Australian Adult Population Research Articles

Haemorrhoid artery ligation - recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis.

Haemorrhoids remain a highly prevalent condition in Australia, affecting 39% of the adult Australian population. While haemorrhoidectomy remains the gold standard in the management of haemorrhoids, newer techniques such as haemorrhoid artery ligation-recto anal repair (HAL-RAR) are emerging as promising management modalities. We compare the efficacy of non-Doppler guided (non-DG) HAL-RAR versus Doppler-guided (DG) HAL-RAR in the management of haemorrhoids. This study was registered with PROSPERO (CRD42022353806) and adhered to PRISMA 2020 guidelines. We conducted a systematic review using Medline, Embase and Cochrane database for comparative studies between Doppler-guided HAL-RAR and non-Doppler-guided HAL-RAR in accordance with the PRISMA 2020 statement for reporting systematic reviews. Five studies were included in our systematic review and meta-analysis. There was no clinically significant difference in operative times (SMD 0.46, 9% CI -3.16 0 4.08, P = 0.804) or post-operative bleeding (P = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (P < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, P < 0.001). Our review of non-DG HAL-RAR compared to DG HAL-RAR reflects the non-inferiority of the non-DG HALRAR procedure. We hope that these results would provide a guide to clinicians performing HAL-RAR, and would provide some cost savings for institutions who are unable to procure the necessary equipment for DG HAL-RAR.

What natural therapeutics are Australians using to relieve feelings of anxiousness?

IntroductionFeelings of anxiousness are experienced in the absence of diagnosed anxiety in Australia with prevalence and management of anxiousness not well understood within the population. Anxiety statistics represent the closest statistical comparison to anxiousness affecting 13 % of the Australian population. This figure is estimated to be much higher post pandemic based on global prevalence increasing. MethodsThe overall aim of this research is to identify natural ingestive and lifestyle therapeutics used by Australian adults to address their anxiousness. 115 provided consent. A cross sectional survey of the Australian adult population was conducted. The survey included enquiry about the impact of the COVID-19 pandemic, concomitant or isolated pharmaceutical use, demographic factors, potential barriers of access to natural therapeutics, types of practitioners commonly sought, exacerbating factors and manifestations of anxiousness. ResultsOne hundred and fifteen (n=115) respondents completed the survey. The survey allowed respondents to select more than one lifestyle option. The survey found that of the natural therapeutic options, 90.32 % (n=84) used lifestyle medicine (deep breathing, time in nature and meditation), 55.9 % (n=52) used herbal medicine (Passionflower, Lemon balm, Withania and St John’s wort) and 53.2 % (n=49) used nutrients (Magnesium, B Vitamins and Theanine and SAMe). The survey identified that complementary and alternative medicine (CAM) practitioners were the most common type of practitioner sought for information with naturopaths the preferred CAM practitioners. ConclusionNatural therapeutics as a strategy for managing anxiety has potential therapeutic application for Australian’s experiencing anxiousness, particularly post COVID-19 pandemic. Lifestyle medicine was the most common strategy utilized. There was a significant openness to trialing natural therapies.

The Medicines Intelligence Data Platform: A Population-Based Data Resource From New South Wales, Australia.

The Medicines Intelligence (MedIntel) Data Platform is an anonymised linked data resource designed to generate real-world evidence on prescribed medicine use, effectiveness, safety, costs and cost-effectiveness in Australia. The platform comprises Medicare-eligible people who are ≥18 years and residing in New South Wales (NSW), Australia, any time during 2005-2020, with linked administrative data on dispensed prescription medicines (Pharmaceutical Benefits Scheme), health service use (Medicare Benefits Schedule), emergency department visits (NSW Emergency Department Data Collection), hospitalisations (NSW Admitted Patient Data Collection) plus death (National Death Index) and cancer registrations (NSW Cancer Registry). Data are currently available to 2022, with approval to update the cohort and data collections annually. The platform includes 7.4 million unique people across all years, covering 36.9% of the Australian adult population; the overall population increased from 4.8 M in 2005 to 6.0 M in 2020. As of 1 January 2019 (the last pre-pandemic year), the cohort had a mean age of 48.7 years (51.1% female), with most people (4.4 M, 74.7%) residing in a major city. In 2019, 4.4 M people (73.3%) were dispensed a medicine, 1.2 M (20.5%) were hospitalised, 5.3 M (89.4%) had a GP or specialist appointment, and 54 003 people died. Anti-infectives were the most prevalent medicines dispensed to the cohort in 2019 (43.1%), followed by nervous system (32.2%) and cardiovascular system medicines (30.2%). The MedIntel Data Platform creates opportunities for national and international research collaborations and enables us to address contemporary clinically- and policy-relevant research questions about quality use of medicines and health outcomes in Australia and globally.

