SEARCH
The Study of Environment on Aboriginal Resilience and Child Health
The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is the first major research program established by the Coalition for Research to Improve Aboriginal Health (CRIAH), a partnership between the Aboriginal Health and Medical Research Council of NSW and the Sax Institute.
The objective of CRIAH is to facilitate research to improve Aboriginal health that:
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Evaluates potential solutions building a strong evidence base about the determinants of health and the impact of programs and services
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Is relevant to the needs of Aboriginal people
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Integrally involves Aboriginal communities as partners
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Builds research capacity among people from Indigenous backgrounds.
SEARCH will make significant gains in all these areas as it:
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Is conducted in partnership with Aboriginal Medical Services
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Combines the expertise of leaders in Aboriginal health with the expertise of leaders in relevant research disciplines to conduct SEARCH in a culturally appropriate and scientifically excellent manner
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Will employ and train at least 10 Aboriginal researchers.
The idea for SEARCH came about during community consultations conducted in the early years of CRIAH. Community leaders stated that they were interested in research which:
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Examined the health and wellbeing of children and families
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Looked at health holistically - taking into account things like housing, financial pressures and mental health
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Followed families for up to 20 years to see how their health progressed, and the things that predicted health getting better or worse
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Included interventions in important areas - ear health and housing were nominated as particularly important.
SEARCH has been designed to do all of these things.
Contents:
What is SEARCH?
SEARCH is the first large scale study into the health and well being of Aboriginal children living in urban communities in New South Wales. Many studies have looked at how rural and remote communities cope, but little is known about how families living in urban areas get on.
The primary objective of SEARCH is to provide more detailed descriptions of the health of urban Aboriginal infants, children, adolescents and their families. SEARCH will gather information on ear infections, vaccinations, mental health, injury, environmental health and risk factors for later chronic diseases.
To achieve this, families will be recruited from Aboriginal Medical Services across NSW to participate in:
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A cross-sectional study of 800 families in urban and large regional centres
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A prospective longitudinal cohort study of the 800 families over 5-20 years.
Where will SEARCH be conducted?
SEARCH will be conducted through a number of Aboriginal Medical Services located in urban and large regional centres in NSW including Mount Druitt (Aboriginal Medical Service Western Sydney), Campbelltown (Tharawal Aboriginal Corporation), Wagga Wagga (Riverina Medical and Dental Aboriginal Corporation), and Newcastle (Awabakal Newcastle Aboriginal Co-op).
Who is leading the research?
SEARCH is lead by the Coalition for Research to Improve Aboriginal Health (CRIAH). The Principal SEARCH Investigator is Professor Jonathan Craig from the University of Sydney. The full list of Chief Investigators on the Study are:
Professor Jonathan Craig
Professor in Clinical Epidemiology, School of Public Health
University of Sydney
Professor Richard Taylor
Head, Division of International Health,
University of Queensland
Director, Australian Centre for International and Tropical Health and Nutrition
Ms Sandra Bailey
Chief Executive Officer
Aboriginal Health and Medical Research Council
Associate Professor Emily Banks
NHMRC Fellow, National Centre for Epidemiology and Population Health Australian National University
Scientific Director, The 45 and Up Study
Associate Professor Alan Cass
Director, Renal Division
The George Institute for International Health
Professor Kathleen Clapham
Director, Woolyungah Indigenous Centre
University of Wollongong
Dr John Daniels
Medical Director
Aboriginal Medical Service Redfern
Professor Sandra Eades
Head, Indigenous Maternal and Child Health Research Program
The Baker IDI Heart and Diabetes Institute
Professor Susan Kippax
Professorial Research Fellow, National Centre in HIV Social Research
University of New South Wales
Professor Peter McIntyre
Director, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases
Ms Maree Keogh
Chief Executive Officer
Riverina Medical and Dental Aboriginal Corporation
Professor Beverly Raphael
Director of Population Mental Health and Disasters
University of Western Sydney
Professor Sally Redman
Chief Executive Officer
The Sax Institute
Mr Frank Vincent
Chief Executive Officer
Aboriginal Medical Service Western Sydney
The Chief Investigators form the SEARCH Steering Committee and are responsible for the overall scientific and ethical conduct of the Study. In addition to the Steering Committee, a series of sub-groups comprising leaders in Aboriginal health and relevant research disciplines have been convened to oversee specialist areas within the Study.
