Improving Access to Cancer Clinical Trials for Patients From Culturally and Linguistically Diverse Backgrounds in Australia: A Survey of Clinical and Research Professionals.

PURPOSE: Patients with cancer from racial and ethnic minorities, referred to as culturally and linguistically diverse (CALD) in Australia, are significantly under-represented in cancer clinical trials. We performed a national survey of the Australian cancer clinical trials workforce to determine barriers and preferred solutions to address this inequity. METHODS: A 15-item online survey containing both closed- and open-ended purpose-designed questions was created using REDCap. The survey was emailed to members of the Clinical Oncology Society of Australia, Medical Oncology Group of Australia, and Australian cancer cooperative trial groups, and promoted via Twitter. Descriptive analyses summarized quantitative data, and free-text entries underwent thematic analysis with NVivo Version 12. RESULTS: Ninety one respondents completed the survey-with representation across Australia. Eighty-seven percent were directly involved in clinical trial recruitment. Sixty-eight percent were clinicians. Seventy-four percent of respondents did not collect routine data on CALD patient enrollment to cancer clinical trials. Communication (eg, lack of translated materials) and opportunity-related barriers (eg, exclusionary trial protocols) were the most frequently perceived barriers to recruitment. Additionally, qualitative analysis indicated that insufficient consultation time and difficulties accessing interpreters for patients with non-English language preference were significant barriers. Trial navigators and a generic cancer trial pamphlet available in multiple languages were judged the most likely solutions to improve recruitment. CONCLUSION: This study articulates the Australian clinical trials workforce's perspective on current barriers and potential solutions to the under-representation of patients from CALD backgrounds on cancer clinical trials. The insights and solutions from this survey provide steps toward achieving equity in Australian cancer clinical trials.

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study.

BACKGROUND: Poor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney. METHODS: A mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach. RESULTS: A sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL. CONCLUSIONS: Strategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

The case for citizen science in public health policy and practice: a mixed methods study of policymaker and practitioner perspectives and experiences.

BACKGROUND: Citizen science (CS) is increasingly being utilised to involve the public in public health research, but little is known about whether and how CS can address the needs of policy and practice stakeholders in health promotion and chronic disease prevention. METHODS: Using a mixed methods approach we conducted an online survey (n = 83) and semi-structured interviews (n = 21) with policy and practice stakeholders across Australia to explore how CS approaches are perceived and applied in chronic disease prevention, how CS aligns with existing approaches to community engagement, and how the uptake of CS can be supported within policy and practice settings. RESULTS: Most participants had heard of CS, and while few had experience of using CS, there was widespread support for this approach, with many seeing it as complementary to other community engagement approaches. CS was seen as providing: (a) a robust framework for engagement; (b) access to rich data; (c) opportunities for more meaningful engagement; and (d) a mutually beneficial approach for stakeholders and community members. However, stakeholders identified a need to weigh benefits against potential risks and challenges including competing organisational priorities, resourcing and expertise, data quality and rigour, governance, and engagement. CONCLUSIONS: To expand the use of CS, stakeholders identified the need for increased awareness, acceptance, and capacity for CS within public health organisations, greater access to supporting tools and technology, and evidence on processes, feasibility and impacts to enhance the visibility and legitimacy of CS approaches.

Engaging adults in organized physical activity: a scoping review of recruitment strategies.

Scaling up established physical activity (PA) opportunities for broader population reach requires practitioners to carefully consider strategies implemented to recruit and attract new participants to their PA programs. This scoping review examines the effectiveness of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic databases were searched for articles published between March 1995 and September 2022. Qualitative, quantitative and mixed methods papers were included. Recruitment strategies were assessed against Foster et al. (Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011;8:137-137.) assessment of quality for reporting recruitment and the determinants of recruitment rates were examined. 8394 titles and abstracts were screened; 22 articles were assessed for eligibility; 9 papers were included. Three of the 6 quantitative papers adopted a combination of passive and active recruitment strategies and 3 relied solely on active strategies. All 6 quantitative papers reported on recruitment rates; 2 evaluated the efficacy of recruitment strategies based on the achieved levels of participation. The evaluation evidence on how individuals are successfully recruited into organized PA programs, and how recruitment strategies influence or address inequities in PA participation, is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the reporting and measurement of recruitment strategies into PA programs is essential to better understand which strategies are attracting various population groups thus allowing program implementers to employ recruitment strategies best suited to the needs of their community while making efficient use of program funding.

