Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985-1994

We estimated risk of suicide in adults in New South Wales (NSW) by sex, country of birth and rural/urban residence, after adjusting for age; we also examined youth suicide (age 15-24 years). The study population was the entire population of NSW, Australia, aged greater than or equal to 15 years during the period 1985-1994. Poisson regression was used to examine the relationship between predictor variables and the risk of suicide, with the focus on migrant status and area of residence. A significantly higher risk of suicide was found in male migrants from Northern Europe and Eastern Europe/former USSR, compared to Australian-born males; a significantly lower suicide risk occurred in males from Southern Europe, the Middle East and Asia. In female migrants, those from UK/Eire, Northern Europe, Eastern Europe/former USSR and New Zealand exhibited a significantly higher risk of suicide compared to Australian-born females. A significantly lower risk of suicide occurred in females from the Middle East. Male migrants overall were at significantly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born females. Among migrant males overall, the rural-urban suicide risk differential was significantly higher for those living in non-metropolitan areas (RR = 1.9; 95% CI: 1.7-2.1). Suicide risk was significantly higher in non-metropolitan male immigrants from the UK/Eire (RR = 1.4; 95% CI: 1.1-1.7), Southern Europe (RR = 1.7; 95% CI: 1.2-2.4), Northern/Western Europe (1.5; 95% CI: 1.2-1.9), the Middle East (RR = 3.8; 95% CI: 1.9-7.8), New :Zealand (RR = 1.4; 95% CI: 1.0-1.8) and 'other' (RR = 2.6; 95% CI: 1.9-3.5), when compared to their urban counterparts. There was no statistically significant difference in suicide risk between rural and urban Australian-born males. For female suicide, significantly lower risk was found in female immigrants living in non-metropolitan areas who were from Northern/Western Europe (RR = 0.7; 95% CI: 0.4-0.96), as well as the Australian-born (RR = 0.7; 95% CI: 0.6-0.8), when compared to their urban counterparts. The non-metropolitan/metropolitan relative risk for suicide in female migrants overall was not significantly different from one. Among male youth there was a significantly higher suicide risk in non-metropolitan areas, with a relative risk estimate of 1.4 for Australian-born youth (95% CI: 1.2-1.5) and 1.7 for migrant youth (95% CI: 1.2-2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan areas accounts for most of the excess of male suicide in rural NSW, and the significantly lower risk of suicide for non-metropolitan Australian-born women does not apply to migrant women. (C) 1999 Published by Elsevier Science Ltd. All rights reserved.

Associations between rural background and where South Australian general practitioners work

Objective: To determine the association between rural background on practice location of general practitioners (GPs) (rural or urban). Design: Comparison of data from two postal surveys. Subjects: 268 rural and 236 urban GPs practising in South Australia. Main outcome measures: Association between practice location (rural or urban) and demographic characteristics, training, qualifications, and rural background. Results: Rural GPs were younger than urban GPs (mean age 47 versus 50 years, P<0,01) and more likely to be male (81% versus 67%, P=0.001), to be Australian-born (72% Versus 61%, P=0,01), to have a partner (95% versus 85%, P= 0.001), and to have children (94% Versus 85%, P=0.001). Similar proportions of rural and urban GPs were trained in Australia and were Fellows of the Royal Australian College of General Practitioners, but more rural GPs were vocationally registered (94% versus 84%, P=0,001). Rural GPs were more likely to have grown up in the country (37% versus 27%, P= 0,02), to have received primary (33% versus 19%, P=0,001) and secondary (25% versus 13%, P=0,001) education there, and to have a partner who grew up in the country (49% Versus 24%, P=0.001). In multivariate analysis, only primary education in the country (odds ratio [OR], 2.43; 95% CI, 1.09-5.56) and partner of rural background (OR, 3.14; 95% CI, 1.96-5.10) were independently associated with rural practice. Conclusion: Our findings support the policy of promoting entry to medical school of students with a rural background and provide an argument for policies that address the needs of partners and maintain quality primary and secondary education in the country.

Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors

Objective To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice. Methods National case - control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience. Results Rural GPs were more likely to report having had any rural undergraduate training [ odds ratio ( OR) 1.61, 95% confidence interval (CI) 1.32 - 1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training ( OR 3.14, 95% CI 2.57 - 3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs ( OR 10.52, 95% CI 5.39 - 20.51). South Australians whose final high school year was rural were more likely to be rural GPs ( OR 3.18, 95% CI 0.99 - 10.22). Conclusions Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.

Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia

Objective: To compare rates of self-reported use of health services between rural, remote and urban South Australians. Methods: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. Results: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use ( greater than or equal to6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). Conclusion: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State.

Extra-curricular involvement and self-regulation in children

The research investigated the relationship between extra-curricular involvement (ECI) and self-regulated behaviours in 8 to 9 year old children, and identified sex, location, and socio-economic status (SES) differences in their ECI and self-regulatory behaviours. 550 children from 44 schools in Queensland and New South Wales completed the Child Self-Regulatory Process Inventory and questions about their ECI. Nearly 90 percent of students were involved in at least one extra-curricular activity with the mean number of activities being 1.27. Girls and urban children were significantly more involved in school-based extra- curricular activities than their male and rural counterparts; there were no significant differences among SES groups. Urban children and children in the high SES group reported significantly greater involvement for non-school based activities. For the three self- regulation strategies, girls scored significantly higher than boys. Moreover, children in the high ECI group reported significantly greater use of self-regulation strategies than children in both the low and medium ECI groups. Implications of findings are discussed in light of the need for quality extra-curricular programs, especially in terms of emotional climate and self-directed activities.

Categories of indigenous 'homelessness' people and good practice responses to their needs

Mainstream concepts of homelessness do not serve Indigenous people well. Those designing policies or programs for Indigenous homeless people may need to re-think or change their concepts of homeless in order to adequately understand and respond to the needs of this group of people.

Understanding and enhancing research-policy linkages in Australian housing: A discussion paper

This project aimed to develop a systematic framework for understanding the relationship between social science research and public policy, and to build more effective linkages between social researchers and policy practitioners in the Australian housing system, particularly through AHURI. The project is explicitly applied and solution-focused. It was undertaken in close collaboration with AHURI and has contributed to AHURI's overall mission and strategy to enhancing research-based housing policy. It provided an opportunity for the AHURI policy community to engage in a process of action-oriented, self-reflection around its core business of applied housing policy research.