How social class shapes breast cancer risk perspectives and prevention practices of Australian midlife women: a qualitative study using the concept of 'breast cancer candidacy'.

BACKGROUND: The increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women's breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women's breast cancer risk perspectives. It engages Bourdieu's relational social class theory to unpack how women's social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention. METHODS: In this qualitative study 43 Australian midlife women (aged 45-64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu's concepts of habitus, capital, and fields to understand how women's social class positions shapes risk perspectives and prevention practices was conducted. RESULTS: This social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier 'lifestyles. 'They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen. CONCLUSIONS: Women interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices.

A monitoring and site visit intervention to reduce sales to minors at packaged liquor outlets.

ISSUE ADDRESSED: Selling alcohol to a minor is a serious offence in the New South Wales Liquor Act. However, minors report they can purchase alcohol easily. This study used an intersectoral partnership between the Central Coast Local Health District (CCLHD) Health Promotion Service, and Liquor & Gaming NSW (L&GNSW) Compliance Operations to test a site visit intervention to increase ID checks at packaged liquor outlets (PLOs). METHODS: As the current legislative framework does not allow minors to attempt to purchase alcohol from PLOs, even under compliance operations, this study employed pseudo-minors aged 18-19 years. Pseudo-minors visited all PLOs on the Central Coast, NSW in four survey rounds, attempting to purchase alcohol without ID. If a PLO sold alcohol to the pseudo-minor, they received a visit from a Health Promotion Officer and L&GNSW Inspector to inform them of the sale and that they are at risk of selling alcohol to a minor. RESULTS: Site visits were an effective intervention to increase the rates of ID checking. Alcohol sales to pseudo-minors without ID decreased from 34% in Round 1 to 7% in Round 4. Young sales staff and independent stores were less likely to check ID. CONCLUSIONS: This intervention was associated with some of the lowest rates of underage alcohol purchasing reported to date. However, it may not be sustainable in the long term. It is recommended that: future studies randomise site visits to investigate their contribution to the observed reduction, cost effectiveness of the intervention is explored and legislative change to allow controlled purchase operations for alcohol is considered. SO WHAT?: Young people under 18 years of age should not be able to purchase alcohol from liquor licence outlets, and strong laws apply if a sale is detected. However, despite these rules, young people still report they can access alcohol in this manner. Whilst our intervention of site visits with the regulatory body saw decreases in sales to our pseudo-minors, we advocate for controlled purchase operations (similar to tobacco control) as a more sustainable and effective intervention to reduce sales to minors - while this is not yet legislated for packaged liquor outlets in Australia, it is deemed best practice in other countries.

Thirsty? Choose Water! A regional perspective to promoting water consumption in secondary school students.

OBJECTIVE: Adolescents are high consumers of sugar-sweetened beverages (SSB), which contribute to overweight and obesity - a significant public health issue. Evidence suggests that replacing SSB with water and school-based interventions can reduce consumption. This study examines the acceptability of a previously trialled intervention (Thirsty? Choose Water!) in regional and remote secondary schools. DESIGN: An open-label randomised controlled trial using a two-by-two factorial design tested the outcomes of a behavioural and/or environmental intervention on SSB and water consumption. SETTING: Regional and remote secondary schools (public, catholic and independent) within the boundaries of two regional Local Health Districts within New South Wales. PARTICIPANTS: Twenty-four schools participated in the study. The target group was year 7 students (n 1640) - 72 % of eligible students completed baseline data. The study followed students into year 8 (n 1188) - 52 % of eligible students completed post-intervention data. Forty teachers undertook training to deliver the intervention. RESULTS: Interventions showed high levels of acceptability. Students demonstrated changes in knowledge, attitudes and consumption behaviours. Multivariable ordinal logression analysis demonstrated that all interventions increased the odds of students increasing their water consumption (though not statistically significant). Conversely, the combined (OR: 0·75; 95 % CI: 0·59, 0·97) or environmental intervention (OR: 0·68; 95 % CI: 0·51, 0·90) had greater odds of reducing SSB consumption and was statistically significant. CONCLUSIONS: This study builds on recent Australian evidence regarding the impact of school-based interventions on water and SSB consumption. In this study, despite a minor intervention change, and the impacts of fires, floods and COVID-19 on study implementation, the interventions were highly regarded by the school communities with positive outcomes.

