McCulloch, Brad, McDermott, Robyn, Miller, Geoff, Leonard, Dympna, Elwell, Michelle, and Muller, Reinhold (2003) Self-reported diabetes and health behaviors in remote Indigenous communities in Northern Queensland, Australia. Diabetes Care, 26 (2). pp. 397-403.

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Abstract

OBJECTIVE: this study examines associations between self-reported diabetes and self-reported smoking, alcohol consumption, fruit consumption, and participation in adequate exercise in remote indigenous communities, using data from the Well Persons’ Health Check (WPHC).

RESEARCH DESIGN AND METHODS: the WPHC was a cross-sectional survey of 2,862 indigenous individuals (1,602 Aborigines, 1,074 Torres Strait Islanders, and 186 persons of joint descent) aged ≥15 years. The study was conducted in 26 remote communities in northern Queensland, Australia, between March 1998 and October 2000.

RESULTS: a total of 32% of individuals with self-reported diabetes and 25% of other individuals reported eating enough fruit, according to National Health and Medical Research Council criteria: odds ratio (OR) 1.407 (95% CI 1.108–1.786), P = 0.006. After adjustment for age, sex, and ethnicity, no significant difference could be observed: adjusted OR 1.22 (0.944–1.574), P = 0.128. A total of 58% of participants who reported diabetes and 51% of others reported adequate exercise: OR 0.761 (0.609–0.952), P = 0.018. This difference was not significant after adjustment for age, sex, and ethnicity: adjusted OR 0.896 (0.705–1.14), P = 0.370. A total of 43% of individuals who reported diabetes and 72% of others reported consuming alcohol: OR 0.295 (0.235–0.369), P < 0.001. After adjustment for age, sex, and ethnicity, this difference was still significant: adjusted OR 0.550 (0.428–0.709), P < 0.001. Diabetic drinkers consumed alcohol at harmful levels similar to those of nondiabetic drinkers (P = 0.691). A total of 40% of individuals who reported diabetes and 63% of other persons were tobacco smokers: OR 0.403 (0.322–0.505), P < 0.001. Although this crude difference was attenuated by adjustment for age, sex, and ethnicity, persons with self-reported diabetes were still significantly less likely to smoke tobacco than other participants: adjusted OR 0.666 (0.521–0.852), P = 0.001. Smoking prevalence among the diabetic indigenous participants was more than double that in nondiabetic nonindigenous Australians.

CONCLUSIONS: this study suggests that indigenous individuals with diabetes living in rural and remote communities are not adopting lifestyle changes required for optimal self-management of the disease. This contributes to the large excess of mortality and morbidity experienced by this population.

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