Bruce Maycock

Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students

BACKGROUND University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program. METHODS A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (> or =8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking. RESULTS Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables. CONCLUSION Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely.

Your picture is your bait: Use and meaning of cyberspace among gay men

The Internet is seen by many as a form of cyberspace or environment in which to interact and socialise. This research project drew from the data of a quantitative and qualitative study of gay men in Perth, Western Australia. We examined gay mens usage patterns of chat rooms and other social aspects of the Internet to meet sexual partners. We then reviewed in detail the meanings gay men have for the various Internet environments, and the range of friendship, relationship, casual, or esoteric sex‐seeking goals. We argue that gay men view and engage with the Internet differently from how they view and engage with other more traditional gay spaces. This different approach influences how interaction between the men, either online or face‐to‐face, progresses and how assumptions and expectations are built. This has implications for how sexual health promotion interventions determine the appropriate role and relationship they have with these online social spaces.

‘Weddings, parties, anything…’, a qualitative analysis of ecstasy use in Perth, Western Australia

This study investigates the patterns of use, the meanings associated with use, the perception of risk and the strategies adopted to reduce these risks for a sample of ecstasy users in Perth, Western Australia. The sample was purposively chosen to represent the heterogeneous nature of ecstasy users in Perth. Data were collected from 31 ecstasy users and 157 h of participant observation in a variety of settings. The study found that users exhibited a reasonable degree of control over their consumption, incorporating a series of risk reduction strategies. Application of these strategies was inconsistent, with a large percentage of the sample indulging in occasional binges, spontaneous purchases, polydrug use and purchasing from unknown individuals in clubs/pubs. As users became more experienced, they tended to become less concerned about the risks associated with use and exhibited greater risk taking behaviour. Understanding the beliefs and events that influence the adoption (or non-adoption) of harm reduction strategies and the heterogeneous nature of ecstasy users is important for future health promotion interventions and policy.

Education and Support for Fathers Improves Breastfeeding Rates A Randomized Controlled Trial

Background: Studies have identified numerous factors affecting breastfeeding initiation and duration, including maternal education, mode of delivery, birth weight, socioeconomic status, and support of the infant’s father. Objective: The objective was to investigate the effects of an antenatal education session and postnatal support targeted to fathers. Methods: The Fathers Infant Feeding Initiative (FIFI Study) is a randomized controlled trial to increase the initiation and duration of breastfeeding that was conducted in 8 public maternity hospitals in Perth, Western Australia. A total of 699 couples were randomized within hospitals to either intervention or control groups. The intervention consisted of a 2-hour antenatal education session and postnatal support provided to fathers. Results: The any breastfeeding rate for the intervention group was significantly greater at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group, odds ratio 1.46 (95% CI, 1.01-2.13). After adjustment for age and hospital, the odds ratio for any breastfeeding in the intervention group was 1.58 (1.06-2.35) and for socioeconomic status (SES), 1.56 (1.06-2.30). The infants of older fathers were more likely to be breastfed at 6 weeks compared to infants of younger fathers (P < .01), and infants of fathers with high SES more likely than infants of fathers with low SES (P = .013). Conclusion: Even a small increase in breastfeeding rates brings public health benefits. In this study, a minimal intervention was found to significantly increase any breastfeeding at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group.

The Power of Peers: Why Some Students Bully Others to Conform

Utilizing an interactionist perspective, two associated sensitizing constructs, and a combination of social psychological theory, this article reports on the influence of the peer group on individual perceptions, and its impact on initiation and persistence of bullying. The specific research question, “How does the need to conform with peers and the peer group influence the initiation and persistence of bullying others?” is investigated. Semistructured, one-on-one interviews with a purposive sample of 51 Grade 7 students (aged 12 years) were conducted during school time to investigate factors that influence students to bully others and what might help them to stop. Emerging from the theme of peer group was the need for belonging and group status, in particular social norms or the need to conform, which was influential when students described why they initiated and persisted with bullying others. The influence of labeling, the group process, and the aspiration to be like others within their group emerged as key constructs. The implications of these data for schools will be described and recommendations made.

