A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby.

BACKGROUND: Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS: A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS: QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION: QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.

Baseline status of policy and legislation actions to address non communicable diseases crisis in the Pacific.

BACKGROUND: Non-Communicable Diseases (NCD) are the leading cause of death in the Pacific Island Countries and Territories (PICTs) accounting for approximately 70% of mortalities. Pacific leaders committed to take action on the Pacific NCD Roadmap, which specifies NCD policy and legislation. To monitor progress against the NCD Roadmap, the Pacific Monitoring Alliance for NCD Action (MANA) was formed and the MANA dashboard was developed. This paper reports on the first status assessment for all 21 PICTs. METHODS: The MANA Dashboard comprises 31 indicators across the domains of leadership and governance, preventive policies, health system response and monitoring processes, and uses a 'traffic light' rating scheme to track progress. The dashboard indicators draw on WHO's best-buy interventions and track highly cost-effective interventions for addressing NCDs. The MANA coordination team in collaboration with national NCD focal points completed Dashboards for all 21 PICTs between 2017 and 2018 in an agreed process. The data were analysed and presented within each area of the MANA dashboard. RESULTS: This assessment found that PICTs are at varying stages of developing and implementing NCD policy and legislation. Some policy and legislation are in place in most PICTs e.g. smoke free environment (18 PICTs), alcohol licensing (19 PICTs), physical education in schools (14 PICTs), reduction of population salt consumption (14 PICTs) etc. However, no PICTs has policy or legislation on tobacco industry interference, controlling marketing of foods and drinks to children, and reducing trans-fats in the food supply, and only 7 PICTs have policies restricting alcohol advertising. Eighteen PICTs implement tobacco taxation measures, however only five were defined as having strong measures in place. Nineteen PICTs have alcohol taxation mechanisms and 13 PICTs have fiscal policies on foods to promote healthier diets. CONCLUSION: This baseline assessment fills a knowledge gap on current strengths and areas where more action is needed to scale up NCD action in a sustained 'whole of government and whole of society approach' in PICTs. The findings of this assessment can be used to identify priority actions, and as a mutual accountability mechanism to track progress on implementation of NCD policy and legislation at both national and Pacific level.

Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study.

BACKGROUND: Providing culturally safe health care can contribute to improved health among Aboriginal people. However, little is known about how to make hospitals culturally safe for Aboriginal people. This study assessed the impact of an emergency department (ED)-based continuous quality improvement program on: the accuracy of recording of Aboriginal status in ED information systems; incomplete ED visits among Aboriginal patients; and the cultural appropriateness of ED systems and environments. METHODS: Between 2012 and 2014, the Aboriginal Identification in Hospitals Quality Improvement Program (AIHQIP) was implemented in eight EDs in NSW, Australia. A multiple baseline design and analysis of linked administrative data were used to assess program impact on the proportion of Aboriginal patients correctly identified as Aboriginal in ED information systems and incomplete ED visits in Aboriginal patients. Key informant interviews and document review were used to explore organisational changes. RESULTS: In all EDs combined, the AIHQIP was not associated with a reduction in incomplete ED visits in Aboriginal people, nor did it influence the proportion of ED visits made by Aboriginal people that had an accurate recording of Aboriginal status. However, in two EDs it was associated with an increase in the trend of accurate recording of Aboriginality from baseline to the intervention period (odds ratio (OR) 1.31, p < 0.001 in ED 4 and OR 1.15, p = 0.020 in ED 5). In other words, the accuracy of recording of Aboriginality increased from 61.4 to 70% in ED 4 and from 72.6 to 73.9% in ED 5. If the program were not implemented, only a marginal increase would have occurred in ED 4 (from 61.4 to 64%) and, in ED 5, the accuracy of reporting would have decreased (from 72.6 to 71.1%). Organisational changes were achieved across EDs, including modifications to waiting areas and improved processes for identifying Aboriginal patients and managing incomplete visits. CONCLUSIONS: The AIHQIP did not have an overall effect on the accuracy of recording of Aboriginal status or on levels of incomplete ED visits in Aboriginal patients. However, important organisational changes were achieved. Further research investigating the effectiveness of interventions to improve Aboriginal cultural safety is warranted.

The impact of telephone follow up on adverse events for Aboriginal people with chronic disease in new South Wales, Australia: a retrospective cohort study.

