Summary of the project:

This research investigates the connection between smoking tobacco along coronary disease among Indigenous Australian men aged 65 years and more than that. In terms of examining the prevalence of smoking in this specific group of people, the research will be able to estimate its contribution as a fundamental risk factor for coronary disease.

Data for this research will be gathered from medical records as well as surveys along with interviews to make sure the ethical considerations are fulfilled. The purpose of this project is to provide valuable perceptions to direct public health interventions as well as advance the well-being of the heart in the indigenous group of people.

Background to the project:

Tobacco smoking is the most significant cause of preventable disease as well as death in Australia. Smoking is a profound independent risk factor for cardiovascular diseases along with mortality rates even in older individuals. Coronary disease is one of the major reasons for morbidity as well as mortality all over the globe and the Indigenous Australian population is impacted excessively, as suggested by Crosland et al. (2019).

The Indigenous Australian population specifically males aged 65 and older face exceptional rates of heart disease and risk factors which include tobacco smoking. This study has shown that smoking is an efficient risk factor for cardiovascular diseases which include ‘coronary heart disease (CHD)’ as it leads to atherosclerosis as well as expands the probable chances of heart attacks. As suggested by AIHW (2018), in the years 2014 and 2015 about 42% of Indigenous people aged 15 and older were present smokers (186,000 present smokers).

The rate of smoking for Indigenous people aged 15 and older was 2.7 times as inflated as for non-Indigenous grown persons. Moreover, smoking-related hospitalizations among Indigenous Australians have risen sharply, reflecting a public health crisis. Smoking was linked to around two-fifths of the burden of cancer (39%), cardiovascular disease (39%), and respiratory illness (42%), underscoring the urgent need for targeted interventions and smoking cessation programs tailored to Indigenous communities (AIHW, 2024).

Research indicates that tobacco smoking is a significant risk factor for coronary heart disease (CHD) among various populations, including Indigenous Australians. The prevalence of smoking is specifically concerning because of its intensified impacts on cardiovascular risk factors about age, among aged Indigenous males. Tobacco smoking is exceptionally recorded as a fundamental transformable risk factor for CHD that impacts lipid profiles as well as expanding oxidative stress and resulting in direct endothelial disruption, as supported by Dahdah et al. (2022). There has been a deficiency of extensive surveys concentrating particularly on

Indigenous males aged 65 and older, accelerating an immediate requirement for selected investigations that analyse the interconnection between smoking and ‘coronary health disease (CHD)’ inside this selected group of people. At the same time when public health attempts have focused on decreasing smoking rates in the wider Indigenous communities, their effectiveness inside this aged people group is yet to be estimated. The possible increasing disruption from lifelong smoking stays undiscovered. Studies show that Indigenous males have much higher smoking prevalence rates, which exacerbate their risk for CHD (Burnette et al., 2020).

The Australian Indigenous HealthInfoNet highlights that smoking rates among Indigenous men aged 15 and over are substantially higher than the national average, contributing to much more increased cardiovascular morbidity (Colonna et al., 2020). Furthermore, in this context, Mancilla et al. (2020) stated that the intersection of smoking with socioeconomic factors, such as lower access to healthcare and higher rates of stress, compounds health risks.

Recent studies very effectively emphasise the urgent need and particular requirement for culturally sensitive health interventions much more tailored to Indigenous communities to address and tackle smoking cessation and promote cardiovascular health (Canuto et al., 2021). Overall, the existing literature very significantly demonstrates and underscores the urgent need and requirement to properly investigate and examine the specific impacts and effectiveness of tobacco smoking on coronary disease among Indigenous males aged 65 and over.

Stakeholders which include ‘Indigenous health councils’ as well as ‘cardiology experts’ along with ‘public health agencies’ have recognized the requirement for culturally sensitive, age-specific interventions. The purpose of this research is to connect types of gaps in the existing literature assisting in informing future guidelines along with healthcare exercises by mainly focusing on and concentrating on the way tobacco smoking adds to coronary disease in older Indigenous males of Australia.

These kinds of stakeholders provide and offer much more valuable types of insights into cultural sensitivities, health behaviours, and socioeconomic factors specific to Indigenous communities. Their important and valuable input helps shape and reform the research design, ensuring it properly addresses the unique kinds of needs and requirements of Indigenous males aged 65 and over.

Stakeholders also contribute to formulating important types of ethical guidelines and ensuring that outcomes lead to much more effective, culturally tailored interventions. For instance, a study conducted and organised by the Queensland Aboriginal and Islander Health Council found that heart disease is the leading and main type of cause and reason for death among Indigenous Australians, with smoking identified as a particular critical risk factor (AIHW, 2023).

