Adults In Australia Research Articles

From euphoria to wellbeing: Correlates of gender euphoria and its association with mental wellbeing among transgender adults

Purpose There is a growing body of literature focusing on the importance of gender euphoria for transgender (hereafter ‘trans’) people. This article aims to explore factors that are associated with experiencing gender euphoria among trans adults in Australia, as well as identifying any correlation between gender euphoria and mental health within this population. Methods Data from 1359 trans adults was drawn from Private Lives 3, the largest survey of LGBTQ+ people aged 18 and over in Australia. Multivariable logistic regression analyses were conducted to identify the individual factors (sociodemographic characteristics, community connection and access to gender affirming care) associated with having ever experienced gender euphoria and to explore associations between gender euphoria and mental health outcomes, including psychological distress, suicidal ideation and suicide attempt within the past 12 months. Results Most (69.1%) of the sample had experienced gender euphoria in their lifetime. However, the likelihood of ever experiencing gender euphoria differed across several factors, including sexual orientation, gender, age, level of education, and residential location. Most notably, non-binary participants were least likely to have experienced gender euphoria. Importantly, participants who felt that they were a part of the LGBTQ+ community in Australia and those who indicated that they were easily able to access gender affirming care were more likely to have experienced gender euphoria. Participants who were currently experiencing gender euphoria were less likely to report high/very high psychological distress and less likely to have experienced suicidal ideation in the past year. Conclusion Experiencing gender euphoria may have important implications for the mental wellbeing of trans people, however, some are less likely than others to report these experiences. These findings have important implications for shaping trans affirming practices that enable experiences of gender euphoria.

The burden of cardiovascular disease attributable to high dietary sodium intake in Australia between 1990 and 2019.

Diets high in sodium are associated with adverse cardiovascular outcomes. We aimed to quantify the burden of cardiovascular disease (CVD) attributable to high dietary sodium consumption in the Australian population. Using data from the Global Burden of Disease (GBD) 2019, we estimated the age-standardised rates (per 100 000 population) and the total numbers of years lived with a disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and deaths for CVD attributable to high sodium (≥1000 mg/day) consumption in the Australian population, by sex and age groups (≥25 years) between 1990 and 2019. The study compared Australian estimates with similar high-income countries (Group of 20 [G20] members). From 1990 to 2019, the age-standardized rates of CVD deaths, DALYs, YLDs, and YLLs per 100 000 population in Australia attributable to high sodium decreased. However, between 2013 and 2019, the total number of CVD deaths increased, and the number of CVD YLDs increased exponentially for both sexes for the whole period between 1990 and 2019. Men had a two-fold higher rate for high sodium CVD burden, compared to females between 1990 to 2019. Individuals aged between 80 and 84 years had the highest rates of CVD burden during the same period; however, older age groups reported the greatest decline in CVD burden compared to young and middle-aged adults in Australia. The age-standardised rates for high sodium attributable CVD consistently contributed more towards DALYs than YLDs in 2019 for both sexes. When compared to G20 countries, Australians displayed the lowest age-standardized rates for CVD deaths, DALYs, YLDs, and YLLs alongside Turkey, France, and the United Kingdom in 2019. While age-standardized CVD burden attributable to high sodium consumption decreased for both sexes over the past 30 years, the total number of CVD deaths showed an increase between 2013 and 2019. This study underscores the need for sustained efforts to address the rising absolute number of CVD deaths, especially among men and older people, and emphasizes the importance of continued vigilance in monitoring and implementing strategies to reduce the impact of high sodium consumption on cardiovascular health in Australia.

