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Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year’s newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead: (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems – governance, information, services, determinants, and capacity – to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

This study evaluated the injury prevention program, Skills for Preventing Injury in Youth (SPIY) for Year 9 students (aged 13–14 years). The aim of SPIY was to reduce adolescent injury by reducing engagement in risk-taking behaviors. A randomized controlled trial was conducted and data analyzed with 32 schools, N = 2,739 students at baseline. Students’ self-reported injury prior to the commencement of SPIY and at 6 and 12 months after the program concluded. For those with few protective factors at baseline, there was less increase in alcohol-related injuries and a decline in violence-related injuries for intervention compared with control students. Findings showed the SPIY program can be effective in reducing adolescent injury for those with few promotive factors.

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Background: Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions. Objectives: We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy. Results and discussion: We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10–21), and thoroughly addressed 13 of 22 (range 5–19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted. Conclusions: The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility. Keywords: Systematic review, Guidelines, Meta analysis, Environmental health, Air pollution, Climate change

Jia, K., Fleiter, J., King, M., Sheehan, M., Ma, W., & Zhang, J. (2015). Knowledge and behaviors of drunk-driving offenders in Guangzhou, China. The International Journal Of Alcohol And Drug Research, 4 (2), 151-158. doi: http://dx.doi.org/10.7895/ijadr.v4i2.203 Aims: To better understand the knowledge and behaviors of drunk-driving offenders relating to alcohol use and driving in the context of recently amended Chinese legislation, and to investigate the involvement of alcohol-use disorders. Design: The study was a cross-sectional survey conducted in 2012. Setting and participants: Data were collected at a local jail and 101 participants were recruited while in detention. Measures: Questionnaire items examined demographic characteristics as well as practices and knowledge relating to alcohol use and driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking levels. Findings: Knowledge about the two legal limits for “drink driving” and for “drunk driving” was low, at 28.3% and 41.4%, respectively. AUDIT scores indicated that a substantial proportion of the offenders had high levels of alcohol-use disorders. Higher AUDIT scores were found among the least experienced drivers, those who lacked knowledge about the legal limits, and recidivist drunk drivers. Conclusions: Limited awareness of legal alcohol limits might contribute to offending; high AUDIT scores suggest that hazardous drinking levels may also contribute. This study provides important information to assist in refining community education and prevention efforts.

Summary: Public health has potential to serve as a frame to convey the urgency of behavior change needed to adapt to a changing climate and reduce greenhouse gas emissions. Local governments form the backbone of climate-related public health preparedness. Yet local health agencies are often inadequately prepared and poorly integrated into climate change assessments and plans. We reviewed the climate health profiles of 16 states and two cities participating in the U.S. Centers for Disease Control and Prevention (CDC)’s Climate-Ready States and Cities Initiative (CRSCI) that aims to build local capacity to assess and respond to the health impacts of climate change. Following recommendations from a recent expert panel strategic review, we present illustrations of emerging promising practice and future directions. We found that CRSCI has strengthened climate preparedness and response in local public health agencies by identifying critical climate-health impacts and vulnerable populations, and has helped integrate health more fully into broader climate planning. Promising practice was found in all three recommendation areas identified by the expert panel (leveraging partnerships, refining assessment methodologies and enhancing communications), particularly with regard to health impacts of extreme heat. Vast needs remain, however, suggesting the need to disseminate CRSCI experience to non-grantees. In conclusion, the CRSCI program approach and selected activities illustrate a way forward toward robust, targeted local preparedness and response that may serve as a useful example for public health departments in the United States and internationally, particularly at a time of uncertain commitment to climate change agreements at the national level. https://doi.org/10.1289/EHP1838

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

The future on-road safety of drivers affected by Whiplash Associated Disorder (WAD), the most common soft-tissue injury suffered in a traffic crash, has not been extensively explored. We obtained an anonymised file of 4280 insurance claimants with WAD and, as controls, 1116 claimants with comparably severe soft-tissue injuries who are considered to be at no increased risk than the general population. Their demographic information, road user type and traffic crash records both prior and subsequent to the traffic incident in which the injury occurred, the index crash, were obtained. Rates of subsequent crash involvement in these two groups were then compared, adjusting for age, sex, road user type and prior crash experience. The risk of a subsequent crash in the WAD group relative to controls was 1.14 (95% confidence interval, 0.87–1.48). To allow for differentially altered driving exposure after index crash we distributed a brief survey asking about changes in driving habits after a traffic crash involving injury via physiotherapy clinics and online through the electronic newsletter of a local motoring organisation. The survey yielded responses from 113 drivers who had experienced WAD in a traffic crash and 53 with other soft tissue injuries. There were no differences on average between the groups in their prior driving levels or their percentage change therein at one, three or six months after injury. There was thus no evidence that drivers with WAD are at any higher safety risk than drivers with other types of relatively minor post-crash soft tissue injury.