How does the subjective well-being of Australian adults with a congenital corpus callosum disorder compare with that of the general Australian population?

PurposeVery little is known about the subjective well-being (SWB) of adults with a congenital corpus callosum disorder (CCD), the extent to which they feel satisfied with their lives, and what might be helpful in improving their SWB and quality of life. This study measured SWB among Australian adults with a CCD and compared the results with normative data for the wider Australian adult population.MethodsOnline surveys were completed independently by 53 Australian adults with a CCD. Data included demographic profiles and answers to questions about satisfaction with life, employing the Personal Wellbeing Index (PWI) and one open ended question. Domains measured included life as a whole, standard of living, health, achieving in life, personal relationships, safety, community connectedness and future security. The PWI results were statistically analysed and means compared with Australian normative data. The qualitative data were analysed using deductive thematic analysis.ResultsAustralian adults with a CCD responded with ratings significantly below what might be expected of the adult Australian population in all domains except for standard of living and safety. Quantitative analysis results were supported by qualitative thematic analysis, expressing particular challenges and barriers to feeling satisfaction with life as a whole, personal relationships, achieving in life, health and future security.ConclusionEvidence from the PWI and accompanying qualitative responses indicate that SWB of Australian adults with CCD is significantly reduced compared with the general population. Further research is needed to examine the lived experience and explore solutions for support of this community.

Nephrology nurse practitioner model of care for chronic kidney disease: Lessons learned and informing future healthcare delivery

Background: Chronic kidney disease (CKD) affects more than 10% of the Australian adult population. It is a progressive disease that involves multiple physiological systems and is associated with several comorbid conditions, making it particularly burdensome on patients and the healthcare system. Alternative models of healthcare delivery are required to slow the progression to kidney failure. Aim: To describe the characteristics, patient profiles, and health outcomes of patients with CKD attending a nephrology nurse practitioner-led clinic. Design: Longitudinal health-service exploratory design. Methods: Following ethics approval, data were extracted from a chronic kidney disease registry for all consenting patients who attended a nephrology nurse practitioner-led clinic. Data were analysed descriptively. Results: Over the study period, 253 patients (122 male and 131 female) attended the clinic. The mean age was 70.27 ± 10.48 years, and at baseline most had either chronic kidney disease grade 3A (32.8%) or 3B (41.5%). For the majority of those who remained in the clinic, kidney function remained stable or slightly improved. A large proportion were within recommended target ranges for systolic (85.6%) and diastolic (98%) blood pressure although many had high BMI (mean 31.99 ± 6.47) and HbA1c (57.1%). Conclusion: The nephrology nurse practitioner-led clinic demonstrated effectiveness in addressing CKD targets for patients and provides an opportunity to transform traditional primary and specialist healthcare delivery. What is already known about the topic? Early intervention in chronic kidney disease (CKD) can slow or halt the progression of the disease, reducing long-term burden and healthcare costs. An integrated model of care including primary and specialist providers is considered optimal for the early detection and treatment of CKD. An integrated nephrology nurse practitioner model is an emerging model of care for CKD patients. However, studies investigating the cost-effectiveness, efficacy, and characteristics of this model compared to specialist or primary care in Australia are lacking. What this paper adds: This paper describes the characteristics and outcomes of a nephrology nurse practitioner-led outpatient clinic embedded within a multidisciplinary model of care. The majority of patients who remained in nephrology nurse practitioner care maintained recommended CKD targets. The findings provide evidence that nephrology nurse practitioners are able to manage patients with less advanced CKD grades who have comorbid conditions and other health risk-factors.

