Parents' attitudes towards the No Jab No Play legislation in Western Australia: a mixed methods study.

BACKGROUND: Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA). METHODS: This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. RESULTS: Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents' beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities. CONCLUSIONS: Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.

A Review of Interventions for Drowning Prevention Among Adults.

Adult drowning is a complex and multifactorial public health challenge requiring community, national and global efforts to mitigate impacts. This study updates the evidence base for public health interventions that address adult fatal and non-fatal drowning. A systematic review was undertaken of the peer-reviewed literature for English-language primary studies published between 2011 and 2021describing a drowning intervention with adults. Twenty-two studies were included. Most studies (n = 16) were conducted in high-income countries. Yearly trends in drowning prevention intervention publications were analysed with 2015 (n = 6) the peak publishing year. Over half of the study designs were pre-post (n = 15). Intervention duration ranged from 4 hours to 11 years. Ten studies described either behaviour change theory or formative evaluation to inform design. Thirteen studies targeted interventions at a population level, seven at a group level and two at individual level. Studies identified a range of prevention strategies, categorised as behavioural (n = 9) (e.g., swimming lessons), socio-ecological (n = 8) (e.g., mandatory personal flotation devices) and mixed (n = 5) (e.g., awareness campaign and barriers to prevent access to water). A range of outcomes were described including changes in awareness, water safety knowledge, attitudes, water safety behaviours and skills, environmental, policy and regulation changes and drowning rates. Findings indicate a small but important increase in the evaluation and publication of effective interventions to prevent adult drowning. The complexity of the issues surrounding drowning requires multi-strategy and context -specific adult focused prevention interventions. Contemporary evidence that identifies effective interventions that contribute to prevention efforts is an essential first step in addressing the challenge.

Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs.

This study aimed to use systems thinking tools to understand network relationships to inform discussions, policy, and practice to improve nutrition, physical activity, and overweight/obesity prevention activities in a Western Australian local government area. An audit of nutrition, physical activity, and obesity prevention activities was conducted, and identified organizations were invited to participate in an organizational network survey. Social network analysis (SNA) determined the extent to which organizations shared information, knowledge, and resources; engaged in joint program planning; applied for and shared funding; and identified operational barriers and contributors. SNA data were mapped and analyzed using UCINET 6 and Netdraw software. Five organizations within the network were identified as core; the remainder were periphery. The strongest networks were sharing information, and the weakest was funding. The connections were centralized to one organization, enabling them to readily influence other organizations and network operations. Remaining organizations indicated limited partnership across the networks. Strengthened collaborations and partnerships are essential to health promotion, as they extend reach and organizational capabilities. This study provides a process for undertaking network analysis, identifying leverage points to facilitate communication and information sharing, and reorienting of collaborations and partnerships to consolidate scarce resources and act strategically within a bounded area. There is a need for stronger relationships between organizations and a reorientation of partnerships to facilitate resource sharing within the local government area, to improve nutrition, physical activity, and obesity prevention practices. SNA can assist in understanding organizational prevention networks within a bounded area to support future planning of practices and policy.

Build and they will come: A follow-up evaluation of outdoor exercise equipment in Western Australia.

ISSUE ADDRESSED: In Australia, the role of local governments authorities (LGAs) are diverse, ranging from waste collection to the provision of recreational facilities, such as parks. One strategy to improve parks is outdoor exercise equipment (OEE), and provide free, community-based physical activity opportunities. We undertook an observational study to capture a profile and behaviour of park visitors and OEE users in 2012 and 2019. METHODS: We compared observational data at two parks using the System for Observing Play and Recreation in Communities (SOPARC) in March and June 2012 and 2019. Data were collected 6:30-7:30 AM and 5:30-6:30 PM weekdays; 8:30-9:30 AM and 3:30 to 4:30 PM weekends. Two trained staff collected data concurrently. RESULTS: Total n = 1654 visitors were observed, most at Park One (68.0%; n = 1117), half were male (50.9%; n = 841). There were significant differences in the gender of visitors across the two parks (P < 0.001). Most visitors observed were young adults (42.6%; n = 705; P < 0.001). In 2012, 3.9% (n = 65) of all observed park visitors used the OEE, in 2019, this increased to 4.8 % (n = 78). CONCLUSIONS: The adage 'Build it, and they will come' did not resonate with the two parks' local community. The key challenge is attracting people to local parks making OEE use attractive and easy. SO WHAT?: There is a demand for the provision of active environments that are accessible and inexpensive. LGAs may hold the key to delivering this infrastructure supported by diverse strategies to engage and promote the benefits of being physically active for all ages.

