The Micro Social Determinants of Obesity - PDF by abstraks


									                                                                                                                          Vol 24 No 2 March 2007

            Contents                                     The Micro Social
 The Micro Social
 Determinants of Obesity          1                  Determinants of Obesity
 Office Bearers                   3
                                          Stephen Leeder
 Education and Affluence                  Director, Australian Health Policy Institute,
 No Barrier to Drinking While
                                          The University of Sydney
 Pregnant                     3

 Pedometer Use in Cardiac                 Public health approaches to obesity and overweight rightly emphasise the importance
 Rehabilitation - The Illawarra           of major structural factors such as the food supply, transport, urban design (especially
 and Shoalhaven Healthy                   walkability) and commercial pressures to over consume food and engage in less
 Heart Project                  4
                                          than optimal physical activity.
 Population Health
 Congress 2008                    5       Michelle Harrison and colleagues, for example, report in the January 1 Medical Journal
                                          of Australia on a series of surveys - the Healthy Food Access Basket surveys – about
 PHAA Update - Advocacy           6       limits on the availability of fresh food in remote areas of Queensland. Citizens paid
                                          each an average of 30% ($114) more to meet their families’ basic food needs each
 Researchers Shares
 International Experience         7       fortnight than those living in cities. The price disparity was greater for basic, healthy
                                          food items while prices for takeaways, soft drinks and tobacco were much the same
 Access to Mammography and                as in the city. Moreover, fewer of the basic healthy foods were available at the time
 Cervical Cancer Screening for            of the survey in remote stores compared with cities.
 Women With Long-Term
 Mental Health Problems        8
                                          Beside these macro determinants of nutrition (and hence of obesity), most of which
 Jouranl Coming Online            10      lie beyond the influence of the individual upon whom they impact, there are micro
                                          social determinants. These may be controlled to an extent by the individual. The
 New - St Vincent’s Campus                power of these micro determinants is explored in a recent book called “Mindless
 Alumni                    10             Eating” by Brian Wansink, a lively American nutrition market research psychologist.

 In Brief                         11
                                          Wansink tells of the thousand ways in which the world anaesthetises our rationality
 New Members                      13      when we make choices about what to eat. He explains how our minds convince us
                                          that, while others may have been conned by food labels, advertisements, serving,
 WHO Publications                 13
                                          packet and plate size into eating more than they intended, we have not!

                                          One of Wansink’s experiments involved giving a group of Chicago citizens attending
                                          a movie matinee straight after lunch, free buckets of popcorn. To half they gave a
                                          medium-size bucket and to half ‘a large-size, bigger-than-your-head, bucket’.
                                          Participants were told they would be asked a few questions later. After the movie
                                          Wansink weighed how much popcorn was left in the large and medium buckets.
                                          Despite strong denials from the huge bucket brigade that they had eaten more
                                          simply because of the size of their bucket of popcorn, they had in fact eaten an
                                          average of 173 more calories and 53% more popcorn than the medium tub eaters.
                                          “And,” writes Wansink, “this was five-day-old popcorn!”
                                                                                                                                continued on next page

The Public Health Association of Australia is the major organisation for public health practitioners in Australia with more than 40
health related disciplines represented in its membership. The Association makes a major contribution to health policy in Australia
and has branches in every state and territory. Any person who supports the objectives of the Association is invited to join.
               The Micro Social Determinants of Obesity