Extending the sociology of candidacy: Bourdieu's relational social class and mid-life women's perceptions of alcohol-related breast cancer risk.

Alcohol is a modifiable breast cancer risk, increasing risk in a dose-dependent manner. Mid-life women (aged 45-64 years) consume alcohol at higher rates than younger women and this, combined with age, make them a high-risk group for breast cancer. This critical public health problem has a seemingly obvious solution (reduce drinking); however, women do not necessarily know alcohol causes breast cancer, and if they do, reducing consumption is not always possible, or desirable. To innovate public health responses, we employ an interpretative sociological framework 'candidacy' to understand women's perspectives on breast cancer risk relative to alcohol consumption and their social class. Drawing on 50 interviews with Australian mid-life women, our findings reveal the socio-structural determinants of 'candidacy', that mean modifying alcohol consumption for breast cancer prevention is impacted by social class. Utilising Bourdieu's relational capitals, our interpretations show how social class shapes women's ascriptions and enactments of breast cancer candidacy. We offer an important theoretical extension to 'candidacy' by demonstrating more or less fluidity in women's assessment of breast cancer risk according to their agency to adopt breast cancer prevention messages. Understanding the social class possibilities and limitations in women's perceptions of breast cancer risk provides a new opportunity to reduce inequities in breast cancer incidence.

The outcomes of Thirsty? Choose Water! Determining the effects of a behavioural and an environmental intervention on water and sugar sweetened beverage consumption in adolescents: A randomised controlled trial.

ISSUE ADDRESSED: Childhood obesity is a serious public health challenge. Consumption of sugar-sweetened beverages (SSBs) is one contributing factor, with adolescents being the highest consumers. METHODS: This study used a randomised controlled trial and two-by-two factorial design to determine the effectiveness of a school-based behavioural intervention (including education/promotional messages) and/or environmental intervention (chilled water station), on encouraging adolescents to choose water instead of SSBs. Sixty-one secondary schools (n = 8992 eligible students year 7 student) were recruited and randomly allocated to one of four study groups, the behavioural intervention, the environmental intervention, both interventions or neither. RESULTS: The primary outcome was increased water consumption; secondary outcomes included changes in students' knowledge and attitudes about water and SSBs and changes in SSB consumption. For students who received at least one intervention there was an increased odds (though not statistically significant) of higher water consumption compared to those that received no intervention. There was a decrease in SSB consumption for students who received both interventions combined (OR: 0.67; 95% confidence interval: 0.55-0.082; P < .01). CONCLUSIONS: The combined intervention had a greater effect on decreasing SSBs consumption. This is noteworthy given SSBs are a key contributor to overweight and obesity. SO WHAT?: To our knowledge this is the first Australian study examining combined school-based interventions to specifically promote the consumption of water and decrease the consumption of SSBs in adolescents. The study findings add to the evidence regarding the benefits of delivering multicomponent school-based interventions which add value to existing interventions that address the complex public health issue of overweight and obesity.

Place of alcohol in the 'wellness toolkits' of midlife women in different social classes: A qualitative study in South Australia.

In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

'I have a healthy relationship with alcohol': Australian midlife women, alcohol consumption and social class.

Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women's lives. This paper draws on 50 qualitative interviews with midlife women (45-64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or 'breaking up with') alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing drinking patterns. If classed differences are not attended to in health promotion efforts, this might mitigate the effectiveness of alcohol risk messaging to women.

Assessing the responses of smokers to requests to stop smoking on hospital grounds.