Despite sustained investments into organized physical activity (PA) opportunities for adults the uptake has not been equal across populations. Achieving broad population reach requires practitioners to consider the strategies adopted to recruit and attract new participants to PA programs. This scoping review examines the effectiveness and determinants of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic database searching yielded 9 papers published between March 1995 and September 2022 for inclusion. Three of the 6 quantitative papers used a combination of passive (such as flyers, TV broadcasts, print, and radio) and active (such as targeted letters, GP referrals, and word of mouth) recruitment strategies. The evaluation evidence on how individuals are successfully recruited into organized PA programs and how recruitment strategies influence or address inequities in PA participation is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the measurement and reporting of recruitment strategies into PA programs will assist program implementers to adopt recruitment strategies best suited to the needs of their community while allowing for efficient use of program funding.

Formative assessment: Is Australia ready for a physical activity surveillance system?

OBJECTIVES: This study investigated the feasibility of establishing a comprehensive and standardised physical activity surveillance system (PASS) in Australia to guide policy and programs to address this public health priority. METHODS: We gathered information about existing data and reporting obligations in relation to physical activity, by conducting cross-sectoral workshops for each state and territory. This information was synthesised by sector/domain using the socioecological model. We developed a set of potential PASS indicators for feedback from the policymakers in the National Physical Activity Network. RESULTS: Jurisdictions identified existing physical activity-relevant surveillance measures across socioecological levels and sectors. The most common were individual behavioural measures; less common were interpersonal, settings, environmental, and policy measures. Feedback was gathered from policymakers about model indicators that could be considered in future discussions. CONCLUSIONS: Our findings reveal areas where data availability is most widespread as well as areas of deficiency. Although this process identified relevant cross-sectoral indicators, further feasibility assessment will require national-level discussions, cross-agency planning, and leadership by Federal and State governments to progress PASS discussions further. IMPLICATIONS FOR PUBLIC HEALTH: The existing physical activity surveillance system in Australia is fragmented and lacks nationwide standardisation. Most physical activity surveillance focuses on individual behaviours, and limited monitoring occurs of broader elements of the "physical activity system." Improvements will contribute to more informed and accountable decision-making and enable more effective monitoring of progress at multiple levels towards achieving state and national physical activity goals. Policymakers need to embrace this agenda and further the discussions on the scope, shape, and structure of a physical activity surveillance system.

Economic evaluation of physical activity mass media campaigns across the globe: a systematic review.

BACKGROUND: Physical activity mass media campaigns can deliver physical activity messages to many people, but it remains unclear whether they offer good value for money. We aimed to investigate the cost-effectiveness, cost-utility, and costs of physical activity mass media campaigns. METHODS: A search for economic evaluations (trial- or model-based) and costing studies of physical activity mass media campaigns was performed in six electronic databases (June/2021). The authors reviewed studies independently. A GRADE style rating was used to assess the overall certainty of each modelled economic evaluation. Results were summarised via narrative synthesis. RESULTS: Twenty-five studies (five model-based economic evaluations and 20 costing studies) were included, and all were conducted in high-income countries except for one costing study that was conducted in a middle-income country. The methods and assumptions used in the model-based analyses were highly heterogeneous and the results varied, ranging from the intervention being more effective and less costly (dominant) in two models to an incremental cost of US$130,740 (2020 base year) per QALY gained. The level of certainty of the models ranged from very low (n = 2) to low (n = 3). Overall, intervention costs were poorly reported. CONCLUSIONS: There are few economic evaluations of physical activity mass media campaigns available. The level of certainty of the models was judged to be very low to low, indicating that we have very little to little confidence that the results are reliable for decision making. Therefore, it remains unclear to what extent physical activity mass media campaigns offer good value for money. Future economic evaluations should consider selecting appropriate and comprehensive measures of campaign effectiveness, clearly report the assumptions of the models and fully explore the impact of assumptions in the results. REVIEW REGISTRATION: https://bit.ly/3tKSBZ3.

