Jonathan Hallett

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.

Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials

Vitamin D is anticipated to have many extra‐skeletal health benefits. We questioned whether supplementation with the vitamin influenced body weight and composition. A systematic review and meta‐analysis was conducted on high‐quality, randomized controlled trials (RCTs) that had supplemented vitamin D without imposing any caloric restriction. Eighteen trials reporting either body weight, body mass index (BMI), fat mass (FM), percentage fat mass (%FM) or lean body mass (LBM) met our criteria. Twelve studies provided the required data for the meta‐analysis. Vitamin D supplementation did not influence the standardized mean difference (SMD) for body weight, FM, %FM or LBM. A small but non‐significant decrease in BMI (SMD = −0.097, 95% confidence interval: [−0.210, 0.016], P = 0.092) was observed. Meta‐regression confirmed that neither the absolute vitamin D status achieved nor its change from baseline influenced the SMD of any obesity measure. However, increasing age of the subjects predicted a shift in the SMD for FM towards the placebo treatment, whereas a greater percentage of women in these studies favoured a decrease in FM following vitamin D. Vitamin D supplementation did not decrease measures of adiposity in the absence of caloric restriction. A potential confounding by age and gender was encountered.

Reducing the Environmental Impact of Dietary Choice: Perspectives from a Behavioural and Social Change Approach

Climate change is recognised as a significant public health issue that will impact on food security. One of the major contributors to global warming is the livestock industry, and, relative to plant-based agriculture, meat production has a much higher environmental impact in relation to freshwater use, amount of land required, and waste products generated. Promoting increased consumption of plant-based foods is a recommended strategy to reduce human impact on the environment and is also now recognised as a potential strategy to reduce the high rates of some chronic diseases such as cardiovascular disease and certain cancers. Currently there is a scant evidence base for policies and programs aiming to increase consumption of plant-based diets and little research on the necessary conditions for that change to occur and the processes involved in such a change. This paper reviews some of the environmental and health consequences of current dietary practices, reviews literature on the determinants of consuming a plant-based diet, and provides recommendations for further research in this area.

The impact of nutritional choices on global warming and policy implications: examining the link between dietary choices and greenhouse gas emissions

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Energy and Emission Control Technologies 2014:2 33–43 Energy and Emission Control Technologies Dovepress

Moving forward: a cross sectional baseline study of staff and student attitudes towards a totally smoke free university campus

BackgroundBaseline data were collected to inform the adoption, implementation and institutionalisation phases of a completely smoke free campus policy at a large Western Australian university with a diverse student and staff community.MethodsAn online survey was randomly emailed to staff and students to measure the attitudes towards and the acceptability and enforcement of the policy prior to implementation. In total, 969 respondents completed the survey.ResultsGeneral attitudes towards smoking were negative. While smokers, ex-smokers and non-smokers were supportive of smoke free policy on campus, 65.7% of respondents felt the campus should be completely smoke free. Respondents indicated a smoke free policy should be stringently enforced. The majority of respondents reported that they had been exposed to second-hand smoke on campus (n = 768; 79.5%).ConclusionTheory of Organisational Change provides a useful framework to support the implementation of the completely smoke free policy in the University setting. The implementation process needs to consider the broad range of issues associated with implementing a completely smoke free policy and address issues such as safety of smokers, ensuring smokers are not marginalised and ensuring a comprehensive program is implemented. These baseline findings can be used to advocate for the implementation of a comprehensive range of strategies that recognise the addictive nature of tobacco smoking and address attitude and behaviour change, environmental adaptations and effective implementation of the policy. Administration should consider smokers and non-smokers when policy is implemented.

Changing communities, changing spaces: the challenges of health promotion outreach in cyberspace

This article is a case study of an Internet chat room outreach project in Perth, Western Australia. The CyberReach project sought to adapt current peer based health promotion outreach, training and supervision frameworks to an online outreach setting in a way that was effective and supported by the online community. It targeted marginalised groups to trial the provision of online mental and sexual health promotion incorporating a participatory action research model into its development and implementation. Three 6-week trial periods were conducted and significant changes were made in response to changes in the online environment and to improve sustainability and effectiveness of the protocols. Four themes arose from CyberReachs experience: online group processes are unique due to the creation of extensive personal networks and occurrence of disclosure without face-to-face contact across potentially large geographic barriers; flexibility is required to adapt to technological changes and online community flux; enforcing boundaries and delineating peer education from therapeutic support can be challenging when only using text-based communication; and Internet outreach can be time intensive with small returns in actual community engagement and constant technological up-skilling of staff may be required. Based on the projects experiences we offer the following recommendations when planning similar Internet outreach strategies: Funding and planning groups need to be aware that the Internet environment is constantly changing and planning and funding arrangements need to reflect a capacity to remain flexible; Programs need to be firmly connected to the communities they are outreaching therefore a peer-based education component is strongly encouraged; Careful consideration should be taken regarding data collection so that the environment and the individuals within are respected; Further research needs to be conducted to understand the styles and approaches of different online interactions, and the relative influence of technical platforms, gender and age.

