The volume and type of unhealthy bus shelter advertising around schools in Perth, Western Australia: Results from an explorative study.

ISSUE ADDRESSED: Exposure to advertising for unhealthy food, alcohol and gambling has been shown to influence children and adolescents' behaviours and attitudes. This exploratory study aimed to assess the volume and type of unhealthy bus shelter advertisements near schools in five local government areas in Perth, Western Australia and to monitor whether the volume of unhealthy advertisements varied seasonally. METHODS: The 29 local governments in the Perth metropolitan region were contacted seeking information regarding the locations of bus shelters featuring advertisements in their local government area. Five local governments provided sufficient information for an audit of the bus shelter advertisements in their area to be conducted. Every bus shelter within 500 m of a school was photographed and the type of advertisement recorded. The advertisements in the food, non-alcoholic beverage, alcohol, or gambling categories were then classified as being healthy, moderate, or unhealthy. This process was carried out in June, September, December 2016, and March 2017 to ascertain whether the type of advertisements displayed changed depending on the season. RESULTS: Of the 293 advertisements recorded over the four audits, 31% featured unhealthy products, 3% moderate, and <1% healthy. Only two of the 293 advertisements were classified as being healthy. Seasonal variation in the volume of unhealthy advertisements was not identified. SO WHAT?: Western Australian school students are regularly exposed to unhealthy bus shelter advertisements. Stricter regulation of outdoor advertising is needed to ensure that young people are protected from the influence of unhealthy industries.

Planning for the next generation of public health advocates: evaluation of an online advocacy mentoring program.

Issue addressed Despite being viewed as a core competency for public health professionals, public health advocacy lacks a prominent place in the public health literature and receives minimal coverage in university curricula. The Public Health Advocacy Institute of Western Australia (PHAIWA) sought to fill this gap by establishing an online e-mentoring program for public health professionals to gain knowledge through skill-based activities and engaging in a mentoring relationship with an experienced public health advocate. This study is a qualitative evaluation of the online e-mentoring program. Methods Semi-structured interviews were conducted with program participants at the conclusion of the 12-month program to examine program benefits and determine the perceived contribution of individual program components to overall advocacy outcomes. Results Increased mentee knowledge, skills, level of confidence and experience, and expanded public health networks were reported. Outcomes were dependent on participants' level of commitment, time and location barriers, mentoring relationship quality, adaptability to the online format and the relevance of activities for application to participants' workplace context. Program facilitators had an important role through the provision of timely feedback and maintaining contact with participants. Conclusion An online program that combines public health advocacy content via skill-based activities with mentoring from an experienced public health advocate is a potential strategy to build advocacy capacity in the public health workforce. So what? Integrating advocacy as a core component of professional development programs will help counteract current issues surrounding hesitancy by public health professionals to proactively engage in advocacy, and ensure that high quality, innovative and effective advocacy leadership continues in the Australian public health workforce.

Outdoor workers and sun protection strategies: two case study examples in Queensland, Australia.

INTRODUCTION: Outdoor workers are at risk of developing skin cancer because they are exposed to high levels of harmful ultraviolet radiation. The Outdoor Workers Sun Protection Project investigated sun protection strategies for high risk outdoor workers in rural and regional Australia. METHODS: Fourteen workplaces (recruitment rate 37%) across four industries in rural and regional Queensland, Australia were recruited to the OWSPP. In 2011-2012, data were collected using pre- and post-intervention interviews and discussion groups. This article presents two workplaces as case study examples. RESULTS: The flat organisational structure of workplace 1 supported the implementation of the Sun Safety Action Plan (SSAP), whilst the hierarchical organisational nature of workplace 2 delayed implementation of the SSAP. Neither workplace had an existing sun protection policy but both workplaces adopted one. An effect related to the researchers' presence was seen in workplace 1 and to a lesser degree in workplace 2. Overt reciprocity was seen between management and workers in workplace 1 but this was not so evident in workplace 2. In both workplaces, the role of the workplace champion was pivotal to SSAP progression. CONCLUSIONS: These two case studies highlight a number of contextually bound workplace characteristics related to sun safety. These issues are (1) the structure of workplace, (2) policy, (3) an effect related to the researchers' presence, (4) the workplace champion and (5) reciprocity. There are several recommendations from this article. Workplace health promotion strategies for sun safety need to be contextualised to individual workplaces to take advantage of the strengths of the workplace and to build capacity.