A comparison of face-to-face and fully online problem-based learning: Student results and staff experiences, 2014-2020.

ISSUE ADDRESSED: Problem-based learning (PBL) is a student-directed pedagogy that promotes critical thinking, self-directed learning and communication skills essential for health promotion students and practitioners. This paper reports on student results, student evaluation and staff experience of PBL in the face-to-face and fully online environment in an undergraduate health sciences unit in an Australian university. METHODS: A single time-point study using quantitative and qualitative administrative student data (2014-2020) and narrative reflection from teaching academics (n = 5) was undertaken. Descriptive, independent t test and bivariate analyses for student results data were conducted; an inductive approach was used to analyse qualitative data and create codes. RESULTS: Student sample (n = 472) consisted face-to-face (n = 358, 75.8%) and online (n = 114, 24.2%) enrolments. Final Unit Mark was significantly higher for fully online students compared with face-to-face students in 2018 (P = .007) and 2019 (P = .001). Final Unit Achievement was significantly higher for fully online students compared with face-to-face students in 2018 (P = .017) and 2019 (P = .043). Three themes emerged: The PBL approach; Evolution of PBLs; Student skills and competencies. DISCUSSION: PBL allows students to learn through facilitated problem solving and strong collaborative skills. The face-to-face and fully online PBLs improved the student and academic staff experience, while supporting the development of critical thinking and self-directed research. Further, it supported students to develop their core health promotion competencies; and enhanced the online student learning experience. SO WHAT?: Vital for contemporary, global graduates, the fully online PBL approach allows students to build critical academic and professional skills utilising current information technology relevant for collaborative professional practice.

"I never had a thought about drowning". Exploring water safety attitudes and practices among older adults in Western Australia.

OBJECTIVES: The aim of this study was to explore factors associated with drowning among older adults aged 65 years and over in Western Australia. METHODS: This paper was concerned with illuminating older adults experience and perspectives of water safety and drowning prevention. The study used in-depth, semi-structured interviews (n = 15) to examine knowledge, attitudes, beliefs and behaviours. The interviews were analysed using a phenomenological hermeneutical interpretation whereby three steps were taken to identify common patterns of meaning from individual's lifeworld. DISCUSSION: Interviews captured the voices of those who identified as swimmers and those who identified as nonswimmers and revealed nine constitutive patterns which support a central theme of life around water. This study provides insights into perceptions and experiences of water safety as individuals' age. The findings suggest individuals who perceived themselves as strong swimmers had a decreased perception of risk, while participants who self-identified as weak swimmers were more likely to avoid risks and modified their behaviour accordingly. Findings highlighted low water safety literacy and suggest that older people not only underestimate their drowning risk, but also lack an understanding of the risk factors for drowning. SO WHAT?: The findings from this study will have a direct impact on the development of a WA health promotion program to prevent drowning among older adults.

Initiatives and partnerships in an Australian metropolitan obesity prevention system: a social network analysis.