OBJECTIVE Little research has examined user perceptions of medication warnings about driving. Consumer perceptions of the Australian national approach to medication warnings about driving are examined. The Australian approach to warning presentation is compared with an alternative approach used in France. Visual characteristics of the warnings and overall warning readability are investigated. Risk perceptions and behavioral intentions associated with the warnings are also examined. METHOD Surveys were conducted with 358 public hospital outpatients in Queensland, Australia. Extending this investigation is a supplementary comparison study of French hospital outpatients (n = 75). RESULTS The results suggest that the Australian warning approach of using a combination of visual characteristics is important for consumers but that the use of a pictogram could enhance effects. Significantly higher levels of risk perception were found among the sample for the French highest severity label compared to the analogous mandatory Australian warning, with a similar trend evident in the French study results. The results also indicated that the French label was associated with more cautious behavioral intentions. CONCLUSION The results are potentially important for the Australian approach to medication warnings about driving impairment. The research contributes practical findings that can be used to enhance the effectiveness of warnings and develop countermeasures in this area. Hospital pharmacy patients should include persons with the highest level of likelihood of knowledge and awareness of medication warning labeling. Even in this context it appears that a review of the Australian warning system would be useful particularly in the context of increasing evidence relating to associated driving risks. Reviewing text size and readability of messages including the addition of pictograms, as well as clarifying the importance of potential risk in a general community context, is recommended for consideration and further research.

Motor vehicle crashes are a leading cause of death among young people. Fourteen percent of adolescents aged 13-14 report passenger-related injuries within three months. Intervention programs typically focus on young drivers and overlook passengers as potential protective influences. Graduated Driver Licensing restricts passenger numbers, and this study focuses on a complementary school-based intervention to increase passengers' personal- and peer-protective behavior. The aim of this research was to assess the impact of the curriculum-based injury prevention program, Skills for Preventing Injury in Youth (SPIY), on passenger-related risk-taking and injuries, and intentions to intervene in friends' risky road behavior. SPIY was implemented in Grade 8 Health classes and evaluated using survey and focus group data from 843 students across 10 Australian secondary schools. Intervention students reported less passenger-related risk-taking six months following the program. Their intention to protect friends from underage driving also increased. The results of this study show that a comprehensive, school-based program targeting individual and social changes can increase adolescent passenger safety.

There is a continued need to consider ways to prevent early adolescent engagement in a variety of harmful risk-taking behaviours for example, violence, road-related risks and alcohol use. The current prospective study examined adolescents’ reports of intervening to try and stop friends’ engagement in such behaviours among 207 early adolescents (mean age = 13.51 years, 50.1% females). Findings showed that intervening behaviour after three months was predicted by the confidence to intervene which in turn was predicted by student and teacher support although not parental support. The findings suggest that the benefits of positive relationship experiences might extend to the safety of early adolescent friendship groups particularly through the development of confidence to try and stop friends’ risky and dangerous behaviours. Findings from the study support the important role of the school in creating a culture of positive adolescent behaviour whereby young people take social responsibility.

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13-14-year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.

In this study, the goals of the Australian Community Health Program were identified and operationalised. Measures of the communities' health were obtained before and after the health centres came into operation. A population from a comparison area in which community health centre services were not available is also examined. The findings fail to support the view that Brisbane community health centres influence community symptom levels. Further, there is no evidence that health centre activities have produced a decline in medical service utilisation. Stillbirth and neonatal mortality rates appear unaltered. Hospital admission rates declined in one intervention area but continued to increase in both the comparison and, at a lower rate, in the other intervention area. The apparent lack of impact of community health centres in Brisbane may, in part, be attributed to political and structural factors which have limited the number and range of intervention programs. Thus it cannot be assumed that these findings reflect upon the Community Health Program as a whole, but they do indicate that in some centres the Program may fail to address adequately some community health needs. 1981 Public Health Association of Australia

This article reports on the development of a school-based intervention to reduce risk taking and associated injuries. There is limited but important evidence that intervention design should ensure participation does not lead to an increase in target risk behaviors with some studies in alcohol and drug prevention finding unexpected negative effects. The short-term evaluation of Skills for Preventing Injury in Youth (SPIY) examined change in interpersonal violence, alcohol use, and transport-related risks. Intervention ( n = 360) and comparison ( n = 180) students were surveyed pre- and postintervention. A qualitative analysis based on focus groups (70 students) explored experiences of change. Findings indicate significant positive changes reinforced by students’ reports. A decrease in reported risk taking for the intervention group and an increase in the comparison group were observed. These findings endorse SPIY as a useful curriculum approach to reducing injuries and lend support to the future conduct of a long-term outcome evaluation.

Typically adolescents' friends are considered a risk factor for adolescent engagement in risk-taking. This study took a more novel approach, by examining adolescent friendship as a protective factor. In particular it investigated friends' potential to intervene to reduce risk-taking. Five-hundred-forty adolescents (mean age 13.47 years) were asked about their intention to intervene to reduce friends' alcohol, drug and alcohol-related harms and about psychosocial factors potentially associated with intervening. More than half indicated that they would intervene in friends' alcohol, drug use, alcohol-related harms and interpersonal violence. Intervening was associated with being female, having friends engage in overall less risk-taking and having greater school connectedness. The findings provide an important understanding of increasing adolescent protective behavior as a potential strategy to reduce alcohol and drug related harms.