Preventing alcohol related traffic injury: a health promotion approach

The conditions that give rise to drinking and driving are complex, with multiple and interrelated causes. Prevention efforts benefit from an approach that relies on the combination of multiple interventions. Health promotion provides a useful framework for conceptualizing and implementing actions to reduce drinking and driving since it involves a combination of educational, behavioral, environmental, and policy approaches. This review draws on data from a range of settings to characterize the effectiveness of various interventions embedded within the health promotion approach. Interventions considered part of the health promotion approach include: (1) economic interventions (2) organizational interventions, (3) policy interventions, and (4) health education interventions, including the use of media, school and community education, and public awareness programs. Effective health promotion strengthens the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of alcohol-impaired driving. There is strong evidence for the effectiveness of some components of health promotion, including economic and retailer interventions, alcohol taxation, reducing alcohol availability, legal and legislative strategies, and strategies addressing the servers of alcohol. There is also evidence for the effectiveness of sobriety checkpoints, lower BAC laws, minimum legal drinking age laws, and supportive media promotion programs. Other interventions with moderate evidence of effectiveness include restricting alcohol advertising and promotion, and actions involving counter advertising. Health education interventions alone that have insufficient evidence for effectiveness include passive server training programs, school drug and alcohol education programs, community mobilization efforts, and health warnings. Because each intervention builds on the strengths of every other one, ecological approaches to reducing alcohol-impaired driving using all four components of the health promotion model are likely to be the most effective. Settings such as schools, workplaces, cities, and communities offer practical opportunities to implement alcohol-impaired driving prevention programs within this framework.

Perceptions of Physical Activity by Older Adults: A Qualitative Study.

Objective To identify issues and perceptions concerning physical activity in older adults. Design Qualitative study. Setting Perth, Western Australia. Methods Sixteen adults aged 65 to 74 years were interviewed in their own homes using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. Results Participants believed that physical activity provided health benefits and reflected positively on physical activity experiences when they were younger, with many expressing a desire to engage in less age-appropriate activities. The major barrier to physical activity was pain. Participants described both positive and negative examples related to society’s support of physical activity. Conclusions A number of issues were raised. These included: the need for more specific information on the benefits of physical activity; the role of pain management in physical activity; the concept that involvement in physical activity in younger years leads to involvement when older; and the expressed desire of older people to engage in less age-appropriate physical activities.

Training patterns and sports injuries in triathletes

Sports-related injuries are a significant health problem within Australia, and constitute a national health priority. There is limited Australian research data available on factors that contribute to triathlon injuries, and in particular on how training patterns relate to injury risk. This study examined the association between training patterns and injury in mostly non-elite triathletes. A cross-sectional survey of 258 triathletes completed a questionnaire that focused on injuries they had sustained during the previous three triathlon seasons. Statistical associations were found between hours of training and sustaining an injury. These associations were U shaped, with those triathletes training at low levels and at high levels more likely to sustain an injury. The results suggest that, for non-elite triathletes, the likelihood of sustaining an injury is least when training for a total of 8 to 10 hrs per week, specifically cycling for five to six hrs and running for three to four hrs weekly. Time spent on swimming training does not appear to affect injury risk. This research is seen as a contribution towards assisting triathletes in the planning of training programs aimed at reducing the risk of injury.

Development of competency-based University health promotion courses

The Curtin University Centre for Health Promotion Research, in conjunction with the Australian Association of Health Promotion Professionals (AAHPP), the National Heart Foundation of Australia and the Health Department of Western Australia, co-ordinated a project to ascertain competencies required for personnel working in health promotion.

The barriers to illegal anabolic steroid use

This paper summarizes the self-reported barriers that men overcame prior to initiating illegal anabolic steroid use, and the associated weakening of social controls that restrict anabolic steroid initiation. Data was collected via participant observation of 147 anabolic steroid users and previous users, 98 in-depth interviews with 42 anabolic steroid users and 49 in-depth interviews with 22 illegal dealers. Additional data came from interviews and eight focus groups with gym instructors, personal trainers and health workers, and the monitoring of policy changes and media reports relating to anabolic steroids. The identified barriers included, coping with potential stigma, gathering of credible information and overcoming structural and resource barriers including developing the skills required to administer the drug and gaining a supply source. As these barriers were overcome there was a reduction in the social controls that inhibit the initiation of illegal anabolic steroid use. By understanding the interaction between potential users, social controls and these barriers it may be possible to strengthen the barriers and hence delay or halt the progression to anabolic steroid use. The paper suggests several demand- and harm-reduction strategies that may assist this process.