Psychometric assessment of scales for measuring loneliness and social isolation: an analysis of the household, income and labour dynamics in Australia (HILDA) survey.

BACKGROUND: Loneliness and social isolation are increasingly recognised as global public health threats, meaning that reliable and valid measures are needed to monitor these conditions at a population level. We aimed to determine if robust and practical scales could be derived for conditions such as loneliness and social isolation using items from a national survey. METHODS: We conducted psychometric analyses of ten items in two waves of the Household, Income and Labour Dynamics in Australia Survey, which included over 15,000 participants. We used the Hull method, exploratory structural equation modelling, and multidimensional item response theory analysis in a calibration sample to determine the number of factors and items within each factor. We cross-validated the factor structure using confirmatory factor analysis in a validation sample. We assessed construct validity by comparing the resulting sub-scales with measures for psychological distress and mental well-being. RESULTS: Calibration and cross-validation consistently revealed a three-factor model, with sub-scales reflecting constructs of loneliness and social isolation. Sub-scales showed high reliability and measurement invariance across waves, gender, and age. Construct validity was supported by significant correlations between the sub-scales and measures of psychological distress and mental health. Individuals who met threshold criteria for loneliness and social isolation had consistently greater odds of being psychologically distressed and having poor mental health than those who did not. CONCLUSIONS: These derived scales provide robust and practical measures of loneliness and social isolation for population-based research.

Fair play? Participation equity in organised sport and physical activity among children and adolescents in high income countries: a systematic review and meta-analysis.

BACKGROUND: Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the disparity in physical activity is inconsistent, has not been reviewed recently, and for sport has never been synthesised. Our aim was to systematically review, and combine via meta-analyses, evidence of the socioeconomic disparities in physical activity and sport participation in children and adolescents in high income countries. METHODS: We conducted searches of five electronic databases using physical activity, sport, and socioeconomic disparity related terms. Two independent reviewers assessed 21,342 articles for peer-reviewed original research, published in English that assessed socioeconomic disparities in physical activity and sport participation in children and adolescents. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis. RESULTS: From the 104 eligible studies, we meta-analysed 163 effect sizes. Overall, children and adolescents living in higher socioeconomic status households were more likely to participate in sport (OR: 1.87, 95% CIs 1.38, 2.36) and participated for a longer duration (d = 0.24, 95% CIs 0.12, 0.35). The socioeconomic disparity in the duration of sport participation was greater in children (d = 0.28, 95% CIs 0.15, 0.41) compared with adolescents (d = 0.13, 95% CIs - 0.03, 0.30). Overall, children and adolescents living in higher socioeconomic status households were more likely to meet physical activity guidelines (OR: 1.21, 95% CIs 1.09, 1.33) and participated for a longer duration (d = 0.08, 95% CIs 0.02, 0.14). The socioeconomic disparity in the duration of total physical activity between low and high socioeconomic status households was greater in children (d = 0.13, 95% CIs 0.04, 0.21) compared with adolescents (d = 0.05, 95% CIs - 0.05, 0.15). There was no significant disparity in leisure time physical activity (d = 0.13, 95% CIs - 0.06, 0.32). CONCLUSIONS: There was evidence of socioeconomic disparities in sport participation and total physical activity participation among children and adolescents. Socioeconomic differences were greater in sport compared to total physical activity and greater in children compared with adolescents. These findings highlight the need importance of targeting sport programs according to socio-economic gradients, to reduce inequities in access and opportunity to organised sport.

On Guessing: An Alternative Adjusted Positive Learning Estimator and Comparing Probability Misspecification With Monte Carlo Simulations.

Practitioners in the sciences have used the "flow" of knowledge (post-test score minus pre-test score) to measure learning in the classroom for the past 50 years. Walstad and Wagner, and Smith and Wagner moved this practice forward by disaggregating the flow of knowledge and accounting for student guessing. These estimates are sensitive to misspecification of the probability of guessing correct. This work provides guidance to practitioners and researchers facing this problem. We introduce a transformed measure of true positive learning that under some knowable conditions performs better when students' ability to guess correctly is misspecified and converges to Hake's normalized learning gain estimator under certain conditions. We then use simulations to compare the accuracy of two estimation techniques under various violations of the assumptions of those techniques. Using recursive partitioning trees fitted to our simulation results, we provide the practitioner concrete guidance based on a set of yes/no questions.

Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios.

While surveillance can identify changes in COVID-19 transmission patterns over time and space, sections of the population at risk, and the efficacy of public health measures, reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases. Our primary objective was to estimate the percentage of cases reported in the general community, considered as those that occurred outside of long-term care facilities (LTCFs), in specific provinces and Canada as a whole. We applied a methodology using the delay-adjusted case fatality ratio (CFR) to all cases and deaths, as well as those representing the general community. Our second objective was to assess whether the assumed CFR (mean = 1.38%) was appropriate for calculating underestimation of cases in Canada. Estimates were developed for the period from March 11th, 2020 to September 16th, 2020. Estimates of the percentage of cases reported (PrCR) and CFR varied spatially and temporally across Canada. For the majority of provinces, and for Canada as a whole, the PrCR increased through the early stages of the pandemic. The estimated PrCR in general community settings for all of Canada increased from 18.1% to 69.0% throughout the entire study period. Estimates were greater when considering only those data from outside of LTCFs. The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07% on March 11th, 2020 to 2.00% on September 16th, 2020. Therefore, the true CFR in the general community in Canada was likely less than 2% on September 16th. According to our analysis, some provinces, such as Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, and Saskatchewan reported a greater percentage of cases as of September 16th, compared to British Columbia, Ontario, and Québec. This could be due to differences in testing rates and criteria, demographics, socioeconomic factors, race, and access to healthcare among the provinces. Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study. The estimates provide context to the summative state of the pandemic in Canada, and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.

The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis.

BACKGROUND AND AIM: Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS AND RESULTS: This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. CONCLUSION: Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.

A farm-to-fork quantitative risk assessment model for Salmonella Heidelberg resistant to third-generation cephalosporins in broiler chickens in Canada.

Salmonella Heidelberg resistant to ceftiofur (a third-generation cephalosporin antimicrobial agent) in broiler chicken products pose a risk to public health in Canada. The objective of this study was to assess the extent of that risk and to evaluate the effect of intervention measures along the agri-food chain. A stochastic farm-to-fork quantitative microbial risk assessment model was developed following the Codex Alimentarius Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance. Different scenarios were analyzed to assess the individual relative effects of 18 possible interventions in comparison to a baseline scenario. The baseline scenario represented the first year of on-farm antimicrobial use surveillance in the Canadian broiler industry and the year before an industry-imposed ban on the preventive use of antimicrobials of very high importance to human health (2013), where 31.3% of broiler flocks consisted of birds to which ceftiofur was administered. The baseline scenario predicted an average probability of illness of 1.1 per 100,000 servings (SE: 0.064 per 100,000), corresponding to an average of 22,000 human infections (SE: 1900) with ceftiofur-resistant S. Heidelberg per year, which is likely an overestimation. This risk was reduced by 90% or 20% when two separate scenarios designed to capture the effect of withdrawing preventive ceftiofur use from poultry production were simulated using different approaches; data used for the former scenario were confounded by other potential concomitant control measures (e.g. Salmonella vaccination programme), so the true effect likely lies somewhere between the two estimates. A theoretical 'worst case' scenario where all flocks had birds exposed to ceftiofur increased the risk by 107%. A 50% reduction in the probability of human prior exposure to antimicrobials, which has a selective and competitive effect for Salmonella spp. following ingestion of contaminated products, reduced the risk by 65%. Other promising measures that could be considered for further risk management included improved cleaning and disinfection between broiler flocks on farm (risk reduction by 26%), exclusive use of air chilling (risk reduction by 34%), and the improvement of meat storage and preparation conditions, e.g., no temperature abuse at retail (risk reduction by 88%). These findings showed the importance of a structured approach to assessing and potentially implementing effective interventions to reduce the risk associated with ceftiofur-resistant S. Heidelberg at different steps along the agri-food chain. Major data gaps included information on concentrations of resistant bacteria, cross contamination at processing and how ceftiofur-resistant S. Heidelberg behave in comparison with susceptible ones, e.g., in terms of growth and survival ability, as well as pathogenicity and virulence.