Adolescents experience many benefits from bicycling; however, there are also potentially significant injury consequences. One effective counter-measure for the prevention of adolescent bicycling injuries is to promote bicycle helmet wearing. An overview is provided of injury risks of bicycle riding with particular attention to the role of helmet wearing and associated countermeasures such as legislation and school and community approaches. The findings are presented of a study conducted in Australia that examined the effectiveness of a theory-based injury prevention program, Skills for Preventing Injury in Youth (SPIY) for ninth-grade students (age 13 to 14 years). The findings showed a significant, 20.2% decrease in cycling without a helmet among the intervention students (n = 360) and no change for the students in the comparison group (n = 363) after 6 months. In addition, it was found that failing to wear a helmet was significantly associated with engaging in other transport-related risks, being male, having friends who do not wear a helmet and are specific targets of change in the SPIY program, showing a negative attitude toward risk, failing to intervene in friends’ risk-taking, and having low knowledge of first aid. Overall, the SPIY program appeared to be an effective theory-based intervention to increase helmet wearing among early adolescents, a group not often targeted in school and community helmet-wearing programs.

ObjectiveDrink driving contributes to significant levels of injury and economic loss in China, but is not well researched. This study examined knowledge, drink driving practices and alcohol misuse problems among general drivers in Yinchuan. The objectives were to gain a better understanding of drink driving in Yinchuan, identify areas that need to be addressed, and compare the results with a similar study in Guangzhou.MethodsThis was a cross-sectional study with a survey designed to collect information of participants' demographic characteristics and their knowledge and practices in relation to drinking and driving. The survey was comprised of questions on knowledge and practices in relation to drink driving and was administered to a convenience sample of 406 drivers. Alcohol misuse problems were assessed by using the Alcohol Use Disorders Identification Test (AUDIT).Results Males accounted for the main proportion of drivers sampled from the general population (“general drivers”). A majority of general drivers in both cities knew that drunk driving had become a criminal offence in 2011, however knowledge of two legal blood alcohol concentration (BAC) limits was quite low. Less drivers in Yinchuan (22.6%) than in Guangzhou (27.9) reported having been stopped by police conducting breath alcohol testing at least once in the last twelve months. The mean AUDIT score in Yinchuan (M = 8.2) was higher than in Guangzhou (M = 7.4), and the proportion of Yinchuan drivers with medium or higher alcohol misuse problems (31.2%) was correspondingly higher than in Guangzhou (23.1%). In Yinchuan, males had a significantly higher AUDIT score than females (t = 3.454, p < .001), similar to Guangzhou. Multiple regression analyses were conducted on potential predictors of the AUDIT score (age, gender, monthly income, education level, years licensed and age started drinking). There were significant individual contributions of gender (beta = 0.173, p = 0.09) and age at which drinking started (beta = 0.141, p = 0.033), but the overall model for Yinchuan was not significant, unlike Guangzhou.ConclusionsThe results show that there are shortfalls in knowledge of the legislation and how to comply with it, and deficiencies in police enforcement. In addition there was evidence of drink driving and drink riding at high levels in both cities. Recommendations are made to address these issues.

BACKGROUND: This review examines the breadth of first aid training delivered to school students and the components that are age appropriate to adolescents. METHOD: Eligible studies included school-based first aid interventions targeting students aged between 10 and 18 years. Online databases were searched, for peer-reviewed publications available as at August 2014. RESULTS: A total of 20 journal articles were relevant to the review. Research supported programs with longer durations (3 hours or more). Most programs taught resuscitation alone and few included content that was context-specific and relevant to the target group. The training experience of the facilitator did not appear to impact on student outcomes. Incorporating both practical and didactic components was found to be an important factor in delivering material and facilitating the retention of knowledge. Educational resources and facilitator training were found to be common features of effective programs. CONCLUSIONS: The review supports first aid in school curriculum and provides details of key components pertinent to design of school-based first aid programs. The findings suggest that first aid training may have benefits wider than the uptake and retention of knowledge and skills. There is a need for future research, particularly randomized controlled trials to aid in identifying best practice approaches. Language: en

The current study tracks the drinking behaviour of new police recruits from their ®rst day in the academy, after 6 months of training, through to one year into training (n ˆ 177). Drinking behaviour was assessed with the AUDIT, a well-researched instru- ment for assessing risk of harm from drinking behaviour. The results showed that recruits' risk of harm from alcohol consumption increased as their training progressed. These ®ndings, based on a longitudinal methodology, suggest that the police service and training process introduces recruits into a culture of alcohol consumption which may impact on their individual consumption levels.

This study examined aspects of the work environment, which may impact on individual police officers’ risk of harm from alcohol consumption. A self report survey containing demographic questions, the AUDIT and questions relating to perceived control over the job, overtime, pressure, boredom and job satisfaction was completed by 67 per cent of officers in an Australian state police service. The results of the current study indicate that gender, age and marital status, are individual risk factors for problem drinking, as has been shown in previous research. Within the policing context, years of service, job satisfaction, perceived control within the job and being an operational officer, also emerged as significant predictors of at risk alcohol consumption patterns. Findings further suggest that there is a strong norm of drinking at work or after a shift, which suggests a culture of acceptance of drinking within the workplace. This acceptance is strongly predictive of both risk of alcohol dependency and negative consequences from drinking within the police service. This study suggests directions for future research, which may lead to the introduction of informed interventions within the police service that could reduce officers’ risk of harm from alcohol consumption.

