultural values. The study’s focus on Council performance recognises that, regardless of underlying questions about the appropriateness of imported Western governance structures, in practice residents of Indigenous communities express strong expectations that their elected Councils will deliver services and programs that meet their needs and aspirations and improve their quality of life. Within the constraints of prevailing legislative and policy frameworks, Indigenous communities exhibit considerable pragmatism in their efforts to optimise opportunities for self-determination through developing their community governments. The case study data canvassed a wide range of governance attributes, institutions and practices suggested by the literature as important to governmental performance, in both indigenous and other contexts. The analysis found that a particular configuration of ‘orthodox’ governance principles and practices was necessary for successful Aboriginal Council performance, comprising: a strategic orientation based on a shared vision, a clear separation of powers, institutionalising the rule of law, positive and strategic engagement with government, targeted community engagement and an effective and efficient administration featuring a commitment to sound financial management, a stable workforce and human resource management practices that value, support and develop staff. The research further identified the key contextual factors that had shaped the distinct approaches to governance in the three communities. These are significant in explaining why some Aboriginal Councils adopt the particular mix of governance attributes that are necessary to improve their performance, while others do not. Key contextual factors include: a resource base of education and skills within the community that matches the needs of the community government; a pool of community members who have had a significant degree of exposure to the outside world; strongly egalitarian political norms underpinning a ‘whole of community’ orientation to governance; and a commitment to overcoming the historical legacy of dependency through a willingness to take responsibility for community government outcomes. These findings provide an indication about the strategies that need to be pursued for Aboriginal community governments to effectively meet the needs and aspirations of their constituents and realise their promise as instruments of self-determination.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Department of Politics and Public Policy
Griffith Business School
Full Text

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2002.
Includes bibliographical references (leaves 72-75).
Tension or outright conflict is a recurring theme in relations between Aboriginal communities and non-Aboriginal institutions and bodies in Canada. Additionally, many Aboriginal communities are fraught with internal divisions that prevent their leaders from taking consistent policy stands and negotiating effectively with other parties. These tensions and divisions can hinder the possibility of cooperation and disrupt the processes of problem-solving that are necessary to address many of the concerns of Aboriginal and non-Aboriginal Canadians. The current policy in Canada to move towards Aboriginal self-governance is likely to increase the frequency and complexity of such disputes. Despite these well-recognized dynamics, there are insufficient mechanisms and resources to address Aboriginal disputes, whether between Aboriginal groups and government, Aboriginal groups and non-governmental, non-Aboriginal parties, or amongst and between Aboriginal groups. A new initiative is proposed in the form of an independent, non-partisan, nonprofit organization devoted to the resolution of Aboriginal public disputes. The organization would work independently and with other organizations to fill the gaps in the field by providing access to professional dispute resolution services and by building capacity amongst Aboriginal and non-Aboriginal stakeholders to resolve such disputes. It would integrate and build on dispute resolution approaches from Western and Aboriginal models. In its startup phase, the organization would maintain a limited focus and engage in a relatively small range of activities. Ultimately, it is envisioned as a national organization, offering a broad range of services, which fundamentally transform the way Aboriginal disputes are addressed in Canada.
by Liora Zion.
M.C.P.

This ethnographic case study examines the experiences of five Aboriginal/Native American women faculty working in universities in Canada and the United States. By using interview, observation and document analysis the author has sought to understand the cultural negotiations of the participants. The hiring of Aboriginal faculty raises new questions about faculty roles and experiences, in much the same manner that the hiring of women and other visible minority faculty raised questions about the structures and culture of the university. These women have successfully attained status positions as tenured and tenure-track faculty. While some of their experience may be explained by their gender, their experiences as Aboriginal women are unique. These women actively work to decolonize the very structures of the university. They reconceptualize the tradition bound roles of researcher, committee member, and teacher. By doing so they make themselves hyper-visible to the lateral oppression of other Aboriginal faculty, and they are vulnerable to the structural oppression that binds a colonial organization. By telling their stories here, these women leave trail-markers for other Aboriginal people who may seek an academic path.