BACKGROUND: Limited resources make prevention of complex population-level issues such as obesity increasingly challenging. Collaboration and partnerships between organisations operating in the same system can assist, however, there is a paucity of research into how relationships function at a local level. The aim of this study was to audit initiatives, explore networks, and identify potential opportunities for improving the obesity prevention system in a Health Service area of Western Australia (WA). METHODS: A mixed-methods study was undertaken in a metropolitan Health Service in Perth, WA in 2019-20. Structured face-to-face interviews (n = 51) were conducted with organisations engaged in obesity prevention, to identify prevention initiatives and their characteristics using a Systems Inventory tool. The Research Team identified the 30 most active organisations during the Systems Inventory, and an online Organisational Network Survey was administered to explore: relationships across six domains; partnership duration; frequency of interaction with other organisations; barriers to implementation; and key contributions to obesity prevention. Descriptive statistics were used to summarise barriers, contributions and Systems Inventory data. Organisational Network Survey data were analysed using social network analysis through UCINET 6 for Windows and Netdraw software. Whole network and cohesion scores were calculated: average degree; density; diameter; and degree centralization. Core-periphery analysis was conducted to identify densely connected core and sparsely connected periphery organisations. RESULTS: The Systems Inventory identified 189 unique prevention initiatives, mostly focusing on individual-level behaviour change. Fifty four percent (n = 15) of the Organisational Network Survey respondent organisations and most core organisations (67%, n = 8) were government. The information and knowledge sharing network had a density of 45% indicating a high level of information and knowledge exchange between organisations. The lowest densities were found within the receiving (3.3%), providing (5.5%) and sharing (5.6%) funding networks, suggesting that these formal relationships were the least established. CONCLUSION: Applying a systems thinking lens to local obesity prevention revealed that initiatives conducted focused on individual-level behaviour change and that collaboration and communication between organisations focused on information sharing. Capturing the extent and nature of initiatives and the way partnerships operate to improve obesity prevention can help to identify opportunities to strengthen the networks.

"A content analysis of news media coverage of drowning events in Western Australia over two summers, 2014-2016".

ISSUE ADDRESSED: Drowning is a leading cause of death globally. Opportunities to promote drowning prevention in news media may be overlooked for attention-grabbing headlines, imagery and narrative. This study examines news media coverage of fatal drowning events in Western Australia (WA). METHODS: Coronial fatal drowning data in WA were extracted for two summer time periods (2014-2016) by date, age, gender, location and description. Corresponding print and online news articles were captured using: (i) Media Alert; (ii) Google News; (iii) Factiva. A content and frame analysis protocol was developed. A qualitative approach was taken to analyse the news angle. A subgroup analysis was undertaken for drowning focused articles. RESULTS: The final sample (n = 50) news articles matched 17 individual drowning events (T1, n = 9; T2, n = 8). Drowning stories rarely appeared on page 1 (n = 2), but were located in the first 2-10 pages (n = 20) (66.6%). In the subanalysis, one-fifth (22%) of the articles employed a news angle relating to community spirit and celebration of life. There were 32 mentions of "who was responsible for the drowning event." Environmental factors were most cited for "what was responsible" (20.4%). Experts were cited in 66.7% of articles and drowning prevention strategies were mentioned in nine of the 50 articles. CONCLUSION: Drowning was considered newsworthy; however, not the front page news. Reporting infrequently prioritised drowning prevention or discussed prevention strategies. SO WHAT?: Working closely with news outlets to embed drowning prevention messages in news stories during high-risk periods such as summer is an imperative.

Lifetime recreational physical activity and the risk of prostate cancer.

PURPOSE: Research on the association between physical activity and the risk of prostate cancer is inconsistent. The aim of this study was to investigate whether the timing, intensity, and type of recreational physical activity influence prostate cancer risk. METHODS: A population-based case-control study was conducted in Western Australia in 2001-2002. Data were collected on lifetime recreational physical activity from a self-reported questionnaire. The estimated effects of recreational physical activity on prostate cancer risk were analyzed using logistic regression, adjusting for demographic and lifestyle factors. This analysis included 569 incident cases and 443 controls. RESULTS: There was a significant, inverse dose-response relationship between vigorous-intensity recreational physical activity between the ages 19 and 34 years and the risk of prostate cancer (pTrend = 0.013). Participants in the most active quartile of vigorous-intensity physical activity in this age period had a 33% lower risk of prostate cancer than participants in the least active quartile (Adjusted Odds Ratio = 0.67, 95% confidence interval = 0.45-1.01). Moderate-intensity recreational physical activity was not associated with the risk of prostate cancer. Recreational physical activity performed over the lifetime showed no association with prostate cancer risk. Weight training performed from early adulthood onwards showed a non-significant but consistent inverse association with prostate cancer risk. There was no strong evidence that physical activity was differentially associated with the risks of low-grade and medium-to-high grade prostate cancers. CONCLUSIONS: A high level of vigorous recreational physical activity in early adulthood may be required to reduce the risk of prostate cancer.

