Australian Cross-sectional Survey Research Articles

Differences in LGBTQ young people’s mental health, wellbeing, and community involvement by residential location

ABSTRACT Residential location can significantly impact the mental health, wellbeing, and community involvement of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) young people. While research has explored geographical differences in LGBTQ adult wellbeing, limited knowledge exists regarding LGBTQ young people’s experiences. Using a large Australian cross-sectional survey of 6,620 LGBTQ individuals aged 14–21, this study examined the associations between residential location and wellbeing outcomes. Findings revealed that LGBTQ young people in rural and remote areas reported higher levels of psychological distress. Cisgender young people in rural areas experienced more verbal and physical harassment, while those in inner-suburban areas faced increased sexual harassment. Participants were also particularly vulnerable to experiencing homelessness when living in regional towns and rural and remote areas. Trans young people were more likely to attend LGBTQ events in inner-suburban areas. These results emphasize the need for policy changes to foster diversity and inclusion in rural areas, along with targeted support services to enhance the mental health and wellbeing of LGBTQ young people. Understanding the unique experiences of LGBTQ young people across different residential locations is vital, calling for tailored interventions and support in all settings.

Women’s experiences with using domperidone as a galactagogue to increase breast milk supply: an Australian cross-sectional survey

BackgroundDomperidone is one of the most commonly utilised pharmacological galactagogues, with evidence of increasing use in clinical practice. However, the use of domperidone as a galactagogue remains controversial, with mixed evidence on safety and efficacy, leading to variable clinical practice recommendations. We sought to evaluate contemporary patterns of domperidone use and examine maternal experiences related to perceived safety and effectiveness.MethodsIn 2019, we conducted an online, cross-sectional survey of Australian breastfeeding women to examine individual experiences related to domperidone use, in addition to perceptions of safety and effectiveness.ResultsAmong 1876 survey responses, 19% (n = 355) reported using domperidone. Domperidone use was significantly higher in women who were primiparous, gave birth preterm, delivered by caesarean section, had self-perceived low milk supply, and saw a lactation consultant. Nearly 20% of women commenced domperidone use in the first week postpartum (19%, n = 67). The median duration of use was six weeks (interquartile range 3–16 weeks). Maximum reported doses of domperidone used ranged from 20 mg/day to 160 mg/day. Half (n = 178, 50%) of women reported using a dose of 30 mg/day or less, 44% (n = 155) reported using a dose between 31 and 60 mg/day, and 6% (n = 22) reported using a dose greater than 61 mg/day. Nearly half of the respondents reported domperidone as ‘very’ or ‘extremely effective’ (45%, n = 161), with only 8% (n = 27) reporting it was ‘not at all effective’. Almost half (n = 172, 48%) of all women using domperidone reported side effects, including weight gain (25%), headaches (17%) and dry mouth (13%). Higher doses were associated with an increased likelihood of any side effects (≤ 30 mg/day, 38%; >31-≤60 mg/day, 48%, > 61 mg/day 73%; P < 0.004), with 31 (9%) stopping domperidone because of side effects.ConclusionWe identified widespread variation in domperidone utilisation patterns, with domperidone broadly perceived to be effective in increasing breast milk supply. Side effects associated with domperidone treatment were common, appeared to be dose-related, and were frequently associated with treatment cessation. These findings highlight the importance of improved clinical practice recommendations and generation of evidence from additional high-quality clinical trials evaluating the efficacy and safety of domperidone. More conclusive clinical trials are needed to determine the efficacy, as well as optimal dose and duration, of domperidone use.

Knowledge, attitudes and behaviours surrounding preconception and pregnancy health: an Australian cross-sectional survey

ObjectiveTo understand Australian women’s knowledge, attitudes and behaviours surrounding preconception and pregnancy health and their preferences for information about these periods.DesignCross-sectional survey.SettingMaking healthy changes can optimise preconception and pregnancy outcomes....

Psychological distress and digital health service use during COVID-19: A national Australian cross-sectional survey.

Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a large amount of research emerged in the first year of the pandemic, the longer-term mental health impacts, contributing factors, and population-level utilization of digital health services are unknown. A population-based online survey of 5,100 Australians adults was conducted in October 2021. Psychological distress was assessed with the Kessler 6-item Psychological Distress Scale. Additional survey questions included use and satisfaction with digital health services. Where available, data were compared with our previous survey conducted in 2018, permitting an examination of pre- and post-pandemic digital health service utilization. In 2021, almost a quarter (n = 1203, 23.6%) of respondents reported serious levels of psychological distress; participants with pre-existing health related conditions, of younger age, lower educational attainment, those who lost their job or were paid fewer hours, or living in states with lockdown policies in place were at highest risk of serious psychological distress. Almost half of all respondents (n = 2177, 42.7%) reported using digital health technologies in 2021, in contrast to just 10.0% in 2018. In 2021, respondents with serious psychological distress were significantly more likely to consult with a healthcare professional via telephone/videoconferencing (P < 0.001), access healthcare via a telephone advice line (P < 0.001), or via an email or webchat advice service (P < 0.001) than those with no serious psychological distress. Those with and without psychological distress were highly satisfied with the care they received via digital health technologies in 2021. Rates of serious psychological distress during the second year of the pandemic remained high, providing further evidence for the serious impact of COVID-19 on the mental health of the general population. Those with psychological distress accessed digital mental health services and were satisfied with the care they received. The results highlight the continued need for mental health support and digital health services, particularly for people living with chronic conditions, younger adults and people most impacted by the COVID-19 pandemic, both in the short term and beyond.

Opioid prescribing in general practice: an Australian cross-sectional survey

BackgroundPrescribed opioid doses > 100 mg oral morphine equivalent (OME) and/or co-prescribing of sedating psychoactive medications increase the risk of unintentional fatal overdose. We describe general practice encounters where opioids are prescribed and examine high-risk opioid prescribing.MethodsThe 2006–2016 BEACH study data, a rolling national cross-sectional survey of randomly selected GPs, was analysed.ResultsOpioid prescribing increased 2006–2007 to 2015–2016, however, this plateaued across the latter half-decade. From 2012–2016 3,897 GPs recorded 389,700 encounters and at least one opioid was prescribed at 5.2%. Opioid encounters more likely involved males, those 45–64 years, concession card holders and the socioeconomically disadvantaged. GPs more likely to prescribe opioids were 55 years or older, male, Australian graduates, and in regional and remote areas. The most common problems managed with opioids involved chronic non-cancer pain. One-in-ten opioid prescribing episodes involved high-risk doses and 11% involved co-prescription of sedating psychoactive medications. Over one-third of GPs provided other (non-pharmacological) interventions at encounters with opioid prescriptions.ConclusionsOnly 5% of GP encounters involved an opioid prescription. Of concern, were: prescribing for chronic non-cancer pain, potentially high-risk opioid encounters where > 100 OME daily dose was prescribed, and/or there was co-prescription of sedating psychoactive medication. However, approximately one-in-three opioid prescribing encounters involved non-pharmacological interventions.

Understanding the Diversity of Pharmacotherapeutic Management of ADHD With Co-occurring Autism: An Australian Cross-Sectional Survey.

ObjectivesAttention deficit hyperactivity disorder (ADHD) frequently co-occurs with other neurodevelopmental diagnoses, such as autism spectrum disorder (autism), which can make clinical decision making around symptom management challenging for clinicians. There is a paucity of research examining pharmacotherapeutic management of children who have ADHD with co-occurring diagnoses. We aimed to report on the co-occurring diagnoses and symptom profile of children, and report on medication use, stratified by ADHD, autism and ADHD + autism diagnoses.Methods and MaterialsCaregivers of 505 children (2–18 years) with ADHD (n = 239), autism (n = 117), and co-occurring ADHD + autism (n = 149) completed a questionnaire on current medication use and clinical rating scales about their child's symptoms, as part of a broader project investigating diagnosis and management of symptoms in children with ADHD or autism.ResultsThe parents of the ADHD group reported a higher proportion of their children had learning disorders (17.15%) and speech and language disorders (4.60%) compared to the parents of the autism and ADHD + autism groups. Parents of the ADHD + autism group reported higher proportions of intellectual disability (5.37%), oppositional defiant disorder (20.13%), anxiety (38.93%), depression (6.71%) and genetic conditions (3.36%) in their children, in comparison to the parents of the ADHD and autism groups. Children with ADHD were reported to be taking a higher proportion of psychotropic medication (90%), followed by ADHD + autism (86%) and autism (39%). The parents of children with ADHD + autism reported a higher proportion of non-stimulant ADHD medication (25.5%), antipsychotic (18.79%), antidepressant (22.15%) and melatonin (31.54%) use by their children, compared to the parents of the ADHD and autism groups.ConclusionsA similar proportion of children with ADHD + autism and ADHD were reported to be taking medication. However, the types of medication taken were different, as expected with reported co-occurring diagnoses. The complexity of symptoms and diagnoses in ADHD + autism warrants targeted research to optimize management and therapeutic outcomes.

An Australian Cross-Sectional Survey of Parents' Experiences of Emergency Department Visits Among Children with Autism Spectrum Disorder.

Parents of children with ASD who had attended an Australian emergency department (ED;n = 421) completed a questionnaire relating to their experiences in the ED, including (1) child's reason for presentation and existing comorbidities, (2) quality of care during the visit (3) child's behaviour during visit, e.g. sensory responses to the ED environment, and disruptive behaviours. Children with comorbid ASD and intellectual disability were more likely to present with gastrointestinal issues and seizures, while those with comorbid ASD and oppositional defiant disorder were more likely to present with self-injury. ED staff awareness of ASD-related issues, including communication and expression of pain, were common difficulties for parents. The ED environment (e.g. lights, sounds, waiting areas), exacerbated child anxiety and led to disruptive behaviour.

1746P - Comparing cancer patients’ and support persons’ preferences for the type of consultation and the format of information provided when making a treatment decision

Background: Cancer patients and their support persons often feel overwhelmed when being confronted with their diagnosis and treatment options. Such information is commonly provided during one consultation with their clinician. We compared cancer patients’ and their support persons’ preferences for: i) attending one 40-minute consultation or two 20-minute consultations when making a treatment decision; and ii) receiving additional information in written form only or in both written and online forms. Methods: An Australian cross-sectional survey, using a discrete choice experiment (DCE), of 159 adult medical oncology patients, and 64 of their support persons. Participants were presented with four hypothetical scenarios and asked to indicate their most and least preferred option. They were told that both treatments would have the same impact on participants’ life expectancy, and that there would be no difference between the scenarios in terms of when treatment would start. Results: 147 patients and 59 support persons completed the DCE. The proportions of patients and support persons choosing each scenario did not differ statistically significantly from each other (p > 0.05). Of the four scenarios, most patients and support persons preferred to receive two consultations along with written and online information (n = 65, 44% and n = 30, 51% respectively). Significantly more participants preferred to receive two shorter consultations rather than one longer consultation when this was combined with written and online information (p < 0.05). Conclusions: When making a cancer treatment decision, both patients and support persons seem to prefer to receive two shorter consultations combined with written and online information. Clinicians should consider offering this consultation style. Legal entity responsible for the study: Anne Herrmann. Funding: This study was funded by a Strategic Research Partnership Grant [CSR 11-02] from the Cancer Council New South Wales to the Newcastle Cancer Control Collaborative (New-3C), and by a Partnership Project [APP1059760] from the National Health & Medical Research Council (NHMRC). The authors also received funding support from the Hunter Cancer Research Alliance Implementation Science Flagship Program, the Hunter New England Local Health District, and the Australian Research Council. Infrastructure funding was provided by the University of Newcastle and Hunter Medical Research Institute. Disclosure: All authors have declared no conflicts of interest.

Use of antiretroviral treatment among people living with HIV in Australia between 1997 and 2012

ABSTRACTCurrent international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8–87.6%, p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake.

Trends in the Prevalence of Morbid and Severe Obesity in Australian Children Aged 7-15 Years, 1985-2012

ObjectiveChildren with severe obesity have greater risk of adverse health outcomes. The purpose of this study was to assess trends in the prevalence of morbid and severe obesity in Australian children between 1985 and 2012.MethodsSecondary analysis of four national Australian cross-sectional surveys of measured height/weight in 7–15 year olds: Australian Health and Fitness Survey 1985 (n = 8,486), National Nutrition Survey 1995 (n = 1,541), the National Children’s Nutrition and Physical Activity Survey 2007 (n = 2,585) and the National Health Survey 2012 (n = 2,940). International Obesity Taskforce cut-point was used for morbid obesity (equivalent to a BMI ≥35kg/m2 at age 18 years). Severe obesity class 2 was defined as BMI ≥120% and <140% of the 95th percentile of the CDC 2000 growth charts or a BMI ≥35 and <40, and severe obesity class 3 as BMI ≥140% of the 95th percentile or a BMI ≥40.ResultsBetween 1985 and 2012 the prevalence of morbid obesity increased from 0.2% to 1.8%, class 2 severe obesity from 0.3% to 2.0%, and class 3 from 0.1% to 0.5%. Children with morbid obesity represented 11.3% of children with obesity in 1985 and increased to 22.5% in 2012 (P = 0.005). Children with severe obesity represented 19.3% of children with obesity in 1985 and increased to 32.0% in 2012 (P = 0.016). The greatest increase was observed between 1995 and 2007. The proportion of children who were classified as morbidly or severely obese was not significantly different between 2007 and 2012, nor was it significantly different between age and sex groups.ConclusionPrevalence of morbid and severe obesity among children is low, but has significantly increased between 1985 and 2012. In contrast to overweight and obese children, children with morbid obesity require tertiary intervention. Failure to treat these children will have significant implications for the individual child and community.

The Meaning of 'Regular Partner' in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey.

Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.

Cumulative risks and cessation of exclusive breast feeding: Australian cross-sectional survey

ObjectivesTo estimate the prevalence of cessation of exclusive breast feeding at each month up to 6 months and document key factors and cumulative risks associated with exclusive breastfeeding cessation for...

What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses.

Many haematological cancer survivors report long-term physiological and psychosocial effects beyond treatment completion. These survivors continue to experience impaired quality of life (QoL) as a result of their disease and aggressive treatment. As key members of the multidisciplinary team, the purpose of this study is to examine the insights of cancer nurses to inform future developments in survivorship care provision. Open text qualitative responses from two prospective Australian cross-sectional surveys of nurses (n = 136) caring for patients with haematological cancer. Data were analysed thematically, using an inductive approach to identify themes. This study has identified a number of issues that nurses perceive as barriers to quality survivorship care provision. Two main themes were identified: the first relating to the challenges nurses face in providing care ('care challenges') and the second relating to the challenges of providing survivorship care within contemporary health care systems ('system challenges'). Cancer nurses perceive the nature of haematological cancer and its treatment and of the health care system itself, as barriers to the provision of quality survivorship care. Care challenges such as the lack of a standard treatment path and the relapsing or remitting nature of haematological cancers may be somewhat intractable, but system challenges relating to clearly defining and delineating professional responsibilities and exchanging information with other clinicians are not. Addressing the issues identified will facilitate cancer nurses' provision of survivorship care and help address haematological survivors' needs with regard to the physical and psychosocial consequences of their cancer and treatment.

Impact of oral disease on quality of life in the US and Australian populations

The US National Health and Nutrition Examination Survey (NHANES 2003-2004) evaluated oral health quality of life for the first time using a previously untested subset of seven Oral Health Impact Profile (OHIP) questions, i.e. the NHANES-OHIP. (i) To describe the impact of dental conditions on quality of life in the US adult population; (ii) to evaluate construct validity and adequacy of the NHANES-OHIP in NHANES 2003-2004 and a comparable Australian survey. In the cross-sectional NHANES 2003-2004 survey of a nationally representative sample of US adults (n=4907), prevalence was quantified as the proportion of adults who reported experiencing one or more impacts fairly often or very often within the past year. Construct validity was tested by comparing prevalence estimates across categories of sociodemographic, dental health and utilization characteristics known to vary in oral health. In 2002, Australian cross-sectional survey of a nationally representative sample of adults (n=2644), adequacy of the NHANES-OHIP questions were tested with reference to a slightly modified version of the OHIP-14 questions. NHANES-OHIP prevalence estimates were markedly similar in the United States (15.3%) and Australia (15.7%). In the US construct, validity was evidenced by higher NHANES-OHIP scores among groups with greater levels of tooth loss, perceived treatment need and problem-oriented visiting and with lack of private dental insurance and low income. In Australia, prevalence for the NHANES-OHIP closely resembled prevalence estimates of the modified OHIP-14. Both varied to a similar degree across levels of tooth loss, perceived treatment need, problem-oriented visiting, and private dental insurance and income, demonstrating adequacy of the NHANES-OHIP as a brief independent instrument. There was acceptable construct validity and adequacy of the NHANES-OHIP questionnaire. In the United States, the impact of oral disease disproportionately affected disadvantaged groups, a finding that supports application of the US Healthy People 2010 major goals of improved quality of life and reduced health disparities.