An exploratory study identifying where local government public health decision makers source their evidence for policy.

ISSUE ADDRESSED: The Western Australian (WA) Public Health Bill will replace the antiquated Health Act 1911. One of the proposed clauses of the Bill requires all WA local governments to develop a Public Health Plan. The Bill states that Public Health Plans should be based on evidence from all levels, including national and statewide priorities, community needs, local statistical evidence, and stakeholder data. METHODS: This exploratory study, which targeted 533 WA local government officers, aimed to identify the sources of evidence used to generate the list of public health risks to be included in local government Public Health Plans. RESULTS: The top four sources identified for informing local policy were: observation of the consequences of the risks in the local community (24.5%), statewide evidence (17.6%), local evidence (17.6%) and coverage in local media (16.2%). CONCLUSIONS: This study confirms that both hard and soft data are used to inform policy decisions at the local level. Therefore, the challenge that this study has highlighted is in the definition or constitution of evidence. SO WHAT? Evidence is critical to the process of sound policy development. This study highlights issues associated with what actually constitutes evidence in the policy development process at the local government level. With the exception of those who work in an extremely narrow field, it is difficult for local government officers, whose role includes policymaking, to read the vast amount of information that has been published in their area of expertise. For those who are committed to the notion of evidence-based policymaking, as advocated within the WA Public Health Bill, this presents a considerable challenge.

Filling gaps - a case study in building advocacy capacity in the health promotion workforce.

Public health advocacy is a fundamental part of public health and health promotion practice. However, gaps exist in the provision of public health advocacy knowledge and skill acquisition both in the tertiary environment and within ongoing professional development programmes. The Goulburn Valley Public Health Unit partnered with the Public Health Advocacy Institute to build the skills of 49 public health and promotion professionals in their regions, to enable them to lead an advocacy project that aimed to promote state-wide initiatives. This involved a series of face-to-face skills-based public health advocacy workshops and post workshop e-mentoring. Results included the creation of locally relevant public health advocacy projects and a community of practice.

Monitoring injury reporting in selected Australian media: a potential advocacy strategy?

ISSUE ADDRESSED: This review of injury articles describes how selected primary print media sources in Australia report injury events and explores how this may impact on public perception of the injury risk and the opportunities it may present to health professionals. METHODS: Media articles specific to injury, compiled by the Public Health Advocacy Institute of Western Australia (PHAIWA) through their MediaWatch service during 2011, were collated and analysed. Articles were gathered from The West Australian, The Australian and The Sunday Times newspapers and ABC Online. Each article was categorised into injury topics and target groups, and preventive strategies were identified. RESULTS: Of the 546 articles that contained injury as a key word, 424 articles were used for the present study. The majority of articles related to community-based injuries (65%) and the most frequent reported injury was violence and assault. The results also indicate that although there is regular media reporting on injury issues, only one-fifth of reports discuss possible preventive measures. CONCLUSIONS: Selected Australian newspapers and the ABC Online are important and low-cost sources of injury-related information for the general public and can impact how the public perceives injury. It is important for public health professionals to embrace media advocacy strategies to assist in influencing and setting local public policy. So what? Public attitudes and understanding of issues are influenced by media coverage. Media monitoring is one tool to track what media sources are reporting about public health issues, the industry and stakeholders. Influencing the quantity and quality of media coverage is critical to advancing healthy public policy, particularly when advocating for prevention strategies to be reported and acted upon. Advocacy is an important health promotion strategy; it is therefore important for health professionals to understand media advocacy and position public health issues as societal issues with policy solutions.

Local government venues' sponsorship and signage policies to limit the promotion of harmful products: A Western Australian public health audit.

OBJECTIVE: Identify and assess publicly available local government sponsorship and signage policies related to harmful products in Western Australia (WA). METHODS: An audit of WA Local Government Authority (LGAs) websites (n=139) was conducted. Sponsorship, signage, venue hire and community grants' policies were located and assessed against set criterion. Policies were scored for the inclusion of statements regarding the display and promotion of harmful commodities (alcohol, tobacco, gambling products, unhealthy food and beverages). RESULTS: Across WA local governments, 477 relevant policies were identified. Six percent (n=28) included statements restricting the promotion of at least one harmful commodity via sponsorships, signage, venue hire, and sporting and/or community grants policy. Twenty-three local governments had at least one policy that restricted unhealthy signage or sponsorship. CONCLUSIONS: Most WA local governments do not have publicly available policies that specifically limit the advertising and promotion of harmful commodities in their government-owned facilities. IMPLICATIONS FOR PUBLIC HEALTH: There is a dearth of research identifying LGA interventions addressing advertising of harmful commodities within council-owned sporting venues. This research indicates opportunities for West Australian LGAs to develop and implement policy to protect public health by restricting the promotion of harmful commodities to their communities, improving the healthfulness of environments.