ISSUE ADDRESSED: Fear of aggression is often cited as an issue for health service staff in approaching smokers who are breaching smoke-free policies. This study collected data to quantify the interactions between Health Promotion Service staff and smokers. The aim was to trial de-escalation based protocols for Authorised Inspectors and one for general staff with regards to the aggression risk to staff when approaching smokers within hospital grounds. METHODS: The study design was a non-randomised trial with no control group. A standard protocol was developed, based on de-escalation techniques. The primary outcomes of the study were measures of aggression and smokers' compliance with instructions to extinguish their cigarette. Aggression was recorded using the Modified Overt Aggression Scale (MOAS). Two hundred interactions were conducted with smokers during business hours by Health Promotion Service staff. The first 100 interactions were based on an enforcement methodology typically delivered by Authorised Inspectors, while the second 100 interactions were based on an information and assistance methodology to reflect those that could be delivered by general health service staff. RESULTS: Only four instances of aggression were experienced, representing 2% of all interactions. Each of these was limited to verbal aggression. No self-aggression, aggression against property, or physical aggression was encountered. Smokers were significantly more compliant to instructions to extinguish their cigarette in the enforcement method (64%) than the information and assistance method (45%) (P < .001). Groups of smokers were more compliant than individual smokers in the enforcement method (76.3% compared to 56.5%, P < .05). CONCLUSIONS: This study quantifies the risk of aggression to health service staff conducting smoking compliance interactions using two methodologies. By following de-escalation-based protocols, staff can approach smokers in a low-risk manner and support smoke-free policy implementation and compliance. For general staff, the emphasis of interactions must be on providing information and assistance to smokers, not enforcement, as indicated by the reduced rate of immediate compliance, introducing an increased risk of escalation if enforcement is attempted. SO WHAT?: These protocols could be implemented by other health services or organisations that are seeking to optimise the involvement of staff in supporting smoke-free policies.

Thirsty? Choose Water! Encouraging Secondary School Students to choose water over sugary drinks. A descriptive analysis of intervention components.

BACKGROUND: Childhood obesity is a significant public health issue. Sugar-sweetened beverage (SSB) consumption contributes to this and adolescents are high consumers. This paper provides a descriptive overview of a school-based intervention to address this. METHODS: 61 secondary schools in New South Wales were randomised to receive a behavioural intervention (BI), a chilled water station (CWS), both interventions or neither (control). The BI was delivered through classroom lessons, school-based promotion and vaccination clinic. The CWS intervention included the installation of one CWS per school. Intervention effectiveness over time was assessed via student surveys at baseline, post-intervention and follow-up (individual-level outcomes), feedback from teachers and vaccination nurses, a school information survey, and remotely monitored CWS water usage (school-level outcomes). RESULTS: Teachers reported the BI was useful in teaching students about drinking water and negative consequences of SSBs. Nurses considered the post-vaccination waiting period a good opportunity to deliver health promotion messages. Students in this group showed statistically significant changes in knowledge about SSBs, dehydration effects and changes in daily SSB consumption (T1 23.18%; T3 18.20%). Positive feedback regarding CWSs was received with an increase in water consumption reported for students in this group (T1 86.15% to T3 89.66%) and a statistically significant increase in students carrying a water bottle to school and filling it observed. CONCLUSIONS: Both interventions were readily implemented with high levels of acceptability and impact on students' knowledge and SSB consumption. The study demonstrates how to promote water consumption in schools utilising two different interventions. SO WHAT?: Evidence regarding how to decrease SSB consumption amongst secondary school students has been strengthened.

Adaptation of public health initiatives: expert views on current guidance and opportunities to advance their application and benefit.

While there is some guidance to support the adaptation of evidence-based public health interventions, little is known about adaptation in practice and how to best support public health practitioners in its operationalization. This qualitative study was undertaken with researchers, methodologists, policy makers and practitioners representing public health expert organizations and universities internationally to explore their views on available adaptation frameworks, elicit potential improvements to such guidance, and identify opportunities to improve implementation of public health initiatives. Participants attended a face to face workshop in Newcastle, Australia in October 2018 where World Café and focus group discussions using Appreciative Inquiry were undertaken. A number of limitations with current guidance were reported, including a lack of detail on 'how' to adapt, limited information on adaptation of implementation strategies and a number of structural issues related to the wording and ordering of elements within frameworks. A number of opportunities to advance the field was identified. Finally, a list of overarching principles that could be applied together with existing frameworks was generated and suggested to provide a practical way of supporting adaptation decisions in practice.

The Experiences of Youth Mental Health Peer Workers over Time: A Qualitative Study with Longitudinal Analysis.