Hernia repair prevalence by age and gender among the Australian adult population from 2017 to 2021

ABSTRACT Despite of high annual rate of surgery worldwide, few national-level studies have explored the epidemiological aspects of various types of hernia repairs. Our study aims to examine the 5-year prevalence of hernia repairs in Australian adults. The number of hernia repair surgeries for femoral, inguinal, incisional, other abdominal, and epigastric hernias were extracted from the Australian Institute of Health and Welfare (AIHW) database from financial year (FY) FY2017 to FY2021. We calculated age-specific prevalence and prevalence ratio (PR) with a 95% confidence interval (CI) to compare the prevalence of hernia repairs by age group and sex. The highest prevalence per 100,000 population of hernia repairs was found in inguinal (223), followed by epigastric (111), other abdominal (59), incisional (52), and femoral hernia (10). People over 65 years old had highest PR of hernias. There was a gender-wise variation across types of hernia procedures. Around 89.6% of patients with inguinal hernia repairs were males, while only 10.4% were females. The PR was lower in males for femoral and incisional hernia when compared two genders with corresponding age groups. Women in the pregnancy group (20–39 years) had a high risk of ventral hernia repair when compared to males. Groups of patients who have higher risks of hernia repair should be prioritized for healthcare service delivery, but more research is needed in hernia epidemiology, in Australia and internationally. Also, our study could serve as a national and international reference for other hernia repair studies where healthcare system is comparable.

Estimates and predictors of alcohol-related harm to intimate partners in Australia An analysis of a nationally representative survey

Aims: This study explores the prevalence and predictors reported in 2019 by men and women of alcohol-related intimate partner violence (ARIPV), that is, verbal abuse, physical abuse, and being put in fear by intimate partners, when partners were under the influence of alcohol. Methods: Secondary data analysis of the 2019 Australia’s cross-sectional National Drug Strategy Household Survey included 22,015 respondents aged 14 years or older (9,804 men, and 12,211 women). The prevalence of ARIPV and each type of ARIPV (verbal abuse, physical abuse, and being put in fear) in the past year is described, and the predictors of all are analysed using chi-square tests and logistic regressions, overall and separately for men and women. Results: An estimated 3.4% of the Australian adult population (4.7% women, 2.1% men) reported ARIPV in 2019. The prevalence of ARIPV was higher among the participants who were women, middle-aged (35-44 years), had a certificate or diploma, were less advantaged, were divorced, separated, or widowed, single with dependents, living in more regional, and remote areas, and undertook heavy episodic drinking (HED) weekly or less often. Age, marital status, household composition, and weekly, monthly, or ever HED predicted ARIPV for women, while higher education levels and weekly or monthly HED were significant for men. Discussion and conclusions: Women were twice as likely to report intimate partner violence (IPV) from their male partner when they were under the influence of alcohol, as were men. The findings underline that interventions are needed to address IPV from intoxicated partners.

The experience of traumatic events, psychological distress, and social support: links to COVID-19 vaccine hesitancy and trends with age in a group of older Australians

BackgroundVaccination is important to reduce disease-associated morbidity and mortality in an ageing global population. While older adults are more likely than younger adults to accept vaccines, some remain hesitant. We sought to understand how traumatic events, psychological distress and social support contribute to older adults’ intention to receive a COVID-19 vaccine and whether these experiences change with age.MethodsWe analysed survey data collected as part of the Sax Institute’s 45 and Up Study in a population of Australian adults aged 60 years and over. Data were derived from the COVID Insights study; a series of supplementary surveys about how participants experienced the COVID-19 pandemic.ResultsHigher intention to receive a COVID-19 vaccine was associated with greater social support (adjusted odds ratio (aOR):1.08; 95%CI:1.06–1.11; p <.001) while lower intention was associated with personally experiencing a serious illness, injury or assault in the last 12 months (aOR:0.79; 95% CI:0.64–0.98; p =.03). Social support and the experience of traumatic events increased significantly with age, while psychological distress decreased.ConclusionsThere may be factors beyond disease-associated risks that play a role in vaccine acceptance with age. Older Australians on the younger end of the age spectrum may have specific needs to address their hesitancy that may be overlooked.

