The economic costs of alcohol-related harms at the local level in New South Wales.

INTRODUCTION: Alcohol is a harmful, toxic and addictive substance that causes many diseases and injuries. Alcohol use also incurs a financial cost to the health care system and wider economy. This project aimed to undertake a cost impact analysis of alcohol-related harms at the local level in New South Wales (NSW). The alcohol-related harms costing model is an interactive tool designed for use by local health districts, stakeholders such as Liquor and Gaming NSW, NSW Independent Liquor and Gaming Authority and community stakeholders. METHODS: Costs included in the analysis were alcohol-related hospitalisations, deaths, crimes, emergency department attendances, outpatient presentations and their impacts on productivity. Two local government areas (LGA) were used as case studies to demonstrate local impacts. RESULTS: In 2019-2020, the total cost of alcohol-related harms for NSW was estimated at $9 billion, at a rate of $120.3 million per 100,000 population. The total costs were comprised of alcohol-attributable premature mortality ($8.3 billion), non-fatal health care costs ($275 million) and crime costs ($457 million). A comparative analysis of two case study LGAs estimated that alcohol-related harms cost $195 million for the Northern Beaches LGA and $351 million for the Central Coast LGA. DISCUSSION AND CONCLUSIONS: This research has developed a 'proof-of-concept' model to estimate the cost of alcohol-related harms at the local level in Australia, empowering health agencies and local community stakeholders to use economic evidence in their submissions in response to new liquor licence applications and other policies that impact their local community. This economic evidence can be used to improve the quality of decisions on alcohol regulation and policies. There are a number of future research opportunities that would enhance the economic evidence available to liquor licensing decision-makers.

Are Perceptions of Government Intervention Related to Support for Prevention? An Australian Survey Study.

BACKGROUND: In Australia, despite the success of tobacco control policy interventions, policymakers remain resistant to policy-based approaches to diet, alcohol, physical inactivity and obesity, concerned about community perceptions of such interventions as "nanny-statist". We examined how people's general positions on government intervention related to their positions on different preventive policy options. METHODS: Data were from a 2018 nationally representative cross-sectional telephone survey of 2601 Australian adults. Survey questions related to endorsement of different conceptualisations of government intervention (nanny state, paternalistic, shared responsibility and communitarian) and support for specific health interventions, using forced-choice questions about preferences for individual/treatment measures versus population/preventive health measures. We analysed associations between scores on different conceptualisations of government intervention and support of different policy options for tobacco and diet, and preferences for prevention over treatment. RESULTS: The Nanny State Scale showed an inverse relationship with support for tobacco- and diet-related interventions, and alternative conceptualisations (paternalistic, shared responsibility and communitarian) showed a positive relationship. Effect sizes in all cases were small. Those aged 55+ demonstrated greater support for policy action on tobacco and diet, and greater preference for systemic rather than individual-level interventions. CONCLUSION: General disposition towards government intervention, although correlated with support for specific policy actions, is not deterministic.

Dissemination of public health research to prevent non-communicable diseases: a scoping review.

BACKGROUND: Dissemination is a critical element of the knowledge translation pathway, and a necessary step to ensure research evidence is adopted and implemented by key end users in order to improve health outcomes. However, evidence-based guidance to inform dissemination activities in research is limited. This scoping review aimed to identify and describe the scientific literature examining strategies to disseminate public health evidence related to the prevention of non-communicable diseases. METHODS: Medline, PsycInfo and EBSCO Search Ultimate were searched in May 2021 for studies published between January 2000 and the search date that reported on the dissemination of evidence to end users of public health evidence, within the context of the prevention of non-communicable diseases. Studies were synthesised according to the four components of Brownson and colleagues' Model for Dissemination of Research (source, message, channel and audience), as well as by study design. RESULTS: Of the 107 included studies, only 14% (n = 15) directly tested dissemination strategies using experimental designs. The remainder primarily reported on dissemination preferences of different populations, or outcomes such as awareness, knowledge and intentions to adopt following evidence dissemination. Evidence related to diet, physical activity and/or obesity prevention was the most disseminated topic. Researchers were the source of disseminated evidence in over half the studies, and study findings/knowledge summaries were more frequently disseminated as the message compared to guidelines or an evidence-based program/intervention. A broad range of dissemination channels were utilised, although peer-reviewed publications/conferences and presentations/workshops predominated. Practitioners were the most commonly reported target audience. CONCLUSIONS: There is a significant gap in the peer reviewed literature, with few experimental studies published that analyse and evaluate the effect of different sources, messages and target audiences on the determinants of uptake of public health evidence for prevention. Such studies are important as they can help inform and improve the effectiveness of current and future dissemination practices in public health contexts.