Aboriginal women and their concerns are largely underrepresented in most political arenas in Canada. In order for their preoccupations to be adequately addressed by governing bodies, these must first be identified and better understood. An exploration of how Aboriginal women resist and challenge oppression is thus needed. In this thesis, I examine a selection of academic works, authored by three prominent Aboriginal women activists in Canada: Sharon Donna McIvor, Patricia A. Monture and Kim Anderson. Their writings address the multiple injustices faced by Aboriginal women. The authors' methods for claiming individual and collective rights range widely, from awareness spreading, to reviving traditional ways, to taking legal action. They all express the difficulties and contradictions they face as indigenous women, though they diverge in their opinions concerning possible solutions. This, as well as their decisions to label themselves feminists or not, is perhaps due to their personal backgrounds and histories.

In the last twenty years there has been a growing desire to devolve justice interventions to the level of the community. An example of one such initiative is the justice committee program, an extrajudicial program set up in a number of Canadian communities to address minor youth cases, and cases involving Aboriginal people. This thesis is a capacity assessment of justice committees in Aboriginal communities in Quebec. With the help of literature on restorative community justice, crime prevention and building sustainable community programs, this thesis explores the recommended capacities for the implementation of sustainable justice committees, as well as the capacities perceived to be currently available to some justice committees in Aboriginal communities in Quebec. Through personal observations gathered during my work with justice committees in the past and interviews with various individuals working closely with justice committees in Quebec, this thesis found that a number of capacities were either lacking or were sporadically available to the communities studied. It concludes that with a common vision of the program's purpose, careful consideration of a community's ability to effectively intervene, and increased collaboration, resources and training; justice committees will be more likely to be implemented in a sustainable manner.

Northern British Columbia (BC) and Alberta are sparsely populated forested lands under provincial jurisdiction (also known as Crown land) which are under intensive oil & gas exploration and pipeline development. Local Aboriginal people continue to implement traditional practices that maintain viable land and productive ecosystems by annual rotation of trap lines, hunting and gathering areas and similar activities. Aboriginal people can exert tremendous influence on pipeline projects through various means. Regulators and enlightened pipeline companies recognize the value of assessing traditional knowledge that has been collected over generations and passed down from the Elders to contribute to final routing, siting and project design identifying effects on environmental resources and traditional land and resource use and developing mitigation opportunities. Traditional knowledge includes experiential and secondary knowledge as well as accepted scientific research in the context of environmental assessments. Robust applications consider sources from all land users while being mindful of the intricacies inherent with Aboriginal engagement in order to gather substantive input for projects on Crown land. This paper explores the contribution of Aboriginal Traditional Ecological Knowledge (TEK) in the environmental assessment process on selected case studies involving recent natural gas pipeline projects in northern BC and Alberta from a balanced perspective. It also describes the evolution of a program developed by the author from its initial emphasis on Traditional Land Use (TLU) studies to the present day application of TLU studies, and TEK studies, focusing on lessons learned and regulatory and engagement challenges and successes.

In 1998, Husky Oil Operations Limited and its partner formerly Rigel Oil, (purchased by Talisman Energy in 1999), constructed a 26.2 km pipeline in Kananaskis Country to transport sour oil, solution gas and produced water from Pad #3 on Cox Hill to the Shell Oil Jumping Pound Gas Plant for processing. Kananaskis Country is a 4160 km2 “Planning Area” that has both Prime Protection and Multiple Use designations. Situated just west of Calgary, Alberta, Canada it has considerable recreational and environmental value, including significant wildlife habitat. The original exploration and subsequent pipeline construction applications required separate Alberta Energy & Utilities Board (AEUB) public hearings with both involving significant public consultation. Prior to drilling on the lands that had been purchased more than a decade ago, Husky adopted several governing principles to reduce environmental impact, mitigate damage and foster open and honest communication with other industrial users, regulators, local interest groups and local aboriginal communities. During planning and construction, careful attention was paid to using existing linear disturbances (seismic lines, roads and cutblocks). A variety of environmental studies, that incorporated ecologically-integrated landscape classification and included the use of indicator species such as the Grizzly Bear, were conducted prior to and during the early stages of development. The results of these studies, along with the information gathered from the public consultation, historical and cultural studies and engineering specifications formed the basis for the route selection. Watercourses presented particular challenges during pipeline construction. The pipeline right-of-way (RoW) intercepted 26 small water runs and 19 creeks. Fishery and water quality issues were identified as important issues in the lower Coxhill Creek and Jumpingpound Creeks. As a result, Jumpingpound Creek was directionally drilled at two locations and all other watercourses were open-cut using low-impact techniques. To minimize new RoW clearing, substantial portions of the pipeline were placed in the ditch of the existing road. Husky attributes the success of this project to planning, broad community input and the co-operation and buy-in by the project management team and construction companies.