Sex estimation of frontal sinus volume from computed tomography scans in a Western Australian adult population.

With the increasing use of radiological three-dimensional imaging, different metric and morphological aspects of the frontal sinuses (FS) have been examined relative to their potential to aid human identification, including sex estimation. The aim of this study is to assess the validity of the metric analysis of the FS volume for estimating sex in a Western Australian (WA) adult population, following the Michel et al. (2015) method. The right, left and total frontal sinus volume (TFSV) from 99 computed tomography scans (47 males and 52 females) of WA individuals aged 18-40 years were three-dimensionally reconstructed using OsiriX® and their volumes acquired in mm3. Sexual dimorphism in the TFSV was tested, and the accuracy of the Michel et al. (2015) formulae was calculated. Population-specific regression equations were also produced. There was a significant difference between the mean TFSV in males and females. The classification accuracy derived from the Michel et al. (2015) formulae was 59.6%. The WA-specific logistic regression analysis yielded an accuracy of 57.2%. The low accuracy rates preclude the use of the sex estimation method in the WA population, but the volume analysis confirmed the individual variability of the frontal sinuses, which may be useful for personal identification.

COVID-19 infection associated with poorer mental health in a representative population sample

ObjectiveThere is limited evidence of the direct effects of COVID-19 infection on mental health, and whether these are influenced by vaccination or physical health symptoms. We aimed to investigate the relationships of COVID-19 infection, current symptom presentation, and vaccination status with mental health symptoms in adults. Study design and settingA cross-sectional sample of the Australian adult population that was representative by age, gender, and location was recruited through market research panels (N = 1407, 51.3% female, mean age 47.9 years). Hierarchical regression analyses were used to examine the associations of COVID-19 infection history and current COVID-19 symptoms with symptoms of depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder-7) and social anxiety (Mini-Social Phobia Inventory). ResultsCOVID-19 infection was associated with significantly higher depression and anxiety symptoms, but only in those who were not fully vaccinated. Current experience of COVID-related symptoms was associated with significantly higher depression and anxiety symptoms, and attenuated the direct effect of infection on mental health outcomes to non-significance. ConclusionCOVID-19 infection may be associated with increased mental health symptoms. However, the effects of infection on mental health were primarily evident in those who were not fully vaccinated and were explained by greater physical health problems associated with COVID-19 infection. The findings reinforce the efficacy of vaccination for reducing physical and mental health symptoms following infection.

Comparing estimates of psychological distress using 7-day and 30-day recall periods: Does it make a difference?

Self-report measures are widely used in mental health research and may use different recall periods depending on the purpose of the assessment. A range of studies aiming to monitor changes in mental health over the course of the COVID-19 pandemic opted to shorten recall periods to increase sensitivity to change over time compared to standard, longer recall periods. However, many of these studies lack pre-pandemic data using the same recall period and may rely on pre-existing data using standard recall periods as a reference point for assessing the impact of the pandemic on mental health. The aim of this study was to assess whether comparing scores on the same questionnaire with a different recall period is valid. A nationally representative sample of 327 participants in Australia completed a 7-day and 30-day version of the six-item Kessler Psychological Distress Scale (K6) and a single-item measure of psychological distress (TTPN item) developed for the Taking the Pulse of the Nation survey. Linear mixed models and mixed logistic regression models were used to assess whether altering the recall period systematically changed response patterns within subjects. No substantive recall period effects were found for the K6 or the TTPN, although there was a trend towards higher K6 scores when asked about the past 30 days compared to the past 7 days (b = 1.00, 95% CI: -0.18, 2.17). This may have been driven by the “feeling nervous” item which was rated higher using the 30-day compared to the 7-day recall period. Neither the K6 nor the TTPN item were significantly affected by the recall period when reduced to a binary variable of likely severe mental illness. The results indicate that altering the recall period of psychological distress measures does not substantively alter the score distribution in the general population of Australian adults.

