Peter Howat

Preventing alcohol related traffic injury: a health promotion approach

The conditions that give rise to drinking and driving are complex, with multiple and interrelated causes. Prevention efforts benefit from an approach that relies on the combination of multiple interventions. Health promotion provides a useful framework for conceptualizing and implementing actions to reduce drinking and driving since it involves a combination of educational, behavioral, environmental, and policy approaches. This review draws on data from a range of settings to characterize the effectiveness of various interventions embedded within the health promotion approach. Interventions considered part of the health promotion approach include: (1) economic interventions (2) organizational interventions, (3) policy interventions, and (4) health education interventions, including the use of media, school and community education, and public awareness programs. Effective health promotion strengthens the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of alcohol-impaired driving. There is strong evidence for the effectiveness of some components of health promotion, including economic and retailer interventions, alcohol taxation, reducing alcohol availability, legal and legislative strategies, and strategies addressing the servers of alcohol. There is also evidence for the effectiveness of sobriety checkpoints, lower BAC laws, minimum legal drinking age laws, and supportive media promotion programs. Other interventions with moderate evidence of effectiveness include restricting alcohol advertising and promotion, and actions involving counter advertising. Health education interventions alone that have insufficient evidence for effectiveness include passive server training programs, school drug and alcohol education programs, community mobilization efforts, and health warnings. Because each intervention builds on the strengths of every other one, ecological approaches to reducing alcohol-impaired driving using all four components of the health promotion model are likely to be the most effective. Settings such as schools, workplaces, cities, and communities offer practical opportunities to implement alcohol-impaired driving prevention programs within this framework.

The effectiveness of a physical activity intervention for seniors

Purpose. To determine whether a tailored, 6-month, neighborhood-based, physical activity intervention for people aged 65 to 74 years could increase their total physical activity levels and to identify factors associated with physical activity times. Design. A longitudinal, prospective, intervention study. Setting. Perth, Western Australia. Subjects. A total of 573 older adults, recruited from 30 intervention (n = 260) and 30 control (n = 313) neighborhoods. Initial response rates were 74% (260/352) in the intervention group and 82% (313/382) in the control group, which provided the 573 adults for participation in the study. A total of 413 participants (177 and 236 in the intervention and control groups, respectively) completed the program. Intervention. A neighborhood-based physical activity intervention. Measures. A self-reported questionnaire administered at three time points. Physical activity levels were measured using the International Physical Activity Questionnaire. Personal and demographic information, including perceived financial struggle and proximity to friends, were collected. Analysis. Descriptive statistics, repeated measures analysis of variance, and generalized estimating equations (GEE). Results. The intervention resulted in a significant increase in total average physical activity times of 2.25 hours per week (p < .001). The GEE analysis confirmed significant increases in physical activity from baseline to midpoint (p = .002) and to postintervention (p = .031). Perception of financial struggle (p = .020) was positively associated with physical activity time spent by participants, whereas having no friends or acquaintances living nearby (p = .037) had a significant negative correlation. The main limitation of this study was the restricted duration of the intervention. Conclusion. The program was successful in increasing weekly mean time for physical activity in seniors and in identifying factors that affect their commitment to physical activities.

Development of competency-based University health promotion courses

The Curtin University Centre for Health Promotion Research, in conjunction with the Australian Association of Health Promotion Professionals (AAHPP), the National Heart Foundation of Australia and the Health Department of Western Australia, co-ordinated a project to ascertain competencies required for personnel working in health promotion.

Health promotion competencies for Australia 2001-5 : trends and their implications

This important research builds on past projects in Australia and internationally that have sought to define and clarify competencies required to work in health promotion. The paper briefly explains the process undertaken in 2005 to update the Australian health promotion competencies as a collaboration of several leading health promotion agencies. The article reports findings from research undertaken in 2001 and 2005 and compares trends in perceptions of health promotion competencies across time. This dialogue among researchers, health promotion academics and practitioners can help to further the impact of competencies research on professional practice in health promotion globally. This project placed a priority on methodology that engaged the health promotion workforce in Australia. A two-stage process was employed including expert consultation with 39 senior health promotion professionals, followed by a modified Delphi process to engage 400 practitioners. Space was allowed for comment on the competencies including suggested word changes, and respondents were also invited to add additional competencies. The research involved a modified Delphi study where participants were invited to rate each competency as “essential”, “desirable” or “not relevant”, and to suggest changes to wording, as well as additions to the list. Responses were received from 400 practitioners and the results were presented and compared with the 2001 survey results. Results indicate a substantial shift in perceptions about health promotion practice in Australia during the initial years of the 21st century.The overall significant changes in perceptions indicate that by 2005 the Australian health promotion workforce had substantially moved away from an individual behaviour-dominated perception of health promotion practice. Increasing recognition was given to competencies that reflect environmental, economic and policy influences on health, and increased recognition that these processes are legitimate and essential components of the health promotion process. (Promot Educ 2008;15(2): 21—26)