Continued from previous page

The University of Illinois at Urbana-Champaign            Wansink offers several ‘reengineering strategies’ to exploit
operates a fine dining laboratory called The Spice        the mindless margin to our advantage. The first is to ‘dish
Box, to ‘figure out what makes a person nibble a          out about 20% less for a meal than you think you might
little or inhale it all’. Each Thursday evening           want before you start to eat’. In his experiments, most
experiments are run with Spice Box diners – diners        people don’t notice the difference until it reaches 30%.
on the left versus diners on the right.                   Wansink’s second strategy is deliberately to see ‘all that
                                                          you eat’. When people pre-plate their food, rather than
A Wansink experiment that I have Australianised ran       eating from a packet or filling up again from a buffet when
thus: one evening all diners at Spice Box were offered    their plate empties, they eat on average 14% less food. If
a complimentary glass of wine on arrival. Those on        you keep empty bottles and cans on the dinner table, guests
the right were served wine from a bottle labeled          drink less. If you keep chicken bones where they can be
Grange ’71. Those on the left received wine from a        seen, diners eat less.
bottle labeled diGusto (short for Disgusto). The wine,
however, was the same, neither Grange nor diGusto!        So, because we eat 30% more from a big packet of breakfast
Later, diGusto drinkers ranked the wine and the           cereal than from small packets, and 40% more M&Ms from a
(identical) meal poorly. The Grange drinkers lingered     pack with ten flavours rather than seven, Wansink suggests
longer over their meals and rated both the meal and       that we serve from small boxes, use smaller dinner plates,
wine highly. Both groups strenuously asserted that,       limit the number of tempting side dishes and toss out left-
while the wine label may have affected others, it         overs. Conversely we can ‘throw the switch’ for healthy food
had not affected them!                                    by putting large bowls of apples on the table. Unconsciously,
                                                          we eat more healthily – without thought.
We make 200 food choices a day. Most are well
beyond the reach of rationality and many push us          Wansink concludes by recommending that we each take a
towards over consumption. Accordingly, to make            sheet of paper, write the days of one month across the top
healthier food choices, we need the help of the           and three, do-able, non-sacrificial structural changes in the
environment to control unconscious decisions.             ‘mindless zone’ down the side. Then each day we record on
Wansink writes:                                           this grid how we have gone, aiming to reduce our calorie
                                                          intake by 100 a day. If we can tick off 32 of the possible 90
         The good news is that the same levers that       changes in a month, we will shed about 500 grams.
         almost invisibly lead you to slowly gain
         weight can also be pushed in the opposite        Wansink speaks to us with positive proposals for change.
         direction to just as invisibly lead you to       Our brains and our rationality trick us to over eat often
         slowly lose weight – unknowingly. If we don’t    without our knowing. But we can turn the tables and use
         realise we are eating a little less than we      the ‘mindless margin’ – the place where we do not notice
         need we don’t feel deprived, we’re less likely   what is happening and where rationality is useless – for
         to backslide and find ourselves overeating       our nutritional advantage with a few simple tricks. Perhaps
         to compensate for everything we’ve forgone.      these tactics can be set alongside proposals for social
         The key lies in the mindless margin.             change at the macro level as useful ideas in the battle of
                                                          the bulge.
The ‘mindless margin’ is ‘…a zone in which we can
either slightly over eat or under eat without being       The Medical Journal of Australia articles can be viewed at:
aware of it.’ It is about 100 calories either side of
what we usually consume. If we use this mindless          har10516_fm.html Healthy Food Access Basket surveys.
margin to our advantage and eat 100 calories less
a day, we could shed 5 kg a year.                         web11210_fm.html availability of basic healthy foods.

                   Office Bearers                                            Education and Affluence
The Board                                                                   No Barrier to Drinking While
President                                                                            Pregnant
Cathy Mead: ph (03) 9479 5773,
Vice President - (Policy)
Jane Freemantle: ph (08) 9489 7754,
Vice President - (Development)                                          As many as 47% of Australian women are drinking while
Mike Daube: ph (08) 9266 4933,                    pregnant and breastfeeding, most of them tertiary-
Vice President - (Finance)                                              educated, older and relatively affluent.
Phillip Schmaal: ph (08) 9332 2811,                                             These are the findings of a study published in the February
SIG Convenors’ representative                                           issue of the Australian and New Zealand Journal of Public
Susan Humphries: ph (03) 9525 5038,              Health.
& Michael Levy:
Branch Presidents’ representative                                       “Women are having babies later in life, and older women
Peter Anderson: ph (07) 3864 3526,               tend to have entrenched patterns of alcohol consumption.
John Coveney:                              This makes it harder for them to stop drinking while
Editors, ANZJPH                                                         pregnant,” explained lead researcher Cate Wallace, who
Judith Lumley: ph (03) 8341 8500, &             conducted the study through the National Drug and Alcohol
Jeanne Daly:
                                                                        Research Centre.
Branch Presidents                                                       “Also, around half of all pregnancies in Australia are
ACT David McDonald: ph (02) 6231 8904,                                  unplanned. Women may be unaware they are pregnant
                                                                        and continue to drink their usual amount.”
NSW Sarah Thackway:
NT Clive Rosewarne:                          While it is widely known that drinking during pregnancy
QLD Peter Anderson: ph(07) 3138 3526,            can have negative consequences for the baby, the jury is
SA John Coveney:
                                                                        still out on how much (or how little) alcohol is safe.
TAS Jennifer Ejlak: ph (03)6222 7702,
VIC TBA                                                                 “The Australian guidelines advise pregnant women to avoid
WA Mike Daube: ph (08) 9266 4933                  intoxication and to consider not drinking altogether. If
                                                                        women do drink, they should consume fewer than seven
SIG Convenors
Aboriginal & Torres Strait Islander Health Peter Waples-Crowe:          standard drinks over the course of a week and have no
ph (03) 9419 3350,                                 more than two standard drinks on any given day,” Ms
Child Health Jan de Groot: ph (08) 9489 7769,      Wallace said.
Environmental Health Liz Hanna:
                                                                        “Because so many pregnancies are unplanned, the
Food & Nutrition Co-convenors, Cate Burns: Ph (03) 9251 7273 & Simone Lowson:Ph (07) 3000 9148                  message about safe alcohol consumption should target                                         all women of childrearing age. If women are planning a
Health Promotion Peter Howat: Ph (08) 9266 7997                         pregnancy, they should consider reducing or stopping                                                   alcohol consumption before trying to conceive, as the risk
Injury Prevention TBA                                                   to the foetus is highest in the very early stages of
International Health : Maxine Whittaker:
Mental Health Susan Humphries: ph 03 9525 5038,                                                  “Older women should also be targeted, as it is this group
Oral Health: Helen Clifford: ph (07) 5509 7218,                         who, on learning they are pregnant, will find it most difficult
                                                                        to reduce the amount of alcohol they drink.”
Political Economy of Health Doug Welch: ph (07) 3284 5155,
Primary Health Care Danny Broderick:                                       For more information about this research, contact the
Prisoner’s Health Michael Levy:                         research author:
Women’s Health Co-Convenors Angela Taft: ph (03) 8341 8571, & Rhonda Small: ph (03) 8341 8542,                Ms Cate Wallace, NSW Department of Health,                                                  (02) 9391 9204,
Executive Director Pieta Laut: ph (02) 6285 2373,