Mobile device use when caring for children 0-5 years: A naturalistic playground study.

ISSUE ADDRESSED: Over the past decade, mobile device use has increased significantly. Adults are now using their mobile device whilst undertaking a range of work and social activities. This naturalistic study aimed to understand parents/carers' use of mobile devices and their associated beliefs about mobile device use whilst caring for children aged five and younger in playgrounds. METHODS: A mixed methods approach was used to collect quantitative and qualitative data from parents/carers. Data were collected by observations (n = 50) and interviews (n = 25) in playgrounds on the North Coast of New South Wales, Australia. RESULTS: Of the 50 observed parents/carers, 76% (n = 38) used their mobile device, with usage time extending to 17.2 minutes of the 20 minute observation period. Text-/type-related mobile device use was most often used (69.6%), followed by voice-related (23.7%) and camera-related mobile device use (6.7%). The 25 interviewed parents/carers beliefs on mobile device use were centred on three themes: diversity of mobile device use, child relationships and mobile device use and the physical environment and mobile device use. CONCLUSION: This study adds to the limited research into parent/carer mobile device use, which has become an integral part of peoples' lifestyle. However, research is required to better understand how parent/carer mobile device use may impact on child supervision and interaction. SO WHAT?: Mobile device use is increasing. We need to better understand its public health impact.

A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries.

Globally, drowning is one of the ten leading causes of child mortality. Children aged <5 years are particularly at risk, and children and young people continue to be overrepresented in drowning statistics. Accordingly, evidence informed interventions to prevent children drowning are of global importance. This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention.

Recreational Drowning Prevention Interventions for Adults, 1990-2012: A Review.

Drowning is a frequently occurring and preventable public health issue. Internationally, drowning literature has focussed on children under 5 years, however, evidence based interventions to prevent adult drowning are needed to reduce deaths on a global scale. The aim of this paper is to systematically identify and analyse the evidence for drowning interventions with an adult focus. A systematic search was undertaken for peer-reviewed articles which were published in English between 1990 and 2012, focused on adults and described a drowning intervention. After quality appraisal by expert reviewers using a purposively tailored checklist, a final total of six studies were included for review. The six studies were all conducted in high income countries. Four were drowning interventions, two were retrospective analyses. The drowning interventions duration ranged from 10 days to 5 years, the analysis studies from 6 to 21 years. Two of the studies reviewed used behaviour change theory to inform development, and two reported formative evaluation. Prevention strategies included education (n = 3), technology (n = 1) and environmental (n = 1). Positive short term effects and significant behaviour change in life jacket use was reported (n = 2). A mixed effect was observed in the six studies. The complexity of the issues surrounding drowning requires the collection of robust data and evaluation of preventative measures to support the development of targeted and tailored prevention interventions. This review reinforces the need for a genuine and sustained global approach to addressing adult drowning prevention. Drowning is a serious public health issue and should receive the same attention as other public health priorities .

Who do we reach? Campaign evaluation of Find Thirty every day® using awareness profiles in a Western Australian cohort.

Mass media campaigns are part of a comprehensive, population-based approach to communicate physical activity behavior change. Campaign awareness is the most frequently reported, short-term comparable measure of campaign effectiveness. Most mass media campaigns report those who were aware with those who are unaware of campaigns. Few campaigns follow awareness in the same respondent, over time, during a mass media campaign to track different patterns of awareness or awareness profiles--"never," "early," "late," or "always"--that may emerge. Using awareness profiles, the authors (a) address any demographic differences between groups and (b) assess changes in physical activity. Find Thirty every day® was a populationwide mass media campaign delivered in Western Australia. The cohort comprised 405 participants, who completed periodic telephone interviews over 2 years. Almost one third (30.4%) were "never aware" of the campaign. More than one third recalled the campaign at one or more time points--"early aware." Ten percent became aware at Time 2 and stayed aware of the campaign across the remaining time. Examining within and across the awareness profiles, only gender was significant. This article provides an approach to profiling awareness, whereby people cycle in and out and few people are "always aware" over a 2-year period. It presents possible implications and considerations for future campaign planners interested in establishing and maintaining campaign awareness with adult populations.

