Kerry Ettridge

Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population

OBJECTIVE To determine if functional health literacy (FHL) mediates the relationship between socio-economic status, and perception of the risk of lifestyle behaviors for cancer. METHODS Cross-sectional, random population survey, 2824 people aged ≥15 years, September-October 2008, included newest vital sign measure of FHL. RESULTS Less than adequate FHL occurred in 45.1%. People who perceived behavioral factors (smoking, diet, obesity, alcohol, physical activity) to be not important, or did not know if they were important cancer risks, were more likely to have inadequate FHL. In a logistic regression model adjusted for age, gender, education, income, occupation, country of birth and area of residence, inadequate FHL was associated with 2-3 (OR=1.9; 95% CI: 1.2-3.0) and 4 or more self-reported lifestyle risk factors (OR=2.8; 95% CI: 1.6-5.0). In a structural equation model of the relationship of socio-economic status, perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions, estimated 29.4% of the total effect. CONCLUSION A specific focus on the literacy demands made on individuals from health promotion and materials with a view to improving health communication is indicated. PRACTICE IMPLICATIONS Health literacy is important for health promotion.

Psychosocial factors that influence men's help‐seeking for cancer symptoms: a systematic synthesis of mixed methods research

Effectiveness of cancer control partly depends upon early identification and treatment. Men appear to be more likely to delay help‐seeking for symptoms, resulting in later diagnosis. This review aims to provide a mixed research synthesis of the psychosocial barriers to and facilitators of help‐seeking for cancer symptoms among men.

Mindfulness-based Cancer Stress Management: impact of a mindfulness-based programme on psychological distress and quality of life

Within the area of cancer care, mindfulness-based therapeutic interventions have been found to be efficacious in reducing psychological distress related to a cancer diagnosis; however, the impact of mindfulness-based interventions on quality of life is unclear. This study explores the impact of a Mindfulness-Based Cancer Stress Management programme on psychological distress and quality of life. Research methodology included a single-group quasi-experimental study of 26 participants experiencing distress related to a cancer diagnosis, including carers, who completed an MBCSM programme and all assessments. Participants completed the Functional Assessment of Cancer Therapy - General version 4 (FACT-G) and its associated spirituality index (FACIT-Sp-Ex), Hospital Anxiety and Depression Scale (HADS), Freiburg Mindfulness Inventory (FMI), and the Distress Thermometer at baseline, post-intervention, and three months after programme completion. Significant improvements were observed on all measures (ranges: P ≤ 0.001 to 0.008, r = -0.53 to -0.79) following the intervention, which were maintained at 3-month follow-up. Mindfulness was significantly correlated with all main outcome measures at post-intervention (range: r = -0.41 to 0.67) and 3-month follow-up (range: r = -0.49 to 0.73), providing evidence for the internal validity of the study. Our findings indicate that the MBCSM programme is effective in reducing psychological distress and improving quality of life, including spiritual well-being.

Are ADHD Gender Patterns Moderated by Sample Source

Objective: To examine whether ADHD gender patterns with respect to social-demographic characteristics, comorbidity, and impairment vary as a function of service use for emotional or behavioral problems. Method: Two hundred and seventy-nine males and 119 females meeting ADHD symptom criteria identified in a nationally representative sample of Australian youth ages 6 to 17 are stratified according to whether they had attended a service in the previous 6 months. Results: ADHD gender patterns vary across service use on only 2 of the 31 comparisons made. The two exceptions were childs age at interview (females were older than males among service attendees but younger among nonattendees) and depressive disorders (females had higher rates than males among service attendees but lower rates among nonattendees). Conclusion: Systematic differences in methods of case identification rather than sample source may be responsible for the discrepant ADHD patterns found between clinic and community-based studies.

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.

“You're made to feel like a dirty filthy smoker when you're not, cigar smoking is another thing all together.” Responses of Australian cigar and cigarillo smokers to plain packaging

Objective To explore experiences of cigar and cigarillo smokers under Australian laws requiring plain packaging (PP) and strengthened graphic health warnings (GHWs). Methods In February/March 2014, we conducted: in-depth interviews with 10 regular premium cigar smokers; two focus groups with occasional premium cigar and premium cigarillo smokers (n=14); four focus groups with non-premium cigarillo smokers (n=28); and a national online survey of cigar and/or cigarillo smokers (n=268). Results Premium cigar smokers had limited exposure to PP, with many purchasing fully branded cigars in boxes duty free or online and singles in non-compliant packaging. Those who were exposed noticed and were concerned by the warnings, tried to avoid them and felt more like ‘dirty smokers’. Changes in perceived taste, harm and value were minimal for experienced premium cigar smokers. Occasional premium cigar and premium cigarillo smokers with higher PP exposure (gained by purchasing boxes rather than singles) perceived cigar/package appeal and value had declined and noticed the GHWs. Non-premium cigarillo smokers reported high PP exposure, reduced perceived appeal, quality, taste, enjoyment and value, somewhat increased perceived harm, greater noticeability of GHWs and concealment of packs and more contemplation of quitting. Online survey participants reported increased noticeability of GHWs (33%), decreased appeal of packaging (53%) and reduced consumption of cigars (42%) and cigarillos (44%) since PP implementation. Conclusions Non-premium cigarillo smokers appear to have been most exposed and influenced by PP, with cigar smokers less so, especially regular premium cigar smokers who have maintained access to fully branded products.