Practical application of the Crohn's disease exclusion diet as therapy in an adult Australian population.

There is demand from patients and clinicians to use the Crohn's disease exclusion diet (CDED) with or without partial enteral nutrition (PEN). However, the therapeutic efficacy and nutritional adequacy of this therapy are rudimentary in an adult population. This review examines the evidence for the CDED in adults with active luminal Crohn's disease and aims to provide practical guidance on the use of the CDED in Australian adults. A working group of nine inflammatory bowel disease (IBD) dietitians of DECCAN (Dietitians Crohn's and Colitis Australian Network) and an IBD gastroenterologist was established. A literature review was undertaken to examine (1) clinical indications, (2) monitoring, (3) dietary adequacy, (4) guidance for remission phase, and (5) diet reintroduction after therapy. Each diet phase was compared with Australian reference ranges for food groups and micronutrients. CDED with PEN is nutritionally adequate for adults containing sufficient energy and protein and meeting >80% of the recommended daily intake of key micronutrients. An optimal care pathway for the clinical use of the CDED in an adult population was developed with accompanying consensus statements, clinician toolkit, and patient education brochure. Recommendations for weaning from the CDED to the Australian dietary guidelines were developed. The CDED+PEN provides an alternate partial food-based therapy for remission induction of active luminal Crohn's disease in an adult population. The CDED+PEN should be prioritized over CDED alone and prescribed by a specialist IBD dietitian. DECCAN cautions against using the maintenance diet beyond 12weeks until further evidence becomes available.

The Short- and Long-Term Outcome Priorities of a Western Australian Adult Burn Population.

To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients.

Association of participants who screened positive for night eating syndrome with physical health, sleep problems, and weight status in an Australian adult population

BackgroundNight eating syndrome (NES) is a unique eating disorder characterised by evening hyperphagia and nocturnal ingestions which cause significant distress and/or impairment in functioning. Despite the growing literature, NES remains poorly understood and under diagnosed. As such, this study aims to compare the prevalence of physical health conditions in participants with NES when compared to participants without an eating disorder (ED) and participants with other eating disorders (including anorexia nervosa (AN), binge eating disorder (BED) and bulimia nervosa (BN)) in a general population Australian sample of adults.MethodsThe data for this study were obtained from the 2017 Health Omnibus Survey (HOS) a multi-stage, cross-sectional survey, conducted by Harrison Research in South Australia. This current study focused on 2547 participants over 18 years of age and specific questions from this population survey including those related to participant demographics and health.ResultsThis study identified that participants who screened positive for night eating syndrome (spNES) when compared to participants with other eating disorders (ED) or no ED diagnosis, were significantly more likely to have an increased age, be female, have lower levels of education and have lower household income. Additionally, the spNES group was significantly associated with sleep apnoea (p = 0.031), insomnia or other sleep problems (p < 0.0001), increased BMI (p < 0.0001), increased levels of pain/discomfort and lower physical health-related quality of life. Hypertension, hypercholesterolemia, and diabetes were not significantly associated with the spNES group or the “other ED” group which included participants with AN, BED, BN.ConclusionsSeveral physical health problems were found to be significantly associated with the spNES group including sleep problems, increased BMI, increased levels of pain and lower self-reported physical health-related quality of life. Consequently, future research exploring the complex interaction between NES and these medical conditions may provide further insight into the diagnosis, screening tools and management of NES. Additionally, this study highlights the need for future studies which use larger population-based samples.Level of evidenceLevel III. Evidence obtained from well-designed cohort or case–control analytic studies.

Valuing the Dental Caries Utility Index in Australia.