Developing a systems thinking guide for enhancing knowledge mobilisation in prevention research.

Knowledge mobilisation aims to increase research impact in policy and practice. 'Mobilising' knowledge implies a social interaction and involves an iterative, collaborative process. We argue that this process is strengthened when underpinned by systems thinking. Previous research has integrated systems thinking with knowledge mobilisation. We built on this to develop an applied tool to support prevention researchers seeking to incorporate systems thinking into their knowledge mobilisation work. We refer to this tool as the 'systems thinking guide for knowledge mobilisation'. Our guide was developed through a stepwise process that included: 1) An inductive thematic synthesis of previous research in this area; 2) Reflexive deliberation to identify critical focus areas, drawing on the synthesis and the authors' experiences of applying systems approaches to knowledge mobilisation; 3) Development of a set of questions designed for end users to consider against the backdrop of their own research and contexts; 4) Trialling these questions through a series of workshops; and 5) Revision based on user feedback. The proposed systems thinking guide includes 13 questions and 18 subquestions to help researchers frame their knowledge mobilisation strategies using a systems perspective. Our next steps are applying this guide to other research projects and reviewing and reporting on its implementation and real-world use. In the meantime, we invite other research teams to test this tool and contribute constructive feedback on its usefulness and potential further development.

Leadership for systems change: Researcher practices for enhancing research impact in the prevention of chronic disease.

Introduction: Strengthening systems for chronic disease prevention is essential. Leadership for systems change is an important key to strengthening systems. Leadership in prevention research for supporting systems change remains a relatively abstract concept and there is limited empirical information about the leadership practices of prevention research teams when viewed through a complexity lens. In this paper we examine and describe some systems leadership practices for creating change through prevention research, as identified in a series of six case studies. Methods: A qualitative approach incorporating semi-structured interviews, participant observation, and document review was used to facilitate an in-depth investigation of the research topic. Results: Several researcher practices for enhancing research impact in the prevention of chronic disease were distilled from the data pertaining to how they sought to create change. These included persuasive communication, compassion and deep listening, reflective practice, and embedding themselves within the systems they sought to change. Discussion: The findings provide insights that may assist prevention researchers and other practitioners dedicated to creating change in chronic disease prevention.

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods.

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia-Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.

Sydney's 'last drinks' laws: A content analysis of news media coverage of views and arguments about a preventive health policy.

INTRODUCTION: News media representation of preventive health policies can influence public discussion and political decision making, impacting policy implementation and sustainability. This study analysed news media coverage of the contested 'last drinks' alcohol laws in Sydney, Australia, to understand the arguments made by different 'actors' (stakeholders) regarding the laws and provide insights on how preventive health policies are positioned within media discourse. METHODS: We identified print and online news media articles discussing the laws from 2014 to 2020. Content analysis was used to quantify the arguments made to justify support or opposition to the laws. RESULTS: A total of 445 articles were included for analysis. Four hundred and thirty-five actors were identified, with industry actors mentioned most (213 times) followed by health actors (136 times). There were more quotes from opponents of the laws compared to supporters of the laws (57% vs. 25%). The proportion of media mentions reduced for supporters (34% in 2014 to 14% in 2020) while mentions increased for opponents (47% in 2014 to 73% in 2020). Supporters used arguments about crime, safety and health. Opponents of the laws focused on issues such as Sydney's 'night time economy' and negative impacts of the laws. DISCUSSION AND CONCLUSIONS: Opponents of the laws strategically used the media to influence public debate. Opponents, including industry actors, also ignored the health impacts of alcohol and utilised campaign groups to advocate against the laws. These findings have implications for how governments and advocates communicate and build support for contested preventive health policies.

Changes in Australian community perceptions of non-communicable disease prevention: a greater role for government?

