Study protocol of an economic evaluation embedded in the Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) trial.

BACKGROUND: Tobacco smoking during pregnancy is the most important preventable risk factor for pregnancy complications and adverse birth outcomes and can have lifelong consequences for infants. Smoking during pregnancy is associated with higher healthcare costs related to birth complications and during childhood. Psychosocial interventions to support pregnant women to quit are effective, yet provision of smoking cessation support has been inconsistent. The Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) intervention provides systems change, and leadership and clinician elements, to support clinicians to help women stop smoking in pregnancy. There have been few long-term analyses conducted of the cost-effectiveness of smoking cessation interventions for pregnant women that target healthcare providers. This protocol describes the economic evaluation of the MOHMQuit trial, a pragmatic stepped-wedge cluster-randomised controlled implementation trial in nine public maternity services in New South Wales (NSW), Australia, to ascertain whether MOHMQuit is cost-effective in supporting clinicians to help women quit smoking in pregnancy compared to usual care. METHODS: Two primary analyses will be carried out comparing MOHMQuit with usual care from an Australian health care system perspective: i) a within-trial cost-effectiveness analysis with results presented as the incremental cost per additional quitter; and ii) a lifetime cost-utility analysis using a published probabilistic decision analytic Markov model with results presented as incremental cost per quality-adjusted life-year (QALY) gained for mother and child. Patient-level data on resource use and outcomes will be used in the within-trial analysis and extrapolated and supplemented with national population statistics and published data from the literature for the lifetime analysis. DISCUSSION: There is increasing demand for information on the cost-effectiveness of implementing healthcare interventions to provide policy makers with critical information for the best value for money within finite budgets. Economic evaluation of the MOHMQuit trial will provide essential, policy-relevant information for decision makers on the value of evidence-based implementation of support for healthcare providers delivering services for pregnant women. TRIAL REGISTRATIONS: ACTRN12622000167763, registered 2 February 2022.

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.

Team characteristics associated with weight loss in a First Nations community intervention: An observational study.

ISSUE ADDRESSED: Group-based weight-loss programs can be effective in addressing high rates of overweight and obesity among Aboriginal and Torres Strait Islander Peoples. The purpose was to determine associations between demographic and baseline weight-related variables and team weight loss in a community-based intervention as no previous studies have analysed this at a team level. METHODS: Binomial models tested associations between team-level age, proportion female and baseline weight and classification as higher weight-loss team (HWT) (>50% persons losing 2.5% of initial weight) vs lower weight-loss team (LWT). Linear regressions compared HWT and LWT on diet and physical activity (PA) outcomes adjusted for age and gender. RESULTS: For each 1 kg increment in mean baseline weight, a team's likelihood of higher weight loss was increased by 4% (APR: 1.04, 95%CI: 1.00, 1.08). HWTs increased vigorous PA by 0.32 sessions more than LWTs (P = .02). Fruit and vegetable intakes were not associated with team weight loss classification. CONCLUSIONS: Only baseline weight and vigorous PA distinguished HWT and LWT. Promoting PA components in team-based weight-loss approaches may be beneficial as these lend themselves to group participation. SO WHAT?: Demographic and baseline weight-related variables are largely not predictive of weight loss success in group programs. Identifying other characteristics shared by HWT may help teams achieve weight loss.

Weight change among repeat participants of an Aboriginal community-based weight loss program.

BACKGROUND: Community-based weight loss programs may have potential to address overweight and obesity at the population level. However, participation patterns and individual outcomes from these programs are understudied. This study examined repeat participation patterns and participant weight change between contests over seven years of an Aboriginal Australian team-based program in order to identify (1) predictors of repeat participation and (2) associations with weight change between contests. METHODS: Data for the 12 contests from 2012 to 2018 were merged, with probabilistic record matching. A total of 7510 enrolments were registered for the 12 contests, representing 4438 unique people. Contest lengths varied from 10 to 16 weeks in duration. Non-repeat participants were those who only competed once in the program by the end of 2018, and repeaters were those who competed in at least two contests. Associations between repeat participation and participant baseline (i.e., first participation occasion) characteristics, change in diet and physical activity and percent change in weight during the first participation occasion were examined using crossed random effects (for person and team) regression adjusted for exposure to the program. Weight percentage change between contests was calculated for consecutive participation occasions occurring at least three months apart, converted to percent change per month. Weight change was regressed on number of repeat participation occasions adjusted for age, gender, baseline weight at first participation occasion, and weight percent change in the immediately preceding contest. RESULTS: One-third of the 4433 participants participated more than once, with women more likely than men to repeat. A 1% reduction in weight during a competition was associated with an increase in weight of 0.05% per month between competition end and subsequent participation. Regain was smaller the heavier participants were at their first participation. CONCLUSIONS: While individuals benefit from weight loss through program participation, strengthening strategies for weight loss maintenance within or following the program could improve long-term weight outcomes and reduce weight cycling.