BACKGROUND: Chronic diseases are more prevalent and occur at a much younger age in Aboriginal people in Australia compared with non-Aboriginal people. Aboriginal people also have higher rates of unplanned hospital readmissions and emergency department presentations. There is a paucity of research on the effectiveness of follow up programs after discharge from hospital in Aboriginal populations. This study aimed to assess the impact of a telephone follow up program, 48 Hour Follow Up, on rates of unplanned hospital readmissions, unplanned emergency department presentations and mortality within 28 days of discharge among Aboriginal people with chronic disease. METHODS: A retrospective cohort of eligible Aboriginal people with chronic diseases was obtained through linkage of routinely-collected health datasets for the period May 2009 to December 2014. The primary outcome was unplanned hospital readmissions within 28 days of separation from any acute New South Wales public hospital. Secondary outcomes were mortality, unplanned emergency department presentations, and at least one adverse event (unplanned hospital readmission, unplanned emergency department presentation or mortality) within 28 days of separation. Logistic regression models were used to assess outcomes among Aboriginal patients who received 48 Hour Follow Up compared with eligible Aboriginal patients who did not receive 48 Hour Follow Up. RESULTS: The final study cohort included 18,659 patients with 49,721 separations, of which 8469 separations (17.0, 95% confidence interval (CI): 16.7-17.4) were recorded as having received 48 Hour Follow Up. After adjusting for potential confounders, there were no significant differences in rates of unplanned readmission or mortality within 28 days between people who received or did not receive 48 Hour Follow Up. Conversely, the odds of an unplanned emergency department presentation (Odds ratio (OR) = 0.92; 95% CI: 0.85, 0.99; P = 0.0312) and at least one adverse event (OR = 0.91; 95% CI: 0.85,0.98; P = 0.0136) within 28 days were significantly lower for separations where the patient received 48 Hour Follow Up compared with those that did not receive follow up. CONCLUSIONS: Receipt of 48 Hour Follow Up was associated with both a reduction in emergency department presentations and at least one  adverse event within 28 days of discharge, suggesting there may be merit in providing post-discharge telephone follow up to Aboriginal people with chronic disease.

The impact of a community-led program promoting weight loss and healthy living in Aboriginal communities: the New South Wales Knockout Health Challenge.

BACKGROUND: Aboriginal people in Australia experience significant health burden from chronic disease. There has been limited research to identify effective healthy lifestyle programs to address risk factors for chronic disease among Aboriginal people. METHODS: The Knockout Health Challenge is a community-led healthy lifestyle program for Aboriginal communities across New South Wales, Australia. An evaluation of the 2013 Knockout Health Challenge was undertaken. Participants' self-reported physical activity and diet were measured at four time points - at the start and end of the Challenge (via paper form), and 5 and 9 months after the Challenge (via telephone survey). Participants' weight was measured objectively at the start and end of the Challenge, and self-reported (via telephone survey) 5 and 9 months after the Challenge. Changes in body composition, physical activity and diet between time points were analysed using linear mixed models. As part of the telephone survey participants were also asked to identify other impacts of the Challenge; these were analysed descriptively (quantitative items) and thematically (qualitative items). RESULTS: A total of 586 people registered in 22 teams to participate in the Challenge. The mean weight at the start was 98.54kg (SD 22.4), and 94% of participants were overweight or obese. Among participants who provided data at all four time points (n=122), the mean weight loss from the start to the end of the Challenge was 2.3kg (95%CI -3.0 to -1.9, p<0.001), and from the start to 9 months after the Challenge was 2.3kg (95%CI -3.3 to -1.3, p<0.001). Body mass index decreased by an average of 0.9kg/m2 (95%CI -1.0 to -0.7, p<0.001) from the start to the end of the Challenge, and 0.8kg/m2 (95%CI -1.2 to -0.4, p<0.001) 9 months after. At the end of the Challenge, participants reported they were more physically active and had increased fruit and vegetable consumption compared with the start of the Challenge, and identified a range of other positive impacts. CONCLUSIONS: The Challenge was effective in reducing weight and promoting healthy lifestyles among Aboriginal people across New South Wales, and has potential to contribute to closing the health gap between Aboriginal and non-Aboriginal people.

Demographic factors associated with smoking cessation during pregnancy in New South Wales, Australia, 2000-2011.

BACKGROUND: Smoking during pregnancy increases the risk of adverse health outcomes for both the mother and the child. Rates of smoking during pregnancy, and rates of smoking cessation during pregnancy, vary between demographic groups. This study describes demographic factors associated with smoking cessation during pregnancy in New South Wales, Australia, and describes trends in smoking cessation in demographic subgroups over the period 2000 - 2011. METHODS: Data were obtained from the New South Wales Perinatal Data Collection, a population-based surveillance system covering all births in New South Wales. Multivariate logistic regression was used to explore associations between smoking cessation during pregnancy and demographic factors. RESULTS: Between 2000 and 2011, rates of smoking cessation in pregnancy increased from 4.0% to 25.2%. Demographic characteristics associated with lower rates of smoking cessation during pregnancy included being a teenage mother, being an Aboriginal person, and having a higher number of previous pregnancies. CONCLUSIONS: Between 2000 and 2011, rates of smoking cessation during pregnancy increased dramatically across all demographic groups. However, specific demographic groups remain significantly less likely to quit smoking, suggesting a need for targeted efforts to promote smoking cessation in these groups.