              Pedometer Use in Cardiac Rehabilitation -
         The Illawarra and Shoalhaven Healthy Heart Project

By Lyra Butler                                       the intervention group participants to set physical activity goals,
                                                     promote self management and self efficacy and provide feedback
What?                                                and advice on starting a physical activity program. Control group
In 2005, South Eastern Sydney Illawarra Area         participants were not given a pedometer or telephone support.
Health Service was awarded a NSW Health
Demonstration Research Grant of $180, 000            Self reported physical activity levels were collected from
to conduct a two year health promotion project       participants in the intervention and control groups at baseline,
investigating the efficacy of a pedometer based      six weeks and six months. The questionnaire also collected
physical activity intervention in people with        information about the participant’s psychosocial factors affecting
heart disease.                                       physical activity participation such as self efficacy for exercise,
                                                     self management strategies and well being. The aerobic capacity
Why?                                                 of the participants in Trial One was assessed using a gas
Participation in physical activity is vitally        exchange analysis system (see photo attached).
important in the treatment and prevention of
cardiovascular disease. Cardiac rehabilitation       Participants were recruited into the project for a 12 month period
programs offer supervised physical activity          from September 2005 – 2006. One hundred and twenty-two
sessions and advice on physical activity             participants were recruited into Trial One (55% response rate)
recommendations. However, only 20 to 30 per          and 221 in Trial Two (47% response rate). Ninety-two per cent of
cent of eligible patients in Australia participate   Trial One participants completed the six week assessments and
in these programs. Furthermore, many people          95 per cent of Trial Two.
with coronary heart disease are not exercising
independently to achieve the recommended             Watch this space!
targets for physical activity (30 minutes of         Six month follow ups will be completed in April 2007 and results
moderate activity on most days of the week).         are expected to be available mid 2007.
As regular exercise reduces cardiac deaths and
improves cardiovascular health and quality of        Potential impact of project
life, alternative ways to promote physical           Evidence from this project could be used in guidelines for
activity need to be considered. Our study            clinicians, health professionals and educators on ways to
investigated the effectiveness of a pedometer        promote physical activity among people with heart disease.
based physical activity intervention offered to      There could be potential and substantial cost savings for the
people with heart disease, regardless of             health system if heart disease patients are more active, which
whether they had participated in cardiac             would result in reduced risk of hospitalisation and repeat
rehabilitation.                                      revascularisation procedures.

How?                                                 As people with heart disease have a high risk of further cardiac
The study comprised two randomised controlled        events and are not doing adequate exercise, this project will
trials. Trial One consisted of participants who      address a significant gap in health promotion practice in the area
had attended cardiac rehabilitation and Trial        of secondary and tertiary prevention of coronary heart disease.
Two were participants who had not attended           If it can be shown that the use of a pedometer is effective in
a rehabilitation program. Participants in the        increasing physical activity in people with heart disease, then
intervention groups were asked to wear a             health professionals, educators and policy makers could
pedometer and record their daily steps for six       incorporate pedometer use in both conventional models and non-
weeks. Regular telephone calls were made to          conventional models of cardiac rehabilitation.
                                                                                                 continued on next page

   Pedometer Use in                                Population Health Congress 2008
 Cardiac Rehabilitation
  - The Illawarra and                    It is fantastic to be able to announce that the Australian Faculty of Public
                                         Health Medicine (the Faculty), the Australian Health Promotion Association
  Shoalhaven Healthy
                                         (APHA), the Australian Epidemiological Association (AEA) and the PHAA have
     Heart Project                       agreed to develop a Congress for 2008 to replace our annual conferences in
                                         that year. This is a very exciting development as it brings together all four of
Continued from previous page             the leading population health non-government organisations.