Environmental Health Responses to COVID 19 in Western Australia: Lessons for the Future.

The COVID-19 pandemic tested the health system of Western Australia (WA) and the relatively new overarching legislative framework that guided the state-wide public health response to the pandemic. This study aimed to evaluate the experiences and roles of environmental health officers (EHOs) in WA during the management of COVID-19 and to identify any policy changes that are needed to facilitate the rapid deployment of EHOs during a future public health crisis. An online survey with 78 respondents was administered and analysis was both qualitative and quantitative. It was found that participants believed there was inadequate resourcing, workforce shortages, increased workloads, and a lack of recognition and integration of the profession within the COVID-19 response. Notably, more than 65% of the respondents believed they could have been better utilised during the pandemic. This research has demonstrated that the COVID-19 pandemic in WA had clear gaps in its processes for managing responses and resilience to pandemics. Policy recommendations outlining a more efficient and integrated delivery of environmental health services throughout the state during emergencies are discussed.

Why sustainable population growth is a key to climate change and public health equity.

Australia's population could reach 42 million by 2050. This rapid population growth, if unabated, will have significant social, public health and environmental implications. On the one hand, it is a major driver of climate change and environmental degradation; on the other it is likely to be a major contributor to growing social and health issues including a decline in quality of life for many residents. Disadvantaged and vulnerable groups will be most affected. The environmental, social and health-related issues include: pressure on the limited arable land in Australia; increased volumes of industrial and domestic waste; inadequate essential services; traffic congestion; lack of affordable housing; declining mental health; increased obesity problems; and inadequate aged care services. Many of these factors are related to the aggravation of climate change and health inequities. It is critical that the Australian Government develops a sustainable population plan with stabilisation of population growth as an option. The plan needs to ensure adequate hospitals and healthcare services, education facilities, road infrastructure, sustainable transport options, water quality and quantity, utilities and other amenities that are already severely overburdened in Australian cities. There is a need for a guarantee that affordable housing will be available and priority be given to training young people and Indigenous people for employment. This paper presents evidence to support the need for the stabilisation of population growth as one of the most significant measures to control climate change as well as to improve public health equity.

Local governments' decade of organisational change to promote child health and wellbeing: a Western Australian qualitative study.

OBJECTIVE: We aim to reflect on the introduction of risk-based approaches to public health, driven by legislation outlining the expected local government public health functions and roles by identifying factors that most influenced organisational change within the Western Australia local government sector when developing and submitting child and young people's health and social policy to an annual Awards program. METHODS: This paper uses 10 years of data from a WA-based Local Government Policy Awards scheme to identify planned organisational change within the local government sector by applying a tangible organisational change model to develop a change narrative to describe factors that influenced local governments to address public health. Semi-structured interviews of 83 local government officers over the 10 years since implementation were used to create the narrative and identify factors that strengthened or hindered policy development and implementation at the local organisational level. RESULTS: Participant interviews highlighted that the Policy Award Scheme contributed to steps outlined in the Pettigrew et al. (1992) stepped model of organisational change theory to support policy development. Implications for public health: Few studies have explored these elements in their own right. We argue that advocacy for structured policy development is continually needed to support and promote internal policy prioritisation and implementation in practice.

South West Food Community: how government and community initiatives are supporting systemic change towards enhanced food security.

OBJECTIVE: Food security refers to adequate physical, social and economic access to food and is regarded as a complex, 'wicked' issue. This research aimed to understand the perspectives of initiative leaders (stakeholders), regarding their project relating to food security and its possession of characteristics associated with system change to enhance food security. METHODS: Stakeholders (n=51) participated in semi-structured interviews that evaluated initiatives (n=52) against 36 desirable characteristics for system change. Transcripts were analysed using QSR NVivo and Wicked Lab's Tool for Systemic Change. RESULTS: Community-based initiatives often harnessed the passion of local communities to enhance food security through awareness-raising activities and partnerships. Few initiatives created conflict to disrupt the current way of working. The largest 'window of opportunity' included better connection between government and community groups. CONCLUSIONS: This novel contribution provided in-depth understanding of individual initiatives and patterns of working among the food security system in the South West region of Western Australia. Implications for public health: Recommendations to better foster connection between the government and community initiatives include: ensuring government worker responsibilities include task and indicator-related measures; and strengthening understanding of food security among community groups of staff and elected member roles within local government and the ways local government could be supported to harness community knowledge.