Young people's alcohol use in and around water: A scoping review of the literature.

ISSUES: The surrounding social and commercial context, including alcohol advertising, heavily influences alcohol consumption. Alcohol use is a major risk factor for both fatal and non-fatal drowning, particularly for young people. APPROACH: We conducted a scoping review to explore the peer-reviewed literature on the use of alcohol by young people (aged 15-34 years) in the context of aquatic environments. Five electronic academic databases were searched for English-language studies conducted in high-income countries and published in the last 15 years (since 2008). The MetaQAT framework was used to assess methodological quality of included studies. KEY FINDINGS: The review included a total of 24 studies, including those addressing the prevalence of and/or risk factors for alcohol use in aquatic environments among young people (n = 13); the epidemiology of alcohol-related unintentional drowning in young people (n = 9); and interventions to reduce alcohol-related harm around water (n = 3). Findings suggest that young people commonly consume alcohol around water, particularly young men. We found multiple influences on this behaviour, including the perception of risk, location of aquatic activity and presence of others, particularly peers. IMPLICATIONS: Understanding the literature addressing alcohol use around water among young people will assist in identifying and setting priorities for drowning prevention, including the need to mitigate the effects of alcohol advertising which promotes drinking in and around water. CONCLUSION: There is a clear imperative to address the use of alcohol by young people in aquatic environments. These findings have key implications for public health policy, advocacy and practice.

Using ERIC to Assess Implementation Science in Drowning Prevention Interventions in High-Income Countries: A Systematic Review.

This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.

The Impact of the No Jab No Play and No Jab No Pay Legislation in Australia: A Scoping Review.

Australia has a long history of population-based immunisation programs including legislations. This paper reports on a review of evaluations of the impact of the federal No Jab No Pay (NJNPay) and state implemented No Jab No Play (NJNPlay) legislations on childhood immunisation coverage and related parental attitudes. Five databases were searched for peer-review papers (Medline (Ovid); Scopus; PsycInfo; ProQuest; and CINAHL). Additional searches were conducted in Google Scholar and Informit (Australian databases) for grey literature. Studies were included if they evaluated the impact of the Australian NJNPay and/or NJNPlay legislations. Ten evaluations were included: nine peer-review studies and one government report. Two studies specifically evaluated NJNPlay, five evaluated NJNPay, and three evaluated both legislations. Findings show small but gradual and significant increases in full coverage and increases in catch-up vaccination after the implementation of the legislations. Full coverage was lowest for lower and higher socio-economic groups. Mandates are influential in encouraging vaccination; however, inequities may exist for lower income families who are reliant on financial incentives and the need to enrol their children in early childhood centres. Vaccine refusal and hesitancy was more evident among higher income parents while practical barriers were more likely to impact lower income families. Interventions to address access and vaccine hesitancy will support these legislations.

Tap into Good Teeth--a Western Australian pilot study of children's drinking patterns.

UNLABELLED: ISSUED ADDRESSED: The increase trend in the prevalence of dental caries in Australian children is a concern to public health professionals. Attitudes, behaviours and lifestyle patterns established in childhood are often carried throughout adult life. The objective of the study was to estimate the proportion of Perth metropolitan year two public primary school children drinking tap water at home, school and play. It also aimed to explore knowledge and attitudes that children and parents have towards drinking tap water, bottled water, fruit juices and soft drinks. METHODS: Nine Western Australian government primary schools were recruited. A facilitator-led questionnaire was administered to year two primary school students and a matched parent self-administered questionnaire was also completed. RESULTS: Forty-two per cent of the children in our study reported if thirsty they drank tap (fluoridated) water at home whereas parents stated 60% of children drank tap water at home. The type of drink appeared to vary with time of day/activity while overall water was most frequently drunk; a higher proportion of milk was drunk at breakfast, whereas soft drinks were drunk in a greater proportion while watching television. CONCLUSION: This study found the vast majority of year two children in metropolitan Perth public primary schools are drinking tap water.