There has been little research examining the use of the Alcohol Use Disorders Identification test (AUDIT) as a workplace screening tool. In the current study a large scale sample (n = 4193) of police personnel completed the 10 AUDIT questions and two readiness to change questions. The sample represented 67% of all members of an Australian State Police organisation. Analysis of AUDIT scores showed that 65% of the sample scored in the low risk of hazardous alcohol consumption range, 32% (33% of males and 24% of females) scored in the at risk for harmful alcohol consumption range and 3% scored in the range indicating risk of alcohol dependence. Age emerged as a clear risk factor of hazardous drinking patterns. The 18 to 25 years age group recorded higher average alcohol consumption, higher rates of risk of abnormal drinking behaviour, higher rates of adverse consequences from drinking alcohol and higher total AUDIT scores than other age groups. This was consistent for both males and females. Of those scoring in the at risk range, 72.5% reported that they did not have a drinking problem. Sixty percent also reported that it would be easy to stop drinking. This study exemplifies how the AUDIT can be used to provide strong evidence for the need for work based intervention programs. Further it can be used to target particular groups within the organisation at risk of harmful alcohol use.

In 1992, a survey was undertaken to study women's knowledge of the physical and emotional changes associated with menopause. Two groups of midlife women: a random sample (n = 381) and a sample of women who attended menopause seminars (n = 95) were asked to select from a list of 39 changes those they thought were directly caused by menopause. Information from readily available books written for a general audience was used to construct the marking guide for a "commonly available knowledge" score. A template for a "biomedical" knowledge score based on an estrogen deficiency perspective of menopause was derived from recently published academic medical literature. The mean score for the commonly available knowledge items was 27 out of 39 (69.2% correct). The mean biomedical knowledge score was lower, 19.3 out of 35 (55.1% correct). While the two groups of women were significantly different in terms of current and past hormone replacement therapy (HRT) use, we found no differences between them in the mean commonly available knowledge or biomedical knowledge scores. This finding challenges the widely held assumption that active information-seekers are more interested and have a better level of knowledge than the general population. The findings also suggest that women are less likely to accept a biomedical model of menopause and that they are using HRT for a multiplicity of reasons, not just those related to estrogen deficiency.

The knowledge of the effects of sunlight on the eyes and protective behaviors were studied in an adolescent population. A group of 652 systematically sampled students aged between 13 and 17 years was surveyed with a standardized questionnaire in Brisbane, Australia in October-November, 1995. Survey data on the knowledge of sunlight effects on the eyes, ultraviolet light, eye and body protection as well as risk factors for ultraviolet (UV) exposure were relatively ranked and totalled to give overall scores. Of the 652 subjects, 330 (51%) were female. Most subjects (568 or 88%) were aged between 15 and 16 years. Overall, this group of subjects demonstrated a moderate level of knowledge with respect to UV, sunlight and the eyes. The knowledge of the effects of sunlight and body protection was higher than the knowledge of the effects of sunlight and eye protection. Almost three-quarters (462 or 71%) of the subjects owned a pair of sunglasses. The mean age at which subjects started to wear sunglasses was 10.4 years. However, most subjects (528 or 81%) only wore sunglasses occasionally or not at all. The reported frequency of wearing sunglasses was significantly related to personal, family and peer attitudes to such use, but not to media advertizing. Assessment of adolescent knowledge is important in the formulation of health promotion strategies designed to prevent excessive UV exposure at this young age.

The lack of definitional consistency about domestic violence and the absence of a well-validated comprehensive abuse screening questionnaire have been major methodological flaws in domestic violence research. While there are several screening questionnaires in use, they either are narrowly defined and do not have discrete measures of physical, emotional, and sexual abuse or have not been validated on both abused and nonabused samples. This study presents the development and preliminary validation of a new partner abuse screening questionnaire (Composite Abuse Scale; CAS). Items measuring the three areas of partner abuse were extracted from four published scales: the Conflict Tactics Scale, Measure of Wife Abuse, Inventory of Spouse Abuse, and Psychological Maltreatment of Women Inventory. A survey using these items was sent to all nurses working at a large Australian public, inner-city teaching hospital. Factor analyses of the responses of 427 participants revealed four dimensions: Severe Combined Abuse, Emotional Abuse, Physical Abuse, and Harassment. Preliminary evidence is presented on validity and a high scale reliability is reported for each subscale.

SUMMARY A total of 164 consecutive patients with a range of biopsy-proven locally advanced or metastatic cancers were interviewed t o assess quality of life using the Rotterdam Symptom Check List (RSCL) at three longitudinal time intervals during a course of palliative radiotherapy. Of the 164 patients, 120 were able to complete all 3 question-naires. Paired t-tests were used t o assess the significance of changes in the patients mean scores over time. Of the 33 symptoms assessed in the RSCL, changes in the degree o f symptomatology were highly consistent with changes expected in clinical practice, as a result of either disease progression or side effects o f treatment. It is concluded that the RSCL provides a practical assessment of various symptoms in patients receiving palliative radiotherapy, and that the changes in symptom profile over time are relevant to clinical practice. The RSCL has never been previously used in the assessment of palliative radiotherapy, and the present study validates this instrument.

Free to read on journal website (may need to create free account first) Summary Objective To assess the usability and validity of the Primary Care Practice Improvement Tool (PC-PIT), a practice performance improvement tool based on 13 key elements identified by a systematic review. It was co-created with a range of partners and designed specifically for primary health care. Design This pilot study examined the PC-PIT using a formative assessment framework and mixed-methods research design. Setting and participants Six high-functioning general practices in Queensland, Australia, between February and July 2013. A total of 28 staff participated — 10 general practitioners, six practice or community nurses, 12 administrators (four practice managers; one business manager and eight reception or general administrative staff). Main outcome measures Readability, content validity and staff perceptions of the PC-PIT. Results The PC-PIT offers an appropriate and acceptable approach to internal quality improvement in general practice. Quantitative assessment scores and qualitative data from all staff identified two areas in which the PC-PIT required modification: a reduction in the indicative reading age, and simplification of governance-related terms and concepts. Conclusion The PC-PIT provides an innovative approach to address the complexity of organisational improvement in general practice and primary health care. This initial validation will be used to develop a suite of supporting, high-quality and free-to-access resources to enhance the use of the PC-PIT in general practice. Based on these findings, a national trial is now underway.