Assessing the Status of Diabetes Associations in the Pacific: A Starting Point for Strengthening Associations to Manage Diabetes.

This study aimed to assess the status of national diabetes associations in the Pacific Island Countries and Territories as a starting point for strengthening their development and effectiveness in the prevention and control of diabetes. This cross-sectional study was conducted in 21 Pacific Island Countries and Territories using a structured questionnaire that gathered information from national non-communicable diseases prevention and control focal persons on diabetes associations, organizational structure, funding sources, and ongoing activities to address diabetes. The overall status of national diabetes associations was assessed using standardized criteria. Of the 21 countries surveyed, 18 (86%) responded. Of these, 12 (67%; American Samoa, Northern Mariana Islands, Federated States of Micronesia, French Polynesia, Fiji, Guam, Nauru, Papua New Guinea, Marshall Islands, Solomon Islands, Tonga, and Vanuatu) have a national diabetes association. Half of the existing associations are fully functioning, while the remainder is either partially functioning or not functioning. Only 50% of existing associations have a regular funding source, and many lack clear visions and workable governance structures. This study fills a knowledge gap on the current status of associations and forms a baseline from which associations can be strengthened. It also draws attention to the need for Pacific leaders to invest and engage more in civil societies for better and effective diabetes care for all.

Dual Burden of Stunting and Obesity Among Elementary School Children on Majuro, Republic of Marshall Islands.

Limited data are available on the dual burden of under- and over-nutrition among children in the Republic of Marshall Islands (RMI). This study aimed to identify the prevalence of stunting and obesity among elementary school students on Majuro, RMI. A cross-sectional study was conducted in public and private elementary schools on Majuro in 2017 - 2018. Anthropometric data were collected for 3,271 children, 4-16 years of age. The main outcome measures were prevalence of stunting and obesity. Differences by gender, age, and school type (public or private) were assessed using chi-squared tests. Overall, 5.1% (95% CI 4.4-5.9) of children were obese, and 23.6% (95% CI 22.2-25.1) of children were stunted. Obesity prevalence was higher among boys (6.3%; girls 3.9%; P=0.002) and children attending private schools (11.8%; public schools 2.9%; P<0.001), and increased with age (4-6 years 3.3%; 10-12 years 7.1%; P<0.001),. Stunting prevalence was higher among children attending public schools (28.8%; private schools 8.0%) and increased with age (4-6 years 20.6%; 10-12 years 27.5%; P<0.001). Prevalence of stunting and obesity observed in this study support the need for interventions to improve nutrition and promote healthy lifestyles among children, both to address current undernutrition, and to intervene early to prevent the onset of obesity.

Multimorbidity among people with HIV in regional New South Wales, Australia.

UNLABELLED: Background Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and healthcare costs while decreasing quality of life. The prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service are described. METHODS: A record review of all HIV positive patients attending the service between 1 July 2011 and 30 June 2012 was conducted. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Univariate and multivariate linear regression analyses were used to determine factors associated with a higher CIRS score. RESULTS: One hundred and eighty-nine individuals were included in the study; the mean age was 51.8 years and 92.6% were men. One-quarter (25.4%) had ever been diagnosed with AIDS. Multimorbidity was extremely common, with 54.5% of individuals having two or more chronic health conditions in addition to HIV; the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on an antiretroviral regimen other than two nucleosides and a non-nucleoside reverse transcriptase inhibitor or protease inhibitor were associated with a higher CIRS score. CONCLUSION: To the best of our knowledge, this is the first study looking at associations with multimorbidity in the Australian setting. Care models for HIV positive patients should include assessing and managing multimorbidity, particularly in older people and those that have ever been diagnosed with AIDS.

Ongoing transmission of tuberculosis in Aboriginal communities in NSW.

This report describes the ongoing transmission of tuberculosis in Aboriginal communities in NSW. From October 2000 to July 2012 there were 30 linked cases of tuberculosis diagnosed in Aboriginal people - 22 in the North Coast area of NSW, with a further three cases in Sydney and five in southern Queensland. It is likely that a range of factors have contributed to this ongoing transmission, including delayed diagnosis, the extensive social connections within the communities affected, and the highly mobile living arrangements of many of those affected. Cases have continued to emerge despite implementation of tuberculosis control measures in line with state and international protocols. Tuberculosis control staff are working in partnership with Aboriginal communities to identify and implement appropriate tuberculosis control strategies.

EpiReview: Meningococcal disease in NSW, 1991-2011: trends in relation to meningococcal C vaccination.