Additionally, the Australian Bureau of Statistics reports that Indigenous Australians have a significant life expectancy of approximately 10.6 years lower than non-Indigenous Australians, largely just due to smoking-related diseases (AIHW, 2015).  An extensive investigation of these factors will help the improvement of more successful health promotion approaches focused on decreasing the prevalence of ‘coronary health disease (CHD)’ in this community.

Aims of the project:

The aim of this research is to evaluate the connection between smoking along with ‘coronary heart disease (CHD)’ in Indigenous males aged 65 and older than the provided age in Australia and desires to accomplish results that can be able to direct the public health approaches for the purpose of decreasing the mortality as well as morbidity of ‘coronary heart disease (CHD)’ via smoking cessation programs customised to the Indigenous group of people.

Primary research question

Is tobacco smoking a major risk factor for coronary heart disease among Indigenous males aged 65 and over in Australia?

Justification:

The ‘justification’ for this research arises from the efficient health load that ‘coronary heart disease (CHD)’ places on Indigenous Australian males aged 65 and older, a group of people that already face intensified health problems. Tobacco smoking has been recognized as a vital risk factor for cardiovascular diseases in the world, but its effect on this group of people remains undiscovered.

The purpose of this research is to fill-up this gap by analysing the interconnection between smoking and coronary disease in older males in Australia. Providing the distinct sociocultural as well as economic factors impacting health behaviours in Indigenous groups of peoples to comprehend this connection is essential to growing selected intervention. The possible advantages of this study involve public health approaches as well as culturally sensitive tobacco cessation programs along with decreased occurrence of ‘coronary heart disease (CHD)’ in an endangered population.

These collected perceptions could be able to justify the ethical risks of the research as well as provide the anticipated developments in health results along with healthcare policies customized to the Australian Indigenous population. This research is vital for providing information regarding making policies at the local as well as national degrees. Moreover, the findings from this research could lead to very significant public health benefits, including the development and growth of culturally sensitive and community-based tobacco cessation programs, specifically designed to resonate with Indigenous values and traditions.

Furthermore, this study could inform important healthcare providers and policymakers at both local and national levels, guiding them to very properly implement more targeted interventions aimed at reducing smoking rates and preventing coronary heart disease among older Indigenous males. By addressing and recognising this critical health issue, the research aims to contribute to very long-term improvements in Indigenous health outcomes, ultimately reducing and minimising the life expectancy gap between Indigenous and non-Indigenous Australians.

 Site selection, recruitment, selection criteria, and participant involvement:

Site selection: Indigenous settings of Australia.

•    Please list the inclusion criteria and the exclusion criteria.
Briefly describe on what basis participants will be included in, or excluded from, the project.

Selection criteria: Participants should be from the Indigenous population of Australia. Participants should be equal to and more than 65 years of age. Moreover, participants must be males and associated with the habit of tobacco smoking. On this basis the targeted participants will be included in this research study. 

•    Please describe the recruitment process that will be used.

Participants will be recruited directly for the research study after being invited via email. They will be required to sign an informed consent form before their recruitment. A random sampling method will be used to select the necessary number of participants for the study.

•    Please describe participants’ level of involvement in the study, e.g. time or financial commitment.

Participant involvements: Males with ages of 65 years and above, will be directly involved in the research study. However, their privacy and confidentiality will be maintained throughout the research. Thus, their level of involvement will only be limited to time commitments. 

 Design & methodology:

In this nursing research context, a population based, cross-sectional study design will be applied. In cross-sectional research designs, correlational data is collected at one time point and can help in the understanding of the state of correlation between the variables of the study at the time of data collection. This is because it enables the researcher to assess and establish co-relations between risk factors, for instance, tobacco smoking, and health outcomes. For instance, CHD in the target population in order to establish the extent of the relation of the selected risk factors with specific health outcomes. 

Firstly, participants with CHD history will be identified through survey questionnaire. Besides, their current and past smoking statuses will also be determined using the same questionnaire during the tobacco smoking survey. As in data collection, the study results will be analyzed using correlation analysis to determine the relationship between tobacco smoking and history of CHD.

Sample size:

A total of 20 participants will be used in the research study. This number of participants has been selected because it is a student’s research and will be conducted by an individual only. Thus, a lack of manpower prevents the selection of a higher number of participants for the research study. 