School connectedness is an important protective factor for adolescent risk-taking behaviour. This study examined a pilot version of the Skills for Preventing Injury in Youth (SPIY) programme, combining teacher professional development (PD) for increasing school connectedness (connectedness component) with a risk and injury prevention curriculum for early adolescents (curriculum component). A process evaluation was conducted on the connectedness component, involving assessments of programme reach, participant receptiveness and initial use, and a preliminary impact evaluation was conducted on the combined connectedness and curriculum programme. The connectedness component was well received by teacher participants, who saw benefits for both themselves and their students. Classroom observation also showed that teachers who received PD made use of the programme strategies. Grade 8 students who participated in the SPIY programme were less likely to report violent behaviour at 6-month follow-up than were control students, and trends also suggested reduced transport injuries. The results of this research support the use of the combined SPIY connectedness and curriculum components in a large-scale effectiveness trial to assess the impact of the programme on students' connectedness, risk-taking and associated injuries.

The alcohol education package 'When You Think About It' was developed by the Queensland Department of Education in co-operation with an Aboriginal community in the Northern region of the State. The community identified a number of behaviours and issues that needed to be addressed and a systematic series of lessons with an associated community video was developed. The package was taught for the first time in the community high school in 1990, and research was undertaken to monitor implementation and impact. Students were surveyed prior to and after the package was taught; and information regarding teaching experience, opinions on alcohol education, and feedback on the students' enjoyment of and interest in the lessons were sought from the teachers. Interviews were held with community members at the completion of the teaching program to ascertain their reactions. Absentee rates were between 20–30% for each lesson and only 22 students completed both questionnaires and attended five lessons. The small sample ...

OBJECTIVE The study investigates the knowledge, intentions, and driving behavior of persons prescribed medications that display a warning about driving. It also examines their confidence that they can self-assess possible impairment, as is required by the Australian labeling system. METHOD We surveyed 358 outpatients in an Australian public hospital pharmacy, representing a well-advised group taking a range of medications including those displaying a warning label about driving. A brief telephone follow-up survey was conducted with a subgroup of the participants. RESULTS The sample had a median age of 53.2 years and was 53 percent male. Nearly three quarters (73.2%) had taken a potentially impairing class of medication and more than half (56.1%) had taken more than one such medication in the past 12 months. Knowledge of the potentially impairing effects of medication was relatively high for most items; however, participants underestimated the possibility of increased impairment from exceeding the prescribed dose and at commencing treatment. Participants' responses to the safety implications of taking drugs with the highest level of warning varied. Around two thirds (62.8%) indicated that they would consult a health practitioner for advice and around half would modify their driving in some way. However, one fifth (20.9%) would drive when the traffic was thought to be less heavy and over a third (37.7%) would modify their medication regime so that they could drive. The findings from the follow-up survey of a subsample taking target drugs at the time of the first interview were also of concern. Only just over half (51%) recalled seeing the warning label on their medications and, of this group, three quarters (78%) reported following the warning label advice. These findings indicated that there remains a large proportion of people who either did not notice or did not consider the warning when deciding whether to drive. There was a very high level of confidence in this group that they could determine whether they were personally affected by the medication, which may be a problem from a safety perspective. CONCLUSION This study involved persons who should have had a very high level of knowledge and awareness of medication warning labeling. Even in this group there was a lack of informed response to potential impairment. A review of the Australian warning system and wider dissemination of information on medication treatment effects would be useful. Clarifying the importance of potential risk in the general community context is recommended for consideration and further research.

Background Methylmercury (MeHg) is a neurotoxin primarily found in seafood; exposures in reproductive-age women are of concern due to vulnerability of the developing fetus. MeHg is mainly eliminated via an enterohepatic cycle involving the liver and gallbladder. Dysfunction in these organs has been associated with slower MeHg elimination in laboratory animals. We hypothesized that women testing positive for chronic hepatitis B (HBV) or C (HCV), both associated with risk of longer-term liver and gallbladder impairment, would have higher total blood mercury (TBHg) concentrations than those negative for the viruses, reflecting slower MeHg elimination. Methods Geometric mean (GM) TBHg levels from a representative sample of over 5,000 seafood-consuming, reproductive-age women from eight years (2001–2008) of the US NHANES survey were compared by viral hepatitis status (as determined by serological assay) using multiple linear regression. Adjustment was made for estimated MeHg intake from seafood consumption, social and demographic variables and other predictors. Results Women with chronic HBV had 1.52 (95% CI 1.13, 2.05, p Conclusions While study design prevents inferences on causality, the finding that MeHg biomarkers differ by hepatitis status in this population suggests viral hepatitis may alter the pace of MeHg elimination. Offspring of HBV-infected seafood-consuming women may be at higher risk of MeHg-induced developmental delays than offspring of those uninfected. Possible reasons for the unanticipated negative association with HCV are explored.