An observer-blind, randomised, placebo-controlled, phase 1, single ascending dose study of dengue monoclonal antibody in healthy adults in Australia

Dengue is highly prevalent in Asia and Latin America and has no specific dengue antiviral treatment. A recombinant monoclonal antibody (VIS513) that neutralises all four serotypes of the dengue virus has been developed in India. After confirmation of safety and efficacy in preclinical studies, it was tested in a first-in-human study to assess the safety and pharmacokinetics. This was a partially blind (observer-blind), randomised, placebo-controlled, phase 1, single ascending dose study in Australia. Participants were dengue naive, healthy adults (aged 18-45 years) with no clinically significant disorders or immunosuppressive conditions. Four dose levels of dengue monoclonal antibody (ie, 1 mg/kg, 3 mg/kg, 7 mg/kg, and 12 mg/kg; n=4 for 1 mg/kg and n=10 each for 3 mg/kg, 7 mg/kg, and 12 mg/kg doses) were assessed in a dose-ascending way with a placebo control (n=2 for each dose cohort, total n=6) for each cohort except for 1 mg/kg. Within each cohort, participants were first randomly assigned (1:1) in a sentinel sub-cohort and then randomly assigned (9:1) in an expansion sub-cohort to dengue monoclonal antibody or placebo except for the 1 mg/kg cohort. Participants, investigators, and outcome assessors were masked and treatment administrators were not masked. 40 participants received a single intravenous injection or infusion of either dengue monoclonal antibody or placebo over a period of 3 min to 2 h and were followed up until day 85. The primary outcomes were proportion of participants with adverse events and serious adverse events (SAEs) up to 84 days after dosing whereas the secondary outcomes were to assess the pharmacokinetic profile of dengue monoclonal antibody and to assess the presence of anti-drug antibody (ADA) to dengue monoclonal antibody. All participants were included in the safety analysis and the pharmacokinetic population involved participants receiving dengue monoclonal antibody. This study is registered with ClinicalTrials.gov, NCT03883620. Between March 22 and Dec 23, 2019, 40 healthy adults were randomly assigned and all completed the study. There were no SAEs reported. None of the placebo recipients (n=6) reported any adverse events. 31 (91%) of 34 participants receiving dengue monoclonal antibody reported 143 adverse events (1 mg/kg: four [100%] of four participants; 3 mg/kg: ten [100%] of ten participants; 7 mg/kg: seven [70%] of ten participants; 12 mg/kg: ten [100%] of ten participants). Of these 143 adverse events, 80 were treatment-related adverse events in 28 (82%) of 34 participants. Headache (16 [47%] of 34), infusion reaction (11 [32%] of 34), lymphopenia (seven [21%] of 34), fatigue (five [15%] of 34), and pyrexia (four [12%] of 34) were the most common reactions. Infusion reactions were reduced in the 7 mg/kg (two [20%] of ten participants) and 12 mg/kg (three [30%] of ten) cohorts with paracetamol premedication compared with the 3 mg/kg cohort (five [50%] of ten). The majority of adverse events were grade 1 or grade 2 in severity, and resolved completely. Median maximum serum concentrations ranged from 28 μg/mL (1 mg/kg) to 525 μg/mL (12 mg/kg). The median elimination half-life ranged from 775 h (1 mg/kg) to 878 h (12 mg/kg). No ADA against dengue monoclonal antibody was detected. Dengue monoclonal antibody was safe and well tolerated. It showed a dose-proportionate increase in pharmacokinetic exposure. These data support further evaluation of dengue monoclonal antibody in patients with dengue for safety and efficacy. Serum Institute of India.

“My wife made me”: motivations for body and beauty work among older Korean and Chinese migrant adults in Australia

This article examines how older Korean and Chinese migrants living in Perth, Australia, engage in various beauty, grooming and fitness practices to negotiate “successful ageing” in transnational contexts. Drawing on semi-structured interviews with 30 men and women aged between 60 and 89, we examine what social meanings are attached to these practices, and how the transnational context of living in Australia has influenced the participants’ perceptions of ageing and presentation of self in later life. Migration in later life is often considered in relation to the ‘host’ countries values and social practices, which can make it difficult for individuals to settle and feel a sense of belonging especially in later life. In this article, we will illustrate how gender, class, and cultural dispositions intersect and link with possibilities for defining and redefining successful ageing in migrant contexts. This study illustrates how successful ageing emerges as a malleable concept that draws on ideas of an ideal ageing body from the cultural values of the ‘home’ country, rather than the ‘host’ country. The findings illustrate how in everyday lived experience, the transnational habitus does not always necessarily result in a ‘divided habitus’ where the values of the ‘home’ country and that of the ‘host’ country are in conflict – even when the migration experience is relatively recent. Quite the contrary, the way the participants utilise everyday beauty, fitness and grooming practices to maintain a future-focused self in the context of ‘home’ country’s age-appropriate body ideals to perform signifiers of ‘successful migrant living’ point to the positive aspects that appearance management can have on an individual in later life, particularly in migrant contexts.