A random sampling process will be used to avoid selection bias. In addition, the expected individuals to be included will comprise of Indigenous males of 65 years and above. A total of 20 participants will be selected randomly from all the individuals interested in participating in the research. Moreover, participants aligned with the inclusion and exclusion criteria of the research will only be selected for the research.

Collection & use of data:

16.    How will the identity and privacy of participants be protected? 

•    If identifying information is to be made public, justify the public identification of individual participants or communities.

No participant data will be allowed to be accessed by any third party. Names of the participants will not be used in any part of the research. However, demographic information will be used in the research study. Thus, public identification of the individual participants will be done by demographic information only, since the names of participants will not be mentioned in the research. 

Outline procedures to be followed in the event of a participant withdrawing consent or dying:

Freedom to withdraw consent from the research will be given to each of the participants. In cases of dying, the participant will be ethically excluded from the research study. However, there are no death risks associated with this research. 
 

English as a second language:

An interpreter will be appointed to make the non-English speaking participants understand the project aims and objectives written in English. The participant groups will be notified about this interpreter service in the declarations section of the informed consent form. 

How will your proposed methodology ensure respect for the cultural, social and religious beliefs and customs, or cultural heritage of participants?

The research study will be carried out with all respect for the culture and beliefs of the Indigenous research participants. Participatory research will be conducted to ensure that participant voices are used to guide the study. Moreover, community leaders will be consulted using culturally appropriate methods to ensure that data collection is a reflection of local customs.

Consent Procedures:

The Participant Consent Form should allow the participant to consent to or give permission to each proposed intervention, the proposed storage or destruction of any biological samples, being videoed or audiotaped, the proposed level of confidentiality and any dissemination of results. 

It is important that the participant consent form states in bold ‘This Means You Can Say NO’ underneath the research title at the top of the page, has a full letterhead with contact details, researchers names and contact details and a space for witness and interpreter signature, name and date in addition to a space for participant signature, name and date.  

The Participant Information Sheet should be given to the participant to keep, and should contain contact details for the researcher/s in case of an emergency. It should clearly state in bold: ‘This Is For You To Keep’ underneath the research title at the top of the page, a full letterhead with contact details, researchers names and contact details in case of an emergency, written in plain English, a paragraph of assurance of confidentiality and a paragraph on concerns and complaints with the contact details and email address of the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research.

Bothshould clearly identify the organisation responsible for conducting the research and provide information allowing the participant to withdraw from the project at any time without giving a reason or not participate at all.

Since no specific organisation will be consulted for the data collection process, this section has no applicability for the proposed study. 

Individual consent will be sought since the proposed research will be based on a primary research design. This is because none of the individuals will be forced to participate in the research. On the other hand, individual consent will be sought to avoid any ethical conflicts that might arise for the proposed primary research.

Anticipated outcomes:

•    Detail the anticipated outcomes from the project and how they will contribute new knowledge to the field as well as any potential applications of the findings. 
•    Justify the risks in terms of the likely benefit to be gained.
    
The anticipated outcomes of the research project based on tobacco smoking as a major risk factor for CHD among elderly Indigenous males are multifaceted. In other words, the conduction of the proposed research study provides a much deeper understanding of the association between CHD prevalence and smoking among Aboriginal males. In addition, the research can also identify specific factors that are responsible for an increase in smoking rates among elderly Indigenous males. Moreover, the outcomes can also talk of the influence of healthcare resource allocation on the relationship between tobacco usage and CHD occurrence. Lastly, the proposed research findings can also provide better recommendations to address the health needs of Aboriginal males and reduce their rates of tobacco smoking. The conduction of the proposed research study will help reduce the impact of a major risk factor (tobacco smoking) of CHD among the elderly Indigenous male population of Australia.

 Intellectual property:

•    If there is a possibility of commercial exploitation of the results, has agreement been reached with participants in relation to ownership of intellectual property?  
No.

Risk management strategy:

The potential risks for the research participants can include concerns of privacy, emotional distress, and issues with cultural sensitivity. In addition, participants can also experience anxiety as well as discomfort while talking about their smoking status and medical history. Moreover, participants can also have think about risks of confidentiality breach, which they can openly express to the researcher also. Furthermore, there are risks of misuse as well as misinterpretation of information obtained from Indigenous people of Australia.  Thus, safeties in the following area will be ensured by the researcher –

Summary of ethical issues:

•    Briefly summarise all the ethical issues related to this project. 
•    These should include at a minimum Benefit/Risk, Indigenous Involvement and Capacity Building, and Generalisability.