Objective: To identify requirements for vocational training and continuing education programs in rural general practice. Design: A questionnaire was sent to all 487 rural doctors and 140 metropolitan and 140 provincial city general practitioners (GPs) in Queensland. A sample of medical educators, health professional and consumer representatives and rural doctors was also interviewed. Responses were compared by geographical area, practice characteristics and level of postgraduate training. Results: There are significant differences between rural and urban practice profiles. Rural doctors have to practise a range of clinical skills in an environment with restricted access to health professional support, although the need for advanced training in procedural or other skills depends on the type of rural practice. Rural and urban doctors want more influence in determining continuing medical education (CME) programs. Interactive learning methods were rated as the most effective education methods by both rural and urban GPs. Rural doctors were less likely to consider that they spent enough time on CME. Conclusion: Vocational training programs should accommodate various rural career objectives, including those requiring advanced levels of procedural work. There is a significant unmet demand for CME tailored to the needs of individual doctors, both rural and urban, but distance and isolation may make this more critical in rural practice. These issues need to be addressed as training opportunities can contribute to improved retention of the rural medical workforce.

The knowledge of sunlight effects on the eyes and protective behaviors was assessed in the general community of Brisbane, Australia. Five hundred people were systematically sampled and surveyed via a telephone questionnaire. Of the participants, 279 (56%) were female and 258 (52%) were aged 40 years or less. Levels of knowledge were found to be lower in the older subjects, those with dark complexions and outdoor workers. Most were unaware of specific ultraviolet light related eye diseases such as cataract, pterygium and eye cancer. Three hundred and ninety (78%) wore sunglasses10% of the time while outdoors during the day; the most common reasons for wearing included protection from glare in 254 (65%) and driving in 60 (15%). Ninety-six (19%) never wore sunglasses, the most common reasons being inconvenience in 16 (17%), thought unnecessary in 16 (17%) and uncomfortable in 13 (14%). Promotion of sun protection to prevent ultraviolet light related diseases should include information on the eye. This information is important for establishing preventative behaviors and the selection of optimal eye protective measures.

Adolescents engage in many risk-taking behaviors that have the potential to lead to injury. The school environment has a significant role in shaping adolescent behavior, and this study aimed to provide additional information about the benefits associated with connectedness to school. Early adolescents aged 13 to 15 years (N=509, 49% boys) were surveyed about school connectedness, engagement in transport and violence risk-taking, and injury experiences. Significant relations were found between school connectedness and reduced engagement in both transport and violence risk-taking, as well as fewer associated injuries. This study has implications for the area of risk-taking and injury prevention, as it suggests the potential for reducing adolescents' injury through school based interventions targeting school connectedness.

Objectives. This paper sought to identify the behaviour change targets for an injury prevention program; Skills for Preventing Injury in Youth (SPIY). The aim was to explore how such behaviours could subsequently be implemented and evaluated in the program. Methods and design. The quantitative procedure involved a survey with 267 Year 8 and 9 students (mean age 13.23 years) regarding their engagement in risk-taking behaviours that may lead to injury. The qualitative study involved 30 students aged 14 to 17 years reporting their experiences of injury and risk-taking. Results. Injury risk behaviours co-occurred among three-quarters of those who reported engaging in any alcohol use or transport or violence related risk behaviour. Students described in detail some of these experiences. Conclusions. The selection process of identifying target behaviours for change for an injury prevention program is described. Adolescents’ description of such risk behaviours can inform the process of operationalising and contextualising program content and deciding on evaluation methodology. The design of an effective injury prevention program involves considerable preparatory work and this paper was able to describe the process of identifying the behavioural targets for change that can be operationalised and evaluated in the injury prevention program, SPIY. What is known about the topic? Injury is a significant health concern for young people with multiple risk behaviours leading to injury. The context of such behaviour and injury is not well understood from the perspective of young people. Further, the clustering of such risky behaviours is often not examined. What does this paper add? This paper reports on a study that examines self-reported behaviours associated with injury among early adolescents and provides a qualitative perspective from the adolescents themselves about their injury and risk behaviour experiences. What are the implications for practitioners? School-based curriculum programs have the potential to deliver health promotion messages. However there are competing demands on curriculum time. Findings from this study suggest a curriculum program could effectively target change in alcohol, transport and violence risk behaviours as the behaviours co-occur and adolescents understood such behaviour and injury experiences are from the same context. School-based health promotion strategies that target many behaviours might thus provide a more efficient and accepted approach.

In all, environmental factors are thought to be responsible for at least one-quarter of the disease and death burden globally (Smith et al. 1999). We cannot be healthy without healthy environments. Throughout the world, environmental degradation is a major cause of poor health. In developing countries, lack of clean drinking water and hygiene leads to 1.7 million premature deaths from intestinal illness every year, mainly affecting children. Smoke-laden indoor air from traditional fuels – used by half of the world’s population – leads to 1.6 million deaths each year from respiratory disease. In developed and developing countries, outdoor air pollution from automobile exhaust and industry causes a further 800,000 respiratory-related deaths per year (WHO 2002). Poisoning from pesticides and other toxics in the environment causes over half a million deaths each year (Fewtrell et al. 2003; WHO 2003). Climate warming driven by greenhouse gas emissions is already causing 150,000 annual deaths from vector-borne disease and heat stress (McMichael et al. 2003).