Typologies of alcohol and other drug-related risk among lesbian, gay, bisexual, transgender (trans) and queer adults.

Prevalence and patterns of alcohol and other drug (AOD) use among specific lesbian, gay, bisexual, transgender (trans) and queer (LGBTQ+) subpopulations are well established. However, patterns of substance-related risk have been less thoroughly explored. This study aimed to determine typologies AOD risk among LGBTQ+ adults in Australia. Latent class analyses were performed to determine distinct patterns of AOD risk (n = 6835), as measured by the Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool. Demographic characteristics, experience of harassment, assault and/or threats, mental wellbeing and LGBTQ+ connectedness were compared across emergent classes. AOD risk was characterised as 'no risk' (13.3% of sample), 'low risk' (15.1%), 'moderate risk' (alcohol + other drugs; 30.1%), or 'moderate alcohol only risk' (41.5%). The 'moderate risk' class was the most likely class to report recent sexual assault, verbal abuse, harassment and physical threats compared to other classes, while those in the 'moderate alcohol only risk' group were least likely to report these experiences of all classes. However, both the 'moderate risk' and 'moderate alcohol risk only' classes reported greater mental wellbeing and LGBTQ+ connectedness compared to the 'no risk' and 'low risk' classes. Our findings indicate that level of AOD risk is not uniform among some LGBTQ+ adults, nor is the distribution of harms experienced by them. Tailored harm-reduction interventions may be fruitful in attenuating harms based on risk profile; most specifically, LGBTQ+ individuals engaging in moderately risky concurrent AOD use.

Improving the quality of life through vitamin D supplementation in people with multiple sclerosis: Pathobiological, immunologically based, A narrative review of the literature

An inadequate vitamin D nutritional status is associated with autoimmune diseases, heart disease, deadly types of cancer, neurological disorders and undesirable consequences in pregnancy, amongother things. In a nationally representative sample of adults in Australia on vitamin D (VitD) congestion in the general population, 20% of participants were verified to be Vit D deficient and 43% to have insufficient VitD levels [1]. It is therefore to be welcomed that in 2020 a guideline on VitD supplementation for medical use was created, taking into consideration the opinions of various global institutions [2]. For more than 15 years there have been reports that vitamin D (VitD) has an immunomodulatory function in multiple sclerosis (MS) [3] and that there is an association between low circulating serum levels of 25-hydroxyvitamin D [s25(OH)D] and an increase in inflammatory activity and impact on quality of life in persons with multiple sclerosis (PwMS) [4] [5]. Nevertheless, up to the present the "neurological community" has not been able to agree to start a daily add-on therapy using an easy to carry out, inexpensive and low-side effect vitamin D supplementation (VitD suppl. from the beginning of the diagnosed MS disease or the chronically isolated syndrome (CIS). In the last decade, there has been an accumulation of evidence of immunological and pathophysiological mechanisms that VitD positively influences the course of the disease and should become an eminent factor in therapy ([6]. For 13 years, neurologists in Sweden have been informing PwMS about the benefits of VitD-suppl. and given a recommendation for add-on therapy [7].

The effect of informal caring on mental health among adolescents and young adults in Australia: a population-based longitudinal study