A Trial One participant during an
aerobic capacity assessment at           The Congress will be held at the Brisbane Convention and Exhibition Center
Port Kembla Hospital.                    from 7 to 9 July 2008.

                                         We can now confirm the theme of the Congress and its name will be “A
                                         Global World – Practical action for health and well-being”. The Congress
                                         will have three sub themes:
                                              • Environment and health;
                                            •   Social cohesion - social capital and health; and
                                            •   Food and health.

                                         These topics have been selected because the Congress Committee believe
                                         that they are topical population health issues and because there is sufficient
                                         in each sub-theme to attract high quality abstracts across a broad range of
                                         methods and applications that will meet the needs of all four of the
                                         organisations involved.

                                         A partnership document is currently being developed solely for the purposes
                                         of holding the Congress. The four organisations have developed an agreement
                                         about the equitable financial contributions and division of any surplus and
                                         are currently developing a list of potential speakers and sponsors.

                                         We will continue to update you on the development of the Congress over the
                                         coming months.

                                              New PHAA Website and Membership Database
                                         In December 2006 we contracted with Longley and Stapleton to redevelop
                                         the PHAA website and a number of the Association’s business systems. This
For references or further                project has been progressing well and we currently have:
information, please contact:                 •   the shell for the updated website incorporating a new navigation
Lyra Butler, Health Promotion                    system that is much more readily used than the existing system; and
Service, South Eastern Sydney                •   a new look/design.
Illawarra Area Health Service
Phone: 02 4221 6700                      Progress is underway on:
Email:                                      •   the membership database, its connections to the website and          accounting packages that will allow members to register and pay
                                                membership fees online;
                                            •   replacement capacities for the bulletin boards; and
                                            •   search capacities for the entire website.

                                         We anticipate that both the new website and the membership database will
                                         be fully functional by the end of March 2007.

                      PHAA Update - Advocacy
Over the past month PHAA has                  submission is on the PHAA website under Advocacy, but in short
undertaken the following advocacy             concentrated on the recognition of legitimate sovereignty of nations
actions at a national level.                  to protect population health.

Climate Change – Three letters to editors     Oral Health – A letter was forwarded to the Australian Federal Minister
were distributed across national and          for Health noting that PHAA believe that Commonwealth involvement
regional papers around Australia. These       in oral health is necessary for the development of a national oral health
focused on the need:                          communications system and to gain the equitable distribution of the
     •  to see the health of the planet       oral health workforce. The letter can be found on the PHAA website
        as the overarching long term          under Advocacy.
        principle to guide government
        policies rather than short to         Ambient Air Quality – PHAA have been invited to attend the Ambient
        medium term economic growth;          Air Quality National Environment Protection Measures Review. As in
     •  for communities to demand that        the past, our Environmental Health Special Interest Group Convenor,
        their politicians, at all levels of   Dr Liz Hanna is attending meetings on PHAA’s behalf.
        government, provide leadership
        in developing local actions to        National Aboriginal and Torres Strait Islander Nutrition Strategy
        both ameliorate climate change        and Action Plan – PHAA has been invited to be part of the NATSINSAP
        and     provide      adjustment       national Reference Group. The designation of an appropriate
        strategies; and                       representative is being discussed between the Secretariat and the
     •  for accurate regional information     Aboriginal and Torres Strait Islander and the Food and Nutrition Special
        on the predicted changes to be        Interest Groups.
        made available to people
        throughout Australia.                 Child Health and Well-being – The Australian Health Minister’s Advisory
These letters were taken up by a variety      Council Committee for Australian Population Development has asked
of regional newspapers and resulted in        for input to its three-year work plan and a submission is currently being
two interviews that provided background       prepared.
information on health effects of climate
change.                                       Submission on Breastfeeding – The Women’s Health Special Interest
                                              Group have been preparing a submission for the House of
Global Trade and Health – the PHAA was        Representatives Inquiry into Breastfeeding and we anticipate that it
a signatory to a submission to the Ways       will be completed for the deadline at the end of February 2007.
and Means Committee, US House of
Representatives Hearing on the US Trade       The advocacy efforts of the PHAA are largely supported by the voluntary
Agenda, that spelt out public health          efforts of individual members. Your help in developing advocacy plans
principles and trade. The content of the      and actions is greatly appreciated.