Sociodemographic correlates of smoking in pregnancy and antenatal-care attendance in Indigenous and non-Indigenous women in South Australia

Smoking in pregnancy is a key health issue in Australia, particularly among Indigenous women. However, few studies have examined the sociodemographic factors associated with smoking in pregnancy or the predictors of antenatal-care attendance among Indigenous and non-Indigenous Australian women who smoke. Data from the South Australian perinatal statistics collection of all births from 2000-2010 (n=197538) were analysed separately by Indigenous status to determine the sociodemographic factors associated with smoking in pregnancy and antenatal-care attendance by women who smoke. For Indigenous and non-Indigenous women, smoking in pregnancy was significantly independently associated with socioeconomic disadvantage, residing in regional or remote areas, increased parity, unemployment, being a public patient and attending fewer antenatal care visits. Smoking in pregnancy was associated with younger age and not being partnered only for non-Indigenous women. For Indigenous and non-Indigenous pregnant women who smoked, antenatal-care attendance was lower among women who were of younger age, higher parity, unemployed and not partnered. Differences in attendance within sociodemographic factors were greater for Indigenous women. Therefore, while sociodemographic correlates of smoking in pregnancy and antenatal-care attendance are largely similar for Indigenous and non-Indigenous women, tailored cessation and antenatal-care programs that reflect the differences in sociodemographic groups most at risk may be beneficial.

Understanding variation in men’s help-seeking for cancer symptoms: a semi-structured interview study

Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men’s experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men’s help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semistructured interviews were conducted with men recently diagnosed with cancer (n = 13). Participants’ partners (n = 8) were recruited to enable data triangulation. Interview schedules addressed participants’ pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behavior was similar for participants residing in urban and rural areas. Five key themes and one subtheme were identified, including symptom factors, traditional masculine norms (subtheme: women’s health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors.

Presenting a strong and united front to tobacco industry interference : a content analysis of Australian newspaper coverage of tobacco plain packaging 2008–2014

Objectives In 2012, Australia was the first country in the world to introduce plain or standardised tobacco packaging, coupled with larger graphic health warnings. This policy was fiercely opposed by industry. Media coverage can be an influential contributor to public debate, and both public health advocates and industry sought media coverage for their positions. The aim of this study was to measure the print media coverage of Australian’s plain packaging laws, from inception to roll-out, in major Australian newspapers. Methods This study monitored mainstream Australian print media (17 newspapers) coverage of the plain packaging policy debate and implementation, over a 7-year period from January 2008 to December 2014. Articles (n=701) were coded for article type, opinion slant and topic(s). Design Content analysis. Results Coverage of plain packaging was low during preimplementation phase (2008–2009), increasing sharply in the lead into legislative processes and diminished substantially after implementation. Articles covered policy rationale, policy progress and industry arguments. Of the news articles, 96% were neutrally framed. Of the editorials, 55% were supportive, 28% were opposing, 12% were neutral and 5% were mixed. Conclusions Protracted political debate, reflected in the media, led to an implementation delay of plain packaging. While Australian media provided comprehensive coverage of industry arguments, news coverage was largely neutral, whereas editorials were mostly supportive or neutral of the policy. Countries seeking to implement plain packaging of tobacco should not be deterred by the volume of news coverage, but should actively promote the evidence for plain packaging in the media to counteract the arguments of the tobacco industry.

‘I don’t think I'd feel good about myself if I was to give up smoking and go to one of these’: perceptions of e-cigarettes among South Australian young adult smokers and ex-smokers

Abstract Objective: To explore South Australian (SA) young adult smokers’ and ex-smokers’ perceptions of e-cigarettes as a possible tool for smoking cessation in a context where only e-cigarettes that do not contain nicotine are legally available. Design: Six focus groups: two groups of five participants each for daily smokers, occasional smokers (less than daily) and ex-smokers. Participants (N = 30, 57% male) were aged between 18 and 25 years; e-cigarette experience ranged from none (33%), experimental (47%) to using them as a cessation aid (20%). Topics discussed included smoking experiences, smoking cessation, and e-cigarette experiences, observations and perceptions. Transcripts of the discussions were analysed thematically. Results: Three overarching themes emerged: (1) E-cigarettes deemed unnecessary for quitting and lack appeal as a quitting aid; (2) Social unacceptability of e-cigarettes; and (3) Ambiguity in how e-cigarettes should be managed given the unknown risks and benefits. These views appeared to limit the desire to use e-cigarettes as a cessation aid. Nonetheless, participants preferred a ‘wait and see’ approach to regulation of e-cigarette availability, highlighting uncertainty about the evidence of harm. Conclusion: Perceptions of e-cigarettes may be shaped by the policy and social environment. Australia’s maintained ban on nicotine-containing e-cigarettes signals potential harm, but unlike other Australian states, SA is yet to implement proposed non-nicotine e-cigarette regulations, which may create confusion about the risks and benefits of use. Further research is needed to identify how to convey information about e-cigarettes that does not undermine existing commitments to protecting the community from potential harm.