Physical Activity among Adults with Low Socioeconomic Status Living in Industrialized Countries: A Meta-Ethnographic Approach to Understanding Socioecological Complexities.

Method: Using MeSH keywords, we searched major electronic databases including Medline, EMBASE, CINAHL, and PsycINFO in order to identify relevant publications published between January 2000 and October 2018. We included 19 qualitative studies which met inclusion criteria and were focused on physical activity determinants among adults. Results: Determinants emerging from these studies were grouped into six themes: (i) urban environment, (ii) financial constraints, (iii) work-life integration, (iv) community engagement, (v) social support, and (vi) psychosocial factors. After conceptualising these six themes into a social ecological model, we identified potential research gaps for physical activity among adults with low socioeconomic status living in industrialized countries. Conclusion: Our major insight was that, in industrialized countries, physical activity overlooks potential strengths to maintain health and well-being of those people with low socioeconomic status. A more complex understanding of contradictions between positive and deficit frames would lead to more critical insights of research gaps of physical activity in adult population with low socioeconomic status.

An assessment of program evaluation methods and quality in Australian prevention agencies.

ISSUE ADDRESSED: This study aimed to examine evaluation methods and quality in Australian health promotion agencies and the factors associated with this. The evidence base for prevention strategies is limited, with the evidence generated through program evaluation by health promotion and disease prevention agencies lacking rigour. Despite the need to improve the quality of evaluation, there is limited evidence of what influences evaluation quality in the prevention field. METHODS: Data were collected using the Evaluation Practice Analysis Survey and an audit and appraisal of evaluation reports. Descriptive analysis was used to examine evaluation characteristics and multivariable regression was used to explore the association between evaluation and organisational attributes and evaluation quality. RESULTS: In total, 392 evaluation reports were reviewed from 78 government and non-government agencies. Process evaluation was conducted most frequently, followed by impact evaluation. Overall evaluation quality was low (median 24.5%). In multivariable regression analysis, only two factors were associated with evaluation quality: health promotion budget (ratio of geometric means 1.53 [95% CI 1.02-2.29]); and, conducting statewide or national prevention programs (1.38 [95% CI 1.05-1.82]). CONCLUSIONS: The findings show that the potential to improve evaluation quality is greatest in smaller organisations that deliver health promotion at a local or regional scale. SO WHAT?: By improving the rigour of existing evaluation, there is opportunity to build the evidence base for prevention strategies, which highlights the importance of embedding the enablers of program learning and evidence generation within health promotion and prevention organisations.

Whole of Systems Approaches to Physical Activity Policy and Practice in Australia: The ASAPa Project Overview and Initial Systems Map.

BACKGROUND: The literature on whole of system approaches (WSAs) has been largely theoretical in focus. The Australian Systems Approaches to Physical Activity is a national project designed to contribute a practical implementation focus to such approaches at the population level. METHODS: National meetings were convened with federal and state government sector stakeholders to identify physical activity (PA) related policies and programs. Policies and programs were audited to develop an understanding of the existing PA system. A WSA conceptual map for PA was developed using feedback from system stakeholders, existing WSAs, and related work in obesity. RESULTS: Completion of the policy audit has revealed key areas of need regarding policy governance, coordination, financing, and evaluation. An initial WSA conceptual map for Australia has been developed incorporating governance, translation, and advocacy. Stakeholder co-production of an integrated framework for PA and design plans for a community of practice knowledge hub has commenced. CONCLUSIONS: In Australia, Australian Systems Approaches to Physical Activity project partners have developed a conceptual whole of systems map that is guiding progress beyond the theoretical to application in the real world: a national PA policy audit, co-production of an integrated PA policy framework, and planning for a PA community of practice knowledge hub.

Toward Whole-of-System Action to Promote Physical Activity: A Cross-Sectoral Analysis of Physical Activity Policy in Australia.

