David Firman

Telephone administration of the SF‐36 health survey: validation studies and population norms for adults in Queensland

Abstract: The Rand Corporation medical outcomes short‐form 36 health survey (SF‐36) is a multidimensional measure of self‐perceived general health status, which has been validated in adult populations in the United States and Great Britain, and, more recently, in an Australian population. The SF‐36 is increasingly being used in health outcomes research internationally, mainly as a self‐administered tool, and clearly has potential for use in Australia. This study aimed to assess the acceptability, reliability and validity of telephone administration of the instrument in the Queensland adult population, and to provide reliable population norms. We report the results of a telephone survey in which we interviewed 12 793 adults. It was the first large‐scale, statewide application of the SF‐36 in Australia. A response rate of 82 per cent was achieved, and the SF‐36 satisfied psychometric criteria for reliability and construct validity. Population norms broken down by age and sex are provided. They will be important for the interpretation of future studies using the SF‐36 in particular population or patient groups.

Prevalence of whole-body skin self-examination in a population at high risk for skin cancer (Australia).

AbstractObjective: Whole-body skin self-examination (SSE) with presentation of suspicious lesions to a physician may improve early detection of melanoma. The aim of this study was to establish the prevalence and determinants of SSE in a high-risk population in preparation for a community-based randomised controlled trial of screening for melanoma. Methods: A telephone survey reached 3110 residents older than 30 years (overall response rate of 66.9%) randomly selected from 18 regional communities in Queensland, Australia. Results: Overall, 804 (25.9%) participants reported whole-body SSE within the past 12 months and 1055 (33.9%) within the past three years. Whole-body SSE was associated in multivariate logistic regression analysis with younger age ( <50 years); higher education; having received either a whole-body skin examination, recommendation or instruction on SSE by a primary care physician; giving skin checks a high priority; concern about skin cancer and a personal history of skin cancer. Conclusion: Overall, the prevalence of SSE in the present study is among the highest yet observed in Australia, with about one-third of the adult population reporting whole-body SSE in the past threeyears. People over 50 years, who are at relatively higher risk for skin cancer, currently perform SSE less frequently than younger people.

Food insufficiency in Queensland.

Abstract: To investigate the prevalence of food insufficiency and factors associated with it, two questions assessing household and individual food insufficiency were included in 13 regional health surveys conducted in Queensland in 1993. The surveys used computer–assisted telephone interviewing methodology. Of the 10 451 people interviewed, 9.7 per cent and 6.4 per cent reported household and individual food insufficiency, respectively, and 11.3 per cent reported at least one type. Prevalence was significantly higher in women than men and in urban than rural residents, and decreased monoton–ically with increasing age from 16.6 per cent in 18– to 30–year–olds to 1.7 per cent in over–70–year–olds. Higher prevalence also was associated with lower income, unemployment, single or separated, divorced or widowed status versus married (or de facto), one–adult households, and shared accommodation. Lower prevalence was associated with more education in those aged 50 and under but not in those over 50 years. Using logistic regression to control simultaneously for important sociodemographic factors, we found that risk of food insufficiency was most highly associated with age and income (threefold risk), unemployment and snared accommodation (twofold risk) and one–adult households, and being single versus separated, widowed or divorced (one–and–a–half–fold risk). Some differences in risks existed between men and women and between rural and urban residents, although none excluded the role of chance. Association of the items with lower reported fruit, vegetable and meat intake, poorer health status, and greater underweight supports their validity.

Factors associated with Pap smear taking in general practice: focusing public health initiatives

Abstract: This study ascertained the relationships of patient, practitioner and consultation factors with: 1. taking a Pap smear or referral to a specialist in the consultation; and 2. an unsuccessful offer to take a Pap smear or making an appointment for a smear. In a cross‐sectional study of 3478 women presenting to 230 randomly selected general practitioners in Brisbane and Toowoomba, information about most recent Pap smear, screening in the consultation, and independent variables were collected from patients and doctors. Relationships between three levels of outcome variable (no action, Pap smear taken or referral, appointment or refusal), and independent variables (practitioner variables, consultation variables, patient variables) were modelled using polytomous logistic regression. Presenting for a routine checkup and breast cancer screening were associated with all types of action. Younger age, longer consultations and consultations with a female practitioner were associated with Pap smear taking and referrals, and not appointments or refusals. Being due for a Pap smear, having blood pressure measured, consulting a younger general practitioner and one who ascribed to current guidelines on screening were associated with an appointment or a refusal, when compared with no action. Results identify different profiles of those who get a Pap smear and those who do not, the former indicating a more proactive patient group, while the latter suggest more active general practitioners who attempted opportunistic screening of passive patients, or women who do not specifically seek Pap smears. We have identified factors that have significance for developing public health programs focused on consumers and providers.

The Gold Coast Suicide Prevention Community study: Interim Report

This paper will present some cogent arguments for mental health promotion being the best way to reduce rates of suicide in young people. Available evidence for effectiveness of mental health promotion will be discussed. The construct of mental health will be unpacked as will the complexity of the health family. Examples of good practice in the area will be utilized to develop a comprehensive picture of how mental health services, the community and energetic individuals may intervene to increase the opportunities for healthy family life.