Peer work is a rapidly growing part of the mental health workforce, yet few studies explore the implementation of peer work in youth mental health. Qualitative focus groups were conducted with eight youth peer workers at the commencement of their employment, then at 3-months and 6-months after this time. Data were transcribed verbatim and analysed using thematic and trajectory analysis. The three main findings included: (1) there was a trajectory from fear to hope; (2) there was an improved understanding of benefits and role definition over time; and (3) there was an evolving concept of understanding shared experiences as a primary asset. Known barriers to implementing peer work are likely to occur in youth mental health settings as well. Ensuring that adequate training, change management and tailored support strategies are important to maximise the chances of successful youth peer work programs.

Optimisation: defining and exploring a concept to enhance the impact of public health initiatives.

BACKGROUND: Repeated, data-driven optimisation processes have been applied in many fields to rapidly transform the performance of products, processes and interventions. While such processes may similarly be employed to enhance the impact of public health initiatives, optimisation has not been defined in the context of public health and there has been little exploration of its key concepts. METHODS: We used a modified, three-round Delphi study with an international group of researchers, public health policy-makers and practitioners to (1) generate a consensus-based definition of optimisation in the context of public health and (2i) describe key considerations for optimisation in that context. A pre-workshop literature review and elicitation of participant views regarding optimisation in public health (round 1) were followed by a daylong workshop and facilitated face-to-face group discussions to refine the definition and generate key considerations (round 2); finally, post-workshop discussions were undertaken to refine and finalise the findings (round 3). A thematic analysis was performed at each round. Study findings reflect an iterative consultation process with study participants. RESULTS: Thirty of 33 invited individuals (91%) participated in the study. Participants reached consensus on the following definition of optimisation in public health: "A deliberate, iterative and data-driven process to improve a health intervention and/or its implementation to meet stakeholder-defined public health impacts within resource constraints". A range of optimisation considerations were explored. Optimisation was considered most suitable when existing public health initiatives are not sufficiently effective, meaningful improvements from an optimisation process are anticipated, quality data to assess impacts are routinely available, and there are stable and ongoing resources to support it. Participants believed optimisation could be applied to improve the impacts of an intervention, an implementation strategy or both, on outcomes valued by stakeholders or end users. While optimisation processes were thought to be facilitated by an understanding of the mechanisms of an intervention or implementation strategy, no agreement was reached regarding the best approach to inform decisions about modifications to improve impact. CONCLUSIONS: The study findings provide a strong basis for future research to explore the potential impact of optimisation in the field of public health.

Thirsty? Choose Water! Behavioural interventions and water stations in secondary schools a two-by-two factorial randomised controlled trial.

BACKGROUND: Childhood overweight and obesity is a significant public health issue. A key contributing factor is sugar sweetened beverages (SSBs) consumption. Evidence suggests that secondary school students are frequent consumers of SSBs, with high daily consumption. The promotion of water consumption and provision of chilled water stations can reduce SSBs consumption. The Thirsty Choose Water! study will evaluate the effectiveness of two interventions, a behavioural intervention, Thirsty? Choose Water! behavioural intervention (TCW-BI), that target students through the domains of the health promoting high schools framework, and the second intervention is the installation and promotion of chilled water stations. METHODS/DESIGN: This community trial will recruit 60 secondary schools from across three Local Health Districts (LHDs) within New South Wales (NSW). A two-by-two factorial study design will be used to determine the effect of the Thirsty? Choose Water! behavioural intervention (TCW-BI), and the installation of chilled water stations. The recruited secondary schools will be randomised and non-blinded to one of four study arms receiving either the TCW-BI or chilled water stations, both interventions, or neither (control group). Baseline measures will be collected including student self-report surveys which will gather data regarding knowledge, attitudes and consumption of water and SSBs, a school profile and an environmental scan. Student surveys will be repeated post the intervention and at follow-up. Regular water meter readings will determine the water flow from the chilled water stations across the study period. DISCUSSION: There is an increasing body of evidence which suggests that decreasing consumption of SSBs can impact positively on childhood overweight and obesity. However, in the Australian context there are limited studies on how this may occur in the secondary school setting. This study will add to this evidence base and establish the effectiveness of TCW-BI and chilled water stations, either alone or combination on increasing water consumption in adolescents. Information about barriers and facilitators to implementation will be documented. Packages to support the implementation of the TCW-BI as a state-wide initiative will be developed. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register ACTRN12618000526279 April 2018.

