Melanie Crane

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is

Associations between the frequency of cycling and domains of quality of life

60.17 million and the campaign cost is

The unrealised potential of bike share schemes to influence population physical activity levels – A narrative review

15.63 million. The benefit cost ratio is 3.85, suggesting that for every

Knowledge, attitudes and beliefs about lung cancer in three culturally and linguistically diverse communities living in Australia: a qualitative study

1 invested a return of

Nanny or canny? Community perceptions of government intervention for preventive health

3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.

General practitioners’ perceptions of population based bowel screening and their influence on practice: a qualitative study

ISSUE ADDRESSED This study examined the association between domains of quality of life (QoL) and the frequency of cycling by men and women. METHOD A cross-sectional survey of 846 healthy adults in Sydney, Australia measured cycling behaviour and self-reported QoL. Participants were aged 18-55 years and were living within 5km of the centre. Cycling frequency for all purposes was recorded as weekly, less than weekly or never cycling. QoL was measured using the four QoL domains of the WHOQOL-BREF: physical psychological, social and environment. Linear regression was used to assess the association between cycling and QoL. RESULTS Among men, at least weekly cycling was associated with physical QoL (P=0.002) and any cycling was positively associated with psychological wellbeing (at least weekly P=0.01, less than weekly P=0.01) after adjusting for age, education and income. No significant associations were observed for women. CONCLUSION Frequent cycling was associated with higher physical and psychological QoL in men, but not among women in this sample. No relationship was observed between cycling and the environment and social QoL domains. SO WHAT?: These findings suggest that cycling offers physical and psychological QoL benefits for men.

A qualitative investigation of factors influencing participation in bowel screening in New South Wales

The recent proliferation of bike share schemes (BSS, also known as public bicycle use programs) in many cities has focused attention on their potential for reducing motorised traffic congestion, improving air quality and reducing car use. Since 2005, hundreds of bike share schemes have been implemented in many cities, with bike share usage patterns monitored in many of them. This paper assesses the development of BSS and provides a rationale for their potential health benefits. The key research question, as yet unanswered, is whether BSS themselves can contribute to improving population health, particularly through increasing population cycling, which would increase population levels of health-enhancing physical activity. This paper presents a framework for evaluating the contribution of BSS to population physical activity, and uses examples of new data analyses to indicate the challenges in answering this question. These illustrative analyses examine cycling in Australia, and [i] compares rates of cycling to work in BSS cities compared to the rest of Australia over time, and [ii] modelling trends in bike counts in Central Melbourne before and after introduction of the BSS in 2010, and compared to adjacent regions in nearby suburbs unexposed to a BSS. These indicative examples point to difficulties in attributing causal increases in cycling for transport to the introduction of a BSS alone. There is an evidence gap, and a need to identify opportunities to improve the health-related components of BSS evaluations, to answer the question whether they have any impact on population physical activity levels.

A Case Study Exploring Associations of Quality of Life Measures with Car and Active Transport Commute Modes in Sydney

ISSUE ADDRESSED Knowledge, attitudes and beliefs about lung cancer among Chinese, Vietnamese and Arabic-speaking communities in Sydney, New South Wales (NSW) are explored. METHODS Seven focus groups were completed with a total of 51 participants (smokers and non-smokers) from three culturally and linguistically diverse communities (CALD). Five topics were discussed and translated summaries from focus groups were thematically analysed. RESULTS There were variations in perceived susceptibility to lung cancer between the CALD groups and between smokers and non-smokers. Fatalistic views towards lung cancer were apparent across all three CALD communities. There were low levels of awareness of lung cancer signs and symptoms, with the exception of haemoptysis. Differences in help-seeking behaviour and levels of trust of general practitioners (GP) were apparent. CONCLUSION Limited awareness of the signs and symptoms of lung cancer, combined with cultural perceptions about cancer, impacted on attitudes towards help-seeking behaviour in these three CALD communities. So what? The prevalence of smoking among Chinese men, Vietnamese men and Arabic-speaking communities in NSW puts them at increased risk of lung cancer. Health promotion initiatives for lung cancer should be tailored for CALD communities and could focus on increasing knowledge of key symptoms, awareness that ex-smokers are at risk and awareness of the diagnostic pathway including the importance of avoiding delays in help-seeking.

Public support for bicycling and transport policies in inner Sydney, Australia: a cross‐sectional survey

Abstract Critics of government intervention for the prevention of lifestyle-related chronic disease often conceptualise such efforts as ‘nanny state’, reflecting a neoliberal perspective and derailing wider debate. However, it is unknown how the community perceives such interventions. Given the importance of public opinion to government willingness to implement population-level system change, we aimed to better understand Australian community attitudes towards government-led prevention, in particular whether nanny state conceptualisations reflect community attitudes. We used an iterative mixed methods approach to data collection and analysis based on focus groups (n = 49) and a national survey (n = 2052). Despite strong endorsement (91%) of personal responsibility for health, 46% of survey respondents thought government plays a large role in prevention. The nanny state conceptualisation was not dominant in either the survey or focus group data. Qualitative data analysis highlighted alternative conceptualisations, namely government as a: canny investor; leader on positive health behaviour; partner or facilitator for health. Respondents’ level of support for specific interventions overlaid these general conceptualisations with considerations of the target population and risk factor, intervention mechanism and government motives. Community perceptions regarding prevention therefore reflect more thoughtful and complex interpretations of preventive actions and policies than suggested by nanny state conceptualisations. We argue that advocates and legislators should not allow debate around preventive measures to be restricted to the nanny state–libertarian continuum, but engage the community in more collectivist considerations of future health costs, beneficiaries, equity and likely outcomes of both action and inaction in order to garner community support and identify information gaps.

Evaluating the transport, health and economic impacts of new urban cycling infrastructure in Sydney, Australia -- protocol paper

BackgroundAlthough largely preventable, Australia has one of the highest rates of bowel cancer in the world. General Practitioners (GPs) have an important role to play in prevention and early detection of bowel cancer, however in Australia this is yet to be optimised and participation remains low. This study sought to understand how GPs’ perceptions of bowel screening influence their attitudes to, and promotion of the faecal occult blood test (FOBT), to identify opportunities to enhance their role.MethodsInterviews were conducted with 31 GPs from metropolitan and regional New South Wales (NSW), Australia. Discussions canvassed GPs’ perceptions of their role in bowel screening and the national screening program; perceptions of screening tests; practices regarding discussing screening with patients; and views on opportunities to enhance their role. Transcripts were coded using Nvivo and thematically analysed.ResultsThe study revealed GPs’ perceptions of screening did not always align with broader public health definitions of ‘population screening’. While many GPs reportedly understood the purpose of population screening, notions of the role of asymptomatic screening for bowel cancer prevention were more limited. Descriptions of screening centred on two major uses: the use of a screening ‘process’ to identify individual patients at higher risk; and the use of screening ‘tools’, including the FOBT, to aid diagnosis. While the FOBT was perceived as useful for identifying patients requiring follow up, GPs expressed concerns about its reliability. Colonoscopy by comparison, was considered by many as the gold standard for both screening and diagnosis. This perception reflects a conceptualisation of the screening process and associated tools as an individualised method for risk assessment and diagnosis, rather than a public health strategy for prevention of bowel cancer.ConclusionThe results show that GPs’ perceptions of screening do not always align with broader public health definitions of ‘population screening’. Furthermore, the way GPs understood screening was shown to impact their clinical practice, influencing their preferences for, and use of ‘screening’ tools such as FOBT. The findings suggest emphasising the preventative opportunity of FOBT screening would be beneficial, as would formally engaging GPs in the promotion of bowel screening.