Academic and personal problems among Australian university students who drink at hazardous levels: web-based survey

ISSUE ADDRESSED Australian university students consume large amounts of alcohol. There is little published information about personal and academic problems associated with this behaviour. We sought to estimate the prevalence, and identify variables associated with, alcohol-related problems among undergraduate hazardous drinkers. METHODS The control group members (942 undergraduates, 53.3% male, mean age 19.4 years) of an internet-based intervention trial, who scored ≥8 on the Alcohol Use Disorders Identification Test, completed two validated questionnaires about their experience of alcohol-related problems in the preceding 4 weeks. Regression models were used to identify associations between individual characteristics and alcohol-related problems. RESULTS One-quarter of participants had missed a class (25.6%) and/or had been unable to concentrate in class (25.7%), and 45% reported that their drinking had impacted negatively on their learning or grades. The most frequent non-academic problems were hangovers (74.8%), blackouts (44.8%), emotional outbursts (30.5%), vomiting (28.1%), arguments (20.2%) and drink-driving (23.2%). Male gender, lower age, being a smoker, being in the Faculty of Health (versus Humanities) and living in shared housing (versus with parents/guardians) were each associated with alcohol-related problems, whereas year of study had no association. CONCLUSIONS There is a high prevalence of preventable alcohol-related problems among undergraduates drinking at hazardous levels and a need for restriction of the availability and promotion of alcohol as well as intervention for individuals at high risk. SO WHAT?: Universities have a duty of care to large populations of young people drinking at hazardous levels and should make greater efforts to address hazardous alcohol consumption.

Tobacco smoking in an Australian university sample and implications for health promotion.

From 2001 to 2007, smoking among 18–24 year old Australians declined from 31% to 23% (ABS, 2009). The proportion of this age group who were current smokers in the USA in 2007 was 22% (CDCP, 2008). A literature review identified no studies of the prevalence of smoking among Australian university students. University life provides a period of transition when health behaviour patterns such as tobacco and alcohol consumption become established (Ling and Glantz, 2002). It is an important time for young people to be exposed to environments that discourage smoking and support cessation. We estimated the prevalence of smoking in a diverse university population and reflected on implications for tobacco control. In April 2007, a random sample of 13,000 undergraduates was invited to complete an online survey, including questions on smoking and alcohol consumption (Kypri et al, 2009). Respondents were asked to indicate whether they “never smoked”; “do not smoke but used to”; “occasionally smoke”; or “currently smoke”. The last three groups are hereafter referred to as ‘Ex-smokers’, ‘Occasional smokers’ and ‘Daily smokers’ respectively (Kypri and Baxter, 2004). The University identified all full-time undergraduates aged 17– 24 years. A letter was sent to each student, inviting them to participate and noting that they would soon receive an e-mailed hyperlink to the questionnaire. Confidentiality was assured and it was emphasised that the research was independent of the university administration. Non-respondents were sent up to two reminder emails and a reminder letter in the following month (Hallett et al., 2009). Over 55% (n=7211) of the sample responded to the smoking questions, 57% were women (n=4108) and 84% were Australian or New Zealand (NZ) residents (n=6049; Table 1). The mean age of the respondents was 19.5 years (SD 1.9) and 10.2% were current smokers (occasional or daily; Table 1). Students with Australian/NZ residency were significantly less likely to be current smokers than were oncampus international students (9.0% versus 16.9%, pb0.001). Men were significantly more likely to be current smokers than were women (12.9% versus 8.3%, pb0.001). Mann–Whitney U tests showed significant differences in the number of cigarettes smoked on a typical day by current smokers, with males (Median=3, IQR 1–8) smoking 50% more than females (Median=2, IQR 0–6; pb0.001) and international students (Median=5, IQR 2–10) smokingmore than residents (Median=2, IQR 0–6; pb0.001).

The Cow in the Room: Public Knowledge of the Links Between Dietary Choices and Health and Environmental Impacts

Issue Addressed This paper describes results of a survey comparing peoples knowledge of health and environmental impacts of dietary choices. Dietary choice is one of the key ways in which individuals can reduce their environmental impact in relation to water use and greenhouse gas emissions but this may not be widely known amongst the public due to limited press coverage. Methods A street intercept survey was conducted asking open ended questions on how people can help the environment, maintain or improve health and basic demographics. The sample size was 107 with a refusal rate of 51%. Results Only 3.2% of the sample made a link between dietary choice and environmental impact whereas 85.6% of the sample referred to dietary choice in relation to personal health. Transport options and keeping active were popular responses to both health and environmental categories. Conclusions It seems that very few people are aware that the livestock sector is the second largest contributor to equivalent greenhouse gas emissions and one of the largest users of fresh water. Reduction in red meat consumption could have both important positive health and environmental impacts.

A systematic review protocol examining the effect of vitamin D supplementation on endothelial function

Introduction Vitamin D has potential benefits for extraskeletal health. These could include an anti-inflammatory effect as well as a reduction in endothelial dysfunction. We aim to provide quality evidence for the hypothesis that supplementation with vitamin D will improve endothelial function (EF), possibly through the abrogation of systemic inflammation. Methods and analysis We will conduct a systematic review of all randomised controlled trials on vitamin D supplementation and EF lasting 12 weeks or more. The search will cover the period 2000–2015 and include studies that describe direct measures of EF, markers of endothelial cell (EC) activation and if concurrently reported, indicators of systemic inflammation. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and study quality will be assessed by the Jadad score in addition to an evaluation of allocation concealment and data analysis. If sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score, for both fixed and random effect models. I2 statistics and Galbraith plots will be used to assess heterogeneity and identify their potential sources. Potential publication and small sample size bias will be assessed by visual inspections of funnel plots and also Eggers test. Meta-regression analysis (if feasible) will be conducted with restricted maximum likelihood (REML) estimation method, controlling for potential confounders (demographics, study methods, location, etc). A backward elimination process will be applied in the regression modelling procedure. Subgroup analysis, conditional on number of studies retrieved and their sample size, will be stratified on participant disease category, total dose administered, degree of 25(OH)D change and type of supplement used. Ethics and dissemination Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the popular press. Trial registration number International Prospective Register for Systematic Reviews (PROSPERO) number CRD42014013523.