                           38th Public Health Association of Australia Annual Conference

                                                ALICE 2007
                                              REALITY CHECK
                                       INEQUALITIES & HEALTH
                                       Tackling the Differentials
                                            Call for Papers
                           for more information visit our webpage at:
                September 2007, Alice Springs Convention Centre, Alice Springs, NT

                          Researcher Shares International Experience
Written by Megan Sully                          for ‘health and living circumstances of the residents of Eindhoven and
                                                surroundings’) started in 1991 and has involved around 19,000
Source: ‘Best of Health’ (a Queensland          participants. It was designed to identify the factors that contribute to
University of Technology Faculty of Health      socioeconomic health inequalities,” she continues.
publication), December 2006.
                                                “GLOBE differs from many studies in its longitudinal component
National Health and Medical Research            (following up the same people over 15 years), unlike many surveys
Council Sidney Sax Fellowship recipient         that look at a situation at one point in time. This has helped us to
Dr Katrina Giskes has returned to the           identify the most important factors that may contribute to health
School of Public Health, Queensland             inequalities,” she explains. More specifically, Dr Giskes’ research looks
University of Technology (Brisbane) to          at smoking, physical activity, body mass index, mortality and dietary
complete her postdoctoral studies and           behaviour in relation to socioeconomic status.
share her international experience with
other Australian researchers.                   During her time in Europe Dr Giskes also worked on a longitudinal study
                                                of socioeconomic inequalities in smoking in nine European countries.
Dr Giskes has spent the last four years
at one of Europe’s leading public health        “This project provided me with the opportunity to collaborate with a
research institutes at Erasmus University       number of renowned researchers on health inequalities in Europe and
in the Netherlands, working on a                led to the development of smoking policy documents that were endorsed
longitudinal        study      examining        by the European Union,” she said.
socioeconomic inequalities in health.
According to Dr Giskes, during her time in      In line with the Fellowship’s requirement for
the Netherlands she was able to develop         recipients to complete two years of their
valuable skills in large-scale quantitative     research overseas and two years in Australia,
and longitudinal research methodologies.        Dr Giskes will be working on developing
                                                research momentum in the health inequalities
“While abroad, I was actively involved in       research area at Queensland University of
the sampling and questionnaire design           Technology. “I hope to use the skills I have
for the 2004 wave of the GLOBE                  gained overseas to contribute to the
longitudinal study,” she elaborates. “The       development of high quality projects examining
GLOBE study (GLOBE is a Dutch acronym           health inequalities in Australia,” she said.
                                                                                                        Dr Katrina Giskes

                                 CHILD PUBLIC HEALTH POSTGRADUATE SUBJECT 2007

              The Child Public Health postgraduate subject introduces students from a wide range of health
              disciplines to aspects and influences on child and adolescent public health. It addresses the impact
              of poverty and disadvantage, public health policies, mental health, injury prevention, indigenous and
              cross-cultural issues, oral health, health screening and surveillance, community genetics, nutrition,
              health promotion, international health, families, and healthy lifestyles.
              The Child Public Health subject is available to:
                            Health professionals whose focus or interest is on the health of children in broad,
                            community settings and who may wish to do the subject as a single subject for a
                            continuing education or training program, or for personal interest
                            Postgraduate students undertaking the Victorian Consortium Master of Public Health
                            Postgraduate students from single or multi-disciplinary tertiary programs at other
                            Australian universities who are interested in doing the subject as an elective for other
                            Masters programs
              This subject is provided as a block subj ct from Monday 2nd July to Frida 7th June 200 It is a
                                                          e                                    y               7.
              subject of the Department of Paediatrics, The University of Melbourne, School of Medicine, and is
              coordinated by and held at the Centre for Community Child Health, at the Royal Children’s Hospital,
              Flemington Rd, Parkville.
              For further information contact: Julie Green Tel: 03 9345 5761 email

                Access to Mammography and Cervical Cancer
                Screening for Women With Long-Term Mental
                              Health Problems

by S. Webster; Hesmondhalgh and G. Smith             disorganisation, these add to the existing barriers.

What                                                 How
Our aim was to assess the change in                  Baseline data for participation rates in breast and cervical screening
participation levels in mammography and Pap          programs were collected during October 2005. The research team
smear screening among women with long-               provided participants with written and verbal information,
term mental health problems due to the               supplemented by brief explanation and encouragement and re-
provision of written and verbal information,         surveyed participants in April 2006.
supplemented by brief explanation and                The project was based on non-confidential information. In
encouragement.                                       presenting the results, we have concealed the identities of all
National and international studies suggest           Who
that women with long-term mental health              The research group surveyed women residing in five boarding
problems are often reluctant to access               houses in Leichhardt and Marrickville (Sydney, Australia) and
preventive health care screening programs or         women in independent living accommodation in the same areas.
to seek medical care. As these women are             Women aged between 20-69 years were included in the cervical
also more likely to engage in health risk            screening survey whilst those aged 50-69 years were also asked
behaviours they are at greater risk of               about mammogram screening. Eligible women were identified by
developing secondary conditions.                     purposive sampling from client’s current community health registry
                                                     of long-termed clients living in this area on the basis that they
Some of the factors identified in explaining this    had not had any form of screening for over two years.
lack of participation include:
          - low self-esteem;                         •   For cervical screening, there were 33 women (90.9% of those
          - past sexual abuse;                           eligible) from boarding houses and 116 (12.1% of those eligible)
          - past lack of interest in health care;        from independent living environments that agreed to
          - fear of pain and embarrassment;              participate. We have fewer female living in boarding houses
          - perceived negative attitudes of health       than those who live independently. Females represented only
              professionals;                             13.8% of the total population of the boarding houses surveyed.
          - GPs being mostly men;                    •   For mammogram screening there were 30 women (40.0% of
          -   low education (secondary education         those eligible) from boarding houses and 14 women (21.4%
              or lower);                                 of those eligible) from independent living agreed to participate.
          - low income; and
          - primary care access issues .             Research findings