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.

Assessment and development of pipeline projects in northern Canada, such as the proposed Mackenzie Valley gas pipeline (MGP), are hampered by a lack of baseline terrain geoscience information including drift thickness, sediment type, presence of massive ground ice, and the availability of granular aggregate resources. Clearly there is a need by Industry, Regulators, Aboriginal groups, and others, to understand the nature and character of near-surface earth materials, in order that pipeline proposals can be properly developed, evaluated, and when approved, proceed with the greatest degree of environmental sustainability and economic efficiency. While numerous field-based reports and surficial geology maps have been prepared for the MGP, there are long stretches along the proposed route for which little near-surface geoscience information is available. This is even more apt for areas outside the defined MGP corridor, where the likelihood of tie-in and gathering pipeline systems exist. Drillers’ logs, recorded during auger drilling of seismic shotholes, represent a virtually untapped resource of regional baseline geoscience information. The Geological Survey of Canada recently produced a digital archive of 76,000 shothole records from the Northwest Territories and Yukon, which had originally been collected on file cards in response to the 1970’s MGP proposal. Released in 2007 as a freely downloadable Open File report (#5465), the archive provides users with an Access database of drillers’ logs and derivative GIS maps in which shapefiles of drift isopach thickness, potential granular aggregate resources, geohazards, permafrost and ground ice occurrences, and muskeg thickness can be opened, viewed, and queried, or otherwise incorporated into GIS platforms of the user’s choice. Realizing the amount of additional archival shothole information held by Industry, and the great utility of bringing this forth in a public database and derivative GIS, a subsequent project has focused on capturing and integrating additional data. Receiving near-universal support by the Petroleum Industry, a Version 2 of the database and GIS is currently being assembled, and is scheduled for release in 2009 with some quarter million individual shothole drillers’ records. This presentation highlights the nature, character and distribution of shothole drillers’ logs in northern Canada. It also reviews the derived GIS layers, and how this baseline geoscience information can be beneficially utilized by the Pipeline and related infrastructure development industries, particularly as it may apply to focusing future field studies. It also serves as a key reference tool for those assessing pipeline development proposals.

Professor Leslie R. Marchant was a Western Australian historian of international renown. Richly educated as a child in political philosophy and critical reason, Marchant’s understandings of western political philosophies were deepened in World War Two when serving with an international crew of the merchant navy. After the war’s end, Marchant was appointed as a Protector of Aborigines in Western Australia’s Depart of Native Affairs. His passionate belief in Enlightenment ideals, including the equality of all people, was challenged by his experiences as a Protector. Leaving that role, he commenced his studies at The University of Western Australia where, in 1952, his Honours thesis made an early case that genocide had been committed in the administration of Aboriginal people in Western Australia. In the years that followed, Marchant became an early researcher of modern China and its relationship with the West, and won respect for his archival research of French maritime history in the Asia-Pacific. This work, including the publication of France Australe in 1982, was later recognised with the award of a French knighthood, the Chevalier d’Ordre National du Mèrite, and his election as a fellow to the Royal Geographical Society. In this festschrift, scholars from The University of Notre Dame Australia appraise Marchant’s work in such areas as Aboriginal history and policy, Westminster traditions, political philosophy, Australia and China and French maritime history.

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.