To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study
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引用次数: 0
Abstract
Background
Racism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children's mental health and sleep problems if interpersonal racial discrimination was eliminated.
Methods
We drew on cross-sectional data from the Speak Out Against Racism (SOAR; N = 2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N = 8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10–15 years; LSAC: 4–5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10–15 years; LSAC: 12–13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10–15 years; LSAC: 14–15 years). An interventional effects causal mediation approach was used.
Findings
Aboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40.1% versus 13.5%; LSAC: 25.3% versus 7.6%) and sleep problems (SOAR: 28.5% versus 18.4%; LSAC: 14.0% versus 9.9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children's experiences of interpersonal racial discrimination could reduce 42.4% and 48.5% of mental health and sleep inequities in SOAR (equivalent to 11.2% and 4.7% absolute reductions) and 25.6% and 1.6% of mental health and sleep inequities in LSAC (equivalent to 5.5% and 0.1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes.
Interpretation
Targeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.
Funding
National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia.
期刊介绍:
The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.