Help-seeking behaviour for emotional or behavioural problems among Australian adolescents: the role of socio-demographic characteristics and mental health problems.

This thesis describes the relationship between the socio-demographic characteristics and level of mental health problems experienced by young adolescents and three different stages of help-seeking through which adolescents may progress when seeking professional help for self-perceived emotional or behavioural problems: (i) Problem recognition; (ii) Perception of a need for professional help for problems; (iii) Having received the help they needed for these problems. The thesis provides new information about help-seeking by separately examining the relationship between the key predictor variables and each of these different stages of help-seeking. Participants were 5,634 adolescents recruited for the beyondblue Schools Research Initiative. Adolescents completed measures of help-seeking behaviour, several measures of mental health problems (emotional and behavioural difficulties, depression and anxiety) and several measures of psychosocial functioning (interpersonal skills, constructive problem solving and perceived levels of social support). Forty percent of all adolescents perceived that they had experienced emotional or behavioural problems in the previous six months and 18% perceived they had more of these problems than their peers. Eight percent of all adolescents perceived a need for professional help with their problems. Only 3% of all adolescents reported receiving the help they needed for their problems, despite perceiving a need for professional help. Adolescents with higher levels of mental health problems were more likely to perceive they had emotional or behavioural problems, more problems than their peers and a need for professional help with these problems beyond that explained by their levels of psychosocial functioning. Perceiving emotional or behavioural problems was more common among females compared to males, adolescents from a non-English speaking background compared to those from an English speaking background, and among adolescents from families where parents did not live together compared to those from families with parents living together. Adolescents from families with separated or divorced parents were more likely to perceive they had more problems than their peers and a need for professional help with their problems compared to those from families with parents living together. These associations were maintained after adjusting for adolescents' levels of mental health problems. Socio-demographic characteristics and level of mental health problems explained little variability in the extent to which adolescents reported that they received the help they needed. However, results of subsidiary analyses revealed that adolescents with higher levels of constructive problem solving skills and perceived levels of family support were more likely to report they had received help. These results highlight a need for intervention programs aimed at increasing adolescents' ability to recognise when they have emotional or behavioural problems and the point at which these problems require professional help, for example, by increasing levels of emotional competence and mental health literacy. These programs should also equip adolescents with resources to assist them in seeking professional help (e.g. problem solving skills and interpersonal skills) for their emotional or behavioural problems.Thesis (Ph.D.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 201

Tobacco plain packaging coverage in Australian newspapers 2008-2014

Background In 2012 Australia was the first country in the world to implement plain tobacco packaging. Both public health agencies and the tobacco industry advocated their position on the legislation in the news media. This study comprehensively documents print media coverage of the plain packaging initiative over the duration of the policy initiation and implementation. Methods Major Australian print newspaper (n=17) articles on plain packaging were sourced through the Australian/New Zealand Reference Centre and Factiva online databases. Articles (n=701) were collected over the 7 year duration of the policy debate and pre- and post-implementation from January 2008 to December 2014. Content analysis regarding article type, topic and frame was undertaken. Results Print media coverage of plain packaging was initially low (2008-2009) and increased during the legislative process, and lead up to implementation. Print media coverage declined substantially post-implementation. News articles were the most common form of coverage (79.6%), followed by editorials (14.3%). Updates on progress of the policy were most commonly discussed (29.4%) followed by the tobacco industry's response to the proposed legislation including 'nanny state' objections (18.3%) and discussions of plain packaging as a tobacco control initiative (17.0%). As well as reporting of policy announcements, policy rationale, implementation, legal challenges and their outcomes, there was also reporting of industry arguments which centred around predictions of unintended consequences including illicit trade, youth smoking and harm to small business, as well as legal arguments about acquisition of intellectual property. Conclusions Plain packaging received significant media coverage in Australia in the years leading up to its implementation, and far less post implementation. Subsequently disproven industry predictions did receive substantial coverage, however they were countered by articles on the public health rationale and the policy's successful progression. Policy makers should expect but not be deterred by coverage of industry arguments through media

Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia

Smoking prevalence among Indigenous Australians far exceeds that of non-Indigenous Australians and is considered the greatest contributor to burden of disease for Indigenous Australians. The Quitline is a primary intervention for facilitating smoking cessation and, given the health implications of tobacco use, maximising its effectiveness for Indigenous Australians is imperative. However, the utilisation and effectiveness of this service within the Indigenous Australian population has not been examined. This study explores the utilisation of the South Australian Quitline by smokers identifying as Indigenous Australian. Quitline counsellors collected data regarding demographic characteristics, and smoking and quitting behaviour from Quitline callers in 2010. Results indicated that the proportion of Indigenous and non-Indigenous smokers who registered for the service was comparable. Demographic variables and smoking addiction at time of registration with the Quitline were similar for Indigenous and non-Indigenous callers. However, results indicated that Indigenous callers received significantly fewer callbacks than non-Indigenous callers and were significantly less likely to set a quit date. Significantly fewer Indigenous callers reported that they were still successfully quit at 3 months. Thus, Indigenous Australian callers may be less engaged with the Quitline and further research is required exploring whether the service could be tailored to make it more engaging for Indigenous Australians who smoke

Who drinks sugar sweetened beverages and juice? An Australian population study of behaviour, awareness and attitudes

Background: The rate of overweight and obesity in Australia is among the highest in the world. Yet Australia lags other countries in developing comprehensive educative or regulatory responses to address sugary drink consumption, a key modifiable risk factor that contributes substantial excess sugar to the diet. Measurement of sugary drink consumption is typically sporadic and nutrition focussed and there is limited knowledge of community perceptions and awareness of the health risks associated with excess sugary drink consumption. The aim of this study was to assess the demographic characteristics, behavioural risk factors and attitudes and knowledge associated with sugar-sweetened beverage (SSB) and 100% fruit juice consumption. Methods: A face-to-face household survey was conducted in 2014 using a stratified random sampling strategy to represent the South Australian population aged 15 years and over. The survey contained questions on sugary drinks, with past week SSB consumption and 100% fruit juice consumption used as outcome variables. Associations were examined with demographic characteristics, behavioural risk factors, and sugary drink attitudes and knowledge. Results: Of the 2732 respondents, 35% had consumed SSBs 1-6 times (moderate consumers) and 16% had consumed SSBs 7 or more times (frequent consumers) in the past week. Furthermore, 35% had consumed 100% fruit juice in the past week, with 10% consuming every day. Rates of SSB consumption were consistently higher among males, younger age groups, and groups with lower education attainment, as well as smokers and frequent consumers of fast food. Awareness of health risks and sugar content of SSBs was low, especially among frequent SSB consumers. Fruit juice consumption was higher among males, younger age groups, the physically active and among those believing that 100% fruit juice did not contain more sugar than SSBs. Conclusions: Consumption of SSBs and 100% fruit juice is common but awareness of health risks and sugar content of these drinks is low. There is a need for greater consumer understanding which could be achieved through educative approaches such as public education campaigns, on-package warning labels and improved nutrition information panels

Clinical and functional outcomes for risk‐appropriate treatments for prostate cancer

Abstract Objectives To describe real‐world clinical and functional outcomes in an Australian cohort of men with localised prostate cancer according to treatment type and risk category. Subjects and methods Men diagnosed from 2008 to 2018 who were enrolled in South Australian Prostate Cancer Clinical Outcomes Collaborative registry—a multi‐institutional prospective clinical registry—were studied. The main outcome measures were overall survival, cancer‐specific survival, decline in functional outcomes, biochemical recurrence and transition to active treatment following active surveillance. Multivariable adjusted models were applied to estimate outcomes. Results Of the 8513 eligible men, majority of men (46%) underwent radical prostatectomy (RP) followed by external beam radiation therapy with or without androgen deprivation therapy (EBRT +/− ADT) in 22% of the cohort. Five‐year overall survival was above 91%, and 5‐year prostate cancer‐specific survival was above 97% in the low‐ and intermediate‐risk categories across all treatments. Five‐year prostate cancer‐specific survival in the active surveillance group was 100%. About 37% of men with high‐risk disease treated with RP and 17% of men treated with EBRT +/− ADT experienced biochemical recurrence within 5 years of treatment. Of men on active surveillance, 15% of those with low risk and 20% with intermediate risk converted to active treatment within 2 years. The decline in urinary continence and sexual function 12 months after treatment was greatest among men who underwent RP while the decline in bowel function was greatest for men who received EBRT +/− ADT. Conclusion This contemporary real‐world evidence on risk‐appropriate treatment outcomes helps inform treatment decision‐making for clinicians and patients

Qualitative insights into Australian consumers’ views for and against government action on sugary drinks