                                                     1) Cervical screening
Characteristics of chronic mental illness include    The results demonstrated a lower participation rate in cervical
limited concentration and poor motivation.           screening among the independent living group than among the
Often         complicated      by   broad   memory   supported living group, and a lower participation rate in both

                                                                                                  continued on next page

           Access to Mammography and Cervical Cancer
           Screening for Women With Long-Term Mental
                         Health Problems
Continued from previous page

groups than in the general NSW population
(60%) at both baseline and follow-up.           •   Women living in boarding houses
Twenty two of the eligible women in             Thirty women were surveyed at both baseline and follow-up.
boarding houses had never been screened.        At baseline, none accessed the program. This increased to a 40%
                                                mammogram screening participation rate at follow-up with full
•   Women living in boarding houses             support from the team.
Thirty-three women were surveyed at both
baseline and follow-up.                         •   Women living independently
None of the women participating in the          Fourteen women were surveyed at both baseline and follow up.
baseline survey attended cervical screening.    At baseline, 10.8% accessed the program. This increased to 21.4%
Surveyed women cited GPs as being their         participation rate at follow-up.
primary care providers However, there was
no evidence that this group was involved        Implications for practice
with the GPs who made regular visit to the      The boarding house group had a higher rate of participation in both
houses.                                         cervical and breast screening programs than the independent living
At follow-up, 33.2% attended the cervical       group. This may indicate that support with access is key to increasing
screening program, 24.2% accessed GPs and       participation rates.   However, the study adds to the belief that
9.0% attended a Women’s Health Nurse            participation rates of both residential and independent living groups
Service when provided with full support from    of women with a mental health problem were lower than the average
the team with appointments and transport.       NSW.

•   Women living independently                  We found that both groups of women were reluctant to access
One hundred and sixteen women were              programs, indicating an increased risk across a range of health issues.
surveyed at baseline, 149 at follow up.         It is vital to increase awareness of the availability of primary health
At baseline, 18.5% of the participating         care and to ensure the elimination of barriers – such as making
women attended a cervical screening             female GPs available - to access to health care by these groups.
                                                The results may be applicable across the NSW health system, but
At follow-up, 31.9% accessed the cervical
                                                further research is needed to develop strategies for primary health
screening program using GPs only.
                                                screening for these groups of women. Limitations of this study were
                                                that the study numbers were small and further studies are needed
2) Mammogram screening
                                                to determine whether this finding is robust
The   results   demonstrated       a   lower
participation rate in mammography among         In the context of marginalisation of these women, these results the
the independent living group than among         urgent need to facilitate access for these women. The results point
the supported living group, and a lower         to the need for a more responsive health care system and strategies

participation rate in both groups than in the   to address the underlying problems to effectively meet the primary
general NSW population (53.1%) at both          prevention needs of women with long-term mental health problems.
baseline and follow-up.

                                  Journal Coming Online
                               Last month we         that the first on-line edition can be available in April 2007.
                               announced        in
                               intouch        that   Once these have been resolved we will be advising members
                               PHAA    will    be    about how you can access the on-line version of the Journal. In
                               making          the   the meantime, we will be maintaining access to the current and
                               Australian and        back issues (to 2000) on the PHAA website.
                               New     Zealand
                               Journal of Public     Part of the contract with Blackwell Publishing is that they will place
Health (the Journal) available on-line via           all the historic issues on the Blackwell site. These will be available
Blackwell Publishing.                                at no additional cost to members and at a cost to both libraries
                                                     and individuals. This should enhance access to important historical
February 2007 has seen the Secretariat, our          papers, as all papers will be able to be accessed via a search
print production house (Substitution), and the       facility on the Blackwell Publishing site.
Editors   in   discussions    with    Blackwell
Publishing to sort out the details of how we         In accordance with PHAA’s requirements to make the Journal
will make this happen. There are a significant       available to resource-poor settings, the Blackwell contract also
number of technical details that require sorting     includes clauses making the Journal available through the WHO
out and we are all keen to address these so          programs for developing countries.