South West Food Community: A Place-Based Pilot Study to Understand the Food Security System.

The objectives of this study were to: (i) Identify initiatives supporting healthy food availability, access and utilisation in the South West region of Western Australia (WA); and (ii) understand how they were functioning as a system to enhance community-level food security (FS). This study used a novel approach; a Systemic Innovation Lab, to interview initiative leaders/stakeholders about their FS initiative. Initiative characteristics measured included those which were associated with creating the effective conditions for FS systems change. Information was uploaded to an innovative online tool, creating a 'transition card' (matrix) of initiatives and partnering organisations. Fifty-one participants reported on 52 initiatives. Initiatives were most likely to possess characteristics relating to reinforcing changes towards an enhanced way of working to address FS and creating disruption to the old way of working. The initiative characteristic that initiatives were least likely to possess related to identifying the different causal factors of FS, and working with other stakeholders on specific components of FS. The South West Food Community pilot project used a comprehensive yet defined approach to demonstrate the value of a place-based, co-design project. Participants and stakeholders could strengthen specific initiative characteristics to facilitate enhanced community-level FS.

Timely and significant call for planetary health promotion.

The 2019 IUHPE Global Health Promotion Conference held in Rotorua New Zealand, provided an unparalleled opportunity to demonstrate the contribution of health promotion to the achievement of planetary health and sustainable development. This brief conference report outlines the intent of the two conference statements and calls for action by health promoters at all levels to integrate these principles into their everyday work.

Unhealthy sponsorship in sport: a case study of the AFL.

OBJECTIVE: To analyse the presence of unhealthy sponsorship on Australian Football League (AFL) club websites and player uniforms. METHODS: An audit of AFL club websites and playing uniforms identified sponsors and used a traffic light system to categorise sponsors. Food and beverage sponsors were classified as Red, Amber or Green using nutrient criteria. Alcohol sponsors were classified as Red. Gambling sponsors were classified as Red (wagering companies and casinos) or Amber (venues that provide gambling and other services). Sponsors promoting healthy lifestyle concepts were classified as Green. All other sponsors were classified as Other. RESULTS: Unhealthy sponsorship on AFL club websites and player uniforms is extensive. All 18 clubs had at least one Red sponsor. Fifteen clubs were sponsored by alcohol companies. Five clubs featured Red sponsor logos on their playing uniforms. Twelve clubs had Green sponsors. No clubs displayed Green sponsors on their playing uniforms. CONCLUSIONS: This study identified that unhealthy sponsorship is prevalent on AFL club websites and playing uniforms. Implications for public health: Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand. The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable. Policy makers are encouraged to consider innovative health promotion strategies and work with sporting clubs and codes to ensure healthy messages are prominent.

The illusion of choice: an exploratory study looking at the top 10 food companies in Australia and their brand connections.

OBJECTIVE: To identify the brands owned by each of the 10 top grossing food companies operating in Australia and visually represent them on an infographic. METHODS: Desktop research was conducted to determine Australia's 10 largest food companies based on revenue. Brand ownership for each of the companies was traced through financial records and company publications. This information was then visually documented in the form of an infographic 'food web' to clearly illustrate company and brand ownership. RESULTS: Fonterra, Coca-Cola Amatil, Lion, Murray Goulburn, George Weston Foods, Wilmar, Nestle, Mondelez, Parmalat and Asahi were determined as the top 10 food companies operating in Australia. The food web illustrated that brand ownership ranged from 75 (Nestle) to four (Fonterra) brands per company. CONCLUSIONS: The food web illustrates the dominance of each of these major companies within Australia and shows how their diverse brand ownership limits consumer choice. Implications for public health: This study expands on current knowledge and further defines the breadth of market influence that the top 10 food companies have within the Australian food context, and how they use their brand power to create an illusion of choice for consumers. The food web will assist in promoting transparency of brand ownership in the Australian food market, therefore allowing consumers to make an informed decision about the food they purchase, and will allow community and other organisations to make an informed decision about which companies they form partnerships with.

"It's just everywhere!" Children and parents discuss the marketing of sports wagering in Australia.