The Dental Caries Utility Index (DCUI) is a new oral health-specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort, difficulty eating food/drinking, worried, ability to participate in activities, and appearance. Each domain has 4 response levels. This study aims to generate an Australian-specific utility algorithm for the DCUI. An online survey was conducted using a representative sample of the adult Australian general population. The discrete choice experiment (DCE) was used to elicit the preferences on 5 domains. Then, the latent utilities were anchored onto the full health-dead scale using the visual analogue scale (VAS). DCE data were modeled using conditional logit, and 2 anchoring procedures were considered: anchor based on the worst health state and a mapping approach. The optimal anchoring procedure was selected based on the model parsimony and the mean absolute error (MAE). A total of 995 adults from the Australian general population completed the survey. The conditional logit estimates on 5 dimensions and levels were monotonic and statistically significant, except for the second level of the "worried" and "appearance" domains. The mapping approach was selected based on a smaller MAE between the 2 anchoring procedures. The Australian-specific tariff of DCUI ranges from 0.1681 to 1. This study developed a utility algorithm for the DCUI. This value set will facilitate utility value calculations from the participants' responses for DCUI in economic evaluations of dental caries interventions targeted for adolescents. Preference-based quality-of-life measures (PBMs), which consist of a health state classification system and a set of utility values (a scoring algorithm), are used to generate utility weights for economic evaluations.This study is the first to develop an Australian utility value set for the Dental Caries Utility Index (DCUI), a new oral health-specific classification system for adolescents.The availability of a utility value set will enable using DCUI in economic evaluations of oral health interventions targeted for adolescents and may ultimately lead to more effective and efficient planning of oral health care services.

Feasibility of transsphenoidal approach for hypothalamic biopsy based on a radiological evaluation of subchiasmatic corridor dimension

BackgroundSurgical access to hypothalamic pathologies can be challenging. Recent case series demonstrate that the transsphenoidal approach to the hypothalamus can be safe and effective, however, may not be feasible in all patients. This study aims to investigate the feasibility of the endonasal transsphenoidal suprasellar subchiasmatic (ETSS) approach to the hypothalamus through a radiological evaluation of the subchiasmatic corridor dimension in an adult population. MethodsA retrospective review of magnetic resonance imaging of the brain was performed on 164 consecutive adult patients at our institution, of which 100 patients were deemed eligible for inclusion. Measurements were obtained at the two narrowest points along the subchiasmatic corridor: the subchiamastic window, which is the face of the subchiasmatic corridor and the midpoint window, which is located in the middle of the subchiasmatic corridor. Based on defined parameters, including the subchasmiatic window width (SW), subchiasmatic window height (SH), midpoint window width (MW), and midpoint window height (MH), patients were dichotomised into groups: patients with subchiasmatic corridor measurements any dimension of less than 3 mm, or patients with dimensions greater than or equal to 3 mm. ResultsA total of 72 (72%) of the study population had dimensions of equal to or greater than 3 mm throughout the entirety of the subchiasmatic corridor, making hypothalamic biopsy feasible through the ETSS route for these patients. ConclusionBased on a radiological evaluation of the subchiasmatic corridor dimension in an Australian adult population, the majority of the population are suitable to undergo an endonasal transsphenoidal suprasellar subchiasmatic biopsy of the hypothalamus.

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study

BackgroundPoor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney.MethodsA mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach.ResultsA sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL.ConclusionsStrategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

Can Motivation, Opportunity and Ability Theory Informed Segments Be Validated in the Australian Defence Force?

Background Segmentation use in social marketing especially in improving the health of young adults is limited, and theory use within segmentation remains infrequent. A generalisable segmentation structure that can be reliably applied across different young adult’s samples may assist social marketers to move beyond one size fits all healthy eating programs. Focus of the Article Segmentation is an essential marketing principle which allows customising marketing activities to the needs of specific segments. Evidence shows that behaviour change is more likely when more principles are used, yet segmentation remains underutilised and a cross-sample validation of segments across different populations remains to be demonstrated. Importance to the Social Marketing Field Delivery of healthy eating programs targeted to group differences and accommodating a broader theory-based socio-ecological viewpoint is needed to engage with a cross section of young adults more effectively along with a cross-sample validation of segments across different populations to identify a valid segmentation structure that can be reliably applied across the Australian young adult population. Methods A replication study was conducted using the same constructs, items and analytical procedures as in the original study. Data was collected online and in person using a paper survey in two military bases to ensure a mix of Australian Defence Force (ADF) trainee types. Psychographic variables informed by the MOA framework were collected and used to segment the sample with two-step cluster analysis along with a demographic measure (education) and behavioural measure (eating behaviour) to repeat the segmentation analysis. Results The ability of the MOA framework to explain eating behaviour was confirmed in the ADF trainee sample, and two-step cluster analysis produced a similar segment structure to the original study with education, opportunity and motivation to eat healthy being the most important variables in segment formation. Recommendations for Research or Practice Segmentation is important for developing understanding that enables social marketers to design social change programs to meet the needs of young adults. This empirical replication study confirmed a similar theory-driven healthy eating segment solution across two young adult populations illustrating the value of using behavioural theories to draw segments and utilising the same theory to cross-validate the constructs in a comparable sample. Future research could use this approach to identify a valid segmentation structure that can be reliably applied across different populations and behavioural contexts.