                     New - St Vincent’s Campus Alumni
As part of celebrations to mark the 150 anniversary of St Vincent’s Hospital in Sydney, a St Vincent’s Campus
Alumni will be established.

Former doctors, nurses and allied health practitioners from St Vincent’s Hospital, St Vincent’s Private Hospital and
Sacred Heart Hospice are invited to join the Alumni.

A special function for all Alumni members will be held on Saturday 26 May, 2007 on the St Vincent’s Campus.
For more information, or to join the Alumni, please phone 02 8382 6445.

                                      A Guide to Data Development

 For more than a decade, the Australian Institute of Health and Welfare (AIHW) has been undertaking data
 development, and assisting other organisations with related activities. In doing so, the AIHW has developed
 a body of expertise in data development. Much of this experience has been distilled into ‘A guide to data
 development’. The guide covers the basics of data development and the steps to follow when developing
 data. It outlines sound data development practices that incorporate the necessary steps to produce
 high-quality data that meet the needs of all users of the data and attract the necessary level of
 agreement on content and authority behind the data specifications. The document promotes the role of
 metadata in describing data and the use of data standards to improve consistency in data recording
 where data consistency and comparability is required.
 AIHW catalogue number (HWI 94). Available from Can Print for $27 (1300 889 873).

  In Brief
National public health expenditure report 2004-05            Report on the evaluation of the National Minimum Data
Expenditure on public health activities aims to prevent      Set for Public Hospital Establishments
illness and enhance the present and future wellbeing         ‘Report on the evaluation of the National Minimum Data
and quality of life of a nation’s population and such        Set for Public Hospital Establishments’ presents the
investments minimise future health costs. This               AIHW’s most comprehensive assessment to date of the
publication is the fifth in a series that reports            Public Hospitals Establishments data collection. The
expenditure on public health activities by governments       evaluation assesses the quality and utility of the data
in Australia. It provides detailed estimates of recurrent    set to determine its suitability as to current requirements
expenditure for financial year 2004-05 along with            and to identify changes required to improve data quality
selected time series data back to 1999-00. The report        and comparability. Detailed information is presented on
summarises estimates of funding and recurrent                the data provided for each data element and the extent
expenditure from key health departments and agencies         to which these data are provided in accordance with
of the Australian Government and each State and              specifications published in the ‘National health data
Territory Government by nine public health activity          dictionary’. This report is a useful resource for health
categories. AIHW catalogue number (HWE 36).                  information managers, researchers, state and territory
COST: $30                                                    data providers, and all users of data based on this
                                                             national minimum data set. AIHW catalogue number
Developing a nationally consistent data set for needle       (HSE 45). Cost: $32
and syringe programs
                                                             Final report on the development of the Children’s
This report details a project undertaken by the Australian
                                                             Services National Minimum Data Set
Institute of Health and Welfare on behalf of the
                                                             This is the final report of the Children’s Services Data
Australian Government Department of Health and
                                                             Working Group on the development of the Children’s
Ageing to develop a national Needle and Syringe
                                                             Services National Minimum Data Set (CSNMDS). It
Program data set and associated reporting instrument
                                                             describes the background to the CSNMDS, its
to facilitate consistent and comparable data collection
                                                             development, testing and final approval. It also includes
and reporting. It provides a description of the
                                                             the Final Children’s Services National Minimum Data Set
methodology used and includes a copy of the data set
                                                             Specifications. AIHW catalogue number (CFS 6).
and reporting instrument developed as part of the
                                                             Cost: 28
project. The report includes a number of
recommendations regarding the future development and
                                                             Assisted reproduction technology in Australia and
expansion of the data set. ‘Developing a nationally
                                                             New Zealand 2004
consistent data set for needle and syringe programs’ is
                                                             Assisted Reproduction Technology in Australia and New
the result of consultations with service providers and
                                                             Zealand 2004 presents information on all assisted
state and territory representatives and the Australian
                                                             reproduction technology (ART) treatments that took
government. AIHW catalogue number (HWI 90).
                                                             place in 2004 and the resulting pregnancies and births.
COST: $27
                                                             It is the third report using data from the Australian and
                                                             New Zealand Assisted Reproduction Database set up
Statistical snapshot of people with asthma in Australia
                                                             in 2002. The report includes information on ART
                                                             treatment and on intra-uterine insemination using
This report identifies the demographics and health-
                                                             donated sperm. It presents specific data on success
related characteristics that define people with asthma
                                                             rates based on live births and how they vary by
and that distinguish them from those who have never
                                                             treatment type, cause of infertility, women’s age and
had asthma. It highlights the overall burden experienced
                                                             number of embryos transferred. Also included is
by people with asthma, including the presence of other
                                                             information on birth outcomes such as multiple birth,
diseases, the use of medications and other health
                                                             gestational age, birthweight and perinatal mortality. The
services, and effects on quality of life. AIHW catalogue
                                                             report, produced by the AIHW National Perinatal
number (ACM 8). Cost $23