The barriers to illegal anabolic steroid use

This paper summarizes the self-reported barriers that men overcame prior to initiating illegal anabolic steroid use, and the associated weakening of social controls that restrict anabolic steroid initiation. Data was collected via participant observation of 147 anabolic steroid users and previous users, 98 in-depth interviews with 42 anabolic steroid users and 49 in-depth interviews with 22 illegal dealers. Additional data came from interviews and eight focus groups with gym instructors, personal trainers and health workers, and the monitoring of policy changes and media reports relating to anabolic steroids. The identified barriers included, coping with potential stigma, gathering of credible information and overcoming structural and resource barriers including developing the skills required to administer the drug and gaining a supply source. As these barriers were overcome there was a reduction in the social controls that inhibit the initiation of illegal anabolic steroid use. By understanding the interaction between potential users, social controls and these barriers it may be possible to strengthen the barriers and hence delay or halt the progression to anabolic steroid use. The paper suggests several demand- and harm-reduction strategies that may assist this process.

Self-Reported Weight and Height for Evaluating Obesity Control Programs

OBJECTIVESnTo assess the adequacy of self-reported weight and height as indicators for BMI in community-based obesity control programs.nnnMETHODSnSelf-reported and measured weight and height and calculated BMI in 6979 adults were assessed using analysis of covariance.nnnRESULTSnPrevalence of obesity (BMI > 25 kg/m(2)) and overweight (25-29.9 kg/m(2)) was lower using self-reported values by 3.2% and 5.0%, respectively. Females underreported BMI more than males did; and older subjects, more than younger subjects.nnnCONCLUSIONSnSelf-reported weight and height measurements may be used for the evaluation of community-based obesity control programs with the application of correction factors. This will minimize costs associated with physical measurements.

Review of Competencies for Australian Health Promotion

Les auteurs ont effectue une etude afin de determiner les competences que doivent posseder les professionnels de la promotion de la sante travaillant dans le contexte australien. Le travail consistait en une recherche documentaire et le recrutement dun groupe dexperts compose de professionnels charge detudier et de modifier la liste actuelle des competences. Deux tours de la methode Delphi ont permis de recueillir les avis dun echantillon de 425 professionnels de toute lAustralie. Les auteurs presentent les resultats obtenus. Les competences jugees « essentielles », « souhaitables » ou « specifiques par les professionnels de la promotion de la sante sont mises en evidence. Le consensus general est demontre pour une liste de 82 competences classees sous les huit chapitres suivants: ○ evaluation des besoins ○ planification ○ mise en oeuvre ○ communication ○ connaissance ○ organisation et gestion ○ evaluation et recherche ○ utilisation des technologies Les auteurs proposent des applications de ces competences, notamment leur utilisation pour lelaboration de cours pour les etablissements denseignement superieur, la formation continue au sein des institutions ou pour la gestion des performances et la redaction des descriptions de postes.

The protocol of a randomized controlled trial for playgroup mothers: Reminder on Food, Relaxation, Exercise, and Support for Health (REFRESH) Program

BackgroundMothers physical activity levels are relatively low, while their energy consumption is generally high resulting in 58% of Australian women over the age of 18 years being overweight or obese. This study aims to confirm if a low-cost, accessible playgroup based intervention program can improve the dietary and physical activity behaviours of mothers with young children.Methods/DesignThe current study is a randomized controlled trial lifestyle (nutrition and physical activity) intervention for mothers with children aged between 0 to 5 years attending playgroups in Perth, Western Australia. Nine-hundred participants will be recruited and randomly assigned to the intervention (n = 450) and control (n = 450) groups. The study is based on the Social Cognitive Theory (SCT) and the Transtheoretical Model (TTM), and the Precede-Proceed Framework incorporating goal setting, motivational interviewing, social support and self-efficacy. The six month intervention will include multiple strategies and resources to ensure the engagement and retention of participants. The main strategy is home based and will include a specially designed booklet with dietary and physical activity information, a muscle strength and flexibility exercise chart, a nutrition label reading shopping list and menu planner. The home based strategy will be supported by face-to-face dietary and physical activity workshops in the playgroup setting, posted and emailed bi-monthly newsletters, and monthly Short Message Service (SMS) reminders via mobile phones. Participants in the control group receive no intervention materials. Outcome measures will be assessed using data that will be collected at baseline, six months and 12 months from participants in the control and intervention groups.DiscussionThis trial will add to the evidence base on the recruitment, retention and the impact of community based dietary and physical activity interventions for mothers with young children.Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN12609000735257

Effectiveness of a Home-Based Postal and Telephone Physical Activity and Nutrition Pilot Program for Seniors

Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.

Using Theory to Guide Practice in Children's Pedestrian Safety Education.

Abstract Few pedestrian injury prevention programs appear to articulate the theory upon which their design and evaluation are based. This article describes how theory was used to plan, develop, implement, and evaluate the educational component of a comprehensive child pedestrian intervention. Organizational and planning theories were used to guide the conceptual development, implementation, and evaluation of the program, while behavioral and child development theories were used to identify the content and strategies to address the pedestrian behavior of seven to nine year old children. The resultant program demonstrated improved road crossing and playing behaviors in the intervention group children compared to those in the comparison group. The systematic use of relevant theory in this program is likely to be associated with its positive impact on childrens pedestrian safety.