Objectives: Despite significant evidence of harms associated with high levels of sugar-sweetened beverage (SSB) consumption, and international moves towards regulation to curb overconsumption of such drinks, Australia has been slow to take policy action. This study provides in-depth insights into consumers’ reactions to different SSB policy options. Methods: Eight focus groups were undertaken with 59 regular SSB consumers and/or household purchasers, stratified by: young adults aged 21–29 years (no children), parents aged 35–50 (with children at home); gender; and socio-economic status. Consumer responses to potential government intervention and policy options were explored using thematic analysis. Results: Three main themes were identified. Theme 1 describes participants’ changing views on regulation of SSBs throughout the focus groups, expressed through shifts in understandings of personal responsibility and the role of government. It was noted that the term ‘regulation’ should be used judiciously, as it was widely misunderstood to infer bans. Theme 2 articulates the participants’ preference for child-focused measures and educative measures such as clearer front-of-pack labelling. Taxation on SSBs was viewed more favourably if paired with investment into education. Theme 3 describes the parallels that participants drew between SSBs and other substances. Conclusions: A comprehensive approach that includes education, child-focused interventions and regulatory approaches may increase acceptability of policy measures to curb overconsumption of SSBs

When we were young, it really was a treat; now sugar is just the norm every day -A qualitative study of parents\u27 and young adults\u27 perceptions and consumption of sugary drinks

2019 Australian Health Promotion Association Issue addressed: Sugar-sweetened beverages (SSB) are the leading source of free sugars in Australian children\u27s and adults\u27 diets. This study explores drivers of consumption among parents and young adults to inform interventions. Methods: Eight focus groups (n = 59) stratified by gender, age/life stage and SES were analysed thematically. Results: Daily SSB consumption was normalised. Participants drank SSBs to avoid perceived energy/sugar deficits, to treat themselves and as a function of familial influence. Frequent consumption was considered acceptable if in moderation and/or balanced with exercise/diet; however, there was a large disconnect between this language of moderation and actual consumption practices. Participants acknowledged that social norms had changed over time. There was little evidence of accurate knowledge of sugar content for any beverage type. Participants relied heavily on packaging and labelling, much of which conveyed a health halo effect. While participants could list health effects of excess consumption, they were considered long-term or of low personal relevance. Awareness of health recommendations was low. Conclusions: Consumers\u27 adoption and use of concepts such as treat, moderation and balance reflect both food and beverage industry marketing and public health messaging. However, the disconnect between this language and knowledge and consumption practices is problematic. So what?: SSB consumption is very high with serious implications for health. Curbing consumption among young adults and parents has potential to change the health trajectories for current and future generations. There is a clear need to increase health literacy around SSB consumption. Simple consumption guidelines, clearer sugar content labelling and health warnings offer potential

Measuring psychosocial outcomes of men living with prostate cancer : Feasibility of regular assessment of patient-reported outcomes

Objective To trial collecting patient-reported outcome measures (PROMs) to assess psychosocial outcomes in men with prostate cancer (PC). Methods A cross-sectional postal survey was sent to three groups of 160 men with PC (6, 12 and 24 months post-initial treatment; ntotal = 480), through the South Australian Prostate Cancer Clinical Outcomes Collaborative (SAPCCOC) registry (2017). Outcomes were as follows: response rate, completeness, general and disease-specific quality of life, distress, insomnia, fear of recurrence, decisional difficulties and unmet need. Results A response rate of 57–61% (n = 284) was achieved across groups. Data completeness was over 90% for 88% of survey items, with lower response (76–78%) for EPIC-26 urinary and sexual functioning subscales, sexual aid use (78%) and physical activity (68%). In general, higher socio-economic indicators were associated with higher completion of these measures (absolute difference 12–26%, p < 0.05). Lower unmet need on the sexuality domain (SCNS-SF34) was associated with lower completion of the EPIC-26 sexual functioning subscale [M (SD) = 12.4 (21.6); M (SD) = 26.3 (27.3), p < .001]. Worse leaking urine was associated with lower completion of urinary pad/diaper use question (EPIC-26) [M (SD) = 65.9 (26.5), M (SD) = 77.3 (23.9), p < .01]. Conclusion Assessment of psychosocial PROMs through a PC registry is feasible and offers insight beyond global quality of life assessment, to facilitate targeting and improvements in services and treatments

Additional file 1 of Patient-reported functional outcome measures and treatment choice for prostate cancer

Supplementary Material