In Brief
Statistics Unit based at the University of New South           All publications listed are available from Can Print
Wales, will be particularly useful to healthcare               (1300 889 873).
professionals, governments, academics and researchers
with an interest in ART treatment and outcomes, and
for people undergoing or considering treatment through
ART. AIHW catalogue number PER 39. Cost: $30

General practice activity in Australia 2005-06                 Hospitalised injury of Aboriginal and Torres Strait
This publication is the 19th in the General Practice Series    Islander peoples 2000-02
produced by the Australian General Practice Statistics         The report provides a cross-sectional summary of
and Classification Centre, a collaborating unit of the         hospital separations due to injury and poisoning for the
Australian Institute of Health and Welfare (AIHW) and          aggregated data collection periods 2000-01 and 2001-
the University of Sydney. It gives the results of the eighth   the 02 for Australia’s Aboriginal and Torres Strait Islander
year of the BEACH program, April 2005 to March 2006.           people.
Data reported by 1,017 general practitioners on 101,700        AIHW catalogue number INJ 94. Available only online at
GP-patient encounters are used to describe aspects of
general practice in Australia: the general practitioners       10408
and their patients, the problems managed and the
treatments provided. The contribution of practice nurses       Promoting safer chemical use
to the GP-patient encounters, in terms of their clinical       The Australian Government’s National Industrial
activities, the problems they assist with and the Medicare     Chemicals Notification and Assessment Scheme
items claimed, are described for the first time in this        (NICNAS) has published its Final Report and the
report. Information on body weight to height ratio,            Recommendations of the Existing Chemicals Review
smoking status and alcohol use of a sub-sample of              Steering Committee.    The Report proposes 23
patients is also included. Changes that have occurred          recommendations that address issues ranging from
since 1999-00 are investigated. Data for each of the           communication and engagement to legislative reach and
last 5 years of BEACH are summarised in the appendices         control powers. It is intended to begin implementing
to this report. AIHW catalogue number GEP 19.                  the recommendations early in 2007 after the preparation
Cost: $28.00                                                   of an implementation plan. The NICNAS Community
                                                               Engagement Forum will be publishing bulletins at
                                                      Visit the NICNAS
Hospital separations due to injury and poisoning,
                                                               website for further information
Australia 2003-04
                                                               about the review, the Report and the recommendations.
This report presents national statistics on injuries that
resulted in admission to hospitals in Australia. It includes
cases discharged during the year to 30 June 2004. The
                                                               Trends in women’s health
report was designed to complement Injury deaths,
                                                               Women’s Health Australia has released the results of
Australia 2003-04. Falls, transport-related injury,
                                                               the Australian Longitudinal Study on Women’s Health.
intentional self-harm and assault are common causes
                                                               The main report, Trends in Women’s Health: Results from
of hospitalised injury in the Australian community.
                                                               the Australian Longitudinal Study of Women’s Health.
Injuries due to these and other causes are described,
                                                               Priority conditions, risk factors and health behaviours
in terms of case numbers and rates, by age and sex,
                                                               can be obtained by contacting the research team at the
remoteness of usual residence, length of stay in hospital,
                                                               University of Queensland, tel 07 3346 4723 or the
external causes of injury and other characteristics. The
                                                               University of New castle tel 02 4923 68 73. For more
report will be relevant to anyone interested in gaining
                                                               about the survey, details of scientific publications and
an insight into patterns of injury morbidity and the
                                                               other information about the project see the project
burden it imposes on the Australian community.
AIHW catalogue number INJCAT 88. Cost: $30

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                World Health Organization Publications                                                              20 Napier Close
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Promoting physical activity and                       Prevention of blindness from
                                                                                                                    If further information is required
active living in urban                                diabetes mellitus
                                                                                                                    please contact PHAA via email:
environments The role of local                        ISBN 92 4 154712 X
governments. The solid facts.                         Cost: US$9.00                                       
ISBN 92 890 2181 0                                    Order No. 11500673
Cost: US$18.00                                        Email:                                     or phone 02 6285 2373
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EDITORS: Elizabeth Proude, Susan Stratigos, Jacky Hony and Pippa Burns

             Editor: Executive Director Design: Design Direction                         How to join PHAA
             Articles appearing in intouch do not necessarily reflect the views of the   Membership enquiries to:
             PHAA but are intended to inform and stimulate thought, discussion and
                                                                                         Membership Coordinator, PHAA
             comment. Contributions are welcome and should be sent to:
                                                                                         PO Box 319, Curtin ACT 2605
             The Editor, intouch, PHAA                                                   Tel 02 6285 2373 Fax 02 6282 5438
             PO Box 319, Curtin ACT 2605                                                 email
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