Headspace Gosford data: The local application of a National model.

OBJECTIVES: Despite the high prevalence of mental health problems for young Australians, many do not have ready access to treatment or are reluctant to seek help. Until recently there was a tendency for young Australians to fall between the gap of Child and Adolescent Mental Health Services and Adult Mental Health Services, and this has contributed to low rates of service use for young people. In 2006, the Australian Government sought to redress this gap in service delivery with its establishment of the Australian National Youth Mental Health Foundation, headspace. This paper presents demographic data collected at headspace Gosford over a 5.5-year period. CONCLUSIONS: The data presented indicates that headspace Gosford has been successful in improving early access to mental health treatment for young people on the Central Coast, in particular for young people aged 14-18. Headspace Gosford has attracted young people of both sexes, with a higher proportion of females. The majority of young people access headspace for mental health problems, predominantly depression and anxiety; however, a significant proportion report physical health or alcohol and drug-related reasons. The likelihood of these referral reasons is informed by gender and age.

Enhancing parenting skills for parents with mental illness: the Mental Health Positive Parenting Program.

OBJECTIVE: To determine the effect of the Mental Health Positive Parenting Program (MHPPP) on parenting practices of parents reporting a mental health problem. DESIGN, SETTING AND PARTICIPANTS: A prospective before-and-after examination of positive parenting skills and parent-reported child outcomes among parents of children aged 2-10 years who had self-reported a mental health problem. One hundred and eleven (85.4%) of 130 parents who commenced the MHPPP completed the program. Of these, 77.5% (n = 86) completed both before- and after-intervention measures. The MHPPP was conducted across four community health centres. INTERVENTION: A 10-week intervention was tailored to parents with a mental health problem. The intervention was divided into a 6-week group parenting program based on the Positive Parenting Program and four weekly home visits. MAIN OUTCOME MEASURES: Parental discipline practices and children's behaviour were measured by the Parenting Scale (PS) and the Eyberg Child Behavior Inventory (ECBI), respectively. RESULTS: Following the MHPPP, parents scored significantly lower on each of the PS subscales: laxness (Z = - 6.23; P < 0.001), over-reactivity (Z = - 7.15; P < 0.001) and verbosity (Z = - 6.59; P < 0.001); and significantly lower on both ECBI subscales: intensity (Z = - 7.08, P < 0.001) and problem (Z = - 7.57; P < 0.001). CONCLUSIONS: Our findings suggest the MHPPP can reduce the number of dysfunctional parenting strategies and parent-reported child behavioural problems. The MHPPP is a promising avenue for early intervention in this population.

Prevalence of parents within an adult mental health service: census results 2008-2011.

OBJECTIVE: The objective of this article is to determine the prevalence of parents of children (aged 0-17 years) within a mental health service system and gather contextual data regarding this population. METHOD: The study uses a census approach. The Census is conducted annually across Central Coast Adult Mental Health Services, NSW, Australia. All five community mental health teams and four acute inpatient units within the service participate, with each team completing Census forms for active clients identified as parents on Census day. The Census form collects data on parents and children including demographic data, parental diagnosis, parental contact and risk factors. RESULTS: Consecutive data shows 25-28% of active clients are parents. Annually, at least 400 children are identified; approximately 60% reside permanently with their parent with a mental illness. CONCLUSIONS: The Census is a valuable tool to determine the prevalence of parenthood. Moreover, it collects contextual data on this population. Data show an emerging relationship between parental diagnosis and parental contact. A picture of level of risk across the system has also been highlighted. Results add to the evidence regarding parental mental illness and circumstances of these families. The data clearly articulate a large need for interventions for children of parents with a mental illness (COPMI) within this population, given the high proportion of children who permanently reside with their parent with a mental illness.

Use of Kids Helpline by Children and Young People in Australia During the COVID-19 Pandemic.