It is important to familiarise yourself with the National Statement on Ethical Conduct in Human Research (NHMRC) before attempting this summary.

Many ethical issues can arise during the conduction of the proposed research. The first key ethical issue can be informed consent, if not obtained from each of the participants. Then, comes the language barrier, which can hamper the communication processes between the researcher and the participants. Moreover, this issue can also lead to problems in obtaining informed consent from the Aboriginal participants. Following this issue, ethical issues in maintaining confidentiality are also critical for the proposed research project. This is because, in small communities, participants can be easily identified. Thus, hiding their identity inside the research study will be of utmost importance for the researcher. The researcher should ensure that robust data protections are used to prevent data breaching risks associated with the research.

The main benefits of this research will include gaining new knowledge, fostering social development, and the improvement of overall health outcomes. These benefits will outweigh the potential risks of cultural issues, exploitation of information, and emotional distress. On the other hand, capacity building is another aspect associated with the ethical issues of the proposed research project. The researcher will not only extract knowledge from Aboriginal participants but also help in promoting healthy behaviour among them. This can further involve the training of Indigenous community members and provide education as well as support for local infrastructures.

The researcher will encourage Indigenous people to take ownership of the research as well as the outcomes. In this way, he can ensure that the long-term benefits of the research are promoted and extended beyond the proposed research. However, it can be said that generalisation in research studies involving Aboriginal communities needs caution. This is because the results obtained from a single Indigenous community might not be generalised for other Aboriginal communities. However, the findings can be still localized as well as applied in ways that are primarily relevant for most of the Aboriginal communities. On a summarising note, it can be said that the main aim of the researcher will be to minimise the ethical risks associated with the proposed research study. Furthermore, the approach will also foster respectful, ethical, and impactful research for the welfare of the Indigenous Australian population.
 

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References

AIHW (2018). Health behaviours of Indigenous Australians. https://www.aihw.gov.au/getmedia/9677d3dc-c48e-4bef-8c26-9ecead8e1fc8/aihw-aus-221-chapter-6-5.pdf.aspx#:~:text=In%202014%E2%80%9315%2C%20around%2042,smokers%20(186%2C000%20current%20smokers).&text=The%20smoking%20rate%20for%20Indigenous,rate)%20(ABS%202017) (accessed: September 19, 2024).
AIHW (2024) 2.15 tobacco use. https://www.indigenoushpf.gov.au/measures/2-15-tobacco-use.
AIHW 2015, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015, AIHW, Canberra. doi:10.25816/5ebcbd26fa7e4
Australian Institute of Health and Welfare & National Indigenous Australians Agency (AIHW) 2023, Measure 1.05 Cardiovascular disease, Aboriginal and Torres Strait Islander Health Performance Framework website, viewed 20 September 2024, https://www.indigenoushpf.gov.au/measures/1-05-cardiovascular-disease
Burnette, C. E., Ka’apu, K., Scarnato, J. M., and Liddell, J., 2020. Cardiovascular health among US Indigenous peoples: A holistic and sex-specific systematic review. Journal of Evidence-Based Social Work, 17(1), 24-48.
Canuto, K.J., Aromataris, E., Burgess, T., Davy, C., McKivett, A., Schwartzkopff, K., Canuto, K., Tufanaru, C., Lockwood, C. and Brown, A., 2021. A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors. Health Promotion Journal of Australia, 32(1), pp.46-74.
Colonna, E., Cohen, R., Doery, K., Guthrie, J., Lovett, R., Maddox, R., Marmor, A., Thomas, D., Thurber, K.A. and Wells, S., 2020. Review of tobacco use among Aboriginal and Torres Strait Islander peoples.
Crosland, P., Ananthapavan, J., Davison, J., Lambert, M. and Carter, R., 2019. The health burden of preventable disease in Australia: a systematic review. Australian and New Zealand journal of public health, 43(2), pp.163-170.
Dahdah, A., Jaggers, R.M., Sreejit, G., Johnson, J., Kanuri, B., Murphy, A.J. and Nagareddy, P.R., 2022. Immunological insights into cigarette smoking-induced cardiovascular disease risk. Cells, 11(20), p.3190.
Mancilla, V.J., Peeri, N.C., Silzer, T., Basha, R., Felini, M., Jones, H.P., Phillips, N., Tao, M.H., Thyagarajan, S. and Vishwanatha, J.K., 2020. Understanding the interplay between health disparities and epigenomics. Frontiers in genetics, 11, p.903.