Young carers are people aged up to 25 years who provide unpaid care to a relative or a friend living with a long-term condition or a disability. Providing informal care is associated with poor mental health. Longitudinal evidence on this relationship among young people is scarce. To address this gap, we assessed the mental health of people aged 15-25 years when providing informal care compared with when not providing informal care. We conducted a population-based longitudinal study using 20 years of data between 2001 and 2020 from the Household Income and Labour Dynamics in Australia (HILDA) survey. We included observations of participants aged 15-25 years with at least two observations across 20 waves of HILDA. Informal care was categorised as 0 h per week, 1-19 h per week, and 20 or more h per week. Mental health was measured using the Mental Health Inventory (MHI-5) from the 36-Item Short Form Survey (SF-36). Multivariate linear fixed-effects regression models were fitted to assess within-person changes in mental health when providing different levels of informal care. Of 44 663 people with 410 658 observations who participated in HILDA waves 1 to 20, 32 726 were excluded with 351 445 observations. 11 937 young people (with 59 213 observations) were deemed eligible for this study and, of these, 8996 participants with 43 231 observations were included in the complete case analytical sample. When caring for 1-19 h per week, young carers had an MHI-5 score of -1·98 points (95% CI -3·06 to -0·89) compared with when caring for 0 h per week. Mental health was worse when caring for 20 or more h per week, with participants displaying an MHI-5 score of -3·47 points (95% CI -6·02 to -0·92) compared with when caring for 0 h per week. Our findings were consistent across sensitivity tests. Our findings suggest potential mental health effects of informal care in young people, particularly when providing an intense amount of caregiving. Reducing young caring loads could be a possible avenue for intervention. Melbourne Disability Institute Scholarship, University of Melbourne Research Training Program Scholarship, Australian Research Council Discovery Early Career Researcher Award, National Health and Medical Research Council of Australia funded Centre of Research Excellence in Disability and Health.

Venovenous bypass in adult liver transplant recipients: A single-center observational case series.

Very little information is currently available on the use and outcomes of venovenous bypass (VVB) in liver transplantation (LT) in adults in Australia. In this study, we explored the indications, intraoperative course, and postoperative outcomes of patients who underwent VVB in a high-volume LT unit. The study was a single-center, retrospective observational case series of adult patients who underwent VVB during LT at Austin Health in Melbourne, Australia between March 2008 and March 2022. Information on baseline preoperative status and intraoperative variables, including specific VVB characteristics as well as postoperative and VVB-related complications was collected. The lengths of intensive care unit and hospital stays as well as intraoperative and in-hospital mortality were recorded. Of the 900 LTs performed at this center during the aforementioned 14-year period, 27 (3%) included a VVB procedure. VVB was performed electively in 16 of these 27 patients (59.3%) and as a rescue technique to control massive bleeding in the other 11 (40.1%). The median (interquartile range [IQR]) age of those who underwent VVB procedures was 48 (39-55) years; the median age was 56 (47-62) years in the non-VVB group (p<0.0001). The median model for end-stage liver disease (MELD) scores were similar between the two patient groups. Complete blood data was available for 622 non-VVB patients. Twenty-six VVB (96.3%) and 603 non-VVB (96.9%) patients required intraoperative blood transfusions. The median (IQR) number of units of packed red blood cells transfused was 7 (4.8-12.5) units in the VVB group compared to 3.0 units (1.0-6.0) in the non-VVB group (p<0.0001). Inpatient mortality was 18.5% and 1.1% for the VVB and non-VVB groups, respectively (p<0.0001). There were no significant differences in length of hospital stay or incidence of acute kidney injury, primary graft dysfunction, or long-term graft failure between the two groups. Patients in the VVB group experienced a higher rate of postoperative non-anastomotic biliary stricture compared to patients in the non-VVB group (33% and 7.9%, respectively; p = 0.0003). VVB continues to play a vital role in LT. This case series highlights the heightened risk of major complications linked to VVB. However, the global transition to selective use of VVB underscores the urgent need for collaborative multi-center studies designed to address outstanding questions and parameters related to the safe implementation of this procedure.

Out in Suburbia: Associations between residential location, mental health, and community connectedness among LGBTQ Australians

ABSTRACT This article critically examines the contemporary applicability of homonormativity in understanding LGBTQ experiences in outer suburban Australia. Representing a departure from urban-rural dichotomies in queer geographical research, this study enriches our understanding of LGBTQ life in suburban areas. Drawing on a comprehensive national survey encompassing 6835 LGBTQ adults in Australia, the research provides novel quantitative insights into the geographic distribution of LGBTQ mental health and wellbeing outcomes. Contrary to assumptions of suburban privilege, the article challenges the notion of homonormativity in the suburbs, shedding light on the unique challenges faced by LGBTQ people in these areas. Findings reveal that LGBTQ people in outer suburban Australia experience higher psychological distress and suicidal ideation compared to their inner suburban and rural counterparts. Additionally, they report lower levels of connection with LGBTQ communities, indicating a dearth of supportive resources in these areas. These insights have crucial policy implications, advocating for changes that foster diversity and inclusion in outer suburban areas. By emphasizing the distinct experiences of LGBTQ individuals in these settings, the research underscores the necessity for targeted interventions and support. This work extends beyond conventional urban-centric studies, offering valuable insights to inform policies, advocacy efforts, and community support initiatives for LGBTQ people in suburban environments.

Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand: TSANZ position statement summary.

Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand: TSANZ position statement summary.

Combined population genomic screening for three high-risk conditions in Australia: a modelling study

No previous health-economic evaluation has assessed the impact and cost-effectiveness of offering combined adult population genomic screening for mutliple high-risk conditions in a national public healthcare system. This modeling study assessed the impact of offering combined genomic screening for hereditary breast and ovarian cancer, Lynch syndrome and familial hypercholesterolaemia to all young adults in Australia, compared with the current practice of clinical criteria-based testing for each condition separately. The intervention of genomic screening, assumed as an up-front single cost in the first annual model cycle, would detect pathogenic variants in seven high-risk genes. The simulated population was 18-40 year-olds (8,324,242 individuals), modelling per-sample test costs ranging AU$100-$1200 (base-case AU$200) from the year 2023 onwards with testing uptake of 50%. Interventions for identified high-risk variant carriers follow current Australian guidelines, modelling imperfect uptake and adherence. Outcome measures were morbidity and mortality due to cancer (breast, ovarian, colorectal and endometrial) and coronary heart disease (CHD) over a lifetime horizon, from healthcare-system and societal perspectives. Outcomes included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER), discounted 5% annually (with 3% discounting in scenario analysis). Over the population lifetime (to age 80 years), the model estimated that genomic screening per-100,000 individuals would lead to 747 QALYs gained by preventing 63 cancers, 31 CHD cases and 97 deaths. In the total model population, this would translate to 31,094 QALYs gained by preventing 2612 cancers, 542 non-fatal CHD events and 4047 total deaths. At AU$200 per-test, genomic screening would require an investment of AU$832 million for screening of 50% of the population. Our findings suggest that this intervention would be cost-effective from a healthcare-system perspective, yielding an ICER of AU$23,926 (∼£12,050/€14,110/US$15,345) per QALY gained over the status quo. In scenario analysis with 3% discounting, an ICER of AU$4758/QALY was obtained. Sensitivity analysis for the base case indicated that combined genomic screening would be cost-effective under 70% of simulations, cost-saving under 25% and not cost-effective under 5%. Threshold analysis showed that genomic screening would be cost-effective under the AU$50,000/QALY willingness-to-pay threshold at per-test costs up to AU$325 (∼£164/€192/US$208). Our findings suggest that offering combined genomic screening for high-risk conditions to young adults would be cost-effective in the Australian public healthcare system, at currently realistic testing costs. Other matters, including psychosocial impacts, ethical and societal issues, and implementation challenges, also need consideration. Australian Government, Department of Health, Medical Research Future Fund, Genomics Health Futures Mission (APP2009024). National Heart Foundation Future Leader Fellowship (102604).

Excessive Smartphone Use is Associated with Depression, Anxiety, Stress, and Sleep Quality of Australian Adults