Who will participate in the study?
Two thousand Aboriginal children from 800 families. Families will be interviewed at baseline and followed up for at least five years.
How is SEARCH funded?
SEARCH has primarily been funded through competitive grants from the National Health and Medical Research Council. Support for the study has also been provided through the Rio Tinto Aboriginal Foundation and the Centre for Aboriginal Health within the NSW Department of Health.
Aims of SEARCH
The aims of SEARCH are to describe and investigate the causes of health and illness in approximately 2000 Aboriginal children aged 0 - 17 years with a focus on healthy environments and selected child health problems through an initial cross sectional study and an ongoing longitudinal cohort study.
These studies will form the basis of an urban Aboriginal cohort study, which we hope will span 20 years with funding from alternates sources.
A healthy environment is defined as one which:
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Has quality housing
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Is safe
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Has access to appropriate health and community services
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Has care providers who are physically and mentally healthy
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Has adequate resilience both within the family and within the wider community
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Has an adequate level of income.
The child health problems are: injury; otitis media; vaccinations; mental health; developmental delay; obesity and; risk factors for later chronic disease.
Overview of Study Methods
Families meeting inclusion criteria will be invited to participate in SEARCH at the time of presentation to one of the participating Aboriginal Medical Services. Families that agree to participate will complete a series of measures that will be used as part of the initial cross-sectional study, as detailed below.
1. Baseline survey
An Aboriginal Research Officer will interview the family using standard surveys with specific questions based on the age of their children. This survey will include basic demographic information, measures of the child and carer's health and wellbeing, health service use, community and family resilience and quality and safety of housing.
2. Clinical measures
An Aboriginal Research Officer will also take the following clinical measures on all participants recruited to the study:
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Height
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Weight
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Waist circumference
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Blood pressure
3. Audiology assessment
All children aged 6 months or older will be referred to a SEARCH Audiologist in each AMS for formal standardised, age-appropriate hearing assessment. Using a video-otoscope the audiologist will capture a digital image of the eardrum for the purpose of detecting abnormal conditions that might require further evaluation or treatment. A tympanometer will test how well the middle ear system is functioning and how well the eardrum can move.
4. Speech and development assessment
All children aged between one and seven years will be referred to a SEARCH Speech Pathologist. These children will be assessed against the Parent Evaluation of Developmental Status questions (PEDS) and will undergo a set of standardised age-appropriate speech testing.
Sub-Studies within SEARCH
The recruitment, assessment and long term follow up, including linkage to routinely collected state and national population health data sets, of 2,000 Indigenous children across New South Wales, creates a foundation for a wide variety of research to inform and influence interventions and service delivery. Projects to date that have been generated form this foundation, include:
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a controlled trial to examine whether a community appointed health broker, that works directly with families, can improve the ear health of Indigenous children
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a descriptive study investigating the housing needs of 70 Indigenous families living in urban communities in NSW based around four issues: safety; insulation; mould; and vermin. Based on the information from the descriptive study, this project will then plan and separately seek funding for a larger scale intervention targeting the issues of most need
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a study of the validity of the Strengths and Difficulties Questionnaire (SDQ) (a screening tool for emotional and behavioural problems) to determine whether the SDQ is a culturally appropriate and useful screening tool for Indigenous children living in urban communities in NSW
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a study using individual-level data from the SEARCH study to determine the type, quality and amount of green space available to participating Indigenous families to: (i) Describe patterns of physical activity, overweight and obesity; (ii) Examine the self reported use of local green space for physical activity; (iii) Explore barriers to the use of green space for exercise; (iv) Examine the relationship between green space, physical activity, overweight and obesity
Outcomes from SEARCH
We anticipate that the information from SEARCH will contribute to decisions by Aboriginal Medical Services and by governments about appropriate programs to close the gap in life expectancy and to improve Aboriginal health. Because the study is long term, it will provide unique information about the causes of poor or better health among the children as they grow up.