A process evaluation provides critical information that can inform the design and implementation of a programme. This study sought to provide examples of how to operationalize a process evaluation of an effective programme (Skills for Preventing Injury in Youth). A comprehensive definition of process evaluation was used which included assessing dose, adherence, quality of process, participant responsiveness and programme differentiation. Dose was assessed through teacher and student ratings as well as independent observations. Reports from an observer were used to assess adherence to programme objectives, the quality of process including interactive delivery and programme differentiation. Participant responsiveness was assessed quantitatively and qualitatively with students providing greater depth to the findings. Findings regarding dose varied and suggested different sources of reports provided supplementary information. The findings also suggested that independent observations are an important tool for process evaluation and identified challenges for programme designers regarding interactive material. Overall, the research indicated that a comprehensive definition of process evaluation could be operationalized and provided an understanding of an application of a process evaluation to an injury prevention programme. Continued development of process evaluations will enable a better understanding of the conduct of interventions and maximize the likely effect of such interventions.

Although public health campaigns focusing on alcohol in the work-place are receiving increasing attention, there is little empirical evidence regarding the use of screening. In this work-place study, 152 mining personnel (67% of the work-force) completed a self report screen using the Alcohol Use Disorders Identification Test (AUDIT). One hundred and thirty-three of these (58.5% of the work-force) also consented to be breathalysed and one (0.75%) recorded a BAC just over threshold for detection. Forty-eight males (37.7% of the male work-force) recorded AUDIT scores of eight or more consistent with hazardous alcohol use and one female registered a cumulative score above the female cut-off level for hazardous alcohol use. Eighty males (67% of the work-force), recorded binge drinking at least monthly and 81 males recorded a cumulative AUDIT score of less than eight; however, on item analysis, 64 (83%) of these recorded binge drinking at least sometimes. There is substantial hazardous alcohol use in this sample work group and younger males had higher alcohol consumption, more adverse consequences and higher total AUDIT scores identifying them as particularly at risk. The Cronbach & AUDIT was 0.72, confirming adequate internal consistency.

The current study aimed to examine the prevalence of alcohol use within a large sample (n = 4,193) of Australian police offers. Prevalence and at risk behaviour was measured through the use of a self-report survey containing the AUDIT and standard frequency and quantity questions. Results indicated that although police did not report drinking with high frequency when compared to the national statistics, they did drink in far greater quantities. Further, both males and females in the police sample reported high rates of binge drinking. The 18- to 25-year old age group reported the highest levels of frequency and quantity of alcohol consumed. Twenty-five percent of officers reported having drunk whilst on duty. An alarming proportion of the sample (30%) scored in the ‘at risk of harmful consumption’ category on the AUDIT while a further 3% scored in the ‘alcohol dependant’ category. Examination of demographic variables revealed that males, 18- to 35-year-olds, those divorced or separated, constables, operational personnel and officers who have served between 4 and 10 years were the groups most likely to fall in the risk category on the AUDIT. This was similar for the alcohol-dependant category except that males and females were equally likely to fall in this category. In conclusion, a significant number of police officers displayed at risk alcohol consumption behaviour; in comparison to earlier studies this proportion is not decreasing. Interventions and education programmes are needed within the police workplace, particularly in regard to the dangers of binge drinking for females and youth.

Objectives. We describe the attitude and views of general practitioners towards the menopause and hormone replacement therapy (HRT) in metropolitan Brisbane, Australia. Methods. A total of 216 general practitioners were nominated by a random sample of urban-dwelling women aged 45-54 years who formed the Brisbane Women's health study. A 20-30 minute face-to-face questionnaire with the general practitioners was administered and analysed by demographic characteristics. Results. There was a 93% response rate. Management of the menopause and HRT was routinely undertaken by general practitioners for their own patients. After deciding to initiate HRT, > 60% of general practitioners ordered five investigations or more. They may have confused the risk of thrombo-embolism from oestrogens used in the post-menopause with that for contraception. There were differences between male and female practitioners in some areas. Male general practitioners, in particular, reported more difficulty with tailoring and adjusting regimes. Conclusions. Specific areas for further education are explored to meet the educational needs of general practitioners.

People from rural and remote areas commonly need to attend provincial and metropolitan cities for specialist care. There decisions to make such trips 'away' involve a number of non-medical considerations that include economic, emotional and social factors. This paper reports the results of two surveys that sought information about the types and importance of non-medical considerations taken into account by rural and remote Queensland householders when faced with a trip away. In addition, the problems encountered by respondents on their last trip away are reported and discussed. The data revealed that important considerations taken into account when planning the trip were predominantly related to urgency, household organisation and the costs likely to be incurred where away. A number of avoidable problems occurring at destination were also described. Generally, remote area respondents saw these impediments as more serious barriers to seeking care than did rural area respondents. When respondents were further asked to identify major problems associated with their last trip to an urban facility, problems at the destination figured more prominently, particularly problems directly related to the lack of understanding of the transport and distance needs of rural people. With one exception, these problems were reported by similar proportions of rural and remote area respondents. These are matters that merit high priority attention in any programs to enhance access to specialist medical services by people in rural and remote areas.