Cross-sectional survey of a convenience sample of Australians who use alcohol home delivery services.

Online alcohol purchasing and home delivery has increased in recent years, accelerated by the onset of the coronavirus disease 2019 pandemic. This article aims to investigate the purchasing and drinking behaviour of Australians who use online alcohol delivery services. A cross-sectional self-report survey with a convenience sample of 1158 Australians ≥18 years (49.3% female) who used an online alcohol delivery service in the past 3months, recruited through paid social media advertisements from September to November 2021. Quota sampling was used to obtain a sample with age and gender strata proportional to the Australian adult population. Descriptive statistics were generated and logistic regression used to explore variables that predict hazardous/harmful drinking (Alcohol Use Disorders Identification Test score ≥8). One-in-five (20.1%, 95% confidence interval [CI] 17.8-22.5) participants had used an alcohol delivery service to extend a home drinking session because they had run out of alcohol and wanted to continue drinking and, of these, one-third (33.9%, 95% CI 27.9-40.4) indicated that if the service was not available they would have stopped drinking. Using delivery services in this way was associated with six times higher odds of drinking at hazardous/harmful levels (oddsratio 6.26, 95% CI 3.78-10.36). Participants ≤25 years were significantly more likely to report never having their identification verified when receiving their alcohol delivery at the door compared with purchasing takeaway alcohol in-person at a bottle shop (p< 0.001, McNemar). Given the risks associated with alcohol delivery, regulation of these services should be improved to meet the same standards as bricks-and-mortar bottle shops.

Potential impact of the adult-targeted LiveLighter "Sugary Drinks" campaign on adolescent consumption: Findings from a national cross-sectional school survey.

To examine the potential impact on trends in reported adolescent sugar-sweetened beverage (SSB) consumption following the adult-targeted Western Australian (WA) LiveLighter "Sugary Drinks" campaign, which is a television-led healthy lifestyle promotion and education mass media campaign that aired in multiple bursts between July 2013 and December 2018. Data were from a repeated cross-sectional survey of Australian secondary school students aged 12-17 years conducted nation-wide in 2009-2010 (n=13 790 from 238 schools), 2012-2013 (n=10309 from 196 schools) and 2018 (n=9102 from 104 schools). Significant declines in high SSB consumption (≥4 cups/week) were observed between 2009-2010 and 2012-2013 among students in both WA (27.1% vs 20.3%; odds ratio[OR]=0.65, 95% confidence interval [CI]=0.50-0.84, P=.001) and all other states and territories combined (30.6% vs 21.4%; OR=0.60, 95% CI=0.53-0.68, P < .001). Compared to 2012-2013, the proportion of students in WA who reported high SSB consumption was significantly lower in 2018 (20.3% vs 9.6%; OR=0.37, 95% CI=0.21-0.65, P=.001), whereas this significant decrease was not observed in all other states and territories combined (21.4% vs 17.8%; OR=0.81, 95% CI=0.67-0.97, P=.024). Interaction testing indicated that the recent decline observed in WA was more pronounced among female than male students. Mass media campaigns targeted towards the Australian adult population may have favourable effects among adolescents with the steeper decline in high SSB consumption observed in WA between 2012-2013 and 2018 coinciding with the repeated airing of the LiveLighter "Sugary Drinks" campaign in this state. SO WHAT?: Government investment in mass media campaigns may hasten declines in adolescents' SSB consumption.