Melissa Kang

Encounters between adolescents and general practice in Australia

Aim:  To describe the nature of the encounters between adolescents and general practice in Australia.

Prevalence of Chlamydia trachomatis infection among ‘high risk’ young people in New South Wales

International research on homeless adolescents has found that incidence and prevalence of sexually transmissible infections is relatively high. This study reports on a chlamydia prevalence survey conducted among high-risk young people (14-25 years) in New South Wales. The participants were recruited from youth health centres, which target homeless and high-risk youth. Of 333 clients (42.6% male), 84.1% were sexually active and mean number of sexual partners over the preceding 3 months was 1.4. Among sexually active participants, 24.6% claimed to use condoms always and 25% never. Sixteen of 274 available urine samples tested positive for Chlamydia trachomatis infection. Further research is warranted to better define high-risk groups and clarify the nature of associations between various factors impacting on sexual health. Most importantly, research is now called for into effective strategies for engaging and attracting young people to screening, treatment and contact tracing.

Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace

Objectives Chlamydia notifications have been rising in Australia for over a decade and are highest in young people. This study aimed to evaluate the impact of an internet-based intervention on chlamydia testing among young people 16–25 years. Methods In this randomised controlled trial, recruitment, data collection, study interventions and follow-up occurred entirely in cyberspace, facilitated by a website. Eligible participants were aged 16–25 years and resided in Australia. The intervention group received personalised emails inviting interaction about chlamydia testing, while the control group received regular impersonal emails. Primary outcome was self-reported chlamydia testing at 6-month follow-up; secondary outcomes were condom use and changes in knowledge and attitudes. Results 704 young people completed baseline information, 40 were excluded and five withdrew prior to follow-up. The follow-up rate was 47.3% overall. In the intervention group, 40.6% (95% CI 30.7% to 51.1%) reported having had a chlamydia test at follow-up compared with 31.0% (95% CI 24.8% to 37.2%) in the control group (p=0.07). A per-protocol analysis found that those who engaged in email interaction were more likely to report chlamydia test uptake compared with those in the control group (52.5%, 95% CI 39.3 to 65.4% cf 31.0%, 95% CI 24.8% to 37.2%, p=0.002). There were no differences in secondary outcomes between groups. Conclusions This is the first randomised controlled trial undertaken in cyberspace to promote chlamydia testing. E-technology may be useful in promoting chlamydia testing and healthcare seeking behaviour in young people.

Young people's concerns about sex: unsolicited questions to a teenage radio talkback programme over three years

This paper describes a novel qualitative study that identified the concerns of young people about sex through a talk‐back segment from 2002 to 2004 on an Australian national radio popular music programme targeting 15–24 year olds. Two hundred and thirty‐one unsolicited callers (150 female and 81 male) went to air over the study period, and 212 (92%) of these asked questions relating to sexuality and sexual health. Content analysis was used to categorise the verbatim data. Four categories were identified: sexual development; sexual and reproductive health, sexual relationship issues and sexual practices. The findings suggest that young people have a wide range of concerns, many of which are very explicit. An important finding was the high proportion of questions related to concerns over relationships. The overall implication for health educators and professionals is that a broader approach to sex education is warranted.

Prevalence of tuberculosis infection among homeless young people in central and eastern Sydney.

Objective: To determine the prevalence of tuberculosis (TB) infection among homeless young people (aged 12–25 years) in central and eastern Sydney.

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.

BackgroundThe National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.Methods/DesignHPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.DiscussionThis study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12614000404628, 14.04.2014.

Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: baseline data from a randomised controlled trial

BackgroundChlamydia infection is the most common notifiable sexually transmitted infection (STI) in Australia and mostly affects young people (15 – 25 years). This paper presents baseline data from a randomised controlled trial that aimed to increase chlamydia testing among sexually active young people. The objectives were to identify associations between sexual behaviour, substance use and STI history and explore attitudes to chlamydia testing.MethodsThis study was conducted in cyberspace. Study recruitment, allocation, delivery of interventions and baseline and follow up data collection all took place online. Participants were 16 – 25 years old and resided in Australia. Substance use correlates of sexual activity; predictors of history of STIs; barriers to and facilitators of chlamydia testing were analysed.ResultsOf 856 participants (79.1% female), 704 had experienced penetrative intercourse. Sexually active participants were more likely to smoke regularly or daily, to drink alcohol, or to have binge drunk or used marijuana or other illicit substances recently. Risk factors for having a history of any STI were 3 or more sexual partners ever, 6 or more partners in the past 12 months, condom non-use and being 20 years or older. Almost all sexually active participants said that they would have a chlamydia test if their doctor recommended it.ConclusionsSexually active young people are at risk of STIs and may engage in substance use risk behaviours. Where one health risk behaviour is identified, it is important to seek information about others. Chlamydia testing can be facilitated by doctors and nurses recommending it. Primary care providers have a useful role in chlamydia control.Trial RegistrationAustralian and New Zealand Trials Registry ACTRN12607000582459

Sexually transmitted infections. Initiatives for prevention.