BACKGROUND: The value of a systems thinking approach to tackling population physical inactivity is increasingly recognized. This study used conceptual systems thinking to develop a cognitive map for physical activity (PA) influences and intervention points, which informed a standardized approach to the coding and notation of PA-related policies in Australia. METHODS: Policies were identified through desktop searches and input from 33 nominated government representatives attending 2 national PA policy workshops. Documents were audited using predefined criteria spanning policy development, strategic approaches to PA, implementation processes, and evaluation. Data were analyzed using descriptive statistics. RESULTS: The audit included 110 policies, mainly led by the health or planning/infrastructure sectors (n = 54, 49%). Most policies purporting to promote PA did so as a cobenefit of another objective that was not focused on PA (n = 63, 57%). An intention to monitor progress was indicated in most (n = 94, 85%); however, fewer than half (n = 52, 47%) contained evaluable goals/actions relevant to PA. Descriptions of resourcing/funding arrangements were generally absent or lacked specific commitment (n = 67, 61%). CONCLUSIONS: This study describes current PA-relevant policy in Australia and identifies opportunities for improving coordination, implementation, and evaluation to strengthen a whole-of-system and cross-agency approach to increasing population PA.

Integrating Whole-Genome Sequencing Data Into Quantitative Risk Assessment of Foodborne Antimicrobial Resistance: A Review of Opportunities and Challenges.

Whole-genome sequencing (WGS) will soon replace traditional phenotypic methods for routine testing of foodborne antimicrobial resistance (AMR). WGS is expected to improve AMR surveillance by providing a greater understanding of the transmission of resistant bacteria and AMR genes throughout the food chain, and therefore support risk assessment activities. At this stage, it is unclear how WGS data can be integrated into quantitative microbial risk assessment (QMRA) models and whether their integration will impact final risk estimates or the assessment of risk mitigation measures. This review explores opportunities and challenges of integrating WGS data into QMRA models that follow the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR. We describe how WGS offers an opportunity to enhance the next-generation of foodborne AMR QMRA modeling. Instead of considering all hazard strains as equally likely to cause disease, WGS data can improve hazard identification by focusing on those strains of highest public health relevance. WGS results can be used to stratify hazards into strains with similar genetic profiles that are expected to behave similarly, e.g., in terms of growth, survival, virulence or response to antimicrobial treatment. The QMRA input distributions can be tailored to each strain accordingly, making it possible to capture the variability in the strains of interest while decreasing the uncertainty in the model. WGS also allows for a more meaningful approach to explore genetic similarity among bacterial populations found at successive stages of the food chain, improving the estimation of the probability and magnitude of exposure to AMR hazards at point of consumption. WGS therefore has the potential to substantially improve the utility of foodborne AMR QMRA models. However, some degree of uncertainty remains in relation to the thresholds of genetic similarity to be used, as well as the degree of correlation between genotypic and phenotypic profiles. The latter could be improved using a functional approach based on prediction of microbial behavior from a combination of 'omics' techniques (e.g., transcriptomics, proteomics and metabolomics). We strongly recommend that methodologies to incorporate WGS data in risk assessment be included in any future revision of the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR.

Understanding the factors that influence health promotion evaluation: The development and validation of the evaluation practice analysis survey.

The demand for improved quality of health promotion evaluation and greater capacity to undertake evaluation is growing, yet evidence of the challenges and facilitators to evaluation practice within the health promotion field is lacking. A limited number of evaluation capacity measurement instruments have been validated in government or non-government organisations (NGO), however there is no instrument designed for health promotion organisations. This study aimed to develop and validate an Evaluation Practice Analysis Survey (EPAS) to examine evaluation practices in health promotion organisations. Qualitative interviews, existing frameworks and instruments informed the survey development. Health promotion practitioners from government agencies and NGOs completed the survey (n = 169). Principal components analysis was used to determine scale structure and Cronbach's α used to estimate internal reliability. Logistic regression was conducted to assess predictive validity of selected EPAS scale. The final survey instrument included 25 scales (125 items). The EPAS demonstrated good internal reliability (α > 0.7) for 23 scales. Dedicated resources and time for evaluation, leadership, organisational culture and internal support for evaluation showed promising predictive validity. The EPAS can be used to describe elements of evaluation capacity at the individual, organisational and system levels and to guide initiatives to improve evaluation practice in health promotion organisations.

Cash transfers and the social determinants of health: a conceptual framework.

Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs' evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation.