title: Driver licensing: descriptive epidemiology of a social determinant of Aboriginal and Torres Strait Islander health.
abstract: OBJECTIVE
  Education, employment and equitable access to services are commonly accepted as important underlying social determinants of health. For most Australians, access to health, education and other services is facilitated by private transport and a driver licence. This study aimed to examine licensing rates and predictors of licensing in a sample of Aboriginal and Torres Strait Islander people, as these have previously been poorly described.
  
  
  METHODS
  Interviewer-administered surveys were conducted with 625 people 16 years or older in four Aboriginal Community Controlled Health Services in New South Wales and South Australia over a two-week period in 2012-2013.
  
  
  RESULTS
  Licensing rates varied from 51% to 77% by site. Compared to not having a licence, having a driver licence was significantly associated with higher odds of full-time employment (adjusted OR 4.0, 95%CI 2.5-6.3) and educational attainment (adjusted OR 1.9, 95%CI 1.2-2.8 for trade or certificate; adjusted OR 4.0, 95%CI 1.6-9.5 for degree qualification).
  
  
  CONCLUSIONS
  Variation in driver licensing rates suggests different yet pervasive barriers to access. There is a strong association between driver licensing, education and employment.
  
  
  CONCLUSIONS
  Licensing inequality has far-reaching impacts on the broader health and wellbeing of Aboriginal and Torres Strait Islander people, reinforcing the need for appropriate and accessible pathways to achieving and maintaining driver licensing.
authors.affiliation: The George Institute for Global Health, The University of Sydney, New South Wales.|Flinders University, South Australia.
authors.forename: Rebecca Q
authors.initials: RQ
authors.lastname: Ivers
authors.affiliation: The George Institute for Global Health, The University of Sydney, New South Wales.|The Poche Centre for Indigenous Health, University of Western Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Hunter
authors.affiliation: Australian Health Services Research Institute, University of Wollongong, New South Wales.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Clapham
authors.affiliation: Flinders University, South Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Helps
authors.affiliation: Transport and Road Safety Research, The University of New South Wales.
authors.forename: Teresa
authors.initials: T
authors.lastname: Senserrick
authors.affiliation: The George Institute for Global Health, The University of Sydney, New South Wales.
authors.forename: Jake
authors.initials: J
authors.lastname: Byrne
authors.affiliation: The George Institute for Global Health, The University of Sydney, New South Wales.|Sydney Medical School, The University of Sydney, New South Wales.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Martiniuk
authors.affiliation: University of Wollongong, New South Wales.
authors.forename: John
authors.initials: J
authors.lastname: Daniels
authors.affiliation: Flinders University, South Australia.
authors.forename: James E
authors.initials: JE
authors.lastname: Harrison
mesh_terms: D000293:Adolescent; D000328:Adult; D001333:Automobile Driver Examination / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008004:Licensure / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011634:Public Health / Q000379:methods* / Q000706:statistics & numerical data; D012946:Social Welfare / Q000706:statistics & numerical data; D013021:South Australia; D011795:Surveys and Questionnaires; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal health; driver licensing; road safety