Sexually transmissible infections (STIs) are responsible for a significant burden of disease in both developed and developing countries and young people are disproportionately affected by STIs and their consequences. STI rates in young people are determined by a wide range of well documented influences. These include physiological, cognitive and behavioural factors, as well as environmental factors such as the social, and cultural context in which young people live. Despite the erecognition of these influences, their complex inter-relationships are less well documented and the evidence for interventions to reduce STIs in young people is similarly less clear. This paper explore tht most important factors that impact STI rates in young people in Australia and reviews interventions that have shown success, in Australia and elsewhere. In addition, promising strategies for the promotion of sexual health and reduction of STIs in young Australians, are discussed.

The promise of primary health reform for youth health.

As in other nations, the Australian primary care sector represents the first port of call for most young people aged 12 to 24 years seeking health care. Australian young people are more likely to consult general practitioners (GPs) for support and counsel than other clinicians. This is especially the case for sensitive matters, like mental health issues. Seventy to ninety per cent of young people access primary care at least once a year, primarily for respiratory or dermatological concerns. GPs are therefore well-placed to promote youth health. As part of the primary care sector, GPs are responsible for promoting and reinforcing prevention, early intervention and connected care. In some Western nations, like the UK and Australia, they serve as the conduit to secondary and tertiary care, and thus moderate patient-flow within the health system. Furthermore, the developmental phase of young people provides an opportune period for prevention and early intervention. Attending to youth health represents a sound investment. This is recognised by a number of governments that endeavour to facilitate youth access to general practice. For instance, the Department of Health in the UK has released criteria to promote youth access to health care, which include the availability of appointment times that are accessible to young people, confidentiality, and staff training in youth health. Similarly, the Australian federal government entitles young people to hold their own Medicare card from the age of 15 years and thus access primary care services independently. Despite government support for primary care and young people’s seeming acceptance of GPs, youth access to primary care remains limited. Recent research on GP activity throughout Australia suggests that patients aged 15 to 24 years account for approximately 8.6 percent of all encounters – yet young people represent 13.6 percent of the Australian population. At a state level, NSW data suggest that youth access to GPs is largely in decline, particularly among young males. Although this research indicates that over two-thirds of NSW young people access a GP within a given 12-month period, this means that one-third do not, representing close to 300 000 young people. Furthermore, research would suggest that these young people may be less likely to seek help in the future. Even when young people access primary care services, research suggests some receive suboptimal care. A national study of general practice in Australia revealed that GPs do not embrace opportunities to target problematic lifestyle choices with patients, including alcohol and tobacco use. This reflects international research findings. For instance, in a North American study involving approximately four-hundred young people aged 15 to 25 years, 76% screened positive for at least one major health-related social problem – yet only 3% reported comprehensive screening by any clinician within the last 12 months, and 33% had not been screened at all. These examples might partly explain why young people have been described as a ‘forgotten group caught between bureaucratic barriers and professional spheres of influence’. Limited youth access to timely and appropriate health care can have personal, social and economic implications. At the personal level, many Australian young people experience chronic health and/or mental health issues. At a social level, chronic health and/or mental health issues can exacerbate the oft-cited burden of care among family members; these issues can also limit educational opportunities and employment prospects. At an economic level, lack of well-being is likely to require more services, more hospitalisation, more treatment, more medication, and continued access to clinicians and other practitioners. Furthermore, lack of well-being foreshadows reduced employability and perhaps increased reliance on government benefits. Given there are almost 3 million young people in Australia, ‘adolescent health [represents] an opportunity not to be missed’. To harness this opportunity and enhance youth health, innovative, systemic change is required. This includes (but is not limited to) changing the types of primary care services delivered to young people, how they are delivered and how these services are supported. In this epoch of health reform, there is arguably no better time for such change. Like many other nations, Australia is witnessing ‘the single biggest health reform in a quarter of a century’, the essence of which is health care that is ‘funded nationally . . . and run locally’. Given mounting evidence on what works in youth health care, current health reforms represent a window of opportunity to promote youth health. This article reveals how recent policy developments and growing research on evidence-based youth health care provide a strong platform on which to promote youth health. This is achieved through a narrative review of recent Australian health Correspondence: Professor David Bennett, Youth Health and Wellbeing, NSW Kids and Families, LMB 961, North Sydney, NSW 2059, Australia. Fax: +61 02 9424 5888; email: David.bennett@health.nsw.gov.au

Primary health care for young people in Australia.

This article gives an overview of the primary health care system and the evolution of adolescent medicine and health care in Australia over the past three decades. The various ways that Australian young people come into contact with different elements of primary health care are described, as well as research findings into improving young peoples access to and quality of primary health care. Challenges and future directions are discussed.