OBJECTIVE: To investigate how children and adults recall the content and promotional channels for sports wagering marketing. METHODS: A mixed methods study of 152 parent/child (8-16 years) dyads was conducted at AFL (Australian Football League), NRL (National Rugby League), and soccer sporting sites in New South Wales and Victoria, Australia. Questions related to the frequency of viewing AFL and NRL matches, sports wagering promotions and perceptions of the normalisation of wagering in sport. Descriptive statistics and thematic analysis were used to analyse data. RESULTS: Children recruited from NRL (n=75, 96.2%) and AFL (n=46, 92.0%) sites were significantly more likely to have recalled having ever seen a promotion for sports wagering as compared to children from Soccer sites (n=18, 75.0%) (p<0.05). Children and adults identified seeing sports wagering promotions in similar environments, most commonly on television, and at stadiums. Three-quarters of children (75.0%) and the majority of adults (90.0%) perceived that sports wagering was becoming a normal part of sport. CONCLUSION AND IMPLICATIONS: This research shows that children engaged in particular sports have high awareness of wagering marketing, particularly as seen on television or at sporting matches. Regulation should comprehensively address the placement, quantity and content of wagering marketing aligned with sport to prevent current and/or future gambling harm.

What encourages sun protection among outdoor workers from four industries?

OBJECTIVES: We aimed to identify current practice of sun protection and factors associated with effective use in four outdoor worker industries in Queensland, Australia. METHODS: Workplaces in four industries with a high proportion of outdoor workers (building/construction, rural/farming, local government, and public sector industries) were identified using an online telephone directory, screened for eligibility, and invited to participant via mail (n=15, recruitment rate 37%). A convenience sample of workers were recruited within each workplace (n=162). Workplaces' sun protective policies and procedures were identified using interviews and policy analysis with workplace representatives, and discussion groups and computer-assisted telephone interviews with workers. Personal characteristics and sun protection knowledge, attitudes and behaviors were collated and analysed. RESULTS: Just over half the workplaces had an existing policy which referred to sun protection (58%), and most provided at least some personal protective equipment (PPE), but few scheduled work outside peak sun hours (43%) or provided skin checks (21%). Several worker and workplace characteristics were associated with greater sun protection behaviour among workers, including having received education on the use of PPE (p<0.001), being concerned about being in the sun (p=0.002); and working in a smaller workplace (p=0.035). CONCLUSIONS: Uptake of sun protection by outdoor workers is affected by a complex interplay of both workplace and personal factors, and there is a need for effective strategies targeting both the workplace environment and workers' knowledge, attitudes and behaviors to decrease harmful sun exposure further.

Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review.

BACKGROUND: Outdoor workers are at high risk of harmful ultraviolet radiation exposure and are identified as an at risk group for the development of skin cancer. This systematic evidence based review provides an update to a previous review published in 2007 about interventions for the prevention of skin cancer in outdoor workers. RESULTS: This review includes interventions published between 2007-2012 and presents findings about sun protection behaviours and/or objective measures of skin cancer risk. Six papers met inclusion criteria and were included in the review. Large studies with extended follow-up times demonstrated the efficacy of educational and multi-component interventions to increase sun protection, with some higher use of personal protective equipment such as sunscreen. However, there is less evidence for the effectiveness of policy or specific intervention components. CONCLUSIONS: Further research aimed at improving overall attitudes towards sun protection in outdoor workers is needed to provide an overarching framework.

Changes in outdoor workers' sun-related attitudes, beliefs, and behaviors: a pre-post workplace intervention.

OBJECTIVE: To evaluate changes in outdoor workers' sun-related attitudes, beliefs, and behaviors in response to a health promotion intervention using a participatory action research process. METHODS: Fourteen workplaces across four outdoor industry types worked collaboratively with the project team to develop tailored sun protection action plans. Workers were assessed before and after the 18-month intervention. RESULTS: Outdoor workers reported increases in workplace support for sun protection (P < 0.01) and personal use of sun protection (P < 0.01). More workers reported seeking natural shade (+20%) and wearing more personal protective equipment, including broad-brimmed hats (+25%), long-sleeved collared shirts (+19%), and long trousers (+16%). The proportion of workers reporting sunburn over the past 12 months was lower at postintervention (-14%) (P = 0.03); however, the intensity of reported sunburn increased. CONCLUSIONS: This intervention was successful in increasing workers' sun protective attitudes, beliefs, and behaviors.