This study reports on the impact of a “drink driving education program” taught to grade ten high school students. The program which involves twelve lessons uses strategies based on the Ajzen and Madden theory of planned behavior. Students were trained to use alternatives to drink driving and passenger behaviors. One thousand seven hundred and seventy-four students who had been taught the program in randomly assigned control and intervention schools were followed up three years later. There had been a major reduction in drink driving behaviors in both intervention and control students. In addition to this cohort change there was a trend toward reduced drink driving in the intervention group and a significant reduction in passenger behavior in this group. Readiness to use alternatives suggested that the major impact of the program was on students who were experimenting with the behavior at the time the program was taught. The program seems to have optimized concurrent social attitude and behavior change.

Focus groups were used to investigate women's perception and experience of menopause, hormone replacement therapy, osteoporosis and doctor-patient relationships. Forty women aged between 45 and 55 years participated in seven focus groups. Most women thought that these topics were not widely or freely discussed in the community. Nevertheless they were able to share their experiences on this occasion. Lack of reliable, accessible and current information on menopause and related topics was identified as a problem. This was compounded by the contradictory nature of the information which was available. Hysterectomy and osteoporosis were identified as specific areas in which information was inadequate and not readily accessible. Solutions suggested by the women included distributing information pamphlets with contact numbers for further information to non-health-related settings such as hairdressing salons. The need to foster open discussion between women and their doctors was highlighted, with contributions required from both parties to develop a more equal partnership. A review of doctors' and women's surveillance practices with regard to hormone replacement therapy may also be warranted. We found focus groups a useful method for accessing women's experiences and perceptions. There was particular benefit in researchers being involved as moderators and scribes, and in an early post-focus group meeting to amplify and clarify records of the discussions. Small group size and an emphasis on confidentiality were, we believe, helpful strategies in encouraging discussion of intimate topics.

OBJECTIVE: Our purpose was to determine the efficacy of dietary calcium augmentation in the prevention of early postmenopausal bone density loss in comparison with hormonal replacement therapy and placebo. STUDY DESIGN: A three-arm parallel rnadomized trial comparing the ifluence of placebo, dietary calcium augmentation, and estrogen-progesterone-calcium in 118 women who were within 6 years of menopause was conducted. Dual phton absorptiometry was performed annually to measure lean and fat mass. In addition, the ratio of fat in the trunk/extremities was measured. RESULTS: Body weight increased in each group. The increase was statistically significant in the hormone replacement group (0.8 kg/year). the percent of body fat increased in each group from baseline measurements, with the greatest increase in the hormonal replacement group. There was a decline in the extremity/trunk ratio in the hormonal replacement group as a result of a relatively greater increase in the trunk fat mass. There was a rapid rate of loss in lean body mass that was equal among groups. CONCLUSIONS: Menopause is associatedwith a gain in fat mass and a loss of lean body mass, but these changes in body composition are not prevented by hormone replacement therapy.

Background Adolescent injury is a serious public health concern. Adolescents classified as high-risk are a population most vulnerable to harm from injury due to increased engagement in risk-taking behaviour. Aims/Objectives/Purpose The aim of this research is to evaluate responsiveness of high-risk young Australian adolescents (13-14 years) to a curriculum based injury prevention programme. Methods Fifteen schools implemented the Skills for Preventing Injury in Youth (SPIY) programme in April to June 2012. Focus groups were conducted with a random sample of teachers after the conclusion of SPIY in July 2012.Teachers classified the risk-level of students based on perceptions of student engagement in risk-taking behaviour (eg, alcohol, violence, transport risks) and reported on dose, adherence, quality of process and participant responsiveness. Results/Outcomes The findings of teacher focus groups are presented regarding perceptions of the implementation of the curriculum based injury prevention programme and perceived responsiveness for high-risk young adolescents. Programme strengths and weaknesses are reported in the context of meeting the needs of high-risk young adolescents and the amount of material high-risk young adolescents received in line with the SPIY curriculum. Significance/Contribution to the Field Teachers provide insight into responsiveness of high-risk young adolescents for a curriculum based injury prevention programme as well as the way it is implemented for high-risk young adolescents. Findings of this research have the potential to enhance implementation of school based interventions for high-risk young adolescents who are still participating in mainstream schooling and maximise programme effect and sustainability. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background Injury is a leading cause of adolescent death. Risk-taking behaviours, including unsafe road behaviours, violence and alcohol use, are primary contributors. Recent research suggests adolescents look out for their friends and engage in protective behaviour to reduce others' involvement in risk-taking. A positive school environment, and particularly students' school connectedness, is also associated with reduced injury-risks. Aim This study aimed to understand the role of school connectedness in adolescents' intentions to protect and prevent their friends from involvement in alcohol use, fights, drink driving and unlicensed driving. Method Surveys were completed by 540 13-14-year-old students (49% male). Four sequential logistic regression analyses were conducted to determine whether school connectedness statistically predicted intentions to protect friends from injury-risk behaviours. Gender and ethnicity were entered at step 1, students' own risk behaviour at step 2, and school connectedness scores at step 3 for all analyses. Results School connectedness significantly predicted intentions to protect friends from all four injury-risk behaviours, after accounting for the variance attributable to sex, ethnicity and adolescents' own involvement in injury-risks. Significance School connectedness is negatively associated with adolescents' own injury-risk behaviours. This research extends our knowledge of this critical protective factor, as it shows that students who are connected to school are also more likely to protect their friends from alcohol use, violence and unsafe road behaviours. School connectedness may therefore be an important factor to target in school-based prevention programmes, both to reduce adolescents' own injury-risk behaviour and to increase injury prevention among friends. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.