BACKGROUND: Monitoring trends in community opinion can identify critical opportunities to implement upstream health policies or interventions. Our study examines change and demographic modifiers of change in community perceptions of government intervention for prevention of lifestyle-related chronic disease across two time points in Australia. METHODS: Data were drawn from the 2016 (n = 2052) and 2018 (n = 2601) waves of a nationally representative cross-sectional telephone survey, 'AUSPOPS'. Survey questions gauged perceptions of government intervention for health in general, peoples'/organizations' role in maintaining health (e.g., parents, government) and support for specific health interventions (e.g., taxing soft drink). Bivariate and multivariate regression models tested for change between the two surveys, adjusted for demographic characteristics. Models with interactions between survey wave and demographic variables tested for differential change. One-tailed variance ratio tests examined whether opinions had become more polarized in 2018 compared with 2016. RESULTS: The large, significant increase observed in the perceived size of the role that government has in maintaining people's health was uniform across demographic subpopulations. The role for employers and private health insurers was also perceived to be larger in 2018 compared with 2016, but the degree of change varied by gender, age and/or socioeconomic status. Support for some government interventions (e.g., taxing soft drinks) increased among specific demographic subgroups whilst exhibiting no overall change. Opinion was more polarized on general attitudes to government intervention for population health in 2018 compared to 2016, despite little change in central tendency. CONCLUSIONS: Opportunities may exist to implement government health-promoting policies (e.g., taxing soft drinks), although advocacy may be needed to address the concerns of less supportive subpopulations. Attitudes on government intervention in general may be becoming more polarized; future research examining the association of such changes with exposure to different information sources could inform communication strategies for future health policy change.

A call to action for undertaking and sharing formative evaluations of public health campaigns.

Mass media campaigns are common interventions used in public health, but publicly available evaluations of such campaigns are few and far between, and particularly so for formative evaluations. In 2019, the Heart Foundation released a new campaign called 'Heartless Words', including a major advertisement that sparked instant controversy. In the backlash that followed, very little was said about the importance of rigorous pre-campaign formative evaluations and sharing these evaluations for the benefit of other researchers, practitioners and policy makers. We argue the takeaway points of such controversial campaigns are not only whether they provoke certain emotions or discussion, but also whether they are supported by robust formative evaluations that are publicly available. Formative evaluations are crucial in public health so that we can share and learn what works, for whom, and why. We call on researchers and practitioners to develop, implement and, crucially, disseminate formative evaluations for public health mass media campaigns.

Are young adults' discussions of public health nutrition policies associated with common food industry discourses? A qualitative pilot study.

OBJECTIVE: Unhealthy diets are a key risk factor for chronic disease, with young adults (18-30 years old) in high-income countries like Australia and the UK particularly at risk. Improved public health nutrition policies can help address unhealthy diets in the population, but many of the more regulatory policies are opposed by food industry groups. This research explores how young adults in Australia and the UK discuss a range of topical public health nutrition policies and analyses whether and how their views may be associated with food industry discourses. METHODS: Eight focus groups were held in Sydney, Australia, and Glasgow, UK, with a total of thirty young adults participating. A deliberative-style method was used in the focus groups to generate discussion about six public health nutrition policies, such as taxation of sugar-sweetened beverages and restrictions on advertising of less-healthy foods. Discourse analysis was used to examine participants' discussions. RESULTS: Twenty discourse codes were developed iteratively from the focus group data. These were thematically linked with nine food industry discourses found in the peer-reviewed literature, including industry self-regulation, personal responsibility, corporate social responsibility and challenging nutrition science. CONCLUSIONS: These results demonstrate there is an association between common food industry discourses and some young adults' views about public health nutrition policies. Implications for public health: Identifying, engaging with and responding to common industry discourses is a priority in order to build greater public support and acceptability of policies that will improve diet and prevent chronic disease.

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS).

OBJECTIVES: Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention. METHODS: Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions. RESULTS: 2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government. CONCLUSIONS: There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous.

A scoping review of policies promoting and supporting sustainable food systems in the university setting.

BACKGROUND: Transitioning towards sustainable food systems for the health of the population and planet will require governments and institutions to develop effective governance to support the adoption of sustainable food practices. The aim of the paper is to describe current governance within Australian and New Zealand universities designed to support sustainable food systems. METHODS: A systematic search of governance documents to support sustainable food systems within Australian and New Zealand universities was conducted. Data were obtained from 1) targeted websites 2) internet search engines and 3) expert consultations. Inclusion criteria consisted of university governance documents including by-laws, policies, guidelines, frameworks, and procedures that support sustainable food systems. RESULTS: Twenty-nine governance documents across nineteen Australian and New Zealand universities were included for synthesis, including waste management policies (n = 3), fair-trade/procurement policies (n = 6), catering and or event guidelines (n = 7) and catering policies (n = 2), and environmental management plans (n = 11). The main strategies adopted by universities were sustainable waste management and prevention (e.g. reducing landfill, reducing wasted food, (27%)), ethical procurement practices (i.e. fair-trade (27%)) and environmentally sustainable food consumption (e.g. local, seasonal, organic, vegetarian food supply (14.5%)). Only 12.5% of universities addressed all three of the main strategies identified. CONCLUSIONS: This study indicates that while sustainable food systems are considered in some university governance documents, efforts are predominantly focused on aspects such as waste management or procurement of fair-trade items which as stand-alone practices are likely to have minimal impact. This review highlights the scope of universities to provide strong leadership in promoting and supporting sustainable food systems through holistic institutional policies and governance mechanisms.