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.

Factors influencing workplace violence risk among correctional health workers: insights from an Australian survey.

Little is known about the environmental and organisational determinants of workplace violence in correctional health settings. This paper describes the views of health professionals working in these settings on the factors influencing workplace violence risk. All employees of a large correctional health service in New South Wales, Australia, were invited to complete an online survey. The survey included an open-ended question seeking the views of participants about the factors influencing workplace violence in correctional health settings. Responses to this question were analysed using qualitative thematic analysis. Participants identified several factors that they felt reduced the risk of violence in their workplace, including: appropriate workplace health and safety policies and procedures; professionalism among health staff; the presence of prison guards and the quality of security provided; and physical barriers within clinics. Conversely, participants perceived workplace violence risk to be increased by: low health staff-to-patient and correctional officer-to-patient ratios; high workloads; insufficient or underperforming security staff; and poor management of violence, especially horizontal violence. The views of these participants should inform efforts to prevent workplace violence among correctional health professionals.

Protocol for the process evaluation of an intervention to improve antenatal smoking cessation support (MOHMQuit) in maternity services in New South Wales, Australia.

INTRODUCTION: Smoking cessation in pregnancy remains a public health priority. Our team used the Behaviour Change Wheel to develop the Midwives and Obstetricians Helping Mothers to Quit smoking (MOHMQuit) intervention with health system, leader (including managers and educators) and clinician components. MOHMQuit addresses a critical evidence to practice gap in the provision of smoking cessation support in antenatal care. It involves nine maternity services in New South Wales in a cluster randomised stepped-wedge controlled trial of effectiveness. This paper describes the design and rationale for the process evaluation of MOHMQuit. The process evaluation aims to assess to what extent and how MOHMQuit is being implemented (acceptability; adoption/uptake; appropriateness; feasibility; fidelity; penetration and sustainability), and the context in which it is implemented, in order to support further refinement of MOHMQuit throughout the trial, and aid understanding and interpretation of the results of the trial. METHODS AND ANALYSIS: The process evaluation is an integral part of the stepped-wedge trial. Its design is underpinned by implementation science frameworks and adopts a mixed methods approach. Quantitative evidence from participating leaders and clinicians in our study will be used to produce individual and site-level descriptive statistics. Qualitative evidence of leaders' perceptions about the implementation will be collected using semistructured interviews and will be analysed descriptively within-site and thematically across the dataset. The process evaluation will also use publicly available data and observations from the research team implementing MOHMQuit, for example, training logs. These data will be synthesised to provide site-level as well as individual-level implementation outcomes. ETHICS AND DISSEMINATION: The study received ethical approval from the Population Health Services Research Ethics Committee for NSW, Australia (Reference 2021/ETH00887). Results will be communicated via the study's steering committee and will also be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: Australian New Zealand Trials Registry ACTRN12622000167763. https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12622000167763.

Relationship between the population incidence of pertussis in children in New South Wales, Australia and emergency department visits with cough: a time series analysis.

BACKGROUND: Little is known about the potential of syndromic surveillance to provide early warning of pertussis outbreaks. We conducted a time series analysis to assess whether an emergency department (ED) cough syndrome would respond to changes in the incidence of pertussis in children aged under 10 years in New South Wales (NSW), Australia, and to evaluate the timing of any association. A further aim was to assess the lag between the onset of pertussis symptoms and case notification in the infectious diseases surveillance system in NSW. METHODS: Using routinely collected data, we prepared a daily count time series of visits to NSW EDs assigned a provisional diagnosis of cough. Separate daily series were prepared for three independent variables: notifications of cases of pertussis and influenza and ED visits with bronchiolitis (a proxy measure of respiratory syncytial virus (RSV) infection). The study period was 1/1/2007-31/12/2010. A negative binomial multivariate model was used to assess associations between the outcome and independent variables. We also evaluated the median delay in days between the estimated onset of a case of pertussis and the date the local public health authority was notified of that case. RESULTS: When notified pertussis increased by 10 cases in one day, ED visits with cough increased by 5.2% (95% confidence interval (CI): 0.5%-10.0%) seven days later. Daily increases in the other independent variables had a smaller impact on cough visits. When notified influenza increased by 10 cases in one day, ED visits with cough increased by 0.8% (95% CI: 0%-1.7%) seven days later. When ED visits with bronchiolitis increased by 10 visits in one day, ED visits with cough increased by 4.8% (95% CI: 1.2%-8.6%) one day earlier. The median interval between estimated onset of pertussis and case notification was seven days. CONCLUSIONS: Pertussis appears to be an important driver of ED visits with cough in children aged under 10 years. However, the median delay in notification of cases of pertussis was similar to the lag in the pertussis-associated short-term increases in ED visits with cough. Elevations in RSV and influenza activity may also explain increases in the ED cough syndrome. Real time monitoring of ED visits with cough in children is therefore unlikely to consistently detect a potential outbreak of pertussis before passive surveillance.

Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records.

BACKGROUND: Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. METHODS: The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. RESULTS: During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as 'high risk' work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury - there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. CONCLUSIONS: Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.

Workplace abuse among correctional health professionals in New South Wales, Australia.

OBJECTIVE: Studies have found that health workers are at elevated risk of being abused while at work. Little is known, however, about workplace abuse among correctional health professionals. We implemented a cross-sectional study to investigate the prevalence, sources and consequences of workplace abuse among correctional health professionals in New South Wales, Australia. METHODS All employees of Justice Health (a statutory health corporation) were invited to complete a self-administered survey, which was delivered via the internet. Among nurses, medical doctors and allied health professionals, 299 usable surveys were returned; a response rate of 42%. RESULTS: In the preceding 3 months, 76% of participants had personally experienced some form of abuse in their workplace, all but one of whom recalled verbal abuse. Only 16% reported physical abuse. Seventy per cent reported feeling safe in their workplace. Patients were identified as the main perpetrators of abuse, followed by fellow health staff. Participants felt that incidents of workplace abuse increased their potential to make errors while providing care to patients and reduced their productivity while at work. CONCLUSIONS: Compared with health workers who practise in a community setting, the risk of physical abuse among correctional health professionals appears to be low.

Team members influence retention in a First Peoples' community-based weight-loss program.

The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant's odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples' engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.

The MOHMQuit (Midwives and Obstetricians Helping Mothers to Quit Smoking) Trial: protocol for a stepped-wedge implementation trial to improve best practice smoking cessation support in public antenatal care services.

BACKGROUND: Smoking during pregnancy is the most important preventable cause of adverse pregnancy outcomes, yet smoking cessation support (SCS) is inconsistently provided. The MOMHQUIT intervention was developed to address this evidence-practice gap, using the Behaviour Change Wheel method by mapping barriers to intervention strategies. MOHMQuit includes systems, leadership and clinician elements. This implementation trial will determine the effectiveness and cost-effectiveness of MOHMQuit in improving smoking cessation rates in pregnant women in public maternity care services in Australia; test the mechanisms of action of the intervention strategies; and examine implementation outcomes. METHODS: A stepped-wedge cluster-randomised design will be used. Implementation of MOHMQuit will include reinforcing leadership investment in SCS as a clinical priority, strengthening maternity care clinicians' knowledge, skills, confidence and attitudes towards the provision of SCS, and clinicians' documentation of guideline-recommended SCS provided during antenatal care. Approximately, 4000 women who report smoking during pregnancy will be recruited across nine sites. The intervention and its implementation will be evaluated using a mixed methods approach. The primary outcome will be 7-day point prevalence abstinence at the end of pregnancy, among pregnant smokers, verified by salivary cotinine testing. Continuous data collection from electronic medical records and telephone interviews with postpartum women will occur throughout 32 months of the trial to assess changes in cessation rates reported by women, and SCS documented by clinicians and reported by women. Data collection to assess changes in clinicians' knowledge, skills, confidence and attitudes will occur prior to and immediately after the intervention at each site, and again 6 months later. Questionnaires at 3 months following the intervention, and semi-structured interviews at 6 months with maternity service leaders will explore leaders' perceptions of acceptability, adoption, appropriateness, feasibility, adaptations and fidelity of delivery of the MOHMQuit intervention. Structural equation modelling will examine causal linkages between the strategies, mediators and outcomes. Cost-effectiveness analyses will also be undertaken. DISCUSSION: This study will provide evidence of the effectiveness of a multi-level implementation intervention to support policy decisions; and evidence regarding mechanisms of action of the intervention strategies (how the strategies effected outcomes) to support further theoretical developments in implementation science. TRIAL REGISTRATION: ACTRN12622000167763, registered February 2nd 2022.

Reorienting a paediatric oral health service towards prevention: lessons from a qualitative study of dental professionals.