Problematic smartphone use has been associated with poorer mental health in different population groups; however, little is known about how levels of smartphone use were associated with mental health outcomes of adults in Australia. Using data from a cross-sectional survey among Australian adults aged 18–59 years (n = 655, Mean = 24.55 [SD = 5.59] years; 66% female), the current study aimed to examine association between problematic smartphone use and different psychological outcomes. Participants completed measures of problematic smartphone use with Mobile Phone Problem Use Scale (MPPUS), mental health outcomes with Depression, Anxiety, and Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI), in addition to some socio-demographics. Smartphone use was categorised into three groups: low-moderate, moderate-high, and high-severe. A total of 160 adults (24.4%) reported high-severe smartphone use. Multivariable linear regression analyses showed that smartphone use was inversely associated with psychological outcomes in a dose-dependent manner with high-severe smartphone uses having the most adverse effects. Compared to low-moderate use, average depression score was 3.5 points higher for moderate-high smartphone use (β = 3.51, 95% CI: 1.63–5.40) and 6.9 points higher for high-severe smartphone use (β = 6.91, 95% CI: 4.74–9.07). Similarly, average stress score was 3.4 points higher for moderate-high smartphone use (β = 3.40, 95% CI: 1.75–5.06) and 7.0 points higher for high-severe smartphone use (β = 7.02, 95% CI: 5.11–8.93). Similar association estimates were found for anxiety and sleep quality. Reducing smartphone use has the potential to optimise depression, anxiety, stress, and sleep quality; however, longitudinal research is warranted to establish directionality of the association.

The smallest worthwhile effect on pain intensity of nonsteroidal anti-inflammatory drugs and exercise therapy for acute and chronic low back pain: a benefit-harm trade-off study.

What are the smallest worthwhile effects of nonsteroidal anti-inflammatory drugs (NSAIDs) for people with acute and chronic low back pain (LBP)? What is the smallest worthwhile effect of individualised exercise for people with chronic LBP compared with no intervention? Benefit-harm trade-off study. Participants were recruited by advertisement on social media and included if they were English-speaking adults in Australia who had non-specific LBP. Pain intensity. A total of 116 people with acute LBP and 230 people with chronic LBP were recruited. For acute LBP, the smallest worthwhile effect of NSAIDs additional to no intervention was a 30% (IQR 10 to 40%) reduction in pain intensity. For chronic LBP, the smallest worthwhile effect of NSAIDs additional to no intervention was a 27.5% (IQR 10 to 50%) reduction in pain intensity. For chronic LBP, the smallest worthwhile effect of exercise additional to no intervention was a 20% (IQR 10 to 40%) reduction in pain intensity. There were small associations between baseline pain, duration of pain and level of exercise and the smallest worthwhile effect of NSAIDs for acute LBP. There were no other clear associations. For people with LBP, the smallest worthwhile effect of exercise and NSAIDs additional to no intervention is approximately a 20 to 30% reduction in pain. These results can inform the interpretation of the effects of NSAIDs and exercise in randomised trials and meta-analyses, incorporating consumers' perspectives. Further research on comparisons between different interventions and on other core LBP outcomes may inform decision-making. OSF osf.io/3erjx/.

Development and validation of the COVID-19 Impact Scale in Australia

Objective The COVID-19 pandemic significantly impacted and continues to impact the health and well-being of Australian adults. However, there has been no instrument validated to comprehensively measure how the COVID-19 pandemic impacted adults in Australia across several domains (e.g. fear of COVID-19, attitudes towards vaccination, psychosocial impact of lockdowns). The current study conducted a rigorous psychometric process to develop and validate an instrument to measure the impact of the COVID-19 pandemic in Australia, the COVID-19 Impact Scale (CIS). Method Data was obtained from the Australian population. Participants (N = 563) aged between 19 and 91 years (M = 54.50, SD = 16.16) provided online responses between June, 2021 and May, 2022. The majority of participants were female (60.9%), employed either full-time (37.7%) or part-time (22.0%), and had completed an undergraduate degree or higher (70.1%). An initial pool of 30 items was developed based on a review of the literature and input from a panel of experts including psychologists, epidemiologists, and public health experts, among others. The study used network psychometrics to examine the psychometric properties of: (1) item score distributions; (2) item redundancy; (3) dimensionality; (4) model fit; (5) measurement invariance; (6) reliability; and (7) criterion validity. Results Following an evaluation of items for ceiling/floor effects and redundancy, the final CIS network model included eighteen nodes and displayed a three-dimensional structure. The three communities of “Fear” (consisting of three nodes; ω = 0.82), “Attitudes” (consisting of ten nodes; ω = 0.89), and “Ill-being” (consisting of five nodes; ω = 0.79) displayed adequate reliability. The evaluation of model fit indicated a good fit of the network model (RMSEA = 0.047; CFI =0.98). Conclusion The instrument is available to be used by Australian researchers and implemented to evaluate public policies, adapted for future pandemics, or used internationally.