Creating healthier graduates, campuses and communities: Why Australia needs to invest in health promoting universities.

ISSUE: Higher education is an important and influential setting for embedding health promotion principles and practice. Universities have a responsibility to their communities and more broadly as leaders in society. PROJECT: Settings-based health promotion is an effective method for increasing healthy environments and an organisational culture that supports health. "Healthy Universities" and the Okanagan Charter aim to embed health within the university structure through committed policies and programs. Collaboration across Australia can support this sector-wide adoption. CONCLUSIONS: Leadership is required from Australian universities to invest in health promotion. This is the time for higher education in Australia to consider its role in shaping the health of its local and global communities.

Content of university alcohol policies in New South Wales, Australia.

ISSUE ADDRESSED: This study aimed to develop a working checklist for university alcohol policies and apply this checklist to current policies in universities in New South Wales (NSW), Australia. METHODS: We developed a working checklist of possible university alcohol policy approaches, drawn from the World Health Organization's alcohol policy recommendations, university alcohol policy research from the United States and norms and expectations currently incorporated in Australian university alcohol policies. We then conducted a content analysis of university alcohol policies in NSW, Australia, based on this checklist. All NSW university websites were searched for any policies or guidelines related to alcohol. The content of each policy or guideline was assessed in terms of whether it satisfied the various components of the checklist. RESULTS: All 11 universities in NSW have an alcohol policy, and these policies are readily available and accessible online. There were two main themes identified in the aims across documents: maximising health and safety of individuals and protecting the university as an institutional entity. Inclusiveness and safety were the predominant themes that satisfied policy content. No document incorporated methods for monitoring/evaluating policy impact. CONCLUSIONS: University alcohol policies that incorporated both individual-level and population-based approaches to alcohol harm reduction were more likely to score higher on the checklist. However, this analysis highlighted many opportunities to strengthen policies by increasing their comprehensiveness and incorporating means to evaluate their effectiveness. SO WHAT?: We present a working checklist that can be used for future research and policy development, regarding university alcohol policies and guidelines.

Adequacy of Data Sources for Investigation of Tertiary Education Student's Wellbeing in Australia: A Scoping Review.

Young adulthood is a period of transition, which for many includes higher education. Higher education is associated with specific risks to wellbeing. Understanding the available data on wellbeing in this group may help inform the future collection of data to inform policy and practice in the sector. This scoping review aimed to identify the availability of data sources on the wellbeing of the Australian young adult population who are attending tertiary education. Using the methods of Arksey and O'Malley, data from three primary sources, i.e., Australian Bureau of Statistics, Australian Institute of Health and Welfare and relevant longitudinal studies, were identified. Data sources were screened and coded, and relevant information was extracted. Key data for eight areas related to wellbeing, namely, family and community, health, education and training, work, economic wellbeing, housing, crime and justice, and culture and leisure sources were identified. Forty individual data sets from 16 surveys and six active longitudinal studies were identified. Two data sets contained seven of the areas of wellbeing, of which one was specific to young adults in tertiary education, while the other survey was not limited to young adults. Both data sets lacked information concerning crime and justice variables, which have recently been identified as being of major concern among Australian university students. We recommend that government policy address the collection of a comprehensive data set encompassing each of the eight areas of wellbeing to inform future policy and practice.

'Buying Salad Is a Lot More Expensive than Going to McDonalds': Young Adults' Views about What Influences Their Food Choices.

Young adults (18⁻30 years of age) are an 'at-risk' group for poor dietary behaviours and less healthy food choices. Previous research with young adults has looked at the barriers and enablers driving their food choices, focusing primarily on university and college students. However, there is less research using qualitative methods with young adults as a broader population group. This study aimed to explore the experiences of young adults in two different yet similar settings: Sydney, Australia and Glasgow, Scotland. Eight focus groups of young adult participants, ranging in size from 2⁻6 participants, were held in Sydney, Australia (n = 14) and Glasgow, Scotland (n = 16) to discuss, explore and compare the determinants and influences of their food choices. Focus group transcripts were coded thematically based on a process of narrative analysis. Three major narratives were identified across both locations: value of food; appeal of food; and emotional connections with food. These narratives were underpinned by a broader narrative of 'performing adulthood.' This narrative reflected a belief amongst participants that they should make rational, informed choices about food despite this conflicting with their broader food environment. Future research could examine which environment-level or policy-based interventions are most acceptable to young adults in terms of influencing their food choices and dietary behaviours.