Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial.

BACKGROUND: Robust evidence regarding the benefits and harms of notifying Australian women when routine breast screening identifies that they have dense breasts is needed for informing future mammography population screening practice and policy. OBJECTIVES: To assess the psychosocial and health services use effects of notifying women participating in population-based breast cancer screening that they have dense breasts; to examine whether the mode of communicating this information about its implications (print, online formats) influences these effects. METHODS AND ANALYSIS: The study population comprises women aged 40 years or older who attend BreastScreen Queensland Sunshine Coast services for mammographic screening and are found to have dense breasts (BI-RADS density C or D). The randomised controlled trial includes three arms (952 women each): standard BreastScreen care (no notification of breast density; control arm); notification of dense breasts in screening results letter and print health literacy-sensitive information (intervention arm 1) or a link or QR code to online video-based health literacy-sensitive information (intervention arm 2). Baseline demographic data will be obtained from BreastScreen Queensland. Outcomes data will be collected in questionnaires at baseline and eight weeks, twelve months, and 27 months after breast screening. Primary outcomes will be psychological outcomes and health service use; secondary outcomes will be supplemental screening outcomes, cancer worry, perceived breast cancer risk, knowledge about breast density, future mammographic screening intentions, and acceptability of notification about dense breasts. ETHICS APPROVAL: Gold Coast Hospital and Health Service Ethics Committee (HREC/2023/QGC/89770); Sunshine Coast Hospital and Health Service Research Governance and Development (SSA/2023/QSC/89770). DISSEMINATION OF FINDINGS: Findings will be reported in peer-reviewed journals and at national and international conferences. They will also be reported to BreastScreen Queensland, BreastScreen Australia, Cancer Australia, and other bodies involved in cancer care and screening, including patient and support organisations. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000001695p (prospective: 9 January 2023).

Perceptions and implications for cervical screening and self-collection: A qualitative exploration of never and under-screened Queensland women.

BACKGROUND: Over 70% of cervical cancers are detected in women not currently screening. Queensland Health wanted to better understand the drivers of screening to inform our planning and capitalise on self-collection as an option to reach under-screened women. In 2020 Queensland Health commissioned qualitative research to explore barriers and enablers to cervical screening with never-screened and under-screened women in Queensland (with under-screeners defined as having last screened more than 4 years ago and being more than 2 years overdue). Additionally, the research explored the acceptability of self-collection amongst this cohort. METHODS: A mixed methods qualitative approach of online focus groups and in-depth interviews was employed. Online focus groups were conducted with under-screeners. In-depth telephone interviews were conducted with never-screeners due to the anticipated personal nature of their reasons for not screening. RESULTS: A total of 51 Queensland women aged 30 to 50 years participated in the research. CONCLUSIONS: Queensland women cited several negative experiences and aspects of the current program, as well as barriers in their social and personal lives that limited screening intention and behaviour. Barriers and enablers to cervical screening identified in this research have been classified into four categories: structural, knowledge and attitudinal, social, and personal. The research identified more factors associated with nonparticipation than participation. However, the research did uncover a range of potential enablers to encourage screening, some of which related to the program design. SO WHAT?: The concept of self-collection was broadly well accepted by research participants, particularly by never-screeners. Recommendations resulting from this research include communications, systems, and eligibility changes, particularly regarding the availability and benefits of self-collection.

Does physical activity increase the risk of unsafe sun exposure?

ISSUE ADDRESSED: Recent increases in the prevalence of self-reported participation in physical activity are encouraging and beneficial for health overall. However, the implications for sun safety need to be considered, particularly in Australia, which has the highest incidence of skin cancer in the world. This study investigated the relationship between physical activity and sunburn to determine if there is a need for integration of sun safety in physical activity promotion. METHODS: During the 2009/10 southern hemisphere summer, 7802 adults aged 18 to 74 years participated in a computer-assisted telephone interview survey which included a range of self-reported health measures including physical activity, sunburn, skin type, sun protection behaviour and demographic questions. Multivariate logistic regression modelling was undertaken to estimate the association between physical activity and sunburn. RESULTS: Those who reported doing any level of physical activity were significantly more likely to report having experienced sunburn in the past 12 months and on the last weekend, compared with those who did none, with the strongest association among those who undertook 7 hours or more. Each hour of physical activity was associated with a modest increase in the odds of experiencing sunburn in the previous 12 months (OR 1.02, 95% CI 1.010-1.037) and weekend (OR 1.04, 95% CI: 1.023-1.065), after adjusting for potential confounding variables. CONCLUSIONS: This study highlights the need for sun protection to be given more prominence in physical activity promotion in order to optimise health benefits without increasing the prevalence of sunburn and associated skin cancer risk.

The population approach to falls injury prevention in older people: findings of a two community trial.

BACKGROUND: There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. METHODS: Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. RESULTS: The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. CONCLUSIONS: The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented.

Testing an extended theory of planned behaviour to predict young people's sun safety in a high risk area.

OBJECTIVES: The present research examined the sun protection intentions and behaviours of young people in a high risk skin cancer area using an extended theory of planned behaviour (TPB) incorporating additional social influences of group and image norms. DESIGN: The study employed a prospective design to examine young people's sun protection intentions and behaviour. METHOD: Participants (N=1,134), aged 12-20 years, were students (school, university, TAFE) and young employees living in Queensland, Australia. Participants completed a questionnaire assessing the TPB predictors (attitude, subjective norm, perceived behavioural control) and additional social influences (group norm, image norm) of sun protection intentions. Two weeks later, participants (N=734) reported their sun protection behaviour for the previous fortnight. RESULTS: Results revealed that the TPB variables of attitude, subjective norm and perceived behavioural control and the additional social influence variable of group norms, but not image norms, emerged as significant predictors of intentions to engage in sun protection. The extended TPB variables accounted for 36% of the variance in intentions. For behaviour, the extended TPB variables accounted for 27% of the variance with both intention and, unexpectedly, group norm as the significant direct predictors of sun protective behaviours. CONCLUSIONS: Results of this study provide support for the application of the TPB in the sun safety context and highlight the importance of considering the influence of group norms in the development of future interventions to increase young people's sun protection intentions and behaviour.

Documenting the development of social capital in a community Safety Promotion Network: it's not what you know but who you know.

ISSUE ADDRESSED: The Mackay Whitsunday Safe Communities (MWSC) was established in February 2000 in response to high rates of injury observed in the region. A key objective was to consolidate and better coordinate a network of community groups already working in community safety promotion. METHODS: This study used Social Network Analysis (SNA) to document and analyse the social resources, or social capital, mobilised by the network. Using a snowballing methodology, the chain of relationships that constitute MWSC and its Support Network (SN) was elucidated and quantified. RESULTS: Since it was launched in February 2000, MWSC and its SN almost doubled its bonding social capital, while bridging social capital increased 160% and linking social capital increased 280%. Relationships were not evenly distributed. Forty-four per cent of relationships were maintained by six actors who also maintained 60% of the network's brokerage potential. CONCLUSION: SNA proved a powerful tool for describing and analysing relationships within the MWSC and its SN. It provided diagrammatic representation of the social structure and quantified important aspects of its structure and function. It highlighted the asymmetric distribution of relationships, resources and power that had a profound impact on how the network functioned.

Young people and sun safety: the role of attitudes, norms and control factors.

ISSUE ADDRESSED: Differences in the behavioural, normative and control beliefs of young Australian sun-protectors and non sun-protectors are analysed using a theory of planned behaviour belief-based framework. METHODS: A questionnaire assessed the sun-safety-related beliefs and perceptions of a Queensland sample (n=858) of young people aged between 12 and 20 years. Two weeks later, participants reported their sun-protective behaviour for the previous fortnight. RESULTS: The study found that clear differences emerged between sun-protectors and non-protectors on underlying normative and control beliefs related to sun-safety behaviours (but not behavioural beliefs). Specifically, sun-protectors were more likely to believe that their friends and family think they should perform sun-protective behaviours. Sun-protectors were also more likely to perceive that a range of motivating factors would encourage them to perform sun-safety behaviours. Finally, non-protectors were more likely to report forgetfulness and laziness as barriers preventing them from performing sun-protection behaviours than sun-protectors. CONCLUSIONS: Findings indicate that future interventions should target young people's normative and control beliefs related to sun safety.

The injury iceberg: an ecological approach to planning sustainable community safety interventions.

ISSUE ADDRESSED: A systematic ecological framework in which to design sustainable, community-based, safety promotion interventions is presented. METHOD: A literature review was undertaken of English-language articles addressing the topics of 'ecological injury prevention or safety promotion', 'ecological health promotion', 'sustainable economic, health or ecological systems' and 'steady state', with 143 articles retrieved and reviewed. RESULTS: Injury prevention is a biomedical construct, in which injury is perceived to be a physical event resulting from the sudden release of environmental energy producing tissue damage in an individual. This reductionist perspective overlooks the importance of psychological and sociological determinants of injury. Safety has physical, psychological and sociological dimensions. It is inherently an ecological concept. Interventions aiming to achieve long-term improvements in community safety must seek to develop sustainable safety promoting characteristics within the target community. CONCLUSION: To reduce a community's risk of injury and sustain this lowered risk, the community 'ecological system' must have access to the resources necessary to maintain the desired outcome and the ability to mobilise these resources.

Physical activity improves strength, balance and endurance in adults aged 40-65 years: a systematic review.

QUESTION: Can physical activity in adults aged 40-65 years enhance strength and balance and prevent falls? DESIGN: Systematic review with meta-analysis of randomised clinical trials. PARTICIPANTS: Healthy adults aged 40-65 years. INTERVENTION: Programs that involved the performance of any physical activity in community settings and workplaces. OUTCOME MEASURES: Strength, balance, endurance, and falls rate. RESULTS: Twenty-three eligible trials were identified and 17 of these were pooled in the meta-analyses. The meta-analysis of strength outcomes found a moderate effect of physical activity on strength (SMD=0.54, 95% CI 0.38 to 0.70). Larger effects were observed from programs that specifically targeted strength (SMD=0.68, 95% CI 0.49 to 0.87), when compared to those that did not (SMD=0.32, 95% CI 0.09 to 0.55). This difference was statistically significant (effect of strength in meta-regression p=0.045). Physical activity also had a moderate effect on both balance (SMD=0.52, 95% CI 0.24 to 0.79) and endurance (SMD=0.73, 95% CI 0.50 to 0.96). No trials reported effects of physical activity on falls soon after receiving the intervention. A statistically non-significant effect on falls 15 years after receiving a physical activity intervention was found in one trial (RR=0.82, 95% CI 0.53 to 1.26). CONCLUSIONS: This review found that muscle strength, balance, and endurance can be improved by physical activity in people aged 40-65 years. There were bigger effects on muscle strength from programs that used resistance exercises, indicating the need to include a resistance training component if strength enhancement is the goal.