ISSUE ADDRESSED: Reorienting primary care dental services towards prevention is a priority for improving the oral health of Australian children with extensive dental caries. We explored the attitudes and beliefs of dental staff about the factors that helped or hindered the establishment and implementation of a hospital-based parent counselling program to manage existing, and prevent new, carious lesions in children. A further aim was to explore the influence of the program on the hospital's reorientation to prevention. METHODS: Eight of nine program staff participated in two focus group interviews, and two co-ordinating staff participated in semi-structured interviews. Interviews were audio-recorded and transcribed. Interview recordings and transcripts were analysed by qualitative thematic analysis. RESULTS: The participants identified a number of factors that they felt influenced the establishment and implementation of the program, including the dental team's support of the initiative, the advantages of building on existing clinic infrastructure and procedures, the utility of harnessing dental assistants as a resource for oral health promotion, and the confidence of dental professionals to provide parent counselling. CONCLUSION: Efforts to establish a preventive program in a public paediatric dental service should ensure that all members of the dental team are engaged during all phases of the program, that dental assistants are trained and supported to deliver parent counselling, and that interprofessional partnerships with services such as dietetics are fostered.

Benefits of not smoking during pregnancy for non-Aboriginal women and their babies in New South Wales, Australia: a record linkage study.

BACKGROUND: Smoking rates among pregnant women in New South Wales (NSW) have plateaued at 8-9%. To inform relevant smoking reduction efforts, we aimed to quantify the benefits of not smoking during pregnancy for non-Aboriginal NSW mothers and their babies. The benefits of not smoking during pregnancy for NSW Aboriginal mothers have previously been described. These data are important inputs in modelling health and economic impacts of smoking cessation interventions. METHODS: This population-based cohort study used linked-data from routinely collected data sets. Not smoking during pregnancy was the exposure of interest among all NSW non-Aboriginal women who became mothers of singleton babies in 2012-2016. Unadjusted and adjusted relative risks (aRR) were used to examine associations between not smoking during pregnancy and adverse outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated to quantify adverse perinatal outcomes avoided in the population if all mothers were non-smokers. RESULTS: Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR = 0.68, 95%CI 0.61-0.76), preterm birth (aRR = 0.58, 95%CI 0.56-0.61) and small-for-gestational age (aRR = 0.48, 95%CI 0.47-0.50). PAFs(%) were 3.9% for perinatal death, 5.6% for preterm birth and 7.3% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 36,518), those who did not smoke (n = 413,072) had a lower risk of suffering severe maternal morbidity (aRR = 0.87, 95%CI 0.81-0.93) and being transferred to another hospital (aRR = 0.92, 95%CI 0.86-0.99). CONCLUSIONS: Mothers who reported not smoking during pregnancy had a small reduction in their risk of morbidity and of being transferred to another hospital whilst their babies had substantially reduced risks of all adverse perinatal outcomes. Results have implications for clinician training, clinical care standards, and performance management.

Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012-2015.

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.

The Aboriginal Population Health Training Initiative: a NSW Health program established to strengthen the Aboriginal public health workforce.

OBJECTIVES: Increasing the representation of Aboriginal people in the health workforce can contribute to improving Aboriginal people's health and wellbeing by supporting the provision of more culturally appropriate health programs and services. The Aboriginal Population Health Training Initiative aims to strengthen the Aboriginal public health workforce in New South Wales (NSW), with the long-term goal of improving the health of Aboriginal people. Type of program or service: The program provides comprehensive, competency-based public health training for Aboriginal people. METHODS: Participants undertake a series of work placements in public health, and complete a Master of Public Health degree. RESULTS: A 2014 evaluation demonstrated that the program makes an important contribution to strengthening the NSW Aboriginal public health workforce. Trainees reported a high level of satisfaction with the quality of their work placements, the flexibility of the program to support their work and study, and efforts made to ensure the program's cultural safety. The program has a high trainee retention rate (17 of 18 trainees), and all graduates have successfully gained employment within the NSW health system. LESSONS LEARNT: Three key factors contribute to the success of the program: trainees undertake their training within their communities; the structure promotes the direct application of learning through simultaneous work and study; and the NSW Government shows strong leadership and support.

A validation study of assessing physical activity and sedentary behavior in children aged 3 to 5 years.

Assessing young children's physical activity and sedentary behavior can be challenging and costly. This study aimed to assess the validity of a brief survey about activity preferences as a proxy of physical activity and of a 7-day activity diary, both completed by the parents and using accelerometers as a reference measure. Thirty-four parents and their children (aged 3-5 years) who attended childcare centers in Sydney (Australia) were recruited for the study. Parents were asked to complete a 9-item brief survey about activity preferences of their child and a 7-day diary recording the child's physical activity and sedentary behaviors. Both measures were compared with accelerometer data collected from the child over the same period as the diary survey. The findings suggest that parent completed diaries have acceptable correlation coefficients with accelerometer measures and could be considered in future research assessing physical activity and sedentary behavior of children aged 3-5 years.