AIM: To review the epidemiology of invasive meningococcal disease in NSW for the period 1991-2011, in particular since the introduction of the meningococcal C vaccination program in 2003. METHODS: We undertook a descriptive analysis of NSW notifications of invasive meningococcal disease for the period 2003-2011, and explored long-term changes in the epidemiology of invasive meningococcal disease over the period 1991-2011. RESULTS: In the period 2003-2011, there were 1009 notifications of invasive meningococcal disease in NSW, an average annual rate of 1.6 per 100000 population. Notification rates were highest in the 0-4 and 15-19-year age groups (8.5 and 3.6 per 100000 population respectively). In the period 1991-2011, invasive meningococcal disease notifications increased between 1991 and 2000, peaking at 3.8 notifications per 100000 population in 2000. Notifications have decreased since that time to 1.0 per 100000 population in 2011, most markedly for serogroup C disease since the introduction of the meningococcal C vaccination program in 2003. Meningococcal C notifications reduced from 54 in 2002 (0.8 per 100000 population) to two in 2011 (0.03 per 100000 population). Meningococcal C deaths have also decreased, from nine in 2002 to zero in 2011. The greatest reduction in meningococcal C notifications has been in those aged 1-19 years, the target group for the vaccination program. Meningococcal B notifications have also decreased over the study period, however serogroup B remains the predominant serogroup for invasive meningococcal disease in NSW. CONCLUSION: Notification rates of invasive meningococcal disease have decreased in NSW since 2000. Rates of serogroup C disease have decreased since the introduction of the meningococcal C vaccination program in 2003. Most of the burden of invasive meningococcal disease in NSW is now due to serogroup B disease.

Two pilot studies of the effect of bicycling on balance and leg strength among older adults.

OBJECTIVES: Study 1 examines whether age-related declines in balance are moderated by bicycling. Study 2 tests whether regular cycling can increase leg strength and improve balance. METHODS: Study 1: a cross-sectional survey of 43 adults aged 44-79 was conducted. Leg strength was measured, and Balance was measured using the choice stepping reaction time (CSRT) test (decision time and response time), leg strength and timed single leg standing. Study 2: 18 older adults aged 49-72 were recruited into a 12-week cycling program. The same pre- and postmeasures as used in Study 1 were collected. RESULTS: Study 1: participants who had cycled in the last month performed significantly better on measures of decision time and response time. Study 2: cycling at least one hour a week was associated with significant improvements in balance (decision time and response time) and timed single leg standing. CONCLUSIONS: Cycling by healthy older adults appears promising for improving risk factors for falls.

Joy, exercise, enjoyment, getting out: a qualitative study of older people's experience of cycling in Sydney, Australia.

INTRODUCTION: Cycling can be an enjoyable way to meet physical activity recommendations and is suitable for older people; however cycling participation by older Australians is low. This qualitative study explored motivators, enablers, and barriers to cycling among older people through an age-targeted cycling promotion program. METHODS: Seventeen adults who aged 50-75 years participated in a 12-week cycling promotion program which included a cycling skills course, mentor, and resource pack. Semistructured interviews at the beginning and end of the program explored motivators, enablers, and barriers to cycling. RESULTS: Fitness and recreation were the primary motivators for cycling. The biggest barrier was fear of cars and traffic, and the cycling skills course was the most important enabler for improving participants' confidence. Reported outcomes from cycling included improved quality of life (better mental health, social benefit, and empowerment) and improved physical health. CONCLUSIONS: A simple cycling program increased cycling participation among older people. This work confirms the importance of improving confidence in this age group through a skills course, mentors, and maps and highlights additional strategies for promoting cycling, such as ongoing improvement to infrastructure and advertising.

The pathway to dementia diagnosis.

OBJECTIVE: To describe the steps taken by health professionals to diagnose dementia and the timeframes for these steps, as reported by carers. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional, anonymous survey was mailed or distributed by Alzheimer's Australia New South Wales, six Sydney residential aged care facilities and 13 Sydney general practitioners to 415 carers or family members of patients with dementia between May and August 2007. MAIN OUTCOME MEASURES: First symptoms noticed and actions taken; time to first health professional consultation and diagnosis; reported actions of first health professional; satisfaction with first consultation; and use of dementia and chronic illness resources. RESULTS: 209 surveys were returned. Family members noticed the first symptoms of dementia at a mean of 1.9 years before the first health professional consultation about dementia, and 3.1 years before a firm diagnosis. Resource use first occurred 2.8 years after the first symptoms. Most carers (72%) were satisfied with the first consultation, which was usually with a GP (84%). Two-thirds of carers (64%) reported that the first health professional had performed a memory test. CONCLUSIONS: Delays in presentation, diagnosis and resource use may have clinical and social implications for people with dementia and their families, in addition to the challenges of the process of obtaining a firm diagnosis.