Sex on screens: the language of sexting and amateur pornography

Frequently referred to as ‘sexting’ or ‘amateur pornography’, digital sexual images and videos form an increasingly common part of adult sexual relationships. However, the vocabulary available to speak about these practices is limited, with ‘sexting’ often associated with young people in negative terms. This study is based on 23 interviews with adults in Australia who are 25 years and older. It explores the language adults employ to discuss and comprehend the creation and sharing of sexualised images and videos. Findings show that negative or positive connotations associated with the terms used to discuss sexual images and videos influenced the ways participants drew on, or rejected, terms to align digital practices with their sexual subjectivity. Reticence to engage in active communication about digital sexual practices, and participant’s distancing of their own practices from the terms commonly understood to refer to such practices, made it difficult to engage in conversations about consent or desire in the context of digitally mediated sex. Findings provide insight into the ways that ­digital sexual subjectivities are discursively framed and extend these implications for sexual health promotion with respect to how to frame messages of digital sexual safety in a sex-positive and open way.

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001–20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position—education, occupation, and household wealth—and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001–20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.

Mental Health Service Use and Barriers to Accessing Services in a Cohort of Transgender, Gender Diverse, and Non-binary Adults in Australia

Abstract Introduction Transgender, gender diverse, and non-binary people (TGDNB) access mental health services more frequently compared to the cisgender population, yet they continue to experience significant unmet mental health needs. The present study examined rates of mental health service use, satisfaction with services, barriers to service access, and help-seeking intentions in a sample of TGDNB adults in Australia. In addition, we examined whether barriers to service access were associated with help-seeking intentions. Methods Participants were 150 TGDNB adults (Mage = 37.19, SD = 15.73) who reported transfeminine (n = 77), transmasculine (n = 37), or non-binary (n = 36) genders. Self-reported recency of service use, satisfaction with services, barriers to service access, and help-seeking intentions were obtained in an online questionnaire, completed in 2016. Results Most participants had accessed mental health services in the past 6 months (55.3%). However, less than two thirds were either very satisfied (28%) or somewhat satisfied (32.7%) with these services. Common barriers to accessing services included a lack of professionals adequately trained and competent to work with TGDNB people, the cost of services, and concern with being treated poorly. Barriers to accessing services were negatively associated with help-seeking intentions, and stigma-related barriers had a greater negative effect on help-seeking intentions when satisfaction with prior services was low. Conclusions TGDNB adults face multiple barriers to accessing mental health services, many of which appear to predict help-seeking intentions. Policy Implications Implications and future research directions are discussed, with particular emphasis on ways to reduce barriers to service access for TGDNB adults.

A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study.

The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was "acceptable," with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development.

Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia

BackgroundStandard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. MethodsThis is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002–2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. ResultsBetween 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315–9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9–38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. ConclusionsFrom the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.

A qualitative evaluation of a video gambling campaign among young Australians

Gambling is an emerging public health issue within Australia, which can lead to various adverse impacts on individuals and society. Online gambling is becoming increasingly popular and is considered a high-risk environment where problem gambling is likely to occur. This rising prevalence emphasises the need for prevention and responsible gambling initiatives in Australia. C’Mon Australia Don’t Let the Game Play Ya! is a recently developed responsible gambling video campaign. The campaign focuses on online gambling and aims to promote responsible gambling messages towards young Australians, a vulnerable population at risk of gambling-related harm. This study qualitatively evaluated the campaign to gather feedback and understand whether the campaign raised awareness of gambling participation and associated risks. The sample (n = 8) was comprised of young adults in Australia, who were aged between 18 and 24 and were not required to be gamblers to participate. Semi-structured focus groups were conducted and responses were analysed using thematic analysis. Results revealed mainly positive feedback, commenting on the design elements, the messaging, and the dissemination of the campaign. The feedback highlighted likeable features of C’Mon Australia Don’t Let the Game play Ya! and provided suggestions for revisions. This study provides valuable insight to inform the development of future responsible gambling campaigns, and future research is recommended to evaluate the campaign across varying contexts, timeframes, and demographics.