PURPOSE: The benefits of helplines are particularly valuable during a pandemic when face-to-face services and natural supports are difficult to access. Kids Helpline, Australia's national youth helpline, provides children and young people with free 24/7 information and counseling through telephone, WebChat, and e-mail. We aimed to examine the use of Kids Helpline during the COVID-19 pandemic. METHODS: We analyzed monthly and weekly time trends of demand for and response by the Kids Helpline. The frequency of counseling contacts by common concern types, age, and gender were also examined. We used Joinpoint regression. RESULTS: Analyses of weekly demand for Kids Helpline showed an increase when the pandemic was declared, followed by a gradual decline. A second rise from 12 July 2020 when parts of Australia experienced a second wave of infections, followed by another decline, occurred more recently. Increased demand was almost entirely in the WebChat modality. Most answered counseling contacts were from girls and those aged 13-18 years. The number of contacts about mental health, suicide/self-harm, and family relationships increased, with mental health contacts also increasing as a proportion of total contacts. COVID-19-related concerns were the most common reason for contact in April 2020. CONCLUSIONS: In Australia, the COVID-19 pandemic saw a rapid increase in demand for Kids Helpline, mainly by WebChat, with the virus itself, mental health, suicide/self-harm, and relationships common reasons for contact. Responding to rapid changes in demand for particular modalities is challenging and understanding of the use and effectiveness of different modalities is needed.

Help-Seeking from a National Youth Helpline in Australia: An Analysis of Kids Helpline Contacts.

Counselling helplines or hotlines are key support services for young people with mental health concerns or in suicide and self-harm crises. We aimed to describe young peoples' use of a national youth helpline (Kids Helpline, Australia, KHL) to understand how usage changed over time. A descriptive analysis was conducted on 1,415,228 answered contacts between 2012-2018. We described the trend of service usage over the observed period, the types of youth who used the service, and the problems young people contacted the service about. Phone (APC = -9.1, KHL: -10.4 to -7.8, p < 0.001) and email (APC = -13.7, 95%CI: -17.1 to -10.2, p < 0.001) contacts decreased over time whereas webchat contacts increased (APC = 16.7, 95%CI: 11.7 to 22.0, p < 0.001). With this increase in webchat contacts, there was an associated increase in total webchat contact duration. Concerns raised in contacts to the service were primarily related to emotional wellbeing and mental health concerns (53.2% phone, 57.3% webchat, 58.2% email) followed by social relationship issues (20.4% phone, 20.3% webchat, 16.8% email) and family relationships (19.4% phone, 17.2% webchat, 21.8% email). The increased preference for online text-based information and counselling services can help inform development of services for young people and allocation of staff/service training and resources.

How Are the Links between Alcohol Consumption and Breast Cancer Portrayed in Australian Newspapers?: A Paired Thematic and Framing Media Analysis.

A dose-dependent relationship between alcohol consumption and increased breast cancer risk is well established, even at low levels of consumption. Australian women in midlife (45-64 years) are at highest lifetime risk for developing breast cancer but demonstrate low awareness of this link. We explore women's exposure to messages about alcohol and breast cancer in Australian print media in the period 2002-2018. METHODS: Paired thematic and framing analyses were undertaken of Australian print media from three time-defined subsamples: 2002-2004, 2009-2011, and 2016-2018. RESULTS: Five key themes arose from the thematic framing analysis: Ascribing Blame, Individual Responsibility, Cultural Entrenchment, False Equilibrium, and Recognition of Population Impact. The framing analysis showed that the alcohol-breast cancer link was predominantly framed as a behavioural concern, neglecting medical and societal frames. DISCUSSION: We explore the representations of the alcohol and breast cancer risk relationship. We found their portrayal to be conflicting and unbalanced at times and tended to emphasise individual choice and responsibility in modifying health behaviours. We argue that key stakeholders including government, public health, and media should accept shared responsibility for increasing awareness of the alcohol-breast cancer link and invite media advocates to assist with brokering correct public health information.

Revisiting Candidacy: What Might It Offer Cancer Prevention?

The notion of candidacy emerged three decades ago through Davison and colleagues' exploration of people's understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one's own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy's predictive ability, however, was fallible, and it was from this perspective that the public's reticence to adhere to prevention messages could be explained, as ultimately anybody could be 'at-risk'. This work continues to resonate in health research, with over 700 citations of Davison's Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.